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20Q: Holistic and Compassionate Care Educator

20Q: Holistic and Compassionate Care Educator
Kristine Haertl, Ph.D., OTR/L, FAOTA
December 9, 2019

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Kristine Haertl, A Holistic and Compassionate Care Educator

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Kristine Haertl is a distinguished professor, author, private practitioner and community consultant in behavioral health and developmental disabilities. Kristi is a professor in the Department of Occupational Science and Occupational Therapy at St. Catherine University. Kristi has been active in mental health research related to peer-supported mental health housing models; the role of writing in the development of the self; the lived experience of ASD; and exploration of the nature and efficacy of services at a free-standing psychiatric occupational therapy clinic.  Kristi’s research has led to legislative changes regarding evidenced-based mental health practice in Minnesota and has helped secure funding for the development of Fairweather housing units in Pennsylvania.

 

 

 

Franklin Stein, PhD, OTR/L, FAOTA

Contributing Editor

Salute to OT Leaders Series

20Q: Holistic and Compassionate Care Educator

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Kristine Haertl, PhD, OTR/L, FAOTA

Mental Health and Developmental Disabilities

Learning Outcomes

After this course, readers will be able to:

  • Describe the role of the occupational therapy consultant in mental and behavioral health
  • Identify the important factors in private practice in mental and behavioral health.
  • List the concepts of a holistic occupational therapy program in mental and behavioral health.
  • Describe personal strategies for occupational therapists to use to deal with stress management and potential burn out.

1.  You have dedicated much of your professional career to working with people who have mental health and developmental disabilities? Can you describe how you first became interested in these populations?

I have an immediate family member with a serious and persistent mental illness who motivated me to work in mental health (both in community and state mental health facilities) immediately after receiving my degree in occupational therapy. Through these experiences, I also worked with several individuals who were dually diagnosed with mental illness and developmental disabilities. I later became a consultant for the state of Minnesota, and I continue to serve on multiple mental health boards. My experience in these areas generated my interest in research and publication.

2. Based on your research, how can occupational therapists improve the lives of people with mental health issues and/or developmental disabilities?

I tell students that the first and most important goal with any client is the development of rapport (establishing a caring relationship). I believe it is essential to look at the client holistically; too often occupational therapists are given referrals for a narrow scope (e.g., a sensory evaluation, a living skills evaluation, etc.). We must come to know and appreciate the entire client in order to provide holistic compassionate care. Holistic compassionate care is working with the client on many levels including social skills, leisure and work interests, exercise, nutrition, family relations as well as activities of daily living. We must have cultural humility and educate ourselves on working with individuals from diverse backgrounds.

Therapists work in multiple settings through various models of service delivery with behavioral health populations. It is important to remember that mental and behavioral health conditions are in every setting occupational therapists work, and therefore, we must use our clinical judgment and therapeutic use of self in serving all populations.

Fairweather Model

3. Besides research, you have been an active mental health practitioner. Can you describe your work in community agencies?

I initially worked in community mental health at a Fairweather Model organization, Tasks Unlimited in the mid-1980s. I was later recruited to help develop an occupational therapy department at a state hospital. I have continued to serve on the Executive Board of Tasks Unlimited for the last 30 years. I have also conducted research on the Fairweather Model and the importance of peer-support models and peer-supported housing. Too often we push people into their own apartments when this may or may not be their choice nor the best option. We must have a variety of housing options that provide high-quality holistic care.

The Fairweather Model was developed by Dr. George Fairweather under a National Institute of Health grant in the 1960s. He demonstrated that he could keep people out of state psychiatric hospitals by providing quality housing, meaningful work, and training in how to live in peer-supported environments. Today there are Fairweather Model programs around the county, and they are under the National Coalition of Community living. Common features of the Fairweather Model are that 1) members have a stake in the system, 2) they are given much autonomy, 3) their role is voluntary, 4) there are opportunities for advancement in the system, 5) they fulfill societal roles, and 6) work is a primary feature of the program (Haertl, 2005; 2007).

In addition to my work with Tasks Unlimited, I have developed a private practice with persons who have dual diagnoses with psychiatric and developmental disabilities. I consult with both individuals and organizations. When consulting with an organization, I may make recommendations on the home environment, schedule, staffing and staff training, and means to maximize occupational performance and quality of life.

Private practice whether full or part-time is an important area for occupational therapy consultation. There are several websites and organizations available to help occupational therapists who are interested in developing their own private practice. Important considerations include developing the business as a sole proprietor or LLC, securing liability insurance, setting up a practice model, and determining how to bill for services. Although I originally billed through traditional Medical Assistance and third-party payers, I now bill directly to clients, businesses, counties, states, and the Federal Government.

Within my private practice, I find it important to see the client in his/her home or work setting. If we see a client in the clinic, we may not have an accurate view of how the client lives in the home environment. For instance, if I am conducting a systems consultation to a group home, I start with a needs assessment and review the questions and concerns of the stakeholders (the clients, staff, administrators, and caregivers). I then determine how best my services may be delivered. I typically review the home or work environment, the needs of the clientele, the staff training, and I look at the roles, routines, and daily functioning in the home. Following this process, I make suggestions of how the system may be improved (e.g., if the facility has a need for a sensorimotor area; if there should be consideration of adding exercise equipment; the staff training needed; and general suggestions). I often follow up with staff and administrator training. This approach has become popular with businesses, and I now regularly conduct training several times a year for a number of corporations that own group homes for persons with MI (Mental Illness) and IDD (Intellectual and Developmental Disability).

When working with individual clients, I typically do a comprehensive evaluation of the client and make recommendations for intervention at their home/group home, or if possible, I may refer to an occupational therapy clinic. Often it is difficult to find services for clients who are teens and older and have a history of assault or property destruction. As a result, I often need to make recommendations for means to service these clients in their existing residential environments.

4. You have also been very active in legislative issues that affect mental health. How did you get involved in this area?

I have primarily been active when organizations I have been involved with have needed to lobby or to change legislative statutes. I have learned that advocacy and involvement in this area is integral to assuring we have policies, procedures, and laws in place to meet the needs of the clients and also to protect and advocate for health professionals

From 2000-2003, I conducted my PhD dissertation research on factors that influence success in a Fairweather Model program. I later collaborated with the organization to conduct a 5 and 10 year follow up. The results demonstrated that clients that were able to graduate from the training program for the Fairweather Model had over 90% reduction in re-hospitalization, had over 500% increase in wages, and had high satisfaction with the program. Those most likely to succeed had to want to be in the program, had to have a desire and capacity for work, had to have some level of chemical health stability, and accepted support from those meaningful to them (e.g., close friends or family).

At the time of the original study, funding for this type of program (the Fairweather Model) was fairly low compared to some other models. As a result of lobbying with the organization and in conjunction with the positive research outcome the Fairweather Model was declared under Minnesota Statutes as evidenced-based and thus was eligible to receive increased funding. The research was also used in Pennsylvania to help secure funding for more Fairweather Lodges in that state as well (Haertl 2005; 2006; 2007).

Mental Health Interventions

5. What interventions have you used as a practitioner in mental health?

I have used interventions in all areas, and as mentioned previously, it is imperative we work with clients holistically. The type of interventions used of course depends on the context and the client's needs across the lifespan. I apply the following occupational therapy interventions as needed:

Skill training/ ADL/ IADL. The comprehensive occupational profile and OT evaluation process to identify client strengths and needs. If the client is lacking in ADL/ IADL skills, it is important to determine the client’s capacity for learning and adjust skill training as needed. For instance, many of my clients with mental health conditions are able to learn financial management and household management. Conversely, some of my IDD clients may not have the cognitive capacity to learn higher-level living skills and thus adaptations and environmental supports and resources are important to assure their needs are met.

Sensory Strategies. Many clients with mental and behavioral health challenges have corresponding sensory processing difficulties. Strategies may incorporate classic Ayres Sensory Integration treatment (often with younger populations) or may include related approaches such as using personal sensory calming techniques for emotional regulation of an adult on the autism spectrum.

Coping Strategies. Positive coping strategies are key for all of us. Many of the clients are able to learn positive coping through the use of educational sessions and practice. Some of the younger clients and those with lower cognition may need external help for emotional regulation such as the use of emotions charts.

DBT/ CBT. Students often learn about the cognitive-behavioral therapy (CBT) frame of reference in their educational training. CBT is an evidence-based approach for many areas of occupational therapy. DBT (dialectical behavioral therapy) is a formal type of CBT that was originally designed for persons with borderline personality disorder but now is used with a wide variety of populations including depression, eating disorders, and anxiety disorders. Typically, occupational therapists need extra training beyond their OT practice in order to apply DBT. I personally went through DBT training. It is important to discern the difference between an OT delivering CBT vs. a social worker or psychologist. It is important for us to incorporate CBT techniques with occupation. For instance, I may work with a client to challenge cognitive distortions in order for him/her to engage in the student role.

Leisure exploration. Leisure exploration is an important part of occupational therapy. Within mental and behavioral health, it is important to discern where we are similar or different from other professionals addressing this area. For instance, many mental and behavioral settings also have recreation therapy. Within the state hospital, the recreation therapists often conduct large groups of recreational opportunities (e.g. volleyball in the gym or a bowling outing) while the occupational therapists work with smaller groups or individuals on considering personal leisure exploration.

MOHO approaches. I often use occupation-based approaches focused on the Model of Human Occupation. Consideration of the client’s volition, habituation and performance are important in considering life balance. Not only is this important in working with mental health populations, but also, this is important when working with clients who have intellectual and developmental disabilities (IDD). Often, those with lower cognitive function may be placed in front of a TV or video much of the day. Not only do I take a client-centered approach with these clients, I educate staff on meaningful occupations that may be used to productively engage these clients.

Cognitive Disability Approaches. I have found the Allen Cognitive Disabilities Model highly effective in helping to determine a client’s current cognitive level, determining approaches to intervention, and educating staff and caregivers. It is important however to use this in conjunction with clinical judgment. We must never use the Allen Screening tool as the only means of determination of client function. It is important to conduct a comprehensive evaluation and determine a client's strengths and weaknesses. In addition, though extensive adaptation and compensation are often used at the Allen levels 1-3, we can use rote learning and adapted skill training at higher levels. It is important to carefully determine when it is appropriate to use remedial/restorative strategies, when to use compensatory/adaptive strategies, and when a combination of approaches is appropriate.

Illness Management and Recovery (IM&R). This approach is used to teach illness self-management for persons with serious and persistent mental illness. This is an evidenced-based approach, yet it is important to determine the client’s capacity to learn the skills. IM&R uses psychoeducation, skill training, cognitive-behavioral, and other approaches to address health and medication management, social skills training, coping skills, and relapse prevention.

Wellness Recovery Action Plan (WRAP). The WRAP plan is an individualized plan developed with the client in order to promote personal recovery. This includes the identification of occupations and other factors that contribute to the client’s health, understanding of triggers that may cause one’s mental health to deteriorate, and the development of a crisis plan.

In addition to the above, there are many other approaches including the focus on family systems. The use of psychoeducation and addressing client relationships are also key to the recovery process.

6. In your edited book "Adults with Intellectual Disability" you have delineated interventions that you have found effective. Can you describe them?

The book is organized into three sections.

a) Facilitating quality of life: This section provides an overview of evaluation and intervention for those with IDD. It discusses how to develop quality individual and systems approaches for IDD clients.

b) Considerations with specialty populations: This section covers dual diagnosis, populations on the autism spectrum, the transition years, and aging adults with IDD.

c) innovative approaches to intervention for adults with IDD: This is the most comprehensive section and covers the use of behavioral strategies; sensory strategies; play/ leisure and ADL/IADL; facilitating employment, driving, and assistive technology.

I authored several of the chapters in the book and also found international authors who were leaders in their field (e.g., lead psychiatrists at Kennedy Kreiger in Johns Hopkins; Robert and Lynn Koegel, who were instrumental in the development and advancement of Positive Behavioral Approaches, and Carolyn Unsworth who is known for her work in driving habilitation and rehabilitation).

My personal philosophy in applying evidence and clinical judgment emphasizes the importance of developing rapport and trust with the client, use of therapeutic use of self, and applying a holistic approach that seeks to help improve the client’s quality of life and to maximize occupational performance in work, leisure and daily social interactions.

Research

7. What do you consider your most significant research study?

Within a therapeutic applied research focus, my research on the Fairweather Mental Health Model previously discussed was significant, in part because it influenced State statutes at the time and helped advocate for funds to support Fairweather Lodges in Minnesota and Pennsylvania. In addition, there is very little research on this model so I had the opportunity to conduct a series of presentations and workshops in various settings as related to the model and research.

Within occupational science, one of my more personal studies has a heuristic and phenomenological study of the role of personal writing in the development of the self and the healing properties of writing (Haertl, 2014; Haertl & Ero-Phillips, 2017).

8. What was the methodology that you used in the Fairweather research study?

The first study was a mixed design study (incorporating both quantitative and qualitative methods) with a 10 year follow up. The study utilized chart reviews, staff surveys, and current and former client interviews. Data was synthesized to answer study questions related to factors that contribute to success in a Fairweather Model mental health program.

The second study on personal writing was a three-phased study. The first two studies were heuristic in nature and the third phase was phenomenological. Heuristic methodology (Moustakas, 1990) involves a research question that at first is of significance to the researcher and yet may have universal significance. Within heuristic inquiry, the researcher may start a process of self-discovery and then later include other participants who become co-researchers. So for instance, within my study, I sought to answer the question, “What is the role of writing in the development of the self." I went through 30+ years of my personal poetry and journal writing through my mother’s mental illness (schizophrenia) and my brother’s brain injury and epilepsy. After a period of self-discovery and analysis, I traveled the US and interviewed others who were lifetime personal writers. Participants were interviewed and became co-researchers in the analysis process of the data. Interestingly, within the second phase of this research, although I was recruiting from the general population, over half of the volunteers had a diagnosis of mental illness. As a result, following the second phase, a third phase phenomenological study was conducted on 12 individuals with mental illness who engaged in personal writing. This phase sought to answer questions related to the healing properties of personal writing. (Haertl, 2014; Haertl & Ero-Phillips, 2017). Phenomenology studies are the lived experience and perspective of the participants in the study.

9. What have been the most significant findings from your research that can be applied to practice?

I believe my findings are related to the importance of peer-supported models. Too often, we operate from a top-down expert model but advocating, enabling, and educating on the importance of peer support is integral to quality of life. Within peer-supported models such as the Fairweather Model, clients have an equal stake in the system and have significant decision-making power. Residential housing units in the Fairweather Model are referred to as Lodges and clients take on leadership roles and share the duties of maintaining the lodge. At Tasks Unlimited, we also have client members on our Board of Directors and on each of the subsidiary boards of the organization. Clients are also able to take on supervisory roles at the work-site. When Dr. George Fairweather developed this model, it was considered fairly radical in the 1960s given that the Medical Model which embraced expertise was often favored over collaborative peer-supported models such as Fairweather. Today, we have more peer-supported models and too, we’ve seen an emergence of peer-support counselors in mental health service delivery.

10. What plans do you have for future research studies?

Currently, I am a partner in a study that is looking at student perceptions of how mental health is addressed in non-mental health settings. AOTA has a mandate that fieldwork includes psychosocial factors, yet there is often confusion about what this means and how it is manifested in non-mental health sites.

Our study is looking at students across two universities who are placed in non-mental health settings (e.g., a TCU [transitional care unit], school, rehab hospital, etc.). Students are asked to reflect on how these sites are meeting the psychological/social/mental health needs of the clients served. This study is seen as important in order to inform the university programs, the sites, and the profession related to addressing mental health in non-mental health settings.

Career

11. Now, I would like to discuss your career as an occupational therapist. Why did you select occupational therapy as a career?

To be honest I think it was a “God Thing”. As a senior in high school, I went to a Bible Study. The pastor asked what we planned to study in college and/or the profession we hoped to pursue. Though I was planning on pre-med, the person before me at the Bible Study mentioned occupational therapy. I turned to inquire about what occupational therapy was. Once she told me about the profession, I thought it sounded interesting and a potential avenue to pursue prior to medical school. I then chose to volunteer in the OT department at the Courage Center and was fascinated with the progress I saw clients make in OT. This experience confirmed my decision to pursue OT as a career. Once I was in OT school and was educated on the possibility of working as an OT in mental health, I felt as though mental health occupational therapy was a perfect fit for me and thus I pursued OT as my future career rather than medicine.

12. What was your first clinical position?

I applied for a job at the Fairweather Model Mental Health Program previously discussed, Tasks Unlimited. They were looking for someone to develop a living skills curriculum, and I convinced the management that occupational therapy could be of benefit to them. I was hired, and it was an excellent fit. I helped develop their living skills curricula and emphasized the importance of peer-support models. 

13. What other clinical experiences did you have?

Following my work at Tasks Unlimited, I was hired to help develop an occupational therapy program at a state psychiatric hospital in Minnesota, Anoka Metro Regional Treatment Center (now referred to as ARTC). Ultimately, I was responsible for supervising OT on 3 units at the hospital. When I first arrived, there was only one other occupational therapist. We had a plan to grow the department to 3 OTR’s and 7 COTA’s. I conducted needs assessments on the various units, partnered with some of the new staff, and we developed programming for each of the units.

At the time each unit had a specialty (e.g., chemical health, forensics, geropsychiatry, etc.). During my tenure at ARTC, I worked in nearly every area and supervised the COTA’s assigned to their corresponding units. Needs varied from unit to unit. For instance, the unit with chemical health clients included more groups and programs designed to promote positive chemical health. The geropsychiatric unit had a variety of craft, ADL/IADL opportunities, as well as a group based on cognitive, sensory, and social activities. Across all units, we too had a variety of living skills groups that were aimed at the level of the client. For instance, clients that were scheduled to go to a group home had a different type of living skills group than those who were going to their own living situation such as an apartment. The unit that had several individuals with Borderline Personality Disorder had CBT and DBT groups, and the forensic units also had groups designed for re-entry into the community. Currently, as is the case in many states throughout the US, many of the beds at the hospital are filled with forensic clients with mental illnesses.

After about 9 years at the state hospital, I was recruited by a former professor of mine who was then working at St. Catherine University in St. Paul. Although I loved my position at the state hospital, after much prayer and many discussions with friends and family, I decided that the move to higher education would be a growth experience and would offer me the opportunity to educate the next generation of occupational therapists.

14. How did you become a professor?

I again feel as though this was God led. I was recruited to St. Catherine University. Although I was not planning to leave the state hospital position, I felt it important to visit the campus and talk with the faculty. Once given a specific offer, it was a difficult decision at the time but I have now been a professor for 23 years and have loved the profession of teaching. It has afforded me opportunities to teach eager graduate students and to conduct workshops and presentations in collaboration with colleagues all over the world. I am humbled to have had the opportunity to present research on 6 continents and have come to realize the importance of learning various models of service delivery from my global colleague friends.

15. Describe your research on mental health housing projects in the community.

As previously discussed, my research focused on factors that lead to success in Fairweather Model Mental Health programs. Our program at the time had robust outcomes as those who made it through training and to a Fairweather Lodge had over 95% reduction in hospitalization. It was, however, important to discern who was most likely to succeed in the model. Important factors include a desire to work, some level of chemical health stability, and family support (or support from a loved one).   

Education

16. How would you define OT to a new graduate student?

I stress to a new graduate that we are a profession that emphasizes the role of occupation in health and well being. I find that often students have a limited perspective of OT based on past experience (e.g., a grandfather who had a stroke, a brother with autism, etc.). It is important we view the client more holistically. I usually discuss how we use occupation both as a means and an end as I come to understand the students’ perspectives on OT. In using occupation as a means, it becomes a tool in therapy. For instance, in the state hospital, I witnessed the healing power of crafts to bring out emotion, to enable clients to express, to practice following direction, and as an opportunity for social engagement. Within this example, the craft is a therapeutic means to work on a goal. We had a horticulture program that not only taught the skill of horticulture (occupation as an end), clients found the actual process of gardening as therapeutic (occupation as a means). Thus, it is important to consider that the root of our profession, occupation, is a powerful tool both as a means and as an outcome.

17. In your experience how do you help graduates cope with the stress of being a new therapist?

I believe that coping with stress and preventing workplace burnout is deeply important for all health professionals. Health care workers are particularly susceptible due to the rigorous demands of the current health care system and the fact that we are extensively giving to others in our profession. I recommend the following strategies to help new graduates cope with stress:

  • Find a trusted mentor in occupational therapy. This can be helpful both in higher education and in your workplace. Having someone to learn from, someone to process ideas with, and a mentor who is willing to help you come to understand the workplace culture and expectations can be highly valuable.
  • Maintain outside interests and a life balance. As occupational therapists, we are excellent at teaching our clients life balance, but we may not be as proficient in doing so ourselves. It is highly important that you maintain outside interests, have positive outlets for stress such as exercise and have a healthy social network. Oftentimes, we work in high-stress situations (e.g., in mental and behavioral health many clients are a danger to self or others). We must learn to be able to have some separation between our work-life the rest of our lives. Outside interests are important like physical outlets such as aerobics/ exercise/ walking and spending time with those important to us are highly important.
  • Maintain positive physical and mental health. When we are busy it is easy to short circuit sleep, healthy eating patterns, or exercise routines. Lack of sleep affects not only concentration but mood, health, and quality of life. Keeping a consistent routine of healthy habits is integral to maintaining stress at the workplace.
  • Acknowledge the importance of learning throughout your career. Australian occupational therapist Carolyn Unsworth spoke of the difference between novice and expert therapists. Often novices draw upon textbook knowledge while expert therapists rely not only on theoretical knowledge but also on clinical judgment and expertise. As a newer therapist and/or a therapist transitioning to a new setting, it is important to embrace your given knowledge and experiences, yet too, seek out new learning. Go easy on yourself and give yourself time in a new position. We often want to feel like an expert on day one, yet this takes time and practice.
  • Take Time Off. Although newer employees do not always qualify for as much vacation time, it is important to take time off during the year. Such time off provides an opportunity to refresh and renew perspective.
  • Attend Conferences and Educational Opportunities. Continuing education is highly important not only to keep up on current evidence and practices, but it also affords us the opportunity to network with valued colleagues and friends in similar areas of practice.
  • Utilize Mindfulness and other Healthy Stress and Coping Mechanisms. Brown, Schell, and Paschniak (2017) published a study on occupational therapists' experience of workplace fatigue. The study cited many factors discussed above including high demand workplaces, the impact of working in health care, lack of sleep, and the health care system and organizational cultures (among other things) as contributing to workplace stress. The authors advocate for organizational approaches to preventing workplace burnout and fatigue including the development of employee health-related programs focused on fatigue management, mindfulness, stress and coping, and relationship-based cultures. Haertl (2019) emphasized the importance of self-awareness in personal coping styles and the development of healthy coping techniques. Too often we are aware of the challenges our clients face but may overlook our own challenges. It is important to keep a healthy routine, trusted colleagues and mentors, and be willing to ask for help when needed.

18. What are the trends in occupational therapy education?

I’ve seen educational programs change to reflect not only practice but the emphasis on dual points of entry at the masters and doctoral levels. Programs have had to transition to address telehealth (the provision of health care services through technology such as computers, phones, and other technologies), emerging technologies in assistive devices, ever-changing health policies, interprofessional practice, and education on cultural humility and diversity. There is an ongoing discussion of how best to address the faculty shortage and increase research in areas relevant to OT.

19. How can we generate more research in OT?

I believe the discussion of increasing research in areas relevant to OT is integral to the future of our profession. Some believe that any mandate or increase in entry-level doctorate (OTD) may decrease the number of research doctorates (e.g. EdD or PhD). Often, students aren’t aware of the differences in doctorates. We must develop robust systems of mentoring, funding, and partnering in order to foster research relevant to the profession. We should consider partnering with other healthcare professions in generating interprofessional research, applied research, and unique models that may be more appropriate for certain contexts and geographical locations (e.g., at the World Federation of Occupational Therapists Congress in Cape Town South Africa- it was mentioned that 80% of the research in OT is from 20% of the world and often not relevant to remote, developing health care systems). I believe that OT needs to become increasingly culturally relevant, interprofessional, and be applicable to the global needs of individuals especially in developing nations.

Summary

20. How would you summarize your contributions to the occupational therapy profession?

I have tried to devote my life to teaching, research, service, and advocacy in behavioral health and developmental disabilities. I have a passion for the profession not only as a professor, teacher, researcher, and author but also as a clinician. We must remember why it is we chose this profession and continue to work together to advance occupational therapy into the future.

My life motto is to live life fully, love fervently, and strive to make a positive difference. Blessings to all as you venture on your occupational therapy journey!

References

Brown, C. A., Schell, J., & Pashniak, L. M. (2017). Occupational therapists’ experience of workplace fatigue: Issues and action. Work, 57, 517-527. DOI:10.3233/WOR-172576

Haertl, K. H. (2005). Factors influencing success in a Fairweather Model mental health program. Psychiatric Rehabilitation Journal, 28, 370-377.

Haertl, K. H., Minato, M. (2006). Daily occupations in persons with mental illness: Themes from Japan and America. Occupational therapy in mental health journal, 22, (19-32).

Haertl, K. H. (2007). The Fairweather mental health housing model- A peer supported environment: Implications for psychiatric rehabilitation. American Journal of Psychiatric Rehabilitation 10, (2) 149-162.

Haertl, K. (2014). Writing and the development of the self- heuristic inquiry: A unique way of exploring the power of the written word. Journal of Poetry Therapy, 27, 55-68. DOI: http://dx.doi.org/10.1080/08893675.2014.895488

Haertl, K., & Ero-Phillips, A. (2017). The healing properties of writing for persons with mental health conditions. Arts and Health: An International Journal for Research, Policy and Practice. DOI: 10.1080/17533015.2017.1413400

Haertl, K. (2019). Coping and resilience. In C. Brown & V. Stoffel’s Occupational therapy in mental health: A vision for participation (2nd ed. pp.342-365).Philadelphia: F. A. Davis.

Moustakas, C. (1990). Heuristic research: Design, methodology and applications. London: Sage.

Citation

Haertl, K. (2019). 20Q: Holistic and compassionate care educator. OccupationalTherapy.com, Article 5035. Retrieved from www.occupationaltherapy.com

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kristine haertl

Kristine Haertl, Ph.D., OTR/L, FAOTA

Kristi is a professor in the Department of Occupational Science and Occupational Therapy at St. Catherine University. Kristi has been active in mental health research related to peer-supported mental health housing models; the role of writing in the development of the self; the lived experience of ASD; and exploration of the nature and efficacy of services at a free standing psychiatric occupational therapy clinic.  Kristi’s research has led to legislative changes regarding evidenced based mental health practice in Minnesota and has helped secure funding for the development of Fairweather housing units in Pennsylvania. In addition to full time faculty work, Kristi has served as the Chair of a large mental health board in Minnesota, she is the co-founder and co-chair of Occupational Therapy for the Advancement of Minnesota Mental Health Services (OTAMMHS) and she maintains a private practice serving persons with psychiatric disorders and developmental disabilities. Kristi has extensive publications and presentations on a regional, national, and international level. Kristi is honored to be a Fellow of the American Occupational Therapy Association, a member of the Leaders and Legacy Society of the American Occupational Therapy Foundation, and is a former recipient of Faculty of the Year at St. Catherine University. In addition to occupational therapy Kristi has taught Group Fitness classes for 34 years and in 2003 won a National Group Fitness Instructor of the Year award. Outside of professional work, Kristi is active in sports, church, and spending time with dearly loved friends and family.



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The purpose of this course is to educate allied health care professionals on HIV fundamentals. Incidence, transmission, and infection control considerations relevant to patient management will be outlined.

20Q: Overview of the Stress Management Questionnaire
Presented by Franklin Stein, Ph.D., OTR/L, FAOTA
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Course: #3349Level: Introductory1 Hour
This is an exciting new series on OccupationalTherapy.com. In this first edition of 20Q, we are taking a look at the work of Dr. Franklin Stein, his legacy over the past 59 years, and in particular, the development of the Stress Management Questionnaire (SMQ), in an engaging Q & A format. This course is part of an exciting new series on OccupationalTherapy.com designed as a salute to the OT pioneers with contributing editor Dr. Franklin Stein. It is presented in an engaging Q & A format and highlights the OT pioneer's journey into occupational therapy and research accomplishments.

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