Occupational Therapy Service

1. Occupational Therapy Service East and North CHCPCommunity Elderly Mental Health Service

2. 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

3. 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”

4. 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”

5. 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”

6. 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”

7. 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.

8. Occupation and Memory group East and North CHCP

9. 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

10. 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’(Keilhofner & 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

11. 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 MOHOST completed after 2nd group session Clients attend seven weekly sessions lasting 1hr 30 mins approx Home visit conducted to address any further Occupational performance needs and to contribute to wider multidisciplinary interventions Qualitative evaluation gathered and MOHOST repeated

12. 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.

14. 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.

15. Qualitative feedback ‘Before the group I would sit down and do nothing’ ‘I feel better than I did’ ‘Very interesting….i now understand more’ ‘’I’m 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 I’d rather come myself’

16. 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

17. 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.

18. References: • Zarit S (2004) Memory Club:A 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 • Scottishgovernment 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