Occupational Therapy 'Recovery through Activity' - Group Service Development

During the pandemic, our clients were particularly struggling to manage anxiety and depression, in relation to an increase in life stressors. One core element of Occupational Therapy practice is adapting the physical and social environment, to support health and well-being. Additionally, occupational engagement can help people gain confidence in their ability to achieve actions, developing personal causation and a sense of control over their health needs (Kielhofner, Forysth and Barrett 2003).

As Occupational Therapists, we found ourselves focusing on fundamental OT skills and principles, to help support people in a time of crisis. Research suggests that COVID-19 has increased the demand for OT input, given worldwide experiences of occupational isolation, deprivation and injustice (Balser et al., 2020, WFOT, 2020). The pandemic significantly impacted one’s ability to maintain daily routines, roles and meaningful occupations. Many people were also struggling with a lack of social connection, finding it difficult to achieve relaxation and distraction from everyday stressors. We decided to create an OT group, to support clients during this time of crisis...

The study was based on participants in the Neighbourhood Community Mental Health Team (which may limit generalisability across settings and locations). Participants had a number of different diagnosis, but they were all within the category of severe and enduring mental health needs. The service was already using the Model of Human Occupation (MOHO, Kielhofner 2008) assessment tools; therefore it made sense to use the Model of Human Occupation Screening Tool (MOHOST), to screen for eligibility for the group and provide an outcome measure. We used the Recovery Through Activity (2017) book, to help develop sessions, based on evidence in practice.

 The project aimed to reduce the OT waiting list, providing a short term intervention, in order to reduce the need for intensive support. Each session explored a different topic, such as leisure, creative, physical and community activities. The aim for participants was to explore the use of activity planning, meaningful occupations and goal setting.

The MOHOST tool was repeated after the group by the same Occupational Therapist, in order to assess any change. Five participants were referred but only four attended, along with two Occupational Therapists. The group was held every week by Webex (video conference calling); sessions consisted of a mix of group and individual sessions, to assess progress and review goals. Each session involved some time for discussion on the topic and SMART goal setting, to support goal achievement.

While occupational therapists strive to implement occupation-focused work, many have recognised difficulty in maintaining practice within a generic mental health role (Lloyd et al 2002), due to other responsibilities.

There is risk of resorting to symptom reduction, rather than using our core function in promoting the health benefits of meaningful occupation in everyday lives (College of Occupational Therapists, 2008). The Recovery Through Activity programme was designed to support occupational therapists in mental health to carry out this specialist core role (Parkinson, 2017). The Model of Human Occupation provides the framework, analysing occupational life according to a person’s volition, roles and routine and performance skills (Kielhofner 2008).
 

Occupational Therapists help people to expand their activities, interests and hobbies, through exploration, competency and achievement of leisure occupations (Pepin et al, 2008). This can help to develop a sense of achievement, social connection and personal gratification, via valued occupations. Through engagement in daily and pleasurable activities, research suggests improvements in mental state, based on quality of life indicators (Kelly et al, 2001). Hence we decided to use the Recovery Through Activity programme, in order to structure sessions based on the theory and research.

Group activities included social games (e.g. hang man), physical exercise (e.g. chair-based) and creative activities (e.g. 'zen tangles' exercise). The sessions that appeared the most engaging were those that involved engagement in activities, rather than planning activities (e.g. using the interest checklist). The self-care session involved some discussion around the benefit of self-care and sleep hygiene. There was also a mindful tea making exercise, where clients were asked to using mindfulness skills to fully engage in the activity together, in a virtual environment. Participants were sent a selection of tea bags before the session, in order to encourage choice.

The session plans were sometimes difficult to apply online, however we tried to be creative and adapt the tasks to fit the needs of the group. For example, for the scavenger hunt clients were asked to spend some time in their own garden/local outdoor space. Participants were asked to share their items and discuss what attracted them to specific items. The final two groups were community and social activities, therefore highly appropriate to meet outside whilst maintaining infection control measures. The social aspect helped motivate those participations who usually struggled to independently access the community.

On reflection, it likely helped with attendance to offer telephone calls to prompt attendance, with a better turn out in the first session compared to the second. Additionally, we aimed to hold a session to explain the virtual platform to clients. However, time capacity did not allow for everyone to have a session, which caused some technological issues. We found that allowing lots of time to reflect on and discuss topics and technology allowed the content of conversation to flow - again something that, for a face-to-face session, would not be a challenge. We also found that having the colleagues in the same room while on Webex was helpful; we were then able to make suggestions to each other, without having to share information with group members.

A feedback form was developed to make improvements, given that this was a pilot group. People reported to benefit from the social aspect of the group, as well as developing skills in goal setting. While significant changes were not demonstrated through the MOHOST, therapists recognised some improvements in goal setting, engagement with the team and peer learning. One client reflected that the routine of weekly sessions helped him to better understand the importance of structure. He reported increased motivation to re-engage with past daily living activities, roles and responsibilities. The aim of the group was to explore the use of activity planning, goal setting and recovery through activity.

This was a pilot group, so it is likely that recommendations and changes will be made for following groups. The Occupational Therapists involved agreed that clients appeared to gain something important from the group, even if it was difficult to measure in the MOHOST screen. It is also difficult to fully assess progress when clients did not attend all the groups. The programme would need to be repeated several times to assess the effectiveness of group sessions - and consider how many sessions are required to support consistent change with the population studied. It is likely that clients will benefit from time to review goals and consolidate progress within their everyday lives. The group will likely benefit from further cohorts, in order to implement learning and further assess the benefit of the Recovery Through Activity programme.