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