The VdTMoCA provides theory for the practice of occupational therapy but can be extremely useful to other disciplines and inform service delivery as a whole. A few examples are below.
When an MDT of an inpatient service shares a basic understanding of the levels of creative ability commonly seen in the service, all staff can utilise the treatment principles in their day-to-day relations with each patient. A team of nurses at a Psychiatric Intensive Care Unit in Stafford used the levels and phases of creative ability to gain insight into the needs of patients, predominantly on the levels of Self-differentiation and Self-presentation. Knowledge of these levels enabled them to understand patients' needs and to respond in a therapeutic, enabling way. This occurs in every interaction with individuals by using the handling principles and in meeting their occupational needs by having activities ready to use in response to individuals' rapidly changing presentation. Each individual's level of creative ability was included in each handover and informed ward round discussions and discharge planning.
"Our service has used the VdTMoCA for over 4 years now. During this time it has significantly enhanced the quality of our OT provision but has also influenced the care we provide as nurses. The VdTMoCA provides us with a common language which enables us to communicate more effectively with the MDT and with our patients. A major benefit we have found is using the levels to help us plan care in the most effective manner. For instance, a patient’s level guides us in the communication styles we should use when engaging with patients, how they may respond to group settings and social interaction and whether leave would be beneficial.
As a nursing team we have found that the VdTMoCA has improved collaboration within the MDT, enhanced the quality and appropriateness of the care we plan and deliver and has also enabled us to more clearly recognise improvements in our patients' mental health and level of functioning" (Tom Tunnicliffe, 2020).
In a Medium Secure Forensic ward in Northampton, the MDT also utilised the levels of creative ability to inform ward round discussions and decisions (patients' levels were formally recorded in ward rounds, care plans etc). The Health Care Assistants found the VdTMoCA invaluable for day-to-day practice:
"We adopt our approach now to suit patients’ needs.
We can now engage really poorly patients, before we didn’t know how.
We understand why activities need to be adapted.
It makes us feel more satisfied when we can do successful activities, helps us understand the patients’ behaviour better, which means the ward is calmer and risks are reduced". (2015).
In a Forensic service for adolescents with developmental disabilities, the OTs graded a range of activities to levels of creative ability commonly experienced by young people in seclusion. A trolley of activities together with guidance on how to facilitate them (using the treatment principles) was provided for nurses who were spending many hours with the young person in seclusion. This initiative enabled nurses to reduce occupational deprivation by meeting patients' occupational and social needs. "The VdTMoCA has been crucial to the service as it has given clinicians a better understanding of how to engage young people at an appropriate level" (Hosier et al. 2011).
A Community Mental Health Team trained in the VdTMoCA and all disciplines use knowledge of the levels and the treatment principles to inform their work. The psychologist has amended the duration of appointments and interventions, and has graded group-based interventions to better match the needs of clients on specific levels of creative ability. Similarly, a psychologist collaborated with an Occupational Therapist to grade group-based interventions in a rehab unit for people with complex needs. A description of this and how the VdTMoCA informed the whole MDT approach is provided by Murphy (2021).
A group of OTs working in CAMHS, shares the VdTMoCA with the MDT, providing educational input (Wimbourne, 2022). The team have considered how knowledge of the levels can inform how the MDT, particularly the nurses can better manage mealtimes for young people in an adolescent unit. The difficulty is the distress caused by the rule that everyone must eat their meal and cannot leave the dining room until finished, including young people with an easting disorder. Advice on how to lay the table, involve the young people in aspects of meal times, and how to explain the rule and facilitate mealtimes according to different levels, could be helpful.
At Broadmoor high security hospital, the treatment principles have been used to make changes to ward-based activity sessions on rehab wards. The rehab wards were not actively providing rehabilitation, many patients staying in their rooms, in bed, watching TV etc. Using the VdTMoCA brought about a significant change, not only for the OT sessions, but the rehab potential of the ward. Level-specific groups “...elicited a great deal of intrigue and motivation from our patients. This has proven incredibly successful with great numbers of attendees and a high quality of engagement from patients who used to spend a large amount of their week asleep or just sat in the day area watching TV.”
A mental health assessment ward for older people in Oxford uses the VdTMoCA to inform all intervention in the service. The nurses are advocates for the model which even informs information leaflets about the service, written slightly differently depending upon the level of creative ability of the client. An example of a leaflet is available on the icancreativity Patreon page -