The service. The OT role where do we fit in? The future?

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2 The service The OT role where do we fit in? The future?

3 Medical Consultants Assistant Practitioner Therapy Assistant Dietitians SWMS Team Health Trainer Physiotherapists Psychologist Occupational Therapists

4 Domiciliary Service Psychology / OT group. DBT informed Service promotion and development Co facilitator of MDT group The role of the OT SWMS Volunteers role development. Joint clinic with OT/Dietician or Physio Home Visits Maternity pathway 1:1 interventions, Relaxation group Support group self management group

5 Low self esteem Poor self confidence Difficulties problem solving Difficulties with motivation, goal setting and structuring of time Low mood and high levels of expressed anxiety Restricted range of movement Difficulties mobilising High levels of physical pain

6 Planning and maintaining routines through meaningful activity. Developing new coping strategies Identifying and challenging thought processes Improving sleep hygiene and pain management Group programme to target emotional eating and dietary education Improving the physical environment through equipment and minor adaptations Anxiety management/assertion/stress management Improving volition by improving confidence, self esteem, physical functioning.

7 Sharon. 41yr Old Female. Weight kg completed Bariatric Surgery pathway Co-morbidities: impaired glucose tolerance, anxiety and depression, severe backache affecting mobility, previous binge eating, psychosis. Initial occupational performance difficulties identified: Outdoor mobility Household management Bathing Shopping - unable to go out Meal Prep Pain Severe anxiety Initial COPM scores P 2.25 S2

8 So what did we do? 1:1 OT intervention at home initially, main focus on anxiety management and graded exposure for agoraphobia. Attended Psychology and OT group, therapeutic support with emotional eating and increase tolerance to distress. Following input from OT was able to attend MDT group provided by OT and dietitian, for education on diet, exercise and well-being. Did this work? Weight 115.3kg COPM P S 6 She turned everything on its head, in good way! talk to you like you re a real person and not just an NHS number. I m really glad to have had to chance to meet a lovely team who work well together and go above and beyond what is required of them.

9 And now? Mood I am much more confident and able to socialise. I ve even now been abroad on holiday. Mobility This has greatly increased. My breathing is much better; I can now run upstairs where as before I went up on my hands and knees. Pain My pain is still the same, but now I can do much more within it. Dietary My diet has changed dramatically. What I have learnt means I have the ability to make better dietary choices. Weight My weight has fluctuated. The team helped me get back on track and start losing again, I ve now lost all the regained weight and continuing to decrease. Health I feel much better within myself; I m more confident, less anxious and generally much happier than I was.

10 Recent shift towards applying DBT informed practice during OT interventions. Key areas include; Commitment strategies Encouraging mindfulness skills; Mindful eating is my biggest change. Thinking about choices in what and how much I eat. Accepting me. Identifying triggers and how to avoid them. Developing and improving distress tolerance skills Using emotion regulation skills as an alternative to distraction techniques. Distraction does not address the problem. I have learned to think and act accordingly instead of just doing a

11 Ran by Psychology and O.T. 10 session programme for individuals with disordered eating. Individuals with a diagnosed eating disorder, including Binge Eating are referred on to appropriate service. Structured (each session, whole treatment process, homework) Emphasises therapist / client collaboration Disordered Eating group Patient feedback; I not just had my epiphany(!) but made some good friends as well. We ve bared our souls and supported each other I was hesitant about group sessions but being with people with similar problems meant we could help each other attain goals. a

12 One:one Patients may benefit from aids to improve ADL function. Grading and pacing interventions Anxiety management Relaxation Group Teaches progressive muscle relaxation and guided imagery techniques to assist in relaxation and stress management. Proven to reduce heartburn, pain, improve sleep and develop effective coping strategy for anxiety often present in early pregnancy. Can also be implemented during labour. a

13 What is the support group? The aim of the support group is to consolidate the new information patients learnt in the past few months and to build on this, to develop confidence, increase well-being and share experiences. It is Led by an O.T and an assistant practitioner and runs for an hour once a month. What does it entail? The Kawa (Japanese for river) model uses a familiar metaphor of nature as an effective medium to translate subjective views of self, life, well-being and the meanings of occupations ww.kawa.com The Kawa model is used to guide discussion, identify barriers and encourage reflection. a

14 Professional Patient volunteers Help manage patient expectations Build encouraging and enabling relationships Support group activities for the people who use the service Support the collection of monitoring data as required. Have a role within the support group Promoting Volunteers will: Support the collection of monitoring data as required e.g. patient experience and DNA audit Support SWMS service development groups Offer a patient s perspective on SWMS resources Support positive promotion and marketing of SWMS Support the SWMS newsletter and social media initiatives

15 Children s weight management service- transition pathway/support Web-based LWFG- compliments the pathway and requires further work to incorporate. Increased psychological input Service promotion, road show's and local events. Development within early intervention and re-ablement services within Wigan Council. The use of technology to provide assessment and intervention over webcams.

16 Developing a standardised Outcome measure Research, Book Development of an app for those with disordered eating COT drive: Do you work with people with bariatric needs? Would you like resources from COT to support practice? What type of resource would you like? Replies to genevieve.smyth@cot.co.uk

17 COT Hot Topic, 2014 OTN articles, August 2013 & January 2014 National Obesity Forum; Foresight report ASO NOO

18 Why obesity? The service and OT role The future Resources

19 eighthome.aspx