Exploring the ideal practice for occupational therapists on assertive community treatment teams

Abstract

Introduction Canadian occupational therapists are employed as case managers on assertive community treatment (ACT) teams to support community living for individuals with severe and persistent mental illnesses. In this position, occupational therapists act primarily as generalists, typically attending appointments with clients, supervising medication adherence, supporting basic living needs, and managing client crises. Occupational therapists may also provide psychotherapy and coping skill groups, as well as profession-specific practices, such as skills training. Exploring how ACT occupational therapists describe their perceived ideal practice may support transformation in long-standing, occupational therapy practices on ACT teams. Method This qualitative, interpretive description study involved 11 Canadian ACT team occupational therapists in one individual, semi-structured in-depth interview using an interview guide containing open-ended questions. Interview transcripts were analyzed to identify themes pertaining to therapists’ descriptions of their perceived ideal occupational therapy practice on ACT teams. Results Three themes emerged: (a) Engaging in practice “with intention”; (b) Finding the space for occupational therapy practice; and (c) Supporting clients in their recovery to find their best occupational self. Conclusions The findings highlight practice possibilities for occupational therapist working on ACT teams and provide a foundation for advocating for better use of specific occupational therapy practices within community mental health settings.

Current insights of community mental healthcare for people with severe mental illness: A scoping review

“…Besides that, one expert paper states that evidence-based, psychosocial interventions should be deployed to support individuals to achieve both personal recovery and increased independence ( 3 ). In addition, one qualitative study reports that occupational therapists should support clients in their recovery to find their best self ( 50 ). Lastly, one cross-sectional paper states that most of their respondents (64.8%) were not employed, but those who were working presented higher levels of functional capacity than those who were not ( 76 ).…”

“…Further, we found many papers concerning multidisciplinary teams. Peer supporters ( 29 , 30 , 47 , 48 , 51 , 53 ), occupational therapists ( 44 , 50 ), and nurses ( 34 ) are frequently mentioned as important disciplines in a multidisciplinary team, besides the regular disciplines of psychologists, psychiatrists, and social psychiatric care workers. Peer supporters have been a part of the (F)ACT teams for more than our searched 10 years ( 87 ).…”

“…Therefore, one RCT finds positive results with regard to the health benefits for individuals for having received nurse practitioner services in a mental health setting to address primary care needs (34). In addition, two papers with a qualitative design emphasize adding an occupational therapist to a multidisciplinary team (44,50). Finally, seven papers show the value of peer support to multidisciplinary teams; of which these seven papers, there are three reviews (29)(30)(31), three qualitative papers (47,48,51), and one expert paper (53).…”

Clinical practices, challenges, and job satisfaction of occupational therapists working in Community Mental Health Centers in Turkey

“…The dual role of case manager (generalist) and occupational therapist (specialist) is described as a role conflict or dilemma (Hughes, 2001), which has even been shown to cause stress and to complicate the implementation of occupational therapy interventions (Culverhouse and Bibby, 2008; Lloyd et al, 2002). Lama et al (2021) showed that ACT therapists whose primary role is case management experienced role conflict because they could not fulfil their occupational therapy profession. On the other hand, occupational therapists working with elderly individuals in community mental health teams in England were involved in both roles by maintaining their professional identity (Abendstern et al, 2017).…”

Mental health – An area of high priority in occupational therapy

“…When working in assertive community treatment (ACT) teams, occupational therapists tend to work as generalists. This was the incentive for a Canadian qualitative study exploring the ideal practice for occupational therapists working in ACT teams supporting people with severe and persistent mental illness (Lama et al, 2021). Interviews with occupational therapists generated themes that expressed an ideal where the occupational therapist used their specialist practice skills: a practice that involved setting and pursuing occupational goals; organising space for occupational therapy practice; and supporting service users in their recovery to find their best occupational self.…”