Generic and Specialist Occupational Therapy Casework in Community Mental Health Teams

There has recently been a debate in the British occupational therapy literature as to the optimal type of casework for occupational therapists working in community mental health teams (Parker 2001, Corrigan 2002, Dunrose and Leeson 2002, Forsyth and Summerfield-Mann 2002, Harries 2002, Stone 2002). One of the issues of the debate is how much time should be given to generic casework and how much time should be given to clients who primarily have difficulties in occupational performance. Three patterns of working have been described in the literature: generic casework, specialist occupational therapy casework and a mixture of the two. Some occupational therapists are working solely as a generic case coordinator, a role that has been considered by some to be the most effective method of providing services to the client (ParryJones et al 1998). This role began in the early 1990s, when it became government policy that a single professional should be responsible for the management of a client’s needs (Department of Health 1990). Taking a generic role is a common expectation in many community teams (Brown et al 2000). Unfortunately, generic working has had some drawbacks. In theory, each professional can refer to the other team members when needed but, owing to workload pressures, this does not always occur. Therefore, team members do not necessarily feel skilled in meeting all the needs of the client and they may have to work outside their areas of expertise (Brown et al 2000). Team members recognise that they must not focus on their own areas of professional interest but on the needs of the client. These needs must lead the orientation of the service provision. In relation to generic working, role stress and role confusion have been commonly reported (Parry-Jones et al 1998). Some occupational therapists work only as occupational therapy specialists, therefore accepting only occupational therapy type referrals. This type of casework may include case coordination, but only if the client’s main needs can be met by occupational therapy. Finally, some occupational therapists hold a mixed generic and specialist caseload. From the data collected prior to the cluster analysis, this appeared to be the most common method of working (Harries and Gilhooly 2003). The professional body for occupational therapists recommends that, in this type of mixed caseload, occupational therapists The aim of this research was to conduct a cluster analysis on data from 40 community mental health occupational therapists to determine if subgroups of therapists had differing referral prioritisation policies. A Ward’s cluster analysis showed four clusters to be present. These four subgroups of occupational therapists were found to differ according to several factors: the percentage of role dedicated to specialist occupational therapy or generic work, satisfaction with the balance in these roles, the number of hours worked, the number of professionally trained team members and the presence of referral prioritisation policies. The subgroups were named the aspiring specialists, the satisfied specialists, the satisfied genericists and the chameleons (those not set in applying a consistent or specific policy). The policies that led to mainly generic working gave greatest importance to clients who were potentially violent or at risk of suicide. The policies that led to more of an occupational therapy role gave particular importance to the reason for referral and the client’s diagnosis. The College of Occupational Therapists has recommended that the majority of casework should be focused on specialist occupational therapy interventions (Craik et al 1998): most of the participants in this study were not meeting this recommendation. Although some aspired to being more specialist, the pressures to work generically may have been affecting referral policies.