An Aggregate Fieldwork ModelAn Aggregate Fieldwork ModelPat Precin, M.S., OTR/L

Method:Method: Fifty OT level II interns (94% female, 90% first placement, average age 23) from 15 different educational facilities participated

in the AFM with the same OT supervisor (writer). Six interns, often from different educational facilities, were assigned to the same inpatient,

acute, psychiatric unit at the same time for a three-month internship. A week before the interns’ completion date, a new set of six interns arrived

to take their place. The OTIs awaiting completion provided an in-depth orientation of the unit to the new interns under the close supervision of

their OT supervisor. Interns rotated this way throughout the two-and-a-half years that the AFM was studied.

The program consisted of three components: 1) cooperative learning, 2) clinical project or research publication, and 3) interdisciplinary training

and intervention.

The cooperative learning component refers to OTIs speaking with each other in order to problem solve, process emotionally loaded material,

share newly learned material, practice skills, plan interventions, prioritize tasks, and develop clinical reasoning skills. Interns met once a week

for one hour and a half in group supervision with their OT supervisors. They were responsible for co-leading at least two intervention groups per

week, and carried approximately 17 clients on their caseload by the end of three months.

Interdisciplinary training included visiting other treatment settings and receiving instruction and feedback on an ongoing basis from

multidisciplinary staff on their primary unit. Interns co-led interdisciplinary intervention groups, participated in weekly interdisciplinary intern

seminars, provided OT orientation to new multidisciplinary staff and interns, and observed courtroom trials for clients who refused medication

or requested to leave the hospital.

In addition, all students were involved with a research project or a clinical project designed by the clinical supervisor and approved by the

educational setting if used as a master’s thesis.

For a full description of the program see Precin (2007 and 2009).

Results and Discussion:Results and Discussion: Staff Surveys: A staff satisfaction survey was developed by an OTI as part of his clinical

project publication to measure the teams’ perceived value of OTI services on the unit under the AFM. One hundred percent of the staff surveyed

on both teams reported that OTI services were both necessary and helpful to the unit and its clients. One hundred percent of the staff surveyed

considered the OTIs to be part of the team and 95% viewed them as staff. Ninety-five percent of the staff surveyed believed the value of OTI

services exceeded the amount of effort and time spent in interdisciplinary training.

Occupational Therapy Intern Logs: Some OTIs elected to write weekly logs as part of their clinical project publication. Most of their logs or

excerpts from their logs were published in the book, Client-Centered Reasoning (Precin, 2002). Their logs substantiate the effectiveness of the

AFM.

Occupational Therapy Interns’ Verbal Reports in Supervision: Inters reported that orienting new staff and interns, working closely with

multidisciplinary staff, and participating in weekly multidisciplinary inter seminars helped them delineate and define the role of OT in a

psychosocial setting. Working closely with multidisciplinary inters was reported to have helped OTIs reflect on their own clinical and education

experiences and professional roles. It was apparent from their verbal reports in supervision and seemingly low self-assessed grades on their

midterms, that the majority of the OTIs underestimated their skills and knowledge. It was not until they oriented the medical staff and new OTIs

that they could appreciate how much they had learned.

Supervisory Sessions: Interns were able to process important feelings and situations on a very deep level during supervision, perhaps

because the day to day details of unit procedures had already been solved through working with interdisciplinary staff and collaboratively with

each other. Reactions to and interventions for suicide attempts, physical violence, hypersexuality, and severe pathology that otherwise may

have been avoided were discussed at length. What happened to one OTI during the day, seemed to affect each of them, thus multiplying their

experiences.

Peer Reviewed Publications: Approximately 23 OTIs’ projects (research and clinical) or parts of their projects were published in peer reviewed

books or journals. Interns became familiar with the steps necessary to prepare a manuscript for publication. They reviewed each other’s

manuscripts. Some wrote query letters. Interns were honored at book signings. One OTI from Russia stated that he gained so much confidence

in his English writing skills through his publication that he applied to an OT master’s program, something he would not have done before.

Conference Presentations: Three presentations that involved many OTIs’ research projects were given at the American Occupational Therapy

Association’s National Conferences.

Verbal Feedback from Education Institutions: Occupational therapy programs’ verbal response to the AFM was very positive. Schools believed

that the model was very rigorous and that OTIs worked extremely hard and received a wonderful clinical experience. Schools stated that they

reserved this placement site for students who were very interested in psychosocial practice.

Abstract:Abstract: An aggregate fieldwork model (AFM), a level II

fieldwork model that combines cooperative learning, interdisciplinary

training and intervention, and research or clinical project publication,

was implemented over a two-and-a- half year period on an acute

inpatient psychiatric setting with a multidisciplinary staff and interns at

a metropolitan hospital. Data based on 50 occupational therapy interns’

(OTIs’) logs and verbal reports in supervision, peer reviewed

publications, conference presentations, verbal feedback from the

occupational therapy (OT) educational institutes, supervisor’s

comparisons with other fieldwork models, and staff surveys are

reported. The outcome of the AFM is that students do well, seem to

learn more than in 1:1 supervisory models, and manage to publish

while on fieldwork. The purpose of this poster is to educate OTI

supervisors about the AFM in hope that they will be stimulated to use

this model in their own setting.

Introduction:Introduction: Over 26% of adults in the U.S. suffer from

a diagnosable mental disorder (NIMH, 2006). Yet, OT has gradually

moved away from its original roots in mental health (Norris, Bunger,

Courchesne, Smith, Willaghty, 2007). The new Accreditation Council for

Occupational Therapy Education (ACOTE) standards (ACOE, 2006)

states that psychosocial issues affecting engagement in occupation

must be integrated into all fieldwork settings. The council encourages

fieldwork supervisors to establish well constructed models of fieldwork

best practice. The AOTA’s 2017 Centennial Vision (2007) identifies four

main focus areas in education as outlined by Messelman (2007, p. 295).

They include, “The quality of fieldwork placements, the collaboration

between education and practice, and utilization of scientific evidence to

support practice efficacy and our participation in the academy, and,

finally, the education of practitioners who capably and willingly fulfill a

range of roles.”

A psychosocial fieldwork model that encourages educators, students,

supervisors, and clinical settings to work together to train students,

provide clinical services, and publish OT material, may improve the

quality and quantity of students’ psychosocial experiences and

maintain this area of practice. This author was able to develop a model

that effectively educated 50 OTIs in a manner that integrated clinical

and research skills and runs counter to the trend of decline in

psychosocial fieldwork and practice mentioned above. This mode, the

AFM, was developed in a context that considered the decline of

psychosocial fieldwork opportunities along with the increased demand

for ‘holistic’ practitioners that are clinical researchers.

Results and Discussion cont.:Results and Discussion cont.:

Supervisor’s Comparison to other Fieldwork Models: The OT

supervisor had employed other fieldwork methods throughout her

career including one-on-one supervision without cooperative learning

or multidisciplinary collaboration, intervention and individual intern

projects that did not involve research or publication, and various

combinations thereof. Yet, the model that worked the best was the

aggregate model. Interns trained under the AFM as compared to OTIs

who were not (all supervised by the same supervisor) seemed to learn

and process more material at a faster pace and on a deer level. They

interacted more with staff, resulting in higher visibility of OT services.

They spent more “quality” time in supervision and were able to express

themselves with a greater degree of freedom. They often reported that

they were not alone in their feelings and problems because of their

close associations to other OTIs and overall, emerged more

independent and confident by the end of their fieldwork.

Summary:Summary: The AFM with its combination of cooperative

learning, interdisciplinary collaboration and intervention, and research

or clinical project publication as described, is an effective model for OT

level II psychosocial fieldwork. The AFM benefits education institutions

by providing hard to find psychosocial placements, master’s thesis

projects, publications referencing the education institution, and well

prepared entry level therapists carrying the school name. Clinical sites

benefit from additional help, publication of clinically needed projects

and research, and a more integrated team with new ideas. Interns

trained in the AFM are prepared not only as entry level therapists, but

also as therapists who add to the growing body of OT literature in this

important time of best practice.

References:References:1. Accreditation Council for Occupational Therapy Education. (August,

2006). Accreditation Council for Occupation Therapy Education (AOTE.

Education Standards and Interpretive Guidelines. Rockville, MD:

Accreditation Council for Occupational Therapy Education.

2. American Occupational Therapy Association. (2006). AOTA’s

centennial vision. Retrieved December, 2, 2007 from

http://www.aota.org/nonmembers/area16/docs/vision.pdf

3. Musselman, L. (2007). Achieving AOTA’s Centennial vision: The role

of educators. Occupation Therapy in Health Care, 21(1/2), 295-300.

4. NIMH. (2006). The numbers count: Mental disorders in America.

Retrieved on December 2, 2007, from http://

www.nimh.nih.gov/publicat/numbers.cfm

5. Norris, S., Bunger, T., Courchesne, K., Smith, K. A., & Willoughby, M.

M. (2007). Future of mental health occupational therapy: Student

perspective and concerns. Occupational Therapy in Health Care,

21(1/2), 305-307.

6. Precin, P. (2009). An aggregate fieldwork model: Cooperative

learning, research, and clinical project publication components.

Occupational Therapy in Health care, 25(1).

7. Precin, P. (2007). An aggregate fieldwork model: Interdisciplinary

training/intervention component. Occupation Therapy in Health care,

21(1/2), 123-131.

8. Precin, P. (2002). Client-centered reasoning: Narratives of people

with mental illness. Woburn, MS: Butterworth-Heinemann.