The team has fed back that the training has provided them with more confidence about what they are doing well and how different strategies could be trialled for a number of the individuals we work alongside .”
clarifying or correcting any misconceptions along the way .
I found that the team were comfortable with the idea of questioning , asking : ‘ What do we do next ?’ ‘ Where are the spoons ?’ ‘ Do you think it is in the cupboard ?’ Verbal and visual prompts were equally familiar , but did need some further expansion as to subtle ways to apply and not ‘ over help ’, deskilling the individual they are working with .
Distinguishing between modelled and mirrored support required a greater level of discussion with the team .
We visually worked through the differences , starting with modelled , where the team member would complete an action then ask the individual to do the same for their own drink , for example removing the tea bag and putting it in the bin .
We then compared this to mirrored , where the action is completed at the same time as the individual , allowing time to process and complete at each micro step .
The team were able to recognise that they regularly did these approaches in their own personal lives with children , parents or loved ones , identifying times where this approach could then be used within the work environment , not just with those in our care , but new team members , being an active part of learning .
Tier three – higher level of support
This domain required the most input for the team , who were unfamiliar with forward or backward chaining , where the individual being supported completes either the very first step of the activity or very last , with steps gradually added over time .
The team was reasonably confident with directional steps that were discussed for the next stage , with emphasis being given that a single person should be talking at any one time , giving the individual time to process and respond , while seeking to ensure as little environmental distractions as possible to support focus .
Some of the team recognised that time limitations or inconsistent approaches could hamper this level of support , as some individuals then become reliant on being dependant and avoid active participation .
After recognising the importance of a consistent team approach , we discussed positive communication , using our therapeutic self mindfully to promote participation , wellbeing , dignity and respect .
As a team we explored hand-over-hand support , considering what and how hand-overhand support looked like in an activity of daily living .
Finally , I randomly assigned case study scenarios to apply the proposed hierarchy to , before opening discussions to consider why these levels of grading and adapting are important and what would happen to an individual ’ s cognitive , physical and emotional wellbeing if active participation in activities of daily living was not promoted .
The team has fed back that the training has provided them with more confidence about what they are doing well and how different strategies could be trialled for a number of the individuals we work alongside .
Training with the team is still ongoing , seeking to promote as much independence and active participation as possible in everyday activities to support rehabilitation and wellbeing .
Words NICHOLA RYDER , Occupational Therapist within Complex Needs , Lancashire , and advocate for The Advocacy People , and soon to be a director of Mental Capacity Ltd www . mentalcapacity . co . uk info @ mental-capacity . co . uk
44 OTnews April 2022