initiating self-management through occupational lifestyle ... · – psycho-educational program to...
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Initiating Self-Management through
Occupational Lifestyle Redesign
for People with Chronic Illness
Kwok Fai Leung KCC, CSC(AH)
KCC, CM(Occ therapy)
QEH, DM (Occupational Therapy)
Symposium 7
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The biggest challenge for People with Chronic illness
Stroke, Parkinsonism, cognitive decline, chronic pain,
arthritis, orthopedic conditions,
common mental disorders, depression, psychosis, etc
Adaptation
Live positively with chronic symptoms
Learn ways to live a successful life
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The Three Key Questions
Who Need Help in Adaption?
What interventions are needed?
What is the right time of
intervention?
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Chronic 10-30%
Delayed 5-10%
Recovery 15-35%
Resilience 35-55%
Event 1 Year 2 Year
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Prototypical trajectories of disruption in normal
functioning during the 2-year period following a loss or
potential trauma
Bonanno, George. A Resilience in the Face of Potential Trauma.
Current Directions in Psychological Science, Volume 14, Number 3, June 2005 , pp. 135-138(4)
Rapid Adaptation
Gradual Adaptation
Mal-adaption
Chronic Dysfunction
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What the hospital is doing to promote
self management / adaptation?
• Screening and medical intervention & monitoring
• Provide knowledge - patient / carer education programs
• Referral of patient to NGO for community services –
through partnership with NGO
– Psycho-education program – enhance gaining of knowledge,
learning of skills and forming correct attitude
– Psycho-social support
• There may not be sufficient service to meet those
who are mal-adaptive or chronic dysfunction.
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Occupational Therapy for People with
Chronic illnesses and functional limitations
• Conventional Occupational Therapy – Splints, pressure garment, and hand functional training to restore basic functions
– ADL, domestic, social and community living skill training to promote successful living
– Use of daily activity assistive devices to compensate lost function
– Psycho-educational program to promote knowledge & attitude in everyday life living
– Environmental / home adaption to ensure safe & convenient living at home and work
– Occupational rehabilitation, retraining and resettlement to enhance employability
• Recent development in Occupational Therapy
– Occupational lifestyle redesign programs
• Promote acceptance and adaptation of chronic illnesses and
functional limitations
• Development of successful and happiness inducing lifestyle in
family, leisure, social and work
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Occupational lifestyle redesign programs
「生活重整課程」
• Designed and developed by occupational therapists in HA hospitals
in 2006.
• Target: Patient with chronic illness or functional limitations and are
experiencing occupational lifestyle dysfunction, resulting in
distressing living
• Integrate theories and techniques in Occupational Therapy & Life
Coaching
• Guide & coach patient to establish a successful & happiness
inducing lifestyle that is compatible to their functional limitations.
• Delivered in a mix of individual or group sessions in a period of 3-6
months.
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Indoor Sessions Action planning and implementation
Do something that induce happiness and meanings
within own functional capacity and personal resources
Learn and practice adaptive strategies and skills
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Indoor sessions Share & celebrate successes
Learn in relaxing and happiness inducing environment
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Outing: Ferry to Cheng Chau Practice adaptive strategies in real life environment
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Outing: BBQ Plan and enjoy leisure activities within own functional limitation
Regain confidence after successful participation
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Outing: Visit a museum Personal functional and psychological breakthrough
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Graduation Ceremony
2008
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Graduation Ceremony
2009
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Graduation Ceremony
2010
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Graduation Ceremony
2011
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What are the benefits of
Occupational lifestyle redesign?
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Specific sequence of changes • Positivity coaching
– Induce +ve change in leisure life
– Overcome depressive mood
– Broaden the view and promote acceptance
• Relationship coaching
– Induce +ve change in social life
– Repair reversible social relationship
– Rebuild social support network
• Wellness coaching
– Induce +ve control of symptoms & health
• Life coaching
– Induce +ve change in home-making & work life
– Finding new role in family life
– RTW coaching
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Underlining Principles of
Occupational lifestyle redesign programs
• Acceptance and Adaptation
– Acceptance
• chronic nature of symptom and dysfunction
– Adaptation
• Learn, personal, & contextualize adaptive strategies and
skills in different life domains
• Approach
– Activity based intervention
• Making change in attitude, skills, habit through participate in
everyday life activities
– Change lifestyle
• to induce further changes in emotion and thinking
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Miracle Occupational Experiences
generate the energy for change
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The Miracle Experience • Their changes were not evolved in a linear progressive
manner, but in form of sudden “quantum change”,
– starting with some small oscillating changes, accumulating sufficient “energy”, and suddenly making big change and transcend to a higher level of thinking & functioning in life, in a short period time, i.e. 1 to 3 weeks,
21
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What is Miracle Occupational Experience?
• The experiences in successful completion of a single or a series of occupational activities that resulted in very intense positive experience
• The experience consist of 1 or more of the following 5 critical components,
– induces strong intrinsic motivation & satisfaction
– is challenging but achievable
– requires self-directed implementation
– allows learning new adaptive skills
– provides strong positive emotional and cognitive feedbacks 22
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The Hypothesis
• Successful completion of an occupational activities produce energy for change
• Each of the 5 components alone can produce high level of energy for change.
• Combination and resonation of energies induced by more than 1 features multiple to produce a large impulse of extremely intensive energy for change,
• acceptance and change in
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Conclusion
Who Need Help in Adaption?
What interventions is needed?
What is the right time of
intervention?
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Who Need Help in Adaption?
Chronic Dysfunction
Delayed Dysfunction
Recovery
Resilience
Dis
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tio
n o
f N
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Event 1 Year 2 Year
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Would OLSR helps in adaptation?
Yes, through
• Guided participation in weekly action plan
• Successful implementation of activities
that is happiness inducing or meaningful
• Increased in positive emotion
• Miracle occupational experience
– Acceptance of chronic illness
– Learning of adaptive strategies
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What interventions are
needed?
Chronic Dysfunction
Delayed Dysfunction
Recovery
Resilience Conventional Occupational Therapy & Other rehab intervention
Psycho-education & Carer education
Group & individual Coaching: Occupational Lifestyle Redesign program
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Chronic 10-30%
Delayed 5-10%
Recovery 15-35%
Resilience 35-55%
Event 1 Year 2 Year
Dis
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n o
f N
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Mil
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What is the right time of
intervention?
Bonanno, George. A Resilience in the Face of Potential Trauma.
Current Directions in Psychological Science, Volume 14, Number 3, June 2005 , pp. 135-138(4)
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Thanks