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OT-Pathways-LLL event-London region-2009-Morley.pdf

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  • 1. 11/17/2009 Occupational Therapy Pathways: Overview of Presentation the journey so far • London Mental Health OTs Leads programmes • London adapted pathways project: the journey so far • Sharing Tips for ImplementingDr Mary Morley, South West London and St Georges Mental Health NHS Trust National Strategy for Occupational Our journey so far… Therapy • Individual Trusts with different systems and patchy OT Key messages: involvement in IM&T agenda • Phased introduction of RIO electronic healthcare record • Build pathways of care across 7 London mental health Trusts that highlight what • Pan-London network of OTs with a special interest of service users can expect IM&T of their intervention – Seven MoHO assessments built into RIO – Shared format for ADL assessment reports – OT Guide to RIO • Pathways development network • Provide evidence for • Collaborating on quality metrics and PROMS commissioners on the • Representation on local, London-wide and national effectiveness of OT working groups interventions • ……..enthusiasts but not experts COT (2006) Definition of an High quality care for all: NHS Next Stage integrated care pathway Review final report: 30 June 2008 “A multidisciplinary care plan that give • Focus on the quality of detailed guidance for each stage in the care; outcomes not inputs care of a patient with a specific condition, over a given period of time”. • Pathways of integrated (Riley,1998) care • Change will benefit An ICP is a document that describes a patients and process within health and social care, and • Be clinically driven and that collects variations between planned locally led and actual care. 1
  • 2. 11/17/2009 Benefits of ICP’s - Benefits of Therapy Pathways a whole systems approach • To provide a Occupational Therapy pathway of• Aligned with government and professional guidelines care that is clear to all• Gives a structure of care that is clear to all and • Supports the use of evidence based tools underpinned by evidence-based practice • A tool to analyse what works and what doesn’t• Outcome–based approach to service delivery • Promotes occupational therapy’s specific• Provides a systematic approach to the review and contribution to mental health improvements of practice • A tool for teaching, supervision, induction and• Makes the best use of resources staff satisfaction Why this matters to service users A Collaborative Pathway Project • In 2002, 2gether NHS Foundation Trust started to develop OT pathways with UKCORE • Includes guidance of best practice, evidence based, • The original pathway was developed by Jane Melton and Jonathan Hill (2gether NHS Foundation Trust) and Dr. Kirsty Forsyth, (UK client-centred care used in the everyday setting Centre for Outcomes, Research end Education (UKCORE) • These were presented at national conferences 2005 and 2008 • Provides better information to service users about • In 2007, OT Leads of London Mental Health Trusts proposed a shared their care, choices and expected outcomes project adapting the original pathways • Dr. Mary Morley and Majvor Darnton (South West London & St. • Provides a more consistent service to those with Georges Mental Health Trust) adapted the pathways on behalf of the Professional Leads for Occupational Therapy in the London mental highest levels of occupational need health Trusts. • 8 occupational therapy pathways have been agreed • Pathways launched at COT in September 2009 Occupational Therapy Pathways The adapted London OT Pathways: Process• Acute adult in-patient • Developed by experienced practitioners across the• Community mental health nine Trusts who pooled expertise and evidence.• Rehabilitation• Forensic• Older people • Use MOHO and COPM as evidence-based• Employment theoretical models for outcomes.• Child and Adolescent mental health• Learning disabilities • Include latest policy and guidance. Melton, Forsyth, Hill, Morley (2009) Occupational Therapy Care Pathway (adapted version), 2gether NHS Foundation Trust, UKCORE & London Occupational Therapy Mental Health Professional Leads. (Unpublished). • High level pathways for adapting into local contexts.NB Substance misuse pathway now being written • Used process mapping to design the occupational therapy part of a wider MDT integrated pathway. 2
  • 3. 11/17/2009 Format ofOccupational therapy pathway: a high- Occupational Therapy level pathway linked to the mental health Pathways pathway • Made up of a document – Background Multidisciplinary team pathway – Instructions for use – Narrative with symbols and explanatory text OT physical pathway – References AND • Flowchart OT pathway Mental Health Pathway The Pathway Folder Getting Staff Engagement • Copies for each OT • Remember this is a change management Lead containing: process: To fail to plan is to plan to fail • Handbook • Use a phased approach • Training Materials • Occupational Therapy • Sell the positives Pathways Narratives and Flowchart • Perseverance • References and resources • Don’t re-invent the wheel • CD-Rom – Pdf Versions of narratives • Share workload and ideas with other OT and flowcharts leads – Powerpoint presentations of training materials Making a difference… It capture’s a lot about me and it feels therapeutic to read. (Service user) How did you get this…to occupational therapists information? I’ve been trying for ages without success. (Team member)• I’m newly qualified OT and as the only OT on my That’s me team I am extremely grateful to have these tools to down to a tee…can I keep help structure and guide my practice. (OT) it? (Service user) I didn’t realise the value of OT’s, It’s the• Using the MoHO assessments gives me a clearer best report I’ve seen” understanding of the clients on my caseload. (OT) (Team member) If only all reports were as specific as OT reports the job of theAnd to others……….. accommodation panel would be so much easier (Chair of Housing Panel) 3
  • 4. 11/17/2009 Getting Going – where to start? • Pilot the pathways and allow enough time Pilot Project • Leadership with pathway experience as well as • Make yourself familiar with the concept of clinical expertise pathways • Secure senior stakeholder support, eg service managers • Identify service • Link up with other pathway work in the Trust • Set specific aims and objectives • Remember implementing the pathways will change what the OTs are doing or not doing • Select a small team to lead the pilot • Training and introduction Pilot and Review Occupational Therapy Variances - • Discuss outcomes of pilot and actions Start by setting goals for the expected service…. • Redesign pathway to suit your service • What are the occupational therapy • Implementation objectives? • What are our standards? • Variance tracking to monitor and review • How will these be measured? • What variances might you expect? • Focus on the long-term benefits and be generous with ideas and solutions Example of a variance tracking sheet: Variance Recording :Complete when recommended interventions do not occur Information gathered - Date Activity Code Varian ce Code Action to be Taken (If you need to repeat an intervention then fill in the blank rows in the appropriate time frame) SignThis should:• provide us with the evidence that we have met our objectives Variance Source Codes• be easy to use Patient/carer codes 1.1 Patient unavailable System codes 2.1 Date and time of Other agencies 3.1 Accommodation not 1.2 Carer unavailable intervention changed available• add value to our service users and/or .3 Patient refused 1.4 Carer refused 2.2 Awaiting consultation from others 2.3 Staff/service not available 3.2 Community support not available 2.4 Lack of time 3.3 Day services not available 1.5Intervention inappropriate service 1.6 Deterioration of mental state: 1.7 intervention inappropriate 2.5 Intervention postponed/cancelled 3.4 Funding/benefits not available 2.6 Information/results not 3.5 Transport not available 1.8 Improvement of mental state: available 3.6 Other (please state) 1.9 intervention inappropriate 2.7 Dept closed/room not 1.10 Patient refused due to poor available motivation 2.8 appointment not 1.11 Intervention repeated due to available/delayed lack of understanding or skill 1.12 2.9 Other (please state) Other (please state) 4
  • 5. 11/17/2009 With thanks to: Next Steps• London adapted pathways to be piloted in local services• London adapted pathways will be included in Assessments Manual • Chairs and members of the work to be published in next few months groups for each pathway• Mental Health OTs engaging in London AHP Quality metrics and • Majvor Darnton, Pathway Project lead – Occupational Therapy, PROMS work SWLSTG• OT pathways form an important building block in the OT mental • 2Gether NHS Foundation Trust health PbR work and UKCORE who generously shared their pathway• PbR Core group has embarked on two-phase study in collaboration • South West London & St with Kielhofner (UIC) to develop ‘care pathways’ for the 21 PbR Georges Mental Health NHS clusters: Trust who hosted and funded the – Data analysis of MOHOST to identify occupational profiles for project service users And the the London Leads for Occupational Therapy in Mental – Action research study to develop care pathways for the profiles Health Trusts for supported this project (and the next!) 5

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