Navigating Life Transitions.

Navigating Life Transition: Demonstrating the Pivotal Role of Longstanding Occupational Therapy in Teen and Family Wellbeing and Functioning.

In June 2024, our team presented the findings of an in-house research study at the National Occupational Therapy XChange (OTX) Conference in Perth. The study explored how longstanding, responsive and relationship-based occupational therapy supports adolescents and their families through one of life’s most pivotal stages, and the results were striking.

Why we did this research

Adolescence is a time of significant physical, psychological and social change. Research tells us that around 50% of mental health disorders manifest by age 14, and that this cohort needs flexible, responsive support during the years their identities, relationships and independence are taking shape.

Yet there is a well-documented “gap” in Australian health services for young people. Child development services typically cease around age 12–16, while adult health services begin at 18. Child and Adolescent Mental Health Services apply exclusion criteria around diagnosis, risk and co-morbidity. The result is that many adolescents and families are navigating this rapid life transition with minimal continuity of care.

At Inside Out Occupational Therapy Group, we have built our service around bridging this gap through a longstanding, responsive and relationship-based model of care. We wanted to understand, through the voices of the young people and families we work with, what difference this model actually makes.

The Inside Out care framework

Three principles sit at the heart of how we work:

Decades of OT research support each of these principles. The therapeutic relationship has been shown to significantly impact the effectiveness of therapy (Palmadottir, 2006), and parents have consistently raised concerns about therapist turnover, having to retell their story, and the uncertainty of continuing care when their child exits early-intervention services (Ziviani et al., 2014).

About the study

We used a mixed-method approach combining interviews, questionnaires and clinical data analysis. We then evaluated the impact on mental health, socialisation and family connectedness.

Finding 1: A responsive approach

Our occupational therapists are trained to address a wide range of performance areas. We grouped these into 24 intervention categories. Across the study, every single participant (100%) reported working on 12 or more of these areas, powerful evidence of how broad and shifting the needs of adolescence really are.

Themes from family feedback on a responsive approach to OT (Inside Out research study, 2024).

When asked how helpful it is that OT sessions can change to fit what is needed, 100% of respondents reported the responsive approach was either very or exceptionally helpful.

Finding 2: A longstanding approach

The duration and consistency of OT support emerged as a defining factor in family experience. Most of the families in our study had attended fortnightly or as-needed sessions, often over a span of 4–8 years.

Session frequency reported by clients surveyed.

Years engaged in service. The majority of clients had worked with their OT for 4 years or more.

Themes from family feedback on the longstanding nature of our service.

When asked how helpful it is to have a consistent therapist over a long period, the overwhelming majority of families reported this was exceptionally helpful.

Finding 3: A relational approach

Of all the themes that emerged through the qualitative interviews, the strength of the therapeutic relationship was the most consistently reported. Many families described their OT as an extension of their family, and emphasised themes of trust, respect, connection and care.

Themes from family feedback on the relational nature of our OT service.

When asked how valuable the relationship is between a client and their OT, 100% of families reported it was either very valuable or invaluable.

The benefits we measured

This longstanding, responsive and relationship-based approach showed significant therapeutic benefits for the adolescents and families involved in the study. Both the qualitative and quantitative data pointed strongly to four areas of impact:

Every adolescent in our study reported working on mental health goals during their time with us, an important reflection of how central this is for the cohort. Families also reported improvements in sibling and parent–child communication, and in feeling informed and confident when navigating schools and other services.

Barriers we identified

The study also surfaced honest reflection on the limits of the current Australian funding landscape. Many adolescents and families are not eligible for the NDIS, and Medicare rebates through the Better Access to Mental Health Care Scheme and Enhanced Primary Care Scheme cover only a limited number of sessions per year. Rising cost of living adds further pressure. These constraints can interrupt longstanding therapeutic relationships at precisely the moment a young person most needs continuity.

Key takeaways: bridging the gap

• Adolescence is marked by rapid change. There is a real, observable gap where child services typically cease and adult services start, and that gap costs families monitoring, management and support during a critical period.
• 100% of adolescents in our study worked on 12 or more areas of intervention. Therapists supporting this cohort need to be responsive and broadly trained.
• The most common areas of intervention focused on social and emotional skills, these become increasingly important as a young person develops.
• Meaningful intervention rests on strong therapeutic relationships, and strong therapeutic relationships are built over time.
• Services for adolescents should prioritise longer-term involvement, therapist consistency and stability, and breadth of training across the areas this cohort needs.

From the conference

© Inside Out Occupational Therapy Group Pty Ltd. Presented at the National Occupational Therapy XChange Conference, Perth, Western Australia, June 2024.