Date of Award

2020

Document Type

Scholarly Project

Degree Name

Master of Occupational Therapy (MOT)

Department

Occupational Therapy

First Advisor

Nicole Harris

Abstract

Eating disorders (EDs) have the highest mortality rate of any mental health condition for all ages (Watt & Dickens, 2018). Eating disorders are particularly deadly in adolescents with 1.8% of adolescents dying and 17% remaining unwell long term (Beukers, Berends, de Man‐van Ginkel, van Elburg, & van Meijel, 2015). Carter et al. (2012) expressed that specialized intensive treatment for AN often produces successful responses to treatment, but the significant rate of relapse suggests that acute inpatient/day treatment alone may not be adequate to result in long lasting behavioral changes to maintain normal weight and symptom abstinence once the external structure of the hospital program is removed. EDs interfere with an individual’s daily life, and can impact most areas of occupation such as activities of daily living (ADLs), work, education, relationships and social participation, leisure, rest and sleep, and instrumental activities of daily living (IADLs).

Occupational therapy (OT) is one of the primary disciplines that plays a key role in the treatment of individuals with EDs in all treatment settings (Mack, 2019). Occupational therapy allows for unique opportunities to address various client factors such as values, beliefs, interpersonal skills, habits, roles, environmental context, and routines (Mack, 2019). OTs, therefore, are able to identify and address meaningful tasks, unhealthy occupations or behaviors, rituals, and values that are unique to a patient’s experience with this disorder. Throughout the review of the literature, the authors discovered a lack of availability of home health treatment programs for continuation of treatment after discharge from inpatient facilities, leading to a decrease in generalizability and high relapse rates post-discharge (Sproch & Anderson, 2018). From this discovery, it was determined that creating an occupational therapy structured home program designed to be used as a continuation of therapy after discharge from inpatient treatment would ultimately address one of the most prominent needs of this population. Through the provision of a home-based intervention program, a patient discharged from an inpatient setting would be discharged into a familiar environment that is supportive of continuing and maintaining recovery. In further support of a home treatment program, research has shown that relapse prevention strategies involving implementing change to the patient’s home environment may be highly beneficial and critical to maintaining behavioral changes that were initiated in the inpatient treatment facility (Sproch & Anderson, 2018).

The methodology of this scholarly project included a review of literature regarding the current role of occupational therapy in the treatment of eating disorders, current treatment options and approaches, relapse and recovery rates, impact on occupational performance and participation, and availability of home health treatment options. This research helped to determine the components that would be the most beneficial to be addressed when creating a home based treatment program for individuals with eating disorders. Following this, a procedure manual was created for implementation of this program by an occupational therapist with experience treating clients with EDs.

To address the need for a home-based intervention program for continuation of treatment post discharge from an inpatient setting, a procedure manual was created outlining twelve sessions addressing various topics designed to help individuals with EDs continue with successful recovery. The topics used in this program include: self-compassion, routines, trigger and coping identification, relaxation and stress management, family, self-esteem and body image, meal preparation, assertiveness, social participation, leisure, and spirituality. This program was designed to be implemented by an occupational therapist, with the client and occupational therapist meeting in the client’s home for an hour, once per week for 12 weeks. The hope is that this program will establish a supportive environment in the client’s home to promote generalization of treatment approaches, and will reinforce continued recovery by providing clients with tools and strategies they can use to return to successful participation in meaningful occupations.

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