Occupational Therapy Service

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Occupational Therapy Service

• East and North CHCPCommunity Elderly Mental
  Health
• Service

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Influential Factors on Group Development

• Recovering Ordinary Lives (The strategy for
  occuptaional therapy in mental health services
  2007 2017, A vision for the next ten years)
• Scottish Perspective on Nice Public Health
  Guidance 16 Dementia The Nice-scie guideline on
  supporting people with dementia and their carers
  in health and social care
• Co-ordinated, integrated and fit for purpose A
  Delivery Framework for Adult Rehabilitation in
  Scotland

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Recovering Ordinary Lives

• Occupation is central to the existence of
  individuals, groups and communities. It is the
  mechanism by which people maintain themselves in
  the world and realise their potentials (Wilcock
  1998)
• Older People need occupations and activities
  that support their ability to be independent and
  give them a valued role in
• society

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Scottish Perspective on NICE Public Health
Guidance 16

• Occupational therapy interventions and physical
  activity interventions to promote the mental
  wellbeing of older people in primary care and
  residential care
• Identifies occupational therapy
  interventions will
• Provide individual/group interventions to
  encourage
• older people to identify, construct,rehearse
  and carry
• out daily routines and activities that help
  to maintain or
• improve their health and wellbeing

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Scottish Perspective on NICE Public Health
Guidance 16

• Occupational therapy sessions should
• improve old people as experts and partners in
  maintaining or improving their quality of life
• pay particular attention to communication,
  physical access..and informality to encourage
  the exchange of ideas and foster peer support
• provide practical solutions to problem areas

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Co-ordinated, integrated and fit for purposeA
Delivery Framework for Adult Rehabilition in
Scotland

• Framework adopts the Kings Fund definition for
  rehabilitation as
• A process aiming to restore personal autonomy to
  those aspects of daily life considered most
  relevant by patients or service users, and their
  family carers

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Impact of Group Development on OccupationalTherapy
Service

• Occupational focus now more evident in all
  aspects of service delivery with earlier
  referrals to service for core skill assessment.
• Development of poster presentation
• Linking practice to SIGN and NICE guidelines and
  Recovering Ordinary Lives plan.

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Occupation and Memory group

• East and North CHCP

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Aims and objectives

• The occupation and memory group is for clients
  attending the Community mental health team with
  mild cognitive impairment and early dementia.
• The aim of the group is to limit the occupational
  impact of cognitive impairment and dementia
  through
• promoting independence and engagement in
  purposeful activity.
• To provide the opportunity for ongoing assessment
  and peer review
• Encourage individuals in goal setting and
  activity planning

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Theoretical basis and group approach

• Model of Human Occupation (MOHO) (Keilhofner
  and Forsyth 1997) provides the framework for
  group content and evaluation
• The focus of the model is on the motivation for
  occupation the patterning of occupational
  behaviour into routines and lifestyles the
  nature of skilled performance and the influence
  of environment on occupational behaviour(Keilhofn
  er Forsyth 1997)
• A therapeutic group approach was adopted to
  provide
• - a safe supportive environment
• - to allow exploration of the functional
  
• impact of memory problems
• Carers involvement encouraged but not part of the
  group

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The Group Process
Client referred to Group by MDT member
Home visit conducted to assess clients suitability
for group. Carer involvement encouraged at this
stage
Clients attend seven weekly sessions lasting
1hr 30 mins approx
MOHOST completed after 2nd group session
Home visit conducted to address any further
Occupational performance needs and to contribute
to wider multidisciplinary interventions
Qualitative evaluation gathered
and MOHOST repeated
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Referral and group focus

• Clients have insight into their memory problems
  to allow discussion and group problem solving
• Our MDT have strong educational focus to
  interventions.
• Our occupation and memory group focus is on
  occupational engagement. We aim to enable clients
  to keep living their lives, to empower them in
  addressing their problems in terms of day to day
  activity.

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Evaluation methods

• Qualitative questionnaire
• How would you rate the venue?
• Since attending the group have your activity
  levels improved?
• How did you rate the hand outs?
• Would you like your carer involved?
• Have you made any changes to your habits/routine?
• Mainly closed questions with room for further
  comments
• Flexible approach adopted to meet clients needs.

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Qualitative feedback
Before the group I would sit down and do nothing
I feel better than I did
Very interesting.i now understand more
Im reading more and writing letters again
I found the content of the group very good and
feel I understand some things better
Great meeting people with similar problems
My husband would come, but Id rather come
myself
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MOHOST evaluation

• Model of human occupation screening tool
  (MOHOST) is a standardised occupational therapy
  outcome measure
• MOHOST is split in to six sections which allows
  24 skills items related to occupational
  participation to be rated.
• The groups MOHOST detected positive change in
• -Motivation for occupation
• -Appraisal of ability
• -Occupational choices
• -Communication and interactions skills

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Future Practice Development

• To provide carer sessions in tandem with memory
  and occupation group sessions but specifically
  targetting carer role in supporting occupational
  performance techniques discussed. Promoting
  enablement and maintenance in occupational roles
  and routine.
• Audit use of Assessment of Motor Process Skills
  and the impact this may have on defining specific
  occupational compensatory techniques with
  individuals referred to the occupation and memory
  group.
• Promote group to wider stakeholders to encourage
  early referral to the occupational therapy
  service.

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References

• Zarit S (2004) Memory ClubA group Intervention
  for people with Early stage Dementia and their
  Care Partners. The Gerontologist 44(2)262-269
• Clare L (1999) Memory rehabilitation in early
  dementia. The Journal of Dementia care Research
  Focus.Nov/Dec 33-38
• Clare L et al (2000) Intervening with Everyday
  Memory Problems in Dementia of Alzheimer Type An
  Errorless Learning Approach. Journal of Clinical
  and Experimental Neuropsychology.22 (1)132-146.
• Graff et al (2006) Community based occupational
  therapy for patients with dementia and their care
  givers randomised controlled trial. British
  Medical Journal. Dec 333 1196
• Kielhofner G Forsyth K (1997) The Model of
  Human Occupation an overview of current
  concepts. The British Journal of
  OccupationTtherapy.60 (3)103-110.
• Parkinson S et al (2004) A Users Manual for the
  Model of Human Occupation Screening Tool.
  University of Illinois at Chicago.
• College of Occupational Therapists 2006
  Recovering Ordinary Lives the strategy for
  occupational therapy in mental health services
  2007-2017 College of occupational therapists
  London
• Scottish Executive (2007) Co-ordinated,
  integrated and fit for purpose A delivery
  Framework for Adult rehabilitation in Scotland,
  Edinburgh Scottish executive
• Scottish government Nhs Scotland (2009) Scottish
  perspective on Nice public health guidance 16
  Occupational therapy interventions and physical
  activity interventions to promote the mental
  wellbeing of older people in primary care and
  residential care