© Springer International Publishing Switzerland 2015Ingrid Söderback (ed.)International Handbook of Occupational Therapy Interventions10.1007/978-3-319-08141-0_35
35. Illness Management Training: Transforming Relapse and Instilling Prosperity (TRIP) in an Acute Psychiatric Ward: A User’s Perspective
Occupational Therapy Department (Psychiatric), Pamela Youde Nethersole Eastern Hospital, 1/F, East Block, Hong Kong (SAR), China
Occupational Therapy Department (Psychiatric), J3, Queen Mary Hospital, Hong Kong (SAR), China
Siegfrid Wing-Kin Lee
Participation in transforming relapse and instilling prosperity (TRIP), using the strategies learned from illness management including knowledge enhancement, behavioral tailoring, relapse prevention development, cognitive behavioral technique, and related coping skills (Mueser et al., Psychiatr Serv 53:1272–1284, 2002), helps the clients adhere to treatment recommendations and minimize relapses. Moreover, TRIP leads them to identify ways to redesign or reestablish a goal-driven healthy lifestyle. By learning how to manage their illness effectively, participants can be further reinforced to take part in their respective occupations.
KeywordsAcute psychiatryHealthy lifestyleIllness managementPsychoeducationSchizophrenia
Transforming relapse and instilling prosperity (TRIP) is a ward-based intervention program that aims to decrease treatment noncompliance and relapse by improving insight and health during the visits to acute psychiatric care of clients with schizophrenia.
Statements: The Theoretical Framework of the Intervention
Transforming relapse and instilling prosperity (TRIP) connotes the notions of relapse reduction and health promotion within the program (Chan et al. 2007) by using strategies. It is originally a ten-session psychoeducation program which provides information on illness and relevant skills for coping with symptoms, and a goal-driven, healthy lifestyle is reestablished or designed with the participants. It implies a positive experience of learning and enrichment during a short journey in the hospital.
Traditionally, during an acute stage of hospitalization, due to unstable mental state and restrictions of the ward environment, clients usually follow structured occupational therapy programs consisting of typical work, rest, and leisure activities which aim at the promotion of purposeful engagement and maintenance of healthy activity to assist them in rebuilding basic daily routines. However, such programs cannot fully help them reintegrate into the community on discharge and prevent their relapse, and therefore TRIP was developed to fill this gap. Since the inception of the first version of TRIP, the awareness of illness management along the pathway of recovery process has alarmed the person in recovery (Davidson 2008) as well as the clinicians (e.g., Salyers et al. 2009; Whitley et al. 2009). In view of the trend in shortening the length of stay in hospital, further intensive and tailored-made treatment is needed. Thus, a new version of TRIP is fabricated accordingly.
The purpose of the intervention is to improve insight and health among clients with schizophrenia during acute psychiatric care, so that treatment noncompliance can be reduced and relapse prevented, with the ultimate aim of progressing toward personal healthy goals within clients’ respective occupations.
Candidates for the Intervention
Inclusion criteria for TRIP are as follows:
Age within 18–65
Diagnosed schizophrenia or schizoaffective disorder
Admitted to an acute psychiatric unit
Stabilized mental condition after admission
Attained primary education level or higher
The exclusion criteria are clients with co-morbid diagnosis of substance abuse, organic brain syndrome, or mental retardation
The TRIP program is commonly carried out in a confined area in a psychiatric admission ward or therapy room in occupational therapy department, equipped with audiovisual equipment. Chairs may be arranged in a circle to facilitate discussion as well.
Role of Occupational Therapist in Applying the Intervention
As emphasized by Eaton (2002), an occupational therapist (OT) can play a major role in delivering psychoeducational group interventions in acute mental health settings. The TRIP program is then implemented by the OT under this empirical background. Playing the roles of teacher and facilitator in the group, the OT not only teaches the clients adaptive life skills and knowledge of illness but also promotes the sharing of experiences among themselves.
The OT works with the clients to develop strategies or cues by incorporating the learning content (e.g., recovery goal setting, illness management techniques) into their daily routines, to connect to their respective occupation. It is also important that the OT promotes the importance of a healthy and balanced lifestyle within the program. This includes articulating personalized goals and exploring how illness management (e.g., symptom and medication management) may be useful in achieving these goals. Addressing the personalized goals among clients meaningfully is crucial to engagement and motivating participation. Varieties of techniques are employed to optimize learning and retention. They include interactive teaching, specially designed activities and exercises, emphasizing sharing among group members and assignments after group, and so on. The OT in the group focuses on helping clients to become aware of their own power by gaining life skills that give them a greater sense of personal control (Blair and Hume 2002).
A Brief Guide to Clinical Application
The new version of TRIP program is a four-session activity-based illness management program. Each session lasts for about 90 min. The topics include:
Introduction to mental illness and treatment
Understanding sign and symptoms
Healthy lifestyle and recovery goal development
An operational manual has been written as reference for OTs working in different hospitals in Hong Kong to streamline the group implementation. Various activities have also been designed purposefully in each session to facilitate teaching of the main theme and consolidation of knowledge. OTs can run the topics making use of interactive sharing and activities. Warm-up or socialization games are introduced at the beginning of each session with homework assignments developed collaboratively with the client at the end of each session. During each session, the learning materials are well presented like classroom teaching to draw their attention . Each participant will receive educational handouts or cue cards about the strategies reviewed in every session. Visual aids used in the group can further facilitate their learning and sharing among the group.