Date Presented 04/04/19
This poster presents a model OT treatment template for veterans with PTSD. Utilizing a modified Delphi method of consensus attainment, the study surveyed Canadian OTs to identify treatment template components. The resulting treatment template is present-focused, occupation-focused, occupation-based, and built upon the Canadian Model of Occupational Performance and Engagement, Behavioral Activation, and Acceptance and Commitment Therapy.
Primary Author and Speaker: Steven Gerardi
PURPOSE: Posttraumatic stress disorder (PTSD) affects many combat veterans and is known to adversely impact everyday life activities. Occupational therapists treat veterans with PTSD but there is little evidence in the literature to support occupational therapy (OT) intervention with this population. Specifically, occupational therapists lack a validated OT treatment approach developed expressly for veterans with combat-related PTSD. This poster presentation summarizes the findings of a recent study conducted to address this need. The purpose of the study was to develop a consensus-based OT treatment template for veterans with combat-related PTSD.
DESIGN: This quantitative study utilized a modified Delphi method of consensus attainment to identify components to be included in an occupational therapy treatment template.
METHOD: The study employed two iterative online surveys and a planned focus group with Canadian occupational therapists to develop a consensus of opinion on what should be included in an OT treatment template. Canadian occupational therapists who identified mental health as a practice area where invited to participate in this study. Surveys consisted of questions which were rank ordered or rated on a Likert scale. Question topics were drawn from the literature and a previous pilot study. Item results are presented as the percentage of responses attributed to each response level. Participants rated the components selected for inclusion in the treatment template to determine a consensus of opinion. Consensus of opinion was defined as 75% of panelists rate an item as strongly agree/agree or disagree/strongly disagree. Those items that reached the 75% threshold of agreement were continued to be included in the treatment plan template. Those items that failed to meet the 75% threshold for consensus of agreement were excluded from the treatment template.
RESULTS: The study resulted in a consensus-based treatment template that employs five program goals, is present-focused, and is based upon theoretical foundations from one OT practice model, the Canadian Model of Occupational Performance and Engagement, and two cognitive-behavioral therapy treatment models, Behavioral Activation, and Acceptance and Commitment Therapy. The template utilizes six occupational therapy assessment tools: (a) the Canadian Occupational Performance Measure, (b) the Role Checklist, (c) the Occupational Questionnaire, (d) the Modified Interest checklist, (e) the Self-efficacy Scale, and (f) the functional assessment of the impact of stress triggers and avoidance behaviors on occupational functioning. The template also employs six specific interventions: (a) education on the cause of PTSD, stress reactions, and how it affects function; (b) life skills training; (c) mindfulness techniques; (d) cognitive and sensory grounding techniques; (e) cognitive restructuring of cognitive distortions; and (f) engagement in scheduled, graded, meaningful occupations and activities to support occupational roles, habits and routines.
CONCLUSION: The information derived from the study is presented as a model OT treatment template for veterans with combat-related PTSD that is both occupation-focused and occupation-based. The consensus-based treatment template is present-focused, addressing occupational performance in the present, rather than focusing on the past traumatic event.
The findings of this study are important in that they may serve as a foundation upon which to build a manualized OT intervention for clients with PTSD. This will enable us to demonstrate how our intervention is occupation-focused, and will enable us to compare the OT intervention against other forms of treatment.
References
Gerardi, S. M. (2016). Development of a Manualized Occupational Therapy Intervention for Posttraumatic Stress Disorder. (Unpublished doctoral capstone project). South University - West Palm Beach, FL
Gerardi, S. M. (2017). Development of a consensus-based occupational therapy treatment template for veterans with combat-related posttraumatic stress disorder: A delphi study. (Doctoral dissertation). Retrieved from https://twu-ir.tdl.org/twuir/bitstream/handle/11274/9382/2017Gerardi.pdf
