Equipment and the Specialist LD OT role

College of Occupational Therapists 2009

College of Occupational Therapists

Equipment, Adaptations and the Specialist Learning Disability occupational therapy

role 24th September 2010

Genevieve Smyth and Jane Arrol

College of Occupational Therapists 2009College of Occupational Therapists 2010

Introduction

• The specialist learning disability occupational therapy role

• Scottish guidance on equipment and adaptations

• An exploration of current issues


Occupational therapy services for adults with learning disabilities –Principles for Education and Practice (OTPLD and COT 2003)

Principle one –occupational therapist s working in learning disability services provide a service for people whose primary reason for referral relates to the effect of their learning disability upon their occupational performance

Principle two – People with learning disabilities need to be enabled to have choice and influence over their occupational therapy interventions



Principle three – People with learning disabilities have the right to access generic health and social care

Principle four – Occupational therapy services should be provided in partnership with the person with learning disabilities, his or her carers and all relevant agencies



“If a person has an identified need for occupational therapy unrelated to their learning disability, then he or she should access the relevant generic occupational therapy service e.g. social services, mental health , forensic, acute general hospital” p7

“If the persons learning disability affects how they are able to use generic occupational therapy services the role of the specialist (learning disability) OT service may be to facilitate access to these services” p7



“If the person has specialist (learning disability) occupational therapy needs and generic health needs, then local agreements need to be made to clarify which area each occupational therapist is addressing.

Flexibility and partnership working should be encouraged to meet individual need...documentation should clearly state the lead occupational therapy service for each intervention” p7


Occupational therapy and people with learning disabilities –findings from a research study

(Lillywhite and Haines 2010) Still “doing equipment” p39“Despite the clear guidance (OTPLD 2003) and what

generally seems to be a strong wish to focus on learning disability related needs, assessing for provision of equipment or adaptations to meet physical disability related needs, still dominates the caseloads of some occupational therapists in learning disability teams. There is huge variation in this across the United Kingdom and even between neighbouring services with some concentrating on specific learning disability assessments and others placing the emphasis on seating, wheelchairs and adaptations.”



(Lillywhite and Haines 2010)

“People say, well, you have all has the same training so why can’t you do these sort of tasks as well?”

“We are under increasing pressure to provide both minor and major adaptations which the local (social care) occupational therapists refuse to supply”

“We are in danger of having the skills diluted because we are doing so many things –as a group we need to nurture the specialism” p40



(Lillywhite and Haines 2010) How to establish a specialist learning disability

occupational therapy role p40

• Being assertive and persevering• Be clear and strong about what you do• Recognise expertise of other OTs and support

them around an individuals learning disability• Education and partnership working• Formal protocols• Joint visits



(Lillywhite and Haines 2010) Recommendations p52

Develop a close working relationship with and provide consultation to mainstream health and social care occupational therapist to facilitate people with learning disabilities accessing their services. This includes developing formal local pathways or protocols setting out respective responsibilities.


Equipment and Adaptations

Implications for Occupational Therapy in response to the new Scottish guidance

on Equipment and Adaptations provision


Imperatives for changeSome headline projections

• Scotland’s 65+ population projected to rise by 21% between 2006 - 2016

• By 2031 it will have risen by 62%

• For the 85+ age group specifically, a 38% rise is projected for 2016

• And, for 2031, the increase is 144%


Health and social care expenditure Scottish population aged 65+

(2007/08 total=£4.5bn)

Other Social Work

Care Homes

Home Care

FHS

PrescribingCommunity

Other Hospital care

Emergency admissions

£1.4bn

£0.8bn£0.4bn

£0.4bn

£0.4bn

£0.3bn

£0.6bn

£0.2bn


Current service provision by age group

NB Blue represents individuals who only access universal services

65-74

75-84 85+

People aged 65 and over

hospital est

care home

home care

all others


Equipment and Adaptations (E&A)

National Guidance - Purpose and Aims

• Modernise and integrate E&A within their wider community care context

• Aims– Place the user and carer at the centre of

provision– Promote a consistent approach to

assessment– Ensure access to information on E&A– Promote good practice and partnership

working


Mainstreaming Equipment and Adaptations

Key areas of Guidance • Community care assessment • Information provision • Service delivery models • Major adaptations • Care homes


Equipment and Adaptation Standard definition

‘Standard’ Includes both:

• Standard Equipment - All equipment which does not need to be adapted for the individual, such as shower chairs, raised toilet seats flashing doorbells standard wheelchairs

• Minor Adaptations -Non-structural and temporary – can easily be removed from the property, such as external grab-rails and removable ramps


Equipment and Adaptation Specialist definition

‘Specialist’ includes:

• Specialist Equipment - Equipment that may require a specialist assessment or tailored to meet the individuals needs (e.g. AAC dynamic display devises)

• Major Adaptations - Involve permanent changes to the structure of a person’s home, such as widening doors for wheelchair access, installation of a through floor lift or having an extension added to the property.


Implications for Occupational Therapy

• Identification of front line assessors• Quality assurance of training for front

line assessors• Need for locally agreed care pathways

and funding • Opportunity for extended role in

rehabilitation and enablement• Development of specialist role in major

adaptations


Toolkits and Work streams

• Good practice guide for service delivery – to support local services effectively develop, deliver, manage, and monitor the provision of equipment. It can be used as a ‘checklist’ of good practice to enable local authority’s and NHS partners to benchmark and evaluate their services.

• Adaptations – development of a practitioners guide to the different funding streams available for housing adaptations

• Adaptations –work was undertaken to scope the range of adaptations services in Scotland. This was then used to develop a good practice guide

• Adaptations Provision of Web based adaptations planning tool

• Care homes – CoSLA and the care providers group carrying out a piece of work to establish what equipment should be provided by the home and what statutory providers should supply. Initial work has been carried out on Highland and Glasgow.

• Web based information –Utilise the Care Information Scotland website currently being developed for older people for national information and develop a template detailing the type of information and its format that local areas should have on their own websites


Toolkits and Work streams(continued)

• Telecare –Sensory Impairment – Work has commenced on the role Telecare has in supporting individuals with Sensory Impairment. Work is also ongoing to develop guidance on integrating Telecare into the wider community care services

• Public Information -Develop a range of public information leaflets topics to include Older people, children equipment sensory impairment Alternative Augmented Communication Adaptations Self assessment/selection

• Stage 3 adaptations funding: Looking at whether the funding process could be streamlined

• Recycling - scope work to identify the number of recycling facilities required to cover the services across Scotland

• Support via the Joint Improvement Team(JIT) to Partnerships to implement the E&A guidance


Equipment and Adaptations Guidance and Toolkits available to date

• Guidance on the Provision of Equipment and Adaptations - published 2 December 2009

• Scottish Government web site on E&A as resource for practitoners

• Specific tool kits• Good Practice Guide for the Provision of Community Equipment Services• Self Evaluation Toolkit (To accompany the Good Practice Guide for the Provision of

Equipment and Adaptations) - Published March 2010• Guide to Funding a Major Adaptation - Published August 2010

• Housing Grants Procedures for Housing Association Grants (HAG) for Stage Three Adaptations

• Help with Adaptations to Your Home: A Guide for Disabled People in Private Housing in Scotland

• Implementing the Housing (Scotland) Act 2006: Statutory Guidance for Local Authorities - Volume 5 Scheme of Assistance

• Implementing the Housing (Scotland) Act 2006: Volume 6 - Work to Meet the Needs of Disabled People

• Housing and the Disability Equality Duty A guide to the Disability Equality Duty and Disability Discrimination Act 2005 for the social housing sector (external link)


Useful Web links

Reshaping Care for Older People• http://www.scotland.gov.uk/News/

Releases/2010/03/24111551• http://www.jitscotland.org.uk/action-

areas/reshaping-care-for-older-people/

Equipment and Adaptations Guidance and Toolkits

• http://www.scotland.gov.uk/Topics/Health/care/EandA/UsefulPublications


Any questions or comments so far?


Political activities of daily living reasoning tool

“Politics are concerned with conflicts between groups of people, the development of conflicts, the development of cooperative strategies to influence the outcome of the conflicts ...and the resolution of conflict” p70

(Kronenberg et al 2005 –Occupational Therapy without Borders)


Question one

What are the relevant characteristics of this conflict and cooperation

situation?

(Imagine you have to give an accurate, reliable and concrete description of the situation to a complete stranger with no prior knowledge of the situation)


Question two

Who are the actors and who is the ally, partner or opponent of whom?

(The individuals, groups and organisations who are actively involved in the situation including those who are incidentally affected and those who choose to do nothing. Identify multiple roles and capacities e.g. Organisations can be providers, employers or consumers)


Question three

How do the actors conduct themselves? What are their aims, interests and motives?

(Aims refers to what actors consciously strive for, motives refers to the actors less conscious or publically expressed desires and interests refers to what actors strive for consciously in a way that is clear to others)


Question four

What are their means?

(Refers to everything actors can use to realise their political aims in conflict and cooperation situations including access to power and influence and patterns of power relations. This may include force, coercion, money, connections, information, communication)


Question five

What does the political landscape look like?

(Consists of concrete institutions that may operate at regional, national and global levels and will have policies, decision making processes, procedures, accessibility and other organisational practices. They may also have more vague “rules” which are subject to change and reinterpretation)


Question six

What is the broader context where the conflict and cooperation manifest themselves?

(For example, geographical, climatic, physical features, economy, law, society, culture, language, communication, gender, race, status of everyday activity, employment needs, career progression, family pressures, research)


Comments or questions?


People centred self empowerment ?

“Self empowerment is not a ...process of strengthening individualism at the expense of weaker others...a just process of self empowerment actually requires individuals not to use their innate natural power (such as physical strength) but to derive their power from cooperation with others.” p71

(Kronenberg et al 2005 –Occupational Therapy without Borders)


Summary

• The specialist learning disability occupational therapy role

• Equipment and adaptations• Exploration using the political activities

of daily living reasoning tool

genevieve.smyth@cot,co.uk

Health & Medicine

Equipment and the Specialist LD OT role