Implementing and evaluating occupational formulation

Mynard, Forensicare

Occupational formulation may offer a bridge between theory, assessment and therapy, addressing the difficulties that occupational therapists may experience with linking theory to practice, demonstrating an occupational focus and confidently articulating their therapeutic reasoning. This article describes the implementation and evaluation of structured occupational formulation within an occupational therapy team.

Occupational formulation

Occupational formulation is a theory-based approach for synthesising assessment information about a client to describe their occupational situation and guide input. Brooks and Parkinson (2018) described a three-part structure that can be used with any occupational therapy framework: occupational influences, occupational presentation and occupational focus. Drawing upon concepts from the Model of Human Occupation (MOHO; Taylor, 2017) they operationalised the approach (Brooks & Parkinson, 2018; Parkinson & Brooks, 2021): describing how, after conducting a comprehensive occupation focused assessment, therapists construct a narrative incorporating occupational identity (reflecting the person’s subjective viewpoint), occupational competence (an objective presentation of facts), and key issues/needs for occupational adaptation. A collaborative process, this leads to the negotiation of measurable occupational goals that guide therapy. Despite its strong theoretical underpinning and encouraging subjective outcomes (Parkinson et al., 2011), there is not yet a research base for the approach.

Project aims and approach

Having learned about occupational formulation at an OTA workshop facilitated by Sue Parkinson, the Forensicare occupational therapy leadership team planned to implement and evaluate the approach. The project aims to:

• Strengthen the practice process within the team by embedding a structured approach to occupational formulation and goal setting;

• Evaluate the impact of using the approach from the perspectives of different stakeholders; and

• Contribute to the evidence for knowledge-topractice translation in occupational therapy.

Forensicare (the Victorian Institute for Forensic Mental Health) is the Victorian provider of forensic mental health services for people who experience severe mental illness while involved in the criminal justice system. Service is provided within prisons, the secure Thomas Embling Hospital, courts, and the community. The occupational therapy team comprises approximately 35 occupational therapists, most in discipline-specific roles.

A participatory action research (PAR) approach was selected to empower all stakeholders to participate in learning, making change and conducting research (Taylor et al., 2017).

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