The role of the OT

1. 24/09/2012
WORKING WITH FAMILIES AND
CARERS: THE OCCUPATIONAL Why Families and Carers?
THERAPIST’S ROLE
VERNA MORRIS
SPECIALIST BRAIN INJURY OCCUPATIONAL THERAPIST/
COUNSELLOR
The Context
 SSNP GUIDANCE DOC – “Occupational therapists
working with adults with acquired brain injury:
Guidance for clinical practice”
Mapping for Practice
The Context What will be included
SSNP GUIDANCE DOC – “Occupational therapists working

with adults with acquired brain injury: Guidance for clinical
 The Guidelines context
 Brain Injury and the Family
practice”
maps
National Service Framework for Long-term  Reflective Questions
Conditions (2005). Department of Health  Therapeutic Relationship
and
Rehabilitation following acquired brain injury:
National clinical guidelines (2003). Royal College
of Physicians/British Society of Rehabilitation
Medicine
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2. 24/09/2012
Objectives
An exploration of the key reflective

questions around working with families
“COPING WITH ONE
and carers including a review of some of OF THE MOST
the available evidence base.
DIFFICULT TASK THAT
 Opportunity to use the questions to reflect
on your own practise. CAN CONFRONT A
FAMILY”
(Florian et al, 1989)
Changes in the injured person
What makes brain injury so  Over 80% of brain injury survivors show
personality changes
difficult for families? (Webster et al 1999)
 Neurobehavioural sequelae – Disinhibition,
increased irritability, emotional lability,
aggression, poor memory, lack of
concentration, rigid thinking
(Carnes 2005, Ergh 2002, Florian 1989, Webster 1999)
Other things we know Not all families don’t cope
 Families often experience an increase in stress and  Between 50% and 80 % of primary carers
strain and changing and expanding needs as time reported being satisfied with their families.
since injury progresses (Stebbins 1998, Brooks 86)  Between 27% and 41% of tertiary carers
 Quality of life can diminish over time (Kolakowsky- displayed high levels of psychological distress.
Hayner 2001) (Perlesz, Kinsella and Crowe 1999)
 The impact is not just confined to the primary care
giver (Bowen 2010, Daisley and Webster 2008, (Perlesz  56% of 116 people did not report elevated levels
1999) of distress
 Not all families don’t cope (Perlesz 1999, Gervasio and (Gervasio and Kreutzer, 1997)
Kreutzer 1997)
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3. 24/09/2012
“PATIENTS WHO HAVE Key Reflective Questions
SUPPORTIVE FAMILIES DO
BETTER IN REHABILITATION
THAN THOSE WHO DO NOT”
(Saedy 2010, Sander 2002, Turner 2009)
REFLECTIVE QUESTION
Coping
“HAVE I CHECKED ON HOW FAMILY
MEMBERS AND CARERS ARE COPING WITH  Problem focussed – attempts by the
THEIR RELATIVE’S FUNCTIONAL PROBLEMS individual to deal with stress by acting on
AND IF REQUIRED, the environment or the self
HELPED THEM TO DEVELOP PROBLEM  Emotion focussed - involves a reappraisal
SOLVING STRATEGIES TO HELP THEM COPE of the stressful problem entailing a
WITH FUNCTIONAL SITUATIONS AND change in the perceived meaning of the
ISSUES THAT ARISE IN THE HOME?” problem
(Carnes 2005, Bais and Boisvert 2005) (Verhaeghe 2004, Davis 2009)
REFLECTIVE QUESTION
Case Study example
“HAVE I CHECKED ON HOW FAMILY
MEMBERS AND CARERS ARE COPING WITH  Client: Steve – pre injury a lorry driver
THEIR RELATIVE’S FUNCTIONAL PROBLEMS  Family: Wife – Janice who now works part time in
AND IF REQUIRED, the afternoons and also looks after her elderly mum
with dementia, 2 children aged 7 and 11
HELPED THEM TO DEVELOP PROBLEM  Steve had a brain injury and an incomplete spinal
injury 18 months ago
SOLVING STRATEGIES TO HELP THEM COPE
 Steve’s goal – to learn to make interesting meals
WITH FUNCTIONAL SITUATIONS AND
ISSUES THAT ARISE IN THE HOME?”
 OT activity meal planning and preparation
(Carnes 2005, Bais and Boisvert 2005)
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4. 24/09/2012
Case Study – example
REFLECTIVE QUESTION
 Help with Problem focussed coping through
acquiring the skills to plan and safely prepare
meals “HAVE I OFFERED INFORMATION AND
 Help with emotion focussed coping though EDUCATION ABOUT THE NATURE OF THE
helping them reappraise their role change in a BRAIN INJURY AND ITS POTENTIAL IMPACT
positive way
ON THE CLIENT’S ROLE PERFORMANCE
AND FUNCTIONING?”
(Kreutzer 1994 & 2010, Oddy & Herbert 2003)
REFLECTIVE QUESTION
REFLECTIVE QUESTION
“HAVE I OFFERED AND IF REQUIRED
“HAVE I ‘NORMALISED’ THE BRAIN PROVIDED FAMILY MEMBERS AND CARERS
INJURY RELATED FUNCTIONAL WITH INVOLVEMENT AND A
PROBLEMS ENCOUNTERED BY THE COLLABORATIVE PARTNERSHIP ROLE IN
PATIENT AND THE FAMILY MEMBERS’ PLANNING AND CARRYING OUT TREATMENT
EXPERIENCE AND REACTION?” OBJECTIVES, DEFINING REHABILITATION
GOALS AND PROCESS?”
(Kreutzer 1994) (Sohlberg et al, 2001)
True collaboration requires:
 Respect for the family’s knowledge of the
person with the ABI
 Recognition of their strengths and
REFLECTIONS ON
resources
 Family involvement throughout the
THE KEY REFLECTIVE
assessment and intervention process
(Sohlberg et al 2001)
QUESTIONS!
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5. 24/09/2012
Reflective Questions
 From the list identify any that stand out or
resonate for you personally.
 Use the opportunity to share your
thoughts/perspective/experience with 1
or 2 people around you.
THERAPEUTIC
RELATIONSHIP
(Schonenberger 2006, Sherer 2007, Kreutzer
2010)
TRUE OR FALSE To recap…..
This OT cares about me  The Guidelines context
 Brain Injury and the Family
This OT understands me
 Reflective Questions
This OT respects me  Therapeutic Relationship
I can trust this OT
“PATIENTS WHO HAVE
SUPPORTIVE FAMILIES DO
BETTER IN REHABILITATION
THAN THOSE WHO DO NOT”
FINALLY……
Sander 2002,
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6. 24/09/2012
Thank You
email:therapy@vernamorris.co.uk
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