Question 1

Which of the following diagnoses align with the definition of a serious mental illness?&#10;A) Dementia&#10;B) Alzheimer's disease&#10;C) Bipolar disorder&#10;D) Substance use disorders

Accepted Answer

Community-based occupational therapy practitioners work with persons with mental health disorders across the life span (American Occupational Therapy Association [AOTA], 2016a). This chapter focuses on services and programs for adults with serious mental illness (SMI). An SMI is "a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities" (National Institute of Mental Health [NIMH], 2017, para. 4). Conditions meeting these criteria include psychotic, schizophrenia, schizoaffective, bipolar, major depressive, and borderline personality disorders. Developmental and substance use disorders, dementias, and mental disorders due to medical conditions are not included in this definition (Substance Abuse and Mental Health Services Administration. [SAMHSA], 2010a).

Question 2

Despite the efforts in the 1960s to deinstitutionalize those with serious mental illness, many ended up living in less than ideal situations. In order to remedy this societal issue, the National Institute of Mental Health attempted to establish which resource?

A) Certified Community Behavioral Health Centers
B) Community Support Programs
C) Supplemental Security Income
D) Community mental health

Community Support Programs

Accepted Answer

The creation of the Medicare and Medicaid programs in 1965 and the Supplemental Security Income benefit in 1972 accelerated the deinstitutionalization movement (Turner & TenHoo, 1978). Having federal funding to support community living was a major fiscal incentive for states to transfer thousands of people with SMI from state-financed institutions into the community. Because funding for the integrated medical, rehabilitative, and supportive services required for successful community integration never materialized, deinstitutionalized persons often became homeless or lived in deplorable conditions that were "as stultifying and disabling as mental institutions" (Turner & TenHoo, 1978, p. 322).
In 1977, the NIMH attempted to rectify this systemic neglect by creating Community Support Programs (CSPs) to serve people with SMI. CSPs included crisis stabilization, psychosocial rehabilitation, case management, employment, and housing services; medical and mental health care; and support to families, friends, and the community (Turner & TenHoo, 1978). Many CSPs were successfully established, but due to inadequate funding, their potential was never realized. In 2003, the President's New Freedom Commission on Mental Health addressed this failure and made numerous recommendations to transform the mental health-care system and enable the recovery and full community participation of persons with SMI (Cottrell, 2007). The subsequent Federal Mental Health Action Agenda articulated concrete steps for building a recovery-oriented, evidence-based, and consumer- and family-driven system. Funded actions have been successful. However, services for people with SMI still vary greatly between states. Some have model programs; most provide inadequate care (NAMI, 2015).

Question 3

Occupational therapy may see a resurgence in roles in mental health practice due to OT being included in the funding for which federally supported mental health intervention?&#10;A) Certified Community Behavioral Health Centers&#10;B) Community Support Programs&#10;C) Supplemental Security Income&#10;D) Community mental health

Accepted Answer

The viability of mental health occupational therapy is evident in the AOTA's effective articulation of the profession's distinct value and its successful advocacy for occupational therapists to be recognized as qualified mental health professionals (AOTA, 2016a, 2016b, 2017). Most recently, occupational therapy was included in federally funded Certified Community Behavioral Health Center (CCBHC) staff recommendations. CCBHCs "are coordinated, fully integrated comprehensive community-based providers serving people with behavioral health challenges across the lifespan, while focusing on the needs of those with serious mental illness and chronic substance use disorders facing life transitions" (Swarbrick, 2016, p. 11). These developments and the paradigm shift to recovery-oriented models afford multiple opportunities for occupational therapy practitioners to revitalize their role as primary mental health providers.

Question 4

The psychiatric rehabilitation model uses principles from which other models?:&#10;A) Psychosocial rehabilitation and transition planning&#10;B) Community support programs and psychosocial rehabilitation&#10;C) Physical rehabilitation and community integration&#10;D) Community mental health and wellness programming

Accepted Answer

The psychiatric rehabilitation model was developed in the 1970s to help people with SMI acquire the skills and resources that are needed to live self-determined and satisfying lives in their environments of choice (Liberman, 1988). Often called psychosocial rehabilitation, this model integrates concepts and principles from the physical rehabilitation and community integration movements. The collaborative, individualized, person-directed, and evidence-based approaches used in psychiatric rehabilitation are designed to promote recovery, enable community integration, and improve quality of life (Krupa, Fossey, Anthony, Brown, & Pitts, 2009). This model has much in common with the occupational therapy principles that contributed to its development. Similarities include the belief that health is attained and human potential is optimized when people engage in meaningful occupation; a conviction that change is achieved through personal choice and empowerment; and a commitment to providing interventions that enable doing in people's chosen environments (Krupa et al., 2009).

Question 5

In recovery and wellness models, which of the following key components are actualized in occupational therapy?&#10;A) A strengths-based approach&#10;B) Healing&#10;C) Community integration&#10;D) Counseling

Accepted Answer

The occupational profile and occupation-based assessments provide information about a person's roles, abilities, aspirations, and resources to support the construction of a strengths-based intervention plan.

Question 6

Kristy has a diagnosis of bipolar disorder that is well controlled despite historical childhood trauma. She holds a job and is a busy mother. During a stressful recent visit from her parents, she exhibits mania and seeks some assistance. Kristy is experiencing which component of the Stress-Vulnerability/Coping-Competence Model?

A) Stress
B) Vulnerability
C) Coping
D) Competence

Accepted Answer

The stress-vulnerability/coping-competence model was proposed in the 1980s to explain the occurrence and reoccurrence of psychiatric symptoms (Liberman, 1988). According to this model, increased stress in susceptible individuals can intensify symptoms and trigger a crisis (Liberman, 1988). Unfortunately, the singular application of the model's stress-vulnerability dimension resulted in people with SMI being advised by service providers to avoid engaging in activities that could potentially challenge their adaptive capabilities (Krupa et al., 2009). The pervasive disregard of this model's coping-competence dimension erroneously classified persons with SMI as fragile. This myopic perspective and the resulting harmful advice dissuaded many from pursuing meaningful activities and desired occupations, contributing to occupational disruption and deprivation (Krupa et al., 2009).
Multiple factors can contribute to a person's vulnerability. These include genetics and trauma; neurological, biological, and cognitive impairments; and physical, developmental, and substance use disorders (SAMHSA, 2010a). A lack of opportunities during childhood and adolescence to develop psychosocial skills and performance competencies can increase susceptibility to stress-related exacerbations in adulthood (Russo, Murrough, Han, Charney, & Nestle, 2012). Conversely, when stress-inducing situations are encountered and overcome during development, people acquire pro-resilience capabilities, perceived internal control, and a sense of mastery (Russo et al., 2012). The coping-competence dimension of this model recognizes the influence that development has on promoting adaptive responses to adult stress. Because this process does not always occur, the balanced application of the stress-vulnerability/coping-competence model emphasizes the development of coping skills and functional competencies throughout life. These capacities serve as protective factors to prevent symptom exacerbation and promote future resilience (Liberman, 1988; Ventura, Nuechterlein, Subotnik, Green, & Gitlin, 2004).

Question 7

Andrea is a 34-year-old female who works from home. Her employer has asked her to travel as part of new duties. Andrea suffers from agoraphobia but wants to be able to meet the job demands. Which mental health service would be the most appropriate for Andrea to overcome her mental health challenges?

A) Partial hospitalization
B) Programs for Assertive Community Treatment
C) Intensive outpatient program
D) Home health

Accepted Answer

The movement to treat illnesses and manage chronic conditions in the community rather than hospitals and institutions has increased demand for home-based services (Craig, 2012). Home health for people with SMI is primarily covered by Medicare. To receive Medicare-covered services, a person must be "confined" to the home and, typically, not able to leave without the assistance of others or considerable effort (Centers for Medicare and Medicaid Services [CMS], n.d.). Refusing to leave the home due to agoraphobia, paranoia, and/or anxiety and the presence of acute depression, cognitive impairments, positive symptoms, and/or thought disorders that impair judgment and safety meet these criteria (Azok & Tomlinson, 1994; Earle, 1999). Although "'homebound,'" the person can attend adult day care, religious services, medical appointments, and infrequent, short-term, non-medical appointments or events (CMS, n.d.). Persons with physical or medical conditions who have psychiatric symptoms that interfere with occupational performance may also receive mental health occupational therapy (Chapleau & Tessel, 2010). Given the prevalence of occupational performance problems among home health service recipients, practice opportunities are substantial.

Question 8

Fred is a 24-year-old homeless male with schizophrenia. He desires to gain a stable place to live and would benefit from which mental health intervention?&#10;A) Supportive transitional housing&#10;B) Programs for Assertive Community Treatment&#10;C) An intensive outpatient program&#10;D) Home health

Accepted Answer

Supportive transitional housing provides "active rehabilitation programs with a focus on the promotion of life and social skills, independence, and work" (Nelson, 2010, p. 126). Program staff provide support and skills training that decreases in intensity along a residential continuum of quarterway houses, halfway houses, and shared or clustered apartments. Residents are expected to move along the continuum as competencies are acquired (e.g., from a halfway house to a supervised apartment). Upon completion of these time-limited programs, they must find permanent housing (Nelson, 2010). When available, supportive transitional housing enables independent living and community integration. However, communities often lack the facilities needed for this residential continuum. When post-discharge resources to enable autonomous living are unavailable, the loss of a supportive residence is often disruptive (Nelson, 2010). Consequently, contemporary housing approaches focus on services that support permanent homes for people with SMI.

Question 9

George is an 18-year-old who was diagnosed with major depressive disorder when he was 15 years old. He really wants to attend college. As his school-based occupational therapist, you recommend which supportive service to him as he transitions to college?

A) Supportive transitional housing
B) Supported education
C) Intensive outpatient program
D) Permanent supported housing

Accepted Answer

Postsecondary education for adults is a socially valued developmental norm in the United States (Gutman, Kerner, Zombek, Dulek, & Ramsey, 2009). Sharing this value, adults with mental illness often initiate postsecondary education. However, they withdraw from college at almost double the rate of the general student population (Salzer, 2012). Because postsecondary education helps people acquire viable employment, become financially independent, and fully participate in society, abandoning it can negatively affect impact people's lives (Gutman et al., 2009; SAMHSA, 2011). Supported education (SEd) helps people with mental illness effectively access and engage in postsecondary education by confronting attitudinal barriers (i.e., discrimination, stigma) and providing support, resources, and services as needed to enable student success (Chandler, 2008; SAMHSA, 2011). Programs are provided in postsecondary institutions (i.e., two- and four-year colleges, universities, technical schools, and adult education programs) or by mental health agencies or programs (e.g., clubhouses) that have affiliations with education providers (Chandler, 2008; Ringeisen et al., 2017). Participants, called students, typically receive services that use a psychoeducation approach and a college semester format (Chandler, 2008).

Question 10

Which type of community-based mental health support emphasizes helping individuals with mental illness obtain competitive work in the community and provide the supports necessary to ensure their success in the workplace?

A) Transitional employment
B) Supported education
C) Sheltered workshop
D) Supported employment

Accepted Answer

Historically, segregated "sheltered" workshops were typically the only work option for many with SMI. These provided rote and repetitive work with pay at a subminimum piecework rate. In the 1950s, transitional employment (TE) programs were initiated by Fountain House to help members acquire the skills needed for competitive employment (Dulay & Steichen, 1982; McKay, Nugent, Johnsen, Eaton, & Lidz, 2018). In communities without TE, workshops often remained the only vocational program. Recently, consumer advocacy for competitive work opportunities and evidence supporting integrated employment has led to a paradigm shift away from isolating workshops and to the defunding of these programs (Luciano & Meara, 2014). Contemporary programs enable mainstream employment at prevailing wages (McKay et al., 2018). Supported employment (SE) is an evidence-based approach for people with SMI that "emphasizes helping them obtain competitive work in the community and providing the supports necessary to ensure their success in the workplace" (SAMHSA, 2009, p. 9). Both SE and TE apply principles of recovery and promote community integration through the attainment of competitive employment that matches people's capabilities. SE and TE are provided by psychosocial rehabilitation and peer-delivered programs and state mental health and vocational rehabilitation agencies (SAMHSA, 2009). SE has no time limits; TE programs are time-limited (usually, 6-9 months). The SAMHSA (2009) SE evidence-based kit is a primary resource on how to build, implement, evaluate, and sustain an SE program.

Question 11

In the occupational therapy process in mental health settings, the first step of OT evaluation is:&#10;A) Screening&#10;B) An occupational profile&#10;C) Standardized assessments&#10;D) Patient observations

Accepted Answer

The answer of In the occupational therapy process in mental...

Question 12

Julia is a community mental health occupational therapist. You interview her and seek her biggest challenge in working in community mental health. Her response aligns with what is supported in the literature. Julia's biggest challenge as a community mental health OT is:

A) Lack of patients in need of mental health services
B) Stigma of being a community mental health occupational therapist
C) Heavy workload due to a shortage of occupational therapists in community mental health
D) Working with the interprofessional team

Accepted Answer

The answer of Julia is a community mental health occupational...

Question 13

Mental health services cover occupational therapy in multiple practice areas. Which of the following excludes occupational therapy as an initial qualifying service for home health?&#10;A) Medicaid&#10;B) Medicare&#10;C) Private insurance&#10;D) Grant funding

Accepted Answer

The answer of Mental health services cover occupational therapy in...

Question 14

An important action for the profession of occupational therapy in the future of community mental health is:&#10;A) Advocacy&#10;B) Ignoring it as an occupational therapy practice area&#10;C) Infusing mental health into the medical model&#10;D) Garnering grant funding for community mental health

Accepted Answer

The answer of An important action for the profession of...

Deck 18: Community Mental Health Programs Introduction