The Kalamazoo Psychiatric Hospital clinic is an acute-care psychiatric facility that serves adults and older adults with serious mental illness including schizophrenia, bipolar disorder, borderline personality disorder, major depressive disorder, chemical dependency/substance abuse and dementia including Alzheimer’s type. The hospital also provides court-ordered forensics programming for patients who have serious mental illness and have been deemed either "not guilty by reason of insanity" or "incompetent to stand trial" in a legal court. The focus of the hospital's clinic is to provide patients the opportunity to socially participate in meaningful activities and to learn and practice functional skills to improve quality of life and prepare for transition to community living.
The role of the occupational therapy intern, under supervision of the OTRL, includes providing assessments, treatment planning, and group and one-to-one intervention. Interns complete evaluations consisting of a client-centered interview to create an occupational profile and assessment of functional cognition and sensory motor function. Assessment results are used to develop a comprehensive treatment plan, using the goal attainment scale as an outcome measure. Intervention is designed to improve quality of life by developing and/or maintaining ADL/IADLs, providing opportunities for social and task engagement using sensory-motor activities, improving communication and socialization skills, improving cognitive skills and/or compensatory strategies, and increasing participation in recreational activities.
Interns will be guided in developing client-centered and occupation-based treatment plans supported by appropriate theoretical approaches and empirical evidence. This clinic allows interns to learn more about the role of OT in an acute-care psychiatric setting while providing needed services to the organization in whole. The final project consists of an educational in-service to treatment staff, an opportunity to highlight and advocate for OT services to the interdisciplinary team.
Patient evaluation process
Following a two-week orientation process, interns will complete an evaluation on assigned patients. Evaluations are scheduled over a two-week period (four clinic sessions) and consist of interview, chart review, and various assessment and screening tools, based on patient need. Commonly used assessments include the Allen Cognitive Level Screen, the Sensory Defensiveness Checklist or Adult Sensory Profile, the Modified Interest Checklist, and the Tinetti Balance Assessment Tool. The evaluation identifies strengths, limitations, needs, and potential related to daily living skills, with an emphasis on recommendations to support patient safety. Re-evaluations are completed at the end of the semester as clinically indicated.
Patient intervention process
During fall and spring semesters, intervention is scheduled for eight weeks, twice a week, for a total of 16 sessions. Summer session consists of six weeks of intervention. Interns work together to provide a structured sensory motor group on a designated inpatient unit, as well as individual treatment on the Gero-Medical Unit. Intervention is guided by both sensory motor approaches and the cognitive disabilities model. Groups utilize the Ross’ Five Stages of a Sensorimotor Group format. Interns are also trained in strategies that incorporate cognitive level of functioning with sensorimotor intervention, using the Sensory Connection Program. Interns are responsible for planning and leading one to two of the sensory motor group sessions while assisting peers in co-facilitation for the remaining group sessions. The one-on-one sessions are typically two-to-one services, allowing students to partner to provide individualized services to patients on the Gero-Medical Unit. Interns are expected to review the literature on best practices for evaluation and/or treatment approaches, particularly those consistent with the theoretical frameworks used in this clinic. At the end of the semester, interns present a summary of their findings to the peer group for discussion.
Interns will participate in program evaluation using a continuous quality improvement process. Prior to the evaluation and intervention phases, each intern will identify a personal learning goal for the semester. With guidance from the supervisor, the student will complete the goal attainment scale to establish baseline performance and estimate potential levels of goal attainment in areas such as documentation, content knowledge, leadership, and clinical reasoning. Upon completion of the evaluation process, interns will also complete goal attainment scale on assigned clients, to establish baseline performance and measure treatment progress throughout the semester.
By the end of the semester it is expected that students will have developed the following basic competencies regarding working with adults with mental health disorders:
Evaluation and intervention process
Building therapeutic relationships and therapeutic use of self
Developing client-centered and occupation-based intervention plan supported by appropriate theoretical approaches and empirical evidence
Providing intervention directed toward improving independent or supported living, communication and interaction skills, cognitive skills or use of compensatory strategies, and increasing participation in recreational activities
Implementing one-on-one and group intervention