The Breakfast Club

One of the biggest areas of need which I have found working in a secure unit is promoting healthy lifestyles, in particular healthy eating.
It has been proven that people with severe mental illness consume unhealthier diets in comparison to the general population. Also research has shown that individuals with schizophrenia consume more saturated fat and salt compared to individuals without the condition. Individuals with mental health problems are more likely to have poor eating habits, are less likely to source nutritious meals and do not tend to eat as socially as the general population (Davidson et al., 2001). Negative symptoms of mental illnesses such as self-neglect, apathy, amotivation and an increased appetite also create barriers for maintaining a healthy weight. In addition anti-psychotic medication are known to cause weight gain.

I found that at work the residents struggle with maintaining a healthy balanced diet, because of the above factors but also because of their daily routines, most of the residents on my ward for various reasons do not get out of bed until midday and so do not eat a regular three meals a day but skip breakfast and opt for larger lunches and unhealthy snacks.

I decided to try and tackle this problem by introducing a breakfast group once a week on the ward. The group started at 8.30am for residents to help prepare the food in the OT kitchen and then was served in the main dining room for all residents and staff to enjoy.
The four main aims of the group are as follows:

• To encourage a healthy diet by providing residents with the opportunity to prepare and eat a healthy breakfast.
• To encourage residents to wake up in the morning in order to have a more structured day and participate in meaningful occupations.
• To utilise the group as a way of assessing residents functional and cognitive abilities.
• To encourage social skills to develop and to build upon the existing rapport between residents and staff. 

I devised a table of different breakfast food options which the residents could choose a certain number from each week depending on what they would like to prepare and eat. Foods include: fruit salad and yoghurts, porridge, scrambled egg, muesli, bagels etc. The rationale for choosing these foods and the others was that they kick start your metabolism, provide a slow release of energy to keep you full until lunchtime whilst also being food which tastes good and holds nutritional value.

As most of the residents do not wake up in the morning or go back to bed straight after receiving their medication at 8am it took a couple of weeks and prompting to get the residents to get up and try the group whilst encouraging others to attend as well. After a few weeks more residents wanted to either help with the preparation or would just get up to join in with the eating and socialising once it was served. I was pleasantly surprised to find that those who helped and participated in the group would then stay up for the rest of the morning rather than going back to bed.
I also noticed that the residents were choosing to eat the fruit salad every week and this was one of the most popular foods on the day. It has also been evident that the residents have been choosing to eat healthier food during their meals and in particular on a Thursday when we cook a big unit meal together they have been asking for salads and healthier options.
The group has also provided a useful means for me to assess some of the residents functional and cognitive abilities in a non obtrusive  way and also in an environment which is congruent with everyday activities.

Some written feedback which I have gathered from the residents has shown the benefits which are showing after only a few weeks:

'Having this breakfast make me feel like I have a lot more energy. It keeps me full or day and I am much more alert.'

'It makes myself feel fresh and alert for the day. Its lso helping me have a balanced diet.'

'I have felt quite down the last few days but breakfast group has perked me up. It gets you going for the day.'

The breakfast group has already shown many advantages and benefits to my ward and I am looking forward to seeing how this continues and develops as the weeks go by.

Happy OTuesday,
Kate 

References:

Davidson, S., Judd, F., Jolley, D., Hocking, B., Thompson, S. & Hyland, B. (2001). Cardiovascular risk factors for people with mental illness. Australian and New Zealand Journal of Psychiatry, 35 (2), 196–202. doi:10.1046/j.1440-1614.2001.00877.x

The Outcomes Star

Recently at work I have been starting to plan a Recovery Star group to be delivered across the three wards in the Medium Secure Unit where I work. The group aim is to proactively help the residents take a hold on their recovery with the support of the MDT.

I thought that I could use this blog post to briefly introduce the model to those who are not familiar with the Outcomes Star (the Recovery Star is the Mental Health version) a bit about what it is and where it can be used.

The Outcomes Star was developed and is supported by Triangle Consulting Social Enterprise Ltd. Triangle was founded in 2003 as an outcomes consultancy to enable value driven organisations to "count what really counts" in their work. The enterprise combines research and evaluation skills with an understanding of human behaviour in order to develop systems to support change.

The Outcomes Star both measures and supports progress for service users towards self-reliance or other goals. The Stars are designed to be completed collaboratively as an integral part of rehabilitation.

There are currently fourteen Outcomes stars designed for a range of different services and client groups. The fourteen different stars are:

• Alcohol Star
• Community Star, 
• Drug and Alcohol Star
•  Empowerment Star (domestic violence services)
•  Family Star
•  Homlessness Star
•  Life Star for LD’s
• Mental Health Recovery Star
• Music Therapy Star
• Older Persons Star
• Teen Star
• Spectrum Star for Autism and Aspergers
• Well-being Star
• Work Star

I will be using the Recovery Star in my place of work. The Recovery Star is made up of ten core dimensions which are shown in the diagram below:

Individuals are supported via their MDT care team to use a ladder system to score how their recovery process is progressing. The 'ladder' of places for each branch on the star is broken down into the following areas:

A detailed explanation of the Stars and the scoring and working of the ladder of change can be found at the Outcomes Star website: http://www.outcomesstar.org.uk and I would highly recommend you read into the Outcomes Star if it is of interest to you.

There are many benefits of using the Star, some of which being; It helps improve rehabilitation programmes and provides evidence for outcomes, it is engaging, visual and collaborative, helps both service users and professionals to gain a greater insight into the individuals areas of strengths and needs and supports MDT working.

There are also some really strong and positives benefits reported from Service users on the website given above. One which caught my attention was as follows:

The Star made a massive difference to me because it showed me that there were things I could do to become the person I wanted to be - a more rounded person with a more rounded star.It showed me that there were goals I could achieve. When you're ill, the thought that you can be well seems very daunting but the Star breaks it down into baby steps and you start to feel, "Yes, I can do this". That really built my confidence and gave me hope.

 I am looking forward to continuing my group planning and then implementing the Recovery Star group in my place of work and will use this blog as a place to update you about the positive impact which the group will hopefully have in the future.

Happy OTuesday,
Kate :)

Thoughts on a BJOT Article: Activity and Participation - self assessment according to the ICF.

The September edition of the British Journal of Occupational Therapy arrived on my doorstep this week and I was excited to see more articles about Mental Health Practice. One article in particular caught my eye so I decided to read it and share my thoughts on it as my latest blog post.

The chosen article:

'Activity and Participation - self assessment according to the International Classification of Functioning: a study in mental health.' by Lena Haglund and Susanne Faltman (2012)

The aim of the study was to explore the use of adding a fifth element to the International Classification of Functioning, Disability and Health (ICF) in order to utilise clients experience of satisfaction and enjoyment in activity and participation.

An important requirement in OT and rehabilitation as a whole is to work in a client centred way taking into consideration the needs and views of the individuals we, as health professionals, work with. Using self-assessment reflects that standpoint since the clients themselves make the assessment and convey their views and experiences of how they perceive their ability to handle their situation.

Research indicates that the client’s engagement and participation is decisive to the outcome of the rehabilitation. Consequently, it is important to develop tools with which the clients can highlight their own opinions regarding their everyday life. To manage everyday life, humans need to be engaged and to find satisfaction and meaning in the actions and tasks included in their daily life (Bejerholm 2007).

Twenty-nine clients with schizophrenia and other forms of psychosis participated in the study by using a self-assessment which was then linked to the Activity and Participation qualifier sections.

Currently the ICF component Activity and Participation consists of four qualifiers. The first qualifier describes performance, that is, what a person does in the current environment, which also includes the overall societal context and can be understood as ‘involvement in a life situation’ or ‘the lived experience’

of people in their actual context. Performance can involve assistance, such as technical aids. The second qualifier is about capacity. This describes the client’s ability to execute a task or action. It is intended to indicate the highest probable level of functioning in a given situation. The third and fourth qualifiers make it possible to code capacity with assistance and performance without assistance (WHO 2001).

As proposed by the study the fifth qualifier would make it possible for the rehabilitation process to reflect clients views.

The results of the study revealed that the ‘Major life area’ was rated with the most dissatisfaction and displeasure by the clients. ‘Communication’ and ‘General task and demands’ also had low ratings. ‘Self-care’ was rated with the most satisfaction and enjoyment. There was a correlation between the assessments made by the occupational therapist and the nursing staff, but their assessments differed from those made by the clients. 

The study indicates the importance of using self-assessment when understanding everyday life as presented in the ICF, and the importance of using different assessment methods to gain a broad picture of clients. Below are some of my thoughts on the strengths and limitations of this article and on using self assessment in Mental Health:

Limitations:

• The study was conducted in Sweden and so results may had differed had the study been conducted in the UK.
• The ICF assessment is long and complicated. The clients self assessment used in the study was a combination of two constructed assessments consisted of a seven-page list of 248 categories each - my concern is with how many clients would actually be able to sit and complete the assessments effectively and in one setting, or have the motivation to do so. 
• The results of the ICF assessment are not particularly accessible or easy to understand.
• One trouble which I have found with combining self assessments with professional assessments is the potential difficulty in sharing the professional assessment results when the clients disagree and/or perceive their abilities differently.

Strengths:

• As mentioned above it is crucial to include clients throughout the rehabilitation process and using self assessment is a powerful tool to doing this. 
• Allows greater insight for the professionals into the clients, for example in areas of insight and cognitive areas.
• Helps professionals to gain a therapeutic rapport with clients as they feel respected being able to have an active part in their rehabilitation.
• Using the ICF framework and assessment allows for greater MDT working as a range of professionals are familiar with it and it also shows the significance of Occupational Therapy. 

If you are able to read the article than I would recommend you do as it is a interesting insight into just one way of how professionals can encourage and support client participation in their rehabilitation process.

Happy OTuesday,
Kate.


Reference:

Bejerholm U (2007) Occupational perspectives on health in people with schizophrenia. Unpublished PhD thesis. Lund: Lund University.

Haglund L, Faltman S (2012) Activity and Participation - self assessment according to the International Classification of Functioning: a study in mental health. British Journal of Occupational Therapy, 75(9), pp.412-418.

Word Health Organisation (2001) International Classification of Functioning, Disability and Health (ICF). Geneva:WHO.

Citation du jour.