SETTING OVERVIEW
The unit is a specialist assessment and treatment facility for youth. It is primarily an inpatient unit, but also has a day-patient programme.
The inpatient programme varies from 5 week treatment programmes, to shorter assessment admissions. Patients usually transition from the inpatient programme into the day patient programme during their admission.
The unit's intent is to provide patients with a safe therapeutic environment, in which both the patient and their parents can work towards strengthening individual, and family functioning.
Tuesday, September 2, 2008
CLIENT OVERVIEW
Age: Mid teens
Sex: Female
Referral Source: Psych Emergency Services.
Reason for referral: Family are extremely concerned for her personal safety, as there have been several previous suicide attempts.
She has been experiencing low mood for the past 2 years, and more recently she has been absconding, and presenting with aggression towards her family.
Diagnosis: Anxiety Disorder
History: No previous occupational therapy intervention, but she has been in contact with other Mental Health services due to previous suicide attempts.
Age: Mid teens
Sex: Female
Referral Source: Psych Emergency Services.
Reason for referral: Family are extremely concerned for her personal safety, as there have been several previous suicide attempts.
She has been experiencing low mood for the past 2 years, and more recently she has been absconding, and presenting with aggression towards her family.
Diagnosis: Anxiety Disorder
History: No previous occupational therapy intervention, but she has been in contact with other Mental Health services due to previous suicide attempts.
OT PROCESS
Data Gathering:
A referral from Psych Emergency Services was received. We then had to identify and interpret the appropriate information.
We asked questions to ourselves, these were for example: What does the referring service agent expect from occupational therapy regarding this referral?
Screening:
A screening form was filled out to collect additional data, and answer the questions from the data gathering process. We had a specific form to fill out on the unit, and for this case it concluded there was a need for occupational therapy intervention.
Intervention would include:
1. OCAIRS (The Occupational Circumstances Assessment Interview and Rating Scale). This would be used as an initial assessment.
2. Anxiety Management Education along side the Psychologist.
3. Graded exposure with the Occupational Therapist in social situations.
Model Selection:
A model/frame of reference guides practice, including assessment and intervention.
In this case, the Model of Human Occupation (MOHO) was selected. MOHO is a generic model "to provide a deeper understanding of the nature of occupations in human life and its role in health and illness." (http://www.netf.no/artikler/1103_28_33.pdf)
(Retrieved from http://www.hearingreview.com/issues/articles/2001-02_03.asp on Tuesday 2nd September 2009.)
This image represents the overview of the Model of Human Occupation. The person has three hierarchically arranged subsystems, volition, habituation, and performance, respectively. This open system interacts with the environment via the four mechanisms; intake, throughput, output, and feedback.
The client in this case study had poor a poor feedback mechanism in place, therefore has a poor ability to adapt to her environment, which in turn does not make her complete cycle as productive as it should. This ultimately leads to the human open system to function poorly.
The appropriate assessment that emerged from this model, and that worked with my client was the OCAIRS interview (The Occupational Circumstances Assessment Interview and Rating Scale).
OCAIRS provides a "structure for gathering, analysing and reporting data on the extent and nature of an individual’s occupational participation" (MOHO Clearing House- http://www.moho.uic.edu/).
The OCAIRS interview concluded problems in the following areas: Roles, Short-term goals, Long-term goals and Social environment. This information is useful in my intervention to understand background information on the client, and identifies situations and experiences that may have influenced her symptoms at the time of admission.
Client Concerns:
- Going to school.
- Family disagreements.
- Missing best friend that is in another town.
- Being in uncontrollable social situations.
- Afraid "daydreaming" is going to take over.
Problems:
The client tends to go into a "daydreaming" when the situation becomes our of her control. She feels that she does not have the management techniques to control this.
Clients Strengths:
She is able to identify what is wrong, and when something is becoming a problem for her functioning.
Intervention:
1. Meeting with Psychologist and myself regarding social situations. Discussions around her "daydreaming" state, and to brainstorm techniques to make her feel more in-control of the situation.
2. These meetings concluded with the decision to create a relaxation tape for her to use in her own home once a day.
3. Practice this once a day with myself whilst she is on the unit to become comfortable with using the tape. Before and after the session a self-rating scale of tension is completed to gage change in tension.
4. Using the relaxation techniques in graded social situations to help her stay in-control of this situation.
Short-term goal:
In 2 weeks she will have attempted to use a relaxation technique that she was taught to use in uncomfortable satiations.
Long-term goal/outcome:
To be able to manage anxiety and the "daydreaming" state so she can function independently in the community and school environment.
Data Gathering:
A referral from Psych Emergency Services was received. We then had to identify and interpret the appropriate information.
We asked questions to ourselves, these were for example: What does the referring service agent expect from occupational therapy regarding this referral?
Screening:
A screening form was filled out to collect additional data, and answer the questions from the data gathering process. We had a specific form to fill out on the unit, and for this case it concluded there was a need for occupational therapy intervention.
Intervention would include:
1. OCAIRS (The Occupational Circumstances Assessment Interview and Rating Scale). This would be used as an initial assessment.
2. Anxiety Management Education along side the Psychologist.
3. Graded exposure with the Occupational Therapist in social situations.
Model Selection:
A model/frame of reference guides practice, including assessment and intervention.
In this case, the Model of Human Occupation (MOHO) was selected. MOHO is a generic model "to provide a deeper understanding of the nature of occupations in human life and its role in health and illness." (http://www.netf.no/artikler/1103_28_33.pdf)
(Retrieved from http://www.hearingreview.com/issues/articles/2001-02_03.asp on Tuesday 2nd September 2009.)
This image represents the overview of the Model of Human Occupation. The person has three hierarchically arranged subsystems, volition, habituation, and performance, respectively. This open system interacts with the environment via the four mechanisms; intake, throughput, output, and feedback.
The client in this case study had poor a poor feedback mechanism in place, therefore has a poor ability to adapt to her environment, which in turn does not make her complete cycle as productive as it should. This ultimately leads to the human open system to function poorly.
The appropriate assessment that emerged from this model, and that worked with my client was the OCAIRS interview (The Occupational Circumstances Assessment Interview and Rating Scale).
OCAIRS provides a "structure for gathering, analysing and reporting data on the extent and nature of an individual’s occupational participation" (MOHO Clearing House- http://www.moho.uic.edu/).
The OCAIRS interview concluded problems in the following areas: Roles, Short-term goals, Long-term goals and Social environment. This information is useful in my intervention to understand background information on the client, and identifies situations and experiences that may have influenced her symptoms at the time of admission.
Client Concerns:
- Going to school.
- Family disagreements.
- Missing best friend that is in another town.
- Being in uncontrollable social situations.
- Afraid "daydreaming" is going to take over.
Problems:
The client tends to go into a "daydreaming" when the situation becomes our of her control. She feels that she does not have the management techniques to control this.
Clients Strengths:
She is able to identify what is wrong, and when something is becoming a problem for her functioning.
Intervention:
1. Meeting with Psychologist and myself regarding social situations. Discussions around her "daydreaming" state, and to brainstorm techniques to make her feel more in-control of the situation.
2. These meetings concluded with the decision to create a relaxation tape for her to use in her own home once a day.
3. Practice this once a day with myself whilst she is on the unit to become comfortable with using the tape. Before and after the session a self-rating scale of tension is completed to gage change in tension.
4. Using the relaxation techniques in graded social situations to help her stay in-control of this situation.
Short-term goal:
In 2 weeks she will have attempted to use a relaxation technique that she was taught to use in uncomfortable satiations.
Long-term goal/outcome:
To be able to manage anxiety and the "daydreaming" state so she can function independently in the community and school environment.
FACTORS THAT INFLUENCED THE SUCCESSFUL INTERVENTION
Model of practice:
The Model of Human Occupation (MOHO) guided my assessment and intervention which gave me a clear process to follow. For me as a student I felt this was what I needed as I am not expert in the specialized area of practice, and not competent in choosing correct treatment and rationale.
Client:
This specific client was open and willing to have her "daydreaming" state brought under control, as it was influencing and impacting on her functional activities.
During the OCAIRS interview, she was open to discuss issues and topics with me. After reflection with my supervising therapist, I came to the conclusion that being the same sex as her, and of a similar age (compared with other staff in the unit) helped with compliance and motivation.
Model of practice:
The Model of Human Occupation (MOHO) guided my assessment and intervention which gave me a clear process to follow. For me as a student I felt this was what I needed as I am not expert in the specialized area of practice, and not competent in choosing correct treatment and rationale.
Client:
This specific client was open and willing to have her "daydreaming" state brought under control, as it was influencing and impacting on her functional activities.
During the OCAIRS interview, she was open to discuss issues and topics with me. After reflection with my supervising therapist, I came to the conclusion that being the same sex as her, and of a similar age (compared with other staff in the unit) helped with compliance and motivation.
SETTING POLICIES AND THEIR INFLUENCE ON ME AS THE OCCUPATIONAL THERAPY STUDENT
Dot" Status:
The nature of the clients in the unit required special requirements by the staff. A system specific to the unit was created to notify staff of these requirements, and this was called the "Dot" Status.
The particular client that I was working with had a Red Dot, which indicated past sexual abuse, and a Blue Dot, which indicated a risk of absconding. Both of these statuses meant that I could not see the client on my own, due to the fact that if something happened I had back up evidence. This supervision by a nurse could have altered my results of the OCAIRS interview and influence compliance of intervention.
Confidentiality:
This policy is always a factor for any health professional at all times. Because of the risk of the client and her history, it was important for me to beware that she could disclose some information to me in the interview that I need to inform other people of, regarding her personal safety.
As I am a student and I needed to discuss the results of the interview with my supervisor, I needed to inform her of this and get her consent.
Time:
There is a process in this setting that requires the patient to transfer from an inpatient to the outpatient programme. This strongly influences the amount of time that you have with the patient, therefore intervention and assessment needs to be planned with this in mind. Also treatment needs to be carried out during school hours, 9am to 3pm.
The occupational therapists “do what is best” for the patient:
The occupational therapist in this setting (along with all the other occupational therapists in their respective settings) has the responsibility to do what is good and right for the patient. As the occupational therapy student, I felt pressure to do this and I was always checking concepts and ideas with my supervising therapist. We would have discussions around assessment, intervention and reasoning on a daily basis.
Dot" Status:
The nature of the clients in the unit required special requirements by the staff. A system specific to the unit was created to notify staff of these requirements, and this was called the "Dot" Status.
The particular client that I was working with had a Red Dot, which indicated past sexual abuse, and a Blue Dot, which indicated a risk of absconding. Both of these statuses meant that I could not see the client on my own, due to the fact that if something happened I had back up evidence. This supervision by a nurse could have altered my results of the OCAIRS interview and influence compliance of intervention.
Confidentiality:
This policy is always a factor for any health professional at all times. Because of the risk of the client and her history, it was important for me to beware that she could disclose some information to me in the interview that I need to inform other people of, regarding her personal safety.
As I am a student and I needed to discuss the results of the interview with my supervisor, I needed to inform her of this and get her consent.
Time:
There is a process in this setting that requires the patient to transfer from an inpatient to the outpatient programme. This strongly influences the amount of time that you have with the patient, therefore intervention and assessment needs to be planned with this in mind. Also treatment needs to be carried out during school hours, 9am to 3pm.
The occupational therapists “do what is best” for the patient:
The occupational therapist in this setting (along with all the other occupational therapists in their respective settings) has the responsibility to do what is good and right for the patient. As the occupational therapy student, I felt pressure to do this and I was always checking concepts and ideas with my supervising therapist. We would have discussions around assessment, intervention and reasoning on a daily basis.
MY STRUGGLES AS AN OCCUPATIONAL THERAPY STUDENT
Because of the nature of the setting there were many staff members that had been employed in this setting for a number of years. As a ‘new’ person coming in to this tightly formed group, there are many group dynamics to be aware of.
In relation to the case study, I was aware of the other staff members working with her, and I made a conscientious decision to keep communication lines clearly open with other health professionals. This meant telling the client’s primary nurse interventions that I was planning, and checking the client’s behaviour and arousal levels before my interaction with her.
As a student in this environment I felt like I had ‘eyes’ on me at all times, especially when I was working with clients. I had discussions around this with my supervising therapist, and came to the conclusion that it was ok to feel this way, and that they probably were watching my every move.
Because of the nature of the setting there were many staff members that had been employed in this setting for a number of years. As a ‘new’ person coming in to this tightly formed group, there are many group dynamics to be aware of.
In relation to the case study, I was aware of the other staff members working with her, and I made a conscientious decision to keep communication lines clearly open with other health professionals. This meant telling the client’s primary nurse interventions that I was planning, and checking the client’s behaviour and arousal levels before my interaction with her.
As a student in this environment I felt like I had ‘eyes’ on me at all times, especially when I was working with clients. I had discussions around this with my supervising therapist, and came to the conclusion that it was ok to feel this way, and that they probably were watching my every move.
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