1. A study of the implementation of the tailored activity programme (TAP) in a Scottish context
RCOT Conference 2017
Niamh Kinsella, MSc Occupational Therapy
PhD candidate, Queen Margaret University

2. Objectives Introduction to the TAP Why a context study?
Methodology and methods
What does the TAP look like in Scotland and why?
What next?

3. What is the tailored activity programme?
US developed occupational therapy intervention
People living with dementia and caregivers
Structured, multi-stage including:
- assessment
- activity prescription and implementation
- generalisation and simplification

4. Why a context study? Policy drive for “personalised” interventions
Context has an influence on implementation of evidence in practice
Don’t know much about TAP in Scotland
PhD study- where do we start?
Inclusive research
Can’t do research using CIPP principles if we don’t understand more about what therapists are experiencing, what the real research question is.
Context includes: research culture, leadership and evaluation

5. Aims of study Understand how the TAP is being implemented in Scotland
Understand impact of context on implementation

6. Methodology and methods
Qualitative design
Principles of critical creativity
Reflective discussion
Critical creative dialogue with ‘self’

7. This is what TAP looked like in a Scottish context- or what implementation of evidence in practice looked like to me when I was having these reflective discussions

8. Findings Implementation is not straightforward
Therefore, evaluation not happening

9. Why did it look like this?
Service resources- time
Service referral processes
Person-centred values
Value of professional reasoning

10. “all stated feeling that the number of assessments required in the TAP is excessive and that time constraints limit their capacity to complete them”
“modification also appears to allow the occupational therapists to use the TAP in a person-centred way ”
“TAP is a nice way to bring a couple together in the face of dementia regardless of the presence of behavioural symptoms”

11. So what?
Reason for implementation and the definition of the TAP will vary for each person an occupational therapist works with
Findings gave an idea of how to broadly define TAP in order to study it
At the time

12. Definition that emerged
“a home-based intervention implemented by occupational therapists for any person living with dementia, an informal caregiver and sometimes other family members. It is implemented over five to ten visits in the home. The assessment stage always uses the Large Allen Cognitive Screen alongside other standardised and non-standardised assessments which may or may not have been specified in the step-by-step TAP manual. The TAP includes the use of specific proprietary resources (documentation and manuals) if they are deemed necessary. Finally, the decision to use the TAP is based on: the decision of the person living with dementia; the choice of the caregiver; and the professional judgement of the occupational therapist”

13. Why was this information helpful?
Context study highlighted impact of context
Facilitated identification of person-centred practice
Facilitated creation of definition in order to develop inclusive research questions
Facilitated identification of appropriate research methodology- case study research

14. What does it look like now?
Started study using case study research methodology
Definition was helpful to a point
Person-centred occupational therapy beyond “tailored activity”
A study of professional artistry
Policy context influences what therapists do and how they use their skills, knowledge and experience in practice
Case study research still facilitates exploration of this issue- context is foregrounded rather than “professional artistry” of therapists

15. Any questions? ?