@jamieson2015 @MOHOspark OTnews March 2017 pp36-38

OT role in HMP Grampian understanding and creating opportunities to improve occupational skills, performance and participation OTnews June 2016 pp14-16

Case formulation constructing narratives within a chosen conceptual framework (Loftus & Higgs 2008) to support decision-making and convince others of our efforts (Melton et al 2009)

Case formulation “Creating a conceptualisation of the client’s strengths and challenges” Kielhofner - describing occupational identity & competence, and the key occupational issues

Environment Person Participation Performance Occupational Identity Volition Habituation Performance capacity Performance Occupational Adaptation Skill Person Occupational Competence

Occupational Identity past roles/relationships + volition life turning points + volition current roles/relationships + volition interests + volition volition = feelings related to: values satisfaction goals appraisal of ability & expectation of success

Occupational Competence How a person’s skills performance routines environment match their identity

Case formulation Introducing Scott

Revised Case formulation N.B. Therapeutic use of self is widely accepted as the most important determinant of therapy Taylor 2008

Introduction Name, age and gender Brief history of health conditions /forensic history Reason for referral Occupational assessments completed

Occupational Identity Roles and relationships family acquaintances job interests Voltion feels +++ identifies as important would like to have motivated does not feel confident

Occupational Competence Routine – no contact with family, rarely comes to hall Performance – avoidance + good work standards Environment – minimising stimulation Skills – would benefit from information regarding strengths

Key issues and Summary Occupational issues Summary Skills, performance or participation relating to self-care, productivity or leisure Worded neutrally Summary Positives re identity Contextualising the issues Less than 100 words

Measurable goals Timeframe + MOHO verb + person + issue + setting if needed + level of support

MOHO Taxonomy – verbs specifying the process of change choose commit explore identify negotiate plan practise re-evaluate sustain

‘a catalyst for change’ ‘graded goals make change seem possible’ ‘keeps me focussed’ ‘a catalyst for change’ ‘graded goals make change seem possible’ ‘a way to manage yet communicate complexity’ ‘helps identify and articulate key points’

'I feel stuck and OT gives me a structure to think about what I need to do and I think I can do that' 'I get where you are coming from and what OT is about' ‘It helps me understand what you are looking at' ‘Thats me! - Can I share this with others?'

References Jamieson L (2016) Building occupational skills in the prison population. OTnews 24(6), 14-16 Jamieson L, Parkinson S (2017) Unlocking Potential. OTnews, 25(3), 40-42. Kielhofner G (2008) Model of human occupation: theory and application. 4th ed. Baltimore MD. Lippincott, Williams and Wilkins. Loftus S, Higgs J (2008) Learning the language of clinical reasoning. In: Higgs J, Jones MA, Loftus S, Christensen N eds Clinical reasoning in the health professions. 3rd ed. Butterworth Heinemann. 339-348. Mattingley C (1991) The narrative nature of clinical reasoning. American Journal of Occupational Therapy, 45(11), 98-1005. Melton J, Forsyth K, Freeth D (2009) Using theory in practice. In: Duncan EAS ed. Skills for practice in occupational therapy. Churchill Livingstone. 9-23. Parkinson S, Di Bona L, Fletcher N, Vecsey T, Wheeler K (2015) Profession-specific working in mental health: impacts for occupational therapists and service users. New Zealand Journal of Occupational Therapy, 62(2), 55-66. Parkinson S, Shenfield M, Reece K, Elliott J (2011) Enhancing clinical reasoning through the use of evidence-based assessments, robust case formulations and measurable goals. British Journal of Occupational Therapy, 74(3), 148-152. Rex S,(1999) Desistance from offending: experiences of probation. The Howard Journal, 38(4), 366-83. Taylor R (2008) The Intentional Relationship: Occupational Therapy and use of self. Philadelphia. FA Davis Company