Training novices to make expert, occupationally focused, community mental health referral decisions

Introduction: Currently, British health policy requires services to be prioritised according to an individual's level of need. This is particularly necessary for community mental health services, where referral demand far exceeds service availability. Purpose: The purpose of this study was to use expert occupational therapists' referral priorltisation policies, derived from judgement analysis, to train novices in the skill of referral priorltisation. Method: The therapists' policies chosen were those that supported the occupationally focused practice advocated by the profession. Thirty-seven pre-registration students were asked to prioritise a set of referrals, before and after being trained with graphical and descriptive representations of these experts' policies. Findings: Pre-training, the students overvalued the client's history of violence and undervalued the reason for referral and the client's diagnosis, as compared with the experts. Post-training, the students' policies were better matched to those of the experts. The effect of training was demonstrated through several measures: more accurate prioritisation scores when matched with expert ratings on the same referrals, improved consistency on repeat referrals and higher group agreement. Conclusion: Decision training may be useful in promoting the type of service that aims to target clients' occupational needs in the field of community mental health.