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FEATURE FORENSIC SERVICES
A_ new way of working
32 OTnews June 2018
Joanna Lawrence and Sam Baker, occupational therapists at
Broadmoor Hospital, explain how the use of a new model of practice
has been helping meet service improvement needs
0 ver the past 18 months, the occupational
therapy service at Broadmoor Hospital
has adopted the Vona du Toit Model
of Creative Abitity (VdTMoCA) as
the prina,y model of practice, which has had a
significant mpact upon both patients and the team.
Prior to rnplementlng VdTMoCA, the service was USl'l9 the Model of Human Occupaloo (MOHO) to
ilfoml treatment, whldl consisted of open sessions.
These sessions were often genenc and lacked specrfic
treatment focus, wtjch meMt they were repetitive,
had low levels of pallent attendance and pr<:Mded
IJlll'Wllal ski development opporti.ntl8S.
Following the nnaf ~llonaf therapy
assessment process, rt was felt that the MOHO was
not used effecw~ to develop ongong patJent·
centred treatment, trus 11 was deaded a re,,~ of
WOtk11Q was requred
PreYIOUS ~oonal therapcsts at Broadmoor
had used the VdTMoCA nterrrwttentr,,, but folowng
lu1tl8r exploration by the head of SWV1C8 the team deoded to adopt the VdTMoCA as ltS prwnary moda
of practice
The VdTMoCA was identified as it was seen to be
able to address a number of areas for improvement
that had been recognised by the service. First , a need
for a more robust assessment process to clearly
identify patient treatment needs. This would enable the
team to develop interventions based on specific levels
of creative ability, thus engaging a broader patient
group.
It was also felt that rt could enable the team to
develop a stronger prof8SSIOnal Identity within the
hospital, by creating a clear auditable therapy pathway.
It was also felt that, by implementJng VdTMoCA.
rt ~ prowle an opportunty to demonstrate the
effectiveness ot occupational therapy provision 111 the
hosprtal
SwlCe embedding the VdTMoCA WTthln the service,
a setecoon of treatment-based one-to-one and
grcq> llteM!nOOOS have been run encompassing the
p-ll'qJies of lhe model These were tdenllfed fotlowng
an fl-depth assessment peooo across al wards.
desqled to ascertMl treatment needs and pa!lenls'
le\-'el ot crea!Ne at.fy lSlQ the CPA (Crea!llle
p~ Assessment)
16
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First , a need
J clearly
Jld enable the
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ithin the
apy pathway.
dTMoCA,
strate the
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, the service,
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ified following
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d patients'
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FORENSIC SERVICES FEATURE
16 February 201 -Team attend ~ ~~= 6~~ ?I~,.
OTWeek. t aucfllable
\session~1 20 June 2016 - ~ VdTMoCA
Team provides
J 16 February \ taster sessions 1~ =:a:16
to begin Initial Team attend ActMty treatment
dTMoCA meer,ng assassment OtJiartictt,on pathway
2017 - for VdTM Broadmoor t
";;J/11~ Audrt Commrttee approves service ...
evaluation > prop06ai
These interventions cover specific occupational performance
areas (OPAs):
• Work ability (Including process skills, use of tools, functional
skills);
• Personal management (including life skills. balanced life style,
role performance) and;
• Social ability (Including communication and •r• ~, '\(,hon skills).
The current therapy provision is subject to o . ., evaluation
and continual assessment of the treatment needs of the patients
within the seMce.
Benefits for the service Over the past 18 months there have been a number of benefits
related to the implementation of VdTMoCA. These have been
evident across the department, including service provision,
therapist development and patient experience.
Service provision: Through the implementation of VdTMoCA the
service has been able to utilise treatment time ~ ~ciently and
effectively. By using the treatment principles 11 ~ able to
develop its approach.
An example of this is an increased provision of on-ward
therapy, to address the needs of a wider patient population that
previously did not engage in occupational therapy. On-ward
interventions also require less staff, meaning the service has
increased the number of therapy sessions it can facilitate at one
time.
Occupational therapists: Alongside the improvements noted in
service provision, the implementation of VdTMoCA has provided
therapists with a clearer, more focused assessment and treatment
process.
This provides therapists with more scope to develop
increasingly structured and diverse care plans meeting indMdual
needs.
In addition, there has also been a significant increase in
occupational therapists' motivation and sense of professional
identity; the VdTMoCA has provided a clear platform for
occupational therapists to demonstrate the value of their
contribution and to have a more defined role within the
multidisciplinary team.
It has been incredibly positive to see occupational therapists'
confidence in their rote, skils en:! contnbution to patient care
improving following the mplementation of the model into the service.
Patients: Followtng the introduction of VdTMoCA there has been
a significant improvement in patient engagement in occupational
therapy across the service. This IS demonstrated in a number of
different ways.
There has been increased engagement: previously we
would achieve an average of three patients per session,
predominantly the same patients who would attend an open
group. In comparison, since using the VdTMoCA there has been
a significant increase and the service is now seetng up to 1 O
patients attend a single treatment session.
It has also been observed that by providing more varied and
speafic treatment, there has been an increase in motivation
among patients who p(eviousty engaged minimally with
occupational therapy.
An example of this has been the commencement of actMties
of daily living (AOL) support sessions, offering patients one-to-one
assistance to attend to their personal and domestic needs. This
has led to patients taking increased responsibility with their personal
management, by independently initiating the task and retaining skills
developed collaboratively with the occupational therapist.
As one occupational therapist stated: 'I would Wf that one of biggest benefits of implementing this model has been seeing
patients who never used to attend occupational therapy now
attending, engaging wel and developing their skiUs, meaning they
are progressr,g to vocational areas or even to less secure wards.
They oow see the benefit of attending occupational therapy,
compared with previously.'
The service now believes it has a more robust and dynamic
assessment process. The use of the Activity Participation Outcome
Measure (APOM), underpinned by VdTMoCA, has enabled
occupational therapists to observe and identify subtle changes in
occupational performance. Observation of unfamniar tasks allows occupational thernpists to
gain a more detailed understanding of patients' specific treatment
needs. In terms of being able to offer a broader range of treatment,
prior to the use of VdTMoCA the treatment provided was often
OTnews June 2018 33
FEATURE FORENSIC SERVICES
A multi-site service evaluation more focused on engaging
patients, as opposed .. . one of biggest is underway to assess the
impact of introducing to providing individual
treatment. The model has
enabled the service to design
treatment specific to the
benefits of implementing the new model within
this model has been seeing patients who never used to attend occupational therapy OPAs bsted above, instead of
a more genenc approach.
By utihsing a more
comprehensive and robust
assessment process, including
now attending, engaging well and developing
the service. This is in
collaboration with other
services, including Oxford
Health, St Andrew's
Northampton, St Andrew's
Birmingham, and Professor
Daleen Casteleijn and their skills ... the use of the APOM, occupational
therapists have been able to provide
a more defined care pathway to meet
patients' treatment needs.
The APOM has enabled therapists to assess the
impact of treatment by providing a standardised
outcome measure. This outcome measure provides
occupational therapists with a plalfomi to regularly
evaluate treatment efficacy.
Another therapist states: 'Through the
implementation of the VdTMoCA, I feel this has
been more beneficial for service users as the service
user population have been able to have a more
coUaborative opportunity to formulate ind1v1dual goals
based on the outcome of the APOM measure, to
access a leading and contemporary therapy service
and to see changes in their presentation displayed 1n
a visual manner within 1heir occupational therapy care
programme approach (CPA) reports.'
What's next? While the implementation of the Vc!TMoCA has
been successful within these first 18 months, it 1s
important to note that the service is in tl1e early
stages of redevelopment. In order lo continue
effective service development, it
is crucial the team maintains
a proactive approach to
applying the model to
practice by promoting
the profession
and evidencing
the model's
effectiveness.
Over the
coming year,
the team wiH
continue to
develop the
service 1n a
number of ways
using the model.
34 OTnews June 2018
Dr Roshni Khatri from the
University of Northampton.
A collaborative research project is
planned alongside the University of Southampton
exploring students' experience of practice models.
It is also planned to: further develop the application
of VdTMoCA within high dependency and PICU
wards; fully establish VdTMoCA within all services
across the hospital, 1n preparation for the move to the
new site; and present VdTMoCA service development
to members or the wider multidisciplinary team.
References de Witt P (20 I 4) Creattve ab,lity: A model for tndNldllal and
group occt1pat,onal therapy for cl,ents w,th psychosoc11:11
dystunct,on In. Crouch R and Alers V (20 I 4)
Occupat1onal t/lerapy ,n psychiat,y and mental health
(5th Edition). Chichester: Wiley
Joanna Lawrence and Sam Baker. occupational
therapists, Broadmoor Hospital, West London Mental
Health NHS Trust. Email: [email protected]