Mental Health, Patient-Provider Communication, Substance Use 05.27.2020

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Incorporating Mental Health into Occupational Therapy Training

As part of our series during Mental Health Awareness Month, we chatted with Dr. Allison Sullivan about the need for mental health occupational therapy education and how Kognito’s SBI Skills Assessment simulation trained her OT students.

Tell us more about your role, your students, and the courses you teach.

I am an Associate Professor of Occupational Therapy (OT) at American International College (AIC) in Springfield, Massachusetts. I am the 2017 recipient of the Massachusetts Association of Occupational Therapy’s Catherine Trombly Award for Excellence in Research and Education and AIC’s 2018 Faculty Excellence award.

I’m also Lead Faculty for AIC’s Post-Professional Doctor of Occupational Therapy program, for which I teach teaches courses in scholarship of teaching and learning and occupational therapy theory. I also teach courses in group dynamics, psychosocial occupations of children and adults, and the occupational therapy mental health process for the MSOT program at AIC.

As an occupational therapist and educator, I have dedicated my career toward improving the lives of individuals with cognitive disabilities such as addiction across the lifespan. My research interests include pedagogy in occupational therapy education, cognitive disabilities, and trauma-informed care.

Why is it important to train occupational therapy students in mental health and substance use?

While studying evidence-based practice methods in mental health intervention in 2015, I first learned of SAMHSA’s SBIRT (Screening, Brief Intervention, and Referral to Treatment) program, which I felt strongly could be an ideal method for utilizing occupational therapists’ mental health skills and knowledge in primary care settings more effectively.

As noted in my 2017 article for the American Journal of Occupational Therapy:

“Given the plight of persons with psychiatric disorders and the problems of staff recruitment and retention in psychiatric occupational therapy, we need to explore innovations in occupational therapy curricula that will enhance student attitudes toward persons with psychiatric and other disabilities (Lyons & Hayes, 1993 p. 547). This aim is particularly important for mental health occupational therapy education in the United States, because only 2.4% of occupational therapists and 1.4% of occupational therapy assistants reported that their primary work setting was a mental health setting (American Occupational Therapy Association [AOTA], 2015). Despite the small number of occupational therapy practitioners working in mental health settings, key official documents from AOTA and the Accreditation Council for Occupational Therapy Education® (ACOTE®) highlight the importance of psychosocial factors in influencing engagement in occupation. With the likelihood that few students will have Level II fieldwork opportunities in traditional mental health care settings, one challenge for academic programs is ensuring students’ entry-level competence in mental health skills and knowledge.”

Thus, it is essential for educators to identify pedagogical methods that maximize learning and personal growth. Emphasis on intervention and best practice in OT education concerning addiction is uncommon now due to the very small numbers of therapists that work in settings specific to treatment of addiction.

This is very unfortunate, due to the fact that by instilling in students the significance of developing competency and accuracy in using appropriate techniques when discussing and educating clients on their substance use, OT programs can better prepare students for leadership in settings that employ health care practice models addressing population health, such as the public health model of addiction and recovery and the harms reduction approach.

Occupational therapy practitioners can demonstrate leadership in SBIRT programs as direct service providers, occupying a place of trust in the patient care continuum and providing services in the settings for which SBIRT was intended.

How did you hear about Kognito’s SBI Skills Assessment simulation? What were your goals in having your students complete it?

I first learned about Kognito’s innovative computer simulation trainings in screening and brief intervention (SBI) from a SAMHSA-shared a link on Twitter. The link went to registration for an upcoming webinar the agency was hosting, and concerned results from investigations by several academic institutions using Kognito products to increase students’ competency and accuracy in using appropriate techniques when discussing and educating clients on their substance use.

The results of these investigations were impressive, and I concluded that it was important to identify whether this promising approach to instruction could accomplish the following objectives for our occupational therapy students:

  1. Contribute to the body of evidence regarding best practices in psychosocial occupational therapy education and practice, and
  2. Promote understanding of how the use of educational techniques to improve health professional student competence and confidence in screening and brief intervention (SBI) can strengthen student learning and enhance their understanding of the core values of their professions.

How did you implement the simulation in your course?

After reviewing and personally trialing a variety of training options with representatives from Kognito, I selected their SBI Skills Assessment training, given that I felt it best suited my MSOT second-year students’ learning needs. Students at this point in their education are developing clinical reasoning and practice skills.

The 48 second-year master’s degree students involved in this study participated in the computer simulation training as a new learning activity for their coursework for OTR 5430, Psychosocial Occupations of Adults and Elders. First-year occupational therapy students served as volunteer interview subjects for that class.

This assignment has been what I considered to be an essential experiential learning activity in this course for a number of years. It traditionally included:

Activities were conducted in accordance with an institutional review board waiver for clinical education.

What feedback have you heard from your students?

The results from this study indicate that a strong, positive relationship exists between direct participation in Kognito’s SBI Skills Assessment computer simulation training and the confidence and accuracy of responses by occupational therapy students using these skills.

In addition to the quantitative data that demonstrated this relationship, individual student feedback as illustrated in these quotes was also very positive:

“I enjoyed the simulation; there were a few instances in which I selected the wrong response and I really appreciated how the program explains why mistakes are incorrect. That helped me learn a lot about the appropriate way to phrase feedback in order to avoid language that may lead the individual to consider reasons why they cannot achieve their goals (for example, instead of asking “why didn’t you rate your motivation to change a higher number like 9?” you would ask “why didn’t you rate your motivation to change a lower number like 4?”). This concept is new to me and I believe that the simulation did a great job of teaching it comprehensively”.

“I liked how the responses created a real life response/experience.”

“Once I go out on fieldwork this will be very helpful and I definitely plan on utilizing this knowledge”

What advice do you have for programs that do not include mental health and substance use training in their curricula currently?

“With the likelihood that few students will have Level II fieldwork opportunities in traditional mental health care settings, one challenge for academic programs is ensuring students’ entry-level competence in mental health skills and knowledge.”

Given the fact that many junior and adjunct faculty are expert clinicians often lacking experience and exposure to best practices in teaching and learning, this is particularly challenging. Despite the relatively small number of experienced occupational therapy educators with extensive professional development or formal education in teaching and learning in higher education, key official documents from the Accreditation Council for Occupational Therapy Education highlight the importance of assessment and development of student competence in evaluating clients’ psychosocial factors in influencing engagement in occupation.

Thus, it is essential for educators to identify pedagogical methods that maximize learning and personal growth. A passive approach to instruction and education in occupational therapy theory limits the value of the information being shared and its ability to enhance student clinical reasoning and professional competence.

As I indicated previously, in addition to maximizing student learning via application of evidence-based best practices in instructional methodology, I strongly recommend that OT programs without direct instruction in SBI explore and include this content. By instilling in students the significance of developing competency and accuracy in using appropriate techniques when discussing and educating clients on their substance use, OT programs can better prepare students for leadership in settings that employ health care practice models addressing population health, such as the public health model of addiction and recovery and the harms reduction approach.

Occupational therapy practitioners can demonstrate leadership in SBIRT programs as direct service providers, occupying a place of trust in the patient care continuum and providing services in the settings for which SBIRT was intended.


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