Assessing the Occupational Engagement of Forensic Clients

Chantal Wong, OT Reg.(Ont.) MSc. OT, MSc. Physiology Deidre Arbour, OT Reg.(Ont.), BScOT Trenton Vey, OT Reg.(Ont.), BScOT

“How will you spend your time in the community following discharge?”

• ?

….more time in meaningful occupations (volunteering, employment, day programs, and leisure).

2

Plans to increase occupationswhen in the community

?

Practice Informed Research

The Ontario Review Board annually reviews the status of every person who has been found to be not criminally responsible (NCR) or unfit to stand trial for criminal offences on account of a mental disorder. (Ontario Review Board) NCR clients typically move through forensic program from the most restrictive to least restrictive setting. This includes the hospital stay, community living with support/supervision with the ultimate goal of an absolute discharge (no longer requiring the support of the ORB.

3

Background

Occupation is defined as ‘an activity a person spends time doing’. Occupational Engagement is defined as ‘enabling individuals to perform and do activities that foster health as well as the potential to participate in the everyday tasks of life’1. .

4

Background

Purpose

1) Compare the time spent engaging in meaningful occupation between forensic inpatient and outpatient clients.

2) Explore the motivation behind their choice of occupational engagement to understand why it is meaningful

5

Hypothesis

1)There is a difference in occupational engagement between inpatients and outpatients

2)Motivation to engage in meaningful occupation changes between inpatient and outpatient forensic clients

6

Methods

Recruitment – Purposive sampling • Ontario Shores

– Inpatient: general forensic – Outpatient: forensic outpatient services and forensic ACTT

• Inclusion – Between the age of 18-65 years – In the above service for at least three months – Proficient in spoken English

7

Methods

8

Each participant completed a daily activity log for a period of 7 days, detailing hours of activity in the areas of:

- Work, school, volunteer, groups, exercise, leisure, and other

Following the 7 day period, semi-structured interviews were conducted by the research assistant to explore qualitative information relating to importance, enjoyment, motivation, support/barriers, and modifications.

Results

Category Inpatient (n=21) Outpatient (n=10) Age Average: 39

Range: 25 -70 Average: 39

Range: 30-55 Gender Male: 16

Female: 5 Male: 7

Female: 3 Diagnosis Psychotic Disorder: 20

Mood Disorder: 1 Personality Disorder: 4

Substance Use Disorder: 13

Psychotic Disorder: 8 Mood Disorder: 1

Personality Disorder: 3 Substance Use

Disorder: 3 Medical Conditions Average: 2.6 Average: 3.6

9

Demographics

10

Work

School

Volunteer

Group

Exercise

Leisure

Hou

rs

Results

0

20

40

60

80

100

120

140

Total Hours Engaged per Occupation

Inpatient Outpatient

11

Occupation Inpatient Outpatient Work 2.73 5.95 School 2.28 1.74 Volunteer 1.16 3.88 Group 1.91 3.25 Exercise 8.94 6.94 Leisure 32.8 23.2

Average Hours/Week Engaged in Occupation

Results

Results

12

Hou

rs

0

20

40

60

80

100

120

140

160

180

IP 1 2 3 4 5 6 7 9 10 15 16 17 19 21 23 24 26 27 28 32A

VER

AG

E IP O

P 8 11 12 13 14 18 22 25 33 35A

VER

AG

E O

P

Total Hours Engaged in Occupations as Rated Based on Importance

Hours Very Important

Hours Somewhat Important

Hours Not Important

Inpatient Outpatient

13

Themes identified: • Freedom/fewer restrictions • Boredom • Wellbeing –psychological and physical • Purpose • Learning • Socialization

Motivation

Freedom/Fewer Restrictions – Inpatients

• More privileges/freedom – “work more to get out of hospital”

• Access to the community – Outpatients

• Do not appear to be motivated by more freedom as they are already living in the community

14

Themes

Boredom – Inpatients

• Engaged in leisure activities when bored “to kill time”, “to pass the time”, “gives me something to do”; rather than groups or work

– Outpatients • Participate in volunteer and work as it gives

them “something to do”

IP more leisure; OP more volunteer and work

15

Themes

Well-being (physical and psychological) – Inpatient

• Groups provide psychological well-being, coping skills, and helps them “talk about things”

• View leisure as part of psychological well-being – Outpatient

• Focus on physical well being: “exercise to stay healthy”

IP and OP participate in exercise to lose weight and improve physical well-being 16

Themes

Sense of Purpose – Inpatient

• Groups and school - learn new skills • Volunteer to help find a job; provides job

experience • Intrinsic

– Outpatient • View work as financial gain; receiving a

paycheck • Extrinsic

17

Themes

Socialization – Inpatient

• Groups provide social interaction • Groups and leisure provide opportunity to see

people, and assist with integrating into the community

– Outpatient • Work provides opportunity to socialize; ways to

meet new people • Exercise provides opportunity to see friends

18

Themes

Discussion

1) Inpatients and Outpatients engage in relatively similar occupations

2) Inpatients engaged in more leisure occupations vs. outpatients are engaged in more work, volunteer and groups

3) Most notable difference: motivation to engage in occupation differs between inpatient and outpatients 19

Limitations

1) Low sample size and short data collection period

2) Recruitment bias

3) Self report 20

Future Directions

Longitudinal study – Explore time use across forensic clients’

progress from inpatient to outpatient Explore interventions for supporting occupational engagement

– Differences in motivation may impact our clinical approach

– Can these findings be generalizable to other non forensic units

21

Special Thank You

Alexandra Hernandez Sarah Murli Sharminy Nagulendran Priya Shanmugathas Esther Lee

22

References 1Townsend, E. & Polatajko, H. (Eds.).(2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, ON: CAOT Publication ACE.

2Craik, C., and Stewart, P. (2007). Occupation, Mental Illness and Medium Security: Exploring Time-Use in Forensic Regional Secure Units. British Journal of Occupational Therapy, 70(10), 416-425. 3Lin, N, Kirsh, B., Polatajko, H. & Seto, M. (2009). The nature and meaning of occupational engagement for forensic clients living in the community. Journal of Occupational Science, 16(2), 110-119 4O’Connell, M., Farnworth, L. & Hanson E. (2010). Time use in forensic psychiatry: A naturalistic inquiry into two forensic patients in Australia. International Journal of Forensic Mental Health, 9, 101-109. 5Tjornstrand, C. (2012). Engagement in Community-based Day Centre’s for People with Psychiatric Disabilities. Faculty of Medicine and Department of Health Science/Occupational Therapy and Occupational Science, Faculty of Medicine Doctoral Dissertation Series. 6Vaismoradi, M., Turunen, H. & Bondas, T. (2013). Content analysis and thematic analysis: Implications for conducting a qualitative descriptive study. Nursing & Health Sciences, 15, 398-405.

23

Questions?

24

Results

25

0

10

20

30

40

50

60

70

80

90

100

IP 1

IP 2

IP 3

IP 4

IP 5

IP 6

IP 7

IP 9

IP 1

0IP

15

IP 1

6IP

17

IP 1

9IP

21

IP 2

3IP

24

IP 2

6IP

27

IP 2

8IP

32

AVE

RA

GE

IP

OP

8O

P 11

OP

12O

P 13

OP

14O

P 18

OP

22O

P 25

OP

33O

P 35

Ave

rage

OP

Num

ber o

f Hou

rs

Number of Hours Engaged in Work, Volunteer, Group and Leisure

Leisure

Group

Volunteer

Work

.

26

Ontario Review Board –NCR finding

Hospital or community setting

Socio- Economic factors

Transition into the community

Plans to increase occupations when in the community

Background

27

n=7

n=14

n=6

n=15

n=9

n=12 Participated

No participation

n=4

n=6

n=4

n=6

n=3

n=7

Inpa

tient

O

utpa

tient

Work School Volunteer Participation in Occupation

Results

28

n=14

n=7

n=16

n=5

n=20

n=1

Participated

Noparticipation

n=5 n=5

n=9

n=1

n=9

n=1

Inpa

tient

O

utpa

tient

Group Exercise Leisure Participation in Occupation

Results