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What we expect from you

Before your Placement

Once the University inform you of your placement you are expected to email your PPE at least one week prior to the start date in order to introduce yourself and make arrangements to do a pre-placement visit. You can also ask any questions which will help you prepare for your placement experience. It would be useful for you to provide a summary of your learning to-date for your practice placement educator.

Please follow any instructions that your PPE gives you e.g. provide Smartcard number as this helps us save time by completing processes before you arrive.

Also, you might find it helpful to start thinking about your particular learning objectives prior to starting the placement. 

During your Placement

You are expected to present yourself in a professional manner at all times whilst on placement, abide by the Trust values, policies and procedures and act in accordance with the RCOT Code of Ethics and Professional Conduct for Occupational Therapists.

Your hours of work will be dependent on service requirements and students are expected to comply with the normal hours of work for your placement setting.

Communication

You will:

  • Acknowledge that service users have a choice about whether they wish to engage with you and you must seek their permission prior to assessments/interventions
  • Inform your PPE and/or the member of a staff in charge of their clinical area of work immediately in the event of any critical/unusual incident occurring during a client treatment session either to the client or to them.
  • Ensure that a qualified health practitioner countersigns all the entries that you make in client’s case notes.
  • Report any incidents of verbal, racist or sexual abuse or violence towards its service users or staff, contractors or visitors to their PPE
  • Maintain confidentiality at all times.
  • Make sure that on leaving the placement any outstanding issues regarding patient care are handed over to the practice placement educator and documentation is up-to-date.

Learning contract

You will:

  • Negotiate an individual learning contract and weekly objectives with your PPE
  • Not accept responsibility for tasks that are above and beyond your capabilities or alternatively avoid taking responsibility commensurate with your level of training.
  • Identify, develop and use learning opportunities to achieve placement outcomes.

Supervision and Support

You will:

  • Actively participate in a minimum of one hour of formal supervision with the named PPE per week
  • Be willing to discuss both your strengths and weaknesses so that there is a planned approach to learning and supervision
  • Be aware of the academic and pastoral support available whilst on placement.

Assessment and Evaluation

You will:

  • Carry out self-appraisal and critical reflection on a regular basis in preparation for both formal assessment and supervision sessions.
  • Complete the Trust evaluation questionnaire at the end of the placement.

Health and Safety

 You will:

  • Adhere to your university procedures regarding absences due to sickness and contact the placement at the earliest opportunity and NO LATER THAN the normal start time on the first day of sickness.
  • Alert their PPE to any health issue, which may impinge on client care.
  • Read and adhere to the Trust's health and safety policies and make yourselves aware of and follow the control measures of any risk assessment prepared.
  • Adhere to the Trust’s Smoke Free policy
  • Adhere to the Trust’s dress code.

Accommodation

You will:

Disclosed disabilities

You will:

  • Not be obliged to disclose a disability, however if you choose this option you will be assessed without the benefit of additional support.
  • Be encouraged to initially disclose a disability to their University in order to receive any pre-placement support. You can however disclose a disability whilst on placement.
  • Be required to provide information about how your disability affects you on a daily basis and to identify what 'reasonable adjustments' are required to make the placement accessible.
  • Be encouraged to visit your placement before starting to openly discuss your needs and what adjustments they would find helpful.

Other

You will:

  • Never accept a gift, favour or hospitality from a service user, carer or relative currently receiving care.
  • Not use your mobile phone during work hours except in exceptional circumstances e.g. as a safety measure

mental health care pathways

OCD: Treatment approaches

There are different ways to treating OCD.

The 2005 NICE guidelines for the treatment of OCD and body dysmorphic disorder (BDD) encourage the use of a stepped-care model. The model aims to provide OCD sufferers with the least intrusive but most effective management for the patients needs. Each step provides successively greater intervention, assuming the previous step has already been implemented but has been unsuccessful. The model tailors the level of intervention to characteristics of the sufferers OCD and emphasizes the benefits of involving the family, schools and social workers.

Quick reference guide to the treatment of OCD 

  image Stepped-care model for OCD (145 KB)
(click for image)

Psychological therapy

Exposure Response Prevention (ERP) is a form of cognitive behaviour therapy (CBT) and produces response rates of 85% in subjects who complete therapy. Patients are first required to produce a hierarchy of anxiety-inducing situations. The client then faces the feared situations or objects without performing the compulsive ritual. The objective of ERP is to produce habituation, where anxiety reduces naturally after prolonged exposure to the stimulus. A reduction in anxiety is seen within 60-90 minutes if the patient does not engage in anxiolytic behaviours. The patient works through the graded hierarchy tackling the least feared challenges first.  

ERP can be delivered in a variety of forms, including self-help programs such as books, computer packages and telephone therapy. These provide a self-directed approach to overcoming OCD but with some therapist input for goal identification and early education. CBT often has long waiting lists and is demanding on therapists time. Self-help approaches have the potential to help more patients with minimal input from a clinician and may be monitored at the primary care level.

Psychological interventions for children with OCD follow similar principles as adult-based therapies. It is important to acknowledge developmental discrepancies and language ability in children. Significant emphasis should also be placed on involvement of the family. 

Find out about the National OCD/BDD service provided by the Trust.

Pharmacological therapies

Clomipramine and the Selective Serotonin Reuptake Inhibitors (SSRIs) are the most effective drugs in the treatment of OCD. This is due to their ability to specifically inhibit the synaptic reuptake of serotonin. Advice on prescribing for OCD

 

publication of expenditure

OCD: Epidemiology and aetiology

The epidemiology and aetiology of OCD.

Epidemiology

  • OCD is observed in males and females in approximately equal proportions.
  • Prevalence may be as high as 1% to 3% in adults and 1% to 2% in childhood/ adolescence (especially just before the onset of puberty).
  • Many adult sufferers report symptoms appearing for the first time in childhood or adolescence.
  • Men more frequently present with checking rituals and women are more likely to display compulsive washing. 
  • The course of OCD is usually chronic but may vary in severity in response to stress. 
  • Many individuals do not present to healthcare professionals until early in middle age. 

 Aetiology

  • Multifactorial in origin.
  • Includes environmental and hereditary factors.
  • Brain imaging studies have identified the basal ganglia and orbitofrontal cortex to be involved in the development of OCD.

 

hp ocd bcc treatment

OCD: Differential diagnosis and screening questions

Here are the differential diagnoses and screening questions for OCD.

Differential diagnosis

  • The main differential diagnosis is depression and many patients with OCD have comorbid depressive symptoms.
  • Other differentials include phobic disorders, anorexia nervosa, obsessive or anakastic personality and occasionally schizophrenia.
  • The symptoms of OCD are seen in other conditions such as Tourette's syndrome, autism and frontal lobe lesions.
  • Obsessive-compulsive-related disorders (OCRD) and a range of disorders which share characteristics with OCD (e.g. in symptom profile, biology and treatment outcome).
  • OCRDs include body dysmorphic disorder (BDD - concerns of imagined ugliness), hypochondriasis (concerns about imagined illness), eating disorders and impulse control disorders such as trichotillomania (hair pulling).

 Screening questions for OCD*

  1. Do you have frequent unwanted thoughts that seem uncontrollable?
  2. Do you try to get rid of these thoughts and, if so, what do you do?
  3. Do you have rituals or repetitive behaviours that take a lot of time in a day?
  4. Do you wash or clean a lot?
  5. Do you keep checking things over and over again?
  6. Are you concerned with symmetry and putting things in order?
  7. Do your daily activities take a long time to complete?
  8. Do these problems trouble you?
  9. Does this behaviour make sense to you?

Non-psychiatrists who may be referred patients with OCD

Professional
Reason for consultation
GP Anxiety, depression
Dermatologist Chapped hands, eczema, trichotillomania
Cosmetic surgeon Concerns about appearance
Oncologist Fear of cancer
Genitourinary specialist Fear of HIV
Neurologist OCD associated with Tourette's syndrome
Obstetrician OCD in pregnancy
Gynaecologist Vaginal discomfort from douching

*These screening questions were compiled from the following articles:

  • El-Sayegh S, Bea S and Agelopoulos A. "Obsessive Compulsive Disorder: Unearthing a hidden problem". Cleveland Clinic Journal of Medicine (2003) 70, Number 10: 824-840
  • National Collaborating Centre for Mental Health commissioned by the National Institute for Health and Clinical Excellence. "Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder". National Clinical Practice Guideline, Number 31. Published by The British Psychological Society and The Royal College of Psychiatrists, Jan 2006
  • Heyman I, Mataix-Cols D, Fineburg N A. "Obsessive-compulsive disorder". BMJ (2006), 333: 424-429

 

 

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