University of Huddersfield Repository Brooks, Robert Occupational practice in children and young people©s mental health Original Citation Brooks, Robert (2016) Occupational practice in children and young people©s mental health. Doctoral thesis, University of Huddersfield. This version is available at http://eprints.hud.ac.uk/30195/ The University Repository is a digital collection of the research output of the University, available on Open Access. Copyright and Moral Rights for the items on this site are retained by the individual author and/or other copyright owners. Users may access full items free of charge; copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational or not-for-profit purposes without prior permission or charge, provided: • The authors, title and full bibliographic details is credited in any copy; • A hyperlink and/or URL is included for the original metadata page; and • The content is not changed in any way. For more information, including our policy and submission procedure, please contact the Repository Team at: [email protected]. http://eprints.hud.ac.uk/ OCCUPATIONAL PRACTICE IN CHILDREN AND YOUNG PEOPLE’S MENTAL HEALTH ROBERT BROOKS A thesis submitted to the University of Huddersfield in partial fulfilment of the requirements for the degree of Doctor of Philosophy The University of Huddersfield August 2016 Copyright statement i. The author of this thesis (including any appendices and/or schedules to this thesis) owns any copyright in it (the “Copyright”) and s/he has given The University of Huddersfield the right to use such copyright for any administrative, promotional, educational and/or teaching purposes. ii. Copies of this thesis, either in full or in extracts, may be made only in accordance with the regulations of the University Library. Details of these regulations may be obtained from the Librarian. This page must form part of any such copies made. iii. The ownership of any patents, designs, trademarks and any and all other intellectual property rights except for the Copyright (the “Intellectual Property Rights”) and any reproductions of copyright works, for example graphs and tables (“Reproductions”), which may be described in this thesis, may not be owned by the author and may be owned by third parties. Such Intellectual Property Rights and Reproductions cannot and must not be made available for use without the prior written permission of the owner(s) of the relevant Intellectual Property Rights and/or Reproductions. 2 Acknowledgements I would like to thank my partner, Richard, for his support throughout this PhD; his patience and motivation kept me going. I am indebted to my supervision team, Professor Surya Monro, Dr Sue Peckover and Dr Janice Jones. Your guidance, support, critique and challenge have helped to shape and direct my work in new and exciting ways. My supervision journey was enhanced by support from Professor Annie Topping, Professor Ruth Deery and Professor Jim McAuley, thank you all for your contributions. A special thanks goes to my research participants. The occupational therapists Amanda and Julie (pseudonyms) welcomed me into their departments and enthusiastically allowed me to watch their practice. Without the children and young people this study would not have taken place, I was amazed at their willingness to let me be part of their occupational therapy, thank you. Finally, my thanks go to my work colleagues, Angela, Miranda, Mandy and Penny, who have listened to my frustrations, helped me reflect and provided encouragement. 3 Conference Presentations College of Occupational Therapists Specialist Section for Children Young People and Families Conference. Bradford University, November 2010. Occupation-based Practice in Child and Adolescent Mental Health: What is the Evidence? College of Occupational Therapists Specialist Section for Children, Young People and Families London Network, April 2013. A National Survey of Occupational Therapy Practice in Child and Adolescent Mental Health Services. World Federation of Occupational Therapists Congress. Japan, June 2014. Occupational Therapy in Child and Adolescent Mental Health. College of Occupational Therapists Specialist Section for Children, Young People and Families London and South East Child and Adolescent Mental Health Services Network, London, September 2015. Doing Occupation-Focused Practice in Child Mental Health. 4 Abstract Introduction The use of occupation in occupational therapy has been regularly debated in the profession’s literature. More recently there has been a shift to consider occupation as the core construct of occupational therapy, which informs assessments, interventions and outcomes; this can be described as occupational practice. Studies exploring occupational practice have been limited; this study has sought to address this gap. Methods This was a mixed methods study. First, a United Kingdom survey of occupational therapy practice in children and young people’s mental health was conducted (n=27). The survey findings were analysed using descriptive statistics. The survey was used as a sampling platform for the second stage of the study. Underpinned by an ethnographic approach, the second study used an observer of participant, interview and document collection methods to explore occupational practice (n=2). A grounded theory approach was taken to data analysis. Findings The participants of the survey were 89% female, 49% were at a senior grade and 68% had been qualified for over 10 years. 81% worked in Child and Adolescent Mental Health Services tier 3 or 4. 52% participants had an undergraduate degree in occupational therapy; 64% had no further specialist formal qualifications. Additional training in sensory integration therapy was reported by 34% of participants. The Model of Human Occupation was identified as the most frequently used model of practice. The Sensory Profile was the most regularly used assessment. The participants reported that their interventions commonly focused on talking- style therapies, psycho-education and group work. The ethnographic study revealed a tension at the study sites between the medical- psychological and occupational practice discourses. To manage this tension, the participants used a generic and profession-specific practice to negotiate being ‘one of the team’ and being a ‘real occupational therapist’. Enacting occupational practice included using the Model of Human Occupation, referrals for occupational problems, conducting assessments of occupation, concluding occupational formulations, and using occupation as an intervention. Interventions were characterised as ‘talking about doing’ or ‘doing occupation’ and utilised strategies such as modelling, goal setting and setting a challenge. Conclusion The survey has offered a snapshot of occupational therapy practice. This may help the profession understand the demography and practices of the participants. The Occupational Practice Model for Children and Young People’s Mental Health, which has emerged from the ethnographic findings of this study, is presented as a tool to guide the use of occupation at the level of theory, perspective and intervention. Further qualitative studies are recommended to support the study findings and a systematic review is suggested to examine occupational therapy interventions in the field. 5 Table of Contents Acknowledgements ................................................................................................ 3 Conference Presentations ....................................................................................... 4 Abstract .................................................................................................................. 5 Table of Contents ................................................................................................... 6 List of Tables ........................................................................................................ 13 List of Figures ....................................................................................................... 14 List of abbreviations ............................................................................................. 15 Glossary of Terms ................................................................................................. 16 Chapter One: Background and Context ................................................................. 18 Introduction ...................................................................................................... 18 Context Introduction ......................................................................................... 18 Locating Myself in the Study .............................................................................. 19 Locating Myself in Occupational Therapy ........................................................... 21 Locating Myself in the Understanding of Children and Young People ................. 24 What This Thesis Contains ................................................................................. 25 Delimiting the Study .......................................................................................... 27 Study Question, Aims and Objectives ................................................................ 28 Question ........................................................................................................... 28 Aims ...............................................................................................................