Edited by Susan Bazyk, PhD, OTR/L, FAOTA
This publication provides a foundation for conceptualizing occupational therapy’s role in promoting mental health when working with children and youth in schools and community settings. Chapters emphasize helping children develop and maintain positive mental health, which is reflected in the presence of positive affect and psychological and social functioning, productive activities, and resilience in the face of adversity.
Occupational therapists may need assistance in expanding services to include promotion and prevention activities, in addition to intervention with mental health disorders. To that end, this book has the following objectives:
- Delineate how occupational therapists working with children and youth can contribute to mental health promotion, prevention, and intervention in school and community settings;
- Delineate occupational therapy services related to mental health within a public health framework at the universal, targeted, and individual levels;
- Recognize current approaches within and outside the profession relevant to promotion, prevention, and intervention for meeting the needs of children and youth with and without disabilities or mental illness; and
- Identify practical information for promotion, prevention, and intervention in everyday occupational therapy practice with children and youth.
This book is also available as a Self-Paced Clinical Course. Click here for information on buying the CE test if you already own the book; to purchase the bundled book and CE test (SPCC), click here.
Contents
Part 1. Laying the Foundation—Reframing Occupational Therapy
Chapter 1. Promotion of Positive Mental Health in Children and Youth
Chapter 2. Occupational Therapy Process
Chapter 3. Major Approaches Useful in Addressing the Mental Health Needs of Children and Youth
Chapter 4. Pathways to Positive Development
Chapter 5. Development and Implementation of Groups to Foster Social Participation and Mental Health
Part 2. Addressing the Mental Health Needs of Diverse Groups of Children and Youth
Chapter 6. Enduring Challenges and Situational Stressors During the School Years
Chapter 7. Occupational Therapy for Youth at Risk of Psychosis and Those With Identified Mental Illness
Chapter 8. Autism
Chapter 9. Children and Youth With Disabilities
Chapter 10. Occupational Therapy for Children With Severe Emotional Disturbance in Alternative Educational Settings
Chapter 11. Attention Deficit Hyperactivity Disorder, Developmental Coordination Disorder, and Learning Disabilities
Chapter 12. Promoting Mental Health, Social Participation, and Self-Determination in the Transition From School to Adult Life
978-1-56900-307-7 (print), 302 pages, 2011
978-1-56900-470-8 (ebook)
Importance: An analysis by the Substance Abuse and Mental Health Services Administration (SAMHSA; 2015a) found that an additional 10,000 mental health care providers will be needed by 2025 to meet the expected growth in demand for treatment of people with mental illness, substance use disorder, or both. Despite being the largest payer of mental health services in the United States, the Medicaid program has extremely low numbers of mental health providers (Frank et al., 2003).
Objective: This Health Policy Perspectives column is a collaboration among academics, clinicians, and students in the fields of occupational therapy and law in an effort to advance state occupational therapy associations’ efforts to gain formal recognition of occupational therapy practitioners as Qualified Mental Health Providers (QMHPs) and/or Qualified Behavioral Health Providers (QBHPs).
Conclusion: Coordination among states to identify barriers and opportunities in this important advocacy effort are needed for continued successful inclusion of occupational therapy practitioners as QMHPs, QBHPs, or both.
What This Article Adds: This column will assist other states in their efforts by providing legislation, strategic advocacy examples, and a course of action.
What do I get?
What do I get under the Care Programme Approach (CPA)?
You should get a care coordinator and a care plan.
What does a care coordinator do?
A care coordinator is the person who will coordinate and monitor your care. The care that you need should be written into your care plan. Your care coordinator won’t necessarily be the person who gives you the support that you need. This may be another professional such as a therapist.
Your care coordinator will usually be a social worker, community psychiatric nurse (CPN) or occupational therapist.
You should have regular contact with your care coordinator. Your care coordinator should:
- work with other health professionals to assess your needs,
- write a care plan which shows how the NHS and other services will meet your needs, and
- regularly review your plan with you to check your progress.
Your care plan should say who your care coordinator is. You should be in regular contact with your care coordinator.
Can I choose my care coordinator?
You can’t choose your care coordinator. But your team should try to meet any needs that you have. For example, you may respond better to a care coordinator of a certain gender because of past trauma.
You should be able to choose a care coordinator that takes into account any cultural or religious needs that you have. But this will depend on staff availability.
What should my care plan include?
Your care plan sets out what support you will get day to day and who will give it to you. This might include friends or family who care for you as well as professionals. Your care plan shouldn’t give your carers more to do than they are able to do.
What goes into your care plan will depend on your needs and wishes. The following things are likely to be considered for your care plan.
- Medication and side effects
- Therapy
- Physical health needs
- Help with money problems
- Advice and support
- Occupational therapist to help with everyday living tasks
- Help with employment, training or education
- Help from a support worker
- Help with housing
- Social care services such as support at home and help with getting out of your home
- Personal circumstances including family and carers
- Risk to yourself or others
- Problems with drugs or alcohol
A multi-disciplinary approach should be used to assess your needs and make your care plan. This means that people with different specialities or from different agencies should be involved in your plan. For example, clinical staff will give their opinion about your treatment needs such as therapy and medication. Welfare staff, such as a social worker, will give their opinion about social support that you need at home or in the community.
Your care coordinator should listen to your views about what you think you should get.
Your care coordinator should offer you a copy of your care plan. They should send a copy to your GP. Your carer or relatives can also have a copy if you want them to.
Your care plan should include details of what to do in a crisis. This could include a crisis line number that you could ring.
What about equality?
Your age, disability, gender, sexual orientation, race and ethnicity and religious beliefs should be thought about as part of your assessment, care plan and review.
Will my physical health be assessed under CPA?
Assessing your physical health needs should be a priority. Your care coordinator should help you to get support for your physical health. Your care plan should look at the effect that mental health symptoms and treatments can have on your physical health. It should also look at the effect that physical symptoms can have on your mental health.
Research has found that people with mental illnesses are at a higher risk of physical health conditions such as obesity, heart disease and diabetes. Medications used in mental health can cause weight gain or increase the risk of diabetes.
Will my care plan be reviewed?
You should have a review of your care at least once a year. If your needs change you should have a review of your care, even if this is before your review date.
Your care coordinator is responsible for arranging the review of your care plan. All parties who are involved in the plan should be involved in the review.
Improving the support for people with serious mental health problems is a key priority. The Integrated Care System in Devon is transforming community support through the Community Mental Health Framework.
What is the Community Mental Health Framework?
News
Introduction
Many of the mental health services that we provide in Devon are very good, and we have worked hard over recent years to increase investment, extend the range of services available and improve people’s experience of those services.
One area that has lacked sustained focus and investment, both locally and nationally, is the provision of community mental health services for adults (people aged 18 and over) with severe mental health needs.
In particular, we know that many of our community mental health teams have long waiting lists and there are gaps between services. We also know that people find it difficult to access the services they need and to navigate their way around a system that offers support from many different sources, including GPs, health and social care providers, local authorities and the voluntary sector. Furthermore, we know that mental health support is not as closely integrated as it needs to be with other key services, such as those providing help with housing and employment.
We are now in the process of implementing plans to tackle these issues and to deliver more consistent, joined-up support for people that better meets their personal needs and also the needs of their local communities.
National context
The changes proposed for Devon are part of a national improvement programme called the Community Mental Health Framework (CMHF). The NHS Long Term Plan pledges to deliver £2.3 billion of extra funding to mental health services in England by 2023/24. Over the next five years, £1 billion will be spent to expand and improve community mental health services around the country to meet people’s needs more fully. In Devon, we have successfully bid for our share of this funding. The Framework will bring an additional £15m into the county to support the plan.
What is the plan for Devon?
Over the next 18 months we will introduce a new model of community mental health care in Devon. We received very positive feedback from NHS England and NHS Improvement about our proposals.
The core principles of the new model include:
- Tailored services based around individuals and their whole-life needs – not just their mental health needs
- Services as close-to-home as possible and shaped to meet the needs of local communities
- A one-team approach – removing organisational boundaries to ensure joined-up care
- Support in finding your way around the system
- Co-production and co-design with people who have lived experience of mental health issues
- Consistent services and standards of quality across the county.
The core features of the new model include:
- Targeted neighbourhood support aligned with Devon’s 31 Primary Care Networks(PCNs) and provided by Multi Agency Teams (MATs)
- Peer Navigators to walk alongside people so they get help when and where it is needed
- A specific focus on:
- the transition of young people to adult services
- the needs of younger adults (18–25-year-olds)
- the needs of older adults
- the physical health of people with mental health needs
- Three clinical areas will be the focus of more targeted support:
- eating disorders
- personality disorders
- mental health rehabilitation
- Formal arrangements with the voluntary, community and social enterprise sector (VCSE) and private organisations to ensure fair and equal provision of support across the county.
What’s happening now?
Conversations are under way with staff and people who have lived experience of mental health issues, to ensure that their feedback shapes progress as we move forward.
Discussions are taking place with an alliance of VCSE groups. The aim is for this alliance to be an important provider of the additional support being offered as a core part of the Framework. This alliance will, potentially, receive £3.6m of the new funding. Discussions have been taking place over the summer about how this support can best be provided and it’s hoped an alliance will be selected before the end of 2021.
Closer integration with the county’s GPs and PCNs, and supporting them to provide better and more joined-up care, is a core element of this improvement programme. Devon is divided into five local areas and Locality Implementation Teams (LITs) in each of these areas have started to develop plans for making the Framework a reality in their patch. These LITs bring together key partners from primary care, mental health services, people with lived experience, local authorities and the VCSE.
Staff are already being recruited to boost the workforce. In total there will be around 140 more people directly supporting people in the county with serious mental health needs. Ten Peer Support Workers and 12 Clinical Associate Psychologists have already started work, with more to come.
What happens next?
PCNs are starting to establish their Multi Agency Teams, although they are at different stages in their development. These teams will be introduced gradually over the next 18 months. Meanwhile, plans for the delivery of the three clinical areas of particular focus (eating disorders, personality disorders and rehabilitation) are being finalised.
How do I find out more or get involved?
If you have any queries or would like to receive updates about the programme or get involved, please email [email protected]
You can also stay up-to-date by subscribing to our monthly Community Mental Health Newsletter.
You can also download a leaflet with basic information about the Framework.
