Uncovering Occupational Injustice in Residential Care Environments Using the Assessment Tool for Occupation and Social Engagement (ATOSE) Dr. Mark Morgan-Brown Asst Prof. Joan Brangan RCOT 2018

Engagement is the core of occupational therapy. Attention should be focused on engagement as an outcome measure using standardized assessments. Du Toit, Shen & McGrath, 2018, Scandinavian Journal of Occupational Therapy

OCCUPATIONAL JUSTICE change of focus from individual disability to well-being and human rights broader environmental change Hammell, 2008, Canadian Journal of Occupational Therapy

Environmental interventions are more effective than individual therapy for people with dementia Coppola (1998), American Journal of Occupational Therapy Environment = physical, social, operational Morgan-Brown, Newton & Ormerod, 2013, Aging & Mental Health 5 5

Social Environment Without the animation of staff all communal living spaces become ‘lifeless’ Zeisel, (2005) Alzheimer’s Care Quarterly

ORGANISATIONAL PURPOSE

Operational Environment Good leadership is key. Change programmes stall unless leadership: Establishes clear purpose and direction Allocates resources Facilitates new routines & staff roles Sets targets & reviews progress Motivates staff Role modelling Low et al, 2018, BMC Geriatrics

OWNERSHIP DESCRIPTION UNIT A Mental Health Authority Last remaining ward of a decommissioned psychiatric hospital UNIT B Health Authority Refurbished for ambulant residents with dementia UNIT C Newly refurbished ward in a former hospital UNIT D Privately owned Modern construction UNIT E

Physical Environment Unit A institutional sitting / dining room with large open spaces between residents which makes spontaneous interaction and engagement less likely

RESIDENT AGE PROFILE (N=73) B C D E SUM ♀ ♂ <70 2 5 1 10 70-79 4 3 24 80-89 8 7 35 >90 N=20 N=16 N=11 N=13 73 .

RESIDENT ABILITY PROFILE Residential Unit A B C D E COMMUNICATION PROFILE n=20 n=16 n=11 n=13 n=73 Able to initiate conversation 9 10 5 38 Will respond but not initiate 6 2 1 4 15 Greatly reduced conversation 3 7 No real conversation

RESIDENT ABILITY PROFILE Residential Unit A B C D E SUM ADL DEPENDENCY n=20 n=16 n=11 n=13 n=73 Eating 4 7 6 31 Dressing 15 14 11 13 66 Hygiene 19 16 73 Toileting 5 10 9 43

Interactive Occupation Passive/Agitated Behaviours RESIDENTS   VISITORS STAFF Social Engagement Interactive Occupation Receiving Care Care tasks Non-Engaged Passive/Agitated Behaviours Preparation tasks Work tasks

The ATOSE paper version computerised version

RESIDENT ENGAGED AND NON-ENGAGED LEVELS UNIT N = 73 TOTAL OBSERVATIONS % ENGAGED BEHAVIOURS % NON-ENGAGED BEHAVIOURS A N = 20 2320 17.2% 82.8% B N = 16 2017 40.8% 59.2% C N = 11 1739 44.3% 55.7% D N = 13 1814 41.1% 58.9% E 1978 44.6% 55.4%

STAFF ENGAGED AND NON-ENGAGED LEVELS UNIT TOTAL STAFF OBSERVATIONS % OF ENGAGED BEHAVIOURS % OF NON-ENGAGED BEHAVIOURS A 417 56.35% 43.65% B 333 76.88% 23.12% C 439 70.84% 29.16% D 440 67.27% 32.73% E 316 90.51% 9.49%

QUANTIFYING OCCUPATIONAL INJUSTICE

BENCHMARKING UNDERSTANDING THE SETTING MAKING RECOMMENDATIONS USEFULNESS OF THE ATOSE: FOCUS ON INTERACTIVE OCCUPATION AND SOCIAL ENGAGEMENT BENCHMARKING UNDERSTANDING THE SETTING MAKING RECOMMENDATIONS

Dr. Mark Morgan-Brown on ResearchGate for contact or for links to journal articles and presentations mark.morgan-brown@hotmail.com Assistant Professor Joan Brangan jbrangan@tcd.ie