1. The role of an Occupational Therapist in a Learning Disability service Kate Barter Occupational Therapist Cornwall Foundation Trust January 2011 kate.barter@cft.cornwall.nhs.uk

2. Background  Our core beliefs  How OT developed  The scope of the OT role today  OT needs of people using the learning disabilities service

3. OT service in CFT’s Learning Disability service  Increased numbers  Two teams cover the county, plus an OT in the Intensive Support Team  Where we’re based  Plans for integration with Department of Adult Care and Support

4. Who we work with  Adults with learning disabilities  People who present with ‘challenging behaviours’ – often sensory processing work to be done  People who want to learn new skills

5. Model of Human Occupation:  Motivation  Pattern of occupation  Occupational performance skills: Motor Motor Process Process Communication and interaction Communication and interaction (Sensory processing) (Sensory processing)  Environment

6. Motivation for occupation  Is the activity meaningful to the person?  What motivates the person…are they aware of this?  Are support workers ‘motivators’?

7. Pattern of occupation  Do the person’s activities reflect what you’d expect in an average day?  Is there enough stimulation?  Does the person have choices?  Are there enough opportunities for social inclusion, leisure pursuits, time spent in various environments?  Is the person encouraged to be involved in their own life, eg involved in personal care tasks, domestic chores etc?

8. Occupational performance skills: Motor skills  Does the person have the physical skills to cope with what’s required in an activity? eg Gross motor skills Gross motor skills Fine motor skills - dexterity Fine motor skills - dexterity Balance Balance Co-ordination Co-ordination Flexibility Flexibility Endurance Endurance If not, is there scope to teach them, or is extra support needed so someone helps them with these aspects?

9. Occupational performance skills: Process skills Does the person have the cognitive skills to cope with what’s required in an activity?... object recognition, memory of how to use tools appropriately higher level thinking skills: planning, sequencing, attending, managing risks, noticing problems and problem solving etc May use the Assessment of Motor and Process Skils (posture, mobility, co-ordination, strength and effort, energy, using knowledge, temporal organisation, space and objects, adaptation)

10. Occupational performance skills: Communication and interaction  Does the person understand communication about how to do an activity?  How do they engage with others – support workers, housemates, people at day centre, health professionals, in the community?  Do support team read non-verbal cues effectively?  What is the best way to interact with the person?

11. Occupational performance skills: Sensory needs  Sensory processing is: ‘the neurological process that organises sensations from one’s own body and from the environment and makes it possible to use the body effectively within the environment.’ (Ayres)  Sensory-based occupation may appeal more to our clients  Sensory Processing Pathway includes assessment * sensory diets * Sensory Integration clinic * training for staff teams and families * generic training * sensory group

12. Environment  Physical  Social  Resources

13. Expected outcomes among staff teams… based on an audit of sensory work  New knowledge for staff teams “It’s opened my eyes a bit after 20 years of working with that person” “It’s opened my eyes a bit after 20 years of working with that person”  Re-motivation of staff teams: “I enjoy engaging with the person more since we did the sensory work” “I enjoy engaging with the person more since we did the sensory work”  Increased empathy: “The work made you think…about how you’d like to be looked after in that client’s shoes” “The work made you think…about how you’d like to be looked after in that client’s shoes”  A realisation of the need for activity: “It’s given us new way of thinking, like looking at what can we get out of experiences” “It’s given us new way of thinking, like looking at what can we get out of experiences”  A realisation of the need for skills teaching: “It opens you up to what can be achieved” “It opens you up to what can be achieved”

14. Expected outcomes among people we support… based on an audit of sensory work  ‘We started the Sensory Diet two weeks ago. X has been far more settled since this, and hasn’t ripped any of her tops’  ‘Now that Y’s day is a lot more structured and interesting for her, she is happier to get out of bed in the mornings’  ‘Z’s Sensory Diet is now included in his Care Plan. He’s become…far more responsive to us; making more eye contact and smiling more, and becoming animated at times’  ‘I’ve seen a tremendous improvement in A’s engagement in activities offered to him’  ‘B is happy with her increase in activities, and is happy to be encouraged with domestic jobs around the house’  ‘We’ve seen a total turnaround in C’s general well-being; huge improvements in his skills, interactions, choice making and general confidence…many of his old behaviours which could prove difficult to manage have more or less disappeared’

15. References  Mansell, J. et al. Engagement in Meaningful Activity and the Active Support of People with Intellectual Disabilities in Residential Care. In: Research in Developmental Disabilities, Volume 23 Issue 5, Sept–Oct 2002, pages 342-352  Ayres, A.J., (2005). Sensory Integration and the Child: Understanding hidden sensory challenges. Los Angeles: Western Psychological Services.  Kielhofner, G. (2007). Model of Human Occupation: Theory & Application. Philadelphia: Lippincott, Williams & Wilkins  Turner A, Foster M, Johnson S E (1999). OT and Physical Dysfunction, 4 th edn. Churchill Livingstone, New York  Valuing People, 2001. Department of Health  Valuing People Now, 2009. Department of Health