Download Role of the Occupational Therapist within the mental health liaison

Heidi Fox ([email protected])
Clare Pressdee ([email protected])
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Welsh Government Funding in 2015 to expand &
develop the Liaison service across Wales.
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RAID Model.
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Age 18 +
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Funding for posts included; Nursing ,medical,
psychology & OT.
Covering 4 general hospitals.
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Specialist Mental Health assessments.
• Aim: To support rapid discharge & maintain
independence at home where possible.
Specialist advice, support and consultation.
• Aim: to develop understanding of how mental
health problems impact on a patients abilities to
complete daily tasks.
Specialist OT interventions.
• Aim: to promote health & well being, and improve
or maintain function.
Mental Health Occupational
Therapist Referral Pathway
Adults 18 + identified with
Complex mental health needs
impacting on functioning &
discharge planning home.
Referrals received from internal
Liaison team or from ward staff
including ward based OT’s
Liaison OT assessments
(standardised / functional) and
carer involvement
Recommendations & carer
guidelines for discharge
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Each level is associated with common patterns of
behaviour
Provides a measurement of abilities and needs
The model measures;
How the person interacts with their environment
How the person processes information
Existing abilities (strengths of the person)
Limitations which hinder the person from fully
engaging in Activities of Daily Living (ADL)
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Level 3 – Assistance with all ADL; Requires
assistance with cognitive skills, initiation,
sequencing, judgement, problem solving
and decision making; Difficulties with new
learning
Level 4 – Assistance needed to initiate ADL
and monitor quality of ADL, notable
problems with working memory most
require supervision to ensure safety
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90 year old man admitted from home following a fall
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Lives with son whom works away Mon – Fri & supportive
daughter lives locally.
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Upon admission to hospital presented with
increased confusion & disorientation.
Family reported gradual cognitive decline
over past 12 months.
Feedback from family r.e. Level of function
prior to admission.
Ward staff planning placement prior to any
functional assessment being carried out.
Both Jack and his family were keen for him
to return home .
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OT initial assessment - Model of Human
Occupation Screening Tool (MOHOST)
Large Allen’s Cognitive Level Screen (LACL’s)
assessment.
Liaised with ward OT r.e. Functional assessments
carried out on ward to compare findings – Advised
PADL be carried out.
Allen’s routine task inventory carried out with
Jack’s daughter.
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Recommendations for package of care based on
Allen’s estimate level low level 4 – providing daily
prompting & supervision with ADL’s inc medication
& meal preparation.
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Assistive technology (Motion falls detector)
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Carer guidelines provided to family
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Referral to primary memory services for further
assessment & signposting
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Memory hints & tips for Jack & his family
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Jack was able to return to occupational roles at home with
support, hence positive impact on his health & well being.
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Additional support placed in the home enabled Jack to return
home and reduced pressure on family members.
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Jack’s mood improved on ward environment whilst waiting to
return home.
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Cost Effectiveness - Potential saving for 1 individual
£19,346 per annum (COT Improving Lives, Saving Money, 2017).
Quality of care outcomes – Specialist input from Liaison OT
identified potential in Jack when other professions on the ward
did not.
MDT pilot scheme within an acute medical assessment unit (AMAU),
led by the Specialist Occupational Therapist.
AIMS
1. Reducing admission rates for older adults with cognitive
impairment.
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To discharge patients home within 24hrs – 72hrs following their
admission to AMAU.
To support older adult patients with cognitive impairment to return
to their own home & maintain independence – Specialist
assessment, advice & intervention.
To reduce admission length for individual’s admitted to general
wards from AMAU – Ongoing specialist assessment, advice &
intervention.
 53% of patients returned home and accessed appropriate
community services after Liaison input
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Reduced length of time on the assessment unit – 43%
patients were discharged within the 72 hour period.
 Further need identified to extend the OT role within the
Emergency Department.
 Positive feedback from AMAU staff
 Liaison continue to be a part of AMAU multi disciplinary
meetings.
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Developing OT Support Worker role.
Developing the role of MH OT within the
Emergency Department.
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Ongoing educational role of the MH OT.
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Ongoing consultative role of the MH OT.
Any questions?
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Allen, C.K., Earhart, C.A., and Blue.T. (1992) Occupational Therapy Treatment Goals for the
Physically and Cognitively Disabled. Bethesda, MD: American Occupational Therapy
Association.
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Allen,C.K. (1989). Unpublished routine task inventory (TRI-E).
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Allen, C.K., Austin, S.L., David, S.K., C.A., McCraith, D.B & Riska – Williams, L (2007). Manual for
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the Allen Cognitive Level Screen - 5 (ACL’s – 5) and Large Allen Cogntive Level Screen – 5
(LACL’s – 5). Camarillo, CA: ACL’s and LACL’S Committee, 33 – 39.
Parkinson, S., Forsyth, K., & Kielhofner, G. (2006). The Model of Human Occupation
Screening Tool (MOHOST) (version 2.0). Chicago: The Model of Human Occupation
Clearinghouse, Department of Occupational Therapy, College of Applied
Health Sciences, University of Illinois at Chicago.
Improving Lives, Saving Money (2017). College of Occupational Therapy, London.
For further information on a wider range of unit costs:
Personal Social Services Research Unit, 2016. Unit Costs of Health and Social care 2-16.
Available at:
http:www.pssru.ac.uk/project-pages/unit-costs/2016/index.php