Focused Self-Management Programme

Principal Investigator

Kieran Lewis, Senior Occupational Therapist , Trinty College Dublin.

Research Aim

The aim of this research programme is to: 

1. To outline the design of an occupation-focused self-management programme for college students experiencing mental health difficulties.
2. To explore the efficacy of an occupation-focused self-management programme for college students experiencing mental health difficulties.
3. To explore its use from the students’ and staff perspective in a real world context.

The objectives of this research are to:

1. To investigate if college students with mental health difficulties experience benefits from engaging in an occupation-focused self-management programme as measured by the SF-36v2 quality of life measure (Ware et al., 2007), the Brief Symptom Inventory (Derogatis 1975; 2004), and the College Student Experience Questionnaire (Pace & Kuh, 1998).
2. To explore the role of the Occupational Therapists who are using the programme and the clinical reasoning which underpins their use of the programme? 
3. To inform the development of the occupation-focused self-management programme by exploring the perspectives of students and OTs using the programme.
4. To explore the fidelity of the approach across different OTs and within various Higher Educational Institutes.

Background

College life often involves an expectation of students becoming increasingly autonomous, perhaps learning to balance academic pursuits with social life, manage a household, engage in new interests, form new relationships and possibly take on part-time work.  Students need to develop the ability to self-manage their mental and physical health.  College students are often viewed as a privileged population but are not immune from experiencing the symptoms and functional impacts of mental health difficulties (Hunt & Eisenberg, 2010).  Student life in Higher Education Institutes (HEIs) contains many complex stress factors, which may exacerbate or trigger mental health difficulties (Royal College of Psychiatrists, 2003).   The onset of mental health difficulties commonly occurs in late adolescence and early adulthood (Mowbray et al., 2005) and a significant increase has been noted both in the number of students disclosing a mental health difficulty upon entry to college and the number of students who report experiencing a mental health difficulty while attending college (AHEAD, 2012). 

Associated with their mental health difficulties, these students can experience more difficulty engaging in their student roles, which in turn can lead to lower rates of progression and retention (Kessler, 1995; Collins & Mowbray, 2005; Eisenberg, Golberstein, & Hunt., 2009).  HEIs have traditionally supported these students through course-specific reasonable accommodations in combination with special programmes for targeted groups of students (Sachs & Schreuer, 2011), such as college-based counselling, psychiatric and disability services. These programmes provide a mix of medical, psychosocial and social model guided approaches.  Of the 1,219 students who have applied for supports with the Disability Service in Trinity College Dublin in December 2013, 242 students (19.9%) entered the service with a primary diagnosis within the category of ‘mental health condition’.  The majority of these students are engaged with Occupational Therapists within the Unilink Service.

It has been suggested that college presents as a unique opportunity to identify, prevent and treat emerging mental health difficulties (Royal College of Psychiatrists, 2011; Eisenberg, Downs, Golberstein & Zivin, 2009), but college also presents as an opportunity for students to develop important academic and non-academic self-management skills within a supportive system.  There is a growing evidence base behind the use of these various self-management approaches with various groups and within different contexts.  It was postulated by OTs within Unilink that a self-management approach could be used to facilitate students experiencing mental health difficulties to learn how to manage their engagement in their day to day occupations and maintain their health and well-being, while also meeting their academic demands.

Research approach

The research design in this study involves two separate strands to address the research questions outlined.   Firstly, a student strand aims to explore the reported benefits of the programme from the perspective of the student, and to also evaluate the efficacy, appropriateness and administration of the programme from the students’ perspective.  Secondly, a staff strand aims to evaluate the usability and appropriateness of the programme for students within a college based service context.   A mixed-methods approach (Creswell, 2014) was chosen to answer the research questions from the student perspective with a qualitative study design addressing the research questions from the OT’s perspective.

Disability Service Strategy 2009-2014 phase alignment: Phase 2
Level of research: PhD in Occupational Therapy
Supervisor: Dr. Clodagh Nolan
Stage of research: Year three 2013-2014