Background and Aims:Despite recent initiatives to reduce stigma towards people with mental illness, negative attitudes persist both in the community and among health professionals. Fieldwork experience has been identified as the most powerful way of modifying the attitudes of health professional students. Research to date suggests that later placements tend to have a more positive effect on attitudes than do earlier placements. However, inconsistencies within the literature suggest that it is the nature of the fieldwork experience that is the critical factor. We set out to investigate whether a program of fieldwork that included a tutorial component would bring about positive attitudinal change in first year occupational therapy students. Methods: We conducted secondary analysis of data collected from first year students before and after first year fieldwork experience in mental health settings. Student statements were rated to identify positive versus negative attitudes, and attitudinal themes were analysed. Results: Quantitative analysis revealed that students made significantly more statements reflecting positive attitudes following fieldwork than they did before. From pre-to post-fieldwork, attitudinal themes changed from: people with mental illness as different, fear of people with mental illness, and a deficit focus of mental illness, to: the 'ordinariness' of people with mental illness, students' understanding of people with mental illness, and an enabling approach to people with mental illness. Conclusions: A program of fieldwork that includes a structured tutorial component can bring about positive changes in the attitudes of first year students towards people with mental illness.KEY WORDS attitude and attitude change, fieldwork education, mental illness, occupational therapy.

No abstract

Current literature identifies a lack of knowledge and understanding of the long‐term responses to extreme trauma in children, particularly from an occupational therapy perspective. Five school children participated in the present study to explore and describe a child's occupational performance as a school student following their experience of refugee trauma. The study used semi‐structured, indepth interviews with the children, parents and teachers. The interviews were combined with participant observation within various school environments. The results indicate that a child's student role performance can be affected by the experience of refugee trauma. Effects were manifested in various ways, such as poor academic performance, gross motor problems and difficulty interacting with peers. It is critical that occupational therapists recognize their potential contribution in meeting the needs of children from politically troubled countries who have experienced trauma. Opportunities to work with these children are suggested, as are avenues for further research.

Enduring personality change after catastrophic experience (EPCACE) is a diagnostic category included in the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10), as one of the adult personality disorders. Preliminary investigation suggests there is considerable endorsement in principle for this new category amongst experts in the field of intentional human trauma, yet many aspects of the diagnosis remain contentious. EPCACE is described in 2 sets of ICD-10 criteria: the Diagnostic Criteria for Research (DCR) and the Clinical Description and Diagnostic Guidelines (CDDG). Studies have found that the use of the DCR and CDDG for some disorders has created issues related to lack of compatibility and agreement between these 2 versions. This article examines the similarities and differences between the DCR and CDDG for EPCACE. Using background literature to inform our analysis, this article highlights issues related to the stressor criterion, symptom criteria, impairment criterion, criterion related to exclusion of personal vulnerability and early psychiatric history, symptom duration and relationship of post-traumatic-stress disorder with EPCACE. The similarities and differences between the research criteria and diagnostic guidelines of EPCACE are consistent with concerns already identified in the literature for other disorders. This presents a challenge to the way in which diagnostic criteria are conceptualized and stated.

No abstract

Background:  The occupational adaptation frame of reference asserts that a person's occupational functioning may be improved through positive changes in his/her adaptive processes. This framework's authors advocate that occupational adaptation theory can be applied to practice with clients of all ages (Schultz & Schkade, 1992). Published literature to date has been focused on the application of this framework with adults and adolescents. Method:  This paper reviews the major theoretical constructs and guide to practice of occupational adaptation theory whilst interweaving descriptions of its application to a paediatric case study conducted within a child and adolescent mental health unit. Conclusion:  While it was shown through the case study that the occupational adaptation frame of reference can guide occupational therapy practice with a child nearing adolescence critical reflections about the experience suggest some challenges for the practitioner and students.

Specialized mental health services for refugees may be more acceptable to refugee populations than their mainstream counterparts, perhaps because better communication with patients and their families is possible in the specialized services. Patients and families who are in a position to evaluate services fully are more likely to be critical of treatments offered.

No abstract