At the initial assessment, the occupational therapist was able to meet Ryan and his siblings and gain a thorough understanding of the difficulties they were having. The bathroom on the ground floor is the family bathroom and on the 1st floor there was a very small ensuite with a shower cubicle, wholly inappropriate for use as a family bathroom. Both the room identified as Ryan’s bedroom and the family bathroom are on the ground floor. There was a standard bath in the ground floor bathroom, wash hand basin and WC. Ryan’s parents have been lifting Ryan in and out of the bath, as he did not have access to any other washing facilities within the property.
Adaptations to the bathroom were discussed and it was acknowledged that Ryan had three younger siblings who all used the bath and as this was the only bathroom in the property, it was important to retain a bath within the property whilst allowing Ryan access. His mum explained that he was using a flotation device in the bath to support him and benefited from the relaxation and the feeling of weightlessness while he bathed. Ryan was able to lie down in the bath, however his parents were having difficulties in lifting him from the bottom of the bath.
The Canadian Model of Occupation, Performance and Engagement or CMOP-E (Townsend and Polatajko, 2007) was used as a model to shape the assessment of this child. The CMOP-E, with a person at its centre, supports the occupational therapist’s client-centred perspective. Occupational therapists are expected to provide services that are client-centred, as stated in the Code of Ethics and Professional Conduct (RCOT, 2015): “Assessment, interventions, outcomes and documentation should be centred on occupational performance, engagement and participation in life roles”. The CMOP-E therefore provides occupational therapists with framework for assessment of person, throughout the occupational therapy process.
The importance of bathing
When assessing the environment, the culture of this particular family meant that they placed a lot of emphasis on the importance of bathing young children. The family did not wish to have the bath removed due to the effect they felt it would have on the rest of the family. In addition, mum had described how she used the bath as a form of relaxation and ‘escapism’ after a busy week caring for the children.
The physical environment was not supportive of Ryan, who is a full-time wheelchair user, to access the bath safely. The bath was not at the correct height for the carer, nor was there anywhere to change Ryan once he had bathed.
The social environment was a busy household with four children, one with special needs and the entire family had to be accounted for within the assessment, as well as their wishes and needs.