Monitoring the Progress of Young People's Occupational Performance in an Inpatient Mental Health Setting
Schnell, Glenda, New Zealand Journal of Occupational Therapy
When adolescents face serious mental health issues, their performance of daily activities can be disrupted. Similarly, when these issues are evident for extended periods of time they may impact on normal development (Henry & Coster, 1996). It has been reported that up to 36.6% of young people in New Zealand aged between 11 and 18 years (see Fig. 1) have mental health disorders (Fergusson, Horwood & Lynsky, 1997; Ministry of Health 1998). The Child and Family Unit (CFU), is a regional inpatient facility, set up to support children, adolescents, and families who experience serious mental health disorders which result in disrupted occupational performance. Young people who use the service, usually stay in the unit between one week and nine months (see Table 1). They have a range of psychiatric disorders, including mood and anxiety disorders, psychotic disorders and eating disorders (see Table 2). The unit serves to assess and treat these complex conditions.
[FIGURE 1 OMITTED]
Changes in young people's performance or presentation over time had not previously been captured within the unit. There were no outcome measures being used and valuable information about the success of interventions within the unit was being lost. This information could provide evidence of the mental state generally observed by members of the clinical team or symptoms reported by the adolescents (Margolis, Harrison, Robinson & Jayram, 1996; Schnell, 2004).
To ascertain what trends occur for young people in their recovery and return to daily life, a retrospective analysis of existing data was undertaken for the purpose of practice evaluation. It was hypothesised by occupational therapists in the unit that young people would slowly recover over time, and that a pattern of improvements and setbacks would be evident. This hypothesis is at the root of two questions:
1. To what extent do young people in an inpatient mental health setting improve in the area of occupational performance?
2. Does a pattern emerge over time?
An interdisciplinary team, which included three occupational therapists, psychologists, registered nurses, social workers, psychiatrists and a kaiatawhai (Maori cultural worker), are involved in setting goals towards wellness and recovery with the young people and their families. Occupational therapists play a leading role towards improving function and re-entry into the community. It is their job to address young people's occupational performance issues using group work as a therapeutic medium. The aim of intervention is not only to return adolescents to their pre-morbid level of ability, but also to help them to proceed with age appropriate developmental tasks (Zaff, Calkins, Bridges & Margie, 2002). Group work interventions are an interdisciplinary initiative in the unit and all disciplines are involved to some degree. The groups are combined with the school programme and given the name 'The Unit Programme'.
The unit programme
Group programmes are fundamental to the unit's inpatient services as they provide an opportunity for learning, engaging with others, and development of occupational performance skills to support graded re-entry into the community. Group activities also offer a release from ward monotony (Parahoo, McGurn & McDonnell, 1995). Types of group work made available to people in the unit include recreational, physical, and craft orientated groups. In addition, discussion groups centre on coping strategies, goal setting and life skills as well as those which facilitate self-awareness and self-reflection. Some groups are specifically designed to role play normal social behaviour in the community.
These group sessions are used as stepping stones to recovery, in that they inherently offer choice, opportunity and hope. This in turn gives adolescents opportunities for self-determination (Deegan, 2001; Howe & Schwartzberg, 2001). …