My name is Emily Scott and I work as a specialist perinatal occupational therapist in a community perinatal mental health team. We offer OT support to people referred to the team with complex and severe mental health conditions in the antenatal and postnatal period. Currently, we offer 1:1 OT assessments and interventions for clients we support as care coordinators and for those referred by other care coordinators (mental health nurses and social workers), psychologists and psychiatrists within the team. We are also offering group intervention – an OT-guided antenatal group using a virtual platform and an in-person postnatal group.
As OTs, we work holistically, and I personally feel that one of the most holistic tools we can use is the occupational circumstances assessment interview and rating scale (OCAIRS). Although a time-consuming assessment, we can utilise this for the individuals we support through multiple sessions as required. I have most frequently used this scale to provide a therapeutic tool to get in-depth information about the client I am working with, but also to individualise future work. Although, as the name suggests, this is a piece of work used for assessment, I believe it can be used as part of intervention-based work and allows our future work to be person-centred throughout. I am making our clients aware that this is a piece of assessment, but I have been most frequently using this tool part of the way through their journey under the service.
As with every OT assessment and intervention, there are certain aspects which are likely going to be the most beneficial; for many of our service users, it has been personal causation – determining what our clients are proud of through their life and the goals section – which considers longer-term goals and how clients could achieve these. I personally feel that talking about future goals – whether they are one, five or 10 years in the future is particularly helpful for those women in the perinatal period as they often do not consider what their life will look like without their child being a new-born, or when they are no longer pregnant. For every person, this will look slightly different, parenthood is a period of time with identity shifts and changes in routine and roles due to the extensive life change.
I have added a case example, one lady that I work with is a high achiever, she struggled with severe post-natal depression following the birth of her child and struggled to come to terms with parenthood. She has provided me with consent to share parts of her story, as well as feedback on the work using the OCAIRS. This lady found it difficult to remember ‘before pregnancy’ and felt a complete loss of identity, she was not sure where to start in regard to our work together, she spoke about long-term goals, such as finishing her PhD, finding a meaningful and successful job and publishing a book. I spoke to her about the concept of OCAIRS and explained that although this is a piece of assessment work, I believed it would be able to show in-depth areas of her life and how we can best support her.
While completing the OCAIRS we spoke in-depth about her past and she could recognise and reflect on memories – both positive and difficult throughout her life and how she believes this has shaped who she is today. When we completed the goal aspect of the OCAIRS she spoke about feeling that she could think about the future and how she might feel once her child is older. She explained that no-one in their care circle had asked about the future in five to 10 years, she found it a positive overall experience and then decided to consider her future with her partner in their own time. We also set goals for the following week and fortnight and she found that manageable. Meaningful goals were extremely beneficial for her to have something to aim for, this included caring for her baby for the evening without support, and completing a keeping-in-touch day at work. When this lady succeeded in managing these thought-through and achievable goals she found her mood improved.
The feedback that I received from this client shows how beneficial this piece of OT intervention in the form of an assessment document was for her, she has provided consent for this to be shared: “Emily helped me through some really useful goal setting, over a couple of sessions. She helped me come up with two different types of goals—personal/family and professional/academic—to align with how my life is organised and how I’m thinking about and planning things. She followed up with me at our next session, checking in on how I’d managed to approach each goal, and how I felt about them, which was self-affirming and felt like such positive progress. She was exceptionally kind throughout, and very gently encouraged me to set attainable goals, and not to overreach and risk getting disheartened. I’ve found it so helpful, and good for building up more confidence and enjoyment in my day-to-day life and responsibilities.”
I have been offering the OCAIRS forms to be completed over two to three sessions, particularly for our service when clients have children whom they are caring for, this will need to be altered for each individual service as appropriate. I have also completed the OCAIRS with other care coordinators who have other professional backgrounds and the ladies that they support, this helps provide identification for meaningful occupations to support recovery, alongside determining any future OT-specific intervention. I hope that I have encouraged other OTs to use the OCAIRS for assessments, but also for therapeutic intervention ideas for longer-term work.