Every day, occupational therapists help people push past their boundaries to lead their best lives. As more people become aware of the benefits of occupational therapy, the presence of these clinicians grows, sometimes in unexpected places. One area where OTs have made strides is substance abuse recovery. At treatment facilities, they have been integrated into the mental health team, helping clients ease back into meaningful occupations. In this type of setting, occupational therapists help people replace old habits with new, healthier ways to structure their day.
"OTs help people return to and reengage in their meaningful life roles," explained Ginny Stoffel, PhD, OT, BCMH, associate professor of occupational therapy at the University of Wisconsin-Milwaukee, current president of the AOTA, and a subject matter expert on substance abuse for the AOTA.
In Seattle, the Swedish Medical Center, Ballard Campus houses addiction recovery services, both an acute three to seven day inpatient withdraw program and an inpatient rehab program specifically designed for pregnant women. "We use OTs every day," said James Walsh, MD, medical director, Swedish Addiction Recovery Services.
Walsh recognizes the importance of occupational therapists to his patients, yet not every program utilizes them. "I think increasingly at AOTA we are trying to raise awareness among other professionals about the work we do," noted Stoffel. Each recovery program attracts patients with different levels of addiction. The greater the complexity of an individual's case, the greater their need for OT assistance. The Occupational Therapy in Mental Health Act (H.R. 1037), sponsored by Rep. Paul Tonko [D-NY], currently referred to the House sub-committee on Health, would amend the Public Health Service Act to include occupational therapists as behavioral and mental health professionals. "It would solidify OT as member of the team," Stoffel said.
As more fully-integrated team members, substance abuse programs could turn to occupational therapists to help patients with both the mental and the physical roadblocks to recovery. The patients in acute withdraw at Ballard Campus are frequently delirious, which leads them to struggle with their activities of daily living. Occupational therapy helps not only with delirium, but with the anger and other mood disruptions that can accompany addiction and withdraw. Patients' orientation can vary hour-by-hour, requiring the therapists to constantly think on their feet. Cognitive deficits are one side-effect of long-term alcohol abuse and OTs can give patients coping strategies.
Occupational therapy can help people in these situations better manage stress. One way OTs can assist is by helping people have sleep habits that support their best health, as better rest increases the ability to deal with triggers.
"For our pregnant moms treatment is entirely peer supported," Walsh explained. Groups like that are common place in the recovery standard of care. A peer support model is one of the emerging niches of mental health practice, as determined by the AOTA, and the association sees great potential for occupational therapy practitioners to partner with and support peer support specialists.
From a physical standpoint, especially for those in acute withdraw, "People are really confused and ataxic for motor function," Walsh explained, which leads to problems such as spilling food and drinks and dropping things. Occupational therapists help the patients re-learn ADL's like showering and brushing their teeth. As Walsh said, "When the patients are able to do something, they feel so much better."
Pregnant patients, in particular, can have chronic pain. Occupational therapy practitioners help patients feel comfortable. Both physical and occupational therapists address that, creating braces or splints, and helping with mobility. Therapy services have been "amazingly positive" in reducing falls, noted Walsh
Together, nurses, physicians and therapists make assessments on what is best for the patients. "For every patient it's critical to have a follow-up plan, but it's variable," Walsh noted. Upon discharge from acute rehab at Ballard, further recovery plans include either additional inpatient treatment or therapy at an outpatient facility. Both the patient's willingness to commit to therapy and their insurance coverage play a part in where they land after leaving.
Increased Need for Services
Across the country, in Philadelphia, 2nd year occupational therapy students from Thomas Jefferson University work with a unique population at Morris Home. Run by Resources for Human Development, this residential treatment facility houses up to 8 clients. To be admitted to Morris Home, one must be transgender or gender variant, and have a history of both substance abuse and homelessness. The partnership with Jefferson was initiated by Susan Santalucia MS, OTR/L, academic fieldwork coordinator and instructor in the School of Health Professions.
In conjunction with their course, Enhancing Social Participation, the Jefferson students are required to do a community-based level one fieldwork at a location that does not an occupational therapist in-house. At the beginning of the semester, they rank the sites in order of preference and the university matches them at one of twelve fieldwork sites. Six second-years work at Morris Home, three on Tuesdays and three on Wednesdays. Unlike the short-term care offered at Ballard, residents at Morris home can stay there for up to two years, with no minimum length-of-stay.
While Morris Home has been serving the community since 2011, the demand for mental health services will increase. Stoffel explained, "With the Affordable Care Act, people who did not have access to interventions are going to be coming to the table."
"OT is centered around increasing patient's quality of life and participation in healthy activities," explained Lauren Donlan, OTS. The students run two life skills groups. Donlan and Elise Leizerovich, OTS, and Alexandra Harkins, OTS, run a weekly home life skills group, with each taking turns as leader. They focus on shopping, meal prep, cooking and hygiene. One week, they discussed grocery shopping and couponing, teaching the residents there are many things that can be purchased while on a budget. The next session focused on finding recipes and the students guided the residents through making their own recipe books, which they will take with them when they move out of Morris Home. During the following session, they cooked some of their recipes.
On Tuesdays, the 3 other Jefferson OT students run a personal skills group, where they teach resume writing, interview skills, professional dress, and other outside-the-home skills. Both sessions are intended to prepare residents for when they transition out of Morris Home to live independently.
Two full-time Resources for Human Development mental health professionals sit in on the group therapy sessions to see the interactions and give feedback. "It's collaborative," noted Harkins. "The overarching goal is to become more competent in running group activities." Back at Jefferson, the students have the opportunity to collaborate with classmates and their instructor, asking questions, processing, and planning interventions for the site.
Stoffel agreed that a main function of occupational therapy in this kind of setting is helping clients set up healthy routines promoting recovery, participation, and well-being. OTs can help create a plan for personal finances, a plan to return to meaningful work, and as is important for people recovering from substance abuse, a plan to regain the trust of friends and family. Addressing addiction requires lifestyle changes and that is precisely what OTs are poised to do best. Stoffel said, "Our emphasis on health and well-being is a good match."
For a month before the group sessions began, the students visited Morris Home, an invaluable experience. Leizerovich urges other students prior to their community based fieldwork, "Get to know setting and staff and members before running group so won't be completely in the dark."
Stoffel urged occupational therapists, "Identify the unique way they can influence recovery and how OT can bring increased value to that equation."
Harkins echoed those sentiments, "You can read as much as you want but the important thing is to get to know each client. There are only 8 of them here but they are all so different."
Danielle Bullen is on staff at ADVANCE. Contact: email@example.com