Verna Morris - working with families

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The role of the OT


<ul><li> 1. 24/09/2012WORKING WITH FAMILIES ANDCARERS: THE OCCUPATIONALWhy Families and Carers?THERAPISTS ROLEVERNA MORRISSPECIALIST BRAIN INJURY OCCUPATIONAL THERAPIST/ COUNSELLOR The Context SSNP GUIDANCE DOC Occupational therapistsworking with adults with acquired brain injury:Guidance for clinical practice Mapping for Practice The ContextWhat will be includedSSNP GUIDANCE DOC Occupational therapists workingwith adults with acquired brain injury: Guidance for clinical The Guidelines context Brain Injury and the FamilypracticemapsNational Service Framework for Long-term Reflective QuestionsConditions (2005). Department of Health Therapeutic Relationship andRehabilitation following acquired brain injury:National clinical guidelines (2003). Royal Collegeof Physicians/British Society of RehabilitationMedicine1</li></ul> <p> 2. 24/09/2012 ObjectivesAn exploration of the key reflectivequestions around working with familiesCOPING WITH ONEand carers including a review of some ofOF THE MOSTthe available evidence base.DIFFICULT TASK THAT Opportunity to use the questions to reflecton your own practise. CAN CONFRONT AFAMILY(Florian et al, 1989)Changes in the injured personWhat makes brain injury so Over 80% of brain injury survivors showpersonality changesdifficult for families?(Webster et al 1999) Neurobehavioural sequelae Disinhibition,increased irritability, emotional lability,aggression, poor memory, lack ofconcentration, rigid thinking(Carnes 2005, Ergh 2002, Florian 1989, Webster 1999) Other things we know Not all families dont cope Families often experience an increase in stress and Between 50% and 80 % of primary carersstrain 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 caregiver (Bowen 2010, Daisley and Webster 2008, (Perlesz 56% of 116 people did not report elevated levels1999) of distress Not all families dont cope (Perlesz 1999, Gervasio and (Gervasio and Kreutzer, 1997)Kreutzer 1997) 2 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 QUESTIONCopingHAVE I CHECKED ON HOW FAMILYMEMBERS AND CARERS ARE COPING WITH Problem focussed attempts by theTHEIR RELATIVES FUNCTIONAL PROBLEMSindividual to deal with stress by acting onAND IF REQUIRED,the environment or the selfHELPED THEM TO DEVELOP PROBLEM Emotion focussed - involves a reappraisalSOLVING STRATEGIES TO HELP THEM COPEof the stressful problem entailing aWITH FUNCTIONAL SITUATIONS ANDchange in the perceived meaning of theISSUES THAT ARISE IN THE HOME? problem(Carnes 2005, Bais and Boisvert 2005) (Verhaeghe 2004, Davis 2009)REFLECTIVE QUESTIONCase Study exampleHAVE I CHECKED ON HOW FAMILYMEMBERS AND CARERS ARE COPING WITH Client: Steve pre injury a lorry driverTHEIR RELATIVES FUNCTIONAL PROBLEMS Family: Wife Janice who now works part time inAND IF REQUIRED,the afternoons and also looks after her elderly mumwith dementia, 2 children aged 7 and 11HELPED THEM TO DEVELOP PROBLEM Steve had a brain injury and an incomplete spinalinjury 18 months agoSOLVING STRATEGIES TO HELP THEM COPE Steves goal to learn to make interesting mealsWITH FUNCTIONAL SITUATIONS ANDISSUES THAT ARISE IN THE HOME? OT activity meal planning and preparation(Carnes 2005, Bais and Boisvert 2005) 3 4. 24/09/2012Case Study exampleREFLECTIVE QUESTION Help with Problem focussed coping throughacquiring the skills to plan and safely preparemeals HAVE I OFFERED INFORMATION AND Help with emotion focussed coping thoughEDUCATION ABOUT THE NATURE OF THEhelping them reappraise their role change in aBRAIN INJURY AND ITS POTENTIAL IMPACTpositive wayON THE CLIENTS ROLE PERFORMANCEAND FUNCTIONING? (Kreutzer 1994 &amp; 2010, Oddy &amp; Herbert 2003)REFLECTIVE QUESTION REFLECTIVE QUESTIONHAVE I OFFERED AND IF REQUIREDHAVE I NORMALISED THE BRAINPROVIDED FAMILY MEMBERS AND CARERSINJURY RELATED FUNCTIONAL WITH INVOLVEMENT AND APROBLEMS ENCOUNTERED BY THE COLLABORATIVE PARTNERSHIP ROLE INPATIENT AND THE FAMILY MEMBERS PLANNING AND CARRYING OUT TREATMENTEXPERIENCE AND REACTION? OBJECTIVES, DEFINING REHABILITATIONGOALS AND PROCESS?(Kreutzer 1994) (Sohlberg et al, 2001)True collaboration requires: Respect for the familys knowledge of theperson with the ABI Recognition of their strengths andREFLECTIONS ONresources Family involvement throughout theTHE KEY REFLECTIVEassessment and intervention process (Sohlberg et al 2001)QUESTIONS! 4 5. 24/09/2012Reflective Questions From the list identify any that stand out orresonate for you personally. Use the opportunity to share yourthoughts/perspective/experience with 1or 2 people around you. THERAPEUTIC RELATIONSHIP(Schonenberger 2006, Sherer 2007, Kreutzer2010)TRUE OR FALSETo recap..This OT cares about me The Guidelines context Brain Injury and the FamilyThis OT understands me Reflective QuestionsThis OT respects me Therapeutic RelationshipI can trust this OT PATIENTS WHO HAVE SUPPORTIVE FAMILIES DO BETTER IN REHABILITATION THAN THOSE WHO DO NOTFINALLYSander 2002, 5 6. 24/09/2012 Thank </p>