not just bread and butter ot · 2015. 9. 28. · not just bread and butter ot understanding our...
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Not just bread and butter OT
Understanding our role in the design and construction of housing
adaptations
Rachel Russell
• Occupational Therapist
• PhD Candidate
• Lecturer of Occupational Therapy
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• Understanding the theory behind
what we do
• Understand design and
construction as an intervention for
improving health and well-being
• Share Process Protocol for Home
Modifications
• Getting you enthusiastic about
what you
• genHOME project
What this session is about?
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Why is OT theory so important to our
housing adaptations practice…?
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They see…
What we see!
Leisure
Personal Care
Tasks
Play
Development
Domestic
Tasks/Role
Ritual/habits
Cultural
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Back to Basics: How the built environment
influences Occupational Performance
Design and construction methods
can be used to enhance, restore,
acquire, or prevent the loss of
occupational performance skills
Getting the right “fit” modification (Brandt and Pope 1997)
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Disablement Process
Persons needs cannot be
met by the home
environment
Home Modification
- Aids to Daily Living
- Housing
Adaptations
- Home Care
- Assistive
Technology
- Re-ablement
Functional Restoration
- Medication
- Neural Repair
- Rehabilitation
- Re-ablement
Enablement
Process
Adapted from Brandt and Pope 1997
How we get
the right fit
Back to Basics: How we get the right fit
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Enhance the person’s capabilities – Motor
– Sensory
– Cognitive
Reduce the demands of the environment – Space
– Heights
– Change in level
– Forces
– Noise
– Light
– Temperature
– Moisture
Reduce the demands of the task – Frequency
– Reduce steps and actions
– Carer strain
– More efficient use of the environment
Back to Basics: How the built environment
influences Occupational Performance
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What I’ve learnt so far…
This is the outcome of our intervention…
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…this is our intervention
© 2013 Rachel Russell. All rights reserved
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Some authors have been critical of the process
used by OTs when modifying home environments.
• Don’t fully explore what client require from a modification.
Accessibility Vs Usability (Fange & Iwarrson 2005)
• Focus on a narrow spectrum of Person, Environment and Task fit (Hocking 1999 and Heywood 2004)
• Fail to adopt a collaborative approach with people needing a
modification, and when OTs do collaborate the individual finds it
confusing (Nord et al 2009)
• Lack the ability to effectively analyse how recommended home
modifications will enhance occupational performance (Palmon 2004, Bridges
2007)
Heywood (2004) A poor home modification process
leads to an adaptation that does not provide the right
fit for the person, resulting in financial waste and
potential harm to the person.
Why I have done the research:
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How the Design and Construction
Industry can help:
• Similar issues to OTs
• Design and construction industry
researchers recognise how complex the
process is
• Developed a number of standardised
processes to help manage their
practice.
• Collect the right information, at the right
time, and to use the information to
design and construct buildings that meet
the needs of those occupying them.
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We need an occupation-focused design and construction process that helps us collect the:
– Right information
– At the right time
– Guides us to use the information in the right way
– So at the end, we have the right adaptation
What part 1 of my research
showed…
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The Occupational
Therapy
Intervention
Process Model
(Fisher 2009)
Generic Design and Construction Process Protocol (Cooper et al 2000)
Process Protocol for Home Modifications
Questionnaire Data
Developing the Process Protocol
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OTIPM Fisher (2013)
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© 2013 Rachel Russell. All rights reserved
Process Protocol for Home Modification
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4 Phases – 9 sub-phases Assessment
Intervention Planning
Intervention
Evaluation
Description of each sub-phase
Key question
Action needed at each phase
Outcome of each phase
Tools to assist with phase
Collect the ‘right’ information, at the ‘right’ time, and to use the information in the ‘right’ way to
design and construct the ‘right fit’ home modification.
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© 2013 Rachel Russell. All rights reserved
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© 2013 Rachel Russell. All rights reserved
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© 2013 Rachel Russell. All rights reserved
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Proof of concept approach:
• Identified why the team wanted to use the
Process Protocol
• Mapped the existing process
• Identified what the team needed to do to
implement the Process Protocol
• Implemented the changes
• March 2014 – September 2014
Part 2: Trying the Process Protocol out
with a team of Housing OT’s
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• Occupation-focused
• Encourage consistency of practice amongst
the team
• Understand how the OT process fits within
the existing housing adaptations process
• Promote the role of OT in the Housing Team
• Understand the role of OT in the design and
construction process
What the team were wanting to achieve
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The Existing process mapped onto the
Process Protocol for Home Mods
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Feedback from the proof of
concept:
• It was helpful to have clear stages and a step-by-step guide to the home
modification process, as we realised that we had a tendency to cram multiple
stages into one visit
• The protocol focusses us on each different step in the process, making sure that
nothing is left out and that the client is consulted at every stage
• We have developed a product information sheet for use with clients as a result
of this
• Examine our current practice, and how we fit within our wider team and with
other services
• Illustrate our role to colleagues in other professions, and explain our
involvement in the major adaptation process
• Use as an induction tool with new OT staff
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…to conclude!
• Theory can be our ally
• OTs should feel proud about the role they play in
design and construction of home modifications
• The design and construction process is our
intervention
• We need the to ask the question: Are we are using
the most appropriate intervention to support our
“clients”
• The Home Modification Process Protocol may be
away to support out practice
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• Rachel Russell twitter @Bronteot
http://www.salford.ac.uk/built-environment/research/research-
centres/surface
• Please e-mail if you want a copy of the presentation
and references
Thank you
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http://www.cot.co.uk/genhome
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Why do we need a genHOME?
Heywood and Awang (2011) Evidence about the effectiveness of housing interventions for older and disabled people is : • Unsystematic • Large gaps in knowledge • The evidence that does exist is not sufficiently compelling to attract substantial
investment • Weakness impedes evidence-based practice
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Phase 1 of the genHOME (Maria Parks)
Scoping of the literature: • 222 articles
• 45 different journals
• Housing • Ageing • OT
• Majority of articles were about older people (n=81 36%)
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Phase 1 of the genHOME
Scoping of the literature: • Gaps in the literature
• Children • Inclusive and accessible design
• Falls prevention programmes were most common intervention studies
examined
• 53 studies used outcome measures • 2 studies used bespoke outcome measures • 51 used existing outcomes (49 different types)
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Phase 1 of the genHOME
Purpose of study Type of study
Expert opinion
Policy/ guidance
document Primary research
Secondary
research
Assessment of needs 1 2
Audit 2
Design guidance 3 2 9 1
Economic evaluation 1 3 2
Housing policy 6 2 5 2
Housing tenure &
mobility
1
Impact on participation 8 4
Professionals
perspective
5 8 1
Research methodology 5 1
Service evaluation 5 1 48 13
Service user perspective 16
Standardised tool
development
2 22
Theory development 7 13 6
Other 6 2 3 3
TOTALS 41 7 140 33
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Phase 1 of the genHOME
Basket of measure for housing research: • Client-Clinician Assessment Protocol (C-CAP) • EuroQol-5D • Falls Efficacy Scale • Functional Independence Measure • Housing Enabler • Usability in My Home
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Phase 2 of the genHOME
Developing the data base Symposium (2016) • Bringing together experts • Identifying the structure to support researchers • Developing the research priorities
http://www.cot.co.uk/genhome