SIGNIFICANCE: Occupational therapy has its roots in mental health practice, with a long heritage in therapeutic use of the self to address psychosocial concerns in all practice areas (Gutman & Raphael-Greenfield, 2014). A steady decline in occupational therapists working primarily in mental health care (American Occupational Therapy Association [AOTA], 2010) has decreased opportunities for occupational therapy students to gain experience in addressing psychological and social concerns. Clients now present for psychosocial intervention in a variety of health care settings, and therapeutic progress may be impeded by not having psychosocial factors identified and addressed directly. To determine whether students are educated to adequately address psychosocial factors of clients in different practice settings, we designed a study to evaluate the ways in which those factors were addressed in Level II fieldwork and in what ways students applied therapeutic use of self. The results of the study can be used to strengthen entry-level preparedness of practitioners. Level II students submitted weekly reports with descriptions of strategies used to address specific client psychosocial factors. Additionally, students examined how reflecting on psychosocial factors increased their therapeutic use of self. This form of data collection is based on John Dewey’s theory of reflective thinking (King & Kitchener, 1994) and allowed students to report needed information to the researchers while developing the ability to critique complex situations. This low-cost, high-yield research method produced more than 1,500 narratives for analysis.

PURPOSE: The purpose of this grounded theory study was to discover how Level II fieldwork students integrate psychosocial interventions in a variety of practice settings. Research questions included the following: (1) What psychosocial concerns do students identify? (2) Did student responses indicate academic preparation to respond to the concerns? (3) In what ways did the students describe therapeutic use of self?

METHOD: There has been a steady decline in occupational therapy practitioners working in facilities with primarily mental and behavioral health services. To prepare entry-level practitioners to address psychosocial factors for clients in a variety of settings, researchers need to show that other learning opportunities are effective at developing holistic practice. In this research study, we report on a retrospective cohort of 98 Level II fieldwork occupational therapy students in more than 70 sites in 2 consecutive yr. Qualitative data sources include student narrative responses on weekly review forms, blogs, and responses to a questionnaire. Grounded theory methodology was used during analysis.

RESULTS AND CONCLUSION: The results indicate that students most frequently describe client and caregiver symptoms of anxiety and depression and their empathetic responses. Students reported therapeutic use of self and using occupations meaningful to the client as tools for addressing psychosocial factors. Students reported using skills learned in Level I fieldwork to guide them in providing interventions to restore physical and mental health. The conclusion is that students who had Level I fieldwork experience and intervention courses focused on mental health are prepared to address psychosocial factors in clients at a variety of practice settings. This study was limited to participants in only one academic program.

American Occupational Therapy Association. (2010). Your career in occupational therapy: Workforce trends in occupational therapy. Retrieved from https://www.aota.org/-/media/Corporate/Files/EducationCareers/Prospective/Workforce-trends-in-OT.PDF

Gutman, S. A., & Raphael-Greenfield, E. I. (2014). Five years of mental health research in the American Journal of Occupational Therapy, 2009–2013. American Journal of Occupational Therapy, 68, e21–e36. http://dx.doi.org/10.5014/ajot.2014.010249

King, P. M., & Kitchener, K. S. (1994). Developing reflective judgment: Understanding and promoting intellectual growth and critical thinking in adolescents and adults. San Francisco: Jossey-Bass.