**3. Occupational therapy models in forensic rehabilitation**

The use of occupational therapy models in forensic rehabilitation focus on client-centered, holistic and occupation-focused practice with the approach of clinical reasoning based on individual preferences and needs. Normally, individuals engage in occupations which they prefer or want throughout their life; however, in secure environment situations, this ability of the individual can be limited or can be restricted by the individual's mental health/disorder/ learning disability, their perceived and their actual risks to themselves or others and institutional regulations, policies or legal restrictions. Individuals who need forensic rehabilitation face some participation limitations to all or a combination of activities and this can cause occupational deprivation additionally to the sense of hopelessness and poor mental health [6, 11, 15]. Moreover, community life skills and performing daily living activities and interaction with the environment of the individual can be limited. Therefore, group or individual occupational therapy programs often target basic living skills, self-care, vocational skills, adaptive coping strategies, creative arts and anger or stress management. The general aim of occupational therapy is to enable individual to experience occupational enrichment and achieve optimal occupational functioning. Occupational enrichment in forensic settings can be considered as both the goal and process of occupational therapy interventions, so evidence-based practice is very important [15].

Occupational therapy guideline recommendations show that Model of Human Occupation (MOHO) and its associated assessments are the most used occupational therapy model in forensic occupational therapy. The model was developed in the 1980s by Professor Gary Kielhofner and has had some revisions and collaborations until now. MOHO supports that human occupation is motivated, patterned and performed. Humans are conceptualized as three interrelated components: volition, habituation and performance capacity [16]. Also, environmental considerations are very important to increase the occupational participation of the individual having forensic occupational therapy and rehabilitation [15].

According to the Model of Human Occupation, performance capacity is related to an individual's adaptive interaction with the environment, and the ability to do activities provided by physical and mental components and the associated subjective experience. Occupationally restricted individuals have problems with occupational performance skills for independence in daily living. Moreover, performance skills may not be acquired or learned during transition from child to adult. Occupational therapists in secure environments have a major role to play in helping patients to develop, maintain or acquire new skills for successful community reintegration or transition to less secure settings, for example in the area of vocational rehabilitation. Occupational therapists can guide individuals to identify possible vocational areas

Occupational Therapy in Forensic Settings http://dx.doi.org/10.5772/intechopen.79366 59

Occupational therapy interventions should help the individual to identify prevocational needs and sometimes individuals have not been or will not have a productive activity like working again and therefore the therapists need to help them to establish different prosocial, productive and meaningful occupations to increase health, wellbeing, occupational performance and general quality of life. For these reasons, it is important for occupational therapists to measure and follow the progress of the individual with outcome measures during daily

Social and physical isolation of the individuals can cause problems to access their own complex occupational and environmental worlds. Being cut from own life can cause limitations over occupational choices and experience, so environmental changes and supports during activity performance can provide opportunities, constraints and demands to the individual. The literature supports that individuals in secure environments spend much of their time in passive leisure, personal care and rest occupations and occupational therapists are one of the core elements in increasing activity participation of the individual and develop occupations of their choice [15, 16]. Also, occupational therapists can facilitate the exploration of new or

As it is given earlier, there is a great model need to understand the volition, habituation, performance skills, physical and social environments in which an individual's occupation takes place. MOHO assists the understanding of occupation(s) and problems of occupation that occur in terms of volition, habituation, performance capacity and environmental context. This system-based model includes well-designed assessments, observational, self-report and interview schedules. One of the advantages of this model is that because of its extensive use in mental health settings; a forensic version of an assessment tool 'Occupational Circumstances Assessment and Interview and Rating Scale' was designed. But, the literature also supports that this tool is not the only one for the use of occupational therapists, and occupational therapists may find any particular model, or standardized assessment/outcome measures to support their interventions [4, 15, 16, 21, 22].The literature supports that the use of occupational therapy models in forensic mental health may increase evidence-based practice and help the professionals to show the effect of occupational therapy. As Model of Human Occupation is seen to be the most used occupational therapy model, models including environmental and individual issues such as psychological issues, desires, wants, activity performance and satisfaction from the activity performance can help the occupational therapist to plan more

unknown occupations to increase positive life experiences of the individual.

such as study/education, voluntary or paid employment [16, 20, 21].

living activities [17, 18, 21].

Volition presents the individual's motivation for occupation and relates to individual's motivation to participate to occupations combined with their self-belief and capacity to succeed which means personal causation. Motivation and personal causation can be affected by the individual's mental health (such as depression, schizophrenia, personality disorder) or their perception of the reason and need for their admission. Therefore, the literature supports that it is important to establish the individual's own goals to ensure treatment readiness. Some individuals can have complex occupational histories, which are situated within social tensions related to their antisocial or criminal occupations present lack of motivation to engage and participate activities they want and these individuals can view the environment as a barrier to participation in usual activities which can impact the individual's mental health and well-being negatively. It is supported that volitional problems are likely to be highly relevant in the secure setting which can cause decrease in personal causation, difficulty in identifying or having unrealistic goals and an inability to and meaning or interest in activities [15, 16].

Occupational therapists have the skills and expertise to assess and engage people in those occupations which are meaningful and motivating. This requires a careful understanding and appreciation of what underlies the motivation and creating occupational opportunities like self-care, productivity and recreational activities. Occupational therapists also help people to identify and achieve their own hopes and aspirations such as vocational rehabilitation and work skills [15, 16].

Habituation refers the individual's roles and behavior patterns consistent with his/her lifestyle. It presents automatically and effectively doing routine tasks related to their environment. Roles of the individual are responsibilities of the individual associated with personal identity, occupations and activities of daily life and extraordinary occupations. Individual with criminal lifestyles can have problems on participating prosocial roles with their daily routines and occupations [15, 16].

Occupational therapy interventions in secure environments help individual to participate in prosocial roles and occupations in an effort to live within society without resorting to previous criminal or new antisocial behaviors. The imposed legal and security restrictions in secure environments can mean that patients are unable to participate in their habitual or chosen occupations; this may be because such occupations are antisocial, or due to lack of resources, facilities or particular environments being available in secure settings. Often patients benefit from the structure, stability and consistency of admission [19].

For occupational therapy interventions age, ethnicity and culture, finding the 'right' occupations that are culturally relevant, risk-managed and appropriate to the 'typical' forensic population can be challenging. The literature supports that not only redesigning lifestyle but also technological advances have an impact on the range of occupations that occupational therapist is able to offer to extend the inclusion level of the individual such as contemporary videogames and Nintendo® WiiTM additionally to participating actual sports and recreation activities [16].

According to the Model of Human Occupation, performance capacity is related to an individual's adaptive interaction with the environment, and the ability to do activities provided by physical and mental components and the associated subjective experience. Occupationally restricted individuals have problems with occupational performance skills for independence in daily living. Moreover, performance skills may not be acquired or learned during transition from child to adult. Occupational therapists in secure environments have a major role to play in helping patients to develop, maintain or acquire new skills for successful community reintegration or transition to less secure settings, for example in the area of vocational rehabilitation. Occupational therapists can guide individuals to identify possible vocational areas such as study/education, voluntary or paid employment [16, 20, 21].

environmental considerations are very important to increase the occupational participation

Volition presents the individual's motivation for occupation and relates to individual's motivation to participate to occupations combined with their self-belief and capacity to succeed which means personal causation. Motivation and personal causation can be affected by the individual's mental health (such as depression, schizophrenia, personality disorder) or their perception of the reason and need for their admission. Therefore, the literature supports that it is important to establish the individual's own goals to ensure treatment readiness. Some individuals can have complex occupational histories, which are situated within social tensions related to their antisocial or criminal occupations present lack of motivation to engage and participate activities they want and these individuals can view the environment as a barrier to participation in usual activities which can impact the individual's mental health and well-being negatively. It is supported that volitional problems are likely to be highly relevant in the secure setting which can cause decrease in personal causation, difficulty in identifying or having unrealistic goals and an inability to and meaning or interest in activities [15, 16].

Occupational therapists have the skills and expertise to assess and engage people in those occupations which are meaningful and motivating. This requires a careful understanding and appreciation of what underlies the motivation and creating occupational opportunities like self-care, productivity and recreational activities. Occupational therapists also help people to identify and achieve their own hopes and aspirations such as vocational rehabilitation and

Habituation refers the individual's roles and behavior patterns consistent with his/her lifestyle. It presents automatically and effectively doing routine tasks related to their environment. Roles of the individual are responsibilities of the individual associated with personal identity, occupations and activities of daily life and extraordinary occupations. Individual with criminal lifestyles can have problems on participating prosocial roles with their daily

Occupational therapy interventions in secure environments help individual to participate in prosocial roles and occupations in an effort to live within society without resorting to previous criminal or new antisocial behaviors. The imposed legal and security restrictions in secure environments can mean that patients are unable to participate in their habitual or chosen occupations; this may be because such occupations are antisocial, or due to lack of resources, facilities or particular environments being available in secure settings. Often patients benefit

For occupational therapy interventions age, ethnicity and culture, finding the 'right' occupations that are culturally relevant, risk-managed and appropriate to the 'typical' forensic population can be challenging. The literature supports that not only redesigning lifestyle but also technological advances have an impact on the range of occupations that occupational therapist is able to offer to extend the inclusion level of the individual such as contemporary videogames and Nintendo® WiiTM additionally to participating actual sports and recreation

work skills [15, 16].

activities [16].

routines and occupations [15, 16].

from the structure, stability and consistency of admission [19].

of the individual having forensic occupational therapy and rehabilitation [15].

58 Occupational Therapy - Therapeutic and Creative Use of Activity

Occupational therapy interventions should help the individual to identify prevocational needs and sometimes individuals have not been or will not have a productive activity like working again and therefore the therapists need to help them to establish different prosocial, productive and meaningful occupations to increase health, wellbeing, occupational performance and general quality of life. For these reasons, it is important for occupational therapists to measure and follow the progress of the individual with outcome measures during daily living activities [17, 18, 21].

Social and physical isolation of the individuals can cause problems to access their own complex occupational and environmental worlds. Being cut from own life can cause limitations over occupational choices and experience, so environmental changes and supports during activity performance can provide opportunities, constraints and demands to the individual. The literature supports that individuals in secure environments spend much of their time in passive leisure, personal care and rest occupations and occupational therapists are one of the core elements in increasing activity participation of the individual and develop occupations of their choice [15, 16]. Also, occupational therapists can facilitate the exploration of new or unknown occupations to increase positive life experiences of the individual.

As it is given earlier, there is a great model need to understand the volition, habituation, performance skills, physical and social environments in which an individual's occupation takes place. MOHO assists the understanding of occupation(s) and problems of occupation that occur in terms of volition, habituation, performance capacity and environmental context. This system-based model includes well-designed assessments, observational, self-report and interview schedules. One of the advantages of this model is that because of its extensive use in mental health settings; a forensic version of an assessment tool 'Occupational Circumstances Assessment and Interview and Rating Scale' was designed. But, the literature also supports that this tool is not the only one for the use of occupational therapists, and occupational therapists may find any particular model, or standardized assessment/outcome measures to support their interventions [4, 15, 16, 21, 22].The literature supports that the use of occupational therapy models in forensic mental health may increase evidence-based practice and help the professionals to show the effect of occupational therapy. As Model of Human Occupation is seen to be the most used occupational therapy model, models including environmental and individual issues such as psychological issues, desires, wants, activity performance and satisfaction from the activity performance can help the occupational therapist to plan more effective assessments and interventions. Although the literature is still limited; different occupational models such as KAWA model, creative ability model, PEOP (Person, environment, occupation, performance), the Canadian model of occupational performance and engagement and the individual placement and support model with can be effectively used with standardized assessments and outcome measures in various individuals, situations, cultures and environments in provision of occupational therapy services in a cost-effective way [6, 15, 16].

in the business association during the presentation of information, evaluation and outcome

Occupational Therapy in Forensic Settings http://dx.doi.org/10.5772/intechopen.79366 61

Occupational therapists are aware that the occupational performance of an individual is influenced by factors related to the individual as well as by the performance patterns and the environment. Roles, routines, rituals, and habits constitute performance patterns [15]. Routines and habits allow the individual to perform his/her daily activities without thinking about how to move, without trying to remember. Occupational therapists working in forensic health services care about whether the prisoner has useful habits and routines for him. It is necessary to know how individuals spend their days and which routines they create from day to guide to get new routines and habits to use the time and energy more efficiently when the living conditions change [11]. Roles are the whole of the behaviors that an individual imposes on his/her responsibility, which is imposed by the environment and culture. Rituals are symbolic behaviors that are understood by social, cultural and spiritual values that shape the occupational identity of the individual. During the evaluations, the roles of the prisoner and the importance of these roles and the determination of meaningful rituals in the individual's life provide significant benefits for the therapist's intervention plan. Changes in location and time can also cause changes in the roles and rituals of individuals. The change in the role and ritual of the individual after conviction can cause occupational alienation in the individual. In the context of a forensic health service, acquisition of the prisoner's new skills and habits, and the new roles and rituals that are well integrated with the environment make an important contribution to the occupational balance of the

Understanding the environments in which occupational performance takes place, it is important for occupational therapists to understand the underlying effects of occupational participation. The environment includes dimensions related to physical, social (including individuals in the individual's life) and policies, and at the same time creates a supportive or restrictive effect for the occupational adaptation of the individual. Situations such as an absence of freedom for the individual, individual secrecy, and the meaningful and socially acceptable occupations constitute a barrier to prisoners' participation in their environment and occupation [15, 24]. Occupational therapists should also be thoroughly evaluating the environment of individuals who are establishing an intervention plan with prisoners apply-

We have already mentioned the preferred models for forensic occupational therapy applications. MOHO, one of these theories, includes structured and unstructured assessment and information gathering tools [3, 4, 11] for collecting and evaluating information about offend-

• Occupational performance history interview (OPHI II)—A semi-structured measure of

• Assessment of communication and interaction skills (ACIS)—evaluates three subdomain individuals, including the physical dimension of communication, information exchange,

self-care and information about the individual's life history;

and relationships, in an occupational pattern or in a social group [25];

measures, and the prisoner is actively involved in this process.

individual [3, 16, 23].

ers. Some of those:

ing to the occupational therapy service.
