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Using the occupational performance history interview (OPHI): therapists' reflections
- Author:
- FOSSEY Ellie
- Journal article citation:
- British Journal of Occupational Therapy, 59(5), May 1996, pp.223-228.
- Publisher:
- Sage
Clinical interviews provide occupational therapists with sensitive and versatile sources of information; however, reliable means to collect and interpret this information are necessary for effective clinical decision making. The Occupational Performance History Interview (OPHI) is a semi-structured interview, designed to address the need for a reliable and clinically useful tool in occupational therapy. This article describes a qualitative research study, in which four experienced therapists reflected on their use of the OPHI to interview people referred to a psychiatric day hospital service.
Occupational performance of people diagnosed with schizophrenia in supported housing and outreach programmes in Australia
- Authors:
- FOSSEY Ellie, et al
- Journal article citation:
- British Journal of Occupational Therapy, 69(9), October 2006, pp.409-419.
- Publisher:
- Sage
This study compared the occupational performance in activities of daily living (ADL) of people diagnosed with schizophrenia in two settings: 25 people in residential rehabilitation facilities and 18 people receiving intensive outreach support in their homes in urban Australia. All participants were assessed with structured interviews, the Assessment of Motor and Process Skills (a performance-based measure of ADL ability) and the Life Skills Profile (an informant-report measure of disability). Hypothesised differences in ADL performance between the two settings were not supported. Mean ADL process ability, based on the AMPS process skills subscale, indicated that the majority (58%) of the 43 participants needed some assistance in community living, irrespective of where they lived and the types of support received. Many participants (42%) performed ADL tasks with relative ease, efficiency, safety and independence as measured by AMPS, indicating that they could live in housing arrangements with outreach support. However, the ADL process ability measures for two-thirds of these participants indicated that they would struggle in community living in the absence of outreach support. Given these findings, the eligibility criteria and screening for residential and outreach support services need re-examination and performance-based assessments of ADL ability could improve the identification of housing-related support needs. Occupational therapists have expertise in this area to develop individualised supports that enable a greater choice of living arrangements for people diagnosed with schizophrenia.
The home environments and occupational engagement of people with intellectual disabilities in supported living
- Authors:
- ASHLEY Danielle, FOSSEY Ellie, BIGBY Christine
- Journal article citation:
- British Journal of Occupational Therapy, 82(11), 2019, pp.698-709.
- Publisher:
- Sage
Introduction: Social inclusion for people with intellectual disabilities includes engagement in the occupations of daily life. Given the focus on people with intellectual disabilities living independently with support, identifying the qualities of their home environments is integral to understanding the possibilities for engagement in occupations of daily life and better quality of life outcomes. In turn, this can inform the types of person-centred supports, such as active support, necessary to enable increased engagement for people with intellectual disabilities. Method: A case study methodology and mixed methods were utilised to develop an in-depth understanding of the home environments of six people with intellectual disabilities in supported living, and their experience of how these environments impacted their occupational engagement both at home and in their community. Semi-structured interviews and observation of participants’ home environments, using the Residential Environment Impact Survey – Short Form, were completed. Findings: Participants valued the opportunity to be self-reliant and live in their own homes. They had adequate means to engage in basic daily activities; however, their homes lacked expression of their occupational identity, and they had minimal occupational opportunities and demands, resulting in limited occupational engagement. Conclusion: For people with intellectual disabilities, it is important to increase opportunities for participation in valued occupations that foster social identities, and to provide adequate environmental supports and demands, to enable sustained occupational engagement and social inclusion. (Publisher abstract)
A home but how to connect with others? A qualitative meta‐synthesis of experiences of people with mental illness living in supported housing
- Authors:
- WATSON Jasmin, FOSSEY Ellie, HARVEY Carol
- Journal article citation:
- Health and Social Care in the Community, 27(3), 2019, pp.546-564.
- Publisher:
- Wiley
Supported housing principles emphasise the importance of decent, stable and affordable housing, and the provision of individualised support to enable people experiencing mental illness to live in their preferred communities, and to recover. This study sought to synthesise qualitative research addressing the question: how does living in supported housing facilitate social connections and participation from the viewpoints of people living with mental illness? Three databases (CINAHL, PsycINFO, Medline) were systematically searched to identify 19 peer‐reviewed reports on 17 studies published during 2001–2016, in which the views and experiences of supported housing residents with mental illness were reported. Most studies were informed by grounded theory and used interview methods. Appraisal indicated the reports were of varying quality, but all met the inclusion criterion of reporting qualitative data relevant to the research question. Constant comparative methods were used to synthesise the reported data, and to identify themes across the studies. There were four overarching themes regarding the lived experience of supported housing for people with mental illness: (a) living in supported housing gave individuals privacy, a sense of control, stability and security; (b) stable housing supported residents’ confidence to rebuild an identity and meaning in life, (c) there is a delicate balance between appreciating privacy and dealing with loneliness, and (d) opportunities and support to reconnect with families, friends and community are valued. The meta‐synthesis findings highlight that supported housing residents face challenges of protecting their privacy and being lonely when on their own. Individualised support approaches need to attend to personal preferences for social participation and their varied meanings and significance. Further research is required to better understand how individualised forms of support can enable supported housing residents to connect with family, friends and community in their preferred ways. (Edited publisher abstract)
Sustaining employment in a social firm: use of the Work Environment Impact Scale v2.0 to explore views of employees with psychiatric disabilities
- Authors:
- WILLIAMS Anne, FOSSEY Ellie, HARVEY Carol
- Journal article citation:
- British Journal of Occupational Therapy, 73(11), November 2010, pp.531-539.
- Publisher:
- Sage
Evidence suggests that people with psychiatric disabilities find it difficult to get and keep jobs, with workplace characteristics contributing to difficulties staying in employment. This qualitative study aimed to understand the views of employees with a psychiatric disability about working in an Australian social firm, and to identify factors within the workplace that contribute to these employees sustaining employment. Social firms are competitive businesses which are designed to provide an inclusive and supportive work environment. Seven participants who had sustained jobs for 6 months or longer in the social firm, a contract cleaning business, were interviewed using the Work Environment Impact Scale (Version 2.0). The interviews were audiotaped, transcribed and analysed inductively using thematic and narrative analysis. The participants' views of the work environment included that the regular structure and achievable tasks, the supportive and cooperative team and the benefits of the job made working in the social firm enjoyable and the right job for now. The findings suggest that participants' decisions to stay in their jobs were influenced by the social firm environment, which supported their wellbeing, and by their individual illness and occupational narratives. The study also demonstrated that the WEISv2.0 was effective in gaining participants' views on wide-ranging features of their workplaces. Further research is recommended to expand the evidence base concerning workplace features that support employees with psychiatric disabilities to sustain their jobs.
A grounded theory of intuition among occupational therapists in mental health practice
- Authors:
- CHAFFEY Lisa, UNSWORTH Carolyn, FOSSEY Ellie
- Journal article citation:
- British Journal of Occupational Therapy, 73(7), July 2010, pp.300-308.
- Publisher:
- Sage
This study explored nine occupational therapists’ (OTs) understanding and use of intuition, whilst interacting and connecting with mental health patients during the clinical reasoning process which guides their decision making on practice. Using a grounded theory approach and the evolving theories on clinical reasoning and CCT (the Cognitive Continuum Theory), the authors conducted qualitative, semi-structured interviews with participants recruited from mental health presentations at an Australian OTs conference. They were asked to describe an example of intuition in their everyday life and professional practice and discuss it further in response to the researcher’s probes and definitions. Participant demographic data and methods of data analysis are illustrated in Table 1 and Figure 1, respectively. From the data, intuition was defined as knowledge without conscious awareness of reasoning and was found to be embedded in clinical reasoning. Participants described it as “elusive and underground”, and suggested, in their own words in the text, that with greater professional experience, came more comfort in its use. Using intuition relied on therapists’ understanding of their own and others’ emotions and intuition partnered analysis within their clinical reasoning, say these authors. This paper concludes with a presentation of a grounded theory for the use of intuition in mental health settings (Figure 2), and proposes that intuition be considered with analysis as an important tool within a clinical reasoning framework.
Being in a secure forensic psychiatric unit: every day is the same, killing time or making the most of it
- Authors:
- FARNSWORTH Louise, NIKITIN Lara, FOSSEY Ellie
- Journal article citation:
- British Journal of Occupational Therapy, 67(10), October 2004, pp.430-438.
- Publisher:
- Sage
Describes time use of a group of in-patients, most diagnosed with schizophrenia, in a secure forensic psychiatric unit in Australia. Time diaries, interviews and field notes were collected over 5 weeks. Eight participants completed time diaries for 2 consecutive days; 5 were also interviewed using the Occupational Performance History Interview II. Time use was dominated by personal care and leisure. In general, participants were dissatisfied, describing themselves as 'bored' or 'killing time'. Many perceived the environment created barriers to participation in valued occupations, yet some found occupations providing solace, challenge or connection with the outside world. Findings indicate the importance of understanding individuals' unique occupational histories, interests and skills to create opportunities to engage them in relevant occupations using personal resources, as part of forensic rehabilitation programmes, and the utility of the Occupational Performance Interview II in this context. Recommends further research exploring patient and staff perspectives on the challenges of occupational programming in forensic settings and its longitudinal impact on in-patients' occupational functioning, health and wellbeing.
Time use of people living with schizophrenia in a North London catchment area
- Authors:
- SHIMITRAS Leah, FOSSEY Ellie, HARVEY Carol
- Journal article citation:
- British Journal of Occupational Therapy, 66(2), February 2003, pp.46-54.
- Publisher:
- Sage
Reports on a study examining the time use of 229 adults diagnosed with schizophrenia from an epidemiological survey in London, England. Twenty-four hour time budgets were collected and time use was calculated for 10 major categories of occupations. Results found that few of the participants were engaged in work, active leisure, education or volunteer occupations, their predominant occupations being sleeping, personal care and passive leisure. Findings indicated that many people diagnosed with schizophrenia are not engaged in occupations that support active lifestyles or social inclusion. Highlights the need for occupational therapists to work with service users and agencies beyond the mental health system to enable service users' participation in such occupations.