Forensics
Feature
S hane Roberts is an occupational therapist with primarily mental health experience , both in community and inpatient settings . With a strong research and practice interest in addressing health inequities , he was awarded RCOT ’ s AMPS-ESI UK and Ireland Award in 2022 .
The award provides support for an individual occupational therapist or BAOT student member towards a practice development ( or practice evaluation ) project , or research activity , in a topic relevant to occupational therapy , which also demonstrates the use of the Assessment of Motor Process Skills ( AMPS ).
‘ For occupational therapists working in a secure prison environment , finding the most appropriate intervention and assessment tools can be a challenge , due to the design of the clinical space and the restrictions on equipment and items that can be brought into the setting ,’ he says .
‘ In my experience , I saw that many individuals experienced cognitive , physical and functional difficulties that prevented them from being able to engage in domestic or meaningful and purposeful activities .
‘ To provide the most appropriate occupational therapy input , I needed to use an assessment tool from which I could apply the results and observations to the community . Being person centred , I chose to use the AMPS tool , as it uses two tasks for a standardised observational objective tool to assess occupational performance . It assesses an individual ’ s overall ability , motor and processing skills .’
Shane explains that he chose the AMPS as it has ‘ high levels of validity , inter-rater reliability and reliability ’ ( Zeltzer et al 2010 ) ‘ allowing for functional abilities , challenges and treatments to be identified , regardless of one ’ s environment ’.
He says : ‘ The original plan of using the AMPS was to gather baseline data , so we could then use group-based interventions appropriately . However , as with all else , COVID-19 prevented us from using groups .
‘ While this was disappointing , I was still able to provide the assessment and carry out one-toone interventions .’ To illustrate this , Shane shares an anonymised brief example ( see box ).
Of his experience of using the AMPS tool , he says honestly : ‘ I found the AMPS was quite a complex tool that required matching up exact observations to the scoring criteria . I think for me , the most difficult part of the AMPS was being restricted to what I could say during the assessment , to keep it as standardised as possible .
Service user example
My patient was a male in his 40s , who presented with physical symptoms , this is , tremors , poor mobility and cognitive symptoms of poor memory , poor attention / concentration , difficulties making decisions and problem solving .
He had a history substance use but had been sober for over a year . In the community , his family had been helping him with his shopping and meal preparation and with personal care prompting . But there were times he struggled to eat , drink , or attend to his personal care in the community .
The patient had an Addenbrooke ’ s Cognitive Examination III ( ACE-III ), which showed significant deficits in his cognition , but we were unable to ascertain a complete standardised functional assessment .
This resulted in us carrying out an AMPS assessment using certain tasks ; making pre-sliced meat and jam sandwiches was selected after carrying out an initial interview . The report allowed us to develop evidenced , appropriate support for this patient in the prison and it will help enable a care package in the community . It also facilitated appropriate continued input from medical and other allied health professionals .
The patient was found to have mild to moderate clumsiness , with increased physical fatigue , and moderate to marked inefficiency / disorganisation . From this information , we were able to develop strategies such as prompts for appointments and meal preparation , and support for both of these were arranged in and outside the prison .
‘ This in itself was a challenge , but focusing on the observations and detailed note-taking did divert me from this , making it easier and allowing the patient to engage with the tasks as they naturally would .
‘ From this I was able to gather information and I think it helps the therapist knowing they only step in if something of danger is about to happen , so for me , dynamically assessing risk throughout was also important .’
Another issue Shane faced was down to him being ‘ a natural problem solver ’. He says : ‘ Having to just look at the “ what ” was happening , not “ why ” it was happening , until afterwards in my report , was such a challenge .
‘ However , reflecting on this now it was also helpful , as it allowed me to discuss this with the patient in a debrief session . Which in itself was of greater therapeutic value to both the patient and their situation .’
Having observed six AMPS and then carried out multiple AMPS once he was certified , Shane says he found the AMPS tool ‘ very useful in both developing evidence for a care package for a patient when they were being liberated from the prison , but also in identifying prison specific supports ’.
February 2023 OTnews 39