GUEST
E D I T O R I A L
PSYCHOSOCIAL ISSUES IN REHABILITATION: BRINGING THE UNCONSCIOUS TO CONSCIOUSNESS
I
n the previous editorial of OTJR: Occupation, Participation and Health, Matuska (2012) found that social support was embedded in the text of many articles as a subtheme in that publication. Having had her own family experience with the contribution of social support to positive rehabilitation outcomes, she decided to extract and expand on this theme within the diverse topics covered in that issue. I was inspired by her creative exploration of this subtheme, so decided to do the same for mental health. Psychosocial issues are important to rehabilitation. The body and mind are tightly coupled (Gardner, Dong-Olson, Castronovo, Hess, & Lawless, 2012). One of the strongest predictors of physical health is mental health (Hager & Runtz, 2012). More than half of visits to general practitioner physicians involved mental health issues (Wickramasekera et al., 1996). When mental health issues were not addressed, health outcomes were poor and prolonged (Watts, 1997). In 2006, I was asked to write a chapter on the effects of psychosocial issues on rehabilitation for a prominent physical therapy text book (O’Sullivan & Schmitz, 2007) that was analogous to Willard and Spackman’s occupational therapy text. I was reluctant at first to “give away our secrets,” but realized that the entire treatment team could benefit from knowledge of phases of adaptation, grief, personality and copying styles, anxiety, depression, substance misuse, and so forth. Although educated on such topics, many occupational therapists practicing in areas other than mental health have moved away from addressing these issues at their treatment settings (Novis, Bunger, Courchesne, Smith, & Willoughby, 2007), in part because of limitations on time and reimbursement. Several of the articles in this issue of OTJR: Occupation, Participation and Health have a mental health sub-context. MacKenzie and Westwood found direct observation to be a valid aspect of occupational performance assessment through their examination of eye movement patterns in occupational therapists and non-healthcare professionals while viewing
2
static photographs of clients post-stroke. Direct observation is also an important method of assessment in mental health because clients with psychosocial issues cannot always articulate how they feel, what they are experiencing, and how their symptoms may be interfering with their occupational performance. Instead, it takes a skilled occupational therapist to observe and listen with a third ear to what the client with psychosocial issues may be trying to relay. In fact, Davis, Asuncion, Rabello, Silangcruz, and van Dyk’s research found that occupational therapists’ active acute listening was necessary for clients to verbally express their feelings while going through the process of life termination during hospice or palliative care. Davis et al.’s results showed that occupational therapists need to address psychosocial, physical, and spiritual needs through providing emotional support that helps guide clients in hospice through the stages of denial, defensiveness, anger, sadness, and acceptance. Psychosocial interventions such as breathing techniques, journaling, and leaving a legacy through constructing photo albums and scrapbooks were suggested for this population. In addition, occupational therapists treating these clients reported wanting time and opportunity to reflect and process their own emotions. Cancer survivors can also benefit from psychosocial intervention. Berg and Hayashi found that young adult cancer survivors in their study suffered from depression, body image distortion, cognitive deficits, fatigue, pain, and memory problems, which tended to effect their social interaction, work, education, and independent living. To manage these late effects, clients in this research study used predominantly exercise, quiet leisure, social support, guided imagery, and rest. These problems are termed late effects because they can reappear up to 20 years after cancer treatment, so occupational therapists need to develop additional ongoing intervention with psychosocial strategies for young adult cancer survivors. Older adult cancer survivors also may require psychosocial intervention because 12% of this population met criteria for clinical depression, according Copyright © American Occupational Therapy Foundation
G U E S T
to a study by Lyons, Lambert, Balan, Hegel, and Bartels. These authors emphasized the need to assess the emotional state and emotional regulation skills of these clients after cancer treatment due to a perceived decrease in activity level in physically demanding social and leisure activities. Results showed that occupational therapists need to use interventions that address both physical and mental health issues that affect occupations. Even though these and many other articles show that mental health issues are important to many clients during physical rehabilitation, many occupational therapists do not provide psychosocial services to their rehabilitation clients due to limits on time and reimbursement. Lee et al.’s article discussed a payment-by-results system of reimbursement for occupational therapy mental health services in the United Kingdom. Under this system, each client is assigned to one of 20 clusters based on diagnosis and the Mental Health Clustering Tool. Programs are based on client-centered intervention and efficient services with outcomes based on self-care, productivity, and leisure as measured by the Model of Occupational Screening Tool. I hope that as you read these interesting and informative articles and apply them to your occupational therapy practices you keep in mind the need for psychosocial assessment and intervention.
OTJR: Occupation, Participation and Health • Vol. 33, No. 1, 2013
E D I T O R I A L
References Gardner, J., Dong-Olson, V., Castronovo, A., Hess, M., & Lawless, K. (2012). Using wellness recovery action plan and sensorybased intervention: A case example. Occupational Therapy in Health Care, 26, 163-173. doi:10.3109/07380577.2012.693650 Hager, A. D., & Runtz, M. G. (2012). Physical and psychological maltreatment in childhood and later health problems in women: An exploratory investigation of the roles of perceived stress and coping strategies. Child Abuse & Neglect, 36, 393-403. doi:10.1016/j.chiabu.2012.02.002 Matuska, K. (2012). Family and friends: A recipe for wellbeing. OTJR: Occupation, Participation and Health, 32, 115-116. doi:10.3928/15394492-20120730-01 Novis, S., Bunger, T., Courchesne, K., Smith, K. A., & Willoughby, M. M. (2007). Future of mental health occupational therapy: Student perspective and concerns. Occupational Therapy in Health Care, 21, 239-253. doi:10.1080/J003v21n01_18 O’Sullivan, S. B., & Schmitz, T. J. (2007). Physical rehabilitation (5th ed.). Philadelphia: F. A. Davis Company. Watts, R. (1997). Trauma counseling and rehabilitation. Journal of Applied Rehabilitation Counseling, 28, 8-10. Wickramasekera, I., Davies, T. E., & Davies, S. M. (1996). Applied psychophysiology: A bridge between the biomedical model and the biopsychosocial model in family medicine. Professional Psychology Research Periodical, 27, 221-233. doi:10.1037/0735-7028.27.3.221
Patricia Jean Precin, MS, OTR/L, LP Editorial Board Member doi: 10.3928/15394492-20121105-01
3
E D I T O R I A L
PSYCHOSOCIAL ISSUES IN REHABILITATION: BRINGING THE UNCONSCIOUS TO CONSCIOUSNESS
I
n the previous editorial of OTJR: Occupation, Participation and Health, Matuska (2012) found that social support was embedded in the text of many articles as a subtheme in that publication. Having had her own family experience with the contribution of social support to positive rehabilitation outcomes, she decided to extract and expand on this theme within the diverse topics covered in that issue. I was inspired by her creative exploration of this subtheme, so decided to do the same for mental health. Psychosocial issues are important to rehabilitation. The body and mind are tightly coupled (Gardner, Dong-Olson, Castronovo, Hess, & Lawless, 2012). One of the strongest predictors of physical health is mental health (Hager & Runtz, 2012). More than half of visits to general practitioner physicians involved mental health issues (Wickramasekera et al., 1996). When mental health issues were not addressed, health outcomes were poor and prolonged (Watts, 1997). In 2006, I was asked to write a chapter on the effects of psychosocial issues on rehabilitation for a prominent physical therapy text book (O’Sullivan & Schmitz, 2007) that was analogous to Willard and Spackman’s occupational therapy text. I was reluctant at first to “give away our secrets,” but realized that the entire treatment team could benefit from knowledge of phases of adaptation, grief, personality and copying styles, anxiety, depression, substance misuse, and so forth. Although educated on such topics, many occupational therapists practicing in areas other than mental health have moved away from addressing these issues at their treatment settings (Novis, Bunger, Courchesne, Smith, & Willoughby, 2007), in part because of limitations on time and reimbursement. Several of the articles in this issue of OTJR: Occupation, Participation and Health have a mental health sub-context. MacKenzie and Westwood found direct observation to be a valid aspect of occupational performance assessment through their examination of eye movement patterns in occupational therapists and non-healthcare professionals while viewing
2
static photographs of clients post-stroke. Direct observation is also an important method of assessment in mental health because clients with psychosocial issues cannot always articulate how they feel, what they are experiencing, and how their symptoms may be interfering with their occupational performance. Instead, it takes a skilled occupational therapist to observe and listen with a third ear to what the client with psychosocial issues may be trying to relay. In fact, Davis, Asuncion, Rabello, Silangcruz, and van Dyk’s research found that occupational therapists’ active acute listening was necessary for clients to verbally express their feelings while going through the process of life termination during hospice or palliative care. Davis et al.’s results showed that occupational therapists need to address psychosocial, physical, and spiritual needs through providing emotional support that helps guide clients in hospice through the stages of denial, defensiveness, anger, sadness, and acceptance. Psychosocial interventions such as breathing techniques, journaling, and leaving a legacy through constructing photo albums and scrapbooks were suggested for this population. In addition, occupational therapists treating these clients reported wanting time and opportunity to reflect and process their own emotions. Cancer survivors can also benefit from psychosocial intervention. Berg and Hayashi found that young adult cancer survivors in their study suffered from depression, body image distortion, cognitive deficits, fatigue, pain, and memory problems, which tended to effect their social interaction, work, education, and independent living. To manage these late effects, clients in this research study used predominantly exercise, quiet leisure, social support, guided imagery, and rest. These problems are termed late effects because they can reappear up to 20 years after cancer treatment, so occupational therapists need to develop additional ongoing intervention with psychosocial strategies for young adult cancer survivors. Older adult cancer survivors also may require psychosocial intervention because 12% of this population met criteria for clinical depression, according Copyright © American Occupational Therapy Foundation
G U E S T
to a study by Lyons, Lambert, Balan, Hegel, and Bartels. These authors emphasized the need to assess the emotional state and emotional regulation skills of these clients after cancer treatment due to a perceived decrease in activity level in physically demanding social and leisure activities. Results showed that occupational therapists need to use interventions that address both physical and mental health issues that affect occupations. Even though these and many other articles show that mental health issues are important to many clients during physical rehabilitation, many occupational therapists do not provide psychosocial services to their rehabilitation clients due to limits on time and reimbursement. Lee et al.’s article discussed a payment-by-results system of reimbursement for occupational therapy mental health services in the United Kingdom. Under this system, each client is assigned to one of 20 clusters based on diagnosis and the Mental Health Clustering Tool. Programs are based on client-centered intervention and efficient services with outcomes based on self-care, productivity, and leisure as measured by the Model of Occupational Screening Tool. I hope that as you read these interesting and informative articles and apply them to your occupational therapy practices you keep in mind the need for psychosocial assessment and intervention.
OTJR: Occupation, Participation and Health • Vol. 33, No. 1, 2013
E D I T O R I A L
References Gardner, J., Dong-Olson, V., Castronovo, A., Hess, M., & Lawless, K. (2012). Using wellness recovery action plan and sensorybased intervention: A case example. Occupational Therapy in Health Care, 26, 163-173. doi:10.3109/07380577.2012.693650 Hager, A. D., & Runtz, M. G. (2012). Physical and psychological maltreatment in childhood and later health problems in women: An exploratory investigation of the roles of perceived stress and coping strategies. Child Abuse & Neglect, 36, 393-403. doi:10.1016/j.chiabu.2012.02.002 Matuska, K. (2012). Family and friends: A recipe for wellbeing. OTJR: Occupation, Participation and Health, 32, 115-116. doi:10.3928/15394492-20120730-01 Novis, S., Bunger, T., Courchesne, K., Smith, K. A., & Willoughby, M. M. (2007). Future of mental health occupational therapy: Student perspective and concerns. Occupational Therapy in Health Care, 21, 239-253. doi:10.1080/J003v21n01_18 O’Sullivan, S. B., & Schmitz, T. J. (2007). Physical rehabilitation (5th ed.). Philadelphia: F. A. Davis Company. Watts, R. (1997). Trauma counseling and rehabilitation. Journal of Applied Rehabilitation Counseling, 28, 8-10. Wickramasekera, I., Davies, T. E., & Davies, S. M. (1996). Applied psychophysiology: A bridge between the biomedical model and the biopsychosocial model in family medicine. Professional Psychology Research Periodical, 27, 221-233. doi:10.1037/0735-7028.27.3.221
Patricia Jean Precin, MS, OTR/L, LP Editorial Board Member doi: 10.3928/15394492-20121105-01
3
