The Model of Human Occupation &
Practice Development
Why Practice Development?:
National Drivers
• Evidence-based practice
David Heasman
Lead Occupational Therapist, Practice Development
South West London & St Georges Mental Health NHS Trust
• Clinical effectiveness &
added value
• ‘……use outcome measures that
give clear evidence that
occupational therapy has made a
difference to people’s occupations’.
[email protected]
COT, 2006
Why focus on one model?
Why MOHO?
Shared concepts & language >
clarity & consistency of communication
• Most evidence-based occupational
therapy model
Allows outcomes to be gathered in a
consistent manner > foundation for audit /
research
• Extensive battery of standardised
assessment tools
Facilitates more efficient practice
development / training
• Volition: importance of motivation
& engagement in mental health
1
Barriers to using MOHO
Lack of knowledge / confidence in applying the
model
Lack of motivation / interest
Lack of time
MOHO Practice Development:
Infrastructure
• Purchased MOHO assessment tools / manuals
• Appointed Practice Development Occupational
Therapist
Difficulty accessing assessment tools etc
Generic working
MOHO Practice Development:
Infrastructure 2: Information Technology
• 2005: Introduction of e-MOHO
software package
• 2007: Introduction of RiO (ECR):
7 MOHO assessments built in
2
MOHO Training Workshops:
Clinical Forums
•
•
•
•
•
•
•
•
•
•
•
•
Adult Kingston
Adult Merton
Adult Richmond
Adult Sutton
Adult Wandsworth
Older people R&W
Older People K,M&S
Rehabilitation
Forensic
Eating Disorders
PLD
CAMHS
Ongoing support mechanisms
• Clinical Forums
• UK Centre for Outcomes Research & Evaluation
(UKCORE): Infrastructure; Assessment; Case
Formulation; Intervention
• Clinical Forum Leads Group
o dynamic & proactive working group focused on
identifying challenges to & strategies for MOHO
implementation
o forum for advice & support in leadership roles
MOHO Practice Development
The Process 2: Workshops
• Structure: 6 x 1.5 hrs or 3 x 3hrs
• Content
MOHO theory
Assessment – selecting and using tools appropriately
Clinical reasoning & case formulation
Intervention
Documentation
Evaluation: outcome measurement
Pan London Collaboration
• Established Track record of Pan London
collaboration within mental
health occupational therapy
• RiO installed on 7/9 Mental Health Trusts –
opportunities for collaboration
• Latest development: network to collaborate
on developing MOHO-based Care
Pathways
3
Care Pathways
MOHO Based Care Pathways
• ‘plans of care that give detailed guidance for each stage in the
care of a patient‘ (Riley 1998).
Benefits:
• Means of embedding MOHO into routine
practice
• Means of implementing clinical guidelines & evidence-based
practice
• Provide explicit guidance on what service users and MDT can
expect from their occupational therapist.
• Provide clear guidelines for therapists
• Promote efficient use of resources & clarify occupational
therapy’s added value
• Means of consistently monitoring and improving clinical
outcomes and experience of the service user
Update on Progress:
No. of completed MOHO assessments
Assessment
MOHOST
OCAIRS
Worker Role Interview
ACIS (Communication-interaction)
OPHI-II (Life history)
Volitional Questionnaire
Work Environment Impact Scale
TOTAL
No. completed
6.07 – 9.08
358
130
6
4
2
2
1
• Process
Map current practice
Identify areas for improvement / added value of
introducing MOHO
Introduce ‘Gloucester’ Pathway template
Introduce Pan London versions & adapt for local use
Evaluation / Update on Progress
Ambivalence (Strategies):
• monitoring & accountability
• explore reasons why staff having difficulty
• reward high achievers
503
4
Pre-Post Outcome measurement
Lessons Learned
• Changing OT practice is not easy!
Service Assess’t
Name
User
Baseline
Date
Most
Recent
Date
Most
Max
Baseline Recent Poss.
Score
Score Score
• Need strong infrastructure & practice development
strategy with clear leadership.
• Training: Workshops in MOHO application
• Ongoing support structures
Jane X
MOHOST 04/01/08
18/01/08
62
80
96
• Monitoring & Accountability
• Work closely & proactively with IMT
John Y
OCAIRS
27/11/07
30/04/08
15
33
48
5