STUDENT EDUCATION FEATURE
We used the Model of Human Occupation (MOHO) as a
framework, due to Mary experiencing extensive coercive control,
which enabled a therapeutic relationship to be developed.
The observational qualities of MOHO allowed the refuge staff
and myself to identify factors that were to act as a support for
Mary’s desired occupation and allowed evaluation of functioning in
her new, uncontrolled environment.
The Model of Human Occupation Screening Tool (MOHOST)
was completed by the staff and myself as an ideal observation
assessment tool, because of Mary’s high anxiety following years of
occupational injustice.
Other assessments completed included the Occupational Self-
Assessment (OSA), Interest checklist and the Hospital Anxiety and
Depressions Scale (HADS).
The assessments identified that, due to coercive control and
psychological abuse, Mary had not eaten solid food, left the house,
or carried out personal activities of daily living, for the last nine
years.
Using MOHO as a framework helped Mary to identify that she
had once run a home, brought up two children and worked full
time, and her love for cooking motivated her to cook and once
again enjoy a variety of foods.
Utilising the graded exposure approach we shopped in local
supermarkets and prepared and began to cook food. Over time,
Mary embarked on eating foods such as beef dinner, egg on toast
and fish and chips.
Mary’s volition enabled her to master socialising in the early
stages of intervention, allowing her to confidently explore her new
environment and to develop positive friendships.
Finally, Mary also developed her processing skills (planning and
problem solving) and communication skills. She began to identify
occupational roles, and became competent with her daily routines,
which reduced her anxiety and feelings of ineffectiveness.
As healthcare providers, it is important that occupational
therapists are involved with men, women and children who have
experienced domestic abuse locally, nationally and globally. The
placement experience emphasised the fact that people have an
occupational nature and that being deprived from occupation
through injustice can lead to anxiety, depression and loss of identity.
Ultimately, the placement demonstrated that working
with an occupational therapist can enable, empower
and coach a person, family and community to
develop occupational identity and master
new lives.
Ballan and Freyer (2020), in a paper that presents findings
from a larger qualitative study, examine the impact of
occupational deprivation on survivors of intimate partner
violence (IPV) who have physical disabilities. Twenty five
women who accessed a non-residential domestic violence
agency in New York, specialising in working with people
with disabilities, participated in semi-structured interviews.
Data were analysed using grounded theory methods.
The findings focus on themes related to instances
of occupational deprivation, specifically educational,
vocational, financial and physical barriers to occupational
engagement. The authors identify that occupational
EVIDENCE LINK
deprivation can entrap women with disabilities in
abusive relationships. They suggest occupational
therapy practitioners can play an important role in
helping survivors of IPV overcome barriers, working with
individuals and domestic violence agencies to promote
occupational engagement and enhance independence.
Reference
Ballan MS, Freyer M (2020) Occupational deprivation
among female survivors of intimate partner violence
who have physical disabilities. American Journal of
Occupational Therapy, 74(4), 1–7.
References
National Institute of Health and Care Excellence (2020) Costing statement:
Domestic violence and abuse. Implementing the NICE guidance on
domestic violence and abuse – how services can respond effectively
(PH50). Available at: www.nice.org.uk/guidance/ph50/resources/costingstatement-pdf-69194701
[accessed 23 January 2020]
Office for National Statistics (2020) Domestic abuse in England and Wales.
Available at: www.ons.gov.uk/peoplepopulationandcommunity/
crimeandjustice/bulletins/domesticabuseinenglandandwales/
yearendingmarch2018 [accessed 22 January 2020]
Walby S (2009) The cost of domestic violence up-date 2009. Lancaster
University, www.lancs.ac.uk/fass/doc_library/sociology/Cost_of_
domestic_ violence_update.doc
Kim Jones, final year occupational therapy student,
Glyndwr University. Email: kimjonesdaot@
yahoo.com
OTnews August 2020 55