Inpatient Psych with Karenna

Hi! My name is Karenna Lillo. I am currently an occupational therapy student who is just a few weeks away from being completely done with my 2nd Level II fieldwork in a school setting! I attend Concordia University-Wisconsin in Mequon, WI. I am not entirely sure what setting I want to work in. I have loved almost every setting I have seen, but I am currently leaning towards either school-based or any mental health setting. We shall see what happens in just a few short months. 

What setting are you sharing about today and can you give a brief description of it? What qualifies a person to receive therapy in this setting?

I will be sharing about my inpatient psychiatric (or behavioral health unit – BHU) Level II Fieldwork placement. The BHU is a locked unit that supports those with a variety of psychiatric diagnoses who: are experiencing either an acute episode; need a medication adjustment; are a danger to themselves or others

What is OT’s role in this setting?

OT’s role within psych is to lead groups on a variety of topics. Some of these topics include coping skills, leisure activities, self-esteem, social support, and negative vs. positive self-talk. Beyond running groups, OTs help support the patients in any way they need, including helping them sign up for housing or encourage them to find something that interests them during the large amount of downtime. 

Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?

Yes! I wanted to do this placement because of my psych class. My university recently hired a new professor who has worked in inpatient psych for many years. We would watch movies portraying those with various mental health diagnoses and would analyze their characteristics and behaviors. We would also practice writing SOAP notes, which helped me to practice being succinct in psych notes (which was very important for me in this setting). 

Before my placement, my CI sent me a link to NAMI that discussed each diagnosis I would see. I then created a handout including the key information. I also looked at different treatment concepts, like CBT and DBT. 

What resources were the most helpful during your time there?

Pinterest, Google, and group planning books from my site were my main resources. These helped me find and plan groups. My CI also had me fill out a group planning form that made me consider all aspects when thinking through a group. I also would often ask the patients what topics they would like to talk about to make the groups meaningful for them. 

How did you stay organized and manage your time?

I brought my binder that included my past groups, fieldwork schedule, and rubrics for my assignments. 

I created a google folder for this placement and put anything and everything that I worked on into it. Because I only ran 2 groups/day, I had a lot of downtime. I had to use this time wisely though, to finish notes, plan for my next group, add in assessments, and work on my project. I had to be self-motivating. 

What was your schedule like?

I had a very nice schedule. I was scheduled to be at clinicals from Monday-Friday from 8am-4:30pm. 

8-9:30amTalk with nurses, hand out assessments, set up for morning group
9:30-11amGoals and project group
11am-1pmNotes, lunch, and plan/prep for life skills group Tuesdays: rounds with psychiatrist, social worker, pharmacist
1-2pmLife skills group
2-4:30pmNotes, input any assessment documentation, work on project and or assignments

What assessments did you use most?

We did not use any traditional assessments that I learned about in OT school. My clinical site uses an assessment that they created that asked the patient a variety of questions including: their perceived strengths and weaknesses, goals for hospitalization, roles, interests, and support systems. This was a mini-occupational profile that the patients filled out by themselves, but I always followed up if I had any questions or I wanted them to write down more perceived strengths and goals. 

What conditions/diagnoses did you see most often?

I saw patients with these diagnoses: depression, bipolar, anxiety disorders, suicidal ideation, alcohol and opiate detox, psychosis, schizoaffective disorder and personality disorders, like Borderline personality disorder (BPD) and narcissism. I was most intrigued by those diagnosed with BPD.  

What did a typical session look like?

Goals and projects group: This group was 1.5 hours. Patients identified 1 goal they had for the day and then were allowed to pick one project they wanted to work on for the rest of the time. I loved this group because it allowed me to ask them questions about their life in a calm and safe environment. 

Life skills group: This group was 1 hour. The topic changed each day and was dependent on the patient population and what they needed. It could include education, discussion, or active participation. 

How did you stay client-centered and occupation-based?

I never made the patients do something they did not want to do. I allowed them to choose a craft or project to work on. By allowing the patient to engage in something they have done before or have never tried, we are allowing them to consider starting a new occupation. I also emphasized how the patient could take what we were doing on the unit back to their home. 

Did you have to do a project or in-service? Could you share what topic you chose? (if you can)

I had a project that I worked on for my entire clinical. I created an example craft for each art project we had. I actually really liked this project, because it allowed me to work on a project with the patients and be vulnerable. I often asked the patients for support when completing my projects. 

What was your favorite part of this fieldwork experience?

This is a hard question! There are so many things I loved about it. My favorite part though was connecting with the patients and leading challenging, thought-provoking groups. I definitely developed many skills for myself that will influence who I am as a person for the rest of my life. 

What was your least favorite part of this fieldwork experience?

I had the hardest time “leaving” the patients at my placement. I would hear their stories and just realize that all of my struggles were nothing compared to them. It wore on my heart. My CI told me this is something you have to deal with when working in psych, so I spent a lot of time reflecting and realizing why I was there: to help support the patients and help them engage in various occupations. 

What is something you learned that you will take with you for the rest of your career?

A lot of the patients were just looking for someone who would talk with them and not at them. I was able to build rapport with my patients quickly because I took time out of my day to see how they were doing and what they wanted to do. Mental health will be in any and EVERY setting I choose to work in one day. These topics need to be explored with all our patients, regardless of setting. 

What advice do you have for a student about to start in this setting?

I think it is really easy to be very timid about having an inpatient psych setting. I would strongly encourage you to acknowledge any fears or insecurities you have with yourself and your CI and then work on getting out of your comfort zone. You will find that a lot of patients are also scared and just want someone that will look and talk with them like they are “normal”. 

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