Suffolk ADL Index

for those of you who are looking for an ADL Outcome Measure.  Have a look at this.  It was made by A. Magpantay in 2012.

Here are some information about it.

1. It measures 9 areas of ADLs compatible with OT uniform terminology and OT practice framework.
2. It uses Baseline Score so every individual would have their individual ceiling of performance and this is where improvements will be based
3. The SADL In Score has very strong positive relationship with Barthel ADL Index. This makes it valid.
4. The performance is expressed and described in percentage compared to baseline score
5. It generates a (PAN) physical assistance need score that can guide a therapist as to how much care support is required at the point of dated assessment.
6. It can easily be communicated to any other team/discipline
7. one can have an overview of performance at a glance
8. it describes level of assistance in terms of moving and handling support the person require

Conditions to Maximise Success of Interdisciplinary Team

9 Conditions to Maximise the Success of Interdisciplinary Team

1.       Allegiance to a mission statement (i.e person centred rehab in the least restrictive setting)

Does your service have a mission statement? Is it explicitly stated so that everybody knows about it? Does everybody adhere to core values?

2.       Specifically delineated roles of each discipline

What are the roles of doctors? Physio, OT, SLT, Nursing, Care coordinator, SW and discharge planning Nurse.

3.       Balance participation by each professional

Are MDT working equally or is there a group that doe more than the others.

4.       Agreement on and implementation of ground rules of interaction

When there is disagreement between MDTs, what do people do? Do people shout? Do they demonstrate tantrums?

5.       Clear and Effective communication and documentation

How are things documented?

6.       Scientific Approach to patient problems

Are professionals giving accurate findings or mostly opinions?

7.       Clearly defined, Measurable Goals

Are we thinking about restorative goals? Adaptive and modification goals?  How can goals be set if there are no problems? Is it goals or tasks that needed to be done? Are we clear about how goal setting should be?

8.       Working Knowledge of Group Process

Who is the facilitator?

9.       Expedient Procedures for coming to consensus and decision making

What is the framework of reasoning?

OT Core Values

Topic 2: OT CORE VALUES

OT profession in the United Kingdom has no publication relating to the core values of Occupational Therapy. (I could well be corrected on this)

There is, however, a publication regarding Code of Ethics and Professional Conduct(COT 2010)

I do not know if OT who trained in the United Kingdom are taught of OT core values.  I, in my personal and professional experiences, have embraced Occupational Therapy as a vocation rather than a profession. 

Embracing OT as a vocation means embracing the core values of Occupational Therapy.

My daily actions are governed by these values and any actions away from these values are actions that I would consider unprofessional.

The core values and attitudes of occupational therapy are organized around seven basic concepts--altruism, equality, freedom, justice, dignity, truth, and prudence. How these core values and attitudes are expressed and implemented by occupational therapy practitioners may vary depending upon the environments and situations in which professional activity occurs.  

Altruism is the unselfish concern for the welfare of others. This concept is reflected in actions and attitudes of commitment, caring, dedication, responsiveness, and understanding. 

Equality requires that all individuals be perceived as having the same fundamental human rights and opportunities. This value is demonstrated by an attitude of fairness and impartiality. We believe that we should respect all individuals, keeping in mind that they may have values, beliefs, or life styles that are different from our own. Equality is practiced in the broad professional arena, but is particularly important in day-to-day interactions with those individuals receiving occupational therapy services. 

           

Freedom allows the individual to exercise choice and to demonstrate independence, initiative, and self-direction. There is a need for all individuals to find a balance between autonomy and societal membership that is reflected in the choice of various patterns of interdependence with the human and nonhuman environment. We believe that individuals are internally and externally motivated toward action in a continuous process of adaptation throughout the life span. Purposeful activity plays a major role in developing and exercising self-direction, initiative, interdependence, and relatedness to the world. Activities verify the individual's ability to adapt, and they establish a satisfying balance between autonomy and societal membership. As professionals, we affirm the freedom of choice for each individual

to pursue goals that have personal and social meaning. 

Justice places value on the upholding of such moral and legal principles as fairness, equity, truthfulness, and objectivity. This means we aspire to provide occupational therapy services for all individuals who are in need of these services and that we will maintain a goal-directed and objective relationship with all those served. Practitioners must be knowledgeable about and have respect for the legal rights of individuals receiving occupational therapy services. In addition, the occupational therapy practitioner must understand and abide by the local, state, and federal laws governing professional practice. 

Dignity emphasizes the importance of valuing the inherent worth and uniqueness of each person. This value is demonstrated by an attitude of empathy and respect for self and others. We believe that each individual is a unique combination of biologic endowment, sociocultural heritage, and life experiences. We view human beings holistically, respecting the unique interaction of the mind, body, and physical and social environment. We believe that dignity is nurtured and grows from the sense of competence and self worth that is integrally linked to the person's ability to perform valued and relevant activities. In occupational therapy we emphasize the importance of dignity by helping the individual build on his or her unique attributes and resources. 

Truth requires that we be faithful to facts and reality. Truthfulness or veracity is demonstrated by being accountable, honest, forthright, accurate, and authentic in our attitudes and actions. There is an obligation to be truthful with ourselves, those who receive services, colleagues, and society. One way that this is exhibited is through maintaining and upgrading professional competence. This happens, in part, through an unfaltering commitment to inquiry and learning, to self-understanding and to the development of an interpersonal competence. 

Prudence is the ability to govern and discipline oneself through the use of reason. To be prudent is to value judiciousness, discretion, vigilance, moderation, care, and circumspection in the management of one's affairs, to temper extremes, make judgments and respond on the basis of intelligent reflection and rational thought.

Summary

Beliefs and values are those intrinsic concepts that underlie the core of the profession and the professional interactions of each practitioner. These values describe the profession's philosophy and provide the basis for defining purpose. The emphasis or priority that is given to each value may change as one's professional career evolves and as the unique characteristics of a situation unfold. This evolution of values is developmental in nature. Although we have basic values that cannot be violated, the degree to which certain values will take priority at a given time is influenced by the specifics situation and the environment in which it occurs. In one instance dignity may be a higher priority than truth; in another prudence may be chosen over freedom. As we process information and make decisions, the weight of the values that we hold may change. The practitioner faces dilemmas because of conflicting values and is required to engage in thoughtful deliberation to determine where the priority lies in a given situation.  The challenge for us all is to know our values, be able to make reasoned choices in situations of conflict, and be able to clearly articulate and defend our choices. At the same time, it is important that all members of the profession be committed to a set of common values. This mutual commitment to a set of beliefs and principles that govern our practice can provide a basis for clarifying expectations between the recipient and the provider of services. Shared values empowers the profession and, in addition, builds trust among ourselves and with others. 

source: AOTA/willard and spackman

A Vulnerable Adult and Abuse: a reminder to what it is

 A vulnerable adult

If we define vulnerable adult as somebody in pain, then most of our patients are vulnerable.  I have looked at government sites and  department of health sites regarding vulnerable adult to see what into the category of vulnerable adult.   

A vulnerable adult is someone aged 18 or over:

·         Who is, or may be, in need of community services due to age, illness or a mental or physical disability

·         Who is, or may be, unable to take care of himself/herself, or unable to protect himself/herself against significant harm or exploitation

(Definition from the Department of Health 2002)

Who is a vulnerable adult?

Abuse can affect any vulnerable adult, but particularly someone who is, or may be, unable to protect themselves against significant harm or exploitation, for example:

·         Older people

·         People with mental health problems

·         Disabled people

·         People with learning difficulties

·         People with acquired brain damage

·         People who misuse substances

What is abuse?

Abuse is a violation of an individual's human and civil rights. It may consist of a single act or repeated acts. It can be physical, verbal or psychological, it may be an act or omission to act, or it may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship

Types of abuse?

·         Physical: including hitting, shaking, biting, grabbing, withholding food or drink, force-feeding, wrongly administering medicine, unnecessary restraint, failing to provide physical care and aids to living

·         Sexual: including sexual assault, rape, inappropriate touching/molesting, pressuring someone into sexual acts they don't understand or feel powerless to refuse

·         Emotional or psychological: including verbal abuse, shouting, swearing, threatening abandonment or harm, isolating, taking away privacy or other rights, bullying/intimidation, blaming, controlling or humiliation

·         Financial or material: including witholding money or possessions, theft of money or property, fraud, intentionally mismanaging finances, borrowing money and not repaying

·         Neglect: including withholding food, drink, heating and clothing, failing to provide access to health, social and educational services, ignoring physical care needs, exposing a person to unacceptable risk, or failing to ensure adequate supervision

·         Discriminatory abuse: including slurs, harassment and maltreatment due to a person's race, gender, disability, age, faith, culture or sexual orientation

·         Institutional abuse: including the use of systems and routines which neglect a person receiving care. This can happen in any setting where formal care is provided.

Outcome Measure for Occupational Therapy

Wondering how you can measure the outcome of your input? I have the solution and it is as simple as a paperclip - it is like a simple wire, bent in a special way, the, presto! it holds everything together.  I presented this in East of England Stroke Forum in 2013.

It is called Service Performance Record of Effectiveness and Efficiency or SPREE.

What is Service Performance Record of Effectiveness and Efficiency or SPREE?

SPREE  is a method of scoring the effectiveness of therapy intervention my measuring the extent of client goals that the therapy has achieved in the course of intervention. It is a platform that measures goal achievement of clients and their therapists. In effect, each patient has their own outcome expectation  but their goal achievement is scored in a standardised a way to allow statistical analysis.

Generic measures include designating a value or Goal Attainment Value (GAV) to rate the extent of how patients’ goals were achieved.

In SPREE, goals are individually identified to balance the needs of the patient and their family and the demand of Service Provider/ Commissioner to prove the and measure the Outcome of the service.

OT Service Performance Record of Effectiveness and Efficiency (OT SPREE)  is the system of measuring therapy outcomes by quantifying the amount of client goals achieved with the help of an Occupational Therapy through intervention and its involvement with the persons’ case.

 Why use it?

1.       OT SPREE is easy to complete and not complicated.

2.       OT SPREE has Flexible goal setting parameters where goals can be set with the help of relevant people involved in clients care.

3.       It can measure goals that encompasses wide variety of contextual and performance problems.

4.       It is a running document that can be used throughout a patient’s stay in the hospital and has the flexibility to be used in various facilities and by multiple of disciplines.

5.       It can be used with other standardised tools and outcome measures.

6.       It has a holistic approach to identifying Occupational Problems of the client.

7.       It encourages a balance between client, their family and therapists’ involvement.

8.       It facilitates realistic goal setting and encourages collaborative goal setting.

9.       It can easily be reported and data summary are hoped to be easily understood by service commissioners.

Interested? email me.

Guide to Making OT Student Placement Work

I recently had a student for 7 weeks and her performance was exceptional I was so impressed. If any of the readers are interested, you can try these 'Guide to Making Student Placement Work' (c) 2013 A.M.

1.       Get the Student Comfortable in the place

-          Observe behaviours

-          Get an impression

2.       Give Foundation Knowledge

-          What does OT do?

-          What are the Domains of Concern

o   Occupation

§  Performance area

§  Performance component

§  Performance context

o   Uniform terminology

o   Overview of OT Practice worldwide: defining the competition

o   What are the tools of practice

-          What is the arena of Practice

o   E.g. Secondary care

-          What is the Role of OT in the continuum of care

-          Where is the service in the Continuum of care

-          What is the model of Practice

o   Ecology of human performance

-          What is the Process of Occupational Therapy

-          What are the facets of clinical reasoning

o   Scientific

o   Narrative

o   Ethical

o   Pragmatic

-          What are the parameters of assessment and intervention

o   Value

o   Independence

o   Safety

o   Adequacy/Quality

-          What are the intervention types – learning about the application of intervention method will take the whole of placement time as cases and opportunities vary.

o   Restore

o   Alter

o   Modify

o   Prevent

o   Support

3.       Facilitate interest in knowing the person’s Occupational History

a.       Get student to just interview and know the person

b.      Give task of interviewing the person

c.       Practice until comfort level is reached

4.       Encourage to ask question

a.       Take note of questions and add them to learning objectives

                                                               i.      Document unknowns and make them an objective to be known

5.       Set targets every week depending on the level and capability of the student

a.       Based on assessment skills

b.      Based on intervention skills

c.       Based on treatment planning skills

d.      Based on documentation skills

e.      Based on medical foundation

f.        Based on OT foundation skills

6.       Update learning opportunities as they present themselves

a.       Though in the initial stage of supervision, the student has identified learning outcomes and objectives on their own, I find it that they may usually have difficulty articulating what needed to be learned thus needing assistance and guidance from the educator.  Their learning objectives can be erratic and fragmented that, if followed without flexibility of change, the student may not be able to see the better picture of the process and philosophical foundations of the profession.

7.       Closely monitor performance

a.       Make notes every day

                                                               i.      Note behaviours that are good

                                                             ii.      Identify behaviours that can improve

                                                            iii.      Document experience

b.      Review performance from MDT

c.       Observe from a distance

d.      Collaborate with other team members so that there is continuity of grading

8.       Objectively Assess every week

a.       Use the grading mechanism that the University has provided

b.      Discuss performance and rate performance based on the above

9.       Comply with documentation requirements

10.   End Placement in agreement of experience and learning

a.       Obtain feedback from student

b.      Give recommendations if necessary

Using the word "Occupation"

Has anybody find it difficult to promote OT? that may be because people(OT's) are afraid to use "Occupations" when they are promoting or explaining OT to MDT or to clients.  Everybody explains it in their own way and they are forgetting the essence and the main core and most simple word....Occupation!!!  It is what sets us apart so we have to market it.  we should use it in our day to day language as  professionals.  People always say " ordinary people will not understand it if we use Occupation so let us not use it and use something else." well excuuuuse me.  That will be the beginning of the death of the profession. there was an article in the OT news.  If I am not mistaken it may be professor Turner( I may be corrected if I am wrong) who, in essence, felt the profession is in its adolescence stage.... a stage of Identity crisis.  OT's are not yet proud to shout out " I am an Occupational Therapist and I deal with Human Occupations!!!" do people feel embarassed?

Until we are prepared to commit to promotong "Occupation" in Occupational Therapy, we will all remain to be JUST "Therapist" to the eyes of everybody.