MENTAL HEALTH BOARD CERTIFICATION
Table of Contents: Activity Evidence Form EXAMPLES

Below is one example for each type of form, not for each criterion. The examples are to help you understand how to
complete each form, regardless of the criterion.

The forms that are included are hyperlinked in the table of contents below.

Please note that these are examples only to help guide you in the type of information to include. For many
reflections, your style may be different; for example, more narrative or more bulleted.

Note that unused forms (pages) are not included in this document. Please do the same with the final set of evidence
forms you submit with your application.
Criterion 1: Knowledge: Lifespan & Conditions
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Formal Learning
Independent Learning
Mentee
Publication – Peer-Reviewed
Criterion 2: Knowledge: Evaluation
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Formal Learning
Independent Learning
Mentee
Publication – Peer-Reviewed
Criterion 3: Knowledge: Intervention
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Formal Learning
Independent Learning
Mentee
Publication – Peer-Reviewed
Criterion 4: Knowledge: Systems
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Formal Learning
Independent Learning
Mentee
Publication – Peer-Reviewed
Criterion 5: Evaluation: Uses Relevant
Evidence
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Client-Based Case Study
Program Development
Research
Self-Analysis of Video Recording
Criterion 6: Evaluation: Prioritizes Needs
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Client-Based Case Study
Program Development
Research
Criterion 7: Intervention: Design &
Implementation
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Client-Based Case Study
Formal Specialized Consultation for
Intervention
Mentee
Self-Analysis of Video Recording
Criterion 8: Intervention: Wellness &
Prevention
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Client-Based Case Study
Formal Specialized Consultation for
Intervention
Mentee
Self-Analysis of Video Recording
Criterion 9: Outcomes
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Formal Specialized Consultation for Outcomes
Program/Service Evaluation
Research
Criterion 10: Holistic Practice
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Holistic Practice Case Study
Criterion 11: Ethical Practice – The 3 ethical
practice scenarios are found within the
application itself.
Criterion 12: Advocating for Change
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Advocacy Case Study
Advocacy Efforts
Volunteer Leadership
Criterion 13: Accessing Networks &
Resources
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Networking Case Study
FORMAL LEARNING
Table of Contents
Criterion 1–Knowledge: Lifespan & Conditions
Demonstrates acquisition of current knowledge of the effects of the interaction between
lifespan issues and relevant conditions that impact occupational performance related to mental
health.
Guidelines
 Minimum of 10 contact hours required.
 Multiple activities may be used to meet the hour requirement for the criterion.
 Learning must have occurred in the past 5 years.
Please identify the type of activity in which you participated:
X AOTA CE: Participation in Self-Paced Clinical Course or CE Product from the list of AOTA offerings
approved for this certification. Completion of course will be verified by AOTA. Submission of
additional documentation beyond this form not required.
☐ Non-AOTA CE: Attending workshops, seminars, lectures, or professional conferences with formal
established objectives.
☐ Participation in post-professional academic coursework. Attach unofficial transcript.
1. Activity information.
Activity Title
Provider/Instructor
Occupational Therapy in Mental Health: Considerations for Advanced
Practice
American Occupational Therapy Association, Inc.,
Self-Paced Clinical Course
Activity Date(s)
January 17, 20XX
No. of Contact Hours
20 contact hours
2. Activity Learning Objectives. List up to 5.
A) Identify the implications of the President’s New Freedom Commission Report (2003)
concerning the transformation of the mental health system in the United States upon OT
mental health practice.
B) Assess how the Recovery Model promotes the participation of consumers diagnosed with
mental illness and how it stands as a framework for OT practice in mental health, including
implications for evaluation and intervention across the life span and settings.
C) Apply principles of mental health transformation and the Recovery Model to the individual
learner’s OT practice.
D) Delineate current trends in mental health, such as trauma informed care, consumer-directed
care and the use of evidence-based practices, and recognize their application to OT therapy.
E) Identify advanced roles for OT’s, including advocacy, leadership, private practice, and
consulting, and understand ways the individual learner may evolve their skills and knowledge
to assume these roles.
3. Describe the relevance of the activity to your practice in mental health. (average word
guideline–200)
The course noted above dedicated a large portion of its contents to addressing provision of OT
services across the lifespan and multiple patient conditions. Specifically, it addressed
occupational engagement, evaluation and interventions for children and youth, adults, and older
adults with mental illness. In addition, it addressed working in high risk, special situations and
trauma care.
This course was relevant to my practice area since I work in a large psychiatric treatment center
that serves inpatient and outpatient clients with mental illness or chronic pain. The inpatient
portion of my practice involves working in several programs including medical psychiatry, mood
disorders, acute care, child and adolescent eating disorders and child, adolescent and family
treatment. As part of the outpatient practice, I work in several programs including an intensive
outpatient program, a pain rehabilitation program, and a fibromyalgia and chronic fatigue
program.
I found this advanced practice course provided me with valuable information as to how the
issues and concerns of these populations are varied, and as a result impact their occupational
performance in a variety of ways based on their current phase in the lifespan continuum.
4. Describe how the knowledge acquired from this activity “demonstrates acquisition of current
knowledge of the effects of the interaction between lifespan issues and relevant conditions that
impact occupational performance related to mental health.” How did the activity influence the
way you practice, or how did it affect your client outcomes? (average word guideline–200)
The knowledge acquired from this course has influenced the way that I practice since I am more
aware of how I evaluate clients as well as what type of probing questions and interventions I
should consider. Although I considered a patient’s condition and place in their lifespan prior to
this course, I find I now consider lifespan development with greater depth, which enables me to
better prepare for evaluations and provide interventions that better match client needs.
In the past, when working with children and youth, I considered how their condition affected
their occupational performance at school, home, and play. As a result of this course, I now
consider their sensitivity to rejection or failure, their ability to regulate their emotions, and how
this affects their socialization, confidence, and risk-taking behavior. In regard to older adults, I
look closer at the link between physical and mental health and consider how something such as
fear of falling can lead to social isolation and depression. Overall, this course assisted me in
better serving clients by looking more closely at how I link mental health conditions and lifespan
issues and their total effect on occupational performance.
5. Submit documentation that verifies completion of the activity, such as certificate of completion
or unofficial transcript. Not required for AOTA courses.
Not applicable as this is an AOTA course.
PUBLICATION – PEER-REVIEWED
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Criterion 2–Knowledge: Evaluation
Demonstrates acquisition of current knowledge of relevant evidence specific to evaluation in
mental health.
Guidelines
 Examples of peer-reviewed publication include journals such as AJOT or OTJR.
 May include a chapter in an occupational therapy or related professional textbook, if chapter has
gone through peer review (a process in which subject matter experts, using a formal system and
defined guidelines, provide content guidance to an author and recommend publication, revision, or
rejection of a work).
1. Submit APA reference for the publication. For in-press publication, also include a verification letter or
e-mail identifying applicant and anticipated date of publication.
Schindler, V. (20XX). Role assessments used in mental health. In B. Hemphill (Ed), Assessments
in occupational therapy in mental health (2nd ed.). Thorofare, NJ: Slack, Inc.
2. If applicant is not identified as first or second author, please describe your contribution/involvement in
the development of the publication. (average word guideline–200)
Not applicable (sole author)
3. Provide a reflection indicating why this publication was chosen to represent “acquisition of current
knowledge of relevant evidence specific to evaluation in mental health” and how it influenced your
practice. (average word guideline–200)
The publication I chose is a chapter in an OT textbook. I chose this chapter to represent the
knowledge in this criterion (evaluation) since it describes a frame of reference entitled, Role
Development, with a specific focus on the evaluations used. I am the author of this frame of
reference (Schindler), and it was the subject of my dissertation for my PhD in OT. Role
Development is based on Mosey’s Acquisition frame of reference and the roles and performance
skills components of the Model of Human Occupation (Kielhofner). The Role Development frame
of reference is designed to assist individuals diagnosed with schizophrenia to develop social roles
and their underlying task and interpersonal skills.
This chapter specifically describes the evaluations within the Role Development frame of
reference and gives instructions for administrating these evaluations. Evaluations include: the
Task Skills Scale, Interpersonal Skills Scale, and the Role Scales. This chapter also provides the
results of reliability and validity studies conducted on these evaluations.
This has influenced my practice since I use these evaluations in both practice and research. In
practice I have used these evaluations in day treatment centers and in supported education and
employment settings. In these settings it has been important for me to understand clients in
terms of their student and worker roles and the task and interpersonal skills that are the
foundation for these roles. This publication represents the culmination of my work on developing,
researching, and implementing these evaluations as part of this comprehensive frame of
reference. These evaluations have been used in several research studies to assess the
effectiveness of this frame of reference and as pre-test and post-test measures to assist
individuals identify and develop roles they find meaningful.
INDEPENDENT LEARNING
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Criterion 3–Knowledge: Intervention
Demonstrates acquisition of current knowledge of relevant evidence specific to intervention
in mental health.
Guidelines
 Minimum of 10 contact hours required.
 Multiple activities may be used to meet the hour requirement for the criterion.
 Learning must have occurred in the past 5 years.
Please identify the type of independent learning activity in which you participated:
☐ Independent reading from AOTA-Approved Independent Learning List in mental health.
☐ Independent reading of recent peer-reviewed, professional articles, or chapters in textbook not
associated with a formal learning course.
Independent review of professional electronic resources (e.g., NIH, CDC, CanChild).
☐
X AOTA Journal Club Toolkit (reading & discussion time). Must be AOTA member to access the kit.
☐ AOTA Critically Appraised Paper (CAP, includes submission to the AOTA Evidence Exchange).
1. Why did you choose this activity?
X Clinical reference for specific population, program, or individual
☐ Invited peer review of scholarly work or publication (print or online)
☐ Preparation for poster or presentation
☐ Preparation for academic lecture
☐ Literature review for research project
☐ Preparation for serving as a mentor
☐ Other, please specify: __________________________________________________________
2. Bibliography of select item(s) used for independent learning. List in APA format.
Arbesman, M., & Logsdon, D. W. (20XX). Occupational therapy interventions for
employment and education for adults with serious mental illness: A
systematic review. American Journal of Occupational Therapy, 65, 238-246.
Bullock, A., & Bannigan, K. (20XX). Effectiveness of activity-based group work in
community mental health: A systematic review. American Journal of Occupational Therapy,
65, 257-266.
Gibson, R. W., D’Amico, M., Jaffe, L., & Arbesman, M. (20XX). Occupational
therapy interventions for recovery in the areas of community integration and normative life roles
for adults with serious mental illness: A systematic review. American Journal of Occupational
Therapy, 65, 247-256.
Katz, N., & Keren, N. (20XX). Effectiveness of occupational goal intervention for clients with
schizophrenia. American Journal of Occupational Therapy, 65, 287-296.
3. Date(s) of independent learning
6 hours independent reading plus 6 hours journal club discussion on Mondays between August 1
- September 15, 20XX for a total of 12 hours.
4. Time spent engaged in independent learning.
 For reading, estimate 8–12 published pages/hour. Not required for AOTA-identified independent
learning list of resources.
 For journal club, discussion time counts toward 10-hour requirement.
12 hours
5. Describe the relevance of the independent learning activity to your practice in mental health. (average
word guideline–200)
In coordination with the mental health department at our hospital, the need for OT interventions
in the mental health practice area was identified through monitoring readmission rates and
overall patient and family member satisfaction with performance skills of psychiatric inpatients.
Previously, there was only an inpatient OT program, consisting of 1 OT and 1 OTA. In order to
expand services and provide a step-down outpatient OT program for those discharged from the
inpatient program, we needed to train and educate additional providers in the mental health
practice area. Since this is a new practice area for our current OT staff, I initiated, researched
and implemented a journal club as an avenue to improve my own and other OT staff knowledge
on relevant evidence, best practice and current interventions that apply to this population. I
chose this method as a quick avenue for gaining this knowledge base. Also, OT staff could
complete the required readings on their own and could together implement the services needed.
6. Describe how the knowledge acquired from this activity “demonstrates acquisition of current
knowledge of relevant evidence specific to intervention in mental health.” How did the activity
influence the way you practice, or how did it affect your client outcomes? (average word guideline–
200)
The knowledge acquired from the journal club articles/discussions has influenced the overall
design of our OT mental health program. I initially guided discussions among staff OTs, and
together we built the OT component of services to the MH department. Program topics included
goal setting, skill development for employment, and social skills training, as these were areas
that showed potential for effectiveness in our new client population based on our journal club
readings.
Our program is designed to assist clients with community integration/re-integration, and is
located in a clinic outside of the main hospital building. The review of these articles and
discussions among staff members has highlighted the fact that additional research is needed in
the practice area of mental health. There is currently evidence available for older adults and
children with Alzheimer’s and schizophrenia, but there is a lack of evidence and research relating
to adults and young adults with other diagnoses. All staff members have begun participating in a
monthly discussion on possible future research topics, and are pursuing continuing education in
current mental health interventions and research development.
MENTORING RELATIONSHIP–MENTEE
Table of Contents
Criterion 4–Knowledge: Systems
Demonstrates acquisition of current knowledge of laws, regulations, payer sources, and service
delivery systems relevant to mental health.
Guidelines
 Must represent a minimum of 10 hours over a minimum of 2 months.
 Does not include supervisory relationships.
 Relationship must have occurred in the past 5 years.
1. Dates of mentoring relationship
December 1, 20XX - June 15, 20XX
2. Approximately how many hours did this represent in total?
20 hours
3. Applicant’s goals for mentoring relationship. Goals must have been met by time of application.
List no more than 3.
A) Verify current coding practices for reimbursement in the area of mental health.
B) Learn about additional mental health resources in the community and alternative facilities
and care options for clients.
C) Understand how the Veterans Administration (VA) benefits and military health insurance
programs apply to our client population.
4.
Mentor
Suzy Q. Master, OTR/L, BCMH
Position/Role of Mentor
VA Occupational Therapist Clinical Lead
Workplace of Mentor
Anytown VA Medical Center
Contact Information for
Mentor (email or phone number)
[email protected]
5. State why the mentor was selected to help you meet the goals identified above relative to the
criterion. (average word guideline–50)
Suzy Master has been an OT for 18 years, including 8 years at the community hospital mental
health outreach program, and 5 years as the clinical lead at the Anytown VA Medical Center.
Previously, she conducted staff education sessions on coding, payer sources, grant writing, and
appropriate billing for mental health services.
6. Briefly describe how the skills acquired from this mentoring activity influenced your service delivery
with clients, specific to your ability to “demonstrate acquisition of current knowledge of laws,
regulations, payer sources, and service delivery systems relevant to mental health.” (average word
guideline–350)
As a new employee at a community-based mental health facility providing services to veterans, I
had not previously encountered clients with VA benefits or military health insurance. My
mentoring relationship with Suzy was instrumental in helping me understand the benefits related
to this system. By correctly coding and billing for services, I am able to spend more time on
client care, while also ensuring that the facility is paid properly, and clients are charged
appropriately.
This mentoring relationship also increased my knowledge of community resources and mental
health delivery systems in order to make appropriate client referrals to outside agencies when
necessary. While learning about local community resources, I identified a gap in resources for
service members recently separated from the military. Subsequently, I (with Suzy’s guidance),
proposed and received a grant to fund a community reintegration program for this population.
This program provided former service members with an opportunity to improve skills needed to
secure a job, maintain their job, and be a productive member of their community.
CLIENT-BASED CASE STUDY
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Criterion 5–Evaluation: Uses Relevant Evidence
Uses relevant evidence to establish an occupational profile with the client (person,
organization, population) and assess the client’s occupational performance through a variety of
measures, including standardized assessments, as appropriate.
Guidelines
 Client-based case study should not include any form of standard client documentation (e.g.,
evaluation summary, discharge plan) or identification of client name(s) or facility information.
1. Date(s) case study represents. August 20, 20XX – August 30, 20XX
2. Describe the client, client factors, and case contexts for the identified case. The context of the case
should be adequately communicated so that relevance and merit of the case to the criterion is easily
determined. (average word guideline–500)
Betty is a 35 year old female diagnosed with Adjustment Disorder. She was referred for an OT
evaluation after being admitted to the hospital for suicidal ideations. She is married with 2
children, ages 12 and 8. She is a stay-at-home mom whose husband is an active duty soldier
and is currently deployed in Iraq. She and her family have recently relocated to the area, and
she admits that she does not have a local support system.
Her prior leisure activities included surfing and swimming, which she no longer had access to at
her new location. Presenting problems include suicidal ideations; weight loss greater than 15
pounds in 1 month; decreased participation in IADLs, including late payment of bills; and
decreased participation in ADLs, including infrequent bathing and less attention paid to childcare
needs. She reports that her children get themselves ready for school in the morning and she has
previously called a babysitter for them in the afternoons, even when she is home. Client states,
“I just can’t seem to get out of bed in the morning.”
3. Articulate how this case demonstrates how you used “relevant evidence to establish an occupational
profile with the client (person, organization, population) and assess the client’s occupational
performance through a variety of measures, including standardized assessments, as appropriate.”
(average word guideline–500)
o During the initial intake evaluation, a standard facility interview was conducted with the client.
General demographics and client factors were gathered, as well as the client’s perception of roles
and satisfaction with those roles. In order to further assess the client’s current problem areas, the
Canadian Occupational Performance Measure (COPM) and the Occupational Case Analysis
Interviewing and Rating Scale (OCAIRS) were utilized. The COPM was chosen since it is designed
to be used across all disability groups and developmental levels, and enables clients to identify
and prioritize issues with their occupational performance. The OCAIRS was chosen since it was
designed for short-term psychiatric inpatients, and it assists clients and providers with assessing a
client’s overall level of functioning. Both tools assist clients with self-evaluation and can be used in
developing intervention plans and goal setting.
o
o The COPM was conducted with this client to enable her to clearly identify problems in areas of
occupation related to self-care, productivity, and leisure. The client was able to identify problem
areas, prioritize these areas in order of importance, and rate performance and satisfaction within
these areas of occupation. Occupational performance problems were identified in the following
areas: grooming/hygiene, performing childcare tasks, decreased leisure activities, and playing
games with her children.
4.
In addition to the COPM, the OCAIRS was used to encourage the client to be self-reflective,
participate in goal setting, and participate in discharge planning. The client fully participated in
this interview and was able to identify lifestyle habits to address and change for improved
occupational performance. Areas identified as having decreased adaptation were as follows:
interests, habits, output, and physical/social environments.
Through use of the COPM and OCAIRS, I was able to develop an accurate occupational profile
and develop relevant, client-centered intervention plans and goals. Ultimately, I used these tools
to identify this client’s areas of improvement upon discharge.
Improvements noted upon discharge included: increased performance and satisfaction in all 4
areas identified as problem areas in the COPM, and the client had improved adaptation in the
areas of interest, habits, and social environments as identified in the OCAIRS. The client
identified 2 goals that she planned to work on after discharge to address the areas of output and
physical environments as identified in the OCAIRS.
PROGRAM DEVELOPMENT
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Criterion 6–Evaluation: Prioritizes Needs
Prioritizes needs related to the client, context, and performance by synthesizing and
interpreting assessment data and clinical observations in mental health.
Guidelines
 Program development refers to the creation of a new program or development of an evolving
program.
1. Dates of program development
October 1, 2, 7, 8, 14, 15, 21, 22, 28 and 29, 20XX. Continued bi-weekly, 4 hours each day
thereafter.
2. Briefly describe the program purpose, services offered, and clients served. (average word guideline–
250)
The program was called “Health Abilities.”
Design:
 1 hour weekly class integrated into an adult day program.
Clients served:
 Seniors age 70+ with a primary diagnosis of severe and persistent mental illness, such as
depression, bipolar disorder, schizophrenia, etc.
 Behaviors that are non-threatening and non-disruptive.
 Referred by their community or state-appointed mental health provider.
Cost:
 The program is not reimbursable by insurance.
 There is a $10/session fee that can be waived based on income assessment.
The purpose of this program is to provide seniors with an opportunity for positive aging by
enhancing their cognitive, physical, social, emotional and mental wellness. It includes purposeful
activities beginning with light sitting exercises and continues with memory games, reminiscing,
exploring new interests, and socialization.
3. Describe how this program development activity demonstrates how you “prioritize needs related to the
client, context, and performance by synthesizing and interpreting assessment data and clinical
observations in mental health.” (average word guideline–500)
There were requests from providers and families in the community for a class at this adult day
program to provide this aging population with a sense of purpose and enjoyment. The existing
program did not address this specific population, and the Activities Coordinator was not
experienced in working with this population.
In addressing this request, part of Administration’s strategic plan was to expand the existing
adult day program to include individuals with the above diagnoses. Their plan involved
developing and integrating a 1 hour class that was structured, yet enjoyable, for communitybased clients who wanted to attend. Administration also directed that this class be offered on
different days 2 times weekly, once in the morning and once in the afternoon.
I work in the outpatient mental health rehabilitation section of this large multi-campus medical
center, and was asked to develop and implement this 1 hour weekly class for the day program,
which had no OT services. I used a three-phase approach to develop this program.
In the first phase, I observed and obtained information regarding the existing activities and
observed the clients and staff interaction in the group activities provided. Classes such as
Current Events were provided by staff reading from the newspaper or clients watching TV and
then discussing the topic. The day program clients varied their time there from 2-8 hours each
day, 1 to 5 times a week.
After assessing the current program, my priority was to develop an intake interview that included
the client’s ADL status (from client, family, caregivers or legally released charts), previous and
current interests and activities that occupied their time throughout the day. I determined a need
to administer the Allen Cognitive Level Screening-5 (ACLS-5) with clients to determine their
cognitive level and potential learning abilities. The score and description of function was noted
and shared with the team, including the staff that would assist me in leading this group.
Although services were in a group format, the knowledge gained from the ACLS-5 was taken into
account for each individual.
Initially the class consisted of 4 clients that were already attending the adult day program, but
did not have a primary diagnosis of severe or persistent mental illness. Their families agreed to
assist in this class development. I conducted the ACLS-5 and intake interviews and determined
that clients who scored 3.2 to 4.8 on the ACLS-5 would be appropriate for the new class.
The Activities Coordinator or nursing aides assisted me in conducting this class. I observed and
noted the clients’ behavior and responses to the activities presented in the class. Based on my
observations of their cognitive abilities, I made adjustments to the class topics and my
facilitation techniques and instructed the staff on these changes.
After 1 month, I recommended that we begin the second phase of this program, which was to
work with outside community mental health providers to refer clients to this class. I determined
the need to screen these clients from outside the established clientele to establish if they would
be more suited for a morning or afternoon session. The morning sessions would be geared
towards clients with limited endurance in order to meet their specific ADL/IADL needs. I kept the
morning and afternoon class topics the same, but provided different levels of facilitation to
promote successful participation and enjoyment for the clients. I provided on-going observations
and assessments based on their cognitive abilities and documented this in their charts.
After another month, I proceeded to the third phase of this program and obtained feedback and
ideas from the clients and family members for any new or additional activities that could be
added to the changing topics. Also, feedback was obtained from family members and mental
health providers on how the clients’ behavior, mood etc. was impacted. The informal feedback
was positive. I then met with Administration to discuss the results of this program
implementation. Administration approved continuation of this class and announced that I had
successfully accomplished this part of their strategic plan.
My ability to integrate, develop, and implement a specific class program within an existing
program demonstrates my ability to evaluate and prioritize the needs of this specific client
population. I was able to synthesize and interpret initial and ongoing assessments, and through
clinical observations, confirm the benefits for the individual client based on their cognitive level.
FORMAL SPECIALIZED CONSULTATION FOR INTERVENTION
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Criterion 8–Intervention: Wellness & Prevention
Provides mental health intervention that incorporates wellness and prevention for clients
(persons, organizations, populations) to optimize present and future occupational engagement.
Guidelines

This should not be confused with consultation that is part of the ongoing services provided in your
routine job duties but is a request to address a particular issue at a particular site, either external
or internal.

Consultation may include (but is not limited to) developing or evaluating a program or service,
developing a strategy for long-term planning, establishing outcomes measures, incorporating
national guidelines into internal policies and procedures, assessing and addressing staff educational
needs, assessing and addressing resource needs, and validating program/service delivery with
current evidence.

Applicant must have had a minimum of 10 hours working with the site.
1.
Entity for Which Consultation
Was Completed
Date(s) of Consultation
No. of Hours Completed During
Consultation
THRIVING (non-profit organization for after-school teens-atrisk program)
20 hours per week, October 1-30, 20XX. Consultation
decreased to 1-2 hours per week in an ongoing capacity once
additional OT staff hired.
80+
2. Objectives for consultation. Objectives must have been met by time of application.
Please list no more than 3.
A) Establish OT’s role, services, and benefits for this grant program for teens with mental health
diagnoses.
B) Develop the OT services section of the program brochure for distribution to community
agencies, clients, and the public.
C) Develop, educate and train existing non-OT staff about the OT groups that are offered.
3. Summarize the consultation results. (average word guideline–200)
I was consulted to assist in developing a Wellness component for an after-school program for
troubled teens. After meeting with staff to understand their vision, I completed the following:
1. Education for staff on OT’s role and ability to assist with this program and its clients.
2. Developed a basic occupational screening process that non-OT staff could incorporate into
their intake interviews.
3. Established group protocols and class content on:
- Self-discovery (including self-esteem, communication, etiquette, and life skills)
- Leisure interests and creative expressions
- Physical well-being
4. Initiated training for non-OT staff on how to facilitate these groups.
5. Provided ongoing revisions and training to the staff on the format, topics and responses
to the teens based on my observations and reports for each group.
6. Developed a draft satisfaction questionnaire as an outcome measure for these classes (for
grant reporting).
7. Completed the OT services section of the program brochure for distribution to community
agencies, clients and the public.
8. Established and worked with staff in creating an educational in-service and handout for
clients, family members, school counselors, etc. to carryover basic communication
techniques and to increase awareness of wellness and prevention tips for this population.
9. Invited to attend team conferences.
10. Obtained approval to add a part-time OTA to co-lead the groups after discussion of their
role in carrying out the intent of OT services.
11. Became a permanent consultant to this program.
4. Summarize how this professional development activity influenced your ability to “provide mental health
intervention that incorporates wellness and prevention for clients (persons, organizations, populations)
to optimize present and future occupational engagement.” (average word guideline–400)
THRIVING, the organization that works with troubled youth, identified a need in the community
to address the increasing problem of teens in trouble or causing trouble after school hours. The
staff obtained grant funds from various agencies to pursue a proactive approach to these
problems, and put in place measures to determine effectiveness in this community. The teens
had diagnoses that included depression, anxiety, substance abuse, etc. The organization felt they
were missing the wellness and prevention piece in their program. The program addictions
counselor, who had worked with OT in the past, identified OT services as a potentially beneficial
addition to this program.
The program offered self-discovery, leisure, and physical well-being groups, but they lacked
structure and guidelines. For example, “creative expressions” allowed watching TV, playing video
games, etc. This lack of structure led to the same attitude and response from the teens as was
seen prior to program admission.
I had the opportunity to demonstrate OT’s role in this type of setting, and how we holistically
address a person’s well-being to include: Occupational profile, Performance, Client factors,
Contexts, Environment, and Activity demands.
I discussed how OT’s ability for activity analysis assists in engaging this population in topics they
can discover and utilize in everyday life. Our background addresses client needs on both an
individual and group basis with a structured, client-centered approach.
The organization requested a trial of OT involvement to show: quality of life improvement for the
teens; positive engagement carryover in school, home and community; and satisfaction with
daily activities. The staff and counselors could observe and individually discuss with the teens
their changes in self-esteem and attitude, and any positive progress they made in achieving their
goals. With this information, staff could request continued grant support, consider expansion of
this model to other nearby communities, and advocate for permanent OT consultation and
services.
My role demonstrates that by integrating structured classes into a concept of wellness of mind,
body and spirit, OT can assist in the prevention of a destructive life-style with this population.
The satisfaction questionnaire has shown positive outcomes, and per staff, family and counselor
informal feedback, the teens’ attitudes were beginning to demonstrate positive change. I am now
a permanent consultant to the program, and I assist the OTA with meeting the intent of OT
services. In addition, the organization asked me to finalize an outcome measure that they will
incorporate into their findings as they pursue long term funding and expansion into nearby
communities.
SELF-ANALYSIS OF VIDEO RECORDING
Table of Contents
Criterion 8–Intervention: Wellness & Prevention
Provides mental health intervention that incorporates wellness and prevention for clients
(persons, organizations, populations) to optimize present and future occupational engagement.
Guidelines
 Submission of actual video recording is not required for application; however, appropriate
permissions should be obtained by applicant whenever engaging a client in a video-taped session.
1.
Age of Client
57
Client Diagnosis(es)
Paranoid Schizophrenia
Setting for Evaluation
Outpatient psychosocial recovery program
Date of Video Recording
10/1/20xx
2. Provide a brief summary of the video contents and how it demonstrates your ability to “provide mental
health intervention that incorporates wellness and prevention for clients (persons, organizations,
populations) to optimize present and future occupational engagement.” (average word guideline–200)
This videotaped session focused on designing a client’s intervention plan. In an earlier session,
an initial evaluation was conducted, and the client identified that obtaining his General
Equivalency Diploma (GED) was very important, and this was his recovery goal. In the
videotape, we identified the smaller steps that he could take to accomplish his goal.
We reviewed his strengths, needs, abilities, and preferences (SNAP). He shared that he has a
very difficult time focusing and attending classes in the community. He would respond to internal
stimuli when activity demands increased; isolated himself when he felt he was not being
understood and supported; and, as a result, had failed multiple times in obtaining his GED.
I suggested that he work on his attendance in a supported environment via classes in this
program. These classes would assist him in: building his self-confidence in communicating his
needs and abilities via Social Skills training; building on his strengths and preferences via
designing a Wellness Recovery Action Plan (WRAP); and expanding his leisure interests to relax
and reduce stress via Creative Expressions.
The client agreed and indicated he understood how these new classes could help him in his
recovery plan. At the end of this video, I scheduled weekly individual meetings to assist and
support him in integrating new skills and techniques to achieve his recovery goal.
3. After reviewing this video, describe the insights you gained, and reflect on how the analysis experience
validated or supported change in your intervention practice. (average word guideline–400)
I use the client-driven recovery approach regularly with clients in this program. I chose this
video since I wanted to validate my practice abilities of working in equal partnership with clients
while developing their intervention plan.
I demonstrated the ability to understand the needs of the client; consider the approaches and
intervention while promoting self-direction, build on their strengths and instill hope. I did not
focus on thought-processing with the client as another professional might, but rather stayed
focused on supporting him to achieve his goals. I acknowledged the client’s concerns, and with
the resources I had to offer, presented them in a way that met the client’s needs and allowed
individual choices.
Although we have preset classes offered through our psychosocial recovery program, I kept in
mind that these classes could still address his individual needs. I informed him of how and why
the classes could benefit him based on his situation. I also informed him that classes can instill
hope, and provided the example of Mary Ellen Copeland, the author of WRAP, who obtained her
PhD despite her mental health provider’s belief and recommendation. He responded well to this
example and voiced his motivation towards pursuing an educational degree.
Through review of this video, I was assured that my body language facilitated a supported
environment. I kept my body relaxed and faced the client. I provided a comfortable professional
space and adjusted the distance when the client appeared to become restless. I listened to my
tone of voice, pace of speech, and responses to the client, which assured me that my
therapeutic style remained motivating and supportive. I facilitated client empowerment by
pausing in between each topic of discussion; enabling him to ask questions and make choices
based on the presented material; and providing guidance on his responses to the topics
discussed. I will continue to expand my approaches when working with individuals who are
having difficulty understanding a recovery approach or challenge the suggestions I provide.
Overall, this video validated my current abilities in working with clients to design interventions
that are client-driven and contextually-relevant by working with the client on his stated goal and
addressing his difficulties using evidence-based class topics to assist him.
PROGRAM/SERVICE EVALUATION
Table of Contents
Criterion 9–Outcomes
Evaluates effectiveness of services delivered, either for caseload or programs, in order to
validate service delivery and make changes as appropriate to maximize outcomes related to
mental health.
Guidelines
 Refers to an activity implemented in a program, department, facility, or organization.
 Should not include any form of standard client documentation (e.g., evaluation summary, discharge
plan) or identification of client name(s) or facility information.
1.
Type of Program/Service Being Evaluated
Occupational therapy services in a 17 day interdisciplinary
outpatient chronic pain rehabilitation program.
Date(s) of Evaluation
January 20XX to December 20XX, 3 years total
2. Describe the caseload or program being evaluated. The context should be adequately communicated
so that relevance and merit to the criterion is easily determined. (average word guideline–300)
This outcomes-based case study was based on a 17 day, outpatient interdisciplinary pain
rehabilitation program that assists clients with chronic pain in attaining functional restoration and
withdrawal from opioid and simple analgesics, rather than curative and interventional
procedures. Persons are encouraged to return to improved activity patterns in regard to selfcare, productive and leisure activities, and to eliminate pain behaviors. Clients must be at least
18 years of age to enter the program, with the average age being 46 years. Clients come from
around the world, with the majority coming from the United States. Typically, clients have had
pain for almost 10 years with a range from 3 months to 65 years. A cognitive-behavioral model
serves as the basis for treatment and incorporates OT, physical therapy, biofeedback, relaxation
training, stress management, wellness instruction (e.g., sleep hygiene, healthy diet), chemical
health education, and pain management training (e.g., activity moderation, elimination of pain
behaviors).
Starting in 20XX, in an effort to better evaluate service effectiveness, I, along with my
colleagues, began utilizing the Canadian Occupational Performance Measure (COPM) with each
client at both program entry and discharge. OTs administer the COPM to obtain each client’s
perceived performance and satisfaction in activities that are important to them. During
treatment, the OTs address improving a client’s occupational performance by assisting in lifestyle
modifications, recommending task adaptations, and educating clients in managing pain through
engagement in meaningful occupations. The OT intervention combines group and one-on-one
discussion and education with hands-on practice of daily activities. Clients are able to
demonstrate both verbal and physical understanding of concepts and techniques through active
participation. OTs also use biofeedback as a tool to assist clients in learning how to perform
relaxation techniques as a means to manage pain.
3. Identify methods or tools used for the program/service evaluation. (average word guideline–200)
Comparison of initial and discharge scores from Canadian Occupational Performance Measure
(COPM) for all clients who completed the program.
4. Summarize evaluation findings. (average word guideline–200)
When evaluating the outcome data of 1,473 clients from January 20XX to December 20XX, it
clearly illustrated positive changes in clients’ functioning, specifically in performance and
satisfaction of activities identified as important to them. When reviewing clients’ overall
performance and satisfaction it was noted that at admission the average performance score on
the COPM was 3.45 and the average satisfaction score was 2.2. At discharge, the average
performance score rose to 7.03 and satisfaction also rose to an average of 6.84.
When analyzing the data in regard to gender differences, males scored significantly higher in
satisfaction at admission, and females scored significantly higher in performance and satisfaction
upon discharge. At admission, the average male satisfaction score was 2.4 and 2.2 for females.
At discharge, scores rose to 6.7 and 8.39 respectively. Females and males did not differ in a
statistically significant manner in performance upon admission. At admission, the average male
performance score was 3.56 and 3.44 for females. At discharge, scores rose to 6.78 and 7.15
respectively.
Finally, data analysis for outcomes for the 5 most prevalent diagnoses – including fibromyalgia,
low back pain, generalized limb pain, abdominal pain, and headache pain –indicated that
changes in performance and satisfaction, from admission to discharge, were statistically
significant based on diagnosis. For the most prevalent diagnostic groups, admission scores rose
to a range of 6.62 to 7.42. Performance ranged from 3.29 to 3.62, and at discharge these scores
rose to a range of 6.91 to 7.41. Satisfaction scores at admission ranged from 2.09 to 2.44 and at
discharge had risen to a range of 6.62 to 7.42.
5. What actions were taken in response to the findings? (average word guideline–300)
Through a formal evaluation of this program, we were able to validate a number of approaches
that had been established. We considered that, although programming is primarily provided in a
group setting, individual one-on-one sessions might be geared to clients more specifically based
on gender and diagnosis in order to provide greater individualization and potentially improved
outcomes, since heterogeneous client populations did not always respond equally. This is
something we continue to explore.
6. Summarize how this program evaluation demonstrates your ability to “evaluate effectiveness of
services delivered, either for caseload or programs, in order to validate service delivery and make
changes as appropriate to maximize outcomes related to mental health.” (average word guideline–
300)
I feel that this service delivery evaluation of a chronic pain program, that uses a cognitivebehavioral approach rather than a curative and interventional approach, illustrates my ability to
evaluate the effectiveness of services delivered. As this is an interdisciplinary pain program,
outcomes could not specifically be linked to OT alone. However, through use of the COPM, we
were able to validate that this interdisciplinary pain rehabilitation program (that incorporated OT
interventions), improved both clients’ performance and satisfaction in activities that were
important to them and enabled their return to occupations they reported to be more satisfying.
RESEARCH
Table of Contents
Criterion 9–Outcomes
Evaluates effectiveness of services delivered, either for caseload or programs, in order to
validate service delivery and make changes as appropriate to maximize outcomes related to
mental health.
What type of research was conducted? Please choose 1.
☐ Scientific inquiry–Qualitative, quantitative, or mixed-methods approach.
☐ Methodological research/instrument development–Scientific inquiry to establish
psychometric properties of (1) a new tool, (2) an existing tool with a new population, or (3) an
existing tool translated to a new language.
☐ Systematic review of the literature–Comprehensive search, review, and analysis of the existing
literature to answer a focused question.
1. Title of research conducted.
A Client-centered, Occupation-Based Occupational Therapy Programme for Adults with
Psychiatric Diagnoses.
2. Mechanism of dissemination:
X
Publication
☐ Peer-reviewed presentation
☐ Grant funding
☐ Critically Appraised Topic (CAT, e.g., AOTA Evidence-Based Practice Project Web site)
☐ Dissertation/thesis
Citation:
Schindler, V. (2010). A client-centred, occupation-based occupational therapy programme for
adults with psychiatric diagnoses. Occupational Therapy International, 17, 105-112.
3. Role of applicant in the research. (average word guideline–25)
I was the primary investigator and the sole author of the publication.
4. Purpose and rationale of the research. (average word guideline–250)
Client-centered and occupation-based are core concepts of OT. Client-centered is “an approach
to service which embraces a philosophy of, respect for, and partnership with, people receiving
services” (Law, Baptiste, & Mills, 1995, p. 253; Law & Mills, 1998). Occupation-based OT is “a
client-centered intervention in which the OT practitioner and client collaboratively select and
design activities that have specific relevance or meaning to the client and support the client’s
interest, needs, health, and participation in daily life” (AOTA, 2008, p. 672; Crepeau, Cohn, &
Schell, 2009, p. 1162).
Individuals diagnosed with mental illness experience functional impairments that negatively
affect performance in occupations (Bonder, 2004; Mairs and Bradshaw, 2004). Occupationbased intervention addressing participation in client-centered occupations is proposed to
enhance life for individuals diagnosed with mental illness (Chan, Krupa, Lawson, & Eastabroook,
2005; Legault & Rebiero, 2001).
The purpose of this study was to assess the effectiveness of a client-centered, occupation-based
OT program in a post-secondary/college setting for individuals with mental health diagnoses in
achieving client-centered goals based on the Canadian
Occupational Performance Measure (Law et al., 2005). The rationale for the study is that if
client-centered and occupation-based activities are proposed to address functional impairments
for individuals diagnosed with mental illness, then these core components of OT need to be
researched for effectiveness.
5. Describe how this research demonstrates your ability to “evaluate effectiveness of services delivered,
either for caseload or programs, in order to validate service delivery and make changes as appropriate
to maximize outcomes related to mental health.” (average word guideline–400)
This demonstrates my ability to meet the criteria because this research study, and the
subsequent article based on the study, assessed the effectiveness of a client-centered,
occupation-based OT program (i.e., intervention) for individuals with psychiatric diagnoses.
Thirty-eight participants included current and former college students and community members
who desired to remain in or return to college and/or work. The Canadian Occupational
Performance Measure (COPM) was used as a pre-and-post test measure. Goals were based on
the clients’ identified occupational performance problems as reported in the COPM and reflected
occupation-based problems in areas of academia (higher education), work, life skills, social
participation and leisure as they relate to higher education and work.
The goals were systematically addressed weekly through activities developed by the participant
and a graduate OT student serving as a mentor. A case study was used to describe the program
in further detail. The results confirmed that the client-centered, occupation-based OT program
increases client scores on satisfaction and performance of occupational performance problems
identified on the COPM.
Implications of the study showed that assessment and intervention based on a client-centered,
occupation-based OT program positively affect clients’ perception of change in self-identified
problem areas of occupational performance. Changes I made as a result of the study included
using the COPM as a pre-and-post measure on a regular basis, and requesting ongoing client
feedback to ensure that interventions in the program are consistently client-centered and
occupation-based.
HOLISTIC PRACTICE CASE STUDY
Table of Contents
Criterion 10–Holistic Practice
Holistically addresses the client’s needs, including physical, social, and emotional well-being,
that may impede occupational performance.
1. Identify the primary reason for referral:
☐ Physical
☐ Social
X Emotional
2. Date(s) case study represents.
January 15 – February 28, 20XX
3. Describe the client, client factors, and case contexts for the identified case. (average word guideline–
300)
This holistic practice case study is based on a 68 year old widowed female. She was referred to
OT for emotional regulation because she was acting out in an aggressive manner at the skilled
nursing home where she was a resident prior to her admission to the hospital’s medical
psychiatry unit. Her diagnoses included, but were not limited to, depression, generalized anxiety
disorder, and multiple sclerosis.
During a semi-structured interview, she identified that she was feeling a lack of control over her
environment, and did not feel that her needs were adequately being met at the nursing home
where she had resided for the past year. She reported fear of falling when getting in and out of
bed, and felt misunderstood by staff at the facility.
As a result, she began physically acting out and directing her aggression towards nursing home
staff members. The client indicated that she lacked a support system since she had no children,
no family in the area, and had lost contact with friends that she had when she lived in the
adjoining assisted living facility where she resided prior to her skilled nursing home admission.
4. Describe the other client needs (physical, social, emotional) you identified over the course of service
delivery and how you addressed these needs. (average word guideline–100)
In addition to addressing the client’s emotional regulation by working on communication skills,
relaxation skills, and diaphragmatic breathing, I worked with her to address her social and
physical needs. We identified barriers to her socialization and explored how she could increase
socialization by reconnecting with past friends. To address her physical needs, I worked with her
on adaptive and safety equipment to increase her safety and independence with activities of
daily living as well as addressing bed mobility and transfers.
5. Articulate how this case demonstrates your ability to “holistically address the client’s needs, including
physical, social, and emotional well-being, that may impede occupational performance.” (average word
guideline–500)
First, this case demonstrates my ability to address the client’s physical needs. When working
with clients in the medical psychiatry unit, my evaluations consider both physical and mental
health needs. After evaluating this client, I determined that her physical deficits included limited
bed mobility and transfer skills that interfered with her ability to get into her wheelchair and
maneuver in her environment. In addition, she was no longer able to don her ankle foot orthosis
or manage lower body dressing skills. While she was in the hospital, I began to work with her on
transfer skills and modifications to her ankle foot orthosis that would increase her ability to don
it. Prior to discharge, I requested our consultant place an order for OT in the discharge summary
for further services once she returned to the skilled nursing facility. I also included specific
recommendations in her discharge summary so the OT could continue to address her physical
needs.
Second, this case demonstrates my ability to address the client’s social needs. While working
with her during her hospitalization, the client was sociable and had a good understanding of
social etiquette. Unfortunately, she had no social connections except with professionals working
at the nursing home. In the adjoining assisted living facility, there were 2 women she had
become good friends with when she lived there. I worked with her to create a plan for seeing
these women on a weekly basis. This plan required calling the recreational therapy department
at her nursing home to see how we could reconnect with these women. Although details were not
finalized before her discharge from the hospital, the plan was initiated to assist these women in
reconnecting on a weekly basis, with staff available to escort them as needed.
Lastly, I addressed the emotional needs of the client in a variety of ways. By assisting her in
becoming more socially re-connected, she had additional outlets to communicate her fears and
anxieties. We began to explore her communication style, which she noted had become more
aggressive since she became more frustrated with her decreased mobility. In addition, I
addressed her difficulties with emotional regulation by teaching her slow paced diaphragmatic
breathing and relaxation techniques. I taught her how to use these skills on a daily basis much
like an exercise routine. I also taught her how to use these skills functionally to 1) decrease her
anxiety when preparing to transfer out of bed with the assistance of others, and 2) when
experiencing stress during communication with particular staff at the nursing home.
In conclusion, this case study demonstrates my ability to work with a client in a holistic manner,
addressing physical, social, and emotional needs, regardless of the primary reason for the
referral. In working with this client on all aspects of her well-being, I facilitated her return to her
prior living environment with increased ability to perform daily occupations.
ETHICAL PRACTICE SCENARIO (Part 1 of 3)—Client Based
Table of Contents
Criterion 11—Ethical Practice: Client-Based
Identifies ethical implications associated with the delivery of services in [area] and
articulates a process for navigating through identified issues.
Guidelines
 The applicant identifies ethical implications associated with the delivery of services and articulates a
process for navigating through the identified issues.
 The applicant shall review the AOTA Code of Ethics and Ethics Standards and align the dilemma with
the ethical principle(s) that is/are challenged.
Ethical Scenarios
Scenario #1
Scenario #2
Scenario #3
An OT is working with a client who is progressing in treatment and is learning how to make
choices for his own benefit. He is considering moving out of his sister’s apartment and into a
boarding home. The therapist feels the client would be successful with his choice. The client’s
sister insists that her brother is unable to make his own decisions and needs to live with her.
The client has not signed a release of information for the therapist to share information with his
sister.
1. To which scenario are you responding? 3
2. From the AOTA Code of Ethics and Ethics Standards, which ethical principle(s) has/have been
challenged in this scenario? Select the top ethical principle(s) that apply, up to a maximum of 3.
1.
2.
3.
4.
Beneficence
Nonmaleficence
Autonomy, Confidentiality
Social Justice
5. Procedural Justice
6. Veracity
7. Fidelity
3. Describe how you would apply the ethical principles identified above to guide you toward a
resolution for the concern noted. (average word guideline—500)
v
In the scenario presented, I would apply the ethical principles of beneficence, autonomy and
confidentiality to navigate through the identified issues. The ethical issues presented include:
the need to protect and defend the client’s right to choose his living environment, regardless of
his sister’s opinion; the fact that the sister is speaking with the therapist without a signed
release of information for the therapist to share confidential information; and the therapist
“feeling” that the client may be ready to live in a boarding home without any mention of an
evidenced-based evaluation being completed to determine if he has the skills to do so.
To start, I would consider the principle of beneficence. Adhering to this principle, I would use an
evidence-based evaluation identifying the client’s strengths and weaknesses in regard to
occupational performance to determine if he has the skills necessary to successfully live in a
boarding home. By performing this evaluation, it enables me to effectively assist him, as
needed, in improving his functional abilities and educate him in compensation techniques to
ensure his well-being and safety. Based on the evaluation outcome, I would share
recommendations that would assist him in maintaining safety and provide strategies that would
allow him to function at his best. Best practice allows the client to come to his own conclusion
regarding his choice of living environment. In this scenario, beneficence means honoring the
client’s right to make care decisions directly impacting his life and letting this decision reside
with him alone. Although the decision would be his, I would encourage him to collaborate with
others who serve as his support system to discuss the risks, benefits, and potential outcomes of
his decision.
Next, I would consider the principles of autonomy and confidentiality. If the client did not have
a legal guardian or power of attorney, I am obligated to respect the rights of the client no
matter what his decision may be. In regard to the client’s sister, I should handle this situation
tactfully. When in contact with the sister, I would not share confidential information, but
instead, encourage her to share her concerns with her brother and ask him if he would allow
her to attend an upcoming therapy session. I would also speak with the client about sharing his
desires and goals with his sister and inviting her to a therapy session to increase her
understanding of his functioning and strategies he is using to improve his performance skills.
Prior to any meeting with the two of them together, I would discuss with the client what
outcome he would like to achieve during the session, and I would facilitate open and
collaborative dialogue. If his sister continues to be insistent that her brother cannot make his
own decisions, I would speak with her regarding my ethical obligation to her brother in allowing
him to make his own decisions. My duty is to protect and defend the rights of the client,
preserve his dignity and individuality, and assist him in reaching his goals.
ADVOCACY CASE STUDY
Table of Contents
Criterion 12–Advocating for Change
Advances access to services or influences policies or programs that promote the health and
occupational engagement of clients (persons, organizations, populations) in the mental health
practice area.
Guidelines
 Efforts toward change that influence access to services or promote the health and occupational
engagement of clients.
 This should not be confused with routine job duties associated with expected occupational therapy
service delivery. For example, submitting letters of necessity for equipment would not meet intent.
1. Date(s) case study represents. October 20XX – July 20XX
2. Describe the client (person, organization, population) or program and the context as it applies to an
identified need for change. (average word guideline–100)
The clients in this case study are served by OT’s in the mental health subdivision of a physical
medicine and rehabilitation (PM&R) department. Services provided to these clients occur in a
separate hospital on the campus, and a subset of therapists provide services throughout the
year. Identified needs for advocacy over the past 5 years have been threefold. First, there has
been a need to educate the mental health hospital’s interdisciplinary team including
psychologists, psychiatrists, physician assistants, and nurses as they demonstrate limited
knowledge of the role and scope of services provided by OTs. Second, the PM&R department
transitioned to a 7 day a week therapy model but omitted making this change in the mental
health hospital. This resulted in a disparity of service provided to clients with physical disabilities
and illnesses compared to those with mental illnesses. Finally, there has been a need to advocate
for additional OT staff in the mental health hospital since the staff to client ratio was no longer
meeting client needs due to increased referrals and program development
3. Summarize your efforts to influence change. (average word guideline–200)
In an effort to influence change at my work site, I began to participate in monthly staff meetings
held in the individual mental health units. I provided education at these meetings regarding our
scope of practice, how we can assist clients in successfully returning to the community, and
reducing re-hospitalizations. I also started a documentation sub-committee to revise our
documentation so it can serve as an educational tool for other providers to better understand our
role and the importance of our services.
In an effort to increase staffing in the mental health hospital, I participated in informal and
formal discussions with my supervisor, manager, and head of my department to help them stay
abreast of changes and trends in the mental health hospital and identify opportunities for
growth. I met with consultants in the mental health hospital to share our interest in expanding
services in the adolescent and eating disorders units. Finally, when the PM&R department began
to transition to providing 7 day a week therapy for clients in the medical hospital, I advocated
that the same services should also be available to clients in the mental health hospital.
4. Describe the change outcomes or progress toward change as a result of your efforts. (average word
guideline–200)
As a result of my advocacy efforts, I have evidence that the interdisciplinary team in the mental
health hospital has a better understanding of our role in client care. Consultants and nurse
practitioners now write orders for services with specific directives or questions to be considered
when working with clients. Communication has improved as staff often asks us what they can do
to assist clients in moving forward with their OT specific goals. Prior to the education, staff
knowledge of the role of OT was limited to providing assistance in symptom management by
teaching relaxation techniques.
My advocacy efforts created excitement concerning potential involvement in the inpatient
adolescent and eating disorders units in the mental health hospital and have led to OT being
invited to share how we can assist clients in 2 new outpatient programs, one of which is currently
being piloted with OT involvement. Successful advocacy also led to the staff increasing from 1.5
to 4 FTE serving the mental health hospital over the past 5 years. Finally, advocacy has resulted
in individual and group programming now being provided on weekends in the mental health
hospital.
5. Articulate how this case demonstrates your ability to “advance access to services or influences policies
or programs that promote the health and occupational engagement of clients (persons, organizations,
populations) in the mental health practice area.” (average word guideline–500)
The advocacy efforts illustrated in this case demonstrate my ability to educate others in the role
of OT in mental health and, as a result, advance access to mental health OT services and
influence departmental policies.
By participating in mental health staff unit meetings, OT plays a more visible role in service
provision rather than just being a “consult service” from the department of physical medicine
and rehabilitation. Since OTs in our mental health hospital are employees of physical medicine
and rehabilitation, rather than employees of psychology and psychiatry, our role in mental health
can be misunderstood by those in PM&R as well as those in the mental health hospital. By
meeting individually with consultants and nurse managers on the mental health hospital units, I
have been able to share how OTs currently serve clients and can become creatively involved with
other populations such as offering groups in our adolescent unit, acute psychiatry unit, and with
clients with eating disorders. As staff in the mental health hospital increase their understanding
of the potential of OT involvement and what services can be offered to enhance programming,
they have been very welcoming and have served as advocates when OT FTE proposals have
been brought forward by PM&R to increase staffing in the mental health hospital.
In addition to advocating through education, my ability to advance access to services was
evident in my role of increasing access to OT services in new programming. As new outpatient
programs have been proposed, I have diligently attended all planning and proposal meetings to
make sure OT was well-represented and that our role in mental health would be better
understood. I felt it was necessary to have an OT with mental health experience available to
ensure our unique skills would be utilized appropriately and effectively in the program, even
though my supervisor and manager would be present, since they had little to no experience
providing mental health OT services.
Finally, this case demonstrates my ability to advance access to services in regard to influencing
departmental policies such as weekend therapy provision. When the PM&R department decided
to transition to 7 days a week therapy, it was initially considered only in the physical disabilities
hospital setting. I felt very strongly that clients in the mental health practice should be afforded
the same opportunities for services as those hospitalized with physical illnesses in order to
reduce mental health disparity. With increasingly shorter hospital stays it is imperative to not
miss an opportunity to work with clients during 2 of the 5-7 days they may be in the hospital. I
felt it was important to share that services should be provided equally and that it would be
discriminatory not to do so.
ADVOCACY EFFORTS
Table of Contents
Criterion 12–Advocating for Change
Advances access to services or influences policies or programs that promote the health and
occupational engagement of clients (persons, organizations, populations) in the mental health
practice area.
Guidelines
 Active involvement in or facilitation of advocacy activities at the local, regional, state, or national
level for the purpose of influencing decision-makers about policy, procedures, services,
reimbursement, or occupational justice issues.
 Merely serving as a participant does not constitute advocacy efforts.
 Minimum of 10 hours over at least 2 months.
Type of advocacy activity: (check all that apply)
X Development and dissemination of advocacy materials (e.g., letters, brochures, Web sites,
podcasts)
X Lobbying to/education for policy-makers
☐ Organizer of community event (e.g., fundraising, health fair)
☐ Subject expert in media interview (e.g., radio, television news, newspaper)
☐ Presentation to stakeholder
☐ Other
1.
Description of Activity
Lobbying to Policy Makers
Development of Service
Brochure
Dissemination of Brochures
at Health Fair
Target Audience
No. of Hours
Involved
Date(s)
Hospital administrators and
mental health department
providers
Adults of varying ages who
seek to improve
participation in their daily
occupations
June 4, 12, and
15, 20XX
8
August 1-15,
20XX
4
Hospital patrons, their
family members, and
Hospital staff
August 20, 20XX
3
2. Applicant’s objectives for advocating for change. List no more than 3.
A) Increase access to care for clients in need of outpatient mental health services
B) Increase awareness of a new mental health OT program available in our organization in order
to increase referrals.
C)
3. Discuss the results, outcomes, or progress toward change affected by this advocacy effort that
demonstrates how you “advance access to services or influences policies or programs that promote the
health and occupational engagement of clients (persons, organizations, populations) in the mental
health practice area.” (average word guideline–350)
My advocacy efforts included: lobbying to hospital administrators and mental health providers,
development of service brochures, and dissemination of printed materials at the annual
community health fair.
I identified the need for an outpatient OT step-down program through monitoring the
readmission rate of inpatient psychiatric patients over a 6 month period, having discussions with
hospital providers who treated these patients, and collecting satisfaction surveys completed by
previous mental health patients. After identifying the need for a new program, I began lobbying
to hospital administrators and other mental health providers for approval.
I began with one-on-one meetings with hospital administrators, and after gaining approval at
that level, expanded my efforts to include presentations at weekly staff meetings for the
hospital‘s mental health department. These presentations provided mental health providers with
information on the status, progress, and ultimately, the referral process and program
design/content.
The program that I advocated for was comprised of 2 group therapy OT sessions a week for 2
weeks that addressed topics such as stress management, leisure participation, effective
communication, and goal setting. The program was designed to improve participation in and
satisfaction with daily occupations, as stated above, by providing patients with a place to practice
and discuss new strategies and life skills to implement into their daily lives. Patients were given
assignments and homework to practice the skills they learned in the sessions.
Through lobbying to hospital administrators and mental health department providers, I was
authorized to develop and institute the outpatient OT mental health step-down program, and I
provided them with new program information as an additional mental health resource within the
hospital. The development and distribution of service brochures enabled us to reach an additional
350 potential clients who attended the hospital health fair in August. We provided these
customers with information on available OT mental health services and the program referral
process. Through these actions, we were able to provide outpatient OT services to 100 new
clients in the past 3 months, and have scheduled 12 new clients for each of the next 6 OT
outpatient step-down program cycles.
VOLUNTEER LEADERSHIP
Table of Contents
Criterion 12–Advocating for Change
Advances access to services or influences policies or programs that promote the health and
occupational engagement of clients (persons, organizations, populations) in the mental health
practice area.
Guidelines
 Service with a local, state, national, or international agency or organization that has relevance to
the criterion.
 Minimum of 25 hours for at least 1 year.
1. Name of organization
Mental Health Advisory Board of Anytown County
2. Dates of service
January 20XX - present
3. Approximate number of hours of service
I serve 3 hours per month from January-June and September–December at Board meetings (30
hours per year). In addition, I spend 2-4 hours per month reviewing information and preparing
for meetings.
The Mental Health Advisory Board meets at 4:30 PM on the first Thursday of the month.
The Board does not meet in July or August.
4. Identification of the volunteer leadership role served (must be leadership in nature, e.g., officer, chair,
committee member, board member)
I serve as a Board Member on the 12-member volunteer Anytown County Mental Health Advisory
Board. I was appointed to this position in 20XX. A member must be an Anytown County resident
and not be affiliated with, or have a family member affiliated with, any agency or program
funded by the State Division of Mental Health Services. Some knowledge of, or an interest in
mental health services is helpful. I was appointed to the Board based on my clinical and
academic credentials in mental health.
The Mental Health Advisory Board serves as an advocate and advisor to the county executive
and the State Division of Mental Health Services (DMHS). Board members are knowledgeable
concerning state and county mental health services and regularly review these services. In
addition, the Board advises and makes recommendations on the development of policies and
procedures addressing community mental health programs.
5. Describe how this leadership activity helped you to “advance access to services or influences policies
or programs that promote the health and occupational engagement of clients (persons, organizations,
populations) in the mental health practice area.” (average word guideline–400)
As a Board member, I review existing services on a yearly basis including: 1) boarding home
services; 2) effectiveness of Programs for Assertive Community Treatment (PACT) services in
reducing recidivism; 3) results of quality review surveys conducted at the local state psychiatric
hospital; and 4) results of annual quality review surveys conducted at the partial care programs
in our county. As a result of these reviews, I collaborated with other Board members to make
recommendations for change in the following areas:
Boarding Homes–The Board recommended that the local mental health association increase the
transportation available for the Boarding Home outreach program and provided increased funding
for van transportation.
PACT Services–The Board recommended that the PACT teams include a Peer Support Counselor
position on each of the teams. The Board successfully petitioned the State to fund this position.
State Hospital–Quality review surveys show that patients have too much idle, unoccupied time.
This has resulted in increased incidents. As the member of the Board with OT expertise, I
provided information to the Board members concerning the benefits of occupational engagement
in meaningful activities. Model programs and evidence supporting occupational engagement was
provided. As a result, the Board made a recommendation to the State hospital to increase
evening and weekend programs, and that an OT should design these programs.
Partial Care Programs–Results of quality review surveys show that clients were physically present
in the group sessions but non-participative (sleeping, reading the newspaper or other activities).
The Board recommended that the partial care staff conduct client focus groups to learn the types
of interventions that clients believe will meet their needs. The Board recommended that survey
results be presented to the Board by June 20xx.
By reviewing existing programs and making recommendations for change, my volunteer
leadership position as a Board member has advanced access to services and influenced policies
and programs that promote the health and occupational engagement of clients in the mental
health practice area. By providing more transportation in the Boarding Home Outreach Program,
a greater number of individuals can participate in community wellness programs and recreation
events. The addition of a Peer Support Counselor on the PACT teams provided a peer for
individuals to discuss and problem-solve the challenges of living with a mental illness. Increased
evening and weekend programs at the state hospital, with an emphasis on occupational
engagement, promoted greater involvement in meaningful activities with a corresponding
decrease in incidents. Focus group surveys at the partial care programs will increase clientcentered care and survey results will be examined by the Board to evaluate the need for an
increase in quantity and/or quality of client-centered interventions to promote occupational
engagement.
NETWORKING CASE STUDY
Table of Contents
Criterion 13–Accessing Networks & Resources
Negotiates the service delivery system to establish networks and collaborate with team
members, referral sources, or stakeholders to support clients’ occupational engagement.
Guidelines
 The networking case study should reflect an understanding of the system in which you work and an
ability to access resources outside of your routine work group and referral pathways.
 The networking case study should not include any form of standard client documentation (e.g.,
evaluation summary, discharge plan).
1. Date(s) case study represents. September 20XX – April 20XX
2. Identify the problem(s) that interfered with the client’s (person, organization, population) occupational
engagement. (average word guideline–100)
Linda was a 51 year old undergraduate student pursuing a degree in psychology. She was
diagnosed with schizophrenia as a young adult and had been pursuing an undergraduate degree
on a sporadic basis for many years. At the college where I work, I have directed an OT-based
supported education program for the past 8 years for enrolled undergraduate students with a
mental health diagnosis. This program is entitled the Bridge Program. Linda presented to the
Bridge Program with a long history of chaos and failure in her academic career. She was
experiencing an increasing number of personal stressors that interfered with successful class
work.
3. Identify the key networks or resources you established or accessed to address the problem. (average
word guideline–100)
Key networks or resources identified for Linda included other students in her classes, faculty
members for classes in which she was enrolled, the Office of Student Disabilities and the Office
of Computer Services. For the College’s Office of Student Disabilities (OSD), the Bridge Program
is the primary program for intervention for students with mental health diagnoses whose
symptoms negatively impact academic performance. The Bridge Program is also part of the
College’s retention plan for students with mental health diagnoses. The Bridge Program is
advertised to students via email, posters, and word-of-mouth, and students are referred through
the OSD, faculty members, or self-referral.
4. Articulate how this case demonstrates your ability to “negotiate the service delivery system to
establish networks and collaborate with team members, referral sources, or stakeholders to support
clients’ occupational engagement.” (average word guideline–500)
This case demonstrates my ability to negotiate the service delivery system within my college
since I developed and implemented a plan that provided specific, occupation-based interventions
that linked the client to resources to support her occupational engagement.
The first resource I identified for Linda was the Bridge Program, as it is the primary service
delivery system for students with mental health diagnoses. Linda learned of the program through
a college-wide advertisement (poster) and self-referred. Her involvement in the Bridge Program
started with an initial evaluation and interview where it was discovered that she had 4 courses
that involved 2 components that had proven difficult for her: group work and computer skills. It
was also discovered that she was not yet linked to the Office of Student Disabilities, or to any of
the services provided by the OSD. Additionally, her computer skills were very limited, and she
had not yet attended any of the free Microsoft Office computer classes.
Next, I collaborated with the Office of Students with Disabilities where Linda was referred and
where she received accommodations according to the ADA, as well as psychological
interventions. Linda scheduled regular counseling sessions with this office and communication
was maintained between Linda, the counselor, and OT. During the semester, Linda struggled
with feelings of depression and anxiety due to a death in her family and a difficult class. As a
result, she was unable to complete assignments over a 2 week period. I met with Linda, a staff
member from the Office of Students with Disabilities, and her mentor from the Bride Program to
discuss this issue and Linda’s emotional state. Collaboratively, it was decided it would be
beneficial for her to withdraw from the difficult class. Once this was accomplished, she was able
to regain focus and successfully complete the remaining classes.
The Office of Computer Services was also part of the network to address the computer skills
necessary for successful completion of assignments. Initial work began in the Bridge Program
learning new computer skills (e.g. Excel, student email, use of a flash drive) until Linda was able
to demonstrate each skill independently. At this point, Linda’s skills were at the level that she
could successfully participate in computer classes offered at the college. Assistance was provided
to her to identify and enroll in relevant classes.
At the end of the semester Linda successfully completed 3 of 4 courses (she previously withdrew
from 1 course as mentioned above). Through OT and psychological counseling, she began to
address the impact of unforeseen difficult events on her symptoms of depression and anxiety and
the necessity to adjust her workload to positively cope with stressful situations. She learned of
other services provided through the Office of Computer Services and scheduled a few additional
classes to attend during the semester break. Finally, Linda enrolled in the Bridge Program for the
next semester and maintained her enrollment in the Office of Students with Disabilities.
By holistically addressing Linda’s needs, this case encouraged me to identify and contact other
networks within the college’s service delivery system in order to support Linda’s successful
engagement as a college student. By working with these networks, I initiated relationships with
staff in the OSD and the Office of Computer Services that resulted in ongoing collaboration
between these two offices and the Bridge Program.