The VdT Model of Creative Ability in Japan
Wendy Sherwood, Lead Director of the VdTMoCA Foundation (UK) has developed a strong relationship with our OT colleagues in Japan since they visited her forensic service during a UK visit in 2003-2004. Led by Yoshiko Nakano and Megumi Sato, senior OTs, the key features of the model have been translated into Japanese in a culturally meaningful way and the model introduced into forensic, mental health, physical and older people services.
The model has had a significantly positive impact on the OTs’ ability to deliver effective therapy to a broad range of service users, particularly those on the lowest levels of creative ability and highly complex cases.
Financed predominantly by ICAN, Wendy has had the pleasure of providing them with teaching and clinical supervision during visits in 2008, 2010, 2012 and 2016. The OTs in Japan work incredibly hard to learn and understand the model and have shown initiative in developing and maintaining monthly study groups to support their learning. During visits to Japan, Wendy has seen some of the very best application of the model in practice. They are very imaginative in their development of activities for therapy and they are extremely good at applying the treatment principles correctly at each level of creative ability. There is a great deal that we can learn from our Japanese colleagues, and this is illustrated by several articles on their practice and examples of their activities in ‘Participation’. Examples of activities are also available in the members’ forum.
There are presentations in the members' forum by Japanese colleagues who presented at the 2015 and 2017 International VdTMoCA conferences in the UK. Some of the key points they made are below.
Perspectives of the model - some comments by colleagues in Japan
From an OT using the model in Saga, Japan:
"When I use this model, I can know the level or stage of the patient - I can know how to approach him/her concretely - it is a good point of this model. This model gives me confidence in how to enable the patient who can make use of the 'ordinary approach' of OT. I now know how to be with the patient because I have abetter understanding of what is happening in terms of occupational performance components / the world of the patient, and the way of approaching him/her.
Before, I was not sure that might approach was right or not, but after I came to know this model I have become confident and I have my own success in practice as evidence to follow this model. I believe that this model can enable me to share the OT assessment with others. The success of the approach is evident in the feedback of other staff on changes in patients.
I am very happy that I know this model. Thank you"
2015 conference presentation key points
The context for occupational therapy in Japan:
- in mental health, long-term admission are common (5-6 times longer than many other countries)
- only approximately 20% discharged in first year of admission at the hospital discussed
- government earns revenue from each patient (privatised hospitals), therefore not the incentive to cut lengths of stay
- the more treatments that are carried out, the more profit hospitals gain therefore OTs have to treat as many patients as they can - something that is actively encouraged by the hospitals
- 5 OTs provide a service for 1600 to 1800 cases on a monthly basis, which amounts to between ï¿¡18,000ï½žï¿¡20,000
- As a standard each patient receives 2 hours of therapy per day; if a patient does not receive those 2 hours of treatment a day, the medical fee cannot be claimed. It is however unrealistic for those patients who are emotionally unstable to be able to receive 2 hours treatment. Hence, many times, the hospital tries to frame the treatment in such a way to complete those two hours in order to be able to claim the medical fee. A single OT manages groups made up of 25 patients. It is customary to manage 50 patients, per day.
- VdTMoCA presented at a conference in Japan in 2012 by Satomi Sakuma
Benefits of the model:
- Using the model has enabled nurses to better understand the best / most enabling environments for clients and to better understand OT
- Using the model has enabled better therapy with clients on the Self-differentiation and Self-presentation levels in particular
- Large groups of 25-50 clients can be managed therapeutically by applying the treatment principles
- Need resources in Japanese
- Not all concepts translate well into the Japanese culture
- The pressure to provide OT to as many patients as possible makes it challenging to provide therapy according to the treatment guide for people on the first levels of creative ability
- However, people are realising that the quality of services is improved through use of the model
OTs are hopeful that use of the model will grow and they are determined to continue to improve services through the VdTMoCA
Reference for this material is: Sakuma S, Ookubo M (2015) The VdTMoCA in Japan: challenges and successes. Presentation given at the 4th International VdT Model of Creative Ability conference, Birmingham.
2017 Conference presentation key points
A case study was presented of a young lady (pseudonym Mutsuko) with self-harming behaviour, and behaviour that significantly challenged the forensic ward. Mutsuko was secluded for a year, to protect her, staff and clients from harm. She was then permitted to attend OT, where her behaviour continued to be highly aggressive and challenging. Having been assessed as being on the level of Self-differentiation, the therapists commenced VdTMoCA-informed therapy.
"Since we started using the VdtMoCA for the level of Self-Differentiation, the erratic, chaotic and destructive behaviours have stopped completely. Without the need to escort her by taking her by the hand, Mutsuko now walks normally to OT and stays for the full duration of the 30 minutes session. She asks about what she is doing, asking “Is this ok?”. She is now able to call the OTs by their names, and she is becoming aware of the difference between situations and environmental conditions. She is also becoming aware of time and aware of routine.
She is considerably more able than before, and we believe, with a better quality of life.
Although one might say that this is purely down to addressing the lack of stimulation that she had, the key point is that prior to learning the VdTMoCA, we wouldn’t have known how to respond to her challenging behaviour, or how to meet her needs for stimulation and activity. In a trial and error way, I’m sure that we would have offered her a range of activities, and in a way that she couldn’t respond to positively i.e. in a way that was not enabling her. The VdTMoCA helped us to see and understand her ability and what she was motivated for, and to meet those needs in a clearly reasoned way.
The MDT’s understanding of OT has also changed significantly. The consultant psychiatrist has credited occupational therapy with making a significant contribution to the positive change seen in Mutsuko. Regarding the nurses, Mutsuko’s key nurse has fed back that:
“We [nurses] have little means to explore Mutsuko’s potential, especially since nursing staff have to focus on self-care. It was exhausting to provide her with self-care, since she was particularly prone to negative behaviours. However, thanks to the occupational therapy, I was able to discover a positive dimension in Mutsuko that I did not know before, and she kindly taught me all the things she could do. In addition, I find the positive feedback that OTs provide us regarding how to work with Mutsuko, is very helpful”.
The VdT Model of Creative Ability in Singapore
Having found the VdTMoCA via the internet, So Sin, then a lecturer at Nanyang Polytechnic put forward the suggestion that the VdTMoCAF (UK) should be invited to share the model with delegates at the Singapore Association of Occupational Therapists. Subsequently, in 2015, Wendy Sherwood gladly delivered the Plenary speaker presentation 'Being inspired to be an occupational therapist . . . what a difference a model makes' at the SAOT conference in Singapore.
The VdTMoCA was introduced to the Diploma in OT at Nanyang Polytechnic a few years ago and with the support of Wendy via ICAN, is now part of the curriculum in the first BSc (Hons) Occupational Therapy programme in Singapore. The programme commenced in 2016.
In 2015, Wendy visited physical rehab and acute mental health services at Changi Hospital, New Horizons dementia day care and various services at the very large mental health hospital at the Institute of Mental Health. Wendy delivered ICAN training a handful of OTs, who have the potential to be the pioneers in the application of the VdTMoCA in Singapore. In 2017, through ICAN, Wendy visited again to teach on the BSc (Hons) Occupational Therapy programme - see photos of students doing problem-based learning on the model.
Wendy also presented to senior clinicians and hospital managers at the Institute for Mental Health. Wendy also visited a long-stay ward where the MDT is keen to learn and apply the model.
Through ICAN, Wendy is currently working on a programme of support for occupational therapists needing training, clinical supervision and support for application of the model in acute and long-stay services. Exploration of MSc level study is also underway. Wendy is hoping to return to Singapore in November 2018 to advance plans and teach OT students and clinicians.