Implementing and evaluating occupational formulation

Taking action

The multi-faceted implementation commenced in early 2021, including:

• Monthly steering group meetings (team leads and educators reviewing progress and operational needs)

• Whole-day training workshops and focused tutorials

• Monthly online community of practice (COP) sessions for team reflection, peer learning and planning

• Inclusion of project on agendas for discipline governance and operational meetings

• Group and individual coaching opportunities

• Purchase of MOHO (Taylor, 2017) and occupational formulation (Parkinson & Brooks, 2021) textbooks for each work area

• Development of a Microsoft Teams channel with guidelines, templates, examples and recorded learning modules

The PAR process is cyclical, with an idea or challenge being identified and then considered by the community of practice reflective group, steering group and project leads, then trialled by therapists who report back on their experiences.

Research evaluation

Monash University provided ethical approval for all aspects of the longitudinal, mixed methods evaluation, which includes drawing from team records, surveys evaluating occupational therapists’ professional thinking and practice, interviews with occupational therapists about their experiences of using occupational formulation in practice and interviews with consumers about their experiences of collaborating with an occupational therapist to develop and use an occupational formulation.

While evaluation will conclude in early 2023, initial findings indicate that occupational therapists believe the approach is beneficial, and COP attendance levels have been consistently high. Although the implementation has been challenging at times, many have articulated gratitude for the support available. Collaborative working with consumers has increased, leading to satisfaction in seeing consumers engage in the process and progress toward occupational goals. Some consumers have reported appreciating having a document that captures who they are, which can be shared with the multidisciplinary team.

Introduction

Greg is a 32-year-old man with a diagnosis of depression who is serving a three-year prison sentence and has been admitted to the acute mental health unit given an increased risk of suicide. This formulation has been informed by a Model of Human Occupation Screening Tool (Parkinson et al., 2006), informal discussion and observation. Greg reviewed a draft, provided further description for the identity section, and agreed the formulation “is me”.

Occupational identity

Greg is one of three children and lived with his mother prior to his sentence. He worked as a sales representative in the construction industry and felt appreciated by his colleagues as he values being “of service” to others. Greg has a close relationship with his mother and feels a strong sense of responsibility for her welfare.

Greg describes himself as “a bit of a loner” who has “kept to himself” since childhood. He feels “unnoticed” by those around him and describes feeling lonely, hopeless, and having difficulty making new friends. Greg enjoys playing guitar, is interested in gardening and likes going for walks when he “needs to get away from it all”.

Greg values the mental health support received from his community counsellor and is keen to engage with mental health services while in prison. He expresses remorse for his offence and describes having committed it to gain attention from those around him. He is concerned about how to occupy his time while in prison.

Occupational competence

Greg engages politely in conversation and provides detailed responses, although is hesitant to initiate conversation and make requests. His mother is a strong support, visiting him and speaking regularly via phone.

Greg can identify people, activities and interests that are meaningful to him. He agrees with his diagnosis of depression and is actively engaging with mental health services in prison. He is unfamiliar with the prison environment though curious about the opportunities for potential work in prison.

Key occupational needs:

• To learn about the prison environment

• To find a meaningful role within the prison

• To get better at meeting new people

Summary

Greg has a strong work ethic and values being of service to others and enjoys playing guitar, gardening and walking. Until sentencing he lived with his mother, supporting her financially. Greg agrees with his diagnosis of depression and wants to learn about the prison environment, find a meaningful role within the prison, and get better at meeting new people.

There is a deeper understanding of concepts from occupational therapy theory, an increased focus on occupational needs and better articulation of occupational perspectives. Understanding of the occupational therapy practice process is developing, supporting continuity of care as consumers move between parts of the service. There has been positive feedback from colleagues about how the occupational formulations help them to see the consumer differently, from the lived experience team who are pleased to see the collaborative approach to care planning, and from executive leadership who value how the approach contributes to the organisation’s model of care.

Moving forward

Others are recognising the potential of occupational formulation: in Victoria it was identified by the Centre for Mental Health Learning as one of the top five learning priorities for public mental health occupational therapists. In Queensland, it was endorsed as a statewide priority by the Mental Health Occupational Therapy Clinical Practice Collaborative (MHOTCPC). These bodies are supporting occupational therapy teams to implement the approach. While these examples of uptake are from the mental health sector, as an approach that links occupational concepts and steps of the practice

Components of an occupational formulation based on MOHO concepts

process, occupational formulation may be a useful approach in any area of occupational therapy practice.

The Forensicare occupational formulation PAR project enables a multi-part implementation and evaluation approach to practice development, with initial encouraging benefits for occupational therapy practice. The completed evaluation may inform whether and how occupational formulation can support occupational therapists in working collaboratively with consumers and linking theory, assessment, and treatment planning to make their unique occupational therapy contribution.

About the author

Lorrae Mynard has worked in varied adult mental health settings in Australia, Canada and the UK, and is presently a lead occupational therapist at Forensicare in Melbourne, chairperson of the Australasian Forensic Occupational Therapy Network, and a doctoral candidate with Monash University, with her research focused on occupational formulation.

Acknowledgements

Lorrae Mynard’s PhD candidature is supported by an Australian Government Research Training Program Scholarship, and an OTA Research Fund Direct Gift Recipient award supported the occupational therapist interview component of evaluation.