Psychosocial Factors in Fieldwork: Upcoming Changes and the Biopsychosocial Model

Amanda Smith BS, COTA/L

FLOTECH SUBMISSION

The 2018 ACOTE Standard C.1.3 states that, “fieldwork objectives for all experiences must include a psychosocial objective.” An additional standard (C.1.7) requires that students have an experience relating to, “behavioral health, or psychological and social factors influencing engagement in occupation” (Accreditation Council for Occupational Therapy Education, 2018). While this is easy enough to meet with site-specific objectives agreed upon between the Fieldwork Educator (FWE) and Academic Fieldwork Educator (AFWC), students sometimes struggle to make connections between non-mental health settings and potential psychosocial factors that their clients are dealing with. If this objective is not emphasized during non-mental health fieldwork rotations it may lead to new clinicians having an under-developed ability to identify and treat for these psychosocial components. 

 An example of this can be found in the hand therapy setting, which features a heavy biomechanical focus with its clients. Commonly used assessments such as the Disabilities of the Arm, Shoulder, and Hand (DASH) do contain a brief mention of formal psychosocial assessment but treatments in this setting reportedly favor a biomechanical approach for up to 90% of interventions (Kurrus et al., 2023). Therapists and clients do report that a holistic approach is taken for around half of interventions performed, but are done in an informal manner. Reasons cited for this discrepancy include limited time, limited insurance, and fear of discrimination on the part of the clients if they disclosed any psychosocial sequela of their injury (Kurrus et al., 2023). For a student in this setting it can be difficult for them to identify and take factors such as fear, chronic pain, embarrassment, and anxiety into account during treatment planning. 

 With the new set of ACOTE Standards scheduled for implementation in 2025, this is a worthwhile topic to examine closely. The definition of what a psychosocial factor is within the standards has changed in addition to the requirements associated with it in the updated C standards (Accreditation Council for Occupational Therapy Education, 2018). Going forward there will be more of a focus on the role of OT practitioners as it relates to behavioral health and psychosocial factors in client performance. This aspect of fieldwork and its associated standards can be thoroughly addressed utilizing a Biopsychosocial Model.

 The modern Biopsychosocial Model combines the bottom-up approach of the more commonly used models (biomechanical, neurodevelopmental) with the top-down, occupation-based focus of some other models which are reportedly used less often in practice (Gentry et al., 2018). This model highlights the interconnectivity between biological factors, psychological factors and social & contextual factors and how they work together to influence outcomes. It can facilitate practitioners in a traditional medical setting such as a hospital or the hand clinic to include the injury or disorder of the client in addition to socio-demographic variables and contextual factors in their treatment planning. 

By introducing this model to students prior to fieldwork and incorporating it into our documentation needed to meet ACOTE requirements, we can help the student and their educator conceptualize these psychosocial components more easily while also assisting to link them with biological factors during treatment planning. In doing so we can also help bring the profession of occupational therapy back to its holistic roots starting with fresh, entry-level clinicians. 

 References

Accreditation Council for Occupational Therapy Education. (2018). 2018 Accreditation Council 

for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide. https://acoteonline.org/accreditation-explained/standards/

Accreditation Council for Occupational Therapy Education. (2023). 2023 Accreditation Council 

for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide. https://acoteonline.org/accreditation-explained/standards/

Gentry, K., Snyder, K., Barstow, B., Hamson-Utley, J. (2018). The Biopsychosocial Model: 

Application to Occupational Therapy Practice. The Open Journal of Occupatinal Therapy, Vol. 6(4).https://doi.org/ 10.15453/2168-6408.1412

Kurrus, M., Jewell, V.D., Gerardi, S., Gerg, M., Qi, Y. (2023). Psychosocial factors addressed by 

occupational therapists in hand therapy: A mixed-methods study. Journal of Hand Therapy, Vol. 36, pp. 632-640. https://doi.org/10.1016/j.jht.2022.07.006