1. Why Practice Development?:
The Model of Human Occupation &
National Drivers
Practice Development
• Evidence-based practice
David Heasman • Clinical effectiveness &
added value
Lead Occupational Therapist, Practice Development • ‘……use outcome measures that
South West London & St Georges Mental Health NHS Trust give clear evidence that
occupational therapy has made a
difference to people’s occupations’.
david.heasman@swlstg-tr.nhs.uk
COT, 2006
Why focus on one model? Why MOHO?
Shared concepts & language > • Most evidence-based occupational
clarity & consistency of communication therapy model
Allows outcomes to be gathered in a • Extensive battery of standardised
consistent manner > foundation for audit / assessment tools
research
• Volition: importance of motivation
Facilitates more efficient practice & engagement in mental health
development / training
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2. MOHO Practice Development:
Barriers to using MOHO
Infrastructure
Lack of knowledge / confidence in applying the
model • Purchased MOHO assessment tools / manuals
Lack of motivation / interest
• Appointed Practice Development Occupational
Therapist
Lack of time
Difficulty accessing assessment tools etc
Generic working
MOHO Practice Development:
Infrastructure 2: Information Technology
• 2005: Introduction of e-MOHO
software package
• 2007: Introduction of RiO (ECR):
7 MOHO assessments built in
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3. MOHO Training Workshops: MOHO Practice Development
Clinical Forums The Process 2: Workshops
• Adult Kingston
• Adult Merton • Structure: 6 x 1.5 hrs or 3 x 3hrs
• Adult Richmond
• Adult Sutton • Content
• Adult Wandsworth MOHO theory
• Older people R&W
Assessment – selecting and using tools appropriately
• Older People K,M&S
• Rehabilitation
Clinical reasoning & case formulation
• Forensic Intervention
• Eating Disorders Documentation
• PLD Evaluation: outcome measurement
• CAMHS
Ongoing support mechanisms Pan London Collaboration
• Clinical Forums • Established Track record of Pan London
collaboration within mental
• UK Centre for Outcomes Research & Evaluation health occupational therapy
(UKCORE): Infrastructure; Assessment; Case
Formulation; Intervention
• RiO installed on 7/9 Mental Health Trusts –
opportunities for collaboration
• Clinical Forum Leads Group
o dynamic & proactive working group focused on
identifying challenges to & strategies for MOHO • Latest development: network to collaborate
implementation on developing MOHO-based Care
o forum for advice & support in leadership roles Pathways
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4. Care Pathways MOHO Based Care Pathways
• ‘plans of care that give detailed guidance for each stage in the
care of a patient‘ (Riley 1998).
• Means of embedding MOHO into routine
Benefits: practice
• Means of implementing clinical guidelines & evidence-based
practice
• Process
• Provide explicit guidance on what service users and MDT can
expect from their occupational therapist. Map current practice
• Provide clear guidelines for therapists Identify areas for improvement / added value of
introducing MOHO
• Promote efficient use of resources & clarify occupational Introduce ‘Gloucester’ Pathway template
therapy’s added value
Introduce Pan London versions & adapt for local use
• Means of consistently monitoring and improving clinical
outcomes and experience of the service user
Update on Progress:
Evaluation / Update on Progress
No. of completed MOHO assessments
Assessment No. completed
6.07 – 9.08 Ambivalence (Strategies):
MOHOST 358 • monitoring & accountability
OCAIRS 130
Worker Role Interview 6 • explore reasons why staff having difficulty
ACIS (Communication-interaction) 4
• reward high achievers
OPHI-II (Life history) 2
Volitional Questionnaire 2
Work Environment Impact Scale 1
TOTAL 503
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5. Pre-Post Outcome measurement Lessons Learned
• Changing OT practice is not easy!
Most Most Max • Need strong infrastructure & practice development
Service Assess’t Baseline Recent Baseline Recent Poss. strategy with clear leadership.
User Name Date Date Score Score Score
• Training: Workshops in MOHO application
• Ongoing support structures
Jane X MOHOST 04/01/08 18/01/08 62 80 96
• Monitoring & Accountability
• Work closely & proactively with IMT
John Y OCAIRS 27/11/07 30/04/08 15 33 48
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