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This is the framework that we use as Occupational Therapist’s to guide our thinking with a client upon receiving a referral, and as such in my experience it feels like perfect sense to the therapeutic process, mirroring the way in which I suspect my own reasoning works. Furthermore, whilst this is not unique to Occupational Therapy, the process is a form of problem solving that is shared amongst many health professionals, of which through its use, key information can gathered and as a result, issues can be prioritised to then develop these into goals to shape client interventions (Duncan, 2011).  This is a continual process that can go round and round in circles as we seek to find the appropriate way to support the client, also that it may well the case that the client is discharged, although for them to experience a physical/mental relapse in their condition, then this Occupational Process may well commence all over again.

The significance of this whenever we are thinking about or participate in the occupational therapy process, we are engaged in that professional reasoning, of which it is not a question of whether we’re doing it, only a question of how well (Boyt Schell, 2009). Of which in my opinion, I perceive this statement that whilst the Occupational Therapy process is intuitively a part of professional reasoning, it is then through practice experience, reflection, and the further addition of Occupational tools such as theoretical models/outcome measures, activity analysis/grading and adapting, can we then really this unpack to then effectively use it in practice.

(The whole of the process from referral through to the client being discharged is the Occupational Therapy intervention)

  1. Referral or reason for Occupational therapy:
  • Appropriateness of the referral: To ask myself, is this an appropriate referral.
  • Validity: upon face value, what would this client benefit from Occupational Therapy

(Working with the client, respecting their views/wishes, but also that they are the expert of how a condition/disruption is affecting them.)

  1. Gathering information:
  • Talk to the referrer: if there’s a concern or some issues as to the appropriateness of the referral, if so to ask the referrer for more information, client background/risks or concerns (to the client or self)/safeguarding issues if any, and how they perceive the client would from the support of an Occupational Therapist.
  • Available information/others: read the existing client notes if any, talk to other health professional/services that have been involved with the client.
  • Research: the client’s condition to get a better insight as to what they might be experiencing, also if applicable some of local/national policies in relation to support this client group.
  • Contacting the client: when arranging an appointment for initial assessment, information could also be gathered as a result of talking to them, also if they are unable then a family member/carer, this may give an indication of some of the issues, as for example: imbalance with sustaining a routine/energy management issues (sleeping during day/getting up at lunchtime, or social issues as the client has difficulties speaking/stutter (anxiety)/forming sentences.
  • Also Occupational Therapy ‘best practice’, with this client group in relation to their circumstances, such as books, guidance materials, and journal articles.

At this point having gathered the information: we could also start to use the Occupational Therapy theoretical models/tools, to begin to identify the ‘barriers and enablers’, from to devise an occupational identity for this client, where there may be areas of imbalance, and to consider where the focus for the initial assessment may reside.

  1. Initial assessment:
  • Observation:

The client’s appearance e.g.: if reported to be usually well-presented.

How they present themselves e.g.: nervous/anxiety.

Environment: if it is a home visit there living conditions, but also even it’s in a more formal setting/outside client’s home how they respond to it.

Physical: how does the client react with their environment e.g. difficulty with stairs/cognitively such as walking into furniture?

Respond to others: tension with family members within their residence/reacting to other people.

  • Talking/the client’s narrative, as they are the expert of their own condition talk to them to get an insight into them as a person, occupationally the things they like to do and would like to, the journey that has led them up to this point.

Also the client’s concerns, which may be very different from the reason for referral, where do they feel the problems, are which need to be addressed. As result to build rapport, so that the client begins to trust you, and their needs can be identified, but also more importantly that with their cooperation, not of these plans/goal cannot be achieved.

Client’s family/carer, talking to them about their concerns, (if appropriate/respecting the clients’ wishes if asked not to be involved) also that it may be that their involvement would be required to implement any plans effectively.

  • Occupational Therapy theoretical models/outcome measures/departmental initial assessment forms, the use of these to fill out with the client if applicable, but also to considered these when talking to the client, and shape the structure of the intervention in order to identify concerns/needs.
  1. Reason for intervention/needs identification/problem formulation (As a result of initial assessment)
  • Client’s needs identified, keys concerns that within the client’s/family/carer’s own opinion needs to be addressed.
  • Further information gathering required, either services/best practice to better understand the needs of the client, also talking to other health professionals currently involved/past with the client, or discussing this further with the referrer.
  • Client inappropriate for Occupational Therapy/discharge, it may be at this point, that upon talking to the client, that they are either inappropriate for Occupational Therapy or not ready and for us to discharge/feedback to the referrer.
  1. Goal setting/Action planning (activity analysis/grading and adapting)
  • Goal setting, having identified the client’s needs, to then break these down into achievable goals with a timescale, that it may be that a client is unable to achieve this at their present capacity, then goals can be devised with this in mind to build confidence/engagement levels and as a result build upon this.

Activity analysis, in order to better understand those identified occupations, the client wishes to engage in, this could be use to look closer at what is entailed participating in this occupation (steps to achieving the occupation’s objective) and as a result better understand the barriers/enablers posed by the occupation/client.  Furthermore the equipment required/environment if this may be an issue, also the demands that may be required of the client, both physically, and emotionally e.g. staying focussed/ability to followed a sequence of steps to achieve the expectations of the desired occupation.

Grading and adapting, with the client having identified their needs with them, and analysed those occupations they wish to engage in, is to now considered where these occupation would require grading over a set amount of time in its level of engagement so that it is achievable for the client within their present level of capacity/sense of achievement to encourage them further (addressing duration/the environment/steps of the occupation/time of day). Furthermore, where adaption’s would made is to alter the parameters’ of the occupation, with the use of tools/equipment/resources such as adapted cutlery eating, templates when drawing, or a raised toilet seat to get on/off of toilet, and strategies to the approaching the occupation differently, although achieving the same outcome.

  1. Action/care planning

To devise an achievable plan with the client using what we have learnt from activity analysis, grading and adapting, into a form the client/health profession can put into action. (Also even at the early stages to identify where the client can go on after the course of Occupational Therapy treatment such as other services, clubs, and voluntary organisations.)

 

  1. Ongoing assessment and revision of action (grading and adapting)

To monitor/assess the action/care plan as it progresses with client, making further grading and adapting as required to ensure its relevance in meeting the needs of the client.

 

  1. Outcome/outcome measurement

To re-visit outcome measures, also Occupational Therapy theoretical model tools/ departmental, discussing with client, whether the goals have been achieved, and whether changes could have been made.

 

  1. End of intervention/discharge from Occupational Therapy/Review

To not only discharge the client, but look to where the client go on to next although this would have been addressed early on in care planning. Furthermore to reflect upon the experience, to consider what went right, what went not as planned, and what could be don’t differently when faced with a similar situation.

References

Boyt Schell, B. A (2009) Willard & Spackman’s occupational therapy. Philadelphia : Wolters Kluwer Health/Lippincott Williams & Wilkins, ©2009.

Creek, J (2003) Occupational Therapy Defined as a Complex Intervention College of Occupational Therapists.

Duncan,E.A.S (2011) Foundations for Practice in Occupational Therapy Churchill Livingstone; 5th Revised edition (27 April 2011)