Academic journal article British Journal of Occupational Therapy

Experiences of Occupational Therapists and Occupational Therapy Students in Using the Assessment of Communication and Interaction Skills in Mental Health Settings in Norway

Academic journal article British Journal of Occupational Therapy

Experiences of Occupational Therapists and Occupational Therapy Students in Using the Assessment of Communication and Interaction Skills in Mental Health Settings in Norway

Article excerpt

Introduction

An important focus for occupational therapy in mental health practice is clients' communication and interaction skills. These skills are essential for establishing and maintaining positive relationships with others, an interpersonal aspect that permeates many daily occupations (Kielhofner 2008). As indicated by earlier studies, such skills are often impaired during severe mental illness (Ikebuchi 2007) and can raise doubts about clients' ability to care for themselves, as in cases where clients speak in a disorganised way or act aggressively towards other people. For clients with non-psychotic disorders, communication and interaction skills are less affected than for those clients with psychotic disorders (Forsyth et al 1999). However, communication and interaction skills are also important for non-psychotic clients' ability to cope with problems, which in turn may affect the course of illness or occupational participation.

The Assessment of Communication and Interaction Skills (ACIS)

The ACIS was developed within the Model of Human Occupation (MOHO) framework (Kielhofner 2008), which conceptualises different types of skills as the building blocks of occupational performance. Occupational skills can be divided into three different types: motor, process, and communication and interaction skills.

Communication and interaction skills are required for expressing intentions and needs, and for coordinating behaviours in interaction with others (Forsyth et al 1999). The ACIS is an observer-rating instrument, which provides a picture of these skills when they are observed from the actions of a particular client in a particular context. To ensure that the situation is meaningful for the client, it is preferable that the social context and the tasks involved are chosen by the client and the therapist in collaboration. The context should also resemble the client's natural environment as much as possible because habituation will influence performance.

The ACIS consists of 20 skill items (Forsyth et al 1998, 1999). These skills can tentatively be placed along a challenge continuum, from easier to harder, and they concern three interaction dimensions: physicality, information exchange, and relations. The client is measured on each item on a four-level scale, where 4 indicates that the skill is present in a degree that supports and maintains the present interaction and 1 indicates that the skill is deficient in a way that causes interaction to stop (without the intervention of others).

Questions remain about the validity of the ACIS in different situations and contexts; the evidence so far suggests that the scores are different when used in different contexts of activities and social surroundings (Kjellberg et al 2003, Haglund and Thorell 2004). This implies that a variety of tasks, situations and contexts should be used in the ACIS assessments of clients.

Few studies provide information concerning clinical experiences using the ACIS. A Swedish study reported that clinicians considered it a structured method for observation, which was easy to administer and could readily be incorporated into clinical practice (Haglund and Thorell 2004). A Danish study of the clinical implementation of the ACIS generated similar positive experiences (Nielsen and Andersen 2006). However, problems occurred in situations where the client had little motivation to participate in the assessment procedure. In some cases, the occupational therapists found it hard to convey to the client both the purpose and the results from the assessment. The occupational therapists found it particularly challenging to give direct feedback to the clients and experienced a high degree of intimacy with the clients in these situations (Nielsen and Andersen 2006).

There is no literature indicating that the ACIS has been systematically used in Norway. This may be because the use of standardised instruments is not firmly embedded in Norwegian occupational therapy practice, particularly in mental health. …

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