Evaluation of an occupation-based, mental-health program: Meeting being, belonging and becoming needs.

INTRODUCTION: Being, belonging and becoming are important theoretical constructs for occupational scientists and therapists, and for members of Northern Initiative for Social Action (NISA), located in northern Ontario, Canada. Collaborative research with service users guided the development of NISA and its evaluation tool: the 3B~S Scale. The aim of this paper is to share the results of the 2018 program evaluation. METHODS: 113 participants completed a questionnaire consisting of the 3B~S Scale, demographic and program satisfaction questions, and open-ended questions. Quantitative analysis used descriptive statistics followed by ordinal logistic regression to determine the intersectional effects of gender, race and age on becoming and system impact outcomes. Open-ended responses were analysed thematically and triangulated with quantitative findings. RESULTS: Participants agreed-to-strongly agreed that the program met their 3B needs (x = 4.20, SD = 0.24). Participants indicated strong satisfaction with the program (x = 4.38, SD = 0.66), and agreement that participating in the program reduced their reliance on other system-based services (x = 3.96, SD = 0.24). The regression revealed no significant differences in gender, race or age in predicting six of 10 outcomes examined; race was not significant for any outcome. Younger females were more likely to agree that the work they do is part of a larger community charitable purpose, the program is helping them to achieve their goals, and is increasing their involvement in community. Younger participants were more likely to agree that participation facilitated a return to school or employment than older participants. CONCLUSIONS: Occupation-based, mental health programs that address participants' being, belonging and becoming needs can contribute to improvements in perceived mental health and well-being, as well as to improved community and system usage outcomes. The NISA model provides a framework for clinically operationalising the 3B's and may provide a unique contribution to ongoing theoretical discussions of these constructs within occupational therapy and science.

Being, belonging and becoming: Development of the 3B Scale.

BACKGROUND: The aim of the current study was to assess the construct validity and internal consistency of a measure used by an occupation-based, mental health program. The measure was formulated according to the 3B theory of being, belong and becoming and system impacts. METHODS: The scale was administered to a sample of 122 current members of Northern Initiative for Social Action. Confirmatory factor analysis (CFA) was carried out to examine the model fit of the 3B Scale. Internal reliability was assessed using Cronbach's alpha measure of internal consistency. RESULTS: The CFA confirmed the four hypothesised underlying constructs of the 3B theory. The results of the CFA reported adequate model fit. Each factor had good to excellent internal reliability with Cronbach's alpha ranging from 0.81 to 0.91. CONCLUSION: The 3B Scale is a valid and reliable tool for measuring Being, Belonging and Becoming needs in an occupation-based mental health program. The 3B Scale is an example of an outcome measure created specifically to quantify program outcomes and demonstrates that instruments suited to unique programs can be individually configured and assist occupational therapists in their efforts to measure client perspectives. These are the essential first steps to client-centred practice and the development of practice-based evidence. The 3B Scale may be useful to similar peer-led programs, as well as community-based occupational programs that foster participation. Further research is needed to determine whether the 3B Scale can detect change over time.

Authentic peer support work: challenges and opportunities for an evolving occupation.

BACKGROUND: The peer support worker (PSW) belongs to the fastest growing occupation in the mental health sector, yet it is often under-valued and poorly understood. Despite an emerging evidence base, and strong support from mental health service users, the PSW remains on the periphery of mainstream services in northeastern Ontario. AIMS: To examine the role of the PSW, along with the challenges and benefits, and to understand why the PSW is not more integrated within mainstream services. METHODS: A sequential, exploratory, mixed-methods design was used to collect data on 52 survey and 33 focus group participants. Qualitative data were analyzed thematically. RESULTS: Peer support work was described by participants as being authentic when PSWs can draw upon lived experience, engage in mutually beneficial discussions, and be a role model. Authentic peer support was noted to be important to the recovery of mental health service users; yet, participants revealed that many positions continue to reflect more generic duties. Challenges to further integration include acceptance, training and credentialing, self-care, and voluntarism. CONCLUSIONS: Future development and mainstream integration of peer support work must reconcile current tensions between standardization and loss of authenticity. Training in communicating the lived experience, setting boundaries and self-care are important steps forward.

Employment services for persons with serious mental illness in northeastern Ontario: the case for partnerships.

OBJECTIVE: To better understand why employment success is low, a case study was conducted to examine the influence of place on access to employment for persons with serious mental illness (SMI) residing in two northeastern Ontario communities (Rebeiro, in progress). METHODS: Community-based participatory research methods were used to engage persons who experience SMI, decision-makers and providers in the research. Forty-six interviews were conducted, complemented by primary and secondary quantitative data sources. RESULTS: While most consumers consider employment to be a key element of their recovery, employment rates for persons with SMI remain limited in northeastern Ontario, Canada. The findings of this case study reveal the importance of collaborative partnerships to fostering better employment outcomes in northeastern Ontario. CONCLUSION: The challenges of collaboration due to rural and northern tensions, as well as various jurisdictional and funding tensions existing at the level of community support the case for partnerships in the provision of employment services in northern and rural places.

Transitions to work for persons with serious mental illness in northeastern Ontario, Canada: examining barriers to employment.

This paper considers the importance of place in the conceptualization of transitions to work for persons with serious mental illness (SMI). A qualitative case study was conducted to explore the influence of place on access to employment for persons with SMI. In-depth interviews, focus groups, and demographic data collected from urban and rural residing individuals who experience SMI, mental health and vocational service providers, and decision makers across northeastern Ontario inform this paper. The results highlight the primary theme, stuck in the mud, which explains how people with SMI, service providers and decision makers are stuck regarding employment. Ultimately, their being stuck creates a variety of place-related tensions and a tendency to settle for less in the area of employment for persons with SMI. The condition of being stuck in the mud is expressed as a metaphor depicting the existing tensions between ideas which govern provincial employment policy for persons with SMI and the mainstream or dominant discourse governing local organizations, programs and practices in the case communities and supports the need to consider place in policy implementation.

Directions for advancing the study of work transitions in the 21st century.

OBJECTIVES: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

"I'm still swimming".

Treatment of bipolar affective disorder is often difficult and lengthy. Enabling participation in a return to work process is equally daunting, primarily due to the dramatic and oftentimes sudden shifts in mood and thought. The following case study attempts to illustrate the complicated process of return to [and stay at] work for an individual who has mixed bipolar affective disorder. Work has always played a significant role in Ray's life and remains a valued goal and accomplishment for Ray. Work has been a means to structure and routine, and it has been from this routine that wellness has become possible for Ray. The metaphor, "I'm still swimming" helps to illustrate the continual treading of water, which both Ray and his occupational therapist [first author] have experienced over the past 6 years. This case study illustrates the strategies employed in maximizing the person-environment-occupation fit for Ray, as well as the importance of collaboration and partnership in the return-to-work process. It is also meant to stimulate thought and discussion about what is important for occupational therapists, and other health professionals to consider, when attempting the task of return-to-work for an individual with mixed bipolar affective disorder.