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Responsiveness or resistance: views of community care workers encountering a new rehabilitation model
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
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
(English)Manuscript (preprint) (Other academic)
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.

Keyword [en]
psychiatric disability, psychotic disorders, supported housing, occupational therapy, recovery
National Category
Medical and Health Sciences
Research subject
Occupational therapy
Identifiers
URN: urn:nbn:se:umu:diva-50042OAI: oai:DiVA.org:umu-50042DiVA: diva2:458663
Projects
Everyday Life Rehabilitation
Available from: 2011-11-23 Created: 2011-11-23 Last updated: 2014-10-07Bibliographically 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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CiteExportLink to record
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Citation style
  • apa
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