1. Learning Disability and the Community Setting
MSC/PGDIP OCCUPATIONAL THERAPY TOT_7_005
By: Kim Lee
2. 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.
3. 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
4. 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
5. 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
6. 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)
7. 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)
8. • Gathering information from what is not said, from the not so
obvious, reading the total situation.
• Kimberly’s back story
Kimberly’s Back Story
9. • 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
10. 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
11. The process can be organized into three overarching categories
that include:
• Evaluation
• Intervention
• and Outcome
(Moyers,1999)
Stages of the OT process
13. • 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
14. Educative Approach – This approach is directed at providing information
that enhances the client’s knowledge base.
In Kimberly’s Case:
Kimberly’s Intervention
15. 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:
17. • 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…
20. • 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
22. • 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
