OTAC presentation article

Improving Occupational Performance in Outpatient Mental Health OT

            Cognitive behavioral therapy (CBT) is an evidence-based psychological treatment approach that emphasizes positive change using behavioral and cognitive interventions for individuals living with mental illnesses. CBT techniques have been integrated into occupational therapy since the late 1960s, where occupational therapy practitioners (OTPs) found success in the treatment’s ability to promote adaptive behaviors that enabled engagement in valued occupations. OTPs can be trained to administer CBT, guided by the Cognitive Behavioral Frame of Reference (CB-FOR), though there are currently no standard or specific requirements to do so.

(Visual map of the CB-FOR (Jones, 2024))

There is a dearth of research on CBT in the outpatient OT setting, despite a long history of collaboration. A recent retrospective study (Jones, 2024) sought to demonstrate the efficacy of using a cognitive behavioral-informed approach to improve occupational performance of children, teens, and adults living with mental illnesses, insomnia, or lifestyle deficits. The study revealed that 90% of patients, regardless of age or gender, demonstrated clinically significant improvement in meaningful occupations as measured by the Canadian Occupational Performance Measure (COPM) in an average of nine sessions.

(Visual representation of data (Jones, 2024))

These results have more salient meaning when individual functioning is examined. Patients no longer avoid social events, have adopted healthier routines, manage time and attention more effectively, and communicate successfully at work, home, and school. Children and adolescents now complete nonpreferred tasks more independently, sleep better with fewer or no sleep aids, return to or obtain work by using coping strategies to reduce overwhelm, and participate more confidently in enjoyable activities and self-advocacy. These functional improvements were observed consistently across populations and regardless of the number of goal areas targeted.

The OTPF-4, specifically global mental functions and specific mental functions, guide OTPs place in the mental health arena. The use of assessments that are occupation-specific such as the COPM, the Functional Outcomes of Sleep Questionnaire (FOSQ-10), and mood inventories, help distinguish the OT profession by establishing an occupation-focused baseline that can be readministered to demonstrate clinically significant change and necessitates treatment for the individual. Billing codes already exist for treatment of mental illnesses and insomnia in the outpatient setting, specifically 97530 (therapeutic activities) and 97535 (self-care/home management training) and there are many applicable referring and treating diagnoses codes that support evaluation and treatment, for example, executive functioning deficit, for this patient population.

Intervention in the outpatient mental health setting includes addressing daily roles and routines in conjunction with cognitive-behavioral tools, including psychoeducation, worksheets, weekly home programming, cognitive restructuring, activity scheduling, role-play, and relaxation strategies. Treatment is action-based and occupation-focused, aiming to restore a patient’s successful participation in areas of performance such as self-care, productivity, and leisure. Discharge occurs when the patient demonstrates the ability to maintain progress between sessions and applies adaptive learned skills across environments, leading to goal attainment. The patient is taught to be their own therapist by the time therapy concludes, leaving patients with a sense of empowerment and success. My hope is that this beneficial treatment approach will one day be widespread across OT practice settings to improve the lived experiences of people everywhere.

Reference:

Jones, M. J. (2024). A Cognitive Behavioral Approach to Improving Performance and Satisfaction in Meaningful Occupations in the Outpatient Mental Health Occupational Therapy Setting. Occupational Therapy in Mental Health, 41(1), 132–153. https://doi.org/10.1080/0164212X.2024.2326411