Forensic Forum - Paper Session.

“The use of reflection for OTS in a forensic personality disorder unit.”

Rawdon CP, Stiles S, Northumberland Tyne and Wear NHS Trust.

There are many different uses and positives to reflecting, one being that effective reflection can inform clinical reasoning and deepen understanding of the behaviours of the above defined clinical group.

Within this paper Gibbs model of reflection was used by both staff and patients.

Staff reflection – Why?

·         Transfererance of emotions

·         Boundaries

·         Entitlement

·         Behaviours

·         Stops taking work/emotions home.

How?

·         Supervision

·         Reflective practice

·         Informal reflection

·         Humour

·         Peer reflection.

Patient reflection – why?

·         Enables ‘enlightenment’

·         Helps them clarify and make sense of things.

·         Helps them to visually and cognitively see problems and the solutions.

When using reflective methods with patients it is important to be careful of patient discomfort when flaws are laid out in front of them – no one likes to come face to face with their flaws! Also try and minimise as much as possible the feeling of always being watched/scrutinized and judged.

I really liked the idea of this paper, which was to encourage both MDT and patient uptake in reflective practice however I think the chosen model could be altered. From my personal opinion although I think that the Gibbs model has some definite positive points there are so many other, newer, models out there which could be utilised. For example I like Driscolls cycle (2000) as it is a more simplified model and would suit a wider range of patients perhaps, especially if they have any cognitive or processing difficulties. Also Johns model of reflection (1994) has been helpful over my three years of studying. 

Forensic Forum - Paper Session.

"Developing social Functioning with OTs and patients with Personality Disorder."
30/06/2011
Firstly what is Personality Disorder??

Personality disorders are metal health conditions that affect how people manage their feelings and relationships to other people. They also affect a person’s pattern of behaviour which can become maladaptive and/or socially unacceptable. (NHS)

For further information I have found these sites very useful:

http://www.mind.org.uk/help/diagnoses_and_conditions/personality_disorders?gclid=CNCjg9fB4qkCFUoc4QodWQs0Xw

http://www.bbc.co.uk/health/emotional_health/mental_health/disorders_person.shtml

http://www.personalitydisorder.org.uk/

Secondly what is Social Functioning?

Social functioning is the ability of an individual to interact and engage in the normal or usual way of society.

Therefore having looked at these two definitions it is clear to see how an individual with a personality disorder may have difficulties and barriers when concerned with social functioning.

Patients with personality disorders who have social functioning disabilities are more likely to be involved in 

anti-social behaviour, offending or reoffending behaviours.

What is the OT role for developing social functioning with PD patients?

Relationships

·         Positive relationships/modelling

·         Interpersonal skills – interventions to gain confidence, social skills, practice, vocational rehabilitation.

Lifestyle

·         Reduce employment anxieties.

·         Stress and anxiety management.

·         Work/Life balance.

·         Vocational Rehabilitation – needs to be meaningful.

·         Pro-social skills.

Satisfaction

·         Occupational focus.

·         Evaluation.

·         Staff support.

·         Grading and adapting.

Recovery

·         Moving forward in the community.

·         Life skills.

·         Building positive futures.

Implications for OT

·         Helping them understand and develop a ‘good life’ now in order to have a ‘good life’ in the future.

·         OT is central to assessing and addressing social functioning.

·         Opportunities are needed to support a future lifestyle with meaning.

·         Variation in occupational opportunities to encourage the development of social function.

Neurological Practice - Paper Session.

“Understanding Prism adaptation as a potential treatment for unilateral spatial neglect.”

“Understanding Prism adaptation as a potential treatment for unilateral spatial neglect.”

Turner AJ, University of the West of England, Bristol.

29.06.2011

Before attending this paper session I was unaware of the Prism adaptation. After listening to the session I was interested in finding out more. From a quick bit of research into the technique this is what I have found out along with what was expressed within the session:

A large proportion of right-hemisphere stroke patients show hemispatial neglect—a neurological deficit of attention, perception and representation presenting as left-sided neglect, inducing many functional debilitating effects on everyday life for example difficulties may arise within mobility, writing, reading and object description etc.

Prism adaptation is a bottom up approach based on the idea of procedural learning and spatial mapping. It is commonly applied by having a person put on goggles with wedge prisms that laterally displace the visual field by around 12degrees adapting the individuals proprioception. The person then interacts with the environment, for example, by pointing toward visual targets.

From the study presented it was revealed that a course of prism adaptation can have positive improvements for stroke patients within developing everyday skills and task participation. It should be recognised however that more research is needed within this area.

The study also revealed that the effects of the technique began to become functionally visible within three days of practice and then could last for two days before the effects wearing off. 

Finally it is important to remember that each individual stroke patient is different and where they are on the recovery curve will impact on the effectiveness of this technique.

The technique seems that it could be easy and simple to carry and could prove to be effective in Stroke/Neuro-rehabilitation. With some further research It could be an important technique to incorporate into clinical practice.

Forensic Forum - Keynote Address

“Forensic Recovery and Rehabilitation”

Dr Tor Pettit and Dr Patricia Abbott – Pennine Care.

29.06.2011

There were three main learning objectives or questions which were covered throughout this address:

1.       What is recovery?

2.       Is recovery different in a forensic setting?

Why OT?

1.

Some brief notes on the definition of recovery:

·         Living a satisfying, hopeful and contributing life alongside an illness.

·         It’s not necessarily a cure.

·         Living well with an illness.

·         Growing as a person.

·         Never underestimate potential quality of life.

·         Analogous to the disabilities rights movement.

Recovery presents challenges for clients:

·         Developing a positive identity.

·         Framing the ‘mental illness’. – Personal experiences. We need to be client centred and see it from their eyes.

·         Self managing mental illness/antisocial- negative behaviours and attitudes.

·         Developing valued social roles.

Recovery also present challenges for staff:

·         Working collaboratively – patients as experts of their lives, OTs as experts in their profession, MDT working.

·         Maintaining hope. Believing in someone who may not have been believe din before. Future orientated.

·         Helping the person to:

o   Understand their own story.

o   Take control/ accept responsibility.

o   Develop plans for getting better/ staying well.

2.

Recovery within forensic settings is crucial is the basic answer. Although it can be hard to justify and carry out when taking into consideration the priority of risk management. Perhaps OTs within forensic services should consider pushing for a shift from:

Managing risk to promoting safety!

Recovery must of course accommodate risk. Risk being the main reason why people are admitted to forensic services. It is important however to understand and monitor how risk labels can negatively affect individuals. Risk accentuates problems with recovery including, its affect on identity, environment, social impact, labelling and personality theories, enduring mental illnesses and also crime and its effects.

Recovery within forensic settings can be achieved in many ways, here are four ways explored:

·         Work collaboratively –Prioritising relationships. Looking for a hook (motivation). Which life choices can we support?

·         Maintaining hope – finding common goals. Future Goals, future you!

·         Helping the person to: Understand their own story, develop future plans/ getting better and staying well.

·         Interventions for cognitive impairment – collaborative working, environmental management, Antecedal control, compensatory aids, structured programs of enjoyable activity, long term goals, and increased tolerance. 

3.

·         Personalised approach – client centred.

·         Enhancing life and quality of life.

·         Moving towards independence.

·         Promoting positive identity and self confidence etc.

Opening Plenary

“Occupation, Evidence and Outcomes: the future of our profession.”

Professor Mary Law – Professor, School of rehabilitation Science, McMasters University and lead author of the Canadian Occupational Performance Measure (COPM)

29.06.2011

Participation is the raison d’etre of occupational therapy.

According to the World Health Organisation (2011) over 27% of people in the UK have a disability which impedes on everyday life. Add this to the current climate (financial, environmental, and societal) and also the complex lifestyles that we now lead it is recognised that people need occupational therapy now more than ever before.

It is widely acknowledged that physical and mental health is affected by financial and economic status. A lack of participation in activities and occupations of importance and meaningful can lead to a decline in the health and well-being of individuals, eventually leading to occupational deprivation. 

Occupational deprivation being defined as:

“a state of percussion from engagement in occupations of necessity and/or meaning due to factors that stand outside the immediate control of the individual.” (Whiteford 2000 p.201)

Participation in activities is also crucial for in life transitions, especially within children and teenagers. For adults and older people participation is associated with feelings of:

Usefulness

·         Engagement

·         Improved health and wellbeing

·         Increasing cognitive behaviours and levels (which can be maintained as well as lengthened through participation in activities.)

It is also important to remember that a person’s diagnosis does not directly affect participation. Elements such as functional ability, personal preferences and environments etc. do. This is where Occupational Therapists are perfectly suited to work with individuals due to their client-centred, holistic and non-medical model focus on assessment and treatment.

OTs open doors to participation and increase individuals participation and involvement in life activities.

Evidence Based Practice as an interlinked concept!

Key principles:

Practice context

·         Occupational science, theories, models of practice, frames of references etc.

·         Therapist’s wisdom and training.

·         Therapeutic use of self.

Person(s) receiving OT services

·         Meaningful occupational goals.

·         Person(s) experiences, dreams and needs.

(Both motivation and positive therapy outcomes are increased by these.)

Occupational and individualised goal setting helps people to focus on participation and helps people to see more realistic and fulfilling goals for themselves. This leads to significant improvements in goal achievement and meaningfulness increasing as opposed to when using generic goals/therapy.

 Best research evidence

·         Occupational focused interventions

·         Changing environments

·         Prevention.

Occupation should be both the means and the end of therapy.

Other key points from the plenary:

·         Professionals are defined by the outcomes of the therapy and their effects to their clients.

·         Occupation is the focus of therapy and participation should be our cornerstone. Outcome measures should reflect this.

·         For ever complex problem there is no simple solution. As OTs we need to draw on all our knowledge and take a holistic approach to each individual client.

Occupational Therapists understand and celebrate complexity.

Home sweet home!

Hello!

Firstly big apologies for not being able to daily update the blog. Unfortunately I have not had internet on my laptop this week and writing blogs on my phone (as good as Blackberrys are) would have taken me forever and induced many a headache!

Conference is now over and I am home sweet home! What a brilliant week I have had. Learning new things, networking with lots of interesting people and reaffirming passions for clinical areas.

If you have not been to the Conference before then I would definitely recommend going. Next year’s COT conference is going to be up in Glasgow, Scotland between the 11-14^th June 2012 which is meant to be a beautiful city - so why not take the week off work and have a holiday as well as going to conference.

The key message which resounds for me from this years conference is the need for us as OTs to place a focus on helping our clients to:

“Live a life which is not dominated by disability.”

I hope you find my notes and thoughts from the various sessions I attended of both interest and of help to you. If you have any questions or would like to contact me in any way then please feel free. :)

Kate.

Day One in Brighton!

Today I arrived in Brighton, the weather has been absolutely beautiful (makes me dream of life in sunnier lands) and I have managed to successfully find the Travelodge and the Brighton Centre where the conference starts tomorrow. Its very exciting being here on my own. I feel very grown up! I spent an hour or so sat by the Brighton Pavilion today which was stunning. The plan for tomorrow is to fit some shopping in, including buying a nice new notebook to take conference notes, before heading to the welcome drinks at the conference.
I don't have the internet in my travelodge room so am blogging on my phone. Will try and blog each day although if I have too much to write I shall wait and post it once I'm back home.
Hope all of you have enjoyed the sun today and have a lovely evening.
I'm off to go get some noodles in a box. Living the dream! :)