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model-of-human-occ-and-prac-dev-LLL event-London Region-heasman.pdf

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model-of-human-occ-and-prac-dev-LLL event-London Region-heasman.pdf

  1. 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 thatSouth 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, 2006Why focus on one model? Why MOHO?Shared concepts & language > • Most evidence-based occupationalclarity & consistency of communication therapy modelAllows outcomes to be gathered in a • Extensive battery of standardisedconsistent manner > foundation for audit / assessment toolsresearch • Volition: importance of motivationFacilitates more efficient practice & engagement in mental healthdevelopment / training 1
  2. 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 2
  3. 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 • CAMHSOngoing 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 3
  4. 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 routineBenefits: 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 & accountabilityOCAIRS 130Worker Role Interview 6 • explore reasons why staff having difficultyACIS (Communication-interaction) 4 • reward high achieversOPHI-II (Life history) 2Volitional Questionnaire 2Work Environment Impact Scale 1TOTAL 503 4
  5. 5. Pre-Post Outcome measurement Lessons Learned • Changing OT practice is not easy! Most Most Max • Need strong infrastructure & practice developmentService 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 structuresJane X MOHOST 04/01/08 18/01/08 62 80 96 • Monitoring & Accountability • Work closely & proactively with IMTJohn Y OCAIRS 27/11/07 30/04/08 15 33 48 5