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The role of the OT
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24/09/2012
1
WORKING WITH FAMILIES AND
CARERS: THE OCCUPATIONAL
THERAPIST’S ROLE
VERNA MORRIS SPECIALIST BRAIN INJURY OCCUPATIONAL THERAPIST/
COUNSELLOR
Why Families and Carers?
The Context
SSNP GUIDANCE DOC – “Occupational therapists
working with adults with acquired brain injury:
Guidance for clinical practice”
Mapping for Practice
The Context
SSNP GUIDANCE DOC – “Occupational therapists working
with adults with acquired brain injury: Guidance for clinical
practice”
maps
National Service Framework for Long-term
Conditions (2005). Department of Health
and
Rehabilitation following acquired brain injury:
National clinical guidelines (2003). Royal College
of Physicians/British Society of Rehabilitation
Medicine
What will be included
The Guidelines context
Brain Injury and the Family
Reflective Questions
Therapeutic Relationship
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Objectives
An exploration of the key reflective
questions around working with families
and carers including a review of some of
the available evidence base.
Opportunity to use the questions to reflect
on your own practise.
“COPING WITH ONE
OF THE MOST
DIFFICULT TASK THAT
CAN CONFRONT A
FAMILY”
(Florian et al, 1989)
What makes brain injury so
difficult for families?
Changes in the injured person
Over 80% of brain injury survivors show personality changes
(Webster et al 1999)
Neurobehavioural sequelae – Disinhibition, increased irritability, emotional lability, aggression, poor memory, lack of concentration, rigid thinking
(Carnes 2005, Ergh 2002, Florian 1989, Webster 1999)
Other things we know
Families often experience an increase in stress and
strain and changing and expanding needs as time
since injury progresses (Stebbins 1998, Brooks 86)
Quality of life can diminish over time (Kolakowsky-
Hayner 2001)
The impact is not just confined to the primary care
giver (Bowen 2010, Daisley and Webster 2008, (Perlesz
1999)
Not all families don’t cope (Perlesz 1999, Gervasio and
Kreutzer 1997)
Not all families don’t cope
Between 50% and 80 % of primary carers
reported being satisfied with their families.
Between 27% and 41% of tertiary carers
displayed high levels of psychological distress.
(Perlesz, Kinsella and Crowe 1999)
56% of 116 people did not report elevated levels
of distress
(Gervasio and Kreutzer, 1997)
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“PATIENTS WHO HAVE
SUPPORTIVE FAMILIES DO
BETTER IN REHABILITATION
THAN THOSE WHO DO NOT”
(Saedy 2010, Sander 2002, Turner 2009)
Key Reflective Questions
REFLECTIVE QUESTION
“HAVE I CHECKED ON HOW FAMILY
MEMBERS AND CARERS ARE COPING WITH
THEIR RELATIVE’S FUNCTIONAL PROBLEMS
AND IF REQUIRED,
HELPED THEM TO DEVELOP PROBLEM
SOLVING STRATEGIES TO HELP THEM COPE
WITH FUNCTIONAL SITUATIONS AND
ISSUES THAT ARISE IN THE HOME?”
(Carnes 2005, Bais and Boisvert 2005)
Coping
Problem focussed – attempts by the
individual to deal with stress by acting on
the environment or the self
Emotion focussed - involves a reappraisal
of the stressful problem entailing a
change in the perceived meaning of the
problem
(Verhaeghe 2004, Davis 2009)
REFLECTIVE QUESTION
“HAVE I CHECKED ON HOW FAMILY
MEMBERS AND CARERS ARE COPING WITH
THEIR RELATIVE’S FUNCTIONAL PROBLEMS
AND IF REQUIRED,
HELPED THEM TO DEVELOP PROBLEM
SOLVING STRATEGIES TO HELP THEM COPE
WITH FUNCTIONAL SITUATIONS AND
ISSUES THAT ARISE IN THE HOME?”
(Carnes 2005, Bais and Boisvert 2005)
Case Study example
Client: Steve – pre injury a lorry driver
Family: Wife – Janice who now works part time in
the afternoons and also looks after her elderly mum
with dementia, 2 children aged 7 and 11
Steve had a brain injury and an incomplete spinal
injury 18 months ago
Steve’s goal – to learn to make interesting meals
OT activity meal planning and preparation
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Case Study – example
Help with Problem focussed coping through
acquiring the skills to plan and safely prepare
meals
Help with emotion focussed coping though
helping them reappraise their role change in a
positive way
REFLECTIVE QUESTION
“HAVE I OFFERED INFORMATION AND
EDUCATION ABOUT THE NATURE OF THE
BRAIN INJURY AND ITS POTENTIAL IMPACT
ON THE CLIENT’S ROLE PERFORMANCE
AND FUNCTIONING?”
(Kreutzer 1994 & 2010, Oddy & Herbert 2003)
REFLECTIVE QUESTION
“HAVE I ‘NORMALISED’ THE BRAIN
INJURY RELATED FUNCTIONAL
PROBLEMS ENCOUNTERED BY THE
PATIENT AND THE FAMILY MEMBERS’
EXPERIENCE AND REACTION?”
(Kreutzer 1994)
REFLECTIVE QUESTION
“HAVE I OFFERED AND IF REQUIRED
PROVIDED FAMILY MEMBERS AND CARERS
WITH INVOLVEMENT AND A
COLLABORATIVE PARTNERSHIP ROLE IN
PLANNING AND CARRYING OUT TREATMENT
OBJECTIVES, DEFINING REHABILITATION
GOALS AND PROCESS?”
(Sohlberg et al, 2001)
True collaboration requires:
Respect for the family’s knowledge of the
person with the ABI
Recognition of their strengths and
resources
Family involvement throughout the
assessment and intervention process
(Sohlberg et al 2001)
REFLECTIONS ON
THE KEY REFLECTIVE
QUESTIONS!
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Reflective Questions
From the list identify any that stand out or
resonate for you personally.
Use the opportunity to share your
thoughts/perspective/experience with 1
or 2 people around you. THERAPEUTIC
RELATIONSHIP (Schonenberger 2006, Sherer 2007, Kreutzer
2010)
TRUE OR FALSE
This OT cares about me
This OT understands me
This OT respects me
I can trust this OT
To recap…..
The Guidelines context
Brain Injury and the Family
Reflective Questions
Therapeutic Relationship
FINALLY……
“PATIENTS WHO HAVE
SUPPORTIVE FAMILIES DO
BETTER IN REHABILITATION
THAN THOSE WHO DO NOT”
Sander 2002,
