Michelle French - MFA Medico Legal and Occupational Therapy Services - A Client Centred Model of...
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Client Centered Framework of Care for people with complex
Care Needs
Michelle French, OT &
Marg Darcy, PT
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Client Centered Framework
• Integrated model of care; • Person centered; • Theore<cally based; • Mo<va<ng; • Strength based; • Cost effec<ve and • Empowering!
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Why is this needed ? • Need to reexamine the way in which we work with this popula<on;
• The number of people with high physical, cogni<ve and communica<on impairments is growing and surviving longer;
• This popula<on has high front end costs (i.e. acute medical care), but there is not gap at the other end;
• This popula<on is vulnerable and safety and comfort is paramount.
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The Person-‐Environment-‐Occupation Model of Occupational Performance
• Interplay determines occupa<onal performance
Person Task/Occupation
Environment Source: The Person-Environment-Occupational Model: A transactive Approach to occupational performance, Law. et al 1996 Canadian Journal of Occupational Therapy 63 (1), 9 – 23.
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Changes over Time
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Changing needs… • Support needs change with <me depending on the person, environment and occupa<on;
• Role of the team is to proac<vely manage the natural process of change;
• Unmet needs ! challenging behaviour
“unmet needs behaviours”
• Outcome that we aim for is preventa<ve based;
• Maintaining the person as an individual;
• Provision of some level of joy in the person’s life.
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Person centered….. • Establish goals as a team;
• Use of standard tools to establish goals
• Wessex Head injury matrix WHIM
• Goal AWainment Scales -‐ GAS
• Canadian Occupa<onal Performance Model -‐ COPM
• SMART goals
• Develop a plan – who, does what, when;
• Review and adjust as necessary.
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Wessex Head Injury Matrix WHIM
• What does it assess? • Recovery in pa<ents with severe head injury. • Who is it suitable for?
• Pa<ents with a severe head injury, aged 16 years+. • Could be adapted for younger individuals, but care is needed and there is no research to support this.
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GAS Scales
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COPM • Looks at three major life areas
• Self-‐care; • Produc<vity and • Leisure • Person self rates their performance and sa<sfac<on
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SMART goals
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Developing a plan
• Consider: -‐ • Equipment needed
• Environment – inclusive of rou<nes and regimes
• The person’s strengths and the meaningfulness for the person with their life context;
• SAFETY & COMFORT
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Safety
• Without individuals feeling safe and having an environment of safety, they then have reluctance of taking part in the city of being ac<ve. They wind up wan<ng to leave the city. That's more detrimental.
Dick Powell
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Chris & Russel example
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Russell & Chris
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Safety & Comfort • People want to contribute;
• PAIN!
• Biomechanical model vs a func<onal model;
• Need to inves<gate and explore HOW can people with complex needs contribute;
• Contribu<on cannot happen if the person is in pain or there is no meaning in the ac<vity for them.
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Safety includes … • Effec<ve posi<oning; • Appropriate equipment;
• Gentle manual handling;
• Well training primary care team;
• Well training aWendant care team.
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Integrated and controlled sensory input
SIGHT SOUND
MOVEMENT
TOUCH
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Why does this approach work???
• Acknowledgement that all people have something to offer and contribute
• Agreed method of care, which is based on an integrated model of care;
• Overlap between therapists Transdisciplinary approach • TRUST, openness and coordina<on/case management • Based on transference of knowledge and skills; • Frequent feedback and adjustment of program;
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• Cri<cal to the success of this approach is:
• The selec<on and training of aWendant carers;
• Careful prescrip<on of equipment to meet the client's needs
• Therapists training carers, family and friends;
• The establishment of a key worker role;
• Regular support of aWendant care workers;
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Procedural Learning
• Manual documen<ng detailed sequencing of all personal care interven<ons and associated sensory prompts;
• Video visually presen<ng the sequencing of interven<ons and the slow pace required for interven<ons in real <me
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Motivation !
• Ac<vity must be meaningful for the client;
• Ac<vity should be strength based – looking at what the client can do;
• All ac<vi<es should be implemented in a procedural manner, every <me;
• There must be some degree of ‘JOY’ and it is essen<al that the person feels SAFE and COMFORTABLE
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Empowering • For the individual
• Safety and comfort;
• Choice making;
• For the carers and families
• Valued members of the team • Increase in confidence
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Cost effective • High cost at the beginning
• Establishment of the program
• Provision of support documenta<on and DVD’s
• Daily care plan • Health management plan
• Maintenance – ongoing care
• Peeks and troughs • Reten<on of carers
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Ongoing questions • This approach has enabled successful management of clients with complex needs over long periods of <me while providing them with choice, QoL, safety and comfort;
• The challenge now is to get governments and agencies to commit : -‐
• The money • Time
• Training • Individualised care
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Everyone deserves JOY!
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