Exploring Patients’ Occupational Profiles in Forensic Settings in England

Abstract

This evaluation presents occupational profiles for patients in English forensic services and reports occupational changes over time. The College of Occupational Therapists’ guidelines for forensic practice (2012) drawn on the Model of Human Occupation (Kielhofner 2008). This evaluation uses clinical information including the Model of Human Occupation Screening tool (Parkinson, Forsyth and Kielhofner 2006). Data was collected at six-month intervals between June 2008 and March 2011 on 481 patients in low and medium secure units across six organisations. Seventy-eight occupational therapists participated in this study. The study was approved by the Office for the Protection of Research at University of Illinois at Chicago (Protocol # 2012-0463) and the research and development leads in the six trusts. The evaluation was jointly resourced by the university and a mental health trust. The Many-facet Rasch analysis (Linacre, 1989) was used to convert ordinal scores from the MOHOST into interval measures. The regression analysis was used to determine clients’ occupational participation changes over time. Occupational profiles of the factors that hindered or facilitated patients’ occupational participation in different settings and with varying levels of engagement were also created. The results showed that patients who were rated as higher engagement have better overall participation, except for motor skills and environment. Patients in low security settings had better overall participation, except for motor skills. In addition, clients’ motivation for occupation, pattern of occupation, communication and interaction skills, process skills and environment had improved over time. The profiles will inform occupational therapy pathways and protocols. The results will be shared in this presentation together with a discussion on how these might be used by forensic occupational therapy services in the context of emerging national policies such as Payment by Results.