The individual may find the OTI beneficial if they meet three or more of the following criteria √
The person’s daily activities demonstrate an imbalance among self-care, productivity, and leisure
The person spends a large amount of time without defined activity on a day-to-day basis
Much of the individual’s day is spent in passive activities or rest
There is a lack of organized routine/structure to the person’s daily activity
The person’s daily activities limit his/her contact with others
The person’s daily activities limit his/her access to a range of community environments
The person cannot define activities/occupations that are meaningful or of personal interest
The person experiences distress, or is easily overwhelmed in activity
The person’s involvement in activity is impacted by a limited experience of enjoyment
Table 25.2
Determining relevance of the Action over Inertia: realizing the benefits of activities
If six or fewer are checked, then this may be a helpful OTI for the individual √ |
|---|
Client engages in activities that provide the opportunity for… |
Skill and/or knowledge development |
Making a contribution to society |
Gaining physical health benefits |
The enjoyment of beautiful things |
Self-expression and creativity |
A range of social interactions |
Meeting personal goals and experiencing accomplishment |
Expressing personal values |
Earning a personal income |
Giving to others, such as family and friends |
Practice Process
The Action over Inertia is intended to be used in partnership between the OT and the client. The practice process includes:
Collaborative evaluation of activity patterns: The therapeutic performance process begins with engaging clients, either individually or within a group treatment setting, in collecting information on their actual time use over the course of a few typical days. Daily time-use logs (Fig. 25.1) are used to keep track of activities engaged in, the location of these activities, and social contacts during these activities.
Fig. 25.1
Daily Time-use log
Reflecting on personal activity patterns: The evaluation is followed by a process of guided reflection on time-use patterns, including several dimensions of time use. For example, the OT and client discuss the time-use patterns with respect to (a) balance, (b) level of occupational engagement, (c) passive and active participation, (d) structure and routines, (e) meaningfulness and personal values, (f) satisfaction, (g) social interactions, and (h) access to community environments. The process involves a personal evaluation by the client of dimensions that might be changed to enhance personal well-being .
Making quick changes in activity: Clients are enabled to identify a few “quick and simple activity changes” to gain momentum in activity participation. “Exhorting to action” is a key skill of enabling that includes inspiring, encouraging, lending energy, influencing, rousing, and inducing.
Providing education about activity, health, and mental illness: Clients are also provided with education about the relationship between serious mental illness, activity involvement, and time use as well as information about the potential health and citizenship benefits of activities. The link between activity participation and recovery is explicitly considered.
Making longer-term changes: The client is engaged in exercises to plan for longer-term changes with regard to time-use and activity involvement. Long-term activity planning (Fig. 25.2) directly addresses the supports and resources anticipated and required to overcome activity challenges.
Fig. 25.2
Planning for activity change
Sustaining and evaluating activity changes: Finally, changes in activity patterns and actual time use are monitored and plans refined accordingly. Emphasis is placed on both the performance and experience of activity participation. The OT is encouraged to use motivational and teaching techniques to facilitate the client’s commitment to the process of change.
Effectiveness: OTs are also engaged in evaluating their practice context with a view to enhancing the profile of activity health as a legitimate concern of service provision, and to ensure changes in health and well-being through activity are captured in service evaluations and continuous improvement initiatives.
The Role of the OT
While Action over Inertia is grounded in the domain of occupational therapy, it could be implemented by other health care team members, consistent with the focus on advancing interdisciplinary practice in community mental health. However, it is advised that an OT with a good understanding of activity health be involved. The OT acts as the leader of the OTI and thus has roles as coach, supervisor, teacher, and the evaluator of the OTI within the service.
Evidence-Based Practice
As mentioned previously, activity participation and time use have been associated with overall well-being and quality of life for people with serious mental illness. The construction of psychometrically sound and sensitive measurements of occupational engagement, such as the profiles of occupational engagement in persons with schizophrenia (POES) , has advanced both clinical applications and research in the area (Bejerholm et al. 2006; Bejerholm and Eklund 2007).
The Action over Inertia is new and to date has been subject to limited research. The OTI does integrate evidence-based practices throughout. For example, the OTI focus on rapidly engaging individuals with serious mental illness in personally and socially meaningful activities while providing support is consistent with evidence-based supported participation models in the community mental health field (Bond et al. 2008; Davidson et al. 2004). In addition, this intervention integrates educational strategies consistent with evidence-based psychoeducation (Xia et al. 2011).
A pilot study of Action over Inertia, using the randomized controlled trial method, demonstrated a positive change. Specifically, an increase in activity participation in relation to a reduction in the amount of time spent sleeping for individuals with serious mental illness who participated over 12 weeks within the context of receiving services from assertive community treatment teams. The increase in activity versus sleep in the treatment group was statistically significant (p < .05); however, there was no significant change in other dimensions of time use patterns. Qualitative feedback from OTs and clients supported its clinical utility and indicated that the OTI was considered useful and well structured. The 12-week time frame of the pilot study was considered too brief to lead to major changes in activity patterns (Edgelow 2008; Edgelow and Krupa 2011). The content of the intervention approach was revised based on feedback from this research.
Discussion
OTs may need to advocate for the implementation of Action over Inertia within community-based treatment teams. The reason is that occupation-focused interventions typically receive little priority compared to biomedical treatment, housing support, and crisis management (Thornicroft et al. 2011). Demonstrating how changes in activity health are related to community stability and integration for people with mental illness may be an important aspect of these advocacy efforts. Due to the complex, dynamic, and highly individualized nature of human occupations and the extent to which inertia may have settled into the daily lives of individuals, the OTI itself may be lengthy, perhaps requiring several weeks or months for meaningful change. While the Action over Inertia itself does not evaluate any particular forms of activity, OTs should keep in mind the extent to which involvement in productivity, specifically education and employment, is considered integral to successful community integration and socioeconomic recovery from mental illness (Waghorn and Lloyd 2005). While Action over Inertia is delivered in the context of community mental health, there has been interest in applying the theory and practice of activity health to other settings. For example, Lipskaya-Velikowsky and colleagues (Lipskaya-Velikowsky et al. 2013) recently applied Action over Inertia for the inpatient context, and that is currently being evaluated.
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