Annals of International Occupational Therapy

Review Supplemental Data

Justice-Based Occupational Therapy: A Scoping Review

Jaime P. Muñoz, PhD, OTR/L, FAOTA; Abigail Catalano, OTD, OTR/L; Yinao Wang, OTD, OTR/L; Gesina A. Phillips, MA, MLIS

Abstract

Background:

Although occupational therapists have endeavored to explain and address the needs of people in justice-based settings from an occupational perspective, no comprehensive, descriptive review of published works exists in the professional literature.

Objective:

The goal of this study was to collect and analyze the literature on occupational therapy (OT) in justice-based systems and describe the practices, processes, and research in this area.

Methods:

We used systematic searching techniques to identify journal articles indexed in the PubMed, CINAHL, and Scopus databases as well as those appearing in OTDBASE and OT Search. No date restrictions were applied, and the search included articles published before October 1, 2019. The final analyses included only articles published in English. We used iterative code-recode processes to categorize and subcategorize the results.

Results:

This analysis included 139 sources. Most (53%) were defined as studies and were subcategorized as examining population characteristics, exploring OT processes, studying the effect of OT interventions, eliciting service user perspectives, or auditing OT practice and processes. The remaining sources (47%) were categorized as non-studies and were subcategorized based on their descriptions of the role of OT in justice-based settings, descriptions of group interventions and programs, descriptions of assessments and interventions, or occupational perspectives on justice-based practices.

Conclusion:

A wide range of literature recommends a strong and central role for OT in the rehabilitation of individuals in justice-based settings and the reintegration of returning citizens into their home communities. The practice models and evaluation and intervention processes of OT should be evaluated for their applicability to justice-based populations and settings. [Annals of International Occupational Therapy. 2020;3(4):162–174.]

Abstract

Background:

Although occupational therapists have endeavored to explain and address the needs of people in justice-based settings from an occupational perspective, no comprehensive, descriptive review of published works exists in the professional literature.

Objective:

The goal of this study was to collect and analyze the literature on occupational therapy (OT) in justice-based systems and describe the practices, processes, and research in this area.

Methods:

We used systematic searching techniques to identify journal articles indexed in the PubMed, CINAHL, and Scopus databases as well as those appearing in OTDBASE and OT Search. No date restrictions were applied, and the search included articles published before October 1, 2019. The final analyses included only articles published in English. We used iterative code-recode processes to categorize and subcategorize the results.

Results:

This analysis included 139 sources. Most (53%) were defined as studies and were subcategorized as examining population characteristics, exploring OT processes, studying the effect of OT interventions, eliciting service user perspectives, or auditing OT practice and processes. The remaining sources (47%) were categorized as non-studies and were subcategorized based on their descriptions of the role of OT in justice-based settings, descriptions of group interventions and programs, descriptions of assessments and interventions, or occupational perspectives on justice-based practices.

Conclusion:

A wide range of literature recommends a strong and central role for OT in the rehabilitation of individuals in justice-based settings and the reintegration of returning citizens into their home communities. The practice models and evaluation and intervention processes of OT should be evaluated for their applicability to justice-based populations and settings. [Annals of International Occupational Therapy. 2020;3(4):162–174.]

Worldwide, prison populations have grown by 24% since 2000. The prison population rate internationally is 145 per 100,000 (World Prison Brief, 2018). Many countries impose punitive incarceration policies, such as extended solitary confinement, life sentences, and execution. At least in the United States, mass incarceration has become a major public health problem (Drucker, 2013, 2018). It is unlikely that the United States is the only country where systemic injustices in health care, education, housing, and systemic racism converge within the walls of justice-based settings and contribute to the overuse of incarceration for social control (Brown & Barganier, 2018).

Worldwide, those in justice-based settings are disproportionately economically impoverished individuals from racial and ethnic minority groups (Pakes, 2019) who lack political voice (Kutateladze et al., 2014; Rodda & Beichner, 2017) and experience systemic disparities in health care (Bui et al., 2019), education (Davis et al., 2013), employment and income (Prison Policy Initiative, 2018), and mental health care (Bronson & Berzofsky, 2017). Many who enter justice-based systems have major social and personal problems (Berghuis, 2018), and on release, community integration is an inevitable challenge. Returning citizens face hardships that include financial insecurity, inadequate housing, mental illness, poor social relationships, substance use, limited access to education, and unemployment (Wildeman & Wang, 2017). In many countries, but particularly in the United States, the most common outcome after release is a return to incarceration (Yukhnenko et al., 2019).

Occupational therapy (OT) has long recognized that people in justice-based systems face lasting challenges that affect their occupational performance and participation (Muñoz, 2019; White et al., 2012). The OT literature includes descriptions of how the environment in justice-based settings can alter sleep, self-care, and overall time use habits; limit opportunities to practice or acquire skills; and restrict meaningful participation in occupation (Craik et al., 2010; Cronin-Davis & Spybey, 2011; Farnworth & Muñoz, 2009; Molineux & Whiteford, 1999). Efforts have been made to review and critique the OT literature on practice in justice-based settings. Mountain (1998) examined the evidence base, but noted that the review was neither comprehensive nor systematic. O'Connell and Farnworth (2007) performed a broader, more structured review that included 65 articles, chapters, and books on OT in forensic settings, and they classified these sources as either research studies or role descriptions. These authors noted limited outcomes research and remarked that descriptions of practice primarily explained assessment and intervention, models of practice used, and challenges to the delivery of OT. Hitch et al. (2016) reviewed 25 English language studies published between 2007 and 2013. They assessed the quality of studies that used published appraisal guidelines to organize their findings with a doing, being, becoming, and belonging framework. These authors concluded that most studies focused on consumers and could be categorized as examining, doing, and being. All of these authors urged the profession to build a stronger evidence base. The goal of our review was to generate a baseline description of how OT has addressed the needs of people in justice-based settings in the hope that a descriptive summation can inform collective strategies to support continued development of OT education, practice, and research in these settings.

Methods

A scoping review was determined to be the appropriate type of study for this investigation, based on the discussion of Arksey and O'Malley (2005) of scoping review frameworks, chiefly those that seek to “[draw] conclusions from existing literature regarding the overall state of research activity” (p. 21). The following research question guided our review: What is the scope of the literature describing OT with individuals in justice-based settings?

Search Strategy

The search strategy used key terms and controlled vocabulary related to the profession and practice of OT and justice-based settings and populations. Terms were tested for relevance, precision, and sensitivity with exploratory searches and also were sourced from review efforts by the first author dating back to 2012. We used PubMed PubReMiner and the Yale MeSH Analyzer to identify any major omissions.

We searched the CINAHL, PubMed, and Scopus databases in September 2019. We did not apply language or date restrictions. Additionally, we searched two OT-specific databases to ensure that disciplinary literature collections and historical literature were included. We used the same individual terms from the comprehensive database searches to search OTDBASE (September 2019) and OT Search (October 2019). The search strings used for the PubMed and CINAHL searches are shown in Table A (available in the online version of the article). These search strings are consistent with the searches conducted in Scopus, OTDBASE, and OT Search.

Search StringsSearch Strings

Table A:

Search Strings

Identifying Sources

Our search identified 1047 sources. We de-duplicated the sources in EndNote with the Bramer et al. (2016) method and transferred 677 results to the screening platform Covidence. The number of duplicates may be attributed to both the number of databases searched and the search method used in OTDBASE and OT Search. Because these databases did not allow for one unified search, we used single-term searches, including searches for different forms of a word (e.g., convict, convicts, conviction, convicted) when truncation was not an option.

Screening for Eligibility and Inclusion

We first screened the results with only titles and abstracts. We included sources in the final analysis if they related to both OT and justice-based settings. We excluded sources that did not meet these two criteria, but sources that could not definitively be eliminated were moved to the second phase of screening. In the second phase, we reviewed the full-text document for each source. We excluded theses and dissertations, books, conference proceedings, and trade publications, and we included journal articles that clearly and significantly identified OT and clearly identified a justice-based setting and/or population. Non-English language sources were included at this stage. For each Non-English language source, we attempted to locate a full-text English language version, and if we could not locate an English translation, we eliminated the source.

At each screening stage, the first and second authors independently screened all sources with Covidence and applied descriptive tags. The third author resolved all disagreements regarding inclusion or exclusion. Figure A (available in the online version of the article) shows the search, screening, inclusion, and exclusion processes, which resulted in a pool of 139 journal articles for analysis.

PRISMA flow diagram illustrating procedure.

Figure A.

PRISMA flow diagram illustrating procedure.

Analysis of Included Sources

We performed initial analyses of the results by examining Covidence tags developed in the second phase of screening. Tags were researcher-defined descriptors that facilitated initial categorization of the sources; for example, “study” and “non-study” were basic initial tags. We identified a source as a study if it defined or implied a research question, distinguished participants, and provided some description of methods, measures, and analytic processes. For this review, we did not assess the study design or strength of evidence. We identified a source as a non-study if it did not include a substantive description of methods, measures, or analytic processes. Some sources that were categorized as non-studies provided some description of a measure or an attempt to analyze the effect of the effort, but for these sources, the primary intent of the author was not deemed to be a systematic analysis.

We used iterative, qualitative code-recode processes to analyze the sources. After coding was completed, we produced Excel tables with columns listing specific characteristics of studies, such as purpose, research question, design, or population. Additional descriptive features included coded columns detailing setting, evaluations and interventions, practice model, and primary conclusions. Continued iterative coding was performed so that the data in these tables could be summarized, categorized, and portrayed effectively. The process was organized, but the process paralleled the challenges that others described as a “difficult and time-consuming activity since there was great diversity and/or overlaps among reports; descriptions of some interventions were insufficient; and authors' definitions did not always appear justifiable or consistent” (Arksey & O'Malley, 2005, p. 28).

Results

The 139 sources in this review spanned 75 years and showed that OT uses broad and diverse processes and practices within a wide range of justice-based settings. The 74 studies and 65 non-studies were subcategorized descriptively (Figure B, available in the online version of the article). Most of the studies (87%) were published in the past two decades, and the bulk of these (72%) were published since 2009. Conversely, most (78%) non-studies were published two or more decades ago (Figure C, available in the online version of the article). Half of all sources originated in the United Kingdom, and more than 80% of them described OT in U.K., U.S., or Canadian justice systems. Australia and New Zealand were the source for 11% of all articles, and the rest were from Sweden, Brazil, Singapore, or South Africa or reflected an international approach. Given this international pool of sources, it was not always easy to categorize the justice-based settings. However, 29% of the sources specifically described forensic mental health settings, and nearly half of the sources implied such a setting. In many cases, the terms high, medium, and/or low secure settings were used in sources that did not use the term forensic mental health, but these studies described a population of individuals with psychiatric disorders. Nearly one fourth (24%) of the remaining sources identified multiple settings. Prisons were the key setting for 13% of the sources, and juvenile justice settings accounted for another 10%. Few sources described OT in community settings (6%), jails (2%), or court systems (2%). Most of the sources focused on men, with few specifically addressing the needs of women (Figure B and Figure C).

Distribution of Sources in the Scoping Review

Figure B:

Distribution of Sources in the Scoping Review

Published Articles 1940–2019

Figure C:

Published Articles 1940–2019

Characteristics of Studies

Most sources (70%) defined as studies originated in the United Kingdom or the United States. The remainder, in order of frequency, originated in Australia, Canada, Sweden, Brazil, or South Africa. For 13 studies that originated in Germany, Spain, France, Israel, Brazil, Columbia, Chile, or Croatia, we could not locate English language versions. Therefore, we excluded these studies from this review. The 74 studies were classified into five subcategories (Figure B).

Examining Population Characteristics

One subcategory of studies (n = 16) examined the characteristics of justice-based populations (Table B, available in the online version of the article). Participants in these studies were service users. Six studies examined how service users perceived and described their experience of time use (Farnworth, 2000; Farnworth et al., 2004; O'Connell et al., 2010), boredom (Bowser et al., 2018), occupational engagement (Stewart & Craik, 2007), or their own performance capacities (Crist et al., 2005). Four studies made structured comparisons. Lindstedt et al. (2011) compared occupational performance and social participation of hospitalized and community-dwelling service users and examined differences in how service users and forensic staff appraised the occupational and social performance of service users (Lindstedt et al., 2004). Other studies compared sensory integrative, perceptual motor, or volitional differences between adolescents who were and were not showing delinquent behaviors (Fanchiang et al., 1990; Lederer et al., 1985). Three studies evaluated occupational performance profiles for activities of daily living (Kottorp et al., 2013), sensory processing (Shea & Wu, 2012), or cognitive style (Stein, 1972). Finally, three studies sought to identify predictive factors for quality of life (O'Flynn et al., 2018), delinquency (Costa et al., 2016), or occupational performance (Lindstedt et al., 2005).

Studies Examining Characteristics of Justice-Based Populations (N=16)Studies Examining Characteristics of Justice-Based Populations (N=16)

Table B:

Studies Examining Characteristics of Justice-Based Populations (N=16)

Exploring Occupational Therapy Processes

Fifteen studies addressed OT processes (Table C, available in the online version of the article). These studies explored the efficacy of an intervention, assessed whether an evaluation process informed the intervention, or broadly explored environmental factors in forensic contexts. Most (53%) assessed the usefulness of a specific framework for directing OT processes. These included the occupational engagement framework (Morris & Ward, 2018), family-focused models (Fitzgerald et al., 2012), the Occupational Adaptation Model (Stelter & Whisner, 2007), the Canadian Model of Occupational Performance (Clarke, 2003), or any OT practice framework (McFadden, 2010). Talbot et al. (2018) completed a process evaluation with an individual placement and support model, whereas other researchers examined a positive intervention approach grounded in the Model of Human Occupation (Graham et al., 2016).

Studies Exploring Occupational Therapy Processes In Justice-Based Systems (N=15)Studies Exploring Occupational Therapy Processes In Justice-Based Systems (N=15)

Table C:

Studies Exploring Occupational Therapy Processes In Justice-Based Systems (N=15)

A few studies examined specific evaluation processes that explored whether social interaction assessment could guide intervention (Williams & Chard, 2016), examined the contributions of OT to risk assessment (Connell, 2015), contrasted evaluation approaches used by teachers and occupational therapists working with at-risk youth (Shea & Giles, 2012), assessed the usefulness of collective narrative approaches (Gardner-Elahi & Zamiri, 2015), or determined whether the Bay Area Functional Performance Evaluation could be applied to forensic populations (Lloyd, 1987d).

Finally, three articles in this subgroup focused specifically on the environmental context. Wagenfeld et al. (2018) evaluated how interaction with nature could reduce stress levels among correctional staff. Fitzgerald et al. (2011) examined processes for engaging service users in modifications to their living space, and Mason (2007) explored whether OT consultation affected interventions with service users and staff opportunities in a forensic setting.

Effect of Occupational Therapy Interventions

Fifteen studies focused on assessing the effect of specific OT interventions (Table D, available in the online version of the article). All but one of these used mixed or quantitative designs. Approximately half (53%) of these studies occurred in low, medium, or high secure settings, predominantly in the United Kingdom. All other studies were situated in the United States, most in juvenile justice settings. The broad range of interventions evaluated resisted subcategorization. For example, studies in forensic mental health settings targeted disparate outcomes, such as social inclusion patterns (Fitzgerald, 2011); segregation, seclusion, and restraint (Tully et al., 2016) or self-harm (Garner et al., 1996); autonomy (Morrow, 2008); well-being (Linstead & Brooks, 2015); obesity prevention (Bacon et al., 2012); skills for prosocial roles (Jones & McColl, 1991); and occupational participation (Fan et al., 2016). Two studies conducted at the same U.S. high secure forensic prison sought to improve task and interpersonal skills and social role performance (Schindler, 2004, 2005).

Studies Assessing the Impact of OT Interventions (N=15)Studies Assessing the Impact of OT Interventions (N=15)

Table D:

Studies Assessing the Impact of OT Interventions (N=15)

Several studies assessed intervention outcomes among youth in juvenile justice settings. The broad range of intervention outcomes tested included mentoring (George-Paschal & Bowen, 2019), life skills (Shea & Siu, 2016), vestibular processing (Hardison & Llorens, 1988), self-efficacy (DeForest et al., 1991), and social skills (Jodrell & Sanson-Fisher, 1975).

Perspectives of Service Users

The perspectives of service users were examined in 14 studies (Table E, available in the online version of the article). These studies were conducted in seven countries. Most (43%) were performed within secure forensic mental health settings in the United Kingdom or Australia. Four examined the perspectives of community-dwelling individuals, three occurred in prison environments, and one was conducted online and drew an international sample. Most (64%) of these studies explored occupation. For example, researchers in Canada (Lin et al., 2009) and Australia (Craik et al., 2010) explored occupational engagement in community and forensic mental health environments, respectively. Falardeau et al. (2015) asked men who had been released from a Canadian prison about their perspectives on occupations before and during incarceration and after release. Other researchers explored the value placed on occupation (Morris et al., 2016), factors that influenced occupational participation (Connell et al., 2019), or perspectives on psychosocial and environmental barriers to occupational participation (Shea & Jackson, 2015). A multinational survey study examined the effect of rape and sexual assault on the experience of occupation (Twinley, 2017).

Studies of Service User Perspectives On Occupation And Occupational Therapy (N=14)Studies of Service User Perspectives On Occupation And Occupational Therapy (N=14)

Table E:

Studies of Service User Perspectives On Occupation And Occupational Therapy (N=14)

Other studies examined the perspectives of service users on the effect of OT services on their recovery (Donovan & Mason, 2010), the elements of an OT education program that they most valued (Crabtree et al., 2016a), or the usefulness of a sensory room in a forensic mental health setting (Wiglesworth & Farnworth, 2016). One study sought to identify the primary occupational performance challenges of women in an Irish prison (Quinn et al., 2019). Three studies examined OT vocational rehabilitation services. McQueen and Turner (2012) examined whether OT services promoted aspirations to work, and Völlm et al. (2014) explored the connection among vocational services, recidivism, and employment. In South Africa, researchers explored the challenges in job acquisition that returning citizens experience after release (Soeker et al., 2013).

Audits of Practice and Processes

This final subcategory included research studies where the units of analysis were occupational therapists or OT literature (Table F, available in the online version of the article). Most studies (71%) originated in the United Kingdom, United States, or Canada, and seven of these used survey methods. Two recent surveys examined factors associated with the willingness of practitioners to work in prison settings (Tucker & Yuen, 2019b) and the attitudes of students toward rehabilitation of people in prisons (Tucker & Yuen, 2019a). Researchers in the United States (Muñoz et al., 2016b) and Canada (Chui et al., 2016) surveyed the scope of OT practice in those countries. Practice in forensic mental health settings within the United Kingdom also has been studied (Cronin-Davis & Spybey, 2011). Researchers in the United Kingdom sought to identify the occupational needs of women in medium secure forensic settings (Baker & McKay, 2001), define the research priorities of forensic occupational therapists (Duncan et al., 2003), and assess the perceptions of practitioners regarding their contribution to reducing recidivism (Connell, 2016) and their beliefs about the use of risk assessments (Cordingley & Ryan, 2009). Dieleman and Duncan (2013) sought to explain how practitioners in forensic settings used an online discussion group to network, share resources, and delineate their role as OT practitioners.

Audits of Occupational Therapy Practice and Processes (N=14)Audits of Occupational Therapy Practice and Processes (N=14)

Table F:

Audits of Occupational Therapy Practice and Processes (N=14)

This category included three literature reviews and one autoethnography. O'Connell and Farnworth (2007) analyzed a broad range of literature and reported findings in two categories: research studies and role descriptions. A more recent review examined 25 studies conducted from 2007 to 2013 (Hitch et al., 2016). Both studies reported progress in defining the parameters of the role of OT within justice-based settings and noted limited research on this topic. Mason and Carton (2002) sought to identify areas for focused training in forensic settings in the OT and multidisciplinary literature. Finally, Zubriski et al. (2020) used an autoethnographic approach to portray the process and experience of developing a new service in a Canadian nonprofit addressing the needs of men in the community after release.

Characteristics of Non-Studies

Of these 65 non-studies, three fourths were published 20 or more years ago. Approximately two thirds of non-studies originated in the United Kingdom or the United States, and most of the rest originated in Canada, Australia, New Zealand, or Singapore. The 65 non-studies were classified into four subcategories (Figure B).

Role of Occupational Therapy

Many non-study sources discussed the role of OT in justice-based settings; however, the primary characteristic of 25 non-studies was description (Table G, available in the online version of the article). This largest subcategory of sources examined the role of OT in multiple settings, such as prisons (Bartholomew, 1976; Penner, 1978; Tan et al., 2015), jails (Provident & Joyce-Gaguzis, 2005), court systems (Ferrazzi, 2019; Smith, 1984), and forensic mental health units (e.g., see Dunn & Seymour, 2008; Flood, 1997). These sources also described the role of OT with various populations, including parents who were abusive (Colman, 1975), people who committed sexual offenses (Lloyd, 1987a), persons with intellectual disabilities (Withers et al., 2012), people diagnosed with AIDS (Schindler, 1991), and elders with dementia (du Toit & McGrath, 2018).

Role of OT In Justice Based Settings (N=25)Role of OT In Justice Based Settings (N=25)Role of OT In Justice Based Settings (N=25)Role of OT In Justice Based Settings (N=25)Role of OT In Justice Based Settings (N=25)

Table G:

Role of OT In Justice Based Settings (N=25)

The three most frequently discussed populations or settings included forensic mental health settings (Dunn & Seymour, 2008; Flood, 1993, 1997; Forward et al., 1999; Lloyd, 1987b, 1995; Tse, 1990), juvenile justice settings and populations (Barrett, 1953; Loveland & Little, 1974; Paulson, 1980; Zinkus et al., 1979), and prisons (Bartholomew, 1976; Farnworth et al., 1987; Penner, 1978; Seek, 1989). These sources generally discussed the key contributions of OT to the rehabilitation of individuals in justice-based settings (du Toit & McGrath, 2018; Lloyd, 1987b), detailed the strength of OT in assessment and intervention practices (Flood, 1993; Smith, 1984; Zinkus et al., 1979), or emphasized staff training as a potential role for OT (Colman, 1975; Loveland & Little, 1974). Some sources articulated various challenges (Flood, 1997) or outlined characteristics of practitioners that were effective in justice-based settings (Forward et al., 1999; Platt et al., 1977; Seek, 1989).

Group Interventions and Program Descriptions

Another large group of non-studies described the structure of OT programming or group formats (Table H, available in the online version of the article). Most of these studies were implemented in the United Kingdom and targeted populations in secure forensic mental health settings. Six articles addressed vocational rehabilitation. Lloyd (1986) was the first to present an outline for vocational rehabilitation in forensic mental health settings. Garner (1995) described prevocational training, and Helbig (2005) used a graded, developmental approach to the development of worker roles in medium and high secure forensic mental health settings. Smith et al. (2010) and Cox et al. (2014) described programs that specifically addressed the needs of persons with learning disabilities. Eggers et al. (2006) addressed the employment needs of men in a U.S. jail.

Group and Program Descriptions (N=17)Group and Program Descriptions (N=17)

Table H:

Group and Program Descriptions (N=17)

Five sources addressed programming with individuals who were convicted of sexual offenses. Lloyd authored four studies on programming in a secure forensic mental health setting in Canada. Two of these articles focused on the goals and processes of OT interventions (Lloyd, 1983, 1987e), and two others provided detailed descriptions of groups that used poetry (Lloyd, 1987–1988) or addressed parenting skills (Lloyd & Watson, 1989). More recently, Wolfendale and Musaabi (2017) described a peer support program for men with learning disabilities.

Studies of structured programs of occupation began with a depiction of a community-based program in a U.S. welfare hotel (Kantor et al., 1974). Smith (1998) later described structured programs for social skills, and others emphasized leisure engagement (Roberts et al., 2015) or described a staff and client choir (Merrick & Maguire, 2017). Tayar (2004) described collaboration between OT and psychology that was designed to address the needs of women in a program to promote relapse of substance abuse. Snyder et al. (1998) described an alternative education program for youth who had or were at risk for gang involvement.

Descriptions of Assessments and Interventions

Approximately 20% of all non-study sources included a description of an intervention and/or assessment (Table I, available in the online version of the article). These sources described interventions in a broad range of settings, such as juvenile detention centers, a children's forensic psychiatry ward, forensic mental health units, or prisons. Several included descriptive case examples to bolster their arguments for the effectiveness of interventions or the usefulness of evaluation processes. Notably, most (71%) of these sources were published more than 30 years ago. Three sources described the evaluation processes used in forensic mental health facilities (Lloyd, 1985, 1988; Lloyd & Guerra, 1988). Others described observational assessments that were used to measure ability and relationships among young people (Manley, 2010) or specifically assessed the merits of using the Kawa Model as a culturally relative tool in New Zealand (Leadley, 2015) or using the Model of Human Occupation in a secure hospital setting (Forsyth et al., 2005). The interventions described in these sources varied considerably. They included arts and crafts (Haliburton, 1943; Kromm et al., 1982; Lloyd & Campbell, 1986–1987); poetry and film (Lloyd, 1987c); education (Piper & Le Grow, 1956); specific skills training, such as anger management, coping, or social skills training (Gooch & Living, 2004; Hood, 1998); and a broad base of skills to support successful community living outside of the institution (Freeman, 1982).

Assessment and Intervention Descriptions (N=14)Assessment and Intervention Descriptions (N=14)Assessment and Intervention Descriptions (N=14)

Table I:

Assessment and Intervention Descriptions (N=14)

Occupational Perspectives on Justice-Based Practices

A few sources (Table J, available in the online version of the article) explored justice-based practices through a lens of occupation. Three of these explored the concept of occupational deprivation. Whiteford (1997) posited that occupational deprivation is a consistent feature in justice-based settings and detailed its effect on occupational performance. Farnworth (1998) questioned the relationship between boredom and human occupation, and Molineux and Whiteford (1999) introduced occupational engagement as a conceptual tool to address occupational deprivation. Crabtree et al. (2016b) described how engaging men in prison as co-researchers provided new insights into the lived experience of occupational deprivation. Other sources argued that an occupational perspective could inform rehabilitation in justice-based environments (Farnworth & Muñoz, 2009) or that occupational perspectives could help to transform justice-based settings (Muñoz et al., 2016a). Virikowic (1993) conceptualized ways in which the Model of Human Occupation could be used as a lens to understand and address the needs of youth who are delinquent. Finally, two sources provided conceptual explorations of the relationship between violence and occupation (Aldrich & White, 2012) and of serial crime as occupation (Sethi & Barney, 2018).

Occupational Perspectives on Justice Based Practices (N=9)Occupational Perspectives on Justice Based Practices (N=9)

Table J:

Occupational Perspectives on Justice Based Practices (N=9)

Discussion

The results of this scoping review confirmed that occupational therapists have long described their efforts to bring a distinct occupational perspective to the rehabilitation of individuals in justice-based settings (Lloyd, 1995; O'Connell & Farnworth, 2007; White et al., 2012). The notable increase in the volume of sources over the past three decades, particularly the notable increase in research publications, is a promising sign. This increased research productivity may reflect maturing of the efforts of the profession and indicate that the international OT workforce is growing. During full-text screening, we excluded sources that were coded as conference proceedings (n = 55), trade magazine publications (n = 16), theses (n = 10), or books (n = 6). These sources may reflect a hidden strength and an untapped potential workforce to extend OT practice in justice-based settings. It may be useful to examine the capacity of the profession to provide mentoring to transform conference research presentations to publications, convert community-engaged education to paid positions, and connect scattered researchers with coordinated scholarly efforts. The studies in this review suggest that OT appears to focus on the experiences of service users, the experiences of OT practitioners as service providers, and the processes used in justice-based settings, expending far less effort on examining the outcomes of interventions.

Study and non-study sources in this review reflected significant diversity and broad applications of OT in justice-based systems. This finding is consistent with earlier reviews (Duncan et al., 2003; Hitch et al., 2016; O'Connell & Farnworth, 2007) and suggests that the needs of different justice-based populations, such as women, people with intellectual disabilities, or juveniles in different types of settings (including jails, prisons, or the community), are varied, multiple, and complex. This variability also may help to explain the use of differing practice models and assessment tools. However, some publications suggest more frequent use of the Model of Human Occupation and the Canadian Model of Occupational Performance (Chui et al., 2016; Muñoz et al., 2016b; Royal College of Occupational Therapists, 2017). This broad range of approaches also could reflect a lack of focus. Although the place of OT in justice-based settings has been established, perhaps we have not yet generated a collective road map or intentionally assessed the usefulness of OT practice models, evaluation tools, and intervention processes. Regardless of the variability of approaches, consistent foci include using occupation to address performance challenges, delivering skill-building interventions, and targeting improved role functioning. If the increase in research publications reflects growing capacity, collaborative international efforts may help to focus efforts to develop a stronger evidence base to show the effect of OT.

Most sources in this study articulated some aspect of the role of OT in justice-based settings. Nonetheless, except for guidelines for secure forensic mental health settings in the United Kingdom (Royal College of Occupational Therapists, 2017), the profession has no published practice guidelines. The establishment of practice guidelines may encourage professionals to enter OT and also help practitioners to design evidence-based, occupation-focused interventions; articulate the distinct value of OT in justice-based settings; and consolidate efforts to align multiple lines of research. The Royal College of Occupational Therapists (2017) guidelines provide an effective example of evidence-based practice guidelines but are limited to forensic mental health settings. Most of the sources in this review focused on forensic mental health settings, perhaps because these units often exist in secure settings that facilitate predictable access. Further, many sources in this review originated in countries where positions in forensic mental health settings are established by the government or are publicly funded (e.g., Canada, Australia, and several European countries). Juvenile justice settings and prisons appear to show great potential for further development of OT practice, and consolidating the approaches to implementing and evaluating OT interventions is encouraged.

This review showed the limited efforts of OT to address the needs of justice-based populations in the community. Opportunities for authentic occupations abound, and most returning citizens integrate into the community. If OT is to be a transformative force in justice-based systems, it needs a strong, multilevel focus outside of criminal institutions and within the community. This focus can include prevention efforts to address the social determinants of health that may lead to criminal occupations; direct interaction with sentencing and court systems, with an emphasis on diversion programs to redirect adjudicated individuals from incarceration to rehabilitative programs; and design and testing of programs to support integration into communities before and after release.

Limitations

This review was inclusive and descriptive, but it is possible that sources were missed. The research team discontinued searching in October 2019, and as a result, more recent publications—including all of the sources in this special issue—are excluded. Non-English sources were ultimately excluded. A recent report by the World Federation of Occupational Therapy noted that 41 of 88 countries that contributed data indicated that occupational therapists provide some level of service in prisons and correctional facilities in these member countries (World Federation of Occupational Therapy, 2020). The absence of non-English scholarship is a serious limitation. Every effort was made to apply consistent rubrics to decisions about categorization, but readers may find reasonable fault with how a source was catalogued.

Conclusion

We set out to compile a descriptive review to serve as a baseline to encourage further development of OT in justice-based systems. We believe that we provided that review, and this effort to organize the diffuse knowledge can help to fill gaps in our knowledge and create opportunities for participation in education, practice, and research to support the growth and development of OT in justice-based systems.

References

  • Aldrich, R. M. & White, N. (2012). Reconsidering violence: A response to Twinley and Addidle (2012) and Morris (2012). British Journal of Occupational Therapy, 75(11), 527–529 doi:10.4276/030802212X13522194760057 [CrossRef]
  • Arksey, H. & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32 doi:10.1080/1364557032000119616 [CrossRef]
  • Bacon, N., Farnworth, L. & Boyd, R. (2012). The use of the Wii Fit in forensic mental health: Exercise for people at risk of obesity. British Journal of Occupational Therapy, 75(2), 61–68 doi:10.4276/030802212X13286281650992 [CrossRef]
  • Baker, S. & McKay, E. A. (2001). Occupational therapists' perspectives of the needs of women in medium secure units. British Journal of Occupational Therapy, 64(9), 441–448 doi:10.1177/030802260106400905 [CrossRef]
  • Barrett, L. M. (1953). The scope of occupational therapy in the remand home. Occupational Therapy: Official Journal of the Association of Occupational Therapists, 16(3), 157–159 doi:10.1177/030802265301600303 [CrossRef]
  • Bartholomew, A. (1976). The need for recreational activity in forced confinement. Australian Occupational Therapy Journal, 23(2), 62–69 doi:10.1111/j.1440-1630.1976.tb01045.x [CrossRef]
  • Berghuis, M. (2018). Reentry programs for adult male offender recidivism and reintegration: A systematic review and meta-analysis. International Journal of Offender Therapy and Comparative Criminology, 62(14), 4655–4676 doi:10.1177/0306624X18778448 [CrossRef] PMID: 29890873
  • Bowser, A., Link, W., Dickson, M., Collier, L. & Donovan-Hall, M. K. (2018). A qualitative study exploring the causes of boredom for men with a psychosis in a forensic setting. Occupational Therapy in Mental Health, 34(1), 32–48 doi:10.1080/0164212X.2017.1331151 [CrossRef]
  • Bramer, W. M., Giustini, D., de Jonge, G. B., Holland, L. & Bekhuis, T. (2016). De-duplication of database search results for systematic reviews in EndNote. Journal of the Medical Library Association: JMLA, 104(3), 240–243 doi:10.3163/1536-5050.104.3.014 [CrossRef] PMID:27366130
  • Bronson, J. & Berzofsky, M. (2017, June). Indicators of mental health problems reported by prisoners and jail inmates 2011–2012. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. https://www.bjs.gov/content/pub/pdf/imhprpji1112.pdf
  • Brown, E. & Barganier, G. (2018). Race and crime: Geographies of injustice. University of California Press doi:10.1525/9780520967403 [CrossRef]
  • Bui, J., Wendt, M. & Bakos, A. (2019). Understanding and addressing health disparities and health needs of justice involved populations. Public Health Reports, 134(Suppl. 1), 3S–7S doi:10.1177/0033354918813089 [CrossRef]
  • Chui, A. L., Wong, C. I., Maraj, S. A., Fry, D., Jecker, J. & Jung, B. (2016). Forensic occupational therapy in Canada: The current state of practice. Occupational Therapy International, 23(3), 229–240 doi:10.1002/oti.1426 [CrossRef] PMID:26890357
  • Clarke, C. (2003). Clinical application of the Canadian Model of Occupational Performance in a forensic rehabilitation hostel. British Journal of Occupational Therapy, 66(4), 171–174 doi:10.1177/030802260306600407 [CrossRef]
  • Colman, W. (1975). Occupational therapy and child abuse. American Journal of Occupational Therapy, 29(7), 412–417. PMID:1155575
  • Connell, C. (2015). An integrated case formulation approach in forensic practice: The contribution of occupational therapy to risk assessment and formulation. Journal of Forensic Psychiatry & Psychology, 26(1), 94–106 doi:10.1080/14789949.2014.981566 [CrossRef]
  • Connell, C. (2016). Forensic occupational therapy to reduce risk of reoffending: A survey of practice in the United Kingdom. Journal of Forensic Psychiatry & Psychology, 27(6), 907–928 doi:10.1080/14789949.2016.1237535 [CrossRef]
  • Connell, C., McKay, E. A., Furtado, V. & Singh, S. P. (2019). People with severe problematic personality traits and offending histories: What influences occupational participation?European Psychiatry, 60, 14–19 doi:10.1016/j.eurpsy.2019.05.002 [CrossRef] PMID:31100608
  • Cordingley, K. & Ryan, S. (2009). Occupational therapy risk assessment in forensic mental health practice: An exploration. British Journal of Occupational Therapy, 72(12), 531–538 doi:10.4276/030802209X12601857794736 [CrossRef]
  • Costa, L. A., Rocha, D. F., Vieira, G. & Reis, A. (2016). The youth daily life before fulfilling socio-educational measures of deprivation of liberty in Brazil: Ordinary experiences that are tangent to the inclusion in drug trafficking. Occupational Therapy International, 23(3), 265–275 doi:10.1002/oti.1429 [CrossRef] PMID:27279041
  • Cox, A., Simmons, H., Painter, G., Philipson, P., Hill, R. & Chester, V. (2014). Real work opportunities: Establishing an accessible vocational rehabilitation programme within a forensic intellectual disability service. Journal of Intellectual Disabilities and Offending Behaviour, 5(4), 160–166 doi:10.1108/JIDOB-10-2014-0016 [CrossRef]
  • Crabtree, J. L., Ohm, D., Wall, J. M. & Ray, J. (2016a). Evaluation of a prison occupational therapy informal education program: A pilot study. Occupational Therapy International, 23(4), 401–411 doi:10.1002/oti.1442 [CrossRef] PMID:
  • Crabtree, J. L., Wall, J. M. & Ohm, D. (2016b). Critical reflections on participatory action research in a prison setting: Toward occupational justice. Occupational Therapy Journal of Research, 36(6), 244–252 doi:10.1177/1539449216669132 [CrossRef] PMID:27647111
  • Craik, C., Bryant, W., Ryan, A., Barclay, S., Brooke, N., Mason, A. & Russell, P. (2010). A qualitative study of service user experiences of occupation in forensic mental health. Australian Occupational Therapy Journal, 57(7), 339–344 doi:10.1111/j.1440-1630.2010.00857.x [CrossRef] PMID:20868423
  • Crist, P., Fairman, A., Muñoz, J. P., Witchger Hansen, A. M., Sciulli, J. & Eggers, M. (2005). Education and practice collaborations: A pilot case study between a university faculty and county jail practitioners. Occupational Therapy in Health Care, 19(1–2), 193–210 doi:10.1080/J003v19n01_14 [CrossRef] PMID:23927710
  • Cronin-Davis, J. & Spybey, M. (2011). Forensic occupational therapy: A survey. Mental Health Occupational Therapy, 16(1), 20–26.
  • Davis, L. M., Bozick, R., Steele, J. L., Saunders, J. & Miles, J. (2013). Evaluating the effectiveness of correctional education: A meta-analysis of programs that provide education to incarcerated adults. RAND Corporation and the Bureau of Justice Assistance.
  • DeForest, D., Watts, J. H. & Madigan, M. J. (1991). Resonation in the Model of Human Occupation. Occupational Therapy in Mental Health, 11(2–3), 57–71 doi:10.1300/J004v11n02_05 [CrossRef]
  • Dieleman, C. & Duncan, E. A. S. (2013). Investigating the purpose of an online discussion group for health professionals: A case example from forensic occupational therapy. BMC Health Services Research, 13, 253 doi:10.1186/1472-6963-13-253 [CrossRef] PMID:23822895
  • Donovan, J. & Mason, K. (2010). The impact of dedicated occupational therapy on a forensic intensive care unit: Service user and staff views. Mental Health Occupational Therapy, 15(2), 47–49.
  • Drucker, E. (2013). A plague of prisons: The epidemiology of mass incarceration in America. New Press.
  • Drucker, E. (2018). Decarcerating America: From mass punishment to public health. New Press.
  • du Toit, S. H. & McGrath, M. (2018). Dementia in prisons: Enabling better care practices for those ageing in correctional facilities. British Journal of Occupational Therapy, 81(8), 460–462 doi:10.1177/0308022617744509 [CrossRef]
  • Duncan, E. A. S., Munro, K. & Nicol, M. M. (2003). Research priorities in forensic occupational therapy. British Journal of Occupational Therapy, 66(2), 55–64 doi:10.1177/030802260306600203 [CrossRef]
  • Dunn, C. & Seymour, A. (2008). Forensic psychiatry and vocational rehabilitation: Where are we at?British Journal of Occupational Therapy, 71(10), 448–450 doi:10.1177/030802260807101008 [CrossRef]
  • Eggers, M., Muñoz, J. P., Sciulli, J. & Crist, P. A. (2006). The community reintegration project: Occupational therapy at work in a county jail. Occupational Therapy in Health Care, 20(0), 17–37 doi:10.1080/J003v20n01_02 [CrossRef] PMID:23926890
  • Falardeau, M., Morin, J. & Bellemare, J. (2015). The perspective of young prisoners on their occupations. Journal of Occupational Science, 22(3), 334–344 doi:10.1080/14427591.2014.915000 [CrossRef]
  • Fan, C., Morley, M., Garnham, M., Heasman, D. & Taylor, R. (2016). Examining changes in occupational participation in forensic patients using the Model of Human Occupation Screening Tool. British Journal of Occupational Therapy, 79(12), 727–733 doi:10.1177/0308022616651644 [CrossRef]
  • Fanchiang, S. P., Snyder, C., Zobel-Lachiusa, J., Loeffler, C. B. & Thompson, M. E. (1990). Sensory integrative processing in delinquent-prone and non-delinquent-prone adolescents. American Journal of Occupational Therapy, 44(4), 630–639 doi:10.5014/ajot.44.7.630 [CrossRef] PMID:2386189
  • Farnworth, L. (1998). Doing, being, and boredom. Journal of Occupational Science, 5(3), 140–146 doi:10.1080/14427591.1998.9686442 [CrossRef]
  • Farnworth, L. (2000). Time use and leisure occupations of young offenders. American Journal of Occupational Therapy, 54(4), 315–325 doi:10.5014/ajot.54.3.315 [CrossRef] PMID:10842688
  • Farnworth, L., Morgan, S. & Fernando, B. (1987). Prison based occupational therapy. Australian Occupational Therapy Journal, 34(2), 40–46 doi:10.1111/j.1440-1630.1987.tb01567.x [CrossRef]
  • Farnworth, L. & Muñoz, J. P. (2009). An occupational and rehabilitation perspective for institutional practice. Psychiatric Rehabilitation Journal, 32(2), 192–198 doi:10.2975/32.3.2009.192.198 [CrossRef] PMID:19136351
  • Farnworth, L., Nikitin, L. & Fossey, E. (2004). Being in a secure forensic psychiatric unit: Every day is the same, killing time or making the most of it. British Journal of Occupational Therapy, 67(10), 430–438 doi:10.1177/030802260406701003 [CrossRef]
  • Ferrazzi, P. (2019). Occupational therapy and criminal court mental health initiatives: An important emerging practice setting. Occupational Therapy in Mental Health, 35(3), 238–261 doi:10.1080/0164212X.2019.1571467 [CrossRef]
  • Fitzgerald, M. (2011). An evaluation of the impact of a social inclusion programme on occupational functioning for forensic service users. British Journal of Occupational Therapy, 74(10), 465–472 doi:10.4276/030802211X13182481841903 [CrossRef]
  • Fitzgerald, M. M., Kirk, G. D. & Bristow, C. A. (2011). Description and evaluation of a serious game intervention to engage low secure service users with serious mental illness in the design and refurbishment of their environment. Journal of Psychiatric and Mental Health Nursing, 18(8), 316–322 doi:10.1111/j.1365-2850.2010.01668.x [CrossRef] PMID:21418431
  • Fitzgerald, M., Ratcliffe, G. & Blythe, C. (2012). Family work in occupational therapy: A case study from a forensic service. British Journal of Occupational Therapy, 75(3), 152–155 doi:10.4276/030802212X13311219571864 [CrossRef]
  • Flood, B. (1993). Implications for occupational therapy services following the Reed Report. British Journal of Occupational Therapy, 56(8), 293–294 doi:10.1177/030802269305600808 [CrossRef]
  • Flood, B. (1997). An introduction to occupational therapy in forensic psychiatry. British Journal of Occupational Therapy, 4(7), 375–380.
  • Forsyth, K., Duncan, E. A. & Mann, L. S. (2005). Scholarship of practice in the United kingdom: An occupational therapy service case study. Occupational Therapy in Health Care, 19(1–2), 17–29 doi:10.1080/J003v19n01_03 [CrossRef] PMID:23927699
  • Forward, M., Trevan-Hawke, J. & Lloyd, C. A. (1999). The OT in the forensic psychiatric setting. International Journal of Therapy and Rehabilitation, 6(9), 442–446 doi:10.12968/bjtr.1999.6.9.13942 [CrossRef]
  • Freeman, M. (1982). Forensic psychiatry and related topics. British Journal of Occupational Therapy, 45(6), 191–194 doi:10.1177/030802268204500603 [CrossRef]
  • Gardner-Elahi, C. & Zamiri, S. (2015). Collective narrative practice in forensic mental health. Journal of Forensic Practice, 17(3), 204–218 doi:10.1108/JFP-10-2014-0034 [CrossRef]
  • Garner, R. (1995). Prevocational training within a secure environment: A programme designed to enable the forensic patient to prepare for mainstream opportunities. British Journal of Occupational Therapy, 58(1), 2–6 doi:10.1177/030802269505800102 [CrossRef]
  • Garner, R., Butler, G. & Hutchings, D. (1996). A study of the relationship between the patterns of planned activity and incidents of deliberate self-harm within a regional secure unit. British Journal of Occupational Therapy, 59(4), 156–160 doi:10.1177/030802269605900402 [CrossRef]
  • George-Paschal, L. & Bowen, M. R. (2019). Outcomes of a mentoring program based on occupational adaptation for participants in a juvenile drug court. Occupational Therapy in Mental Health, 35(3), 262–286 doi:10.1080/0164212X.2019.1601605 [CrossRef]
  • Gooch, P. & Living, R. (2004). The therapeutic use of videogames within secure forensic settings: A review of the literature and application to practice. British Journal of Occupational Therapy, 67(8), 332–341 doi:10.1177/030802260406700802 [CrossRef]
  • Graham, A., Harbottle, C. & King, D. (2016). Resolve: A community-based forensic learning disability service specializing in supporting male sex offenders: Our model, approach and evidence base for effective intervention. Journal of Intellectual Disabilities and Offending Behaviour, 7(4), 186–194 doi:10.1108/JIDOB-10-2014-0014 [CrossRef]
  • Halliburton, J. K. (1943). Occupational therapy with adult defective delinquents. Archives of Occupational Therapy, 22(6), 274–279. https://journals.lww.com/ajpmr/Citation/1943/12000/OCCUPATIONAL_THERAPY_WITH_ADULT_DEFECTIVE.4.aspx
  • Hardison, J. & Llorens, L. A. (1988). Structured craft group activities for adolescent delinquent girls. Occupational Therapy in Mental Health, 8(3), 101–117 doi:10.1300/J004v08n03_07 [CrossRef]
  • Helbig, K. (2005). The graded skills development programme. Mental Health Occupational Therapy, 10(2), 51–53.
  • Hitch, D., Hii, Q. K. & Davey, I. (2016). Occupational therapy in forensic psychiatry: Recent developments in our understandings (2007–2013). British Journal of Occupational Therapy, 79(4), 197–205 doi:10.1177/0308022615591018 [CrossRef]
  • Hood, C. (1998). Occupational therapy in prison. Psychiatric Care, 5(4), 139–142.
  • Jodrell, R. D. & Sanson-Fisher, R. (1975). Basic concepts of behavior therapy: An experiment involving disturbed adolescent girls. American Journal of Occupational Therapy, 29(10), 620–624. PMID:1181938
  • Jones, E. J. & McColl, M. A. (1991). Development and evaluation of an interactional life skills group of offenders. Occupational Therapy Journal of Research, 11(2), 80–92 doi:10.1177/153944929101100206 [CrossRef]
  • Kantor, O., Hiller, A. & Thuell, J. (1974). Developing an activity program in a welfare hotel. Hospital & Community Psychiatry, 25(5), 520–524 doi:10.1176/ps.25.8.520 [CrossRef] PMID:4135479
  • Kottorp, A., Heuchemer, B., Lie, I. & Gumpert, C. H. (2013). Evaluation of activities of daily living ability and awareness among clients in a forensic psychiatry evaluation unity in Sweden. British Journal of Occupational Therapy, 76(1), 23–30 doi:10.4276/030802213X13576469254658 [CrossRef]
  • Kromm, J., Vasile, R. G. & Gutheil, T. G. (1982). Occupational therapy in the assessment of a woman accused of murder. Psychiatric Quarterly, 54(4), 85–96 doi:10.1007/BF01064750 [CrossRef] PMID:7146217
  • Kutateladze, B. L., Andiloro, N. R., Johnson, B. D. & Spohn, C. C. (2014). Cumulative disadvantage: Examining racial and ethnic disparity in prosecution and sentencing. Criminology, 52(3), 514–551 doi:10.1111/1745-9125.12047 [CrossRef]
  • Leadley, S. (2015). The Kawa Model: Informing the development of a culturally sensitive, occupational therapy assessment tool in Aotearoa/New Zealand. New Zealand Journal of Occupational Therapy, 62(2), 48–54.
  • Lederer, J. M., Kielhofner, G. & Watts, J. H. (1985). Values, personal causation and skills of delinquents and nondelinquents. Occupational Therapy in Mental Health, 5(2), 59–77 doi:10.1300/J004v05n02_05 [CrossRef]
  • Lin, N., Kirsh, B., Polatajko, H. & Seto, M. (2009). The nature and meaning of occupational engagement for forensic clients living in the community. Journal of Occupational Science, 16(2), 110–119 doi:10.1080/14427591.2009.9686650 [CrossRef]
  • Lindstedt, H., Grann, M. & Söderlund, A. (2011). Mentally disordered offenders' daily occupations after one year of forensic care. Scandinavian Journal of Occupational Therapy, 18(8), 302–311 doi:10.3109/11038128.2010.525720 [CrossRef] PMID:
  • Lindstedt, H., Söderlund, A., Stålenheim, G. & Sjödén, P. O. (2004). Mentally disordered offenders' abilities in occupational performance and social participation. Scandinavian Journal of Occupational Therapy, 11, 118–127 doi:10.1080/11038120410020854 [CrossRef]
  • Lindstedt, H., Söderlund, A., Stålenheim, G. & Sjödén, P. O. (2005). Personality traits as predictors of occupational performance and life satisfaction among mentally disordered offenders. Nordic Journal of Psychiatry, 59(9), 357–364 doi:10.1080/08039480500320082 [CrossRef] PMID:
  • Linstead, H. & Brooks, R. (2015). A mixed methods study of the re-animation approach within a forensic mental health setting. Occupational Therapy in Mental Health, 31(4), 402–420 doi:10.1080/0164212X.2015.1067157 [CrossRef]
  • Lloyd, C. (1983). Forensic psychiatry and occupational therapy. British Journal of Occupational Therapy, 46(12), 348–350 doi:10.1177/030802268304601203 [CrossRef]
  • Lloyd, C. (1985). Evaluation and forensic psychiatric occupational therapy. British Journal of Occupational Therapy, 48(5), 137–140 doi:10.1177/030802268504800509 [CrossRef]
  • Lloyd, C. (1986). Vocational evaluation in a forensic psychiatric setting. Canadian Journal of Occupational Therapy, 53(3), 31–35 doi:10.1177/000841748605300107 [CrossRef] PMID:
  • Lloyd, C. (1987a). Sex-offender programs: Is there a role for occupational therapy?Occupational Therapy in Mental Health, 7(3), 55–67 doi:10.1300/J004v07n03_04 [CrossRef]
  • Lloyd, C. (1987b). The role of occupational therapy in the treatment of the forensic psychiatric patient. Australian Occupational Therapy Journal, 34(1), 20–25 doi:10.1111/j.1440-1630.1987.tb01561.x [CrossRef]
  • Lloyd, C. (1987c). The use of films and literature in the treatment of incest offenders. Canadian Journal of Occupational Therapy, 54(4), 173–179 doi:10.1177/000841748705400407 [CrossRef]
  • Lloyd, C. (1987d). The use of the Bay Area Functional Performance Evaluation with a forensic population. South African Journal of Occupational Therapy, 17, 7–13.
  • Lloyd, C. (1987e). Working with the female offender: A case study. British Journal of Occupational Therapy, 50, 44–46 doi:10.1177/030802268705000203 [CrossRef]
  • Lloyd, C. (1987–1988). The use of poetry in therapy: A case study of an incest offender. Journal of New Zealand Association of Occupational Therapists, 38, 7–9.
  • Lloyd, C. (1988). Discharge preparation for the forensic psychiatric patient: A proposed model. Journal of the New Zealand Association of Occupational Therapists, 39(1), 12–14.
  • Lloyd, C. (1995). Trends in forensic psychiatry. British Journal of Occupational Therapy, 58(5), 209–213 doi:10.1177/030802269505800507 [CrossRef]
  • Lloyd, C. & Campbell, J. (1986–1987). The therapeutic use of art in a forensic psychiatric setting. Journal of New Zealand Association of Occupational Therapists, 37, 1–13.
  • Lloyd, C. & Guerra, F. (1988). A vocational rehabilitation programme in forensic psychiatry. British Journal of Occupational Therapy, 51(4), 123–126 doi:10.1177/030802268805100407 [CrossRef]
  • Lloyd, C. & Watson, D. (1989). Parenting a group programme for abusive parents. Australian Journal of Occupational Therapy, 36(1), 24–33 doi:10.1111/j.1440-1630.1989.tb01636.x [CrossRef]
  • Loveland, C. A. & Little, V. L. (1974). Juvenile correctional system. American Journal of Occupational Therapy, 28(8), 537–539. PMID:4414022
  • Manley, I. D. (2010). Delinquency in children and the method of treatment in the psychiatric unit. New Zealand Journal of Occupational Therapy, 57(2), 72–76.
  • Mason, K. (2007). An evaluation of a consultant occupational therapist role and its impact within forensic mental health rehabilitation services. Mental Health Occupational Therapy, 12(3), 101–103.
  • Mason, T. & Carton, G. (2002). Towards a ‘forensic lens’ model of multidisciplinary training. Journal of Psychiatric and Mental Health Nursing, 9(5), 541–551 doi:10.1046/j.1365-2850.2002.00527.x [CrossRef] PMID:12358708
  • McFadden, B. E. (2010). At-risk youths and alternative education: A critical appraisal of the topic. Journal of Occupational Therapy, Schools & Early Intervention, 3(1), 95–104 doi:10.1080/19411241003704809 [CrossRef]
  • McQueen, J. M. & Turner, J. (2012). Exploring forensic mental health service users' views on work: An interpretative phenomenological analysis. British Journal of Forensic Practice, 14(3), 168–179 doi:10.1108/14636641211254897 [CrossRef]
  • Merrick, L. & Maguire, A. (2017). From let it be to it must be love: The development of a choir for patients and staff at a high secure hospital. Arts & Health, 9(1), 73–80 doi:10.1080/17533015.2016.1182566 [CrossRef]
  • Molineux, M. L. & Whiteford, G. E. (1999). Prisons: From occupational deprivation to occupational enrichment. Journal of Occupational Science, 6(3), 124–130. DOI. doi:10.1080/14427591.1999.9686457 [CrossRef]
  • Morris, K., Cox, D. L. & Ward, K. (2016). Exploring stories of occupational engagement in a regional secure unit. Journal of Forensic Psychiatry & Psychology, 27(7), 684–697. DOI doi:10.1080/14789949.2016.1187759 [CrossRef] PMID:27695388
  • Morris, K. & Ward, K. (2018). The implementation of a new conceptual framework for occupational engagement in forensic settings: Feasibility and application to occupational therapy practice. Mental Health Review (Brighton), 23(4), 308–319 doi:10.1108/MHRJ-03-2018-0007 [CrossRef]
  • Morrow, T. (2008). Can a client-centred approach develop autonomy and behavioural changes in male offenders attending group activities in forensic environments?Mental Health Occupational Therapy, 13(1), 35–39.
  • Mountain, G. (1998). Occupational therapy in forensic settings: A preliminary review of the knowledge and research base. College of Occupational Therapists.
  • Muñoz, J. P. (2019). Mental health practice in criminal justice settings. In Brown, C., Stoffel, V. C. & Muñoz, J. P. (Eds.), Occupational therapy in mental health: A vision for the future (2nd ed.). F. A. Davis.
  • Muñoz, J. P., Farnworth, L. & Dieleman, C. (2016a). Harnessing the power of occupation to meet the needs of people in criminal justice settings. Occupational Therapy International, 23(3), 221–228 doi:10.1002/oti.1439 [CrossRef] PMID:27546464
  • Muñoz, J. P., Moreton, E. M. & Sitterly, A. M. (2016b). The scope of practice of occupational therapy in U.S. criminal justice settings. Occupational Therapy International, 23(3), 241–254 doi:10.1002/oti.1427 [CrossRef] PMID:27094024
  • O'Connell, M. & Farnworth, L. (2007). Occupational therapy in forensic psychiatry: A review of the literature and a call for a united and international response. British Journal of Occupational Therapy, 70(5), 184–191 doi:10.1177/030802260707000502 [CrossRef]
  • O'Connell, M., Farnworth, L. & Hanson, E. C. (2010). Time use in forensic psychiatry: A naturalistic inquiry into two forensic patients in Australia. International Journal of Forensic Mental Health, 9(2), 101–109 doi:10.1080/14999013.2010.499558 [CrossRef]
  • O'Flynn, P., O'Regan, R., O'Reilly, K. & Kennedy, G. H. (2018). Predictors of quality of life among inpatients in forensic mental health: Implications for occupational therapists. BMC Psychiatry, 18(1), 16 doi:10.1186/s12888-018-1605-2 [CrossRef] PMID:29351784
  • Pakes, F. (2019). Comparative criminal justice. Taylor & Francis doi:10.4324/9781315175942 [CrossRef]
  • Paulson, C. P. (1980). Juvenile delinquency and occupational choice. American Journal of Occupational Therapy, 34(4), 565–571 doi:10.5014/ajot.34.9.565 [CrossRef] PMID:7457552
  • Penner, D. A. (1978). Correctional institutions: An overview. American Journal of Occupational Therapy, 32(2), 517–524. PMID:696549
  • Piper, B. J. & Le Grow, D. (1956). Tutoring for behavioral delinquents. American Journal of Occupational Therapy, 10(4 Part 1), 147–149. PMID:13339887
  • Platt, N. P., Martell, D. L. & Clements, P. A. (1977). Level I field placement at a federal correctional institution. American Journal of Occupational Therapy, 31(1), 385–387. PMID:879255
  • Prison Policy Initiative. (2018). Out of prison & out of work: Unemployment among formerly incarcerated people. https://www.prisonpolicy.org/reports/outofwork.html
  • Provident, I. M. & Joyce-Gaguzis, K. (2005). Creating an occupational therapy Level II fieldwork experience in a county jail setting. American Journal of Occupational Therapy, 59(9), 101–106 doi:10.5014/ajot.59.1.101 [CrossRef] PMID:15707129
  • Quinn, S., Doyle, S. & Emerson, C. (2019). Female prisoners' problems living in an Irish prison: An exploratory study. Occupational Therapy in Mental Health, 35(3), 219–237 doi:10.1080/0164212X.2019.1619495 [CrossRef]
  • Roberts, C., Davies, J. & Maggs, R. G. (2015). Structured community activity for forensic mental health: A feasibility study. Journal of Forensic Practice, 17(3), 180–191 doi:10.1108/JFP-12-2014-0049 [CrossRef]
  • Rodda, J. & Beichner, D. (2017). Identifying programming needs of women detainees in a jail environment. Journal of Offender Rehabilitation, 56(6), 373–393 doi:10.1080/10509674.2017.1339161 [CrossRef]
  • Royal College of Occupational Therapists. (2017). Occupational therapists' use of occupation-focused practice in secure hospitals: Practice guidelines (2nd ed.). https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines/secure-hospitals
  • Schindler, V. P. (1991). AIDS in a correctional setting. Occupational Therapy in Health Care, 7(2–4), 171–183 doi:10.1080/J003v07n02_15 [CrossRef] PMID:23931177
  • Schindler, V. P. (2004). Occupational therapy in forensic psychiatry: Role development and schizophrenia. Occupational Therapy in Mental Health, 20(3/4), 1–159. doi:10.1300/J004v20n03_01 [CrossRef]
  • Schindler, V. P. (2005). Role development: An evidenced-based intervention for individuals diagnosed with schizophrenia in a forensic facility. Psychiatric Rehabilitation Journal, 28(8), 391–394 doi:10.2975/28.2005.391.394 [CrossRef] PMID:15895924
  • Seek, N. (1989). The New Zealand prison system: The potential role of occupational therapy. Journal of the New Zealand Association of Occupational Therapists, 40, 16–19. https://www.otnz.co.nz/publications/new-zealand-journal-of-occupational-therapy
  • Sethi, C. & Barney, K. (2018). Serial crime as occupation: Parallels between occupational analysis and psychological profiling. Journal of Occupational Science, 25(2), 283–289 doi:10.1080/14427591.2017.1366930 [CrossRef]
  • Shea, C. & Giles, G. M. (2012). Occupational therapists' and teachers' differing beliefs about how they can assist continuation high school students' transition to postsecondary education. Occupational Therapy in Mental Health, 28(1), 88–105 doi:10.1080/0164212X.2012.651368 [CrossRef]
  • Shea, C. & Wu, R. (2012). Examining the sensory profiles of at-risk youth participating in a pre-employment program. Open Journal of Occupational Therapy, 1(1), 5. doi:10.15453/2168-6408.1027 [CrossRef]
  • Shea, C. K. & Jackson, N. (2015). Client perception of a client-centered and occupation-based intervention for at-risk youth. Scandinavian Journal of Occupational Therapy, 22(2), 173–180 doi:10.3109/11038128.2014.958873 [CrossRef] PMID:
  • Shea, C. K. & Siu, A. M. (2016). Engagement in play activities as a means for youth in detention to acquire life skills. Occupational Therapy International, 23(3), 276–286 doi:10.1002/oti.1432 [CrossRef] PMID:27363848
  • Smith, A., Petty, M., Oughton, I. & Alexander, R. T. (2010). Establishing a work-based learning programme: Vocational rehabilitation in a forensic learning disability setting. British Journal of Occupational Therapy, 73(9), 431–436 doi:10.4276/030802210X12839367526174 [CrossRef]
  • Smith, N. (1998). Forensic occupational therapy for people with learning disabilities. British Journal of Therapy and Rehabilitation, 5(9), 472–476 doi:10.12968/bjtr.1998.5.9.14174 [CrossRef]
  • Smith, S. L. (1984). The forensic model of occupational therapy. Occupational Therapy in Health Care, 1(1), 17–22 doi:10.1080/J003v01n01_04 [CrossRef] PMID:23952115
  • Snyder, C., Clark, F., Masunaka-Noriega, M. & Young, B. (1998). Los Angeles street kids: New Occupations for Life Program. Journal of Occupational Science, 5(3), 133–139 doi:10.1080/14427591.1998.9686441 [CrossRef]
  • Soeker, M. S., Carriem, F., Hendricks, M., Joynt, T. & Naidoo, N. (2013). Breaking into the world of employment: The vocational experience of South African male ex-offenders. Work (Reading, Mass.), 44(4), 201–211 doi:10.3233/WOR-2012-1411 [CrossRef] PMID:22927608
  • Stein, F. (1972). Community rehabilitation of disadvantaged youth. American Journal of Occupational Therapy, 26(6), 277–283. PMID:5053676
  • Stelter, L. & Whisner, S. M. (2007). Building responsibility for self through meaningful roles: Occupational adaptation theory applied in forensic psychiatry. Occupational Therapy in Mental Health, 23(1), 69–84 doi:10.1300/J004v23n01_05 [CrossRef]
  • Stewart, P. & Craik, C. (2007). Occupation, mental illness and medium security: Exploring time-use in forensic regional secure units. British Journal of Occupational Therapy, 70(10), 416–425 doi:10.1177/030802260707001002 [CrossRef]
  • Talbot, E., Bird, Y., Russell, J., Sahota, K., Schneider, J. & Khalifa, N. (2018). Implementation of individual placement and support (IPS) into community forensic mental health settings: Lessons learned. British Journal of Occupational Therapy, 81(6), 338–347 doi:10.1177/0308022618756593 [CrossRef]
  • Tan, B. L., Ravindra Kumar, V. R. & Devaraj, P. (2015). Development of new occupational therapy service in a Singapore prison. British Journal of Occupational Therapy, 78(8), 525–529 doi:10.1177/0308022615571083 [CrossRef]
  • Tayar, S. G. (2004). Description of a substance abuse relapse prevention program conducted by occupational therapy and psychology graduate students in a United States women's prison. British Journal of Occupational Therapy, 67(4), 159–166 doi:10.1177/030802260406700404 [CrossRef]
  • Tse, S. (1990). Occupational therapy in a forensic psychiatric unit. New Zealand Journal of Occupational Therapy, 41(2), 18–22.
  • Tucker, S. C. & Yuen, H. K. (2019a). Attitudes toward rehabilitating inmates among occupational therapy students in the United States. Journal of Educational Evaluation for Health Professions, 16(6), 6 doi:10.3352/jeehp.2019.16.6 [CrossRef] PMID:
  • Tucker, S. C. & Yuen, H. K. (2019b). Factors associated with consideration of occupational therapists working in the prison setting. International Journal of Caring Sciences, 12(1), 92–99.
  • Tully, J., McSweeney, L., Harfield, K. L., Castle, C. & Das, M. (2016). Innovation and pragmatism required to reduce seclusion practices. CNS Spectrums, 21(1), 424–429 doi:10.1017/S1092852916000481 [CrossRef] PMID:27788697
  • Twinley, R. (2017). Woman-to-woman rape and sexual assault, and its impact upon the occupation of work: Victim/survivors' life roles of worker or student as disruptive and preservative. Work, 56(4), 505–517. doi:10.3233/WOR-172529 [CrossRef]28409768
  • Virikowic, T. L. (1993). Perspectives on delinquency and the Model of Human Occupation. Journal of Occupational Therapy Students, 7(1), 30–41.
  • Völlm, B., Panesar, K. & Carley, K. (2014). Promoting work related activities in high secure setting: Exploration of staff and patient views. Journal of Forensic Psychiatry & Psychology, 25(1), 26–43 doi:10.1080/14789949.2013.875583 [CrossRef]
  • Wagenfeld, A., Stevens, J., Toews, B., Jarzembowski, S., Ladjahasan, N., Stewart, J. & Raddatz, C. (2018). Addressing correctional staff stress through interaction with nature: A new role for occupational therapy. Occupational Therapy in Mental Health, 34(3), 285–304 doi:10.1080/0164212X.2017.1385435 [CrossRef]
  • White, J. A., Rogers, S., Hamilton, T. & Grass, C. (2012). Occupational therapy in criminal justice. In Cara, L. & MacRae, A. (Eds.), Psychosocial occupational therapy: A clinical practice (3rd ed., pp. 715–773). Delmar Cengage.
  • Whiteford, G. (1997). Occupational deprivation and incarceration. Journal of Occupational Science, 4(3), 126–130 doi:10.1080/14427591.1997.9686429 [CrossRef]
  • Wiglesworth, S. & Farnworth, L. (2016). An exploration of the use of a sensory room in a forensic mental health setting: Staff and patient perspectives. Occupational Therapy International, 23(3), 255–264 doi:10.1002/oti.1428 [CrossRef] PMID:27237722
  • Wildeman, C. & Wang, E. A. (2017). Mass incarceration, public health, and widening inequality in the USA. Lancet, 389(10077), 1464–1474 doi:10.1016/S0140-6736(17)30259-3 [CrossRef] PMID:28402828
  • Williams, B. & Chard, G. (2016). Using the Evaluation of Social Interaction (ESI) with men in a low secure forensic unit. British Journal of Occupational Therapy, 79(4), 206–211 doi:10.1177/0308022615615890 [CrossRef]
  • Withers, P., Boulton, N., Morrison, J. & Jones, A. (2012). Occupational therapy in a medium secure intellectual disability and personality disorder service. Journal of Learning Disabilities and Offending Behaviour, 3(4), 206–218 doi:10.1108/20420921211327356 [CrossRef]
  • Wolfendale, T. & Musaabi, A. (2017). The implementation of a peer support scheme in an assertive rehabilitation ward in high secure forensic services. Mental Health and Social Inclusion, 21(4), 222–229 doi:10.1108/MHSI-05-2017-0023 [CrossRef]
  • World Federation of Occupational Therapy. (2020). Human resources project 2020: Global demographics of the occupational therapy profession. https://www.jaot.or.jp/files/page/kokusai/WFOT-Human-Resources-Project-2020-ALPH-Final%20_japan%20ammended.pdf
  • World Prison Brief. (2018). Institute for Crime & Justice Policy Research (12th ed.). https://www.prisonstudies.org/sites/default/files/resources/downloads/wppl_12.pdf
  • Yukhnenko, D., Sridhar, S. & Fazel, S. (2019). A systematic review of criminal recidivism rates worldwide: 3-year update. Wellcome Open Research, 4(28), 28 doi:10.12688/wellcomeopenres.14970.2 [CrossRef] PMID:31544154
  • Zinkus, P. W., Gottlieb, M. I. & Zinkus, C. B. (1979). The learning-disabled juvenile delinquent: A case for early intervention of perceptually handicapped children. American Journal of Occupational Therapy, 33(3), 180–184. PMID:556377
  • Zubriski, S., Norman, M., Shimmell, L., Gewurtz, R. & Letts, L. (2020). Professional identity and emerging occupational therapy practice: An autoethnography. Canadian Journal of Occupational Therapy, 87(7), 63–72 doi:10.1177/0008417419870615 [CrossRef] PMID:

Search Strings

PubMed Search String
(“Occupational Therapy”[Mesh] OR “occupational therapist”[tiab] OR “occupational therapist”[OT] OR “occupational therapists”[tiab] OR “occupational therapists”[ot] OR “occupational therapies”[tiab] OR “occupational therapies”[ot]) AND (“community corrections”[ot] OR “community corrections”[tiab] OR “convict”[ot] OR “convict”[tiab] OR “convicts”[ot] OR “convicts”[tiab] OR “correctional facility”[ot] OR “correctional facility”[tiab] OR “Criminal Psychology”[Mesh] OR “criminal”[ot] OR “criminal”[tiab] OR “Criminals”[Mesh] OR “criminals”[ot] OR “criminals”[tiab] OR “delinquency”[ot] OR “delinquency”[tiab] OR “delinquent”[ot] OR “delinquent”[tiab] OR “delinquents”[ot] OR “delinquents”[tiab] OR “detainee”[ot] OR “detainee”[tiab] OR “detainees”[ot] OR “detainees”[tiab] OR “detention center”[ot] OR “detention center”[tiab] OR “drug court”[ot] OR “drug court”[tiab] OR “felon”[ot] OR “felon”[tiab] OR “felons”[ot] OR “felons”[tiab] OR “Forensic Psychiatry”[Mesh] OR “forensic”[ot] OR “forensic”[tiab] OR “house arrest”[ot] OR “house arrest”[tiab] OR “incarcerated”[ot] OR “incarcerated”[tiab] OR “incarceration”[ot] OR “incarceration”[tiab] OR “inmate”[ot] OR “inmate”[tiab] OR “inmates”[ot] OR “inmates”[tiab] OR “internee”[ot] OR “internee”[tiab] OR “jail”[ot] OR “jail”[tiab] OR “Juvenile Delinquency”[Mesh] OR “juvenile delinquency”[ot] OR “juvenile delinquency”[tiab] OR “juvenile delinquent”[ot] OR “juvenile delinquent”[tiab] OR “juvenile delinquents”[ot] OR “juvenile delinquents”[tiab] OR “offender”[ot] OR “offender”[tiab] OR “offenders”[ot] OR “offenders”[tiab] OR “parolee”[ot] OR “parolee”[tiab] OR “parolees”[ot] OR “parolees”[tiab] OR “penitentiaries” [ot] OR “penitentiaries” [tiab] OR “penitentiary” [ot] OR “penitentiary” [tiab] OR “prison”[ot] OR “prison”[tiab] OR “prisoner”[ot] OR “prisoner”[tiab] OR “Prisoners”[Mesh] OR “prisoners”[ot] OR “prisoners”[tiab] OR “Prisons”[Mesh] OR “prisons”[ot] OR “prisons”[tiab] OR “recidivism”[ot] OR “recidivism”[tiab] OR “residential treatment”[ot] OR “residential treatment”[tiab] OR “secure facility”[ot] OR “secure facility”[tiab] OR “secure facilities”[ot] OR “secure facilities”[tiab] OR “secure hospital”[ot] OR “secure hospital”[tiab] OR “secure hospitals”[ot] OR “secure hospitals”[tiab] OR “secure mental health facility”[ot] OR “secure mental health facility”[tiab] OR “secure mental health facilities”[ot] OR “secure mental health facilities”[tiab] OR "secure psychiatric"[tiab] OR "secure psychiatric"[ot] OR “security hospital”[ot] OR “security hospital”[tiab] OR “security hospitals”[ot] OR “security hospitals”[tiab] OR "Criminology"[Mesh])
CINAHL Search String
(MH “occupational therapy” OR TI “Occupational Therapy” OR AB “Occupational therapy” OR TI “occupational therapist” OR AB “occupational therapist” OR TI “occupational therapists” OR AB “occupational therapists” OR TI “occupational therapies” OR AB “occupational therapies”) AND ((MH Criminology) OR (MH Prisoners) OR (MH Criminals) OR (MH “Juvenile Delinquency”) OR (MH “Criminal Psychology") OR (MH Prisons) OR (MH “Forensic Psychiatry”) OR TI “community corrections” OR TI convict OR TI convicts OR TI “correctional facility” OR TI criminal OR TI criminals OR TI delinquency OR TI delinquent OR TI delinquents OR TI detainee OR TI detainees OR TI “detention center” OR TI “drug court” OR TI felon OR TI felons OR TI forensic OR TI “house arrest” OR TI incarcerated OR TI incarceration OR TI inmate OR TI inmates OR TI internee OR TI jail OR TI “juvenile delinquency” OR TI “juvenile delinquent” OR TI “juvenile delinquents” OR TI offender OR TI offenders OR TI parolee OR TI parolees OR TI penitentiaries OR TI penitentiary OR TI prison OR TI prisoner OR TI prisoners OR TI prisons OR TI recidivism OR TI “residential treatment” OR TI “secure facility” OR TI “secure hospital” OR TI “secure mental health facility” OR TI “security hospital” OR TI “security hospitals” OR TI “secure facilities” OR TI “secure hospitals” OR TI “secure mental health facilities” OR TI “secure psychiatric” OR AB “community corrections” OR AB convict OR AB convicts OR AB “correctional facility” OR AB criminal OR AB criminals OR AB delinquency OR AB delinquent OR AB delinquents OR AB detainee OR AB detainees OR AB “detention center” OR AB “drug court” OR AB felon OR AB felons OR AB forensic OR AB “house arrest” OR AB incarcerated OR AB incarceration OR AB inmate OR AB inmates OR AB internee OR AB jail OR AB “juvenile delinquency” OR AB “juvenile delinquent” OR AB “juvenile delinquents” OR AB offender OR AB offenders OR AB parolee OR AB parolees OR AB penitentiaries OR AB penitentiary OR AB prison OR AB prisoner OR AB prisoners OR AB prisons OR AB recidivism OR AB “residential treatment” OR AB “secure facility” OR AB “secure hospital” OR AB “secure mental health facility” OR AB “security hospital” OR AB “security hospitals” OR AB “secure facilities” OR AB “secure hospitals” OR AB “secure mental health facilities” OR AB “secure psychiatric”)

Studies Examining Characteristics of Justice-Based Populations (N=16)

Author/Research FocusPopulation/SettingResearch Approach
(Bowser et al., 2018): How do men diagnosed with psychosis and in a forensic setting perceive and describe boredom?8M in a UK medium-secure forensic MH unitQualitative; interpretative approach used interviews with prompts related to environment, roles and routines, volition, skills and diagnosis
(O'Flynn et al., 2018): What predicts QOL amongst service users within an inpatient forensic MH hospital?52M service users with schizophrenia or schizoaffective disorder, residing in UK low, medium and high secure MH wardsMixed methods; elicited naturalistic and observational data and used ward statistics and various assessments like the WHO QOL tool and Occupational and Social Functioning Scales
(Costa et al., 2016): What are the daily lives of young men facing incarceration related to their delinquency and what factors may explain their participation in criminal occupations?22M adolescents who had served their sentences from 4 Brazilian socio-educational centers (delinquency facilities)Qualitative exploratory study; interviews with topics of family living, level of study prior to incarceration, work, leisure and influence of socio-education measures
(Kottorp et al., 2013): What is ADL functioning of clients in forensic MH eval and what is the relationship between ADL scores and their awareness of ADL functioning?8F/27M persons in a forensic MH evaluation unit in SwedenQuantitative; used AMPS, Assessment of Awareness of Ability and reviewed database records
(Shea & Wu, 2012): Can Dunn's sensory processing model be used to investigate the sensory profiles of youth participating in a community-based OT pre-employment program?26F/53M adolescent youth on probation attending a U.S. community-based juvenile justice programQuantitative; retrospectively analyzed data from the AASP completed by youth to examine scores relative to normative means
(Lindstedt et al., 2011): What are occupational performance and social participation abilities 1 year after standard forensic psychiatric care and do abilities differ between those still hospitalized and those living in the community?36M in various Swedish high and medium secure facilities and general MH hospitalsQuantitative; 1-year follow up design cohort study using self-efficacy scale, demographic data in national registry, social interaction and QOL scales and performance and cognitive function measures
(O'Connell et al., 2010): How do 2 forensic patients use their time and what factors influence occ. engagement? n both the prison setting and the secure MH unit2M with schizophrenia housed in an Australian prison then moved to a secure forensic MH facility and 4 staff participants in a focus groupMixed methods, analysis of time use with time diaries; interviews using OPHI-II; naturalistic observations, review of policies and staff focus groups
(Stewart & Craik, 2007): How do people with schizophrenia experience occupational engagement in secure forensic MH units?2F/3M from 2 regional medium and low secure MH units in the U.K.Mixed methodology; elicited time use data using Occupational Questionnaire, interviews and time diaries
(Lindstedt et al., 2005): Do personality traits predict self-reported and observed occupational performance and life satisfaction profiles of male forensic patients?55M sentenced to compulsory forensic MH facilities in SwedenQuantitative; cohort study using self-report, demographics from registry data banks, personality and QOL scales, and performance and cognitive function assessments
(Crist et al., 2005): How do jail inmates perceive their own capacities and the impact of the environment on their occupational performances?6F/61M in a U.S. jail community reintegration programQuantitative; descriptive analysis of OSA data
(Farnworth, 2004): How do clients in a forensic MH setting perceive and describe time use in the context of their occupational histories and environment?8M with schizophrenia in an Australia secure forensic MH unitMixed methods; used daily diaries, OPHI II interviews, observations and field notes to explore topics related to current and historical time use
(Lindstedt et al., 2004): How do appraisals of occupational performance and social participation abilities differ between mentally disordered offenders and staff in a forensic service?74M incarcerated in various forensic MH facilities in SwedenMixed methods; multi-method, descriptive approach using interview, self-reports, observation and data in facility registry
(Farnworth, 2000): How do probationary young offenders spend their wakeful time over the course of one week?16 F/21M Australian 13–18-year-old probationers living with family, in agency accommodations or homelessMixed methods; interviews; time sampling, identified activities being engaged, environment and subjective experiences at various points in time
(Fanchiang et al., 1990): How do the sensory integrative and practice abilities of non-delinquent prone delinquents compare with those of delinquent prone adolescents with learning problems?63F/51M non-delinquent prone adolescents compared to 4F/8M delinquent prone adolescents from U.S. schoolsQuantitative; pre/post-test group comparison using a majority of the Sensory Integration and Praxis, Finger Posture Imitation and the MacQuarrie Mechanical Ability tests
(Lederer et al., 1985): How do factors such as values, locus of control, and perceptual motor skills differ between delinquent and non-delinquent youth?15M incarcerated at a U.S. state correctional institution and 15M, age-matched non-delinquents from local high schoolMixed methods; compared personal standards and goals, roles, sense of control, and visual motor integration variables between groups
(Stein, 1972): What are the cognitive style characteristics of a sample of socially disadvantaged youth attending a residential treatment facility?32M, 14–15 years old in a U.S. residential center for disadvantaged youthQuantitative; Weschler Intelligence Scale used to measure cognitive characteristics

Studies Exploring Occupational Therapy Processes In Justice-Based Systems (N=15)

Author/Research FocusPopulation/SettingResearch Approach
(Morris & Ward, 2018): Can a framework of occupational engagement be used to develop, pilot and evaluate therapeutic tools?11 OTs, gender unspecified from 2 secure MH units in the U.K.Qualitative; action research and focus groups, introduced framework, piloted application and assessed usefulness of framework
(Talbot et al., 2018): What lessons can be learned from implementing an IPS program in community forensic MH settings?Data from a community forensic MH service and a forensic personality disorder service in the U.KMixed methods; process evaluation, 6 months of observations, interviews, IPS Fidelity scale all assessing IPS implementation
(Wagenfeld et al., 2018): What is the relationship between correctional staffs' experiences w/stress and their interactions with nature?1135 useable surveys from correction employees in U.S. prisonsQuantitative; descriptive survey research
(Williams & Chard, 2016): Can the results of a social interaction evaluation inform the MH team and guide occupation -based interventions?6M in UK low secure forensic MH unit in semirural areaMixed methods; used standardized social interaction scale in pre/post design; critical reflection on practice, discussions with both participants and staff to identify skills that supported or limited quality social interactions
(Connell, 2015): What contributions to risk assessment and formulation do OTs provide for persons with personality disorder?1 male in a UK prisonMixed methods; case report and detailed assessment including interview, psychometric scales
(Gardner-Elahi & Zamiri (2015): How are collective narrative practices used in a secure forensic recovery service?4M with at least a 5-year length of stay in a UK secure forensic MH serviceQualitative; case study, focus groups with service users; elicited feedback on narrative therapy, Tree of Life assessment and Knowledge Group
(Graham et al., 2016): Is a model of forensic practice using positive interventions for men with learning disabilities who have committed serious sexual offences effective?1 program serving men with learning disabilities who've committed sexual offenses in a U.K. community-based serviceMixed methods; descriptive case study, used pre-admission evaluations, multi-agency risk assessment; inspection reports of efficacy in practice
(Fitzgerald et al., (2012): What is the nature of family interventions provided by OT to an individual in a secure forensic environment?1M, 24 years old in a U.K. low secure forensic unitQualitative; descriptive case study defines OT assessment that support agenda driven, problem focused approach to engaging the family
(Shea & Giles, 2012). How do the role conceptualizations of working with at-risk youth differ between OTs and teachers?3F/2M teachers and 7 OTs, gender unspecified, from a U.S. high school and OT community-based programQualitative; interviews multiple stakeholders to examine outcomes, personal and environmental, difficulties transitioning to postsecondary education
(Fitzgerald et al., 2011): Can a ‘serious game format’ be used to engage low secure unit pts in the design, layout and refurbishment of their unit?25 service users, gender unspecified, in a low secure forensic MH unit in the U.K.Quantitative; descriptive case study, generated feedback on the gaming approach that directly impacted service decisions
(McFadden, 2010): What is the evidence that programs using an OT practice framework support performance patterns and skills for at-risk adolescents in alternative education programs?Review of 9 studies published from 1999–2007 focused on at-risk youth in alternative education programsQualitative; review using search protocol, in 7 data bases, assessed 9 studies for level of evidence
(Mason, 2007): What is the impact of an OT consultant on the rehabilitation that service users receive and what staff opportunities are afforded by the consultant?19 service users and 24 clinical staff, gender unspecified, in low and medium secure UK facilitiesMixed methods; survey methodology and 3-month dairy exercise (kept by consultant)
(Stelter & Whisner, 2007): To describe an OT sheltered workshop program based on Occupational Adaptation implemented in a secure forensic inpatient psychiatric hospital.Unspecified number of men in a U.S. inpatient forensic MH hospital for offenders.Details shelter workshop program, gives 3 case examples of effectiveness and general evidence of improved mastery in work, community participation, and self-responsibility.
(Clarke, 2003): Is the Canadian Model of Occupational Performance (CMOP) useful in a forensic hostel?Unspecified number of men in a UK forensic rehabilitation hostelMixed methods; single case study descriptive article evaluating practice
(Lloyd, 1987e): Is the BaFPE an applicable evaluation for a forensic population?5F/49M convicted of sexual, violent or property offences in Canadian provincial prisonQuantitative; descriptive statistics to determine the discriminative value of BaFPE Task Oriented Assessment and Social Interaction Scale

Studies Assessing the Impact of OT Interventions (N=15)

Author/Research FocusPopulation/SettingResearch Approach
(George-Paschal & Bowen, 2019): Did participation in an occupational adaptation mentoring program help adjudicated youth meet their goals?3F/7M adjudicated youth, in a U.S. juvenile drug court programMixed methods; case study, interviews, client identified goals, occupational challenges and responses to overcome these
(Fan et al., 2016): What changes are seen in forensic patients' occupational participation over a 2-yr period?36F/453M with psychiatric disorders in U.K low and medium secure forensic unitsQuantitative; analyzed MOHOST data to examine change in participation and dynamic needs of population
(Shea & Siu, 2016): Does a community OT training program using play activities facilitate the acquisition of life skills by youth in detention?10F/16M youths detained in a U.S. juvenile justice centerMixed methods; retrospective measurement of occupational engagement using EOAQ: self-report; AGAS; worksheets and/or paper artworks collected by OT
(Tully et al., 2016): Is a novel intervention strategy for reduction of long-term segregation on a high secure, high dependency forensic psychiatry ward effective?7 people, gender unspecified, living on a high secure forensic MH unit in the U.KMixed methods; tracked seclusion and restraint episodes, staff time required, level of acute risk, qualitative interviews with staff and patients
(Linstead & Brooks, 2015): What is the impact of using the Re-Animation Approach on the well-being and performances of forensic clients?3M in a secure forensic MH facility in the U.K.Mixed methods; G-A-S, interviews
(Bacon et al., 2012): Does the Nintendo® Wii FitTM change the engagement of people in a forensic MH unit at risk of obesity?1F/1M with BMI reflecting obesity in an Australian secure forensic MH hospitalMixed methods; case study design; gathering data from accelerometers, records of time spent playing Wii FitTM and semi-structured interviews
(Fitzgerald, 2011): Does OT impact social inclusion patterns of mentally disordered offenders compared to treatment as usual?7F/36M in a U.K. low secure forensic MH service; 21M/3F in a Social Inclusion Program and 15M/4F in treatment as usual groupQuantitative; pre-test/post-test, using MOHOST scores to compare groups after leisure, literacy, education and employment focused group interventions or usual treatment
(Morrow, 2008): Will a client-centered, humanistic approach employed by staff, produce autonomy and behavioral changes in male offenders attending activities in forensic environments?10M and 4 staff in a forensic MH facility in the UKMixed methods; descriptive case study, observation of task engagement; questionnaire
(Schindler, 2005): Do adults with schizophrenia demonstrate improved task, interpersonal skills and social roles when involved in an individualized Role Development Programme compared to intervention a multi-department activity programme?42M in a treatment and 42M in a control group all diagnosed with schizophrenia and residing in a U.S. maximum security forensic prisonMixed methods; repeated measures pre/post-test group comparisons of data measuring role functioning, task and interpersonal skills; qualitative staff and patient focus group interviews on program processes and outcomes
(Schindler, 2004): Do people with schizophrenia demonstrate greater improvement in task, interpersonal skills and social roles when involved in the Role Development program as compared to an activity program?84 men with schizophrenic disorders in a U.S. prison maximum security forensic MH unitMixed methods; pretest-posttest, repeated measures @ 4,8,12 weeks using role, task and interpersonal performance scales; interviews with staff and participants
(Hardison & Llorens, 1998): What are the effects of a craft group for adolescent females with suspected vestibular processing difficulties?6F adolescents on probation for delinquency, living in 2 U.S. community group homesQualitative; 3 descriptive case studies used detailed observations and performance evaluations to illustrate client growth and benefits of crafts
(Garner et al., 1996): Is there a correlation between patterns of structured activity and incidents of self-harm for forensic MH inpatients?307 incidents of self-harm in a forensic MH unit in the U.K.Quantitative; descriptive statistics of pre- existing data set
(DeForest et al.,1991): Did participation in craft activities impact the belief in self and skills for adolescent males?6M adolescents 13-15 years old in U.S. residential juvenile corrections facilityQuantitative; pre-test, craft activities, and post-test sequence, used belief in self scale to measure belief gross/fine motor, process and communication skills
(Jones & McColl, 1991): Does a life skills group increase desire for participation in other groups, a need for social inclusion, the ability to take on prosocial roles and elicit positive feelings about group participation?23M inpatients in a Canadian forensic MH instituteMixed methods; quasi-experimental, compared Interactional Life Skills program with conventional inpatient group therapy
(Jodrell, 1975): Can behavioral modification improve social skills in disturbed adolescent girls?2 groups of adolescent females, number unspecified, in a U.S. maximum security forensic unitQuantitative; multiple baseline design; repeated measures of frequency & rate of compliance & social greeting behaviors recorded by staff raters

Studies of Service User Perspectives On Occupation And Occupational Therapy (N=14)

Author/Research FocusPopulation/SettingResearch Approach
(Connell et al., 2019): What influences occupational participation for people who receive services at the Offender Personality D/O Pathway program?5F/13M with personality disorder living in the communityQualitative; narrative approach; interview examined everyday life; used OPHI II to examine life course
(Quinn et al., 2019): How do females living in an Irish prison identify problems and concerns and can these data inform prison-based, OT practice?11F living in an Irish prisonQualitative; experiential approach; interviews; some quantitative measures not described in article
(Twinley, 2017): What are the perceived impacts of woman-to-woman rape and sexual assault on victim/survivors' subjective experience of occupation?159F respondents from various nations, experiencing sexual assault, 10F interviewed and 1F provided a written accountMixed methods; autobiographical approach with an occupational science perspective; website survey; semi-structured interviews; one written account
(Crabtree, et al., 2016a): What are the strengths and weaknesses of an OT educational program and what elements of the program were valued by participants?27 men participating in OT educational programming in a medium secure U.S. prisonQualitative; participatory action research; interviews, summative content analysis examining doing, information needs, reentry-fears, technology and self-worth
(Morris et al., 2016): What value do people in a regional secure unit place on occupation and how does that change over 1 year?5M in a U.K. regional forensic secure MH unitQualitative; descriptive case study; qualitative interviews, occupational questionnaire and participant occupation
(Wigglesworth & Farnworth, 2016): What are staff and patient perspectives of the use of a sensory room in a forensic MH setting?10 females and 4 staff using a sensory room in Australian forensic MH hospitalMixed methods; used Sensory Profile, a sensory room use evaluation form and focus groups
(Falardeau et al., 2015): What are perspectives of young prisoners on their occupations before and during incarceration and post-release?8M with history of violent behavior in a Canadian provisional prisonQualitative; seems phenomenological and may be using some grounded theory approaches
(Shea & Jackson, 2014): How do at-risk youth experiencing psychosocial and environmental barriers to occupation respond to person-centered OT?3F/2M adjudicated youth in a U.S. community-based programQualitative; interviews
(Völlm, 2014): How do staff and clients in a secure forensic hospital view the impact of vocational services on MH, recidivism and employment?23F/127M residents and 65 staff, gender unspecified, in a UK high security MH hospitalMixed methods; self-report one patient and one staff questionnaire
(Soeker et al., 2013): How do male ex-offenders who have participated in job training programs describe their challenges in job acquisition?5M ex-offenders and 1F job trainer as a key informant, all living in S. African communitiesQualitative; phenomenological; 2 focus groups with men addressing job programs and obstacles post-release and 2 interviews with key informant
(McQueen & Turner, 2012): What are the views of forensic MH service users on how services promote their aspiration to work, help develop skills for work, and the vocational rehabilitation process?3F/7M receiving vocational services in various forensic MH facilities in ScotlandQualitative; phenomenological; semi-structured interviews focused on: purposeful activity, return to work, transition through care, and recovery; interpretive phenomenological data analysis
(Craik et al., 2010): What does occupational engagement mean to people in forensic units? Can their answers inform service development?5F/21M participants from low and medium secure forensic units in AustraliaQualitative ethnographic; Focus groups exploring occ. engagement
(Donovan & Mason, 2010): What is the impact of OT services to service users, assessment, recovery, and care within this specialty area?30 ward staff and 9 service users gender unspecified in a UK forensic intensive care unitMixed methods; staff completed confidential questionnaire; some service users completed interviews
(Lin et al.,2009): What is the nature & meaning of occupational engagement for people with mental illness charged with a crime and living in the community?5M/5F forensic clients living in the community in CanadaQualitative; phenomenological; interviews w/guide; audio-taped and transcribed; Data analysis using occupational lens in process

Audits of Occupational Therapy Practice and Processes (N=14)

Author/Research FocusPopulation/SettingResearch Approach
(Zubriski et al., 2019): What is the process and meaning of engaging in an emerging OT practice with men transitioning to the community post-imprisonment?1F new OT graduate; 1st person account of working with men in a Canadian post-release community non-profitQualitative; autoethnography using weekly journal entries, process notes from a photovoice project and reflective memos
(Tucker & Yuen, 2019a): What is the likelihood of occupational therapists choosing to work in prison settings, and what are factors associated with willingness to work in such settings?153F/19M OTs in the state of Alabama in the U.S.Mixed methods; 11-item survey and Rehabilitation Orientation Scale (ROS) to assess OTs attitude towards rehabilitation of prison-based populations
(Tucker & Yuen, 2019b): What are the attitudes of OT students towards the rehabilitation of inmates?117F/11M OT students in the state of Alabama in the U.S.Mixed methods; 11-item survey and Rehabilitation Orientation Scale (ROS) to assess OTs attitude towards rehabilitation of prison-based populations
(Chui et al. 2016): What is the current state of forensic occupational therapy practice in Canada?22F/5M OTs working in various forensic MH settings in CanadaMixed methods; on-line survey to elicit data on demographics, setting, evaluation and interventions used
(Connell, 2016): How do forensic OTs' perceive their contribution to reducing reoffending?58 gender unspecified UK OTs from the COT Specialist Section for Forensic MHMixed methods; 5 questions survey to elicit data on reoffending and OT approaches to addressing risks of reoffending
(Hitch et al., 2016): What evidence about OT in forensic psychiatry has been published between 2007–2013?Included 25 English language publications in peer-reviewed journals 2007–2013 that focused on OT in forensic settingMixed methods; used Rosalind Franklin Qualitative Research Appraisal Instrument and National Health and Medical Research Council to appraise the evidence which were organized into doing, being, becoming and belonging categories
(Muñoz et al., 2016b): What is the scope of OT practice in U.S. criminal justice settings?48 OTs, no gender stated, in various U.S. justice-based settingsMixed methods; forced choice and open-ended survey items explored practice models, evaluation and use of individual and group interventions
(Dieleman & Duncan; 2013): How do OT health professionals working in criminal justice understand the purpose of and use online discussion groups?2494 discussion board postings from a variety of international participantsQualitative; case study used thematic analysis to produce descriptions of users and their purposes for participation in an on-line discussion board
(Cronin-Davis & Spybey, 2011): What are working practices, challenges to practice and possible solutions for these among forensic MH practitioners?82 UK forensic MH OTs, gender unstated, most working in U.K. medium secure unitsMixed methods; survey examining details about position, funding, experience, interdisciplinary teamwork
(Cordingley & Ryan, 2009): What are forensic OTs perspectives, beliefs and considerations that inform their use of risk assessments?8 OTs, gender unspecified, working in U.K. low and medium security units, a young offenders' institute and prison settingsQualitative; 3 focus groups to elicit data on use of risk assessment and perceptions of risk, used weighted data analysis that considered frequency, specificity, emotion and extensiveness of content
(O'Connell & Farnworth, 2007). What is the state of evidence and role for OT in forensic practice?Reviewed over 65 articles, chapters and books with content specific to FMHAdvocated for a coordinated international effort to extend the evidence base for OT in justice-based settings and suggested partnerships between practitioners and universities are one key strategy to animate this effort
(Duncan et al., 2003): What are the specific research priorities of forensic OT's?71 OTs, no gender stated, working in forensic settings within the UKMixed methods; nominal group technique, questionnaire to elicit data on research priorities including practice patterns, risk assessment, outcome measures, intervention and group programming
(Mason & Carton, 2002): Do common areas and issues related to forensic MH training exist across multi-disciplinary literature?Unspecified number of sources including research, literature reviews, published personal accounts, published and unpublished reports, and curriculum documentsQualitative; coded and analyzed multiple documents, identified treatment areas, service users views, needs for research and models of treatment in forensic MH across several disciplines
(Baker & McKay, 2001): Are the occupational needs of women in medium secure care being met?45 OTs, gender unspecified, working in varied U.K. regional medium secure unitsQuantitative; postal survey used Likert type items and 1 open-ended item examining perceptions of women's needs/care and current interventions

Role of OT In Justice Based Settings (N=25)

Author and TitlePopulation/SettingPrimary Arguments
(Ferrazzi, 2019): Occupational therapy and criminal court mental health initiatives: An important emerging practice settingCriminal court mental health initiativesKey OT roles are well aligned with the principles, goals, and objectives of therapeutic jurisprudence and problem-solving courts, including mental health courts. OT offers a science-based conception of what is considered therapeutic in the context of therapeutic jurisprudence.
(du Toit & McGrath, 2017): Dementia in prisons: Enabling better care practices for those ageing in correctional facilitiesIncarcerated individuals with a dementia diagnosisThe prison environment presents both physical and social challenges to individuals with dementia. OTs are able to provide person-centered dementia care within the prison environment through environmental modification and meaningful engagement in occupation.
(Tan et al., 2015): Development of new occupational therapy service in a Singapore prison50 male offenders from mainstream prisons in Singapore transferred to special facility called Psychiatric Housing UnitDescribes development of a yearlong OT program within the Singapore prison system. Noted improvements in participating clients, including some cultural shifts in staff away from custodial views to a therapeutic or rehabilitative perspective. Prison staff noted the number and type of offenses committed by clients in the program was reduced.
(Withers et al., 2012): Occupational therapy in a medium secure intellectual disability and personality disorder service.Medium secure serviceOT has a role in the integrated multi-disciplinary team to lead activities program in collaboration with staff. OTs can facilitate a consistent and safe environment to support positive behavior, development of client self-esteem, interpersonal relationships, and emotional regulation.
(Dunn & Seymour, 2008): Forensic psychiatry and vocational rehabilitation: Where are we at?Secure FMH settings with focus on vocational rehabilitation componentsThere exists a clear niche for OTs to support vocational rehabilitation FMH; however, further research and investigation regarding the relationship between occupational therapy, forensic psychiatry, and vocational rehabilitation is needed.
(Provident & Joyce-Gaguzis (2005): Creating an occupational therapy level II fieldwork experience in a county jail settingLevel II OT students entering fieldwork experience in a US urban county jailFieldwork in a county jail facilitates students' understanding of justice-based OT roles. Specific skills training areas that students employed for incarcerated individuals included life-skill development, job skills training, goal setting, and client self-esteem.
(Forward et al., 1999): The OT in the forensic psychiatric settingGeneral forensic psychiatry settingsDescribes roles and functions of OT within forensic psych. Notes the lack of useful assessments, models, and programs for use in forensic psych as an issue. Identifies OT with potential growth into primary role as developer of independence and for preparing clients to function in community post-release. Notes OTs have responsibility to understand legal system and policies relating to justice systems.
(Platt et al., 1997): Level I field placement at a federal correctional institutionUS university faculty member and student leading weekly pre-release meeting group of 15 menParticipants were able to: analyze their skills and specific planned living situation; have the opportunities to identify and discuss their needs; and to assess personal skills to evaluate their views of community concern. Students gained: leadership skills and learned to effectively handle own and group member frustrations and disappointments, as well as difficult staff relationships; experience in exploring community resources and an awareness of employment opportunities for the OT in correctional settings. Staff and participants became more aware of OT and its potential for contributing to programs in a correctional setting; gained information and resources for use in future pre-release groups.
(Flood, 1997): An introduction to occupational therapy in forensic psychiatryGenerally, clients referred from courts, prison, probation, and community in the UKNotes specific issues and challenges to OT practice: managing danger/risk; barriers to testing real world skills from interventions in secure context; impact of lack of staffing on availability of a client to attend therapy, client motivational barriers. Author notes lack of standardized assessment tools specific for OT use with offenders with mental health disorders.
(Lloyd, 1995): Trends in forensic psychiatryMultiple settings noted e.g., prisons. pre-release, forensic psych, etc.OT role is limited in prison and post-release aftercare, however, has great potential in different areas including pre-release, specialized assessment, and forensic psychiatry. In these fields, OTs need to develop: programs and diversion services; aftercare planning; more OT research and models of practice
(Flood, 1993): Implications for occupational therapy services following the Reed ReportBroadly applies to individuals in FMH settingsOTs offer a strong and applicable skill set for assessment and engagement of individuals in FMH settings.
(Schindler, 1991): AIDS in correctional settingIndividuals with HIV and AIDS in correctional settingsHIV and its transmission within correctional settings poses a significant risk to the health of incarcerated populations. OT can provide treatment and programming both for individuals who are HIV/AIDs positive and those who are at high risk for contracting HIV/AIDs.
(Tse, 1990): Occupational therapy in a forensic psychiatric unit.12-bed medium secure unit in New Zealand with male and female offendersDetails the development of services within a medium secure unit; overall evaluation of inclusion of OT was positive. Recommendations for future services included identifying a frame of reference to guide OT practice; to foster a role for OT in community forensic psychiatry, to refine treatment skills and consider including anger and stress management, social skills training, and problem-solving training.
(Seek, 1989): The New Zealand prison system: The potential role of occupational therapyIndividuals in the New Zealand prison systemOTs have a positive role to play in prison system: OT interventions can meet the needs of work, rest, and play to maximize potential within cultural, familial, and community environments
(Farnworth et al., 1987): Prison based occupational therapyBroadly addresses OT work with individuals incarcerated with mental illness in AustraliaThere is opportunity for OT intervention in the prison setting, with further research needed into: causal attributions and locus of control, the development of living skills in the incarcerated population, and more innovative methods of assessment, program planning, and intervention.
(Lloyd, 1987b): Sex-offender programs: Is there a role for occupational therapy?Sex offenders in Canadian justice systemArgues that OTs have a role in addressing the rehabilitative needs of sex offenders focused on developing productive role functioning in family, work and social roles
(Lloyd, 1987a): The role of occupational therapy in the treatment of the forensic psychiatric patient.Patients on Forensic Services Unit in Canadian MH HospitalArgues for OTs role by emphasizing OTs application of purposeful task engagement and consideration of Person-Environment-Occupation interactions
(Smith, 1984): The forensic model of occupational therapyCourt proceedings with OTs, most often hired by attorneys, to act as expert witnessesDescribes the role of OT as an expert witness in a variety of court proceedings, most of which determine a person's ability to function in one or more areas. Comprehensive objective assessment noted as a key skill for OTs in this arena.
(Paulson, 1980): Juvenile delinquency and occupational choice80 young men in the US aged 16 or older, assessed by OT; >85% found to be developmentally delayedReviews literature regarding delinquency and occupational choice; argues that exploration and manipulation of the environment, as well as a strong mother-child bond are positive factors in maturation and occupational choice.
(Zinkus et al., 1979): The learning-disabled juvenile delinquent: A case for early intervention of perceptually handicapped childrenNon-specific: addresses need for services for youth with perceptual processing disorders to reduce involvement with juvenile courtDiscusses possible links between processing disorder and juvenile delinquency. Encourages OT to provide intervention addressing sensory processing and perceptual disorders, as well as to support educational outcomes, with aim to prevent juvenile delinquency before it occurs
(Penner, 1978): Correctional institutions: An overviewExplores the US prison setting with comparison to secure psychiatric settings to argue for OT's roleThere exist several similarities between the conditions and clients in prisons and secure psychiatric settings; however, OT services in prisons are scarce despite clear indicators that they may benefit clients similar to in secure psychiatric settings
(Bartholomew, 1976): The need for recreational activity in forced confinementPrisons in AustraliaProvides 2 primary arguments for recreation in prison. 1) to provide activity and occupation to prevent deterioration of mental and physical health 2) to provide constructive recreational and leisure pursuits that do not contribute to criminal behaviors.
(Colman, 1975): Occupational therapy and child abuseParents identified by public referral sources as “abusive” as well as their children, all participating in a community-based treatment center in San Francisco, USOT plays a key role in this program with knowledge of child development, interpersonal dynamics, and psychological functioning. OT additionally provided group interventions and contributed to the ongoing process of staff development.
(Loveland & Little, 1974): Juvenile correctional systemUS State Juvenile Correction System, examining multidisciplinary teamwork with adjudicated youthDefines responsibilities of OT in the juvenile correction system, including: SI training and testing, vocational day care training unit for girls, recreation and crafts, orientation; providing in-service staff training about OT, SI, VMI, infant stimulation, etc.
(Barrett, 1953): The scope of occupational therapy in the remand homeUnited Kingdom remand home, accommodating 20 girls ages 6–17 with charges including larceny, truancy, and running away from homeWritten >60 years ago arguing that OTs had a "collective responsibility" to help protect young people from future criminal activity. Reports on the scope of OT in a girl's remand home, arguing that the focus can be placed on deterring first-time offenders from re-offending. Emphasizes the therapeutic use of self to provide everything from delicate handling to firm management of behaviors.

Group and Program Descriptions (N=17)

VOCATIONAL REHABILITATION
Source and FocusPopulation, Setting and InterventionPrimary Conclusions
(Cox, 2014): Vocational rehabilitation; UK19 persons, gender not reported, accessible vocational rehab program within a forensic intellectual disability servicePopulation may benefit from highly structured program simulating demands of gainful employment
(Smith et al., 2010): Work-based learning programme in a forensic learning disability setting UKUndefined number of persons, gender not reported with learning disabilities in low, medium and rehabilitation settings; addressed work related competencies and offered graded progression to working in communityConcludes work environment provides opportunities for increased belief in self and skills, improved social and work skills.
(Eggers et al., 2006): Reintegration and reducing recidivism; U.S.87 M, in county jail and post-release in community, individual reintegration planning for acquiring work or education, health and wellness, family (re)connections, living skillsInclusion of OT had positive impact with trends for reduced recidivism and follow-thru with individual goals and action plans
(Helbig, 2005): Graded skills development programme; UKParticipants with persistent mental illness in high secure forensic hospital; graded skills development program moved from engagement, to task group, to life skills, to advanced programmingProgram based on MOHO and developmental principles can help improve and broaden participation in meaningful and therapeutic activities
(Lloyd, 1988): Discharge preparation in forensic psychiatry; CanadaParticipants in forensic psychiatric facilities with personal & social deficiencies and have psychotic dx involved in the preparation program “life outside” to practice learned tasks and learn new skills in 5 domainsA pre-discharge program focused on life outside using OT skills & strategies to prepare clients with adaptive skills in specific areas to enhance the successfulness of discharge and re-integration into the community
(Garner, 1995): Prevocational training; UK16M/4F with psychiatric disorders in medium secure forensic setting; focus on education, employment, realistic work choices and skills, problem solving and interpersonal skillsProgram provided opportunities to practice skills required in community; participants sustained interest, attendance in a program
SEXUAL OFFENSES
(Wolfendale & Musaabi, 2017): Peer support scheme in an assertive rehabilitation ward; U.K.20 M w/learning disabilities who committed serious sexual offenses in a high secure forensic mental health setting; trained men to use a peer support modelProgram helped new men settle into unit quickly with less anxiety and improved sense of community; peer supporters developed pro-social roles and new occupational identity
(Lloyd, 1989): Parenting group for abusive parents; CanadaUnspecified number of M & F in secure forensic unit; parenting group focused on acquisition of skills/habits for parent role, preparation for community and family reintegration and maladaptive relationship patterns, beliefs and skillsProgram with focus on role remediation and communication addressed disrupted family roles and helped develop skills/habits for role competency
(Lloyd, 1987–1988): Poetry as intervention; Canada1M sex offenders in secure forensic unit; length of stay is 2 years; poetry as one modality but also included sex education, vocational counseling, leisure and budget groupsGroups to develop empathic concern for victims of sexual violence, understand impact of one's behavior using films, books, reading and writing poetry
(Lloyd, 1987d): Case study with female offender; Canada1 F sex offender in secure forensic unit; social therapy program, addressed alternative behaviors using film/discussion groups. Individual focus on ADL, work and parentingMakes case for a comprehensive evaluation and for OT's ability to provide practical rehabilitation
(Lloyd, 1983): OT programming in forensic psychiatry; Canada20 bed (14M, 4F, 2 emergency) secure forensic unit for sex offenders; groups interventions addressed self-concept, relationships, assertiveness, impulsivity and sexual identityDiscussed the need for OT to evolve and adapt in a forensic setting and emphasizes OT role in assessment and treatment planning
STRUCTURED ACTIVITY PROGRAMS
(Merrick, 2017): Creating a patient/staff choir in secure unit; UK7 patients & 11 staff in integrated choir group with focus on recovery, social interaction, inclusion and spiritualityDescribes impact of a choir group as a focused form of mental health treatment to address recovery, social inclusion and leisure.
(Roberts et al., (2015): Structured activities in the community; UK79 M with psychiatric disorders in a low secure forensic setting; [check setting]; one program used open college education and outdoor adventure activities and another included a range of sports and physical activities to emphasize leisure accessOT brings specialist skills to forensics, and interventions led to increased motivation and self-directedness; OTs can plan and deliver programs in secure settings.
(Smith, 1998): Forensic OT for people with learning disabilities; UK3 M with learning disabilities in medium secure unit; activity-based group and individual work; 12-week social skills programEmphasizes OT contributions in evaluation and focus on work and functional assessment.
(Kantor et al., 1974): Community based activity program; U.S.140 M in welfare hotel; OT provided through a collaboration with local hospital; groups 3x's week including arts and crafts, food program, socialization events such as cook-outsSocial activities increased interaction, and positivity, food programs invoked sense of community, connecting participation in community events to behavior led to a reduction in drinking
WOMEN
(Snyder et al., 1998): Alternative education program for at-risk street youth; USA100 gender unspecified, African American and Hispanic teens with or at risk for gang affiliation; focused on mastering skills for transition to productive adulthood including communication, anger/stress management and vocational skillsAn alternative education program using occupational science concepts was received positively by teachers, administrators, and students and judged to have overwhelmingly positive impact
YOUTH
(Tayar, 2004). Interdisciplinary substance abuse relapse prevention progra m; U.S.F residents of a rural, forensic women's prison; focus on psychoeducational, cognitive-behavioral and relapse prevention groups using healthy leisure, scheduling, expressing emotions, job & career exploration topicsCollaboration with psychology was positive, overall perception was that women demonstrated skill development, positive personal growth and changes

Assessment and Intervention Descriptions (N=14)

Author, Population, SettingAssessment / InterventionPrimary Conclusions
(Leadley, 2015): 25 patients, gender unspecified, with serious mental illness in a forensic MH service in Aotearoa/New ZealandUsed feedback from service users and staff to assess if the Kawa River Model assessment was applicable in this forensic MH settingKawa Model provided a culturally sensitive, assessment tool in this forensic MH context and helped shape OT interventions. Tool was recovery-centered and helped communicate OT perspectives to participants and the team.
(Manley, 2010): M & F youth exhibiting delinquency and antisocial behaviors in a Scottish children's psychiatric hospitalGeneral observational assessment of a youth's abilities and relationships with group interventions focused on building confidence, meaningful relationships and prosocial behaviorsAn overview of addressing anti-social behaviors and delinquency; provides 3 case descriptions and shares the youths' background, occupational history, general assessment of abilities and behavior before, during and after interventions; emphasizes the need for occupational therapy to work closely with the team.
(Forsyth et al., 2005): 1 high security hospital setting in the U.K.Academics and practitioners work together to define an evaluation process that could support the development of the evidence-base for OTApproach building an evidence base in OT thru a partnership between academia and a forensic MH setting; illuminates rationale and processes; outcomes were improved client engagement, better d/c preparation and positive changes in evaluation and intervention practices
(Gooch & Living, 2004). General review of select U.S., U.K, and Canadian OT journals, focused on use of video games in forensic settings.Focused on examining evidence for the use of video games with clients with forensic mental health facilities as compared to general psychiatry.Video games require use of tools and develop cognitive, coping and social interaction skills, but this is not well studied with forensic populations. Videogames offer safe, virtual environments that encourage exploration, mastery, creativity and an opportunity for relaxation.
(Hood, 1998): 51 "episodes" of OT service provision in a forensic prison in the U.K.Interview to elicit MH and functional concerns; 1:1 therapy for anxiety and anger management, social skills training and sleep facilitation.OT focused on building coping strategies and promoting function during imprisonment was valued; concluded that OT can successfully be adapted to the prison environment and employment of full-time forensic OT can be justified
(Lloyd & Guerra, 1988): Six 20-bed wards in a Canadian forensic MH hospitalVocational evaluation process collected work history and interests, aptitude testing with commercial work evals and exploration of work with picture interest screeningEmphasized OT role in work evaluation and training programs and ability of OT to facilitate the clients return to competitive employment
(Lloyd, 1987) Men convicted of incest and sexual offences in a Canadian forensic MH hospitalUsed films and literature to develop empathy, to understand the impact of sexual violence and to learn appropriate relationship rolesFocused interventions could improve social role performances. Case studies showed process including showing films, discussing reactions, guest speakers, assigned readings and homework
(Lloyd, 1986–1987): 1 M with history of violence in a Canadian forensic psychiatric ward of a hospitalUsed 1:1 expressive art approach employing a scribble technique paired with free associations as both an evaluation and intervention processAsserts this psychoanalytically based use of art allowed client to freely verbally express painful material and helped him transition to more complex intervention phases of the program
Lloyd (1986): Clients in a Canadian hospital forensic mental health service unitEvaluation process included work history, a pictorial vocational interest screening, and use of commercial work sample evaluations.Describes comprehensive vocational evaluation process using a standardized approach. Identifies implications for designing individual and group programming.
(Lloyd, 1985): 6 minimum, medium and maximum security wards in a Canadian forensic MH hospitalEvaluation process included Lifestyle Performance Interview; BaFBE; Vocational assessments, living skill inventories and COTE ScaleTraces origin of an OT role in Canadian forensic psychiatry to 1965 and provides rationale for and detailed description of evaluation process used by OT in a forensic mental health service setting;
(Kromm et al., 1982): 1 F accused of murder on a forensic mental health unit in the U.S.Employed individualized art classes and suggests assessment process using a psychodynamic perspectiveOT evaluation and intervention processes contribute to diagnostic and prognostic determinations; OTs ability to develop therapeutic relationships provides useful insights
(Freeman, 1982): OT in forensic MH hospitals in UK; clients often are unemployed, unskilled and have multiple incarcerationsThe OT program included work, remedial, leisure, domestic, home management, community service, recreational, social and health education activities.OTs have a role in organizing and running ward programs in forensic units; used therapeutic community framework emphasizing trust, responsibility and caring. Reports some good outcomes with limited recidivism; more success when patients had skill rather than relationship deficits.
(Piper & le Grow, 1956): 4M and 2F adolescents exhibiting delinquency and in a U.S. state psychiatric hospital6 case scenarios to emphasize OT role in education by providing opportunities to build capacities for and engagement in learningA specific focus on occupations related to scholastic instruction and learning should be emphasized alongside therapeutic modalities focused on remediation, socialization, and exploration.
(Halliburton, 1943): Adjudicated males with psychiatric disorders, IQ ratings <72 and crimes ranging from theft to murder in a medium security U.S. prisonCase examples using printing, tying square-knot belts and formalized art instruction interventions. Goals to improve relationships, active listening, work and social skills. All assessed via clinical observation.Patience, personality and therapeutic use of self may be most important clinical tools. Observation, ability to read/respond to cues, ability to put biases related to criminal behavior or challenging personalities aside were key skills. Recommends persistence and repetition in therapy and maintaining positive relationships with guards.

Occupational Perspectives on Justice Based Practices (N=9)

AUTHOR/FOCUSSETTING/POPULATIONPRIMARY MESSAGE
(Sethi & Barney, 2018): Serial crime as occupation.Not focused on a specific setting, rather examines crime more broadlyProposes that concepts of occupational science may be useful to studying the form, function and meaning of criminal acts and particularly serial crime as occupation
(Muñoz et al., 2016b):Using occupation to meet needs of people in justice settingsVarious settings in the justice based system globallyOT practice in justice-based settings is limited. Practice may grow when OT generates outcome measures, tests interventions and develops an occupation based risk management tool.
(Crabtree et al., 2016a): Critically reflects on occupation and justice in a prison settingOT Community Living Skills Program for men incarcerated >10 years in a U.S. re-entry education facilityCritically reflects on the physical, social, and moral aspects of prison environments, the centrality of occupation, and the lived experience of occupational deprivation
(Aldrich & White, 2012): Reconsiders violence to examines crime, occupation and violenceNo specific setting; uses occupational science as a lens to examine crime, violence and criminology literatureViolence is a feature of some criminal occupations and advocates for OT to examine the environmental features and social determinants that create a context for violence as "occupational possibility"
(Farnworth & Muñoz; 2009): Occupational and rehabilitation perspective in justice institutionsA variety of justice-based settings and populations globallyEmphasizes need for occupational perspective to rehabilitation for people in justice-based settings especially for those with mental illnesses.
(Molineux, 1999): Explores occupational deprivation and enrichmentPrison settings and populations globallyArgues occupational deprivation is a common result of policies and operational structures in justice-based settings. Occupational enrichment may be a conceptual tool to introduce meaningful occupations in these challenging environments.
(Farnworth, 1998): Analyzes the concept of boredom and its link to human occupation.No specific setting; draws on time use research with young offendersArgues that causes and consequences of boredom need to be understood and perhaps reframed to better understand its impact on human occupation.
(Whiteford, 1997): Occupational deprivation and incarcerationReferences men in an assessment unit in a maximum security prison in AustraliaPrisons can foster sustained occupational deprivation; men cannot orient themselves temporally and lack access to tools that facilitate occupational engagement.
(Virikowic, 1993): Viewing delinquency through the Model of Human OccupationM & F juvenile populations in various detention settings from U.S. perspectiveOverviews biological, psychodynamic & familial influences on delinquency and views these youths needs thru a conceptual lens of MOHO.
Authors

Dr. Muñoz is Department Chair and Associate Professor, Department of Occupational Therapy, Duquesne University, Pittsburgh, Pennsylvania. Dr. Catalano is an independent researcher in Pittsburgh, Pennsylvania. Dr. Wang is a community-based occupational therapist at the East End Cooperative Ministry, Pittsburgh, Pennsylvania. Ms. Phillips is Digital Scholarship Librarian, University of Pittsburgh, Pittsburgh, Pennsylvania.

The authors have no relevant financial relationships to disclose.

Address correspondence to Jaime P. Muñoz, PhD, OTR/L, FAOTA, Department Chair and Associate Professor, Department of Occupational Therapy, Duquesne University, 600 Forbes Avenue, Room 211, Pittsburgh, PA 15282; e-mail: munoz@duq.edu.

Received: June 11, 2020
Accepted: August 31, 2020

10.3928/24761222-20200924-02

Sign up to receive

Journal E-contents