Running head: PERSONAL ENHANCEMENT 1

Personal Enhancement Project

Samantha Shea

B00697223

LEIS 4598

Dalhousie University

Crystal Watson

March 12, 2017

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Personal Enhancement Project Shadowing

For my personal enhancement project I spent three days shadowing other professionals to

get a better understanding of their scope of practice. I had the opportunity to shadow the

occupational therapist at Connections Dartmouth, the social worker at Connections Dartmouth

and the Recreation Therapist at the Burnside Forensics Hospital. It was the perfect opportunity to

see how all the different professionals work together to treat or support clients based on the

needs that they have. It was also very exciting to see the role of the recreation therapist when

their scope of practice is revolving around the criminal justice system.

The definition of an Occupational Therapist is a form of therapy for those recuperating

from physical or mental illness that encourages rehabilitation through the performance of

activities in daily life. Working with the Occupational Therapist at Connections I had the

opportunity meet with one of their new clients on their first day. For the initial meeting I was

able to work on an individual recovery plan. This recovery plan was a generic one also used by

the Recreation Therapist when they have a new client. For this plan we looked at seven different

domains of the clients life. These domains are their employment/education, housing/community

living skills, health/wellness, social, treatment/clinical, family and other. For each domain we

write a little about their current situation and if they have a goal for improvement. Next we work

on an action plan to meet the goals that they have identified for themselves. We talk about the

strengths they have to meet their goals, resources that they have available to them and what

needs to be done in order to help them reach their goals. Lastly, we talked about the programs
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available through Connections Dartmouth and how the involvement in the community is helpful

to their recovery process.

There are is one assessment that the OT uses that are specifically used as an occupational

therapy assessment. This assessment is called the Model of Human Occupation Screening Tool

(MOHOST). This assesses the clients in six different domains; motivation for occupation, pattern

of occupation, communication and interaction skills, motor skills, and environment. The rating

scale is known as FAIR F- Facilitates occupational participation, A- Allows occupational

participation, I Inhibits occupational participation and R Restricts occupational participation.

Under each domain they are assessed in four different categories. For motivation of

occupation they are assessed on their appraisal of ability, so do they have an understanding of

their current abilities, strengths and limitations, an accurate belief in their skill, and their

competence? Their expectation of success, do they display optimism, hope, self-efficacy, sense

of control and self identity. Their interest, do they express enjoyment, satisfaction, curiosity and

participation. Lastly, choices, do they make appropriate commitments, do they have readiness for

change, a sense of value and meaning and do they have preferences and goals.

For their pattern of occupation they are assessed on their routine, do they have balance,

organization of habits, structure and productivity? Adaptability is their anticipation of change,

habitual response to change and tolerance of change. Roles, is there role identify, sense of

belonging, role variety, and involvement. Lastly responsibility, do they complete activities and

meet expectation of related goal obligations.

For communication skills they are assessed on their non verbal skills such as eye contact,

gestures, orientation, and proximity. Also their conversation, disclosing, initiating and sustaining
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conversation, speech content and their language and their vocal expression, are they assertive,

articulate, good tone, volume and pace. Lastly their relationships, are they sociable, supportive,

aware of others, making healthy relationships.

They are assessed on their processing skills. Their knowledge, can they seek and retain

information, do they know what it do in an activity and how to use objects. Their timing, do they

sustain concentration, initiate and complete conversations at appropriate times. Organization,

how they arrange space and objects, neatness, preparation and gathering objects. They are also

assessed on their problem solving and their judgment, adaption, decision making and

responsiveness.

They are assessed on their motor skills. Their posture and mobility, are they stable,

aligned, how their balance, alking, reaching, bending and transfers is, also their coordination,

strength, effort and their energy. Lastly they are assessed on their environment. Their physical

space, of their space affords a range of opportunities, supports and stimulates valued

occupations. Another area is their physical resources, their finances, equipment and tools,

possessions and transports, safety and independence. Their social groups such as family

dynamics, friends and social support, work climate, and expectations and involvement. Lastly

their occupational demands, do the demands of activities match well with their abilities, interests,

energy and their time available.

After assessing all of these areas the OT then will determine which areas they can create

goals in using the resources that they have. The OT does what they can to help reach these goals

but ideally has the client doing the work on their own to have the sense of independence. For

example, if it is determined that the client would benefit from having meaningful involvement in
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voluntary work. The OT would provide him with the information of different places he could call

and inquire about volunteering. The goal is always to have the client do what they are capable of

doing and just giving the guidance. The OT does different types of support whether it is around,

work, education, or social needs.

As part of my personal development experience I had the opportunity to shadow the

social worker Danielle at Connections. I was able to attend a one on one session with a 22 year

old client that was diagnosed with schizophrenia. He was a highly functioning individual who

was living on his own but who had extreme anxiety and paranoia with hypochondriac tendencies.

In the beginning of the meeting with her client the social worker did a wellness check in areas

that were of concern with the client. She asked the client about his sleep patterns and

medications which seemed to have an effect on each other. She also took care of different areas

like filling out paper work for a new health card and completing medical assessment for

employment support and income assistance.

Danielle reviewed the mini mental state exam that she has completed with her client

when he was initially referred to her services. Although she completed this with him, this

assessment is also an assessment that any licensed practitioner is able to complete with their

clients including nurses, occupational therapists, etc. Because Recreation Therapist is going

through the process of being licensed, it is something that we will eventually be completing with

our clients as well. The mini mental is completed with clients for a variety of different reason but

in the case of this client, it was because he felt he was having issues with his memory.
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The mini mental is assessing for a score out of thirty. It consists of different questions and

for each question you get rated a score. The first set of questions is in relation to orientation of

time. Each question is asked a maximum of three times. Examples of this would be what year is

it? What season is it? What month is it? Etc. The second set of questions is related to orientation

to place. Some examples of this would be what country are we in? What province are we in?

What city are we in? The third set of question is in relation to registration. In this section we

would name three words. After all three words were said, you would have the client repeat them

and then after a few minutes, have the client repeat them again. The next section would be

focused on concentration and attention. In this section the client would be asked to spell a word

backwards. Next the client would be shown two items and they would have to recall what it is.

Then they would have to repeat a phrase, read the words on a page and do what it says. The

client would then be told to carry out a task and see if they could comprehend it, write a

se3ntence, and copy a design. After completed all these tasks, they receive a score out of thirty. If

the score is lower then 23, there is some issues going on that will need to be further assessed.

Another assessment I had the chance to review with the social worker was the MOCA

assessment, Montreal Cognitive Assessment. This had a visual spatial/executive section, naming

pictures section, memory section, attention, language, delayed recall, and orientation section.

This assessment is also an assessment which can only be performed with licensed practitioners.

After the client left and we had the chance to review different assessments, the social worker

informed me of other aspects of social working scope of practice in other setting other than

Connections. I found this helpful because a lot of the responsibilities of the professions at

Connections are intertwined with each other and I find it hard to get a clear description of the

roles and responsibilities of the individual professions. Working in the mental health setting like
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connections, Danielle feels as if she does things like running groups and program planning that

she otherwise havent in other areas that she has worked in. Another area that she has experience

in is Mobile Crisis, in this setting she worked 24/7 on a mobile phone line and then between the

hours of 1-1 she worked out in the community responding to crisis situations. When she was in

the community there were two mobile crisis vans that they would work out of, which was

escorted by a police officer. The officer was there in case any arrests need to be made for

example if someone was hurting themselves or another person. If someone was arrested in a time

like this then they would be arrested under the Involuntary Psychiatric Treatment Act. This

would be they would not be criminally responsible and would be taken over to the psychiatric

hospital for further assessment. Working in this setting she dealt a lot with counseling in areas

like finances, relationship stress, and psychotic state episodes.

She also worked in a school setting, working with youth in areas mostly around

relationships, self harm, bullying, family issues and sex education. Lastly she told me about her

experience working at the Dartmouth General. Here she worked a lot around discharges, suicidal

thoughts, family support, etc. If someone was being discharged she would need to ensure that

they had the basic necessities for them to be released so this may involve contacting family

members or shelters. She told me about an incident where one client would repeatedly be coming

in for swallowing razor blades. Once he was discharged from medical, he would work with her

to figure out why this was happening and what was going on in his life that made him want to

keep doing this to himself.

My experience working with the Recreation Therapist at the East Coast Forensics

Hospital was a great experience. I think it was hard to grasp the entire role of the RT in such a

short period of time, especially with the criminal justice aspect of it. This facility is much
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different from what Ive been getting familiar with at Connections. In the forensics hospital there

are 60 beds and also a mentally ill offenders unit where clients are housed for 45 days or less.

Like connections Recreation Therapist attends team meetings, unit meetings and recovery plan

meetings. They also complete chart reviews, and on admission complete and intake, ass4essment

and compete progress notes on their clients.

As part of the recreation department there is a performance plan that is created which is a

program schedule that breaks down what will be going on with programming for eight week

periods with a two week break and then beginning of new programs. The clients have the

privilege of going out in the community to certain programs but it all depends on the level of risk

that they are rated. The higher level of risk that a client is to the community, the fewer amounts

of privileges they are allowed to have. Some clients are not allowed to enter the community and

some are allowed to come out in the community to programs with the recreation therapist, such

as the kitchen party. The kitchen party is an event created by the recreation therapist that the

clients come to and meet with clients from other locations such at connections, abbey lane, etc.

They get together for a jam session at Alderney Landing for an hour that afternoon.

While I was at the forensics hospital I had the opportunity to help run the recreation room

program. It was just an hour that the clients could come into the recreation room and play

different board games, cards, pool, guitar hero and listen to music and relax. I feel like it is

important for everyone to have the chance to participate in leisure but in the short period of time

that I was there it was hard for me to make sense of how certain criminals were entitled to certain

things while others who may very well be living with mental health issues are being kept in the

general population with little to no freedom and not being treated for their illnesses.
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Overall, Connections has been an amazing place to work and I am learning a lot about

how important an interdisciplinary team is and how beneficial all professionals working together

can be for the care of a client. At connections the Recreation Therapist works closely with the

social workers, occupational therapists, nurses, doctors, etc. It is important because by being able

to communicate and effectively share information regarding the needs of your client, everyone

can work together for the same goals of the client. Although each profession has their own way

of service delivery or models that they practice under, when it comes to planning and

implementing an intervention with the client, the process is very similar because the main goal of

all the professionals is the recovery and integration of their client back into the community and

providing enough help but allowing them to be as independent as they can. One thing I noticed

about the professional team at Connections is not everyone has a clear understanding of the roles

of their co workers profession. I remember having a conversation with the occupational therapist

and them telling me that they were a bit confused of the role and responsibility of the recreation

therapist. In my opinion I think it would be beneficial for him to have a good understanding

because he may find that one of his clients would benefit from a certain service that the

recreation therapist could provide to them. By co-coordinating their services for their clients, it

will be the most effective way to provide optimal rehabilitation (Singleton, Makrides, &

Kennedy, 1986). Also in the setting that I was in much of the documentation process is that same

and people of different disciplines are running the same programs as one another. I think this is

somewhat beneficial because all have a different type of service delivery and even though they

all have the overall goal of wellness for the individual, the path they use to get the client there

does differ.
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References

Singleton, J. F., Makrides, L., & Kennedy, M. (1986). Role of Three Professions in Long

Term Care Facilities. ACTIVITIES. ADAPTATION & dG(.VG , 9(1), 57-70.

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