Occupational therapists’ use of occupation-focused practice in secure hospitals Practice guideline

1. Occupational therapists’ use of occupation-focused practice in secure hospitals Practice guideline College of Occupational Therapists Specialist Section – Mental Health, Forensic Forum

2. Learning outcomes • To explore aspects of the practice guideline recommendations in relation to current practice. • To develop an understanding of the importance of using practice guidelines to inform practice. • To explore and develop an understanding of how to use the COT Audit Form for use with the evidence-based recommendations.

3. Practice question: What evidence is there to support the use of occupation in occupational therapy in secure hospitals with patients over the age of 18?

4. Key objective of guideline To provide specific recommendations to support the use of occupation-focused occupational therapy in secure hospitals. The guideline is relevant to high, medium and secure hospitals.

5. Methodology 2. Guideline scope defined involving stakeholders 1. Guideline development group established 4. Screen findings 3. Literature search 5. Critically appraise articles 7. Peer review, stakeholder and service user consultation 6. Development of practice guideline recommendations 8. Final draft approved by COT Practice Publications Group 9. Published by COT 2012

6. Evidence-based recommendations Recommendations are based on the evidence available within 34 critically appraised papers. Each recommendation is assigned: • A strength scoring 1 or 2 (Strong or Conditional) • A quality grading A, B, C or D (High, Moderate, Low or Very Low)

7. Recommendation areas Model of Human Occupation Framework: • Volition • Habituation • Performance capacity • Environmental considerations

8. Volition

9. Volition contd.

10. Habituation

11. Performance capacity

12. Environmental considerations

13. Environmental considerations contd.

14. Impact of practice guideline for you: the practitioner • Challenges / affirms your current practice. • Provides evidence-based recommendations to inform and support your practice. • Raises awareness of benefits and risks and organisational and financial barriers. • Provides a vehicle for you to audit and justify your practice

15. Impact of practice guideline for managers • Provides evidence of the need for occupation-focused occupational therapy for adults in secure hospitals. • Provides a structure to audit the work of occupational therapists within the service to improve service quality. • Provides a vehicle for justifying service provision.

16. Impact of practice guideline for commissioners • Articulates the need for occupational therapy interventions within secure hospital services. • Provides recommendations developed by a NICE Accredited process. • Can help educate commissioners to identify learning needs for the workforce. • Audit form provides a mechanism to review service delivery in accordance with the evidence.

17. Impact of practice guideline for patients • The recommendations reinforce the fundamental importance of the patient perspective • In being adopted by services and occupational therapists, the guideline should improve the consistency and quality of intervention for users of services. • Gives assurance that practitioners use the available evidence to support interventions.

18. Patient perspectives Any reduction in the occupational therapy programme was viewed by one patient as limiting opportunities for engagement in occupational therapy groups and learning new skills The impact of the environment was reinforced by one patient, indicating that a homely environment was desired In relation to the availability of occupational opportunities, another patient reported that it was a struggle at weekends on the ward A preference for one-to-one occupational therapy sessions, with the importance of the occupational therapists in relation to motivation being highlighted, was also expressed by one patient in the context of group work

19. Practice guideline resources • College of Occupational Therapists (2012) Occupational therapists’ use of occupation-focused practice in secure hospitals: practice guideline.London: COT. • Audit tool • Quick Reference Guide • Feedback form Resources are available from the College’s website at: http://www.cot.co.uk/library-publications/cot-publications/practice-guidelines.