occupational therapists’ use of occupation-focused practice in secure hospitals practice guideline

www.COT.org.ukwww.COT.org.uk

Occupational therapists’ use of occupation-focused practice in

secure hospitalsPractice guideline

College of Occupational Therapists

Specialist Section – Mental Health, Forensic Forum

COT Implementation toolkit/CPD Session© 2012 College of Occupational Therapists.This PowerPoint may be copied and adapted for non-commercial use

www.COT.org.uk

Key objective of guideline

To provide specific recommendations to support the use of occupation-focused occupational therapy in secure hospitals.

The guideline is relevant to high, medium and secure hospitals.

2COT Implementation toolkit/CPD Session© 2012 College of Occupational Therapists

www.COT.org.uk

Recommendation areas

Model of Human Occupation Framework:

• Volition• Habituation• Performance capacity• Environmental considerations


www.COT.org.uk

Methodology

4

1. Guideline development group established

2. Guideline scope defined involving stakeholders

5. Critically appraise articles

6. Development of practice guideline recommendations

3. Literature search4. Screen findings

7. Peer review, stakeholder and service user consultation

8. Final draft approved by COT Practice Publications Group

9. Published byCOT 2012

COT Implementation toolkit/CPD Session© 2012 College of Occupational Therapists.

www.COT.org.uk

Evidence-based recommendations

Recommendations are based on the evidence available within 34 critically appraised papers.

Each recommendation is assigned:• A strength scoring 1 or 2 (Strong or Conditional)

• A quality grading A, B, C or D (High, Moderate, Low or Very Low)


www.COT.org.uk

VolitionVolition

1. It is recommended that occupational therapists always take into account the gender specific needs of patients with whom they are working.

(Baker and McKay 2001, C)

1 C

2. It is recommended that occupational therapists consider the occupational life history of patients, including that at the time of the index offence, and its influences on occupational performance, life satisfaction and criminogenic lifestyle.

(Lindstedt et al 2005, B)

1 B

3. It is recommended that occupational therapists establish as part of their assessment, patients’ perspectives of their occupational performance and social participation, and work with those perceptions in planning care.

(Lindstedt et al 2004, B)

1 B

6

www.COT.org.uk

Volition

4. It is recommended that occupational therapists work collaboratively with patients in identifying and planning their care pathways. (Clarke 2002, C)

1 C

5. It is recommended that occupational therapists recognise the specific intrinsic value of occupation to individual patients. (Craik et al 2010, C)

1 C

6. It is recommended that occupational therapists facilitate meaningful occupational choices for patients. (Craik et al 2010, C; Cronin-Davies 2010, C; Mason and Adler 2012, C; Morris 2012, C; O’Connell et al 2010, D; Stewart and Craik 2007, C)

1 C

7. It is recommended that occupational therapists ascertain patients’ aspirations towards paid employment at the earliest opportunity, and during rehabilitation. (McQueen 2011, C)

1 C

7

www.COT.org.uk

Habituation8. It is recommended that occupational therapists consider the patients’ roles, (past, present and future) within treatment planning and interventions. (Schindler 2005, C)

1 C

9. It is recommended that occupational therapy facilitates a range of interventions that enable patients to engage in structured and constructive use of time throughout the week, including weekends and evenings. (Bacon et al 2012, D; Castro et al 2002, C; Farnworth et al 2004, C; Jacques et al 2010, D; Stewart and Craik 2007, C)

1 C

Habituation

8

www.COT.org.uk

Performance capacity 10. It is recommended that occupational therapists routinely used standardised outcome measures to assess and demonstrate patients’ progress. (Green et al 2011, C; Clarke 2003, D; Fitzgerald 2001, C; McQueen 2001, C)

1 C

11. It is recommended that occupational therapists consider supported employment or prevocational training as part of occupation-based intervention opportunities for patients. (Garner 1995, D; McQueen 2011, C; Smith et al 2010, D)

1 C

12. It is recommended that occupational therapists consider the use of healthy living programmes and exercise as activity to benefit health and wellbeing. (Bacon et al 2012, D; McQueen 2011, C; Prebble et al 2011, D; Tetlie et al 2008, C; Tetlie et al 2009, C; Teychenne et al 2010, C)

1 C

13. It is suggested that occupational therapists include social inclusion programmes as part of their intervention to improve occupational functioning. (Fitzgerald 2011, C)

2 C

Performance capacity

9

www.COT.org.uk

Environmental considerations14. It is recommended that occupational therapists fully value the therapeutic use of self as being integral to the positive engagement of patients in occupations. (Mason and Adler 2012, C; Tetlie et al 2009, C)

1 C

15. It is recommended that occupational therapists ensure that risk assessment is a dynamic process, in which judgements are made on an on-going basis in collaboration with patients and members of the multidisciplinary team. (Cordingley and Ryan 2009, B)

1 C

16. It is suggested that occupational therapists recognise the role and contribution of carers in the recovery of patients. (Absalom et al 2010, C; Fitzgerald et al 2012, D)

2 C

Environmental considerations

10

www.COT.org.uk

Environmental considerations

17. It is recommended that occupational therapists consider the impact of the environment on quality of life and occupational engagement. (Craik et al 2010, C; Fitzgerald et al 2011, D; Long et al 2008, C; Long et al 2011, C; Morris 2012, C)

1 C

18. It is suggested that occupational therapists liaise with a range of community services to facilitate replication of patients’ pro-social behaviours developed during an inpatient stay. (Elbogen et al 2011, D; Lin et al 2009, C; Lindstedt et al 2011, C)

2 C

19. It is recommended that occupational therapists demonstrate their competencies (skills and training) to facilitate identified therapeutic groups, enhancing the confidence and participation of patients. (Mason and Adler 2012, C)

1 C

20. It is recommended that occupational therapists articulate, to patients and the multidisciplinary team, their role and the contribution of occupational therapy to the overall treatment performance. (Cronin-Davis 2010, C)

1 C

11

www.COT.org.uk

Impact of practice guideline for you

• Challenges / affirms your current practice.• Informs your practice.• Provides evidence to support your practice

(completion of Audit Form).• Provides a vehicle for you to justify your

practice.


www.COT.org.uk

Impact of practice guideline for managers

• Provides evidence of the need for occupation-focused occupational therapy for adults in secure hospitals.

• Provides a structure to audit the work of occupational therapists within the service to improve service quality.

• Provides a vehicle for justifying service provision.


www.COT.org.uk

Impact of practice guideline for patients

• In being adopted by services and occupational therapists, the guideline should improve the consistency and quality of intervention for users of services.

• Gives assurance that practitioners use the available evidence to support interventions.


www.COT.org.uk

Impact of practice guideline for commissioners

• Articulates the need for occupation-focused occupational therapy interventions within secure hospital services.

• Can help educate commissioners to identify learning needs for the workforce.

• Associated audit form provides a mechanism to review service delivery in accordance with the evidence.


www.COT.org.uk

Help from COT/BAOT• Link up with your BAOT networks to gain advice and

support. Find out through your BAOT regional group or the COT Specialist Section you belong to whether they have resources that can help you.

• iLOD is designed to be a one-stop shop for all your CPD needs and it was developed to make it simple for BAOT members to meet the HCPC’s baseline standards for CPD.If you are having difficulties or need support contact

[email protected]


occupational therapists’ use of occupation-focused practice in secure hospitals practice guideline

Documents