The Role of the Occupational Therapist within the Mental Health Liaison Team Heidi Fox (Heidi.Fox@wales.nhs.uk) Clare Pressdee (Clare.Pressdee@wales.nhs.uk)

Development of the Liaison Mental Health Team Welsh Government Funding in 2015 to expand & develop the Liaison service across Wales. RAID Model. Age 18 + Funding for posts included; Nursing ,medical, psychology & OT. Covering 4 general hospitals.

Role of the Occupational Therapist Specialist Mental Health assessments. Aim: To support rapid discharge & maintain independence at home where possible. Specialist advice, support and consultation. Aim: to develop understanding of how mental health problems impact on a patients abilities to complete daily tasks. Specialist OT interventions. Aim: to promote health & well being, and improve or maintain function. Examples; Adaptation of activities according to functional ability, advice and support to carers, assistive technology, memory aids / compensatory strategies and advice regarding risk and safety at home with ADL’s.

Mental Health Occupational Therapist Referral Pathway Adults 18 + identified with Complex mental health needs impacting on functioning & discharge planning home. Referrals received from internal Liaison team or from ward staff including ward based OT’s Liaison OT assessments (standardised / functional) and carer involvement Recommendations & carer guidelines for discharge

Allen’s Cognitive Disability Model Each level is associated with common patterns of behaviour Provides a measurement of abilities and needs The model measures; How the person interacts with their environment How the person processes information Existing abilities (strengths of the person) Limitations which hinder the person from fully engaging in Activities of Daily Living (ADL)

Allen’s Cognitive Levels Level 3 – Assistance with all ADL; Requires assistance with cognitive skills, initiation, sequencing, judgement, problem solving and decision making; Difficulties with new learning Level 4 – Assistance needed to initiate ADL and monitor quality of ADL, notable problems with working memory most require supervision to ensure safety

Case study – Jack 90 year old man admitted from home following a fall Lives with son whom works away Mon – Fri & supportive daughter lives locally. Upon admission to hospital presented with increased confusion & disorientation. Family reported gradual cognitive decline over past 12 months. Feedback from family r.e. Level of function prior to admission. Ward staff planning placement prior to any functional assessment being carried out. Both Jack and his family were keen for him to return home . HISTORY: Family reported gradual cognitive decline over past 12 months No POC in place prior to admission – Daughter supported with shopping & cleaning etc & reminding to take medication but Jack had been independently with PADL and preparing snacks, hot drinks and preferred to do his own ironing. No history of frequent falls Keen to return to home(A significant factor in Jack’s motivation and recovery)

Liaison OT Assessments completed OT initial assessment - Model of Human Occupation Screening Tool (MOHOST) Large Allen’s Cognitive Level Screen (LACL’s) assessment. Liaised with ward OT r.e. Functional assessments carried out on ward to compare findings – Advised PADL be carried out. Allen’s routine task inventory carried out with Jack’s daughter.

OT intervention & outcomes Jack returned Home! Recommendations for package of care based on Allen’s estimate level low level 4 – providing daily prompting & supervision with ADL’s inc medication & meal preparation. Assistive technology (Motion falls detector) Carer guidelines provided to family Referral to primary memory services for further assessment & signposting Memory hints & tips for Jack & his family

£19,346 per annum (COT Improving Lives, Saving Money, 2017). Jack’s Case study Jack was able to return to occupational roles at home with support, hence positive impact on his health & well being. Additional support placed in the home enabled Jack to return home and reduced pressure on family members. Jack’s mood improved on ward environment whilst waiting to return home. Cost Effectiveness - Potential saving for 1 individual £19,346 per annum (COT Improving Lives, Saving Money, 2017). Quality of care outcomes – Specialist input from Liaison OT identified potential in Jack when other professions on the ward did not. Heidi to discuss average For further information on a wider range of unit costs: http:www.pssru.ac.uk/project-pages/unit-costs/2016/index.php referral rates & potential cost savings

Liaison MDT pilot MDT pilot scheme within an acute medical assessment unit (AMAU), led by the Specialist Occupational Therapist. AIMS Reducing admission rates for older adults with cognitive impairment. To discharge patients home within 24hrs – 72hrs following their admission to AMAU. To support older adult patients with cognitive impairment to return to their own home & maintain independence – Specialist assessment, advice & intervention. To reduce admission length for individual’s admitted to general wards from AMAU – Ongoing specialist assessment, advice & intervention.

Pilot outcomes  53% of patients returned home and accessed appropriate community services after Liaison input Reduced length of time on the assessment unit – 43% patients were discharged within the 72 hour period. Further need identified to extend the OT role within the Emergency Department. Positive feedback from AMAU staff Liaison continue to be a part of AMAU multi disciplinary meetings. Ongoing Liaison MDT attendance in daily AMAU meeting x 3 weekly To provide written contact details for older person’s CMHT for AMAU staff. Identified which general wards predominantly used for elderly / cognitive impairment - This will support us in developing roles of the support workers. Development of the MH OT role within A&E

Future plans Developing OT Support Worker role. Developing the role of MH OT within the Emergency Department. Ongoing educational role of the MH OT. Ongoing consultative role of the MH OT.

Diolch / Thanks for listening! Any questions?

References Allen, C.K., Earhart, C.A., and Blue.T. (1992) Occupational Therapy Treatment Goals for the Physically and Cognitively Disabled. Bethesda, MD: American Occupational Therapy Association. Allen,C.K. (1989). Unpublished routine task inventory (TRI-E). Allen, C.K., Austin, S.L., David, S.K., C.A., McCraith, D.B & Riska – Williams, L (2007). Manual for the Allen Cognitive Level Screen - 5 (ACL’s – 5) and Large Allen Cogntive Level Screen – 5 (LACL’s – 5). Camarillo, CA: ACL’s and LACL’S Committee, 33 – 39. Parkinson, S., Forsyth, K., & Kielhofner, G. (2006). The Model of Human Occupation Screening Tool (MOHOST) (version 2.0). Chicago: The Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago. Improving Lives, Saving Money (2017). College of Occupational Therapy, London. For further information on a wider range of unit costs: Personal Social Services Research Unit, 2016. Unit Costs of Health and Social care 2-16. Available at: http:www.pssru.ac.uk/project-pages/unit-costs/2016/index.php