1. 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

2. 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

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

5. 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

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

7. ORGANISATIONAL PURPOSE

8. 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

9. 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

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

11. 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 .

12. 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

13. 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

14. 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

15. The ATOSE
paper version
computerised version

16. 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%

17. 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%

22. QUANTIFYING OCCUPATIONAL INJUSTICE

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

24. Dr. Mark Morgan-Brown on ResearchGate for contact or for links to journal articles and presentations
Assistant Professor Joan Brangan