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Michelle French - MFA Medico Legal and Occupational Therapy Services - A Client Centred Model of Care for People with Very High Physical, Cognitive & Communication Needs Living in the Community
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Michelle French - MFA Medico Legal and Occupational Therapy Services - A Client Centred Model of Care for People with Very High Physical, Cognitive & Communication Needs Living in the Community

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Michelle French delivered the presentation at the 2014 Younger People with very High & Complex Care Needs Conference. …

Michelle French delivered the presentation at the 2014 Younger People with very High & Complex Care Needs Conference.

The 4th Annual Younger People with very High & Complex Care Needs Conference focused on topics such as report on Summer Foundation’s preliminary findings from NDIS Launch sites in Barwon & the Hunter Valley, identify policy & practice opportunities & barriers for YPINH that arise from the NDIS.

For more information about the event, please visit: http://www.informa.com.au/youngerpeopleconference14

Published in Health & Medicine , Education
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  • 1. Client  Centered  Framework  of   Care  for  people  with  complex   Care  Needs     Michelle  French,  OT     &     Marg  Darcy,  PT  
  • 2. Client  Centered  Framework   •  Integrated  model  of  care;   •  Person  centered;   •  Theore<cally  based;   •  Mo<va<ng;   •  Strength  based;   •  Cost  effec<ve  and   •  Empowering!  
  • 3. 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.  
  • 4. 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.
  • 5. Changes  over  Time  
  • 6. 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.  
  • 7. 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.  
  • 8. 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.    
  • 9. GAS  Scales    
  • 10. COPM   •  Looks  at  three  major  life  areas   •  Self-­‐care;   •  Produc<vity  and     •  Leisure   •  Person  self  rates  their  performance  and  sa<sfac<on  
  • 11. SMART  goals  
  • 12. 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  
  • 13. 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    
  • 14. Chris  &  Russel  example    
  • 15. Russell  &  Chris    
  • 16. 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.    
  • 17. Safety  includes  …     • Effec<ve  posi<oning;   • Appropriate  equipment;   • Gentle  manual  handling;   • Well  training  primary  care  team;     • Well  training  aWendant  care  team.  
  • 18. Integrated  and  controlled  sensory   input   SIGHT     SOUND     MOVEMENT     TOUCH    
  • 19. 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;  
  • 20. •  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;  
  • 21. 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  
  • 22. 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  
  • 23. Empowering     •  For  the  individual   •  Safety  and  comfort;   •  Choice  making;   •  For  the  carers  and  families   •  Valued  members  of  the  team   •  Increase  in  confidence  
  • 24. 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    
  • 25. 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  
  • 26. Everyone  deserves  JOY!