Sense of Belonging, Meaningful Daily Life Participation, and Well-Being: Integrated Investigation.

The association between well-being, sense of belonging, connectedness to community, and meaningful participation in daily life occupations was theoretically proved and demonstrated in several health conditions or specific age groups. This study aimed to investigate an interplay between well-being, sense of belonging, and connectedness, and meaningful participation in a range of daily life occupations among healthy adults of working age in Israel. Participants (N = 121; age: M = 30.8, SD = 10.1; women: N = 94, 77.7%) completed standard instruments to evaluate the main constructs through an internet survey. A variety of communities, that the participants reported to belong to, were not different in the sense of belonging and connectedness, participation dimensions, and well-being. An association was found between sense of belonging and connectedness, the participation subjective dimension, and well-being (0.18 < rp < 0.47, p < 0.05). Sense of belonging explained in a significant way the variance in well-being (F(3) = 14.7, p < 0.001; R2 = 0.274) and was found to be a mediator between participation and well-being (1.86 < Sobel test < 2.39, p < 0.05). The study provides empirical support to the interrelationship between meaningful participation, sense of belonging and connectedness, and well-being in a healthy population. Participation in a range of meaningful activities that contribute to the sense of belonging and connectedness as a universal concept could further promote well-being.

Closing the Gap: From Research to Practice in Mental Health Interventions.

Evidence-based practice is critical but challenging in mental health. Rigorous research-proven interventions often do not yield expected results in the clinical practice. This study aimed to explore factors contributing to the effectiveness of Occupational Connections (OC)-an intervention for promotion of engagement in meaningful occupations in serious mental illness (SMI)-based on case series study of three quasi-experimental studies. The studies focused on people with SMI, admitted to intensive mental health services participated in the OC, as well as on a control condition group. Similar evaluation procedures throughout these studies addressed primary outcomes of participation dimensions and recovery orientation, as well as secondary outcomes of functional capacity, cognition, and symptom severity. Patterns of changes in outcome measures varied between the three studies as to direction and extension. In the OC groups, 29-60% of the outcome measurements were changed, in comparison to 29-43% of measurements in the control groups. The secondary outcomes were consistently improved in the OC (18-100% of measurements) in comparison to the control (18-67%). The analysis of the studies revealed that clinical effectiveness of participation-oriented intervention varied dependent on interplay between the clinical context, clinician actions, served persons' characteristics, and evidence-building process. These factors should be considered to maximize research benefits for practice.

Occupational intervention in mental health hospitals: Study of contextual impact.

BACKGROUND: Recovery-promoting and occupation-oriented interventions for people with schizophrenia who receive in-patient services are scarcely investigated, limiting our understanding of the factors affecting intervention effectiveness and hindering occupational inclusion. AIMS: To investigate the impact of contextual factors on the effectiveness of 'Occupational Connections' (OC) - occupational intervention for in-patient psychiatric settings. MATERIALS AND METHODS: Quasi-experimental, single-blind study compared between inpatients with schizophrenia participating in OC (N = 14) and those receiving treatment as usual only (N = 16) on primary outcomes of participation dimensions and recovery-orientation of the service, and on secondary outcomes of cognition, symptom severity, and functional capacity. RESULTS: Participation in OC in a new context appears to contribute to improvement in cognitive fluency and flexibility, schizophrenia symptoms, and functional capacity (-2.8 0.05) or reduction (-2.25

Study of recovery model implementation in psychiatric hospitals: Clients and multidisciplinary staff perspective.

The recovery model guides mental health services. However, the delivery of recovery-oriented services in inpatient settings is still a challenge. Factors affecting recovery model implementation can be classified into three types: the hospital environment, the inpatient and the service provider. This study aims to quantitatively evaluate the impact of environment, inpatient and service provider factors on recovery model implementation in hospitals. Forty-five service providers and 42 inpatients from three types of wards (acute locked, acute open and daycare) of two hospitals participated in this cross-sectional study. We assessed inpatient cognition, functional capacity and illness severity. In addition, we retrieved information on service providers' professional status and evaluated the recovery model knowledge and attitudes. Implementation of the recovery model was measured using the Recovery Self-Assessment, both the inpatient and service provider versions. Differences were found between the three types of wards in recovery orientation as reported by service providers ( χ 2 2  = 15.3, P < 0.001), but not by inpatients ( χ 2 2  = 2.34, P > 0.05). Providers' internalized knowledge and attitudes toward recovery, inpatients' functional capacity and age of illness onset were associated with recovery implementation (0.31 < r < 0.48, P < 0.05). The findings confirm quantitatively the multilevel nature of factors that affect the implementation of the recovery model in psychiatric hospitals. The inpatients' perspective should be incorporated into the service development process. Based on the study results, the reduction in the restrictive features of the wards' environment is recommended. Promotion of the recovery model implementation in the hospital setting requires the expansion of staff's internal positive attitudes toward recovery.

A multimodal approach for the ecological investigation of sustained attention: A pilot study.

Natural fluctuations in sustained attention can lead to attentional failures in everyday tasks and even dangerous incidences. These fluctuations depend on personal factors, as well as task characteristics. So far, our understanding of sustained attention is partly due to the common usage of laboratory setups and tasks, and the complex interplay between behavior and brain activity. The focus of the current study was thus to test the feasibility of applying a single-channel wireless EEG to monitor patterns of sustained attention during a set of ecological tasks. An EEG marker of attention (BEI-Brain Engagement Index) was continuously recorded from 42 healthy volunteers during auditory and visual tasks from the Test of Everyday Attention (TEA) and Trail Making Test (TMT). We found a descending pattern of both performance and BEI in the auditory tasks as task complexity increases, while the increase in performance and decrease in BEI on the visual task. In addition, patterns of BEI in the complex tasks were used to detect outliers and the optimal range of attention through exploratory models. The current study supports the feasibility of combined electrophysiological and neurocognitive investigation of sustained attention in ecological tasks yielding unique insights on patterns of sustained attention as a function of task modality and task complexity.

Transition to Labor Market among Young Adults with Serious Mental Illness.

Background: The research on job attainment and retention among young adults with serious mental illness (SMI) is limited. The objective of this study was to investigate the contributions of emotional, cognitive, motor, demographic, and work-related factors to the transition into supported employment (SE) and retention. Methods: This cross-sectional study included young adults with SMI involved in prevocational (N = 21) services or those who have transferred to SE (N = 21) following prevocational services. Work-related self-efficacy, executive functions, and motor skills were approached with standard and well-established tools. Results: There was a significant difference between groups in most dimensions of work-related self-efficacy, job history and experience, cognitive strategies, and general independence in daily life. The multivariate analysis demonstrates that holding a profession, experiencing self-efficacy in general work skills, cognitive strategies, and independence in living situations explained the between-group differences (χ2(4) = 34.62, p < 0.001; correct classification−90.2%). Conclusions: The study identifies the factors contributing to a sustainable transition to employment among young adults with SMI, suggesting the importance of a comprehensive approach to address a range of personal factors in an integrative way. The augmentation of prevocational training with continued employment support may be beneficial to meet the unique needs of young adults with SMI.

COVID-19 Isolation in Healthy Population in Israel: Challenges in Daily Life, Mental Health, Resilience, and Quality of Life.

BACKGROUND: Pandemics produce long-lasting secondary impacts on health, with a significant burden on people and society. Until now, the secondary impact of COVID-19 has been little estimated. Our aim was to investigate factors underlying quality of life (QOL) during COVID-19 lockdown among a healthy population, while QOL reduction expands vulnerability to the pandemic secondary impact. METHODS: During the spring lockdown in Israel, 571 healthy adults completed a survey that included standard measurements for psychological distress, participation in daily life activities, a sense of social connectedness, resilience, and QOL. RESULTS: We found a high level of psychological distress, significant reduction in participation dimensions, and in QOL (psychical, psychological, and social). These indices were even lower among women, younger adults, and the unemployed. Path analysis demonstrated that psychological distress, participation dimensions, social connectedness, and self-efficacy explained QOL, while participation dimensions were found to be the mediators. CONCLUSIONS: The COVID-19 has had a wide impact on the general population, with the potential for negative secondary impacts. Women, young adults, and the unemployed are at high risk for secondary effects. Public health strategies should address the reported factors and populations in order to improve QOL in a healthy population and limit the impact of the pandemic.

Occupation-focused intervention for in-patient mental health settings: Pilot study of effectiveness.

PURPOSE: Participation in meaningful occupation is associated with recovery in serious mental illnesses, however, few evidence-based, occupation-focused interventions for hospital settings exist. This study investigated the effectiveness of "Occupational Connections" (OC), a manualized, short-term, group intervention, addressing issues in daily-life occupations' participation and functioning of people with serious mental illness as early as during hospitalization. METHODS: Thirty-three inpatients with schizophrenia completed single-blind, pre-post study procedures (up to 10 weeks) in two groups: OC group intervention and open leisure activity group (control condition), in addition to treatment as usual. They were assessed for occupation and participation dimensions, perceptions of services as recovery-oriented, comprehensive cognitive functioning and schizophrenia symptoms. The sampling was convenience with sequential group allocation. RESULTS: Improvements were found in the study group in the following measurements: intention to participate in daily activities (t(15) = -2.62, p < .05), participation diversity (t(15) = -2.11, p < .05), experience the recovery orientation of the service (t(15) = -3.15, p < .01), functional capacity (t(15) = -3.44, p < .01), cognitive abilities of language understanding, memory and shifting (-4.5

Comparing executive functioning and clinical and sociodemographic characteristics of people with schizophrenia who hold a driver's license to those who do not.

BACKGROUND.: Community engagement requires driving. However, there is paucity of research focusing on the potential to drive for people with schizophrenia. PURPOSE.: This study aimed to characterize people with schizophrenia by comparing clinical signs, executive functions (EF), and sociodemographic aspects of those holding a driver's license to those without one. METHOD.: This cross-sectional study used convenience sampling to select 60 ambulatory individuals to participate: 31 with a driver's license and 29 without one. They completed the Wisconsin Card Sorting Test (WCST) for evaluation of EF and the Positive and Negative Syndrome Scale (PANSS) for symptoms severity evaluation. Data were analyzed using multivariate analyses of covariance and logistic regression models. FINDINGS.: Participants with a license had less severe negative symptoms and general psychopathology and better EF and sociodemographic aspects compared to those without a license. Logistic regression revealed significant odds ratios (OR) in general psychopathology (PANSS; OR = 0.963, p = .011) and in the WCST (OR = 0.504, p = .027). IMPLICATIONS.: This study offers occupational therapists a data-driven perspective on evaluating potential fitness to drive to enable participation in daily life and well-being of people with schizophrenia.

Motor skills, cognition, and work performance of people with severe mental illness.

PURPOSE: Employment offers many benefits to people with mental illness, yet their employment rate is much lower than that of the general population. We investigated the effect of work-related motor skills, neurocognition, and job attitudes on the work performance of people with mental illness, comparing those working in sheltered workshops, with controls working in similar jobs. METHODS: Twenty-nine adults with severe mental illness and 27 controls matched by gender and age were enrolled into the study using convenience sampling. They were assessed for gross and fine motor hand functioning, job attitudes, work performance, and cognition. RESULTS: People with mental illness scored lower on work performance, cognitive functioning, and hand dexterity while sitting and working with tools. They were assigned lower job loads than were controls, and perceived the physical environment at work as more constraining than did controls. Assembling motor skills significantly explained the work performance of people with mental illness. CONCLUSIONS: The results expand our understanding of the complexities involved in the employment of people with severe mental illness, and point to new paths for improving vocational outcomes of people with severe mental illness, taking into account their motor skills and job attitudes. Implications for rehabilitation Therapists should be aware that employed people with severe mental illness may have various unmet needs, affecting their work performance and experience of stress. This study results demonstrate importance of motor skills and perception of the work environment for the promotion of vocational outcomes among individuals with severe mental illness. Employment of people with severe mental illness should be viewed from holistic perspective as with general population, rather than focused on traditionally illness-related factors.

Executive functioning and daily living of individuals with chronic stroke: measurement and implications.

Deficits in executive functioning (EF) are often still present at the chronic stage after stroke, which may negatively impact independent living. The objectives of this study were (a) to characterize the EF and independence in daily living of community-dwelling individuals with chronic stroke by using pen-and-paper and performance-based EF assessments, (b) to explore correlations between scores detected by different EF assessments and (c) to assess the correlations between EF and independence in basic activities of daily living (BADL) and instrumental activities of daily living (IADL). This cross-sectional study included 50 (30 men and 20 women) community-dwelling individuals [mean (SD) age 59.8 (9.3)] with chronic stroke. Participants were overall independent in basic activities of daily living, without significant cognitive impairment. Participants underwent EF assessment using two pen-and-paper tools: Trail Making Test, Zoo Map subtest from the Behavioral Assessment of Dysexecutive Syndrome and two performance-based tools; EF Route-Finding Task and bill-paying subtest from the Executive Functions Performance Test. BADL, IADL, depressive symptoms, gait speed and upper extremity motor impairment were also assessed. Participants demonstrated mild to moderate EF deficits with moderate significant correlations between the scores of various EF assessments. Participants varied in their independence in IADL, and EF was significantly correlated to independence in BADL and IADL (-0.31

Problem-based learning in occupational therapy curriculum - implications and challenges.

PURPOSE: Problem-based learning (PBL) is an educational method that fosters self-directed study in small groups. The purpose of this study was to describe the Tel Aviv University's occupational therapy (OT) program and the challenges implementing such program. In addition, the study compared the PBL grades obtained by students who are native Hebrew speakers with those students who are native Arabic speakers; and, assessed the correlation between the grades in the PBL course and the grades in the clinical fieldwork studies. METHOD: 166-second year OT undergraduate students participated. All completed three PBL courses and seven weeks of clinical fieldwork studies. Data collection included students' grades in PBL course (based on PBL evaluation forms) and in clinical fieldwork studies (based on preceptor's evaluation and a written assignment). RESULTS: Pearson correlations revealed significant correlations between PBL grades and clinical fieldwork studies grades. T-test analysis between students who are native Hebrew speakers and those who are native Arabic speakers revealed significant differences in PBL grades. CONCLUSIONS: Findings imply partial congruence between students' grades in the PBL course and their achievements in the fieldwork studies. Findings might suggest that adjustments should be made in order to assist students from minorities (challenged by language requirements) in gaining higher grades in the PBL program. Implications for Rehabilitation Problem-Based Learning (PBL) is an educational method, which fosters independent, self-directed study in small groups. PBL studies have the potential to prepare students for their clinical experience during studies. The PBL program should be adjusted for students from minorities (challenged by language requirements and different cultural backgrounds) in order to assist them in gaining more benefits from the program.

Prediction of the intensity and diversity of day-to-day activities among people with schizophrenia using parameters obtained during acute hospitalization.

PURPOSE: Participation in day-to-day activities of people with schizophrenia is restricted, causing concern to them, their families, service providers and the communities at large. Participation is a significant component of health and recovery; however, factors predicting participation are still not well established. This study examines whether the parameters obtained during acute hospitalization can predict the intensity and diversity of participation in day-to-day activities six months after discharge. METHOD: In-patients with chronic schizophrenia (N = 104) were enrolled into the study and assessed for cognitive functioning, functional capacity in instrumental activities of daily living (IADL), and symptoms. Six months after discharge, the intensity and diversity of participation in day-to-day activities were evaluated (N = 70). RESULTS: Multiple correlations were found between parameters obtained during hospitalization and participation diversity, but not participation intensity. The model that is better suited to the prediction of participation diversity contains cognitive ability of construction, negative symptoms and number of previous hospitalizations. The total explained variance is 37.8% (F3,66 = 14.99, p < 0.001). CONCLUSIONS: This study provides evidence for ecological validity of the in-patient evaluation process for the prediction of participation diversity in day-to-day activities six months after discharge. Participation diversity is best predicted through a set of factors reflecting personal and environmental indicators. Implications for rehabilitation Results of in-patient evaluations can predict the diversity of participation in day-to-day activities six months after discharge. Higher prediction of participation diversity is obtained using a holistic evaluation model that includes assessments for cognitive abilities, negative symptoms severity and number of hospitalizations.

Description of and Preliminary Findings for Occupational Connections, an Intervention for Inpatient Psychiatry Settings.

People with mental health conditions (MHCs) frequently experience participation and functional restrictions. Today, hospitals still serve a significant number of people with MHCs. However, there is little evidence for occupation-oriented interventions to support participation, health, and well-being in these hospital settings. This article describes a newly developed, short-term, structured intervention for the inpatient setting, Occupational Connections (OC), that focuses on promoting everyday functions and participation in daily life and presents preliminary findings for its effectiveness. Ten people with schizophrenia participated in the program during their stay in acute open inpatient units and completed evaluations both pre- and postintervention. Statistics for a small-sample study design were applied to investigate OC's impact. The results showed OC's contribution to participation dimensions, functional capacity, cognitive functioning, and reduction in schizophrenia symptoms. On the basis of this pilot study's results, extended research is now being conducted to strengthen the evidence for OC's effectiveness.

Participation in daily life of people with schizophrenia in comparison to the general population.

BACKGROUND: Participation in occupations is a basic human right. Although people with schizophrenia commonly experience restrictions in participation, there is a paucity of research in this area. PURPOSE: This study aimed to compare the participation patterns of people with schizophrenia to people without mental illness (control group). METHOD: A total of 140 people of similar age and sex completed the Adults Subjective Assessment of Participation and provided demographic and health-related data. FINDINGS: People with schizophrenia tend to participate in fewer activities and to participate alone. However, they participate with similar intensity as those in the control group. IMPLICATIONS: The participation patterns of people with schizophrenia are both unique and similar to those of the general population. The differences in participation raise concerns due to signs of restriction and social exclusion. However, it appears that people with schizophrenia benefit from occupation and community-based services that promote and support participation with others in diverse activities.

Factors discriminating employment status following in-patient evaluation among persons with schizophrenia.

BACKGROUND: Employment is a key element in recovery from schizophrenia. Yet 60%-80% of people with schizophrenia are not involved in work occupations. Factors influencing employment were explored mostly in community settings, while the recovery process begins already during hospitalization. OBJECTIVE: The aim of the study was to investigate parameters that can distinguish during hospitalization between people with schizophrenia who will work in competitive employment, in sheltered employment or will not work after discharge. METHODS: The research followed 104 participants from acute hospitalization to the community, six months after discharge, to obtain employment related data. The participants' cognitive abilities, schizophrenia symptoms, and functional capacity were evaluated during hospitalization. In addition, demography and illness related factors were collected. RESULTS: The results indicate that persons with different employment statuses varied in several parameters during hospitalization. However, the most effective discriminant model includes negative symptoms, functional capacity measure and the number of hospitalizations. CONCLUSIONS: The study suggests that people with different employment statuses have unique characteristics already during hospitalization. In the future, appropriate rehabilitation programs may be suggested to each group based on these characteristics to promote employment among people with schizophrenia and contribute to recovery.

From hospital admission to independent living: is prediction possible?

An integral component of recovery from mental illness is being able to engage in everyday activities. This ability is often restricted among people with schizophrenia. Although functional deficits are addressed during hospitalization, the ability to predict daily functioning based on information gathered during hospitalization has not been well established. This study examines whether measurements completed during hospitalization can be useful for predicting independent living within the community. Inpatients with schizophrenia (N=104) were enrolled in the study and assessed for cognitive functioning, functional capacity and symptoms. They were approached again 6 months after discharge to evaluate their functioning with respect to everyday life Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Functional capacity during hospitalization predicted 26.8% of ADL functioning and 38.8% of IADL functioning. ADL was best predicted by the severity of negative symptoms, cognitive functioning, and the number of hospitalizations (51.2%), while IADL was best predicted by functional capacity, cognition, and number of hospitalizations (60.1%). This study provides evidence that evaluations during hospitalization can be effective, and demonstrates the advantage of a holistic approach in predicting daily functioning. When a holistic approach is not practical, a functional capacity measurement may serve as an effective predictor.

Sensory modulation and daily-life participation in people with schizophrenia.

Schizophrenia is considered to be an extreme mental health disturbance that affects a person's well-being and participation in everyday activities. Participation in meaningful everyday occupations is an important component of recovery from mental illness, the ultimate goal of mental health services. The participation restrictions of people with schizophrenia have been widely investigated through different factors, such as illness symptoms and course, cognition, and demographic data; however, the resulting explanations were incomplete. The purpose of the study was to explore the contribution of sensory modulation (SM), in addition to cognition and schizophrenia symptoms, to participation in daily life activities of people with schizophrenia. Forty nine in-patients with schizophrenia (study group) and 32 adults without mental illness (control group) comprised the study. They were assessed for their participation patterns, sensory modulation processes, cognitive functioning and symptoms severity. Results indicate significant differences between the study groups in most measurements addressed: participation (diversity and satisfaction), sensory modulation scores (intensity of the response and frequency of response), and cognitive measurements. The most contributive parameters for the prediction of participation dimensions among people with schizophrenia were negative symptoms severity and general cognitive status. In conclusion, people with schizophrenia experience SM disorder with an under responsive tendency. However the complex condition of schizophrenia dominates its influence on participation dimensions.

Context and psychosocial intervention in mental health.

OBJECTIVE: Occupational therapy (OT) services have been provided for people with mental health conditions since the foundation of the profession, but OT practices are not clearly outlined. This paper presents the standard OT practices performed in the mental health area. The aim of the study is to quantitatively characterize domains of OT intervention in mental health. Specifically, OT intervention in community and inpatient-based mental health settings is described, further delineated by age groups and gender. Eighteen occupational therapists (OTs), who work in the area of mental health, participated in the study. Each OT had at least two years of experience, was between the ages of 26 and 40, and documented 2-4 treatment sessions. In total, 70 treatment sessions were recorded; half were recorded in hospitals and the majority of recorded sessions involved clients diagnosed with schizophrenia (n = 47). Significant differences were found in the intervention provided in the different settings. In addition, the intervention focus for men and women, and for age groups, was different. Despite these differences, many aspects of the intervention were similar in all contexts. The study results support previous notions that context influences intervention.