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Occupational Therapy Assessment and Planning

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Josephine George

on 15 December 2015

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Transcript of Occupational Therapy Assessment and Planning

A Case Study Rationale for Occupational Therapy Assessment for Intervention Planning
Jo George

Occupational Therapy (OT) Student
Community Mental Health Team
Gary Marshall
57 year old black man, husband, and former financial service worker who has Moderate Clinical Depression.
Well-being
Top Down or Bottom Up?
"Identifies clients with occupational dysfunction but not necessarily needs or disease"
- Weinstock-Zlotnick and Hinojosa 2004, p.597
Clinical Reasoning
Scientific, Narrative
Model of Human Occupation (MOHO)
Habituation
Performance Capacity
Volition
Environment
Employee
Husband
Pace of life
Sleep disrupted
Mentally capable
57 years old
Mental Stimulation
Workplace
Beach town
Access to social network
Relationship with wife, Isabel
Frame of Reference
Client Centred
Biomechanical
Developmental
Cognitive
Behavioural
Social
Psycho-
Analyical
Compensatory
Frames of Reference (FoR)
What to assess?
Why is this important?
Gaps in knowledge:
Habituation - routine, Activities of Daily Living
(ADL), leisure activities
Performance Capacity - physical components, mental capacity now, subjective experience
Volition - other values, culture, interests, personal causation
Environment - accommodation, current social environment
Client Centred FoR: Contextual Congruence
Occupational Performance (OP) issues
Consider second FoR
Fulfill remit of service: help Gary become independent
Initial Assessment
Considerations in choosing initial assessment:
Needs at this point in therapy
Required Information
Flexible method of information gathering to enable Gary to access assessment
What meets these requirements?
- Model Of Human Occupation Screening Tool (MOHOST)
What is the MOHOST?
What information will it gain?
Strengths: flexibility, reliable, accessible, informal
What will it be like?
Informal Interview
Enabling making choices
FAIR
Combination of methods


What do I want to know more about, and why?
Choosing an assessment tool which is most appropriate and accessible for Gary...
How can I understand the problems Gary identified in the referral in the context of the FoRs and model?
Occupational Mapping
What will it be like?
Influences on goal setting:
Model
FoRs
Facilitation
Long and short term goals


References
?
Questions
Gary's experience
Gary's Values and Interests
Effect of depression on other mental componants
Risk assessment
Beck's Depression Inventory
Occupational Self Assessment (OSA) or Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS)?
What will it be like?
Volitional Questionaire
Occupational Mapping
How will this be useful?
Goal setting
Intervention planning
Occupation: role, tasks and performance
Person: values, interests, goals, performance components
Context: temporal, social, cultural, physical
Assessment Format: informal interview and observation
Goal Setting
Format of goal setting:
SMART - Specific, Measurable, Activity-based, Realistic, Timed
Why SMART goals?

Enablement


What will this stage be like?
Improved routine - better sleep
Participation in new activities - decreased irritation, increased self-esteem
Re-framing experiences - improved adaptability,
greater capacity for independence
Baron, K., Kielhofner, G., Iyenger, A., Goldhammer, V. and Wolenski, J., 2006. Occupational Self Assessment [online]. Illinois: MOHO Clearinghouse. Available from:
http://www.uic.edu/depts/moho/assess/osa.html
[Acessed 17th March 2014].

Beck, A., (1976). Cognitive Therapy and The Emotional Disorders. New York: International Universities Press.

Beck AT, Ward CH, Mendelssohn MJ, Erbaugh J. An inventory for measuring depression Archives of General Psychiatry 1961;4:561-571.

College of Occupational Therapists, 2011. Professional Standards for Occupational Therapy Practice [online]. London: College of Occupational Therapy. Available from:
http://www.cot.co.uk/standards-ethics/consent
[Accessed 17th March 2014].

Duncan, E. A. S., 2006. Foundations For Practice In Occupational Therapy. 4th edition. London: Elsevier.

Forsyth, K., Deshpande, S., Kielhofner, G., Henriksson, C., Haglund, L., Olson, L., Skinner, S. and Kulkarni, S., 2005. The Occupational Circumstances Assessment Interview and Rating Scale [online]. Illinois: MOHO Clearinghouse. Available from:
http://www.uic.edu/depts/moho/assess/ocairs.html
[Acessed 17th March 2014].

Gloria de las Heras, C., Geist, R., Kielhofner, G. and Li, Y., 2007. The Volitional Questionnaire [online]. Illinois: MOHO Clearinghouse. Available from:
http://www.uic.edu/depts/moho/assess/vq.html
[Acessed 17th March 2014].

Kielhofner, G., 2007. Model Of Human Occupation Theory and Application. 4th edition. US: Lippincott Williams & Wilkins.

NHS Choices, 2014. Mental Health Services Available [online]. London: Gov.uk. Available from:
http://www.nhs.uk/NHSEngland/AboutNHSservices/mentalhealthservices/Pages/Availableservices.aspx
[Accessed 17th March 2014].

Parkinson, S., Forsyth, K. and Kielhofner, G., 2006. Model of human occupation screening tool [online]. Illinois: MOHO Clearinghouse. Available from:
http://www.uic.edu/depts/moho/assess/mohost.html
[Acessed 17th March 2014].

Royal College of Psychiatists, 2014. Mental health services/ teams in the community [online]. London: Royal College of Psychiatrists. Available from:
http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/mentalhealthinthecommunity.aspx
[Acessed 17th March 2014].

Weinstock-Zlotnick, G. And Hinojosa, J., 2004. Bottom-up or top-down evaluation: is one better than the other? American Journal of Occupational Therapy, 58(5), 594-99.

World Health Organisation, 1993. ICD-10. World Health Organisation.
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