Date Presented 04/06/19
OTs who worked at forensic settings in England were expected to use the MOHO-based forensic care pathway to guide their interventions. As part of their standard procedures, therapists administered the Model of Human Occupation Screening Tool (MOHOST) and the Health of Nation Outcome Scales (HoNOS) to represent clients’ participation and their health conditions. The study built up a picture for forensic patients with assessments that were already being used regularly in practice.
Primary Author and Speaker: Chia-Wei Fan
PURPOSE: This study used retrospective data to investigate the correlations among forensic clients' overall health status and their occupational participation.
RATIONALE/BACKGROUND: The United Kingdom (UK) has many security hospitals, and it is the first country that developed local secure settings. Therapists worked at forensic settings in England were expected to use the MOHO-based forensic care pathway to guide their interventions.
METHODS:
DESIGN: Retrospective data analysis.
SETTING: Forensic hospitals in England.
PARTICIPANTS: Data were collected from 489 patients in low and medium secure units across six organizations. Seventy-eight occupational therapists across the six institutes participated in this study. The main diagnosis of clients was schizophrenia disorder (n=305, 62.3%). The enrolled clients included 453 (92.6%) males and 36 (7.4%) females, with an average age of 38.7 years old (S.D. = 11.01).
MEASURES: The Model of Human Occupation Screening Tool (MOHOST) provides a broad overview of all the concepts of the MOHO which, collectively, define occupational participation. The Health of Nation Outcome Scales (HoNOS) was commonly used in the security hospitals in United Kingdom as a routine evaluation to understand clients’ overall health status and their need for care.
ANALYTICAL METHODS: The Many-facet Rasch analysis was used to convert clients’ ordinal raw scores from the MOHOST and HoNOS into interval measures. Correlation analyses among items in the MOHOST and the HoNOS were conducted.
RESULTS: The results show that clients’ cognitive problems are significantly correlated with their Process Skills (r=0.383, p=0.000); clients’ relationship problems are significantly correlated with their Communication and Interaction Skills (r=0.350, p=0.000); clients’ activities of daily living problems are significantly correlated with their Pattern of Occupation (r=0.369, p=0.000) and Process Skills (r=0.412, p=0.000).
CONCLUSIONS: Several factors had been identified to have moderate correlations with clients’ occupation participation, which included cognitive problems, relationship problems and activities of daily living problems. Based on the assessment results, the ratings can be incorporated into patients’ care plans.
IMPACT STATEMENT: In occupational therapy, there has been an increased interest in learning the factors that influence clients’ participation. Identifying these factors will help therapists to modify treatment plans and then improve the overall outcomes. As part of their standard procedures, occupational therapists in forensic settings in England administered the Model of Human Occupation Screening Tool (MOHOST) and the Health of Nation Outcome Scales (HoNOS) to represent clients’ participation and their health conditions. The primary contribution of this study is that we built up a picture for forensic patients with assessments that were already being used regularly in practice. Routine outcome measurements used in forensic settings such as the MOHOST and HoNOS help to describe patients’ ongoing and dynamic needs, so that therapists have a picture of their strengths and needs and can foster an evidence-based approach.
References
Fan, C. W., Morley, M., Garnham, M., Heaseman, D., & Taylor, R. (2016). Examining changes in occupational participation in forensic patients using the Model of Human Occupation Screening Tool. British Journal of Occupational Therapy, 0308022616651644, doi:10.1177/0308022616651644.
Hitch, D., Hii, Q.K. & Davey, I. (2015). Occupational therapy in forensic psychiatry: Recent developments in our understandings (2007–2013). British Journal of Occupational Therapy, 79(4), 197–205.
