1. 11/17/2009
Occupational Therapy Pathways:
Overview of Presentation
the journey so far
• London Mental Health OTs Leads
programmes
• London adapted pathways project: the
journey so far
• Sharing Tips for Implementing
Dr Mary Morley, South West London and St Georges Mental Health NHS Trust
National Strategy for Occupational
Our journey so far… Therapy
• Individual Trusts with different systems and patchy OT Key messages:
involvement in IM&T agenda
• Phased introduction of RIO electronic healthcare record • Build pathways of care
across 7 London mental health Trusts that highlight what
• Pan-London network of OTs with a special interest of service users can expect
IM&T of their intervention
– Seven MoHO assessments built into RIO
– Shared format for ADL assessment reports
– OT Guide to RIO
• Pathways development network • Provide evidence for
• Collaborating on quality metrics and PROMS commissioners on the
• Representation on local, London-wide and national effectiveness of OT
working groups interventions
• ……..enthusiasts but not experts
COT (2006)
Definition of an
High quality care for all: NHS Next Stage
integrated care pathway
Review final report: 30 June 2008
“A multidisciplinary care plan that give
• Focus on the quality of detailed guidance for each stage in the
care; outcomes not inputs care of a patient with a specific condition,
over a given period of time”.
• Pathways of integrated (Riley,1998)
care
• Change will benefit An ICP is a document that describes a
patients and process within health and social care, and
• Be clinically driven and that collects variations between planned
locally led and actual care.
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2. 11/17/2009
Benefits of ICP’s - Benefits of Therapy Pathways
a whole systems approach
• To provide a Occupational Therapy pathway of
• Aligned with government and professional guidelines care that is clear to all
• Gives a structure of care that is clear to all and • Supports the use of evidence based tools
underpinned by evidence-based practice
• A tool to analyse what works and what doesn’t
• Outcome–based approach to service delivery
• Promotes occupational therapy’s specific
• Provides a systematic approach to the review and contribution to mental health
improvements of practice
• A tool for teaching, supervision, induction and
• Makes the best use of resources staff satisfaction
Why this matters to service users A Collaborative Pathway Project
• In 2002, 2gether NHS Foundation Trust started to develop OT
pathways with UKCORE
• Includes guidance of best practice, evidence based, • The original pathway was developed by Jane Melton and Jonathan
Hill (2gether NHS Foundation Trust) and Dr. Kirsty Forsyth, (UK
client-centred care used in the everyday setting Centre for Outcomes, Research end Education (UKCORE)
• These were presented at national conferences 2005 and 2008
• Provides better information to service users about • In 2007, OT Leads of London Mental Health Trusts proposed a shared
their care, choices and expected outcomes project adapting the original pathways
• Dr. Mary Morley and Majvor Darnton (South West London & St.
• Provides a more consistent service to those with Georges Mental Health Trust) adapted the pathways on behalf of the
Professional Leads for Occupational Therapy in the London mental
highest levels of occupational need health Trusts.
• 8 occupational therapy pathways have been agreed
• Pathways launched at COT in September 2009
Occupational Therapy Pathways The adapted London OT
Pathways: Process
• Acute adult in-patient • Developed by experienced practitioners across the
• Community mental health nine Trusts who pooled expertise and evidence.
• Rehabilitation
• Forensic
• Older people • Use MOHO and COPM as evidence-based
• Employment theoretical models for outcomes.
• Child and Adolescent mental
health
• Learning disabilities • Include latest policy and guidance.
Melton, Forsyth, Hill, Morley (2009) Occupational Therapy Care Pathway
(adapted version), 2gether NHS Foundation Trust, UKCORE & London
Occupational Therapy Mental Health Professional Leads. (Unpublished).
• High level pathways for adapting into local
contexts.
NB Substance misuse pathway now being
written
• Used process mapping to design the occupational
therapy part of a wider MDT integrated pathway.
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3. 11/17/2009
Format of
Occupational therapy pathway: a high- Occupational Therapy
level pathway linked to the mental health Pathways
pathway
• Made up of a document
– Background
Multidisciplinary team pathway – Instructions for use
– Narrative with symbols
and explanatory text
OT physical pathway – References
AND
• Flowchart
OT pathway
Mental Health Pathway
The Pathway Folder Getting Staff Engagement
• Copies for each OT • Remember this is a change management
Lead containing: process: To fail to plan is to plan to fail
• Handbook
• Use a phased approach
• Training Materials
• Occupational Therapy • Sell the positives
Pathways Narratives and
Flowchart • Perseverance
• References and resources • Don’t re-invent the wheel
• CD-Rom
– Pdf Versions of narratives • Share workload and ideas with other OT
and flowcharts leads
– Powerpoint presentations of
training materials
Making a difference… It capture’s a lot
about me and it
feels therapeutic to
read. (Service user) How did you get this
…to occupational therapists information? I’ve been
trying for ages
without success.
(Team member)
• I’m newly qualified OT and as the only OT on my That’s me
team I am extremely grateful to have these tools to down to a
tee…can I keep
help structure and guide my practice. (OT) it? (Service
user) I didn’t realise the
value of OT’s, It’s the
• Using the MoHO assessments gives me a clearer best report I’ve seen”
understanding of the clients on my caseload. (OT) (Team member)
If only all reports were as
specific as OT reports
the job of the
And to others……….. accommodation panel
would be so much easier
(Chair of Housing Panel)
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4. 11/17/2009
Getting Going – where to start?
• Pilot the pathways and allow enough time Pilot Project
• Leadership with pathway experience as well as • Make yourself familiar with the concept of
clinical expertise pathways
• Secure senior stakeholder support, eg service
managers • Identify service
• Link up with other pathway work in the Trust • Set specific aims and objectives
• Remember implementing the pathways will change
what the OTs are doing or not doing • Select a small team to lead the pilot
• Training and introduction
Pilot and Review Occupational Therapy Variances -
• Discuss outcomes of pilot and actions
Start by setting goals for the expected
service….
• Redesign pathway to suit your service
• What are the occupational therapy
• Implementation
objectives?
• What are our standards?
• Variance tracking to monitor and review • How will these be measured?
• What variances might you expect?
• Focus on the long-term benefits and be
generous with ideas and solutions
Example of a variance tracking sheet:
Variance Recording :Complete when recommended interventions do not occur
Information gathered - Date
Activity
Code
Varian
ce
Code
Action to be Taken
(If you need to repeat an intervention then fill in
the blank rows in the appropriate time frame)
Sign
This should:
• provide us with the evidence that we have
met our objectives Variance Source Codes
• be easy to use Patient/carer codes
1.1 Patient unavailable
System codes
2.1 Date and time of
Other agencies
3.1 Accommodation not
1.2 Carer unavailable intervention changed available
• add value to our service users and/or .3 Patient refused
1.4 Carer refused
2.2 Awaiting consultation from others
2.3 Staff/service not available
3.2 Community support not
available
2.4 Lack of time 3.3 Day services not available
1.5Intervention inappropriate
service 1.6 Deterioration of mental state:
1.7 intervention inappropriate
2.5 Intervention
postponed/cancelled
3.4 Funding/benefits not
available
2.6 Information/results not 3.5 Transport not available
1.8 Improvement of mental state: available 3.6 Other (please state)
1.9 intervention inappropriate 2.7 Dept closed/room not
1.10 Patient refused due to poor available
motivation 2.8 appointment not
1.11 Intervention repeated due to available/delayed
lack of understanding or skill 1.12 2.9 Other (please state)
Other (please state)
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5. 11/17/2009
With thanks to:
Next Steps
• London adapted pathways to be piloted in local services
• London adapted pathways will be included in Assessments Manual • Chairs and members of the work
to be published in next few months groups for each pathway
• Mental Health OTs engaging in London AHP Quality metrics and • Majvor Darnton, Pathway Project
lead – Occupational Therapy,
PROMS work SWLSTG
• OT pathways form an important building block in the OT mental • 2Gether NHS Foundation Trust
health PbR work and UKCORE who generously
shared their pathway
• PbR Core group has embarked on two-phase study in collaboration
• South West London & St
with Kielhofner (UIC) to develop ‘care pathways’ for the 21 PbR Georges Mental Health NHS
clusters: Trust who hosted and funded the
– Data analysis of MOHOST to identify occupational profiles for project
service users And the the London Leads for
Occupational Therapy in Mental
– Action research study to develop care pathways for the profiles Health Trusts for supported this
project (and the next!)
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