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Laura Murphy
Lead OT
Horton Rehabilitation Services
Ascot Villa
Background to the VdTMoCA
Background to the VdTMoCA
progression and regression through the levels.
(Developmental frame of reference)
VOLITION
1 - Motivation
2 - Action
The VdTMoCA enables the team to:
Motivation Action
• Reflects mere existence
• No outward signs of volition
• No evidence of initiative or effort
• Action is haphazard, automatic, no observable purpose,
pre-destructive
• Fleeting contact with materials / objects
• Largely unaware of others, lack awareness of themselves
as separate from environment
• No evidence of awareness or control of bodily functions
• Large care giving component required – largely
dependent
• Typical of a patient in a coma, or in a catatonic state
• Poor awareness of bodily functions, needs assistance to manage personal care.
• Lack community survival skills.
• Initially focussed internally, but then becomes aware of people as go through the level.
• Starts to interact with environment, but involved in the
process of ‘doing’; no end product. Attention span brief.
• Lack initiative, effort erratic and rarely seen.
• Clients on this level are usually found in chronic
institutions, eg institutionalised long-term
patients, or very unwell.
• Involved in material and tools, but with poor handling and composite concept
• Poor end product - regular supervision needed
• Clients often vulnerable – little awareness of safety aspects eg crossing road, hobs
• Routine not structured – needs external support
• Personal care, beginning stage needs lots of support, by end of stage clients becoming interested in grooming
• Brief, egocentric contacts with people - eg will chat to others that smoke if chance of getting a cigarette
• Start to become aware of norms
• High levels of anxiety, and low self-esteem
Difficulty initiating tasks and sustaining effort,
able to complete tasks but needs prompting
• Comprehensive task concept
• Volition directed to: completing products, participating with others, establishing norms and expectations
• Starts testing norms
• Personal care and domestic tasks generally consolidated
• Working things out cognitively & emotionally – often quiet
• Function well when things are going well, but tend to
struggle when stressed
• Community skills limited to familiar situations and routines
Each level covers a wide range of skills and occupational behaviours. In order to distinguish whether the individual is at the beginning, middle or end of the level, the following phrases are used:
Who is this person???
The individual
The MDT
1: Observe and
evaluate client’s
current skills
and abilities in
four areas
2. Establish the
client’s level and
phase of creative ability in each of the four areas
Personal Management: ability to care for self: washing; dressing; caring for
personal belongings; grooming; toileting; money management; road safety etc.
Social Ability: - ability to communicate and interact with familiar and unfamiliar people: form acquaintances; make friends; develop relationships; comply with social norms.
Work Ability: - ability to be productive: initiate, sustain and conclude tasks;
develop new ideas; manage self, workload and resources; work effectively;
evaluate self and product through realistic judgement.
Constructive Use of Free Time: - ability to use free time in a balanced, constructive, recreational and socially acceptable manner to obtain pleasure and to de-stress.
Creative Participation Assessment (CPA) Tool
Overall level of Self Presentation Ttransitional
The degree of each component will differ across the levels
Task Concept
1: Understanding the task as a whole
2: Identifying with the task
3: Task selection
6: Task evaluation and satisfaction
5: Task completion
4: Task execution
2: ELEMENTARY (SD)
Still physical but incorporates function:
- It burns
- It's a drink for when
thristy
1: BASIC (Tone)
Related to sensory processes:
- Brown
Hot
- Wet
- Teabag is squidgy
4: ABSTRACT (PP...)
All concepts:
- Social
- Break time
- Comfort/distraction
- Pleasure, politeness
- Understands stages of making tea
3: COMPOSITE (SP)
Categorising:
- Knows difference between loose leaf and teabags
- Knows different types of tea e.g. earl grey, herbal, iced tea
A Cup of Tea
• exertion of one's self in activity participation
• putting one's self into activity participation
• actively applying one's resources i.e., motivation and mental and/or physical functions, skills and/
or abilities, in active engagement with activity.
Not trying (no effort)
Trying - trying hard (effort)
Trying hard – trying hardest (maximum effort)
To get someone to apply effort there needs to be
CHALLENGE
Self Presentation
TDP
Aims
Implementing the VdTMoCA as the MDT model on Ascot Villa
2017
With Dr Wendy Sherwood
Key Aim:
Improving the service’s ability to better understa...
Team understanding the levels of creative ability
2 cases chosen by the MDT
Key Aim:
Improving the service’s ability to better understand and meet service users’ needs
Interventions
Team understanding the levels
Laura has completed initial ‘training’ sessions with Therapies staff (Music Therapist, Occupational Therapists, Art Therapist, Psychologists).
Laura refers to the model in MDT meetings (documents and discussions) including ward rounds, CPAs and other reviews.
VdTMoCA Manual created for staff
Model introduced into monthly reflective practice by Laura, providing a structure for discussion and a way of supporting understanding of service users.
Team understanding the levels
Activity Co-ordinator (AC) completed Level 1 training in October 2017 and is supported and supervised by Laura in implementing principles of the model
Ward staff (Nurses, Support Workers, Ward Manager and Deputies, Consultant and Specialty Doctor) trained in the model in January 2017
2 Cases chosen by the MDT
Note writing: Laura includes VdTMoCA language and concepts in documentation shared with the MDT including JADE progress notes, ward round documents, monthly CCG updates.
Activity Co-ordinator (AC) completed Level 1 training in October 2017 and is supported and supervised by Laura in implementing principles of the model
Activity Participation Outcome Measure (APOM) and Assessment Summary and Intervention Plan completed by Laura with MDT input and support from Wendy. Key Nurses involved in the process
2 Cases chosen by the MDT
Assessment summaries and treatment guidance shared by Laura in ward rounds and CPAs which were attended by Care Coordinators and CCG representatives. Model positively received.