Developing an Occupational Therapy Trauma Intervention Framework
Contributed by Megan Edgelow
Megan Edgelow, MSc(RHBS), OT Reg. (Ont.) is a Lecturer in the School of Rehabilitation Therapy at Queen’s University. She is currently completing her Doctorate of Education (EdD) at Western University. Her current clinical work, teaching, and research includes military, veteran, and public safety personnel mental health and occupational engagement.
Since 2009, I have had a part-time clinical occupational therapy practice in the Kingston, ON region, providing mental health services to Canadian military personnel and veterans who have experienced trauma. This population has historically been under-served by the health care system, and in the past nine years I have had the opportunity to advance evidence informed, participation focused, health care services.
Recently, exposure to trauma, and its psychological effects, has garnered more attention in the media, and has increased societal awareness of the effects of trauma, including increased risk of suicide (e.g., Canadian Broadcasting Company, 2017; D’Aliesio, 2017; Simkus, Van Til, & Pedlar, 2017). Calls to action have occurred related to trauma (Oliphant, 2016), including the responsibility of the health care system to provide evidence informed care (Magruder, Kassam-Adams, Thoresen, & Olff, 2016).
Of primary interest to occupational therapists is the impact trauma can have on daily life and one’s ability to engage in meaningful activities. A recent scoping review of fifty articles related to trauma and occupational therapy found that trauma survivors experience a variety of occupational performance issues, which are disruptions to one’s ability to engage in the meaningful activities of daily life (Edgelow, MacPherson, Arnaly, Tam-Seto, & Cramm, in press). Productivity-related occupational performance issues may include challenges at school and with returning to and maintaining work. Mental illness costs the Canadian workforce $21 billion in productivity losses each year (Wilson, Guliani, & Boichev, 2016); additionally, the WHO World Mental Health Survey reported that posttraumatic stress disorder (PTSD) led to the second highest proportion of ‘days out of role’ per year at 42.7 average days missed (Alonso et al., 2011).
In recent years, my clinical practice has united with research and teaching opportunities connected to trauma. I co-developed and co-authored the evidence informed Occupational Therapy Trauma Intervention Framework (OTTIF) with my colleague, Dr. Heidi Cramm (Edgelow & Cramm, 2017, framework pictured above). This clinical reasoning framework was developed using existing evidence, with a focus on client readiness and self-regulation. The framework incorporates enablement skills, assessment, treatment, and general approaches used by occupational therapists. Numerous professional development workshops we have provided to date for occupational therapists on the use of the OTTIF have motivated others to advance their clinical practice. To date, we have provided 6 intensive professional development workshops across Canada using the OTTIF, training over 150 occupational therapists in its use. We presented the OTTIF at the Canadian Association of Occupational Therapists (CAOT) Annual Conference and the Canadian Institute for Military and Veteran Health Research (CIMVHR) Forum in 2017. The OTTIF was also presented at invited sessions at the Centre for Addiction and Mental Health (CAMH) Grand Rounds in 2017 and the Ontario Shores Centre for Mental Health Sciences Grand Rounds in 2018. Interest in the development of the framework and opportunities for dissemination and implementation continue to grow.
Our next OTTIF workshop is November 22-23, 2018 in Burlington, ON, hosted by Solutions for Living (http://solutionsforliving.ca/events/), where Dr. Cramm and I look forward to welcoming our next group of participants. Since May 2018, we have been studying therapist experiences in their use of the OTTIF, using surveys immediately after a workshop and six months post-workshop for follow up. Results of this research will be analyzed and disseminated in 2019.
The OTTIF, an occupation-focused trauma intervention clinical reasoning framework, derived from trauma research and occupational therapy theory, provides a foundation for the development of evidence-informed occupational therapy practice with clients who have experienced trauma.
Alonso, J., Petukhova, M., Vilagut, G., Chatterji, S., Heeringa, S., Ustun, T.B., . . . Kessler, R.C. (2011). Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Molecular Psychiatry, 16(12), 1234-1236.
Canadian Broadcasting Company. (2017). PTSD: Beyond trauma. The Nature of Things. Retrieved from: http://www.cbc.ca/natureofthings/features/ptsd-canada-has-the-highest-rate-and-other-surprising-things
D’Aliesio, R. (2017, June 19). Investigation: The unremembered. Globe and Mail. Retrieved from: https://www.theglobeandmail.com/news/veterans/article26499878/
Edgelow, M., & Cramm, H. (2017). Developing an occupational therapy trauma intervention framework. Poster presentation at the Canadian Institute for Military and Veteran Health Research Forum, Toronto, ON.
Edgelow, M., MacPherson, M, Arnaly, F., Tam-Seto, L., & Cramm, H. (in press). A scoping review of occupational therapy and posttraumatic stress disorder. Canadian Journal of Occupational Therapy.
Magruder, K. M., Kassam-Adams, N., Thoresen, S., & Olff, M. (2016). Prevention and public health approaches to trauma and traumatic stress: a rationale and a call to action. European Journal of Psychotraumatology, 7, 10.3402/ejpt.v7.29715.
Oliphant, R.C. (2016). Healthy minds, safe communities: Supporting our public safety officers through a national strategy for operational stress injuries. Ottawa (Canada): Standing Committee on Public Safety and National Security. Retrieved from: http://www.ourcommons.ca/DocumentViewer/en/42-1/SECU/report-5
Simkus, K., Van Til, L., & Pedlar, D. (2017). 2017 veteran suicide mortality study 1976 to 2012. Charlottetown, PE: Veterans Affairs Canada. Retrieved from: http://www.veterans.gc.ca/eng/about-us/research-directorate/publications/reports/vsms-2017
Wilson, S., Guliani, H., & Boichev, G. (2016). On the economics of post-traumatic stress disorder among first responders in Canada. Journal of Community Safety and Well-Being, 1(2), 26-36.