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Promoting agency among people with severe psychiatric disability: occupation-oriented interventions in home and community settings
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
2011 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)Alternativ tittel
Att främja aktörskap hos personer med svårt psykiskt funktionshinder : Aktivitetsinriktade interventioner i hem- och närmiljö (svensk)
Abstract [en]

In general, people with severe psychiatric disability living in sheltered or supported housing lead passive, solitary lives. Current rehabilitative approaches often neglect considering an agentic perspective of the residents in sheltered or supported housing. Furthermore, the outreach and societal contexts are often not considered. Thus, practitioners tend to overlook the potential in providing support and rehabilitation that is adapted to their individual, collective and changing needs.

My approach was to develop a model for Everyday Life Rehabilitation (ELR), which has a potential to promote agency while targeting recovery, meaningful daily occupations, social participation, and person-driven goals. We employed two occupational therapists (OT) and offered an intervention with ELR in a medium-sized municipality in northernSwedenand evaluated this intervention from the perspectives of residents and community care workers (CCW), using a combination of quantitative and qualitative methods.

This thesis comprises four studies that focus on a home and community context, late rehabilitation efforts, daily occupations, and client-centredness. The overall aim is to understand and evaluate the impact of recovery- and occupation-oriented interventions in a home context for people with severe psychiatric disability. The study settings are sheltered and supported housing facilities.

The first study (n=6) explores the significance of home for occupational transformations. The analysis reveals how residential conditions facilitate rehabilitative interactions, generating occupational transformations such as increasing social competence and taking charge of daily occupations. The second study evaluates occupation- and health-related outcomes of the ELR-intervention for residents (n=17). Pre-, post-, and follow-up differences in tests scores on goal attainment, occupation, and health-related factors indicate that important progress is made. The third study explores residents’ (n=16) narratives about occupational transformations in the context of everyday life and life history. Narrative analysis discloses stories of ‘rediscovering agency’, referring to occupational and identity transformations. The fourth study illuminates community care workers’ (n=21) experiences of collaborating with residents and OTs, using ELR. The CCW’ view on residents, rehabilitation, and the own role, along with organisational conditions in the housing facility, seem to characterise different outlooks influencing the CCWs responsiveness or resistance to the intervention.

In conclusion, rehabilitation in a supported housing context appears paradoxical due to tensions between opposing values such as authentic versus artificial, and independence versus dependence. However, if residents are engaged in challenging these tensions, they can function as ‘progressive tensions’ generating change. Considering the personal and social meaning of home also appears to be valuable. The intervention studies on ELR, demonstrate its value for participants and indicates that a recovery approach applying ELR would promote shared perspectives among residents, CCWs, and OTs, while facilitating ‘agent-supported rehabilitation’ and ‘out-of-housing strategies’. The thesis provides initial support for the use of ELR-interventions and proposes continued research.

sted, utgiver, år, opplag, sider
Umeå: Umeå university , 2011. , s. 107
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1456
Emneord [en]
Mental health, Psychotic disorders, Activities of daily living, Social participation, Recovery, Occupational therapy, Rehabilitation, Client centered, Residential facilities, Supported housing, Sheltered housing, Outcome assessment, Qualitative research
HSV kategori
Forskningsprogram
arbetsterapi
Identifikatorer
URN: urn:nbn:se:umu:diva-50038ISBN: 978-91-7459-324-2 (tryckt)OAI: oai:DiVA.org:umu-50038DiVA, id: diva2:458648
Disputas
2011-12-16, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 10:00 (svensk)
Opponent
Veileder
Prosjekter
Vardagslivets Rehabilitering (Everyday Life Rehabilitation)Tilgjengelig fra: 2011-11-25 Laget: 2011-11-23 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Delarbeid
1. Home bittersweet home: the significance of home for occupational transformations
Åpne denne publikasjonen i ny fane eller vindu >>Home bittersweet home: the significance of home for occupational transformations
2011 (engelsk)Inngår i: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 57, nr 3, s. 284-299Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: The study illuminated how persons with psychiatric disabilities experienced the processes of change in a residential context.

Material: Qualitative interviews with residents living in supported housing were conducted and analyzed using constant comparative analysis.

Discussion: Residential conditions appear to provide a complex structure that facilitates rehabilitative interactions, in which ‘progressive tensions’ arise between opposing values, such as authentic versus artificial, and independence versus dependence, both of which are important in the process of change.

Conclusions: A client-centred approach could be taken further if clients are engaged in productive discussions about challenging these ‘progressive tensions’. Awareness of the meaning of home also emerged as central.

sted, utgiver, år, opplag, sider
Sage Publications, 2011
Emneord
occupational change, home- and community-based rehabilitation, psychiatric disability, supported housing
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-31271 (URN)10.1177/0020764009354834 (DOI)000290434500007 ()
Tilgjengelig fra: 2010-02-04 Laget: 2010-02-04 Sist oppdatert: 2018-06-08bibliografisk kontrollert
2. Dealing with real-life challenges: outcome of a home-based occupational therapy intervention for people with severe psychiatric disability
Åpne denne publikasjonen i ny fane eller vindu >>Dealing with real-life challenges: outcome of a home-based occupational therapy intervention for people with severe psychiatric disability
2012 (engelsk)Inngår i: OTJR (Thorofare, N.J.), ISSN 1539-4492, E-ISSN 1938-2383, Vol. 32, nr 2, s. 5-13Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

the authors offered home-based occupational therapy integrated into supported or sheltered housing to help individuals with severe psychiatric disability identify their specific needs of engagement in meaningful occupation. This study aimed to evaluate the client outcomes in activities of daily living (ADL) ability and health factors following their participation in occupation-centered interventions in home and community settings. Seventeen participants (7 women) between the ages of 27 to 66 years, living in sheltered or supported housing participated in the intervention project based on the Everyday Life Rehabilitation (ELR). The following instruments were administered before and after the intervention and at a six-month follow-up: Goal Attainment Scaling, Assessment of Motor and Process Skills, Assessment of Social Interaction, Satisfaction with Daily Occupations, ADL-taxonomy with an effort-scale, and the Symptom Check List-90. Pretest, posttest, and follow-up differences in test scores on goal attainment, occupation, and health-related factors indicate that important progress was made.  These findings support the use of the intervention and suggest that larger randomized clinical trials are needed.

sted, utgiver, år, opplag, sider
Thorofare: Slack Inc, 2012
Emneord
mental health, activity and participation, psychiatric rehabilitation
HSV kategori
Forskningsprogram
arbetsterapi
Identifikatorer
urn:nbn:se:umu:diva-50040 (URN)10.3928/15394492-20110819-01 (DOI)000302274400002 ()
Prosjekter
Everyday Life Rehabilitation
Tilgjengelig fra: 2011-11-23 Laget: 2011-11-23 Sist oppdatert: 2018-06-08bibliografisk kontrollert
3. Stories of rediscovering agency: home-based occupational therapy for people with severe psychiatric disability
Åpne denne publikasjonen i ny fane eller vindu >>Stories of rediscovering agency: home-based occupational therapy for people with severe psychiatric disability
2013 (engelsk)Inngår i: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 23, nr 6, s. 728-740Artikkel i tidsskrift (Annet vitenskapelig) Published
Abstract [en]

As part of a larger study, we offered Everyday Life Rehabilitation (ELR) as a model for integrated occupational therapy in sheltered or supported housing facilities, to enable meaningful daily occupations for people with psychiatric disabilities. Our aim of this article was to understand how participants make sense of their occupational transformations in the context of their everyday life and life history. We carried out qualitative interviews and field observations with 16 participants with psychosis-related disorders. We used narrative analysis and disclosed stories of ‘rediscovering agency’, referring to occupational and identity transformations. A parallel outcome article has shown positive results for participants, and by narrative inquiry we contribute with a deeper understanding of the meaning-making of their transformations and mechanisms of the intervention; i.e. hope, extended value of reaching goals, re-entering the majority world, and transparency of process and attunement to the individual. The findings support the use of the ELR-intervention.

sted, utgiver, år, opplag, sider
Sage Publications, 2013
Emneord
community-based programs; daily occupation; disability; intervention programs; mental health and illness; narrative inquiry; rehabilitation
HSV kategori
Forskningsprogram
arbetsterapi
Identifikatorer
urn:nbn:se:umu:diva-50041 (URN)10.1177/1049732313482047 (DOI)000336257700002 ()
Prosjekter
Everyday Life Rehabilitation
Tilgjengelig fra: 2011-11-23 Laget: 2011-11-23 Sist oppdatert: 2018-06-08bibliografisk kontrollert
4. Responsiveness or resistance: views of community care workers encountering a new rehabilitation model
Åpne denne publikasjonen i ny fane eller vindu >>Responsiveness or resistance: views of community care workers encountering a new rehabilitation model
(engelsk)Manuskript (preprint) (Annet vitenskapelig)
Abstract [en]

The importance of engagement in meaningful occupations and participation in life situations of people with psychiatric disabilities is well known. Therefore, community care workers (CCWs) in sheltered or supported housing are a key resource in the facility context. Yet, the role and views of CCWs, in facilitating or inhibiting rehabilitative opportunities for residents, is only beginning to be understood. We offered an intervention project using the Everyday Life Rehabilitation (ELR), to integrate recovery- and occupation-oriented interventions, including collaboration between occupational therapists (OT) and CCWs, into supported or sheltered housing. As one part of the intervention project, focus group interviews were conducted with 21 CCWs involved in the intervention project. The aim was to illuminate the views of CCWs working with residents partaking the Everyday Life Rehabilitation. Qualitative content analysis revealed seven categories, with associated subcategories. These categories relate to two different disability ideologies: a stabilisation oriented, and a recovery oriented approach to rehabilitation. Related to organisational aspects, we have also identified two different tensions to change: resistance, and responsiveness to the intervention. The findings have implications for the forthcoming development of housing facilities, personnel development, and rehabilitative efforts for people with severe psychiatric disability.

Emneord
psychiatric disability, psychotic disorders, supported housing, occupational therapy, recovery
HSV kategori
Forskningsprogram
arbetsterapi
Identifikatorer
urn:nbn:se:umu:diva-50042 (URN)
Prosjekter
Everyday Life Rehabilitation
Tilgjengelig fra: 2011-11-23 Laget: 2011-11-23 Sist oppdatert: 2018-06-08bibliografisk kontrollert

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