Is There a Role for Occupational Therapy within a Specialist Child and Adolescent Mental Health Eating Disorder Service?
Gardiner, Clare, Brown, Naomi, British Journal of Occupational Therapy
Occupational therapists have worked within multidisciplinary child and adolescent mental health (CAMH) services in Britain for many years (Lougher 2001). In Northern Ireland, however, only two occupational therapists work within this specialist field. The Bamford Review of Mental Health and Learning Disability (Northern Ireland) (2006) recommended the development of specialist child and adolescent outpatient services for eating disorders (EDs). Only one of these emerging services has employed an occupational therapist, despite Bamford's recommendations that occupational therapy should be a core element of CAMH provision. For the purpose of this opinion piece, EDs include anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified (EDNOS). All the conditions included under EDs share common features; however, the authors recognise that each condition has specific symptoms, which require different treatment approaches.
Occupational therapy within CAMH
The unique and key role of occupational therapy within CAMH has been recognised by the National Health Service (NHS) Advisory Service (1995), Finch (2000) and the Bamford Review of Mental Health and Learning Disability (Northern Ireland) (2006). Working within small multidisciplinary CAMH teams (frequently as the sole occupational therapist) has led to role blurring, resulting in some occupational therapists losing and /or denying their professional identity, filling gaps in services and neglecting the occupational philosophy of the profession (Fortune 2000). This is unacceptable in the current climate where commissioners and service users demand a range of treatment options and professions examine core skills to justify positions within CAMH teams (Lougher 2001).
Occupational therapy and eating disorders
The Adolescent Medicine Committee of the Canadian Paediatric Society (1998) described occupational therapy as a useful adjunct to the medical management of EDs. The American Psychiatric Association (2006) stated that for clients with AN, occupational therapy programmes can enhance self-concept and self-efficacy, and Natenshon (2003) stated that occupational therapy is crucial for the successful treatment of adolescents with EDs. However, concerns regarding occupational therapy role clarity or blurring, and lack of recognition from other health professionals, have been documented (Lim and Agnew 1994, Kane et al 2005).
Rockwell (1990) identified approaches used by occupational therapists working with clients with EDs: psychodynamic, cognitive, familial, developmental, behavioural and medical. Lim and Agnew (1994) reported that cognitive-behavioural and occupational dysfunction models were preferred, and Henderson (1999) emphasised psychoanalytical and cognitive-behavioural frames.
The majority of these approaches are obviously not implemented solely by occupational therapists. The College of Occupational Therapists (2006) has urged practitioners to challenge inequalities in health and social care provision, and to use occupational language to reinforce the relationship between occupation, recovery and wellbeing. This opinion piece therefore highlights occupational therapy core skills and the relevant occupational therapy frames of reference and modalities, underlining their application to EDs.
Occupational therapy core skills
Occupational therapists use numerous skills that are generic to multidisciplinary team members, including assessment, patient care, management, research, problem solving, teaching, clinical reasoning, organisation, budgeting, recording, communication, supervisory and basic counselling skills (Hagedorn 2001).
In addition, occupational therapists implement a range of unique skills. Creek (2003) described the core skills of an occupational therapist as client-therapist collaboration; assessment of occupational performance; enabling clients to investigate, accomplish and balance activities of daily living; problem identification and problem solving specific to occupational performance difficulties; the therapeutic use of activity (including activity analysis, adaptation and grading); facilitating activity groups; and the analysis and adaptation of environments to increase function and social participation. …