#COT2017 S5: Unlocking potential: occupational case formulation in a prison setting

The popularity and interest in this session was immediately apparent, arriving almost 30 minutes early there were already quite a few people in the room. Quickly a workshop that originally planned for 25 attendees was bumped up to 40 and in the end almost 100 people attended.

The session aimed to demonstrate how the introduction of case formulations had benefitted an occupational therapy service based in a Scottish prison. The session highlight the many barriers faced by professionals working in both prison and forensic settings. In particular the difficulty of setting goals and providing opportunities in a service that is focused on ‘control, security and containment’.

The introduction and exploration of the process of case formulation and the theory behind it was extremely beneficial. Occupational identity and occupational competence were explained in the context of case formulation. Although many of us will be aware of MOHO we are often used to associating it with concepts such as ‘volition, habituation etc.’ Exploring the use of MOHO through the use of occupational identity and competence provided a new perspective that will be beneficial to my practice.

One of the benefits of case formulation is that unlike many other assessments that may create a score or fit an individual into a box, case formulation allows the therapist to create a narrative about the individual. This not only makes it easy for non-occupational therapy staff to read but it also makes it accessible for the client/service user themselves.

Although it would be hard to outline everything I learnt from this session I’ve comprised a number of ‘top tips’ that might be helpful for anyone interested in case formulation:

  1. The introduction should be ‘quick’ and easy to read. It should provide information regarding; name, age gender, brief history of health conditions, forensic/offending history, reason for referral and occupational assessment completed.
  2. Using references for assessments demonstrates that you know what you are talking about and adds authority
  3. Use man/woman not male/female
  4. It’s ok to use the term ‘feel’ e.g. Joe Bloggs feels that they struggle with attention and concentration
  5. Break up the sections as it helps to identify themes
  6. Make sure that you know how an individual feels about the themes and don’t make assumptions.
  7. Keep occupational identity and occupational competence separate – whilst it’s easy when writing to switch between the two it makes it harder to follow.
  8. Use everyday language
  9. Make sure to include the positives
  10. Have a maximum of 4 issues to be addressed – it is much better to have larger areas that need addressing that to have a lot of issues as it reduces the chances that you ‘won’t get round to it’
  11. A summary statement that should consist of 3 lines – this is your brief commentary on what going on with your client.

My final thought for this session was in regards to something said by Sue Parkinson said during the session; that it can be difficult for those of us who work in mental health to identify how long it will take a client/service user to be able to do something. And that just because someone has not done something for many years does not mean that they can’t do it. In addition she highlighted that we must remember and that I’ll end this entry with: that

many people can do wonderful things but sometimes that environment doesn’t support them”.

By Ailsa Mulligan (@Ailsa_Claire)

2 thoughts on “#COT2017 S5: Unlocking potential: occupational case formulation in a prison setting”

  1. I am struggling with case formulations to be honest – had the training from Sue Parkinson (and I am by no means un-intelligent) but I just don’t seem to be able to get my head round it all, putting the wrong things in the wrong boxes. My clinical supervisor has written out an assessment form, with some suggested questions to gain the flow – and said use the MOHOST manual – We only have to choose 3 issues, but its even labelling these that I have problems with. ie.. Joe blogs has high anxiety, but would like to take his wife out to meet friends in a pub (say) to enhance their relationship and to socialise more. So they key areas here are either Relationships or Socialising? the two rely on each other so how do I separate? I love you tips and have printed them off to display in my help file! thanks


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