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)

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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: Sam.8aker@wlmht.nhs.uk