Profiles of Emergency Department Users with Psychiatric Disorders Related to Barriers to Outpatient Care.

Emergency department (ED) overcrowding is a growing problem worldwide. High ED users have been historically targeted to reduce ED overcrowding and associated high costs. Patients with psychiatric disorders, including substance-related disorders (SRDs), are among the largest contributors to high ED use. Since EDs are meant for urgent cases, they are not an appropriate setting for treating recurrent patients or replacing outpatient care. Identifying ED user profiles in terms of perceived barriers to care, service use, and sociodemographic and clinical characteristics is crucial to reduce ED use and unmet needs. Data were extracted from medical records and a survey was conducted among 299 ED patients from 2021 to 2022 in large Quebec networks. Cluster algorithms and comparison tests identified three profiles. Profile 1 had the most patients without barriers to care, with case managers, and received the best primary care. Profile 2 reported moderate barriers to care and low primary care use, best quality of life, and more serious psychiatric disorders. Profile 3 had the most barriers to care, high ED users, and lower service satisfaction and perceived mental/health conditions. Our findings and recommendations inform decision-makers on evidence-based strategies to address the unmet needs of these vulnerable populations.

Profiles of quality of life among patients using emergency departments for mental health reasons.

BACKGROUND: This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use. METHODS: Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them. RESULTS: Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions. CONCLUSION: The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.

Efficacy of a randomized controlled trial of integrative couple treatment for pathological gambling (ICT-PG): 10-month follow-up.

OBJECTIVE: Assess the efficacy of integrative couple treatment for pathological gambling (ICT-PG) in comparison to treatment provided in an individual approach. METHOD: Eighty couples were assigned randomly to ICT-PG (n = 44, Mage = 42.2, SD [13.4], n male gamblers = 29) or individual treatment (n = 36, Mage = 39.9 SD [13.0], n male gamblers = 31) with follow-ups at 4- and 10-months postadmission regarding the severity of gambling, the individual and couple's well-being. Linear mixed and generalized estimating equation models for repeated measures were applied to take into account the dependency of observations. Protocol was preregistered at www. CLINICALTRIALS: gov (ID: NCT02240485). RESULTS: Participants in both treatments generally improved over time with reductions on gambling expanses from an initial $4,000-$600 in a 90-day period following treatment, without difference across treatment conditions in money spent on gambling or frequency of gambling. However, on different indices of gambling severity, the participants in ICT-PG showed more improvement at follow-ups, with better control capacity (OR = 2.57, p < .0129) and greater reduction in gambling craving (OR = 5.83, p < .0001) and erroneous cognitions (OR = 2.63, p < .0063). The couple treatment was associated with a better individual well-being (e.g., less depression for partners, OR = 5.53; p < .0351, and gamblers, OR = 2.37; p < .0334) and couple well-being (e.g., better dyadic satisfaction for partners, OR = 2.02; p < .0057, and gamblers, OR = 3.07; p < .0212). CONCLUSIONS: The results underline the necessity to provide a greater diversity of treatment for gamblers and their partner. Further research should focus on identifying active components of ICT-PG and widen its provision to gamblers with concurrent addiction disorders. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Factors encouraging or limiting the use of emergency departments for mental health reasons by frequent users of these services]. / Facteurs encourageant ou limitant l'utilisation des services d'urgence pour des raisons de santé mentale par les patients grands utilisateurs de ces services.

Objectives Hospital emergency departments (ED) are often overcrowded, and patients using ED for mental health (MH) reasons contribute in great part to this situation. In Quebec, in 2014-15, 17% of ED users with mental disorders had visited ED at least 4 times for various reasons. These patients' frequent ED use usually reflects the inadequacy of the services provided to them. A better understanding of the underlying reasons behind this frequent ED use would enable stakeholders to formulate recommendations that would help improve services, making them more suited to the needs of these patients. The aim of this study was to identify the factors that encourage or limit the use of ED by frequent ED users, the term "frequent ED users" being defined as patients who use ED at least 3 times over a one-year period. Methodology Between April and September 2021, 20 ED professionals were interviewed concerning factors they perceived as encouraging or limiting ED use among frequent ED users. Participants worked in a psychiatric ED or in other hospital services (e.g., assessment-liaison module), or were partners of the ED within the territory (e.g., crisis centers). Study data were analyzed using a content analysis method carried out in various stages (e.g., data transcription, content coding), and guided by a conceptual framework comprised of 4 categories of factors that encourage or limit frequent use for MH reasons. These factors were related to the healthcare system, patient profiles, health professionals, and the MH network's organizational characteristics. Results More encouraging factors than limiting ones were identified as pertains to ED use. Most factors were associated with the healthcare system (and particularly with the unavailability of MH services), and with patient profiles, more specifically those with complex mental disorders compounded by psychosocial problems. Organizational characteristics, in particular the deployment of innovations in the ED or in partnership with it, although not widely deployed overall, tended to limit ED use. Conclusion This study highlights the importance of developing more innovations in the ED and in conjunction with other hospital and community services to better meet the needs of frequent ED users, and thus reduce their use of these services. ED should optimize their role in the screening, brief treatment, referral, and quality monitoring of services for patients, particularly those not adequately served by outpatient MH services.

[Substance use among older residents in residential and long-term care facilities: A scoping review on intervention practices]. / Consommation de substances psychoactives chez les résident(e)s fréquentant des milieux d'hébergement et de soins de longue durée pour personnes âgées en perte d'autonomie : une revue de la portée sur les pratiques d'intervention.

Objectives Residential and long-term care facilities struggle to support older residents who experience a loss of autonomy, use psychoactive substances and face issues related to their consumption. Substance use can interact negatively with other physical, mental health or social conditions (e.g., homelessness) to create particularly complex profiles. In Quebec, as in many other countries around the world, there are often no clear guidelines for the care of elderly residents using psychoactive substances. The purpose of this study is to document the characteristics of existing interventions and practices towards older people who use psychoactive substances in residential and long-term care facilities in order to support decision makers with improvement of services and quality of care. Methods We carried out a scoping review of the scientific literature. We consulted 7 scientific databases (MEDLINE, EmBASE, PsychINFO, CINAHL, SocIndex, Ageline, Érudit). To identify the relevant grey literature, we explored the websites of governmental, non-governmental organizations and professional associations in the fields of addiction and aging in a selection of OECD countries. In addition, 31 experts were solicited to enhance the documentary research process. We conducted a thematic analysis on 65 documents. Results The philosophies underlying practices related to substance use reflect a hard balance to strike between priorities to be given to health, safety, and respect for human rights in residential and long-term-care settings. These philosophies, and the practices that stem from them, are distributed along a continuum ranging from the demand for abstinence to a total "laissez-faire" approach to substance use. Services offered are varied and involve complementary expertise in the health and social fields to meet the complex needs of this population. Finally, a diversity of organizational dynamics is observed: proposed interventions regarding substance use can be structured programs, informal interventions, internal substance use management policies, or specific settings for older adults who use substances, such as wet eldercare facilities. Conclusion This portrait of the interventions that target the use of psychoactive substances in residential and long-term care settings may assist care workers and service managers in Quebec and internationally, with clinical practice improvements. This may ultimately support both seniors-dedicated and addiction services. In view of population aging and the complex needs of older populations, clear guidelines are crucial to ensure the quality of care and services in these settings.

[The Challenges of Victimization in the Treatment of Substance Addiction: What Do Clinicians Say About It?] / Les enjeux liés à la victimisation dans le traitement de la dépendance aux substances : qu'en disent les cliniciens en dépendance ?

Literature seems to establish a two-way relationship between psychoactive substance use and the presence of victimization. Indeed, substance can be used by a victim to overcome the different impacts lived because of the criminal acts experienced. On the other side, psychoactive substance use may increase the risks of a person being victim of criminal acts. It is therefore no wonder that an important proportion of people who consult for a problem of consumption/addiction to psychoactive substances have already been victims of criminal acts. Since the clinical profiles of these individuals is severe and complex, it appears important that the clinicians working with this person be aware of the presence of victimization in their life in order to help them. The objective of this project is to document the difficulties and the challenges encountered by the addiction clinicians in their interventions with people having already been victims of criminal acts and to present possible solutions to help improve interventions and promote their recovery. Thirty-two addiction clinicians (N = 9 Men) have taken part in individual meetings of about 60 minutes. Once transcribed in verbatim form, the interviews have been analyzed under a continuous theming method following the steps put forward by Braun and Clarke (2006). The results of the qualitative analysis highlighted the four following aspects: (1) Perception of clinicians regarding the portrait of people consulting in a public intervention center specializing in addiction; (2) Perception of addiction clinicians regarding the possible interactions between substance use and victimization; (3) The stakes of substance abuse intervention with the victims of a criminal act and (4) Suggestions to improve services for people with substance addiction and being criminal act victims. The results put forward the complexity of intervention with people with a problem of consumption/addiction and who were victims of criminal act victims. The results highlight the complexity of the intervention with people with a problem of consumption/addiction and who were victims of criminal acts, as well as the need for training addiction clinicians about victimization.

Do the Consequences Experienced by the People in the Life of a Problem Gambler Differ Based on the Nature of Their Relationship with the Gambler?

Consequences experienced by the partners of individuals with a gambling disorder are well documented. However, little is known about the deleterious effects experienced by other people than partners of gamblers. A better understanding of these consequences could help improve clinical practices. The goal of this paper is to compare the consequences experienced by partners of gamblers with those experienced by their close family members (parents, adult children, siblings) by using the categorization method proposed by Langham et al. (BMC Public Health, 2016). To achieve this goal, 46 semi-structured interviews were conducted. Results indicate that the extent and intensity of the consequences experienced vary widely based on their level of emotional and financial involvement with the gambler. Considering the specific elements involved for each type of person in a gambler's life, future research should distinguish participants based on the nature of their relationship with the gambler.

Concurrent Transcranial Direct Current Stimulation and Resting-State Functional Magnetic Resonance Imaging in Patients with Gambling Disorder.

Background/Introduction: Transcranial direct current stimulation (tDCS) delivered over the dorsolateral prefrontal cortex (DLPFC) while patients are at rest can decrease craving in patients with substance-related and addictive disorders. Yet, the effects of tDCS on resting-state brain activity remain unknown in this population. This study examined the effects of tDCS on resting-state functional connectivity (rsFC) with concurrent stimulation and functional magnetic resonance imaging in patients with gambling disorder. Methods: This was a randomized, sham-controlled, double-blind, crossover study. The anodal and cathodal electrodes were applied over the right and left DLPFC, respectively. Patients received 30 min of active and sham stimulation on separate days. rsFC was assessed before and during stimulation with seed-based analyses. Results: There was a significant increase of rsFC between the right DLPFC seed and the right superior parietal lobule during active stimulation as compared to during sham stimulation (p = 0.0059, corrected for multiple comparisons). There was also a positive correlation between rsFC change of this frontoparietal network and brain volume of the right DLPFC (p = 0.0042, corrected for multiple comparisons). Discussion: A single session of tDCS targeting the DLPFC strengthened functional connectivity in a frontoparietal circuit, known to be implicated in cognitive control, especially in patients with a greater volume of the region under the anode electrode. Impact statement Transcranial direct current stimulation increased the functional connectivity of a frontoparietal circuit in patients with gambling disorder. These changes were larger in patients with greater volume of the dorsolateral prefrontal cortex. Transcranial direct current stimulation strengthened the connectivity of a brain network known to be associated with cognitive control.

Brain morphometry in adults with gambling disorder.

Little is known regarding the brain substrates of Gambling Disorder, including surface brain morphometry, and whether these are linked to the clinical profile. A better understanding of the brain substrates will likely help determine targets to treat patients. Hence, the aim of this study was two-fold, that is to examine surface-based morphometry in 17 patients with gambling disorder as compared to norms of healthy individuals (2713 and 2790 subjects for cortical and subcortical anatomical scans, respectively) and to assess the clinical relevance of morphometry in patients with Gambling Disorder. This study measured brain volume, surface and thickness in Gambling Disorder. We compared these measures to those of a normative database that controlled for factors such as age and sex. We also tested for correlations with gambling-related behaviors, such as gambling severity and duration, impulsivity, and depressive symptoms (assessed using the South Oaks Gambling Screen, years of gambling, Barratt Impulsiveness Scale, and Beck Depression Inventory, respectively). Patients displayed thinner prefrontal and parietal cortices, greater volume and thickness of the occipital and the entorhinal cortices, and greater volume of subcortical regions as compared to the norms of healthy individuals. There were positive correlations between surface area of occipital regions and depressive symptoms. This work contributes to better characterize the brain substrates of Gambling Disorder, which appear to resemble those of substance use disorders and Internet Gaming Disorder.

Typology of patients who use emergency departments for mental and substance use disorders.

BACKGROUND: Identifying profiles of people with mental and substance use disorders who use emergency departments may help guide the development of interventions more appropriate to their particular characteristics and needs. AIMS: To develop a typology for the frequency of visits to the emergency department for mental health reasons based on the Andersen model. METHOD: Questionnaires were completed by patients who attended an emergency department (n = 320), recruited in Quebec (Canada), and administrative data were obtained related to sociodemographic/socioeconomic characteristics, mental health diagnoses including alcohol and drug use, and emergency department and mental health service utilization. A cluster analysis was performed, identifying needs, predisposing and enabling factors that differentiated subclasses of participants according to frequency of emergency department visits for mental health reasons. RESULTS: Four classes were identified. Class 1 comprised individuals with moderate emergency department use and low use of other health services; mostly young, economically disadvantaged males with substance use disorders. Class 2 comprised individuals with high emergency department and specialized health service use, with multiple mental and substance use disorders. Class 3 comprised middle-aged, economically advantaged females with common mental disorders, who made moderate use of emergency departments but consulted general practitioners. Class 4 comprised older individuals with multiple chronic physical illnesses co-occurring with mental disorders, who made moderate use of the emergency department, but mainly consulted general practitioners. CONCLUSIONS: The study found heterogeneity in emergency department use for mental health reasons, as each of the four classes represented distinct needs, predisposing and enabling factors. As such, interventions should be tailored to different classes of patients who use emergency departments, based on their characteristics.

Reasons for Emergency Department Use among Patients with Mental Disorders.

Disproportionate use of emergency departments (EDs) by patients with mental disorders suggests the need to evaluate factors associated with ED use. Based on the Andersen Behavioral model, this mixed-method study identified the contributions of predisposing, enabling and needs factors in ED use among 328 patients with mental disorders. We hypothesised that ED use for mental health (MH) reasons would be most strongly associated with need factors. The study was conducted in four EDs located in different territories of Quebec (Canada). ED teams assisted with patient recruitment. Participants completed a questionnaire including a qualitative component on reasons for using the ED and assessments of ED and MH services. Data were organised according to the Andersen model, and analysed thematically. ED users were generally single, with low socioeconomic status and inadequate knowledge of MH services (predisposing factors). Most had a regular source of care which facilitated ED referrals (enabling factors); although inadequate access to outpatient care contributed to ED use. Needs factors were the primary motivators in ED use among patients with mental disorders, especially self-rated importance of problems, and MH diagnoses including suicidal ideation/attempts, depression, anxiety, and substance use disorders. Results confirmed our hypothesis that ED visits were more strongly related to needs factors. The mixed methodology reinforced the importance of predisposing and enabling factors in ED use, particularly in more complex cases. Various strategies (e.g. shared care, recruitment of addiction liaison nurses for SUD screening) are suggested for improving access to other resources and reducing non-urgent ED use.

Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators.

This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.

Online effects of transcranial direct current stimulation on prefrontal metabolites in gambling disorder.

Gambling disorder is characterized by persistent maladaptive gambling behaviors and is now considered among substance-related and addictive disorders. There is still unmet therapeutic need for these clinical populations, however recent advances indicate that interventions targeting the Glutamatergic/GABAergic system hold promise in reducing symptoms in substance-related and addictive disorders, including gambling disorder. There is some data indicating that transcranial direct current stimulation may hold clinical benefits in substance use disorders and modulate levels of brain metabolites including glutamate and GABA. The goal of the present work was to test whether this non-invasive neurostimulation method modulates key metabolites in gambling disorder. We conducted a sham-controlled, crossover, randomized study, blinded at two levels in order to characterize the effects of transcranial direct current stimulation over the dorsolateral prefrontal cortex on neural metabolites levels in sixteen patients with gambling disorder. Metabolite levels were measured with magnetic resonance spectroscopy from the right dorsolateral prefrontal cortex and the right striatum during active and sham stimulation. Active as compared to sham stimulation elevated prefrontal GABA levels. There were no significant changes between stimulation conditions in prefrontal glutamate + glutamine and N-acetyl Aspartate, or in striatal metabolite levels. Results also indicated positive correlations between metabolite levels during active, but not sham, stimulation and levels of risk taking, impulsivity and craving. Our findings suggest that transcranial direct current stimulation can modulate GABA levels in patients with gambling disorder which may represent an interesting future therapeutic avenue.

The Experience of Couples in the Process of Treatment of Pathological Gambling: Couple vs. Individual Therapy.

Context: Couple treatment for pathological gambling is an innovative strategy. There are some results supporting its potential effectiveness, but little is known about the subjective experiences of the participants. Objective: The aim of this article is to document the experiences of gamblers and their partners participating in one of two treatments, namely individual or couple. Method: In a study aiming to evaluate the efficacy of the Integrative Couple Treatment for Pathological Gambling (ICT-PG), couples who were entering specialized treatment for the addiction of one member who was a pathological gambler were randomly assigned to individual or ICT-PG. Nine months after their admission to treatment, gamblers and partners (n = 21 couples; n = 13 ICT-PG; n = 8 individual treatment) were interviewed in semi-structured interviews. A sequenced thematization method was used to extract the major themes. Results: This study highlighted five major themes in the therapeutic process noted by the gamblers and their partners mainly after the couple treatment but also partly through the individual therapy. These were: (1) the gamblers' anxiety about having to reveal their gambling problems in couple therapy; (2) the wish to develop a mutually beneficial understanding of gambling and its effects on the partners in the two types of treatments; (3) the transformation of negative attributions through a more effective intra-couple communication fostered by the couple therapy; (4) the partners' contribution to changes in gambling behavior and prevention of relapses, which were both better supported in couple therapy; and (5) the interpersonal nature of gambling and its connections with the couples' relationship. However, gamblers who were in individual treatment were more likely to mention that their partners' involvement was not necessary. Participants likewise made a few recommendations about the conditions underlying the choice of one treatment method or the other. Discussion: Participants reported satisfaction with both treatment models, but their experience was more positive in couple treatment. Complementary benefits emerged from each form of treatment, which points to future treatments involving both types. Future research should explore both the couple processes associated with attempts to stop pathological gambling and the various ways of involving partners in the gamblers' treatment.

Remission from substance use disorders: A systematic review and meta-analysis.

OBJECTIVE: This paper presents a systematic review and meta-analysis of available evidence on remission rates for substance use disorders (SUDs), providing weighted mean estimates of SUD remission rates. The review also explores study-level characteristics that may explain variations in remission rates across studies. METHODS: A comprehensive search strategy identified studies published between 2000 and 2015 with follow-up periods of at least three years or reported lifetime remission outcomes for potential inclusion in the review. Remission was defined as not meeting diagnostic criteria for abuse or dependence for a minimum period of six months, as of final follow-up. A single-group summary meta-analysis was performed. Pooled estimated annual remission rates (PEARRs) were calculated. Meta-regression techniques and subgroup analyses were used to explore the association between study remission rates and key selected variables. RESULTS: Of 8855 studies identified, 21 met the eligibility criteria. The results suggested that 35.0% to 54.4% of individuals with SUDs achieved remission, and this occurred after a mean follow-up period of 17 years. The PEARRs projected few cases of SUD remission, between 6.8% and 9.1% in any given year. Studies that reported higher remission rates had longer follow-up periods, and lower sample retention rates. CONCLUSIONS: Results support the contention that SUDs are more likely to be "chronic" or long term disorders than acute disorders for a substantial number of individuals. However, more longitudinal research is required. Treatment geared to chronicity, such as assertive community treatment and intensive case management, needs to be more readily available for SUD populations.

Factors Influencing the Frequency of Emergency Department Utilization by Individuals with Substance Use Disorders.

This study assessed the characteristics of individuals with substance use disorders (ISUDs) according to their frequency of emergency department (ED) utilization, and examined which variables were associated with an increase in ED visits using Andersen's model. Data linkage of administrative databanks from three sources [addiction rehabilitation centre registry, physician billing systems, and hospital discharge databank] for 4526 ISUDs was performed. Predisposing, enabling and need factors associated with number of ED visits were determined using a negative binomial regression model and generalised estimating equations. The rate of ED utilization for this population was 9.6 %. Increased number of ED visits was associated with the following variables: older age, social fragmentation, number of consultations with general practitioners, number of consultations with psychiatrists, number of consultations with other types of physicians, alcohol abuse, drug abuse, schizophrenia, anxiety disorders, personality disorders, co-occurring substance dependence and mental disorders, co-occurring substance dependence and chronic physical disorders, and co-occurring mental health disorders and chronic physical disorders. By contrast, a diagnosis of substance dependence, co-occurring drug and alcohol abuse, and a co-occurring diagnosis of substance dependence with mental health and chronic physical disorders decreased ED visits. Efforts to reduce avoidable use of EDs should focus on chronic-disease management and other related strategies aimed at reinforcing services to ISUDs in the community, especially for ISUDs with a co-occurring diagnosis of either mental health disorders or chronic physical disorders.

Impact Evaluation of an Addiction Intervention Program in a Quebec Prison.

OBJECTIVES: This study evaluates the effects of a prison-based addiction intervention program. The evaluation is based on a multidimensional data collection that draws a portrait of the respondents' substance use, and of their psychological/emotional, social, and judicial spheres. It measures the changes, or lack thereof, in substance use; the psychological/emotional, social, and judicial spheres; as well as the post-treatment services used. METHOD: A quasi-experimental repeated measures design (0, 6 weeks, and 6 months) was used. Effects of the program were identified by comparing the results obtained by a group of inmates who had participated in the program (n = 80; experimental group) with those of another group who had received no intervention (n = 70; control group). RESULTS: The preliminary results suggested a certain treatment effect related to impulsivity and psychological distress. CONCLUSION: Although the preliminary results were promising, the experimental and control groups did not differ significantly when more robust analyses were used.

[The importance of playfulness in occupational therapy with adult clients]. / L'importance de l'attitude ludique en ergothérapie avec une clientèle adulte.

BACKGROUND: As there is little documentation pertaining to playfulness in adults, its therapeutic potential remains uncertain. PURPOSE AND METHODOLOGY: A qualitative approach was used in order to develop a conceptual model of playfulness in adults and to discuss its potential uses in occupational therapy. RESULTS: The model identifies the influential sources and the consequences of playfulness in adults. The identified consequences support both the privileged intervention in occupational therapy, in other words, the meaningful activity, and the objectives of the intervention, those which include being the capacity to act, health and well-being. For these reasons, the proposed model presents interesting potential for occupational therapy intervention. CLINICAL IMPLICATIONS: This conceptual model presents a unique and innovative vision of playfulness in adults that could offer a new perspective on meaningful activity. It suggests that playfulness could become an important tool in occupational therapy in developing the capacity to act. Consequently, the model proposes an innovative client-based approach.