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Painted Brain creates lasting community-based solutions to mental health challenges and the impact of social injustice through arts, advocacy, and enterprise. One of the solutions Painted Brain has created is a line of outpatient occupational therapy services.
Occupational therapy is a holistic health profession that contributes to mental health through expertise in cognition, sensory processing, and meaningful engagement in everyday activities. Painted Brain’s occupational therapy services will provide client-centered and evidence-based interventions to facilitate increased participation in meaningful activities and assist individuals with mental illness in realizing their full potential as positively contributing members of society.
Following is a description of the occupational therapy services that individuals can access through Painted Brain and the evidence to support key stakeholders in understanding the integral contribution of occupational therapy to the field of mental health.
PAINTED BRAIN ART OF ENGAGEMENT PROGRAM
Research shows that adults with a serious mental illness who live in the community are susceptible to occupational imbalance and disengagement, as reflected through patterns of increased time spent in sleep and passive leisure activities, and decreased time spent in productive and active leisure activities (Edgelow & Krupa, 2011). Results of a randomized controlled trial, which compared the Art of Engagement intervention to standard care, showed that individuals who participated in Art of Engagement increased time spent in general activity by an average of 47 minutes per day, while decreasing time spent in sleep by 47 minutes per day (Edgelow & Krupa, 2011).
Painted Brain Art of Engagement services are structured around the Action Over Inertia (Krupa et al., 2010) workbook and utilize a collaborative approach that supports engagement in a variety of activities to promote overall health and well-being. Delivered in hourly over 10 sessions, seven dimensions of activity participation are explored:
Through the process of reflecting on current activity patterns, developing knowledge about health benefits of active participation, and reimagining goals and values, clients will be empowered to resume engagement in meaningful activities and maintain long-term community reintegration.
Art of Engagement – Individual Service
Painted Brain Art of Engagement is available in an individual format, for clients who desire an individualized collaborative approach. This intervention is delivered hourly over a period of 10 sessions.
Art of Engagement – Group Service
Painted Brain Art of Engagement is also available in an activity-based group format to increase opportunities for community participation and social support. Peer support is a common component intended to decrease the experience of stigma in current mental health service models. Participants in a group-based intervention for health management describe how experiential learning and problem-solving activities promoted relationship development and peer support for health behavior change (Aschbrenner, Naslund, & Bartels, 2016), and results of systematic review indicated that activity-based group work was significantly more effective than verbally-based group work in improving social functioning (Bullock & Bannigan, 2011).
Painted Brain Art of Engagement Groups are delivered in hourly sessions over a period of 10 weeks.
SUPPORTED PRODUCTIVITY SERVICES
Productive activities include paid or volunteer work, learning new skills and caring for children, relatives, and pets; engagement in these activities contributes to decreased relapse, increased well-being and quality of life, feelings of competency and normalcy, and decreased negative symptoms (Argentzell et al., 2012; Bejerholm & Eklund, 2007; Deegan, 2005).
This individual service begins with placement of the individual in a full-time or part-time job, based on the individual’s preferences and strengths. The occupational therapist will provide support for the individual throughout the job training process, as well as within the workplace. Intervention areas may include collaboration with and psychoeducation for the employer, environmental adaptation, and development of skills in interpersonal communication, executive functioning, and stress management.
Supported employment is provided in hourly sessions over a long-term period.
A long-term study on Supported Employment found that 75% of individuals who received such services worked beyond the initial 18-month study period and earned higher wages, approximately one third worked for 5 years or more, and participation in supported employment was associated with significantly lower utilization of inpatient psychiatric services (Hoffmann, Jackel, Glauser, Mueser, & Kupper, 2014).
This individual service is provided for individuals who desire a student role in a postsecondary education setting. Individual occupational therapy will facilitate success in Painted Brain’s technology-training workshops, or in another community-based education setting. Specific intervention areas may include collaboration with and psychoeducation for educators, environmental adaptation, and development of skills in interpersonal communication, executive functioning, and stress management.
Supported education is provided in hourly sessions over a long-term period.
Results for supported education interventions that incorporated goal setting, social skills, and cognitive skills showed increased participation in educational and employment settings, as well as improved social skills (Arbesman & Logsdon, 2011).
SUPPORTED SELF-CARE SERVICES
This individual service is provided for individuals who desire increased overall functional performance in self-care activities and life skills. Client-centered occupational therapy will facilitate overcoming barriers to performance by focusing on strengths while addressing needs for cognitive support, stress management, and health management.
Self-Care is provided on an hourly basis over 10 to 20 sessions.
Studies show that participants who receive training in specific skills, in areas such as cognition, health management, and personal self-care, display reduced psychiatric symptoms and improved community integration (Arbesman & Logsdon, 2011).
This individual service is provided for individuals who experience disrupted sleep due on a regular basis that affects daytime functioning. Based the Transdiagnostic Sleep and Circadian Intervention (Trans-C) (Harvey & Buysse, 2018) approach, the occupational therapist will, and client will collaborate to improve bedtime and wake up routines, better sleep efficiency, decrease sleep worry, improve the sleep environment, and increase overall health.
Supported Sleep is provided on an hourly basis over 10 to 15 sessions.
Sleep is essential to overall health, including regulating mood, improving attention and learning, and improving immune system functioning. Studies show that “healthy sleep and circadian rhythms are associated with a lower incidence of depression, Alzheimer’s disease, diabetes, cardiovascular disease, and even the common cold” (Harvey & Buysse, 2018, p.1).
Arbesman, M. & Logsdon, D. W. (2011). Occupational therapy interventions for employment and education for adults with serious mental illness: A systematic review. American Journal of Occupational Therapy, 65, 238–246. doi: 10.5014/ ajot.2011.001289
Argentzell, E., Hakansson, C., & Eklund, M. (2012). Experience of meaning in everyday occupations among unemployed people with a severe mental illness. Scandinavian Journal of Occupational Therapy, 19(1): 49-58.
Aschbrenner, K. A., Naslund, J. A., & Bartels, S. J. (2016). A mixed methods study of peer-to-peer support in a group-based lifestyle intervention for adults with serious mental illness. Psychiatric Rehabilitation Journal, 39(4), 328-334. doi:http://dx.doi.org.libproxy2.usc.edu/10.1037/prj0000219
Bejerholm, U. & Eklund, M. (2007). Occupational engagement in persons with schizophrenia: Relationships to self-related variables, psychopathology, and quality of life. American Journal of Occupational Therapy, 61, 21–32.
Bullock, A. & Bannigan, K. (2011). The effectiveness of activity-based group work in community mental health: A systematic review. American Journal of Occupational Therapy, 65, 257–266. doi: 10.5014/ajot.2011.001305
Edgelow, M. & Krupa, T. (2011). Randomized controlled pilot study of an occupational time-use intervention for people with serious mental illness. American Journal of Occupational Therapy, 65, 267–276. doi: 10.5014/ajot.2011.001313
Deegan, P. (2005). The importance of personal medicine: A qualitative study of resilience in people with psychiatric disabilities. Scandinavian Journal of Public Health, 33(Suppl): 29-35. doi: 10.1080/14034950510033345
Harvey, A. G. & Buysse, D. J. (2018). Treat sleep problems: A transdiagnostic approach. New York, NY: The Guilford Press.
Hoffmann, H., Jackel, D., Glauser, S., Mueser, K. T., & Kupper, Z. (2014). Long-term effectiveness of Supported Employment: 5-year follow-up of a randomized controlled trial. American Journal of Psychiatry, 171(11): 1183-1190.
Krupa, T., Edgelow, M., Chen., S., Mieras, C., Almas, A., Perry, A., …Bransfield, M. (2010). Action Over Inertia: Addressing the activity health needs of individuals with serious mental illness. Ottawa, Canada: CAOT Publications ACE.