SIGNIFICANCE: In occupational therapy, there has been an increased interest in the concept of participation and its changes over time. The amount of change in participation is an important indicator of rehabilitation quality. This study was a longitudinal data analysis of an existing data set derived from clinical records in six forensic hospitals in England. In this study, we aim to contribute to the understanding of forensic clients’ occupational profiles and their participation changes over time at 6-mo intervals (clients received follow-up evaluation up to 2 yr).

INNOVATION: The occupational therapists who worked at forensic settings in London were expected to use the Model of Human Occupation (MOHO)-based forensic care pathway to guide their interventions. As part of their standard procedures, occupational therapists administered the MOHO Screening Tool (MOHOST) to represent clients’ needs and their participation. The MOHOST was administered repeatedly every 6 mo to follow up on clients’ conditions and can be used to document clients’ participation changes.

APPROACH: The enrolled clients were continually receiving treatment at the forensic hospitals; therefore, we expected to see their participation improve over time. The United Kingdom has many security hospitals, and it is the first country that developed local secure settings. In this study, we used retrospective data to describe the occupational profiles of forensic clients who received occupational therapy. In addition, clients’ occupational participation changes over time were explored.

METHOD: We used a retrospective data analysis design. The setting took place in forensic hospitals in England. Data were collected from 489 patients in low and medium secure units across six organizations. Seventy-eight occupational therapists across the six institutes participated in this study. The main diagnosis of clients was schizophrenia disorder (n = 305; 62.3%). The enrolled clients included 453 men (92.6%) and 36 women (7.4%), with an average age of 38.7 yr (SD = 11.01).

MOHOST provides a broad overview of all the concepts of the MOHO that, collectively, define occupational participation. Items in MOHOST are scored on a 4-point ordinal scale.

Many-facet Rasch analysis was used to convert clients’ ordinal raw scores from the MOHOST into interval measures for calculating the Rasch person measures (i.e., the clients’ occupational participation) and standard deviations. The regression analysis then was used to examine clients’ participation changes over time.

RESULTS: Clients’ overall occupation participation improved over time (p < .001). Specifically, clients’ participation improved in five of the six MOHOST subdomains, which includes their motivation for occupation, pattern of occupation, communication/interaction skills, process skills, and environment. The effect of occupational therapy was not significant in clients’ motor skills; instead, clients’ age (p = .000) and gender (p = .001) dominated their motor skills. The older clients had less participation than younger clients (p = .02); the male clients had more participation than female clients (p = .004).

CONCLUSION: Occupational therapists are one of the efficient multidisciplinary team members who enable clients to have better participation during hospitalization.