Better Access to Mental Health

(BAMH) For Occupational

Therapists

The Better Access to Mental Health (BAMH) initiative enables community access to mental health professionals and team-based mental health care, through more collaborative relationships between general practitioners and psychiatrists, clinical psychologists, psychologists and social workers and occupational therapists.

This information pack provides helpful information for occupational therapists seeking BAMH endorsement. Further information can be found in the Useful Links section or by visiting the Department of Health: http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-ba-fact-prof

Please note that only Occupational Therapy Australia (OTA) General Members are eligible for endorsement.

Endorsement applications are only accepted from association members. While there is no additional cost for the review of applications and where successful, ongoing endorsement (i.e. costs are covered by the membership fee of the association), ongoing membership is required to enable consistent communication with OTA and ongoing support of your practice. Endorsees are able to access private practice resources, BAMH information, practice information and supports, and a business listing for referrals on the ‘Find an OT’ section of the OTA website (https://www.otaus.com.au/find-an-ot).

In this information pack, the following areas will be discussed:

1. Applying for and eligibility requirements for BAMH endorsement • Information about BAMH for prospective applicants

• Eligibility and requirements for endorsed BAMH providers

• How do I prepare and apply for BAMH endorsement

• What happens after an application is sent?

2. Information for BAMH providers • Information about BAMH for endorsed occupational therapists

• BAMH and Telehealth

• Becoming a DVA Mental Health Service Provider

• Cancellation of BAMH endorsement and reactivation process

3. Useful Links

4. Appendices • Assessed Mental Health Disorders

• Focussed Psychological Strategies

Applying for and eligibility requirements for BAMH endorsement This section provides information about BAMH for prospective applicants, the eligibility requirements for endorsed BAMH providers, how to prepare to apply for BAMH endorsement and what to expect after an application is sent.

1. Applying for and eligibility requirements for BAMH endorsement

1.1 Information about BAMH for prospective applicants

Occupational therapists and Occupational Therapy Australia campaigned tirelessly for initial inclusion and ongoing presence in the Better Access scheme.

Only members of the association are eligible to apply for and maintain endorsement. There are no application fees for BAMH endorsement and annual fees are included in your OTA membership. Member benefits such as Divisional teams and Councils, news and advocacy updates, CPD activities and professional resources support endorsees to better maintain their Better Access provision.

It is important for prospective endorsees to read through the orientation information on the OTA website prior to applying for endorsement.

Further information can be accessed from the Department of Human Services website.

You need to have the appropriate level of mental health practice experience to be eligible to apply for Better Access to Mental Health endorsement and OTA membership is required before you can apply for endorsement, gain and to maintain endorsement for Better Access to Mental Health. We do not charge an additional fee for BAMH endorsement on top of the membership fee.

The process and requirements are outlined below in 1.3 How do I prepare and apply for BAMH endorsement. It is important to step through all of the background information and familiarise yourself with the process and requirements before you apply; the pre-reading will help you to prepare for and achieve endorsement, as applicable.

You must be a General Member and maintain active membership while you are actively working as a BAMH endorsee. If you plan a short break from practice and wish to maintain endorsement but not practice as an OT, you can maintain membership as an Affiliate Member.

1.2 Eligibility and requirements for endorsed BAMH providers

To be eligible to apply to be an endorsed BAMH provider, occupational therapists need to:

• be registered to practice with the Occupational Therapy Board of Australia;

• be a general (full-time or part-time) member of Occupational Therapy Australia;

• have a Medicare Australia Provider Number;

• have a minimum of 2 years full time (or equivalent) supervised practice as a qualified occupational therapist working in mental health with recency of BAMH relevant practice (at least 6 months full time equivalent in the last 5 years). Specifically, this needs to be post-graduate experience. Undergraduate placements and pre-graduation volunteer work will not be considered in the application.

• satisfy all domains of competency as set out in the Occupational Therapy Board of Australia. (Registration requirements are included in the Competency Standards);

• and also meet the National Practice Standards for the Mental Health Workforce 2013.

1.3 How do I prepare and apply for BAMH endorsement

It is vital that you familiarise yourself with the Department of Health (DoH) requirements about practicing under the scheme. Whilst OTA supports you to be able to be a provider under the scheme, the DoH manage all of the reporting and operational processes, and accountability.

Before commencing your application you are expected to have: • Read and understood the Department of Health Better Access to Mental Health Information for

Health Professionals • Read and understood the requirements of being a Medicare provider • A clear understanding of the terms and conditions of being an endorsed BAMH occupational

therapy practitioner. • An appropriate level of mental health practice experience to be eligible to apply for Better Access

to Mental Health endorsement.

If you wish to submit an application for BAMH endorsement, you will need to demonstrate evidence of your mental health practice knowledge and experience via a suite of application forms. To complete your application to become a BAMH endorsee, ensure you have met the following requirements:

• You have a current Medicare provider number. To apply for a Medicare provider number, visit the Department of Human Services website. Never use someone else's provider number or allow someone else to use your number. You can update your details at all times via HPOS.

• To be eligible for Medicare Provider benefits, an occupational therapist needs to meet the requirements of the Health Insurance (Allied Health Services) Determination 2014 as stated on the Federal Register of Legislation.

• If you list your business locality as your home address for your Medicare provider number, the business address (your home address) will be publicly available. Medicare does consider individual requests to discuss the purpose of the provider number, where services are provided to clients and the management of home office details. This can be particularly pertinent to therapists delivering services in the community and external organisations, where the decision has been made not to see clients in the home office of the therapist.

• Complete the Statutory Declaration & BAMH Endorsement Application Form which needs to be co-signed by an approved witness. For clarification on who can be an authourised witness, visit the Attorney- General’s Department.

• You will need to provide relevant evidence of at least 2 years supervised (full time or equivalent) experience in mental health with 6 months recency of practice in the last 5 years. The name and contact details of your most recent supervisor are required and can be included on the relevant CV summary (please see below). (There is no need to have your supervisor co-sign this and no references are required.)

• You MUST include your Curriculum Vitae (CV) in the supporting documentation of your BAMH endorsement application. Ensure you highlight all relevant mental health experience that must be of at least 2 years (post-graduate work).

• An experience summary is required for each mental health role relevant to your application. It is vital that you provide an appropriate level of detail to provide evidence of your skills and experience, relevant to practice within BAMH. You must use the Experience Summary Form provided on the Occupational Therapy Australia website as it specifies the relevant information to be included in the Experience Summary relating to the focussed psychological strategies (see Appendix 2) and assessed mental health disorders (see Appendix 1) covered by the BAMH program. An Experience Summary must be prepared for each relevant role in addition to a current CV.

• Please note that we do not accept multiple roles on the same form to ensure clarity of accrued experience and knowledge from each position. This means for example if you have 5 relevant roles that

you wish to illustrate, you will need to send in 5 CV summaries. If you only wish to highlight 1 relevant role, you only need to provide 1 CV summary.

• You must develop and provide a Supervision Plan to support your transition as an occupational therapist into BAMH. It is expected that your supervision plan will change over time to reflect your practice needs. In order to meet the BAMH CPD requirements, your supervision plan needs to be relevant to your development as a BAMH practitioner and should encompass learning goals that are relevant to the focussed psychological strategies and assessed mental health disorders covered in the BAMH scheme. Therefore, it is important to engage with a supervisor or supervisors with skills and expertise relevant to BAMH practice. The person or people you undertake supervision with, need to have at least 2 years post-graduate mental health experience and contemporary practice knowledge, but do not need to be BAMH endorsed. Your plan should include SMART and specific CPD goals relevant to mental health.

• The CPD/Supervision required as part of your BAMH endorsement application may fall within the OTBA: Registration Standard: Continuing Professional Development.

• All supporting documentation must be supplied at the time of application. Please post an original hard copy to Occupational Therapy Australia, 5/340 Gore Street, Fitzroy VIC 3065 or email (PDF format only) to info@otaus.com.au. We will send a letter of confirmation once you have been endorsed.

• Applications can take up to 10 weeks to process.

1.4 What happens after an application is sent?

In the event that further information, or clarification of experience is required, Occupational Therapy Australia will contact you directly.

When you have demonstrated that you meet the requirements, and your application for endorsement is recommended to Medicare Australia, you will be notified via email by Occupational Therapy Australia.

Once your application for endorsement has been approved and you are fully endorsed, you will receive a written letter via postal mail from Occupational Therapy Australia and Medicare Australia. Medicare may also provide information about practice as a BAMH provider. At this time, your Occupational Therapy Australia membership details will be updated to identify that you are endorsed for practice as a BAMH endorsee.

Information for Occupational Therapy BAMH providers This section includes information about BAMH for endorsed occupational therapists, BAMH and Telehealth, becoming a DVA service provider and cancelling or reactivating BAMH endorsement.

2. Information for Occupational Therapy BAMH providers

2.1 Resources and information about BAMH for endorsed occupational therapists

OTA members are not required to pay any fees for the ongoing endorsement process however, it is the responsibility of each endorsee to ensure that they adhere to the National Practice Standards for the Mental Health Workforce 2013 and the following ongoing requirements when delivering services under BAMH.

BAMH Endorsement and CPD:

• To maintain your BAMH endorsement and to practice as a BAMH endorsee, you need to be registered for practice as an occupational therapist. Also, as part of this endorsement, you are required to complete mental health specific CPD each year (10 hours) related to the focussed psychological strategies. The Occupational Therapy Board accepts that these 10 CPD hours can be claimed in the 20 hours by 30 November required for registration purposes.

• OTA membership must be maintained for you to gain and maintain endorsement. Occupational therapists who are endorsed under the scheme are also required to maintain active engagement in professional supervision. Occupational Therapy Australia manages the annual audit process on behalf of Medicare and randomly audits a percentage of BAMH endorsed practitioners each year. Those who are audited will also be asked to provide evidence of engagement in supervision, goals achieved in their supervised practice and have met the CPD requirements set out for endorsement.

• If you fail to complete the required CPD, supervision or maintain your membership with Occupational Therapy Australia, we will notify Medicare immediately, which will result in your endorsement being lapsed.

Medicare Billing and MBS Items The Department of Health states that “Under the Health Insurance Act 1973 you are legally responsible for services billed to Medicare under your Medicare provider number or in your name”. As you will also be responsible for any incorrect claims, it is recommended you thoroughly read all the information set out by the Medicare Benefits Schedule (MBS).

Please refer to the Medicare website for important information about items that can be rebated, reporting and billing information. It is advisable that prospective and new endorsees are familiar with the services which are similar to, or may appear to overlap with BAMH to ensure clients are eligible for services at all times.

• For detailed information the Better Access initiative MBS items, read the Department of Health Note MN.7.1.

• Keep up to date on all changes to the relevant benefits, schedules and items on the MBS website.

2.2 BAMH and Telehealth

BAMH endorsed occupational therapists are able to undertake BAMH via Telehealth. This means mental health consumers are entitled to claim rebates for Telehealth services provided by occupational therapists. The Better Access Telehealth Guidelines are available on the Department of Health website.

If you elect to undertake a fee for service consultation via Skype or telephone, it is possible that your location of service delivery may be traceable, so it is recommended that you undertake these consultations from a professional workplace.

2.3 Becoming a DVA Mental Health service provider

Occupational Therapy Better Access to Mental Health endorsement is recognised by the Department of Veterans' Affairs (DVA). This means that you can apply to become an occupational therapist provider of Mental Health Services under DVA once you have your BAMH endorsement. For further information on the relevant code to be a newly approved Mental Health Provider under DVA, visit the DVA website.

2.4 Cancellation of BAMH Endorsement and Reactivation Process

OTA will be required to cancel BAMH endorsements if you are no longer an OTA member. If membership lapses or if it is not renewed, we will notify Medicare Australia and the endorsement for BAMH is cancelled.

Membership with OTA ensures consistent contact with endorsees for news, changes to legislation and for the requirement of periodic audits.

OTA members may request to be added to a ‘Lapsed Endorsee’ category if taking a short break from practice in the area and wishing to be exempt from the audit process. Therapists can also request that their BAMH endorsement be cancelled whilst undertaking a career break or change in their practice.

In the event that you are no longer registered as an occupational therapist, your Medicare provider numbers and linked BAMH endorsement is cancelled by Medicare.

How to reactivate BAMH endorsement if it has been cancelled To reactivate your Better Access endorsement, you must:

• Be registered for practice as an occupational therapist in Australia

• Have been a previous Occupational Therapy Australia Better Access to Mental Health (BAMH) Endorsee

• Have an active Medicare provider number

• Be a current general (full time or part time) member of Occupational Therapy Australia

• Have a supervision plan in place, relevant to Better Access to Mental Health Practice

• Be able to demonstrate a minimum of 6 months mental health relevant practice within the last 5 years, along with evidence of supervision.

• Develop a Continuing Professional Development Plan relevant to the Focussed Psychological Strategies used within the BAMH program

Until your application for re-endorsement has been approved, you cannot recommence practice under BAMH. To apply or reactivate your BAMH endorsement, please contact Occupational Therapy Australia on 1300 682 878.

Useful Links This section provides several helpful links to assist in application preparation, professional guidelines, provider requirements and more.

3. Useful Links

• Australian Taxation Office: Starting a New Business

• Billing Accurately Under Medicare

• CBT Fundamentals: Processes and Techniques in Cognitive Behaviour Therapy

• Department of Human Services: Education guide for BAMH providers

• Department of Human Services: Guideline for substantiating a valid Allied Mental Health service

• Department of Human Services: MBS programs and initiatives for allied health professionals

• Department of Human Services: Medicare provider news and updates

• Department of Human Services: Medicare provider number for health professionals

• Fact Sheet for Allied Mental Health Professionals • Health Professionals Online Services

• Human Services Guidelines

• Information about practice and provider numbers via the My Gov online

• MBS Online

• Suicide Prevention Australia • Perinatal Depression and Anxiety (PANDA)

• Lifeline

• Mental Health Australia

• Family Mental Health Support Services

• Better Health Channel

• Australian Human Rights Commission: Mental Health Legislation and Human Rights

• Australian Human Rights Commission: Asylum Seekers and Refugees

Appendices Appendix 1: Assessed Mental Health Disorders Mental disorders eligible for treatment under the better access initiative

Appendix 2: Focussed Psychological Strategies Allied mental health services to be provided

Better Access to Mental Health Care Appendix 1: Assessed Mental Health Disorders - eligible clients Mental disorders eligible for treatment under the better access initiative Allied mental health Medicare services can only be provided to individuals with ‘an assessed mental disorder’ who have been referred by a GP, a psychiatrist, or a paediatrician from an eligible Medicare service. Mental disorder is a term used by Medicare to describe a range of clinically diagnosable disorders that significantly interfere with an individual’s cognitive, emotional or social functioning. The table below presents a list of eligible mental disorders. It is the responsibility of the referring medical practitioner to determine that the client is eligible, and that his/her condition would benefit from a mental health treatment plan and would also benefit from allied mental health services.

Mental disorders eligible for treatment under the better access initiative Acute psychotic disorders Generalised anxiety disorder Adjustment disorder Hyperkinetic (attention deficit) disorder Alcohol use disorders Mental disorder, not otherwise specified Autism Spectrum Disorder Mixed anxiety and depression Bereavement disorders Neurasthenia Bipolar disorder Obsessive compulsive disorder Chronic psychotic disorders Panic disorder Conduct disorder Phobic disorders Depression Post-traumatic stress disorder Dissociative (conversion) disorder Schizophrenia Drug use disorders Sexual disorders Eating disorders Sleep problems Enuresis (non-organic) Unexplained somatic complaints Note: Dementia, delirium, tobacco use disorder and mental retardation are not regarded as mental

disorders for the purposes of these Medicare items Appendix 2: Focussed Psychological Strategies - allied mental health services to be provided Focussed Psychological Strategies (all eligible allied mental health providers) A range of evidence-based psychological strategies known as ‘Focussed Psychological Strategies’ (FPS) has been approved for use by all eligible allied mental health professionals (psychologists, social workers and occupational therapists). A range of major psychological treatments shown to have evidence of effectiveness for a number of psychological disorders have been approved for use by allied mental health providers. These are:

1. Psychoeducation 2. Motivational interviewing 3. Cognitive behavioural therapy including:

• Behavioural interventions - Behaviour modification (especially for children, including behavioural analysis and contingency

management) - Exposure techniques - Activity scheduling (including pleasant events, mastery and time management)

• Cognitive interventions - Cognitive analysis, challenging and restructuring - Self-instructional training - Attention regulation

• Relaxation strategies - Guided imagery, deep muscle and isometric relaxation, controlled breathing

• Skills training

• Problem-solving skills training - Anger management - Stress management - Communication training - Social skills training - Parent management training

4. Interpersonal therapy (especially for depression) There is flexibility to include narrative therapy for Aboriginal and Torres Strait Islander people. Descriptors of Focussed Psychological Strategies

Psychoeducation Psychoeducation is the provision and explanation of information to clients about what is widely known about characteristics of their diagnosis. Clients often require specific information about their diagnosis, such as the meaning of specific symptoms and what is known about the causes, effects, and implications of the problem in question. Information is provided about medications, prognosis, alleviating and aggravating factors. Information is also provided about early signs of relapse and how they can be actively monitored and effectively managed. Clients are helped to understand the diagnosis to enhance their therapy and assist them to live more productive and fulfilled lives. For occupational therapists this may include talking about how symptoms impact on activities of daily living and their usual roles and routines. Motivational interviewing Motivational interviewing is a directive, person-centred counselling style that aims to enhance motivation for change in clients who are either ambivalent about, or reluctant to, change. The examination and resolution of ambivalence is its central purpose, and discrepancies between the client’s current behaviour and their goals are highlighted as a vehicle to trigger behaviour change. Through therapy using motivational interviewing techniques a client is helped to identify their intrinsic motivation to support change. Occupational therapists may use motivational interviewing to assist people in harm minimisation strategies, acknowledging that changing behaviour can be a gradual process and validating someone’s willingness to work towards positive behaviour skill sets. Motivational Interviewing is often used in drug and alcohol services. Cognitive behaviour therapy – behavioural interventions Behaviour modification Behaviour modification starts with a thorough behavioural analysis, which involves specifying and measuring the behaviours to be altered, and identifying the antecedents and consequences controlling these behaviours. This analysis is followed by a systematic program which may include altering the stimuli triggering the unwanted behaviour, shaping new adaptive (competing) behaviour, and contingency management (using reinforcers for increasing desirable behaviour and costs to decrease the unwanted/dysfunctional behaviour). After changing particular behaviours, techniques for generalisation and maintenance of gains are discussed, along with relapse prevention. Exposure techniques Exposure techniques are particularly used to deal with anxiety and phobias. Both imaginal and in vivo exposure may be used, often combined with relaxation and cognitive techniques. Graded exposure is the most commonly used technique. It involves identifying fears, and constructing a hierarchy of the least to most feared situations. The individual then agrees to be exposed in graded (from less to more fear-provoking) steps to the feared object or situation in vivo, such that the anxiety is heightened but not overwhelming. By remaining in this situation until the fear subsides, the persons fears are challenged and hopefully re-assessed as less concerning.

Activity scheduling Activity scheduling involves time management and scheduling in advance activities that support meaningful engagement in a range of occupations. These activities are designed to provide enjoyment, change the person’s self-perception and improve self-esteem. Doing planned activities can distract clients from their problems and negative thoughts, helps them to feel better, paradoxically less tired, more in control of their lives and able to make decisions. Occupational Therapists may use behavioural interventions with children and youth to support their understanding of social norms and environmental cues. These interventions can assist people to function within the environment more effectively which in turn can provide positive feedback to enable community or social engagement. Cognitive behaviour therapy – cognitive interventions Cognitive analysis, challenging and restructuring of thoughts Cognitive analysis involves identifying the dysfunctional thoughts which lead to unwanted emotions and problematic behaviour. This process firstly requires the person to become aware of the thoughts which produce the distressing feelings and behaviour and to uncover the beliefs which underlie the thoughts. These dysfunctional thoughts and beliefs are then challenged and replaced with more rational cognitions and supportive self-statements. Cognitive therapy is most useful in treating internalising disorders (e.g., anxiety, panic disorder, phobias, OCD and depression). Often people with these disorders have cognitive schema which lead them to engage in distorted cognitive processes. Their dysfunctional thought patterns need to be challenged and replaced by more adaptive thoughts to enable them to stop worrying, experience positive emotions, cope with life, and feel successful. In cognitive therapy, clients are made aware of their irrational thoughts and evidence is gathered to dispute or counter the cognitive distortions underlying various disorders. Ultimately the aim is to assist the person to restructure the cognitive schema underlying the maladaptive thinking. Self-instructional training Self-instructional training involves replacing dysfunctional thoughts by self-talk which is functional and guides the person towards adaptive responses to situations they find difficult. The person is taught to think aloud and to replace negative thoughts with coping statements to guide their behaviour and produce a feeling of control. Self-instructional training produces a coping template which assists people to manage difficult situations and emotions and so improves self-efficacy and self-esteem. Attention regulation People with distorted cognitive processing often attend specifically to negative aspects of themselves, others and their environment, and not to neutral or positive aspects. They thus misinterpret events as unduly threatening or confirming of their inability to manage. They believe that others feel negatively towards them and hence that they are not worthwhile. Attention regulation involves teaching people to attend to the positive aspects of themselves, others and situations and to process events in a realistic way. Cognitive therapy can assist people to engage in their chosen activities of daily living, e.g. return to work, grocery shopping, attending social events or being in busy environments. Cognitive therapy can empower people to be more aware of their cognitive processes and keep a check on when thoughts are becoming unhelpful or out of control. Occupational Therapists may use this intervention type to support people who have unwanted or intrusive thoughts (including delusional beliefs or auditory hallucinations). Cognitive behaviour therapy – relaxation strategies Guided imagery, deep muscle relaxation and isometric relaxation There are a number of relaxation techniques, including guided imagery, controlled breathing, deep muscle and isometric relaxation. Relaxation involves voluntarily releasing tension and reducing arousal of the central nervous system. Arousal may produce hyperventilation which can be managed by learning to breathe more slowly and in a controlled manner. Muscles become tense when someone is anxious, deep muscle relaxation aims to teach people how to be aware of

excessive muscle tension followed by educating them in a series of exercises to progressively tense and relax muscles throughout the body. Isometric relaxation is an abbreviated form of muscle relaxation which can be quickly invoked in anxiety-provoking situations. Guided imagery assists with various forms of relaxation by providing a script and images of peaceful surroundings. Occupational therapists often use relaxation strategies as a supportive and restorative activity for those feeling overwhelmed or distressed in some way. Relaxation can be used functionally to support engagement and concentration or as a tool before bed or an event someone knows may be hard. Sometimes relaxation can be integrated with sensory modulation which assists people to be clear on what environmental input assists them to meet their sensory needs. Cognitive behaviour therapy – skills training Skills training involves carefully constructed combinations of various cognitive and behavioural strategies in a manner designed specifically to treat the particular disorder and/or the specific difficulties the person is experiencing. Problem-solving skills training In general, problem-solving skills training involves a structured series of steps. Firstly, the specific problem is identified and analysed in some detail, which may require taking different perspectives on the situation. Goals to be achieved by solving the problem are then set. A long list of possible solutions is then generated, which involves being creative and non-judgemental. The potential solutions are then evaluated in terms of their consequences and how possible they are for the person to implement. Each course of action is assessed to establish how well it meets the goals. The action most likely to solve the problem, and which is practical for the person to carry out, is selected, planned in detail and then carried out. The outcome of taking this particular course of action is then evaluated, and if not successful, another course of action is planned. Anger management Anger management involves the addition of specific techniques to the basic steps of problem-solving to identify when anger is building, and to learn ways to deal with it. The additional steps include: establishing likely anger-arousing situations; learning to identify bodily sensations and thoughts that lead to feelings of anger and aggressive behaviour; and developing alternative strategies that reduce the angry feelings or distract the person to allow time to calm down and to think and behave more rationally. These strategies may include verbal self-instruction, coping statements, relaxation and distraction techniques. Once self-control is established, the person can engage in problem-solving. Stress management Stress management firstly involves identifying the stressful situation or event, and establishing whether it can be altered. Specific techniques are added to problem-solving skills in order to analyse the situation/s the person finds stressful, and to assist the person to cope with or manage whatever reactions the stress produces (e.g., anxiety, depression, somatic symptoms). Thoughts may have to be challenged and coping self-statements learnt, as well as alternative behaviour/s in order to cope with the stressful reactions and be able to engage in problem-solving. In some cases, training in social skills, assertiveness, anger management and conflict resolution is also necessary. Communication training The aim of communication skills training is to teach people how to discuss their thoughts constructively and successfully. Effective communication requires: attention, active listening, accurate understanding, summarising and reflecting, empathy, and responding with clear messages. Appropriate posture, facial expression, gestures, distance from speaker, eye contact, voice modulation and tone may also need to be addressed. Social skills training Social skills training involves the addition of further elements to communication training. These skills may include appropriate ways of approaching people, entering a group, conversation skills (how to start, maintain and close a conversation), co-operative behaviour (sharing and turn-taking), assertiveness and dealing with unpleasant reactions or rejections. Rehearsal with the therapist, planned practice in the person’s social settings, feedback and reinforcement is an essential part of social skills training.

Parent management training Parent management training involves teaching parents appropriate skills to assist in raising their children. Parents are given information about children’s development and needs at different ages and stages and are assisted to establish realistic expectations. Parenting training is based on behaviour management in which parents learn to monitor their children’s behaviour and identify the antecedents and consequences that control it. They are then taught how to modify these variables in order to develop adaptive behaviour. They learn to set appropriate rules and limits, along with logical consequences for breaking the rules which must be consistently implemented. Parents are also encouraged to reward pro-social behaviour, spend quality time with their children, and to work together and support each other in parenting their family. Occupational therapists often use skills training in a hands on and functional way. Occupational therapists may choose to provide verbal intervention alongside practical action-oriented tasks, thus enabling people to learn the skills and experience in vivo feedback. Occupational therapists may use these interventions in group settings. Interpersonal therapy (especially for depression) Interpersonal therapy (IPT) is based on the theory that interpersonal relationships play a significant role in both causing and maintaining depression. IPT aims to identify and resolve interpersonal difficulties that are thought to be related to depression. These difficulties may include conflict with others, role disputes or role transitions, social isolation and prolonged grief following loss. IPT explores clients’ perceptions and expectations of relationships, and aims to improve communication and interpersonal skills. Narrative therapy (Indigenous clients only) Narrative therapy has been approved as a psychological intervention only for Indigenous clients with mental health problems. Narrative therapy has been identified as a mode of working which holds particular value to Aboriginal and Torres Strait Islander people, as it builds on the story telling that is a central part of their culture. Narrative therapy is based on the notion that people arrange their life experiences in sequences across time in order to arrive at a coherent account of themselves and the world around them (referred to as a ‘self-narrative’). The role of narrative therapy is to assist clients to move away from problem-dominated stories that leave them without solutions and towards stories that highlight possibilities and opportunities. Occupational therapists may choose to augment this intervention with an occupation such as drawing/art or movement. (They may choose to use an OT model such as KAWA to guide this.)

Extracted from “Better Access to Mental Health Care Initiative: Orientation manual for clinical psychologists, psychologists, social workers and occupational therapists” (2007) - The Australian Psychological Society Ltd