Practice placement OCT 312 Learning Disabilities (LD) Specialist - - PowerPoint PPT Presentation

Practice placement – OCT 312 Learning Disabilities (LD) Specialist Health Team Case study presentation on a service user who has a mild LD and how this impacts on her role of parent Student number 10529913

Placement setting/Role of occupational therapist

Sensory Processing

• ffer assessment and therapy

to gain greater understanding

• f how an individual

processes sensory information; Ayres SI therapy, when sensory integration is identified as a occupational participation barrier

• proactive approach with

carers to take forward a ‘sensory diet’; enabling the individual to engage in meaningful activities and reduce fluctuating arousal levels. Daily Living Skills (ADLs) Assessment

• Concern regarding skill loss
• Specific assessment and advice

regarding individuals who may be

• n the dementia care pathway
• Skills training/recommendations
• Daily living skills assessment

when an individuals placement is breaking down and little is understood about their support needs

• Placement suitability
• Supporting the role of parents

who have a learning disability. Behaviour That Challenges · Environmental evidence based assessment · Sensory profile. · Understanding occupational needs, routine, consistency and structure. · Staff support/training encouraging a MDT approach, systemic, family/carer relationship work · Physical screening is part of initial LD OT assessment, where onward referral is identified where indicated. Dementia · baseline assessment and follow up. · Changing needs assessment, e.g. Assessment of changing functional, social, environmental needs as dementia progresses, staff support/training.

• Identify changes to

equipment needs, refer

• n to social care

Occupational Therapist’s.

[1] (Creek, 2003), [2] (Parker, 2011), [3] (Lillywhite & Haines, 2010), [4] (NLDPS, 2015).

Learning Disability Specialist Team Occupational Therapy

[1] (Clipartbarn, 2017).

Assessed to have capacity and to consent to treatment.

[1]

Mild learning Disability, Noonan Syndrome, dual sensory impairment.

The service user

Governing body/Policies, guidelines and legislations Relevance to case study/impact on practice National Policy Drivers

Royal College of Occupational Therapists (RCOT) Professional Standards [14]. Service provision, patient welfare, professionalism and ethical frameworks within which registrants must work. Royal College of Occupational Therapists (RCOT) Code of ethics and professional conduct [1]. Healthcare Professional's Council (HCPC) Standards of conduct, performance and ethics [2]. Management of Noonan Syndrome – A Clinical Guidance [3]. Guidelines recommend people with diagnosis of Noonan’s Syndrome are helped to access support for employment, independent living and social skill interventions as needed [3]. Equality Act - Reasonable adjustments [4]. The act ensures, as far as possible, by reasonable means that a person with a disability experiences the least

• disadvantage. Must ensure reasonable adjustments are made to service users to ensure practice is person-

centred and each person is given sufficient opportunity to understand and engage.; ensures all correspondence Kelly receives is an accessible format [13]. Mental Capacity Act [5]. Complying with act is important as it enables people with a LD to make choices, empowering them to make informed decisions and to set their own goals to improve their quality of life. SCIE – helping people with LD in their parenting role [6.] This resource has not been updated since February 2005. It may not reflect current policy but still provides valuable practice guidance; summary of potential support parents with a LD may need. Care Act – Safeguarding [7]. People with a LD can be vulnerable and so it is essential, in practice to be able to identify abuse, develop safety plans and make alerts , to promote the wellbeing and safety of the service user [13]. National Institution of Care Excellence (NICE) - Multimorbidity: clinical assessment and management [8]. Encourage people with multimorbidity to clarify what is important to them, including their personal goals, values and priorities. These may include taking part in social activities and playing an active part in family life, maintaining their independence; further supports the need to work with Kelly to gain increased independence and be able to actively engage in her parenting role.

Local Policy Drivers

Consent and Capacity to consent policy[9]. Confidentiality, sharing of information, gaining consent. Food hygiene policy [10]. Guidance for safe practice in the correct handling of food; impacting on my own ability to be able safely and correctly handle food when working with Kelly. Lone working [11]. Within community working have to ensure personal safety when working alone

Policies and Legislations

[1] (RCOT, 2017a), [2] (HCPC, 2016), [3] (NSGDG, 2010). [4] (Equality Act, 2010), [5] (Mental Capacity Act, 2005), [6] )SCIE, 2005), [7] (Care Act, 2014), [8] (NICE, 2016), [9] (XXXX, 2015a), [10] (XXXX, 2015b), [11] (XXXX, 2016), [12] McSherry & Pearce, 2011), [13] (Lillywhite & Haines, 2010), [14] (RCOT, 2017b).

Collectively, both can affect Kelly’s ability to communicate effectively and engage in her environment; limiting participation in occupations and so the demands of the activity will need to change in order to reduce the risk of occupational deprivation occurring, giving reason for referral to occupational therapy [6][9].

[1] (DOH, 2001), [2] (Holland, 2011), [3] ] (NSGDG, 2010), [4] (Sense, 2017), [5] (Schneider et al., 2011), [6] (Lillywhite & Haines, 2010), [7] (Political Correctness and People with Disabilities, 2017), [8] (PHE, 2016), [9] (Hurst, 2009).

Learning disability [1] [2] A LD is defined as inclusion of the following criteria: initiated before adulthood, a significantly reduced ability to understand new or complex information to learn new skills; a reduced ability to cope independently having a lasting effect on development; with intellectual impairment being classified as an Intelligence Quotient (IQ) of 70 and below. Noonan Syndrome [3] Varying greatly in breadth and severity. It is common for those affected by Noonan Syndrome to have an array of physical and health problems, often causing an under development of hearing and speech.

[7] [3]

Prevalence [8] End of March 2015 there were 252,446 people of all ages on LD registers.

Impact of condition on occupational performance ability and participation Learning Disability [6].

• Struggle to break down and process complexed information which could contribute to poor planning and sequencing which will

ultimately affect engagement and participation in occupation Dual sensory loss (Possibly secondary to Noonan Syndrome) [4][5]

• diminishes communication and well-being and can cause social isolation, reduced independence, and cognitive impairment, impacting on

an Kelly’s ability to access information and advice around health and wellbeing; resulting in difficulties with, maintaining social relationships and having a healthy lifestyle.

Epidemiology

Kelly’s occupation organisation - Habituation Roles

• Parent, partner, friend, daughter.

Routines

• Caring for her son, parent and toddler group every Thursday afternoon – no

formal structure. Environment (facilitators and barriers to engagement in occupation) Physical environment –

• struggles to operate physical resources in home environment due to visual

impairment.

• Moved house – all level, accessible flat.

Social environment –

• Partners mum very supportive of Kelly.
• Struggles in new social situations.
• Relationship with partner.
• Receives support from sensory loss worker once a week – no evidence of care

planning. Kelly’s occupation performance - Performance capacity

• Struggling with some ADLs - mainly meal preparation and cooking. Reported to

be independent in self care for both herself and her son.

• Mild LD.
• Noonan’s Syndrome; visual impairment, mixed conductive and sensorineural

deafness secondary to Noonan’s syndrome.

MOHO [1][2] – Information gathering Volition Habituation Environment Performance skills

Kelly’s motivation for occupation -Volition

• Does not work currently but has previously attended college and completed a

cookery class.

• Recently, has not been able to engage in many meaningful occupations;
• Reported to have an active interest in swimming.

[1](Kielhofner, 2008), [2] (Lillywhite & Haines, 2010), [3] (Townsend & Wilcock, 2004), [4] (Mahoney et al., 2016), [5](American Psychiatric Association, 2013), [6] (Wilcock & Hocking, 2015).

People with learning disabilities may be predisposed to

• ccupational alienation as a result of an inherent need

for ongoing support in at least one major life activity across multiple environments [5][6]; at risk if they are not afforded meaningful choices and opportunities for enriching occupational experiences by being supported to participate in occupations [3][4]. Therefore, important to use MOHO as a framework to guide practice as it will be able to look at a persons facilitators and inhibitors to occupational performance and participation [2]. The model allowed me to keep this focus in my assessment and treatment and to give a client centered approach [1][2].

[16] [8]

The results highlight the importance of using a combination of functional assessment and observations in order to address complexity, acquiring a more complete picture of the service users strengths and limitations to be able to support independent living in the community [2].

Outcome and outcome measures

Model of Human Occupation Screening T

• ol (MOHOST)[2]
• Enables observations in natural environments, increases validity as it adds important objectivity to

assessment that might otherwise be based on speaking to family and support workers [1].

• Straight forward to use for service users with mild- moderate LD [6].
• Within LD service, introduces an evidence base to assessment process without compromising clinical

flexibility [6].

• Can be used to assess Kelly in different environments; identifies a person's key strengths and limitations

in terms of MOHO subsystems. Supporting the use of MOHO as the theoretical framework in practice [1][12].

• Can be used as an outcome measure. – measure of change in how volition, habituation, skill and

environment support participation [12].

• Several studies have shown that therapists find it useful for decision-making, supportive of occupation-

focused thinking and useful as a structure to client-centred practice [1][15].

• Therapist-rated tool; limits clients ability to reflect on their own occupational participation [14].

Assessment of Motor and Process Skills (AMPS) [8]

• Gain insight into a Kelly’s pervious engagement, commonly used in the assessment of people with

learning disabilities [1][19].

• Can assess an individuals ability to perform a functional daily task – self selected activity. Therefore,

making the assessment occupational and client-centred [3][4]; a top-down approach [13].

• Generating objective measures that can be used to implement evidenced based practice [3][4][9].
• Indicates the degree of efficiency and is more accurate in predicting the need for assistance in order to

live in the community [7][14].

• Free of cultural bias - important as should always be vigilant to whether an assessment is valid for client

group based on cultural background, MOHO’s theory incorporates culture into concepts [10][11][12].

Road safety assessment

• Assesses how safely a person can asses the community; community participation is an important aspect to

enhancing life and occupational functioning [17].

• Short, easy to administer.

[1] (Lillywhite & Haines, 2010), [2] (Parkinson, Forsyth & Keilhofner, 2006), [3] (Mesa et al., 2014), [4] (Knecht-Sabres, 2014), [5] (RCOT, 2010), [6] (Hawes & Houlder, 2010), [7] (Merritt 2010), [8] (Fisher, 2005), [9] (Fawcett, 2013), [10] (Gantschnig et al., 2015), [11] (James et al., 2015), [12] (Forsyth, 2017), [13] (Fisher, 2009), [14] (Hitch, 2007), [15] (Forsyth et al., 2011), [16] (All Occupational Therapy, 2017, [17] Loukas & McNeil, 2014), [18] (blog, 2017), [19] (Dwyer & Reep, 2008). [18]

Assessment and frames of reference

Findings/interpretation of results:-

MOHOST [1]

Motivation for Occupation – difficulty identifying interests, ineffective at praising own ability. Process skills – requires encouragement, difficulty initiating, sequencing and completing; delays decisions. Motor skills – difficultly coordinating and manipulating

• bjects; difficulty maintaining energy levels.

Environment – space is mostly adequate; resources impede ability to achieve occupational goals safely; cultural responsibilities source of stress. Pattern of Occupation – time is filled but balance of activities my not always meet responsibilities; wants to take responsibility but does not show awareness of full

• ccupational implications.

Communication and Interaction skills – generally allows

• ccupational participation but copes better 1:1.

AMPS [2]

Kelly experienced significant challenges in the following areas:

• Temporal Organisation
• Adapting Performance

Fatigue was noted at the end of both tasks, which could give explanation to poor results in task analysis (sequencing and planning); significantly limiting activity participation, potentially compromising safety, health and wellbeing [3]. Road safety - no presenting problems.

[1](Parkinson, Forsyth & Keilhofner, 2006), [2] (Fisher, 2005), [3] (Toglia, Golisz & Goverover, 2014), [4] (Parker, 2011).

Routine Adaptability Roles Responsibility

R I A F

Occupational Areas Pattern of Occupation Non-verbal Skills Conversation Vocal Expression Relationships

R I A F

Occupational Areas Communication and Interaction Skills Posture and Mobility Co-ordination Strength and Effort Energy

R I A F

Occupational Areas Motor Skills Physical Space Physical Resources Social Groups Occupational Demands

R I A F

Occupational Areas Environment Appraisal of Abilities Expectation of … Interest Choices

R I A F

Occupational Areas Motivation for Occupation Knowledge Timing Organisation Problem-solving

R I A F Occupational Areas

Process Skills

Long term aim To be able to independently make a range of healthy meals for herself and her son. Long term objective To develop activities of daily living skills (cooking) in the next 12 months. Short term aim To be able to make one healthy fresh meal for herself and her son. Short T erm Objectives (> 2 months) To be able to independently and safely use the cooker and microwave in relation to task (1-2 weeks). To be able to understand and follow instructions for making pizzas (2 – 6 weeks). To maintain and develop performance skills for making pizzas (4-8 weeks). SMART [4] Aims and objectives OT process influenced by patient aim

Aims and objectives were not set until the 3rd visit as Kelly finds new social situations difficult and so was important for me to work towards and building a therapeutic relationship first with Kelly in order to ensure I was being person centred; person centred practice is key to learning disability policy across the UK and can encourage positive change for people with a LD [1][2][3].

[1] (Lillywhite & Haines, 2010), [2] Sanderson, Thompson & Kilbane, 2006), [3] (DOH, 2010), [4] (Park, 2009), [5] (Wigham et al., 2008).

Interventions Implementation/Clinical Reasoning; linking into what aim

Accessible recipes Linking to both short and long term aim;

• recognised challenge with temporal organisation.
• Used reasonable adjustments to remove barriers

to successful skill development through using accessible recipes and information to facilitate and work towards cooking independently [1].

• Using task analysis - breaking down recipes into

small easy to follow steps helping with planning, timing and sequencing; setting them at the just right level [2][3]. Raised stickers for cooker Linking to short term aims;

• Due to dual sensory loss important for Kelly to

be able to use physical resources in her environment safely. Health promotion Linking to long and short term aims:-

• Discussions with Kelly what food is healthy for

both her and her son; important for physical development [7].

• Support carers/family to implement

recommendations.

Intervention, approaches and implementation

[1] (Equality Act, 2010), [2] (Thomas, 2015), [3] (Townsend et al., 2007) [4] (Polglase & Treseder, 2012), [5] (James, 2014), [6] (Lillywhite & Haines, 2010), [7] (Locke, 2009), [8] (RCOT, 2013).

Through the assessments, it was clear that Kelly struggled with planning and sequencing in tasks and so it was important to focus how best to support Kelly to be able to reengage with function and occupation. Each intervention used addresses the performance capacity, volition, motivation and environment aspects of the Model of Human Occupation that has been used to guide the OT process as the interventions are linked to occupation and engagement with function, enhancing mood; so important to give her right amount and type of support to achieve maximal level of independence to achieve best outcome as detailed in the Royal College of Occupational Therapy research study for LD [6][7][8].

Intervention: Accessible recipes

Going forward this format can be used to build a recipe file; helping to work towards Kelly’s long term aim, facilitating her role of parent. [1] (Parker, 2011), [2] (Toglia, Golisz & Goverover, 2014), [3] (Equality Act, 2010), [4] (Meriano & Latella, 2008), [5] (Boyt Schell & Gillen, 2014), [6] Coren, Thomae & Hutchfield, 2011), [7] (Lillywhite & Haines, 2010), [8] Hammel et al., 2014), [9] (Townsend & Wilcock, 2004), [10] (Mahoney et al., 2016), [11] (American Psychiatric Association, 2013), [12] (Wilcock & Hocking, 2015), [13] (Townsend et al., 2007), [14] (RCOT, 2013). A Cochrane systematic review indicated that interventions that are implemented to support parenting, are more successful if broken down into smaller steps, using verbal instructions, specially designed picture books and feedback to mother after the session [6]. Top-down as Kelly is performing ADL skills that incorporates remediation for functional activity deficits [4]. Intervention links to all aspects of model – helping to reach own optimum level of independence, specific to Kelly's environment. Opportunity to practise and develop domestic role skills important for parenting role – occupation focused. Able to work with client to choose recipes – client- centred approach [1]. Contributes to meeting the wider social policy priorities of promoting rights and supporting independence, control and inclusion [7]; considering the holistic needs and desires of the individual as influenced by society, supporting societal

• pportunities by creating an enabling

environment [8].

Structured, adapted and graded, set at the ‘just right level’; helping to maintain and enhance Kelly’s level of functioning [2][13]. Takes in account dual sensory loss, using reasonable adjustments [3]. Blended approaches encourages focus on participation [5]. Using each session to build her confidence; Promoting independence through building confidence and improving self-esteem [7]

‘Occupational therapist’s should offer interventions to people with LD that focus on engagement in

• ccupation and enabling independence – should be of

an appropriate length of time to enable engagement with the service user and development of their independent living skills’ [14]. Intervention helped to meet Kelly’s

• ccupational needs; Enhancing
• ccupational experiences; limiting
• ccupational deprivation [9][10][11][12].

Outcomes of interventions Pre-intervention Post intervention As result of intervention, using MOHOST as an

• utcome measure, it shows Kelly has increased

ability to engage and participate in her

• ccupation; increasing motivation, supporting

her role of parenting.

Allows 42% Inhibits 58%

End of intervention, discharge

• Occupational therapy concludes that Kelly has demonstrated good potential in

developing the practical activities of daily skills required to parent a child, but to also to be able to improve her own quality of life.

• Kelly has been referred to health facilitator but not discharged as will be supervised

by a therapist to still manage on going needs – helping to work towards long term aim, increasing confidence in parenting role and her overall independence; Contributes to working towards NICE guidance [1].

• Discussion with support worker to formulate a care plan to further support Kelly.
• Recommendation report completed and shared with relevant professionals to ensure

further input with Kelly. Important to encourage collaborative working [2]; works to

• ne of the 8 principles that need to be considered when working with people with a

LD, improving quality of life and reducing occupation alienation [5][6].

• Towards end of input – identified possible safeguarding issue

regarding relationship with partner. Documented all that has been noticed, informal discussions with educator and relevant professional

• Contacted safeguarding to gain advice around next steps to take –

important as working with vulnerable client group [3][4].

End of intervention Risk factors

[1] (NICE, 2016), [2] (Lillywhite & Haines, 2010), [3] (Care Act, 2014), [4] (Mental Capacity Act, 2005), [5] (RCOT, 2013), [6] (Wilcock & Hocking, 2015).

Case study review

Why did I pick the case study? The service frequently receives referrals around Learning disability and parenting. Felt it would give me opportunity to experience working with a service user through the majority of the Occupational Therapy Process. Was I client centred?

• Led by service user.
• T
• ok into consideration Kelly’s wants and

needs when considering intervention and desired outcomes. If there anything you would have done or could have done differently to improve patient outcomes?

• Use of Goal Attainment Scale (GAS) goals to

produce a further outcome measure not only to measure performance but also enable service user feedback [1][2][3].

[1] (RCOT, 2010), [2] (Turner-Stokes, 2009), [3] (Turner-Stokes & Williams, 2010).

Volition Habituation Environme nt Performance skills Why MOHO?? Why MOHO? [1][2][3][4][5][7][8][9]

• This model is used as a framework, by the occupational therapists within the service.
• It works well, as within LD it is important to consider volition and the conceptualization of the environment. Ensures

people with learning difficulties' values and interests are not only identified and respected but used as the focus for service provision to enable client centered practice.

• Recognising the importance of the environment, both physical and social, allows identification of environments that

support clients and allow meaningful participation; limiting occupational deprivation.

• Consideration could be given to use the Canadian Model of Performance and Engagement (CMOP-E) [6] in practice

as an alternative framework to guide practice, although it focuses on occupational performance, need and

• engagement. However, on occasions MOHO is a more preferable choice of model, being more suited to

understanding and developing a person's motivation for occupation; helping to build on occupational identity, enhancing health and wellbeing.

[1] ](Kielhofner, 2008), [2] (Lillywhite & Haines, 2010), [3](Clarke, 2003) , [4] (Fawcett, 2007), [5] (Taylor & Kielhofner, 2017), [6] (Polatajiko, Townsend & Craik, 2007), [7] (Melton, Forsyth & Freeth, 2010), [8] (Wilcock & Hocking, 2015), [9] (Wong & Fisher, 2015).

Service evaluation - SWOT analysis [9][13] Weaknesses

• Work under pressure- efficient use of time – service heavy in

meetings and travel.

• Intervention delivery – no time to work with service users;

supporting carers to deliver interventions, hard to manage.

• No formal way of gaining service user feedback – using informal

methods peer reviewed journal discusses how this can also introduce bias [7]; need to establish methods that have a more robust evidence based.

• Need to change culture within service at present as newly

appointed OTs are having to take on complexed referrals; need to re educate and raising profile of what the OT service within LD can

• ffer in terms of assessment and intervention for the service users.
• need to be able to manage and prioritise case load effectively
• Implementing a RAG (red, amber, green) strategy to plan how to

work through weaknesses, reflecting on service development.

Strengths

• Collaborative occupational therapy team, supportive.
• Effective MDT working - key to standard of quality
• care. Underpinned by delivery of effective

communication; However, this is integral to efficient, sustainable and safe staffing in learning disability services [1][3][4][5][6].

• Positive culture enabling strong use of theoretical

framework to help guide practice.

• Occupation focused - Able to meet occupational

needs of the services users through, occupation based assessments and interventions [2].

[1] (Ndoro, 2014), [2] (NLDPS, 2015), [3] (Tuffrey-Wijne et al., 2013), [4] (Hutchison & Kroese, 2015), [5] (Friese & Ailey, 2015), [6] (Young & Chesson, 2006), [7] (Ball & Shanks, 2012), [8] (DOH, 2013), [9] (Roorda, 2012), [10] (RCOT, 2017a), [11] (HCPC, 2016), [12] (Lillywhite & Haines, 2010), [13] (Chilingerian, 2006), [14] (DOH, 2016).

Opportunities

• Recently recruited occupational therapists.
• Scope for professional development, building on

teams existing skills and knowledge, the service is recognising and working towards contemporary reports, guidelines and recommendations [8]; facilitating increased performance of service delivery.

Threats

• Challenges with cuts to social care – health and social care

are now split, LD social workers roles are now generic, creates challenges for when making referrals. LD services are now part of the wider social care crisis, with limited funding available; Department of Health are hoping to change this by 2020 [14].

Strengths Weaknesses

• Develop my communication/ interpersonal skills with

professionals and patients.

• Develop understanding of OT/ MDT role, utilise experience in

LD specialist setting.

• Thoroughly enjoyed every aspect of placement, inspired by the

professionals have been working alongside – considering a career in LD.

• Completed training contributing to CPD.
• Able to develop my clinical reasoning skills.
• Finding sufficient opportunity, due to service restraints, to

complete clinical assessment and intervention planning.

• Split between two educators – managing time; challenging to

manage different case loads and gain the most from from my

• placement. Sometimes hard what to prioritise. Wanting to

manage own case load but also experience ‘real life’ professional working and the challenges that poses.

Opportunities Threats

• Opportunity to develop focused learning in a specialised area of
• ccupational therapy.
• Experience new assessments/ interventions. (MOHOST, PAL,

AMPS, interest checklist).

• Exposure to sensory integration therapy and gained some

understanding within the theoretical framework – an extended scope of practice I am keen to explore upon qualifying,

• Opportunity to complete a research audit for the measure of

fidelity for use of Ayres Sensory Integration therapy with adults with a LD.

• Not enough time to do everything I wanted to be able to do in

my final year placement, feel I could have got more out of the experience if I had had another couple of weeks.

Evaluation of placement – SWOT analysis [1][2]

[1] (Roorda, 2012), [2] (Chilingerian, 2006).

• American Psychiatric Association. (2013) Diagnostic and statistical manual of mental disorders (5th ed.) Arlington, VA: American Psychiatric Publishing.
• All Occupational Therapy (2017). Pinterest. [Online] Available at: https://www.pinterest.co.uk/pin/424816177329874293/ (Accessed: 20 November 2017).
• Ball. J, & Shanks, A. (2012) ‘Gaining feedback from people with learning disabilities’, British Journal of Occupational Therapy, 75(10), 471-477.
• blog, I. (2017) Road Safety Awareness | INCARNATE ICT, INCARNATE ICT. [Online]. Available at: http://incarnateict.com/2017/05/23/road-safety-awareness/ [Accessed: 28 November

2017].

• Boyt Schell, B. A. & Gillen, G. (2014) ’ Overview of Theory Guided intervention’, in Boyt Schell, B. A., Gillen, G. and Scaffa, M. E. Willard & Spackman’s Occupational Therapy. (12th Edn.)

Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. pp. 746-749.

• Care Act 2014, c. 23. [Online] Available at: http://www.legislation.gov.uk/ukpga/2014/23/contents/enacted. (Accessed: 17 November 2017).
• Clarke, C. (2003) ‘Clinical Application of the Canadian Model of Occupational Performance in a Forensic Rehabilitation Hostel’, The British Journal of Occupational Therapy, 66(4), pp. 171-174.

doi:10.1177/030802260306600407.

• ClipartBarn (2017), ClipartBarn. [Online]. Available at: http://clipartbarn.com/stick-person-clipart_22468/. (Accessed: 26 November 2017).
• Coren, E., Thomae, M. & Hutchfield, J. (2011) ‘Parenting Training for Intellectually Disabled Parents: A Cochrane Systematic Review’, Research On Social Work Practice, 21 (4), pp. 432-441.

DOI:10.1177/1049731511399586.

• Chilingerian, J. (2006) 'The discipline of strategic thinking in healthcare', in Jones, R. & Jenkins, F. (Eds.) Managing and leading in the allied health professions. Oxford: Radcliffe, pp. 191-226.
• Creek, J. (2003) Occupational therapy defined as a complex intervention. COT: London. [Online]. Available at: https://www.cot.co.uk/publication/publications/occupational-therapy-defined-

complex-intervention. (Accessed 4 November 2017).

• Curtin, M, (2010) ‘Enabling skills and strategies’, in Curtin, M. (Ed.), Molineux, M. (Ed.), Supyk-Mellson, J. (Ed.) Occupational Therapy and Physical Dysfunction Enabling Occupational Therapy, (6th

Edn.) Edinburgh: ChurchillLivingstone/Elsevier. pp. 111-125.

• Department of Health [DOH] (2016) ‘Shared delivery plan: 2015-2020’, [Online]. Available at: https://www.gov.uk/government/publications/department-of-health-shared-delivery-plan-2015-

to-2020. (Accessed: 23 November 2017).

• Department of Health [DOH] (2013) ‘Learning disabilities good practice report’. [Online]. Available at: https://www.gov.uk/government/publications/learning-disabilities-good-practice-project-
• report. (Accessed: 19 November 2017).
• Department of Health [DOH] (2010) ‘Improving outcomes for people with learning disabilities’. [Online]. Available at: https://www.gov.uk/government/publications/valuing-people-now-summary-

report-march-2009-september-2010. (Accessed: 24 November 2017).

• Department of Health [DOH] (2001). A new strategy for learning disability for the 21st century. London: Secretary of State for Health (Cm 5086).
• Dywer, J. & Reep, J. (2008) ‘How occupational therapists assess adults with learning disabilities’, Advances in Mental Health and Learning Disabilities, Vol. 2 Issue: 4, pp.9-

14, https://doi.org/10.1108/17530180200800034.

References

References

• Equality Act 2010, c. 15. [Online]. Available at : https://www.legislation.gov.uk/ukpga/2010/15/section/20. (Accessed: 24 November 2017).
• Fawcett, A. (2007) Principles of assessment and outcome measurement for occupational therapists and physiotherapists. Chichester, England: John Wiley & Sons.
• Forsyth, K. (2017) ’Assessment: Choosing and using standardised and non-standardised means of gathering information’, in Taylor, R. R. Kielhofners’s Model of Human Occupation. (5th Edn.)

Philadelphia: Lippincott Williams and Wilkins. Pp.173-186.

• Fawcett, A.L. (2013) Principles of assessment and outcome measurement for occupational therapists. Available at:

https://books.google.co.uk/books?id=JdpSiGsYaaoC&pg=PA1974&dq=non+standardised+assessments+AND+subjective&hl=en&sa=X&ved=0ahUKEwiRxLbK_7TRAhVKL8AKHYL5AKgQ 6AEIGjAA#v=onepage&q=non%20standardised%20assessments%20AND%20subjective&f=false (Accessed: 30 May 2017). Fisher, A. G. (2009) Occupational Therapy Intervention Process Model: A model for planning and implementing top-down, client-centred, and occupation-based interventions. Fort Collins, CO: Three Star Press.

• Fisher, A. G. (2009) Occupational Therapy Intervention Process Model: A model for planning and implementing top-down, client-centred, and occupation-based interventions. Fort Collins, CO:

Three Star Press.

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