Occupational Therapy Programme Wedge Gardens Treatment Centre

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1 Occupational Therapy Programme Wedge Gardens Treatment Centre Occupational Therapy at Wedge Gardens Treatment Centre aims to help patients with substance abuse problems to function as independently as possible, by addressing individual needs with regard to Occupational Performance. Occupational Performance consists of Occupational Performance Areas (OPAs) and Occupational Performance Components (OPCs). When looking at Occupational Performance Areas, it consists of the following: Work Leisure Personal Independence such as mobility (walking, making use of transport), personal care activities (eating, bathing, dressing, sleeping), home maintenance activities, functional communication and money handling Interpersonal Relationships (interaction with others in the environment) Life Skills (problem-solving, conflict management, stress management, time management, being assertive and anger management). Occupational Performance Components are the components needed to function in Occupational Performance Areas: Cognitive abilities such as intellect, perceptual ability, thought process organisation, planning, memory, concentration, insight, judgement and reality orientation Motor abilities such as muscle strength, gross motor skills, posture, range of movement, hand function and gait Sensory abilities such as touch, smell, taste, sight and hearing Motivation, which consists of energy levels, handling delayed gratification, constructive use of time, ideals and value systems, internal motivation, drive factors, attitude towards self and treatment, interests in people, objects and the environment, sense of responsibility, the initiation and completion of tasks, decision-making, quality and tempo of tasks executed and perseverance Affective abilities, for example emotional control, appropriateness, range and intensity of emotions, and pathological negative and/or positive emotions. The evaluation process: Assessments are executed during the first week of admission, when patients are in detoxification. Assessments consist of an initial interview with the patient, a work activity, a fine motor activity, co-lateral information from nursing staff, and general observation (interaction with other patients, eating, personal presentation etc.). The Comprehensive Occupational Therapy Evaluation Scale (COTE scale) is then completed which gives a brief idea of the patient in terms of general, interpersonal

2 and task behaviors. It is important to remember that results can change in time and differ as motivation, mood and activities change. Therefore, it is ideal to complete this scale at the beginning, middle and end phases of the programme. Throughout the assessment process, the model of creative participation is used in order to evaluate action, volition, how the patient handles tools and materials, how he relates to other people, how he handles a situation, task concept, quality of products delivered, assistance/supervision needed, behaviour, norm awareness, anxiety, emotional responses and initiative effort. The creative participation model thus gives an idea on which level a patient is currently functioning. The aim during assessment is to evaluate as many OPAs and OPCs as possible, in order to create an holistic image of the patient s abilities. Information generated from assessments are carried over to the final assessment form. This form gives a clear description of the patient with regards to his environment, life roles and tasks, personality, life skills, normal development, and strengths and weaknesses in terms of OPAs and OPCs. Depending on the results, a conclusion and recommendations will be made. Intervention process After evaluation, an intervention plan is generated for each patient in need of Occupational Therapy. The intervention plan consists of the following: Programme(s) used Model(s) used Frame(s) of reference Desired outcomes Aims Plan Case management Future planning Continuous aims. Patients can be seen individually or in a group. Each patient s evaluation and intervention plan is discussed with them. They get an opportunity to sign a contract where they will agree to the terms and conditions of therapy. If a patient decides that he does not want to participate in therapy, he will have the opportunity to indicate this in the contract, and therapy will be terminated with immediate effect. Patients with similar aims are seen in a group setting. Groups are closed, which means that no new members will be allowed to enter the group, and no members are allowed to leave the group.

3 Patients will be divided into five groups: Creative groups (a maximum of 4 patients) Medium Intensity groups (4-8 patients) Relaxation Therapy groups (2-6 patients) High Intensity groups Extension groups Creative groups Creative groups consist of patients who are functioning on a lower level. This means that patients in this group: - show more concrete thinking - need more assistance - still need to develop norm awareness - need to explore to present themselves - need activities to have fewer steps and be less complex. Patients who struggle with interpersonal skills will thus initially not be expected to communicate/interact with others on a deep level, as they are still unsure, hesitant and at times show strange behaviour due to low self-esteem, anxiety and poor emotional control. The aim of creative groups is to increase motivation, develop task concepts, insight, interpersonal skills, emotional control, norms and initiative. Here, creative activities are used to develop creativity, to let them explore. These groups are not product-centered, but rather give patients a sense of gratification, regardless of the quality of product (to enhance self-esteem and to increase motivation). While using fun activities, components such as fine motor skills, concentration, planning, etc. are also addressed. The desired outcome is to improve participation and skills to such an extent that patients can move to the next level of creative participation, to enter a medium intensity group. Creative groups are usually smaller, as more assistance/supervision is needed. Medium Intensity groups These groups consist of patients who are more product-centered. This means that patients in this group: - are directed to attainment of skills and quality

4 - can communicate more effectively in a group - need less supervision - can handle more steps - are more aware of norms and expectations - can better control their emotions - show more initiative and motivation. Through these groups, life skills are being addressed through participation in various activities. Life skills include: - Problem-solving skills - Stress management skills - Conflict management - Planning/time management skills - Anger management. Activities used in Medium Intensity groups: - are more complex - require teamwork - require the development of interpersonal skills - encourage creativity. During these activities, patients are encouraged to think outside the box ; they learn skills, learn how to communicate effectively, learn how to handle conflict (to be able to comply with norms), develop self-awareness, how to behave in a socially acceptable manner, and improve quality of products. The Canadian Occupational Performance Measure can be used to incorporate individual needs into therapy sessions. Medium Intensity groups can be larger and an element of competition can be introduced to increase motivation and participation, as the group is more productcentered. Relaxation Therapy groups Patients with high stress and anxiety levels are included in relaxation therapy. These groups include the Jacobson s Relaxation Therapy technique, breathing and stretching exercises. The aim of this group is to decrease stress and anxiety levels without the need for medication. Methods used are easy to apply and it is recommended that the patients continue this on their own after their sessions are completed. Patients are booked for sessions according to needs and will be terminated as soon as they have mastered the skill.

5 High Intensity groups Patients in this group fall into a high level of creative participation. They are not suitable for Occupational Therapy intervention (unless they have problems with regard to motor/sensory abilities) and it is recommended that they receive psychotherapy. Extension groups The extension group consists of patients who are in their third month of treatment and fall into level 3 of the behaviour modification demerit system implemented by the facility. They are preparing to go job-hunting and need to be slowly reintegrated into society. During this level (level 3), the patients are expected to go job-hunting for 10 working days off the premises, from 09:00 15:00. The aim of this group is to prepare the patients with regards to expectations in the workplace, preparing for interviews, work ethics, relapse prevention and stress management, before they start their job-hunting.

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