Carlie Whittle
Occupational Therapist
ORA service (Wellington Community)
Community ORA service
Comprised of multi disciplinary team (OT,
geriatrician, liaison nurse, social work,
psychologist, family therapist, physio, SLT,
rehab assistants).
 Assessment, treatment and rehabilitation.
 People (16 yrs. +) who have experienced a
health event or health condition which is
significantly impacting function.
 3 community ORA teams (Wellington,
Kenepuru, Kapiti).

Dementia
Problem with managing or home situation
crumbling.
 Safety concerns.
 Perceived unsafe behaviour.
 Level of care / support need decisions.
 To assist with providing diagnosis.

What role does OT have?

Enabling optimal health and well being
through engagement in meaningful activity.
Advocating a person’s right to autonomy.
 Using meaningful activity to enable optimal
participation in daily life activity.

Process of intervention
Information gathering.
 Battery of assessment (e.g. Allen’s
Cognitive Level, COGNISTAT, RBMT,
Assessment of Motor and Process skills).
 Functional assessment.
 Support and education.

How is this useful?
Helped me to understand what is happening
to me.
 Helped me to understand what the diagnosis
actually means for us as a family.
 Given me hope.
 Your support has been crucial.
 You have helped me to manage as well as I
can.

David J (false name)
57 years.
 Alcohol related dementia.
 Dementia specialist care facility.
 Referred to team for medication review.
 Assessed by geriatrician.
 Referred to OT re; challenging behaviour.

Goals

Facility: To have David medicated to stop
the challenging behaviour.

David: To return to community living.
Initial hypothesis
? Behaviour caused by:
 Lack of contact with other people
functioning at a similar level.
 Lack of cognitive stimulation.
 Absence of meaningful activity.
 Lack of opportunity to function at his
optimal ability.
 Loss of freedom and autonomy.
OT Ax revealed
Global cognition – areas of impairment and
areas of STRENGTH.
 Functioned at reasonable level.
 Basic routine activity well established.
 New learning possible (slowly by rote).

So why in DSC?
Placed directly from community.
 Involved with 4 separate hospital
departments leading to placement.

Two themes emerged re placement decision:
1. Impairment focused.
2. The influence of risk on clinical reasoning.

Reside at RH level?
More enriched environment.
 Opportunity for autonomy and greater level
of freedom.
 Access to required cognitive assistance.
 Able to participate in meaningful activity.
 BUT no locked doors!!

Outcome
Moved to RH level care.
Carefully chosen environment.
Residing with people functioning at a
similar level.
 Able to function at his best ability.
 Participate in activity of enjoyment.
 No challenging behaviour!
 Still there!



Useful reminder......
Powerful influence of the environment (the
problem is often not a problem with the
person but with the human / non-human
environment).
 Focus on STRENGHTS!
 Don’t underestimate the potential for new
learning.
 Trial of least restrictive option first.
 Manage our feelings around risk.

Questions???
How can you refer to ORA
/ for OT
Anyone can refer!
 Referrals faxed via Care Co-ordination
Centre
 F: 2382022

How to contact me
Carlie Whittle
PG Dip Occupational Therapy
carlie.whittle@ccdhb.org.nz
T: 04 9185261