Care and support
Feature direct or indirect rehabilitation and life skills . Ultimately a person ’ s functional identity and purpose is affected , impacting cognition , function and wellbeing .
This has led me to take time to critically reflect on all those ‘ micro methods ’ that we use in our occupational therapy toolbox , to share a ‘ best practice approach ’ to how to maximise independence in those everyday engagements we all have with any individual .
I then looked at how to share this knowledge , to help develop our team through empowering a proactive person-centred approach .
I pulled together a training programme for our team and formulated a basic hierarchy of grading and adapting , with the aim of celebrating what the team is presently achieving and helping them to link that to theory , while also guiding them to take this to the next level , widening the methods used within their everyday collaborative working with individuals in all areas of practice .
The proposed hierarchy I shared with the team breaks grading and adapting down into three core tiers , so that those supporting an individual will work in the least dependant or deskilling way possible ( see illustration below ).
The aim is to start from the top and work down through the other options . Once we have established where an individual ’ s level of support is needed , we will continue to give opportunities to work at a higher level . We give the individual time to process and respond and adjust according to how they are presenting and what their needs are in that moment .
Further , we recognise that within different activities of daily living the individual may require a different level of graded support .
Before the training , I put attendees into groups and asked them to consider what the steps are to make a cup of tea or coffee in our kitchen . They then completed the task , following the written instructions only .
After this , I supported a reflective discussion , considering the micro steps of object recognition , problem solving and fine and gross movements .
We continually referenced back to this worked example , while applying the proposed hierarchy of grading and adaptation , considering the individuals it may apply to , or where these skills could be used in other situations .
Tier one – independent
Within the training that is still rolling out across our team , I encouraged discussion surrounding independence and what this looks like ; challenging people to consider if equipment and environmental adaptations remove or improve independence , and why .
We also looked at what we already have in place and what other options have been seen in other venues and locations .
Tier two – low level support
In this section , I used a questioning approach ; working with the team to consider what they understood each of these methods to be , if they used any of these with their families , friends or at work , and why they might be placed in this order ,
Levels of grading and adaptations ( Created by Nicky Ryder 2021 )
Give time to process Clear concise instructions Clear lead to reduce confusion Use resources to help
Remember , preparation is key alongside knowing the individual
Independent
Equipment to support independence
Adapted environment
Low level support : Questioning Visual prompt Verbal prompt Modelled Mirrored
High level support : Forward / backward chaining Directed in small graded steps ( 2 + instructions ) Singular micro steps provided , explaining and reassuring throughout task Hand over hand – physically supported
April 2022 OTnews 43