I n t e r v e n t i o n

Learning Disability and the Community Setting

MSC/PGDIP OCCUPATIONAL THERAPY TOT_7_005

By: Kim Lee

Statement of Confidentiality and Consent

Confidentiality

In adherence with professional standards and to ensure the anonymity

of the client referred to in this case study, the pseudonym Kimberly has

been chosen as the patients’ identifier. In addition to the pseudonym, the

name of the practice educator, staff and location have been omitted or

made anonymous.

Consent

Prior to the commencement of this assignment, verbal consent was

obtained from both the client and practice educator for use of case

information and materials.

Discuss the effects of the following on Kimberly:

• To discus the application of the OT process as it applies to

Intervention within a community Learning Disability (LD) Setting.

• To quickly look at current legislation and its influence on interventions

within the community LD Setting.

• To analyze clinical reasoning used in implementing the chosen

intervention for Kimberly.

• To examine a possible gap in the service’s application of the OT

process. (Suggestion ???)

Objectives

The white paper Valuing People (Department of Health, 2001) was published

to help people with learning disabilities to live normal lives in the community.

It set out the government’s vision for people with learning disabilities based

on the key principles of rights, inclusion, choice and independence. In line

with human rights legislation, the NHS is required, as a public body, to

promote disability equality as outlined in the disability equality duty (Office for

Disability Issues, 2006). The policy exists to give disabled people real choice

and control over the services they receive.

Legislation and Good Practice Guidelines

The extra difficulties for people with learning disabilities who come from

BME communities have been nationally acknowledged and referred to as

being double discrimination against.

file://localhost/Users/charylpitts/Downloads/

Setting_up_a_learning_disability_acute_liaison_team__Practice__Nursing_

Times.htm

Black and Minority Ethnic groups

Kimberly the Client is as a:

• 22 years old

• Female

• She is of African descent

• Has a mild to moderate learning disability

• Lives with her mother, 19 yr. old brother and small dog in a privately owned 3

bedroom house

• Kimberly in known to the adult LD Service and had recently expressed a desire

to learn the skills needed to prepare simple meals for herself safely and

independently

Background Information (PP2)

Setting:Adult Community Learning Disability

MDT made up of Psychiatrist, Psychologist, Nursing, Social workers,

Speech and Language Therapists, Occupational Therapists, Care

Managers all with the purpose to facilitate and help improved client

independence.

Background Information (PP2)

• Gathering information from what is not said, from the not so

obvious, reading the total situation.

• Kimberly’s back story

Kimberly’s Back Story

• College of Occupational Therapists of Ontario, (2003) suggests that

clinical reasoning allows the occupational therapist the ability to

analyze all relevant information collected about the client using logic,

rationale, and a balance of subjective and objective information as a

base to continuously develop recommendations, and determines

resources in relation to those recommendations.

Clinical Reasoning

The base three elements of this model underpinning clinical reasoning:

• Is it possible? (Performance Capacity) analyses the persons mental,

physical & sensory capabilities

• The Why and What’s? (Volition) refers to the process by which persons

are motivated toward and choose what they do.

• The Influences of How? (Habituation) analyses the person’s habits and

routines.

“Volition, habituation, performance capacity and environmental conditions

always resonate together, creating conditions out of which our thoughts,

feelings and behavior emerge”(Kielhofner 2004).

Model Of Human Occupation (MOHO) and Clinical Reasoning

The process can be organized into three overarching categories

that include:

• Evaluation

• Intervention

• and Outcome

(Moyers,1999)

Stages of the OT process

Stages of the OT Process

• The client and therapist can then decide if the intervention plan involves

restoring, developing or maintain particular functions (Law et al., 1990;

Pollock, 1993), and the results can be used to tailor specific interventions

for a maximizing potential (Crist, 1998).

• In the case of Kimberly

Kimberly’s Intervention

Educative Approach – This approach is directed at providing information that

enhances the client’s knowledge base.

In Kimberly’s Case:

Kimberly’s Intervention

Humanistic, Cognitive, Social, Behaviorism, and Experimental learning

• Humanistic – refers to how an individual perceives and or feel about

themselves. It incorporates a self concept and the need to strive for growth.

• Experimental Learning – According to Gibbs (1988) learning from

experiences involve a link between doing and thinking.

• In the case of Kimberly:

Theories underpinning Educative Approaches are:

C o o k i n g a s a n I n t e r v e n t i o n

• Synthesizing all the information gather thus far

• Talking to Kimberly about her goals, her vision what she want to

achieve overall and from the cooking sessions

• Managing Kimberly’s expectations

• Analyzing and address possible risks and safety issues

• Consider the suitability of the environment and supplies needed

• Family finances, schedule and dynamics

Before the first cooking session even begins…

Aspect of Intervention and the OT Process

• College of Occupational Therapists of Ontario, (2003) suggest that goals

and outcomes should be monitored and documented and an Occupational

Therapist should evaluate intervention plans using recognized outcome

measures in conjunction with the service user.

Outcome Measures a possible gap in the OT process

C r i t i c o f O u t c o m e M e a s u r e

• Dunn W 2000 Best Practice in community services with children and

families. Throfare, NJ: Slack

• Gibbs G 1988 Learning by doing: a guide to learning and teaching

methods. London, The Geography Disiplind Network [GDN] Further

Education Unit

• Kielhofner G 2004 Conceptual foundations of occupational therapy 3rd

edition. Philidelphia, FA Davis Company

References

T h a n k s