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Stories of rediscovering agency: home-based occupational therapy for people with severe psychiatric disability
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0002-4540-5373
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
2013 (English)In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 23, no 6, 728-740 p.Article in journal (Other academic) 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.

Place, publisher, year, edition, pages
Sage Publications, 2013. Vol. 23, no 6, 728-740 p.
Keyword [en]
community-based programs; daily occupation; disability; intervention programs; mental health and illness; narrative inquiry; rehabilitation
National Category
Medical and Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Occupational therapy
Identifiers
URN: urn:nbn:se:umu:diva-50041DOI: 10.1177/1049732313482047ISI: 000336257700002OAI: oai:DiVA.org:umu-50041DiVA: diva2:458661
Projects
Everyday Life Rehabilitation
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Promoting agency among people with severe psychiatric disability: occupation-oriented interventions in home and community settings
Open this publication in new window or tab >>Promoting agency among people with severe psychiatric disability: occupation-oriented interventions in home and community settings
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Att främja aktörskap hos personer med svårt psykiskt funktionshinder : Aktivitetsinriktade interventioner i hem- och närmiljö
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.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2011. 107 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1456
Keyword
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
National Category
Medical and Health Sciences
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-50038 (URN)978-91-7459-324-2 (ISBN)
Public defence
2011-12-16, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Projects
Vardagslivets Rehabilitering (Everyday Life Rehabilitation)
Available from: 2011-11-25 Created: 2011-11-23 Last updated: 2014-10-07Bibliographically approved

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Lindström, MariaSjöström, StefanLindberg, Margareta

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