Transcript Occupation and Memory group

Occupational
Therapy Service
East and North CHCP
Community Elderly Mental
Health
Service
Influential Factors on Group
Development
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Recovering Ordinary Lives (The strategy for occuptaional
therapy in mental health services 2007 – 2017, A vision for the
next ten years)
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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
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Co-ordinated, integrated and fit for purpose : A Delivery
Framework for Adult Rehabilitation in Scotland
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”
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”
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”
Co-ordinated, integrated and fit for purpose
A 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”
Impact of Group Development on
OccupationalTherapy Service
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Occupational focus now more evident in all aspects
of service delivery with earlier referrals to service for
core skill assessment.
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Development of poster presentation
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Linking practice to SIGN and NICE guidelines and
Recovering Ordinary Lives plan.
Occupation and
Memory group
East and North CHCP
Aims and objectives
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The occupation and memory group is for clients
attending the Community mental health team with
mild cognitive impairment and early dementia.
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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
-
Theoretical basis and group
approach
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‘Model of Human Occupation’ (MOHO) (Keilhofner and
Forsyth 1997) provides the framework for group content and
evaluation
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‘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)
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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
The Group Process
Client referred to
Group by MDT
member
MOHOST completed
after 2nd group session
Qualitative evaluation
gathered and
MOHOST
repeated
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
Home visit conducted to address
any further Occupational performance
needs and to contribute to wider
multidisciplinary interventions
Referral and group focus

Clients have insight into their memory problems to
allow discussion and group problem solving
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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.
Exploration of
coping
strategies for
emotional
difficulties
Exploration of
the emotions
memory loss
emote
Education on
memory
and memory
problems
Discussions on
the impact of
memory impairment
on daily life
Focus of
Group
sessions
Education on
memory aids
and occupational
supports
Goal setting to
maintain current
occupational
performance
Teach practical
problems
solving skills
and abilities
Evaluation methods
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Qualitative questionnaire;
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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?
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Mainly closed questions with room for further
comments
Flexible approach adopted to meet clients
needs.
Qualitative feedback
‘I feel better
than I did’
‘Great meeting
people with similar
problems’
‘Very interesting….i
now understand
more’
‘’I’m reading
more and
writing letters
again’
‘My husband would
come, but I’d rather
come myself’
‘Before the
group I would
sit down and
do nothing’
‘I found the content
of the group very
good and feel I
understand some
things better’
MOHOST evaluation
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‘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
Future Practice Development
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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.
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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.
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Promote group to wider stakeholders to encourage early
referral to the occupational therapy service.
References:
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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
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