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The purpose of this paper was to interview an occupational therapist who is a leader in mental health and discuss their thoughts on being a leader and their work as a mental health occupational therapist. This paper maybe added to an ebook that will act as a practical resource of best practices in mental health OT practice and leadership for students and new graduates in the field of occupational therapy. This ebook will ask act as an inspirational resource package for occupational therapy students and clinicians who are interested in mental health.
The OT leader that was chosen for this paper was Jenifer Kim, an occupational therapist working at the Centre for Addiction and Mental Health (CAMH). Jenifer Kim has worked an employment specialist in the Learning Employment Advocacy Recreation Network (LEARN). LEARN offers a wide range of services and works to integrate clients who have had a first episode of psychosis into community life through social, educational and vocational opportunities. In this role, Jenifer primarily worked with youths recovering from first episode psychosis and provided vocational training and support for these individuals. These supports include career exploration, vocational assessments, a range of structured and unstructured vocational activities (see appendix for more information about these activities), emotional support, monitoring and on going support. Jenifer acted as their main support system and assisted them in a number of activities which helped them explore, developed, and achieved their employment goals. Therefore, Jenifer was able to help these youths recovering from first episode psychosis directly by providing them one on one support.
Jenifer is currently undertaking a new role where she is working with employers and recruiters to develop new and exciting employment opportunities for individuals with mental health issues. In this role, Jenifer provides support and education to employers and recruiters about the specific needs and the importance of employment to people with mental health issues. Employment is one of the determinants to health and studies have shown that higher income and social status are linked to better health.
Jenifer is a leader in this area because she recognizes the importance of employment for these individuals and is raising awareness of mental health issues and how employers can support these individual in the work environment. Therefore, Jenifer is acting as a bridge connecting employers with individuals with mental health issues. Jenifer has made an impacted in mental illness at both the individual and societal level and will continue to advocate for individuals with mental health issues until their needs are met.
Jenifer thoughts on Leadership
Jenifer Kim is a leader in helping individuals with mental illness find and maintain meaningful employment. She believes a good mental health leader must demonstrate character and acts with personal integrity. To be an effective leader one must demonstrate values and ethics in personal behaviors and incorporates these values and ethics into their practice. A good leader acts with the courage of his/her convictions and are open with their employees. Leaders must be able to understand themselves and their employees to foster the development of others and the organization. Leaders must model honesty, fairness, transparency and show humility, they must act in the interest of both the organization and their employees and not for their own personal gain.
Another important trait of being a good leader is staying motivated. A leader definitely needs to be motivated; those who are not motivated will seem unenthusiastic about their work, which may prevent them from developing a strong therapeutic relationship with their clients. Jenifer is motivated intrinsically and receives a great deal of satisfaction when she is able to help her clients achieve their vocational goals. Jenifer believes it is important for her to stay motivated because her clients depend on her to help them achieve their vocational goals. A motivated leader can have a profound impact on a client’s performance, if he or she can motivate and keep the client highly motivated at all times.
Jenifer stays motivated by keeping updated on the latest trends in occupational therapy and mental health and is member of an international group that discuses mental health polices related to employment. Jenifer also states that her passion for mental health helps keep her motivated. Her passion for mental health started when she was involved in a work study with Bonnie Kirsh, a professor at the University of Toronto, who specializes in community and work integration for persons with mental illnesses.
Leadership is centrally concerned with people and Jenifer states that one of the challenges that can arise when working with clients is the power differential between herself and her clients. The relationship between the client and occupational therapist is by definition an unequal relationship, which results in a power imbalance in favor of the occupational therapist. This is due to the occupational therapist’s position of authority and professional knowledge in relation to the client’s health status, vulnerability, and unique circumstances. The power in the relationship may also results from recommendations made by the occupational therapist and their influence on possible benefits the client may or may not receive.
Jenifer feels that as occupational therapists we must be responsible for anticipating the boundaries that exist with our clients, as well as setting and managing these boundaries, and practice in a manner which establishes and preserves the client’s trust. Jenifer uses reflective practice and acknowledges the issues of power and control to anticipate and minimize the power differential between herself and her clients. Jenifer states that using a client-centred approach may also help minimize the power differential by taking the client’s goals and needs into consideration when developing a treatment plans.
Another challenge that Jenifer faces in her practice is gaining the commitment and acceptance from her clients. Jenifer gains commitment from her clients by helping them develop their own vocational goals. Jenifer states that clients who have identified their own goal will be more likely to stay committed to the program because the goals are meaningful and important to the client. Therefore, we must find ways to involve clients in the goal formation stage and collaborate with the client to develop appropriate goals. By collaborating with the client, Jenifer is able to establish a sense of cooperation and unity for goal attainment. Jenifer encourages ideas and input from her clients and values their contributions in the goal formation process.
Jenifer recalls a story about a client that she helped successfully return to work. The client was a young woman who experienced a first episode of psychosis. This client expressed interest in returning to work and was referred to Jenifer from CAMH. Jenifer and her client worked collaboratively to develop vocational objectives such as improving the client’s interview skills and resume. After achieving these objectives, Jenifer was able to find her client an employment opportunity as a clerk at a local supermarket. Once her client started her new job, Jenifer continued to provide support to her client and her client’s employer. The employer would occasionally call Jenifer when there was a situation with the client and Jenifer would offer advice and support to manage this client’s issues. The employer really understood that the client was a person with a mental illness and was able to see beyond the mental illness. Jenifer states that this employer was very supportive and was instrumental in helping this client maintain employment. Jenifer believes that many employers want to help others, but are unsure or don’t have the knowledge needed to aid these individuals in achieving their employment needs. Jenifer provides the support and education that these employer need to help individuals with mental illness find and maintain meaningful employment.
However, even with the proper supports and education, not all stories end with a happy ending. Jenifer remembers one client where she was unable to help them return to work. The client was a young male who experienced a first episode of psychosis and was referred to Jenifer from CAMH. This client expressed interest in finding work and Jenifer was able to help this individual find an employment opportunity at a supermarket. Jenifer noted that this client was very social, presented very well and was well liked by others around him. However, after the first week on the job, the client stopped showing up for work. The employer gave this client numerous opportunities because the employer really liked this client. Unfortunately, the client never returned to work and Jenifer was forced to terminate the client’s employment.
When asked if there was anything that you would do differently in this situation, Jenifer replied no, because in this situation the client expressed interested in this particular job and was very excited about this employment opportunity. But for some reason the client no longer wanted to go to work and there really were no signs or indication as to why the client decided not to return to work. Sometimes a number of factors can fall outside your control; you must deal with these difficult setbacks and learn from your failures. You must be strong in the face of failure and to continually work towards improving your skills as a clinician.
Individual placement and support model (IPS)à use CPPF (enter/initiate, set the stage, assess/evaluate, agree on objectives and plan, implement plan, monitor/modify, evaluate outcome, conclude, exit)
Using the Individual Placement and Support (IPS) model, Jenifer Kim has helped individuals with mental illness find and maintain employment. Jenifer likes the practical approach of the IPS model and how it helps direct her through the various steps need to help her clients achieve their employment goals. She feels that the IPS model creates a very client-centered approach and it makes it so much easier for clients to be successful. Jenifer thinks the IPS model has been successful at CAMH because of how they integrated their health care team into the program; this makes it really simple for the client because they can meet with all their mental health professionals in one place.
The IPS was developed from the supportive employment model and is widely used as an employment model for people with mental illness in the United States. There is significant body of literature that supports the effectiveness of the IPS model. It has been extensively researched and found to be effective at achieving integrated community employment for persons with mental illness.
The IPS model is based on several defining features including competitive employment, a zero-exclusion policy, rapid job search, the integration of mental health and rehabilitation services on a single team, consumer preferences as the basis of employment, and individualized support of any needed duration.
Competitive employment is the main goal of IPS. Employment specialists help clients obtain competitive employment that is available to anyone in the community and pays at least minimum wage. The focus is always on jobs that are in integrated work settings, rather than on intermediate activities or sheltered work experiences because low expectations lead to poor outcomes. Competitive employment, at least part-time, is a realistic goal for almost everyone who desires it.
The IPS model promotes a zero exclusion policy. An important component of the IPS is the philosophy that anyone with a psychiatric disability who expresses interest in competitive employment is eligible regardless of their diagnosis, symptoms, skill level, history of substance abuse, or other criteria that have been used by professions to exclude people from employment services. The client ultimately determines if and when to participate and does not have to be deemed “work ready” in order to receive these services. Clients who believe they are ready for work are often able to overcome these and other barriers.
A rapid job search is also utilized when implementing the IPS model. In this model, lengthy prevocational assessment, evaluation, training, practice and preparation will not be used to prepare the client for work. Instead, a competitive job will be sought and that position will be used to assess an individual’s ongoing support needs. Typically, the employment specialist or the client begins contacting employers about jobs within one month of starting to work together. Again, the job plan, the pace of searching for a job, and the method of finding a job are based on the individual’s choices.
Supported employment is integrated with mental health and rehabilitation services. Rehabilitation is considered an essential component of mental health treatment rather than a separate service. Employment specialists join and meet regularly with the mental health treatment team to insure that services are seamless and coordinated. Team members develop a consistent plan in close collaboration with clients as part of integrated services. Communication between all practitioners is critical in help clients achieve their employment goals.
A focus on consumer’s preference to ensure the job fits the individual. Clients are assisted in finding jobs that match their preferences, values, skills and goals rather than jobs that are available in a pool. If the employment specialist is unable to find a compatible match between the client and the job, it can greatly affect the client’s job satisfaction, tenure and success.
Individual supports are not time-limited. Individualized supports provided by team members cater to each client’s specific needs and these follow-along supports continue for a time that fits the individual, rather than terminating at a set point after starting a job.
Applying the Canadian Practice Process Framework to Practice
Enter/initiate: Clients are referred to Jenifer from CAMH, this is important because it emphasizes the integration of the client’s mental health treatment team and the employment specialist. In this stage, Jenifer works collaboratively with the client to help identify the vocational challenges and needs of the client. Jenifer and the client must then decide whether to continue or not with the program. When making this decision the client must acknowledge that they understand and consent to the agreed upon plan and Jenifer has to reflect on her own experience and determine if she has the knowledge and skills to take on the referral.
Set the stage: In this stage, Jenifer develops rapport with the client and engages them in discussions about their values, beliefs, assumptions, and uses this opportunity to establish ground rules and expectations. Jenifer works with the client to determine how they can work together and start to identify vocational goals.
Assess/evaluate: Jenifer does not use any prevocational assessments or evaluations as it may discourage client who want competitive employment and is not the goal of the IPS model. However, Jenifer works with her clients to identify their unique preferences in order to find employment opportunities that match their specific needs.
Agree on objectives and plan: In this stage, Jenifer encourages the client to participate and power-share as much as possible to help minimize the power differential between her and her clients. She collaborates with her clients to identify and prioritize vocational goals and a plan on how to achieve these goals.
Implement the plan: Jenifer implements the agreed upon plan by coaching and supporting clients to help them achieve their vocational goals. In order to achieve a client’s vocational goals, Jenifer may need to assist clients in preparing for an interviewing, resume writing, job search and career exploration. Jenifer may also advocate for the client with the employer to identify ways to help the client maintain work and cope with the symptoms.
Monitor and modify: Jenifer would often follow up with her client and their employers to review and monitor the client’s progress at the workplace. Afterwards, Jenifer would provide support to both her client and their employers as needed, but states that many clients are able to manage their new role with very little support.
Evaluate outcome: Jenifer says the main goal for her clients are to find meaningful employment opportunities. Jenifer is responsible for helping her client’s meet this goal and assists them in a number of ways to ensure that they are successful in achieving their goal. However, at CAMH the only outcome measure that they use is the number of clients that successfully achieve competitive employment. They do not track or measure job tenure or how much support is required by each client.
Conclude/exit: Since the IPS model states that individualized supports are not time specific, Jenifer offers support to her clients even after they have successfully achieved competitive employment. Jenifer believes that this is not always realistic and may cause issues with workload balance, but feels that it is necessary and important part in helping her clients maintain employment.
I was inspired by Jenifer’s passion for helping others and the commitment she has made to helping those suffering with mental illness. This interview helped me realize the effects of unemployment on an individual’s health and the value of occupational therapist in advocating for individuals with mental health issues.
Another important message that Jenifer conveyed in one of her stories was to stay positive, even when faced with a difficult situation. We may not always succeed, but we are always given an opportunity to learn, even from our failures. We must be resilient even in the face of failure and must constantly work towards improving our skills because our clients are depending on us.
Jenifer uses mock interviews to help her client practice answering questions. Jenifer would take on the role of the recruiter and attempts to make the interview as realistic as possible by asking questions that are typically asked in an interview. After the interview is over, Jenifer would provide constructive feedback on both the client’s verbal and non-verbal communication skills and strategies on how to improve.
Jenifer also offers some advice when preparing your clients for an interview. Preparation is an important step that is overlooked and often leads to poor results. To prepare for an interview, Jenifer recommends that you learn about the organization, review the job qualifications and your resume, practice an interview with a friend and most importantly arrive early for your interview. When you are in the interview try to stay relaxed and answer each question concisely and promptly. Try to use proper English and avoid using slang at all times, also be enthusiastic and use body language to show interest. Lastly, remember to thank the interviewer when you leave and follow-up with a letter to thanks the interviewers for taking the time to interview you.
Jenifer says that with very little effort, you can create a resume that makes you stand out as a strong candidate for a job. Jenifer offers the following tips when writing your resume, always spell-check your resume, make sure that your resume has proper punctuation, grammar, and spelling. You should always include a cover letter with your resume; this allows you a chance to express why you believe you’re the best candidate for the job. Lastly avoid using paragraphs or long sentences, try using bullet points and action words to condense and summarize your sentences.
Jenifer helps her client explore different career opportunities to help find jobs which fits their interest, skills and abilities. One of the exercises that Jenifer uses to help her clients explore different career opportunities is through job research. This gives the client specific information about the job such as the requirements and qualifications required for the job. The client can then evaluate if this job meets their unique interest, skills and abilities. If the client expresses interest in the job, but does not have the skills and abilities to perform the job, Jenifer would help the client make vocational goals to work towards achieving job. Jenifer also uses different career exploration sites to help identify employment opportunities that fit her client’s individual preferences. A list of these sites can be found in Appendix D.
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