**5. Interventions in offenders rehabilitation**

As already mentioned, offender rehabilitation in forensic settings is not different from other mental services. Intervention methods used by occupational therapists must include life skills development (such as ADLs, IADLs, and health management), occupational development, awareness (such as self-awareness and social awareness), self-management, skill-building (such as social, relationship, vocational skills), education etc.

• The Model of Human Occupation Screening Tool (MOHOST)—gives the client a holistic view of his or her motivation to achieve occupation, communication and interaction skills, occupation patterns and the individual's process and motor skills as well as the environment. MOHOST also allows a highly effective assessment of the effectiveness of occupa-

• Occupational Self-Assessment (OSA)—a method of assessment that reveals how the individual focuses on the occupational competence of the individual about his/her occupational adaptation, helping to shape the needs and values of the individual. OSA is a highly recommended assessment tool for evaluating forensic occupational therapy. Individuals are given a very wide list of daily occupations, individualists are asked to evaluate the

• Occupational circumstances assessment interview and rating scale (OCAIRS-Forensic Mental Health Version)—the therapist has extensive content to get detailed information about the offender. It gives the individual an accurate and holistic view of occupational functionality. If the more fully involved the offender is in the evaluation process, the higher

Evaluations such as Canadian occupational performance measurement, assessment of motor and process skill, independent living scale, and the role checklist are other measures pre-

Another assessment heading in the forensic occupational therapy process is risk assessment. When considering the evaluation processes mentioned earlier, a prisoner who has forensic settings should be considered as a means of risk assessment to determine the potential for another crime or previous crime. Occupational therapists take into account the risk assessment and management of risks posed by each client and to increase the occupational involvement of individuals by taking environmental precautions and managing them to manage risks in environments such as high-risk kitchens and workshops to improve individual skills as well as providing positive risk-taking opportunities to enhance the capabilities of both individuals. Current risk factors such as age and gender, substance use status, criminal history and potential risk factors such as marital status, occupational participation level in the forensic setting, family support should be considered in the risk assessment. Occupational therapists pay attention to the influence of the person-environment-occupation interaction on the occupational adaptation of the individual. Occupational therapists can estimate the effects of individual's personality and sociodemographic characteristics (physical, cognitive and psychological), their level of skill and the environmental risk factors, including interpersonal interaction, social support network, hospice environment, social security status on the possible risk factors. For this reason, they may play an active role in providing counseling to minimize the risks faced by prisoners and these risks' adverse effects on occupational adaptation [3, 21].

As already mentioned, offender rehabilitation in forensic settings is not different from other mental services. Intervention methods used by occupational therapists must include life skills

occupations in their own eyes and the level of their own performance [26];

the participation in intervention practices [27, 28].

**5. Interventions in offenders rehabilitation**

ferred by occupational therapists [3, 24].

tional therapy interventions [26];

62 Occupational Therapy - Therapeutic and Creative Use of Activity

The GLM is a model that overlaps the humanistic point of view of occupational therapy. Although the GLM is a psychology-based model, it supports occupational therapies' application models such as PEO, MOHO, CMOP and role acquisition model. Occupational therapists may develop interventions taking into account the GLM's the primary human goods components. Some intervention recommendations based on the 'primary human goods' are given in **Table 3**.



**1.** Life: Life skills training is a commonly used occupational therapy intervention in mental health [30]. Offenders are at a higher risk for poverty, unemployment and difficulties in relationships. The life skills training interventions can focus on self-care, self-maintenance, intrinsic gratification, social contribution and interpersonal relatedness skills. The interventions must be client centered and the context must be well evaluated. While working with an offender, the balance of daily occupations should be kept in mind for a healthy lifestyle. **2.** Knowledge: The development of interventions for improving self-awareness is very important in offenders' rehabilitation. Self-awareness is the ability to recognize him/herself as an individual who is different from other individuals. Self-awareness is having a clear perception of personality, including strengths, weaknesses, thoughts, beliefs, motivation and emotions. The aim of the interventions is to gain a sense of self-worth. Facilitatory interventions, such as education, feedback, behavior therapy and psychotherapy have

Occupational Therapy in Forensic Settings http://dx.doi.org/10.5772/intechopen.79366 65

been recommended to a greater extent than compensatory interventions.

skills, work-related practice and also work hardening.

for the offenders.

and feelings about one's life [33].

**3.** Excellence in work: The main problem of ex-offenders is employment to maintain their lives [31]. Unemployment concerns begin to increase still they are in prison. They face substantial barriers to many types of legal employment [32]. These barriers are poor basic skills, low self-esteem, a lack of recent work experience, employer discrimination, behavioral and health problems. Interventions must include prevocational training, job search

**4.** Excellence in play: Recreational activities and hobbies are the enjoyable, activities that are restorative in which the clients' choice and control often associated with leisure time. Recreational pursuits and hobbies are the power of life. The main aim of the therapeutic recreation is to enhance the patient's quality of life and ability to participate in leisure and/ or play. Also, it can improve social participation and social skills which is very important

**5.** Excellence in agency: Self-directedness is the ability to organize and adapt a behavior to achieve individual selected goals and values. Self-directedness includes the concept of an autonomous individual and concepts of personal integrity, self-respect, dignity, efficacy

**6.** Inner peace: Anger management problems affect all parts of a persons' life. The goals of treatment are to increase the client's resources for coping with stress and try to decrease the demands made on the client. Treatment is first achieved by increasing awareness of the client about the relationship between anger and stress and then increasing the effective use of the stress management techniques that the client is able to cope with [11, 34]. Anger management interventions begin with recognizing the triggers of anger. The client must take responsibility for his/her own change so that the problem can be solved. The second stage of the intervention is the awareness of the behaviors when the client is angry, such as, shouting, swearing, treating verbal, postural or gestures, abusive behaviors such as phone calls, messaging or other communication ways, harassments, emotional abuses or violent. Also in this stage, the therapist must help the client to identify times when his/her thoughts do not lead to logical or rational conclusions. The third stage is teaching specific skills to help the client to manage triggers for anger effectively, such as relaxation techniques, mindfulness and assertiveness.

**Table 3.** Intervention recommendations in offender's rehabilitation from the view of occupational therapy.

**1.** Life: Life skills training is a commonly used occupational therapy intervention in mental health [30]. Offenders are at a higher risk for poverty, unemployment and difficulties in relationships. The life skills training interventions can focus on self-care, self-maintenance, intrinsic gratification, social contribution and interpersonal relatedness skills. The interventions must be client centered and the context must be well evaluated. While working with an offender, the balance of daily occupations should be kept in mind for a healthy lifestyle.

**The 'primary human goods' Intervention recommendations**

64 Occupational Therapy - Therapeutic and Creative Use of Activity

and values

Motivation

**Occupational strategies:** Anger management Stress management Problem solving skills

**Occupational strategies:** Self-management

**Occupational strategies:** Relationship skills

**Occupational strategies:**

Responsible decision-making

**Occupational strategies:**

**Occupational strategies:** Skills development

**Table 3.** Intervention recommendations in offender's rehabilitation from the view of occupational therapy.

**Aim:** Feeling good, loving life **Occupational strategies:**

Increase self-esteem and confidence

**Aim:** Knowing himself about what he can do

**Aim:** To find meaning and purpose of life

Social skills

Social skills Social awareness

Empathy

Motivation

Motivation

Complex relationship building

**Aim:** Being active in social groups

stress and manage impulses; set goals

**Aim:** To organize and adapt a behavior to achieve individually selected goals

**Aim:** Regulate emotions, thoughts and behaviors across contexts; cope with

Increase self-esteem and confidence by promoting personal responsibility

**Aim:** Establishing and maintaining relationships with others; resisting inappropriate social pressure; working in cooperation; preventing and resolving

interpersonal conflict; asking for help when necessary [29].

Facilitating development of supportive relationships

Graded community engagement and one-to-one goal planning

Vocational activities include such as woodwork, crafts, graphics, horticulture

**5. Excellence in agency** (autonomy

**6. Inner peace** (freedom from emotional turmoil and stress)

**7. Relatedness** (including intimate, romantic and family relationships)

**8. Community** (connection to wider

**9. Spirituality** (in the broad sense of finding meaning and purpose

**10. Pleasure** (feeling good in the

**11. Creativity** (expressing oneself through alternative forms).

social groups)

in life)

here and now)

and self-directedness)


**7.** Relatedness: Group interventions in which the family members and friends are engaged are suitable for relatedness [35]. The aim of the interventions must be establishing and maintaining relationships with others, resisting inappropriate social pressure, working in cooperation, preventing and resolving interpersonal conflict, asking for help when necessary [29].

besides the loss of control and autonomy affects the client's volitions, habits, and routines. Also, lack of opportunities for meaningful, individualized career choices for patients affects the client. Also, change, itself is a challenging condition. There are many factors that affect the daily living activities that are the volitions, habits of the individual and the environment. Therefore, it is not possible to catch the change in every environment. Even in a prison or in a secure hospital or a probation service, the offender has always an obligation and mostly a restricted occupational choice. Motivation or perceived lack of choice is an important challenge. Another challenge is the obligations dictate some occupations and this is not the individual's choice. Occupational therapy is client-centered, but freedom deprivation is a challenge to make interventions. Occupational therapy is client-centered but freedom deprivation is a challenge to make interventions. Labeling and stigma are other challenging parts of the offenders' partici-

Occupational Therapy in Forensic Settings http://dx.doi.org/10.5772/intechopen.79366 67

Keeping the three justices—criminal justice, occupational justice and social justice—in a balance is the main aim of the offender's rehabilitation and the most challenging part of the

\* and Meral Zarif<sup>3</sup>

, Mahmut Yaran<sup>2</sup>

1 Department of Occupational Therapy, Faculty of Health Sciences, Sağlık Bilimleri

2 Department of Therapy and Rehabilitation, Havza Vocational School, Ondokuz Mayıs

3 Department of Occupational Therapy, Faculty of Health Sciences, Hacettepe University,

[1] Townsend E, Polatajko HJ. Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-Being & Justice through Occupation. Ottawa: Canadian

[2] Hitch D, Hii QK, Davey I. Occupational therapy in forensic psychiatry: Recent developments in our understandings (2007-2013). British Journal of Occupational Therapy.

[3] Munoz J. Mental Health Practice in Forensic Settings. Philedelphia: F.A. Davis Company;

pation in the occupations and the community.

, Sümeyye Belhan<sup>1</sup>

\*Address all correspondence to: mahmut.yaran@omu.edu.tr

Association of Occupational Therapists; 2007

rehabilitation.

Esma Ozkan<sup>1</sup>

Ankara, Turkey

**References**

2011

**Author details**

University, Istanbul, Turkey

University, Samsun, Turkey

2016;**79**(4):197-205

