The CMOP (if are referring to the Canadian Model of Occupational Performance)
is not a standardized assessment, it is a frame of
reference. And while your perspective as an OT can certainly
be derived from it or informed by it, it is not an assessment measure.
Perhaps you meant to refer to the Canadian Occupational Performance
Measure (COPM), I am not sure. If you did then COPM is
certainly worth considering.
You may want to check out the text "Assessments in Occupational Therapy
Mental Health: An Integrative Approach by Barbara J.
Hemphill-Pearson" as well the Bonder text that Dr. Meyers referred
to in her post is also an excellent idea. And needless to say
Willard and Spackman is a treasurehouse of diverse learning in a
single source. I consider it to be the OT bible. However, make
sure you are looking either at the 9th or 10th edition. The latter
is the most recent.
Allow me share my perspective of your case assignments. The idea
behind the case study is that you develop a problem list and then
see what aspects of the problem list you can address with what interventions.
This is what the treatment plan would typically be
based on. My perspective of any clinical case study is that
more often there are no clear answers or formulaic applications of a
"standardized assessment" to develop a treatment plan. I think
the process you are going through right now, in confronting the
ambiguity of what to do given the facts in the case studies and the
goal you have, is the real learning that is occurring.
As well my sense is that the professor and/or clincians teaching you
are looking for your clinical reasoning behind the treatment plan
you come up with, rather than pat solutions that focus on completing
the assignment. At the same time I cannot blame you for being
"assignment focused" because the nature of curriculums is often so
time constrained that it becomes hard to see the wood for the
trees (I always get mixed up with this _expression_, someone please correct
me, is it trees for the woods or wood for the trees or yet
something altogether different...lol.....but Emma I think you know
what I am trying to say here).
More specifically here is my suggestion (and to any other students on
the list this applies to you as well) go ahead with your research
for this assignment. Look at what are the clinical issues that
need to be addressed. See what assessments (on a best effort basis
given your timelines) you can come up with and if any particular standardized
assessments fit the identified clinical issues (problem list)
then go with them. If you do not find standardized assessments then
go with a non-standardized assessment, and if that is not possible
see what you can come up with. Once again make sure whatever
you do come up with has sound clinical reasoning underlying it.
Also do not underestimate the power of a good clinical interview (it
pros and cons are spelt out in the Hemphill-Pearson text as
well). In both PTSD and Mood disorders (i.e. your Bipolar client)
understanding what are the client's triggers for the behaviours you
are trying to address are clearly very important. For the PTSD
client you may need to talk to the client and find out what triggers an
episode, when is it more likely to happen. You may also wish
to use an interest inventory with the PTSD client, as that might
encourage her to get involved with something she enjoys doing something.
Perhaps it could be something she can only do outside her
room, but remember small steps make a good start. Focus on gradual
change, rather than rapid. Tailor the pace to the client's
wishes. And if the client refuses initially, try again once you
have developed some rapport with the client. Explain your reasoning
for
whatever treatment plan you develop. This is critical.
With the Bipolar client it sounds like (s)he is in a manic phase, going
by the symptoms you have described i.e. aggressiveness and
promiscuity. Again look at the role of medications and how well
the client is stablized on them. Proceed from there.
To me it sounds like both clients are in institutionalized settings.
In your treatment plan factor in their length of hospitalization.
Talk
directly to OTs at a local mental health facility. Call them
on phone ask them for their time, explain what you are doing, let them
know that you will not take more than x amount of their time.
Get creative along these lines. Ask them what they would do given
what you know about your clients. Look at the DSM IV and find
out what might be the typical presentation of clients who have your
client's diagnoses. Develop your reasoning and rationale for
what you wish to do and why.
Think of the role of rapport building with clients, how are you going
to influence your clients i.e. developing a therapeutic alliance or
what a lot of us refer to as the "therapeutic use of self". In
mental health, clients can be influenced in therapeutic directions using
the
cognitive-behavioural frame of reference in which one influences the
clients behaviour by influencing their thinking. This is what is
going on during the clinical interview, or group work. But before
an OT or any non-medical clinician can gain some meaningful
measure of success the client also needs to be responding to medications.
And medications are usually the first line of treatment.
Throughout treatment in mental health the clinical interview is critical,
because each contact with the client is an opportunity for a
mental status exam. Clearly each contact does not warrant a comprehensive
mental status exam, but initially it most certainly is
required. During later contacts the mental status exam is done
in shorthand i.e. is the client still as thought disordered, mood
disordered as at the first contact. Where are they now, how well
are they oriented to reality, are the symptoms of the diagnoses in
remission, does the client have any insight (or improved insight; incidentally
presence of insight is crucial). Future goals based on
client's improvement, or non-effective approaches which might require
you to try different intervention approaches. These are some
of the thoughts that come to my mind based on what you have described
about the two clients.
Hope the above is helpful in framing some perspective on issues with
your clients. Again please remember there are really no
formulaic approaches in treatment, esp. in mental health. The
only formulaic approaches are where medications are concerned.
Good luck and let us know how it goes,
Best,
Biraj
Emma Cole wrote:
for the post traumatic stress one it is an intial assessment within the CMHT. It must be standardised assessment. Am unsure whether to use yhe CMOP or the OHP 1. But would be gratefull for any other ideas. My client in the case study is 26 year old female with PTS and she spends the day in doors watching TV with the curtians closed.
For the bipolar one is as a ward ot to AX the person with view to returning to a rehab unit as more settled on medication. Does that make more sense. In the case is aggressive adn sexually uninhibited. help.,
emmaxx
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