#OTalk 26th August 2014 – Service User* Involvement

@pixiegirle will be hosting next week’s #OTalk on service user involvement. There are a few sections she’d still like to add to, but here’s her introductory blog post to get you thinking!

Service User* Involvement

*The term Service User in this context, refers primarily to people who utilise mental health services. However, it must be acknowledged that many individuals prefer to use alternative terminology, including, but not limited to, ‘patient’, ‘consumer’, ‘survivor’, ‘the public’ or person. (Welsh Government 2008).

Introduction

The involvement movement has increased in momentum since the 1970’s (SCIE 2014).  Indeed, Patient and Public Involvement (PPI), Citizen Engagement and Participation, Co-production and Service User and Carer Involvement are phrases we hear on a daily basis as Occupational Therapists.   Yet, despite its prevalence in successive policies, strategies and best practice guidelines, there is ‘no single template for involvement’ (JRF 2003).  Indeed, professionals, service users and carers will often find different forms of involvement personally meaningful, leading to an array of definitions of what it means to be involved, and indeed how best to facilitate involvement.

It is important to note that this blog is written from the perspective of being both an Occupational Therapist and an Involvement Activist, and written primarily for fellow Occupational Therapists to enable them to reflect upon their practice and professional development.  Initially, key concepts prevalent to the involvement movement will be discussed, followed by a discussion upon Occupational Therapy and Involvement.  Whilst this blog will draw primarily upon involvement in mental health, many of the principles and practices are applicable to other areas of practice.

 ‘’Broadly Defined’’

Branfield et al (2006) emphasise that Involvement must be broadly defined to ensure it remains inclusive.  Significantly, people with lived experience have highlighted these broad features:-

  • Making experiences, views and ideas known
  • Being able to get together to work collectively for change and mutual support (Branfield et al 2006)

It is also widely advocated that Involvement should occur during the design, planning, delivery and evaluation of services, in addition to education and research (WG 2008).

‘’Powerful Perspectives’’

The notion of power is prevalent throughout the literature on Involvement. As I am unable to provide an account of the implications of power as articulate as Branfield et al (2006), I include a lengthy quote:

‘’Issues have been seen and understood from other more powerful perspectives, like those of politicians, policy makers and professionals. This heritage has also affected understandings of participation and user involvement.

Often user involvement has been framed in terms of seeking to involve service users in the service system’s activities, ways of thinking, goals and structures. The most common calls have been to ‘join our committee’, ‘send in your views to our consultation’, ‘fill in our questionnaire’ and the like. That is still what most service user involvement is like. But from the beginnings of the emergence of new movements of service users, 30 and more years ago, first disabled people and then other groups of service users, began to develop a different understanding of what user involvement and participation might mean. They didn’t necessarily want to get involved in existing organisations and services. They wanted to develop their own.’’ (p ix)

The Involvement Continuum

As highlighted eloquently by Branfield et al (2006), who leads or controls the overall involvement activity and process has a strong influence upon how meaningful Involvement may be for people engaged in the Involvement activity or opportunity.  The Ladder of Involvement presents this concept, however I have drawn upon the notion of a continuum, adapted from Nolan et al (2007).  A continuum acknowledges that involvement must be broadly defined and will depend upon individual preferences.

The Involvement Continuum (Adapted from Hickey and Kipping (1998) and Nolan et al (2007)

Not Involvement Profession led involvement Partnership / co-production Service User led involvement
Tokenistic Involvement where:-

  • Service users are placed in opportunities where they are not supported to be involved or have no real influence on any decisions or outcomes.
Involvement where:-

  • Professionals lead and control involvement activities.
  • Service Users may be present and involved but decisions are primarily made by professionals.
  • Any action based on feedback is taken by professionals.
Involvement where:-

  • Power and responsibility is shared
  • All people, whether service user or professional feel that they are equal collaborators
  • Decisions are made together as equals.
  • All people feel that they have equal influence on any outcomes and action.
Service User led involvement, organisations and initiatives:-

  • Service Users lead and influence all activities.
  • Professionals may be present, however decisions are primarily made by Service Users.
  • Action taken by Service Users.

 

Occupational Therapy and Involvement

Generic vs Core Skills

Involvement is not unique to Occupational Therapy, and is something that all organisations or professionals who work in health and social care should do. Indeed, many organisations will have policies outlining the manner in which the organisation will involve the people who utilise its services.  Whilst Involvement could be perceived as drawing upon Occupational Therapists’ generic skills, Occupational Therapists are in an excellent position to be able to enable involvement at all levels of service delivery given their philosophical underpinnings and core skills.  Indeed, many of the values espoused by Involvement, mirror the values of Occupational Therapy, including:-

  • Client-centeredness
  • Valuing people and their lived experience
  • Enabling and empowering people to do things for themselves independently
  • Facilitating engagement and participation in personally meaningful ways
  • Taking strength based approaches
  • Notions of justice and equality

Furthermore, our core skills, including Activity Analysis, Grading Activities and Environmental Assessment can help facilitate involvement.

Involvement as an Occupation

As an ‘occupation’, Involvement must be personally meaningful and personally defined.  Like any other occupation or activity, involvement has many forms and depends upon the complex interaction between the individual, their occupation and the environment.  Consequently, any involvement activity must be meaningful for the individual involved, which may depend on previous experience or roles, in addition to the individual’s skills and knowledge and preference on the involvement continuum.  It will require preparation to ensure involvement offers the appropriate context to make meaning and provide opportunities for mastery.

The University of the West of England has created an Algorithm of Involvement which can be utilised to aid anyone interested in planning involvement in the future.

Area of practice and Professional Development

It is fundamental that the environment and context is considered when involving people.  Whilst, Branfield et al (2006) emphasise the growing momentum of user-controlled involvement, as Occupational Therapists, we work primarily within exiting organisations and cultures.  Drawing upon COTs Post Qualifying Framework, examples and resources are presented in accordance with Occupational Therapists’ four areas of professional development – Clinical Practice, Management, Education and Research.  I have also supplemented this with examples and resources that pertain to user-led or controlled organisations and involvement activities as our environment should not detract or restrict the growth and success of these activities and organisations.

1.Clinical Practice

Involvement is a concept, widely advocated in mental health.  However, Irrespective of what area of practice we find ourselves in, by the very nature of our profession and in accordance with our Code of Ethics and Professional Standards, Occupational Therapists (COT 2010) should be:

’committed to client-centred practice and the involvement of the service user as a partner in all stages of the therapeutic process.’’ (pv)

Our area of practice will ultimately influence the type and method of Involvement.  Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Working in partnership to develop care plans, enabling and supporting people to set their own therapeutic goals, Peer Workers (who deliver services), delivering training.

  1. Management

Involvement can occur at any level of service provision, from therapeutic intervention to working strategically at Board level.  Whilst meaningful Involvement during therapy is of prime importance to Occupational Therapists, the literature on Involvement places great emphasis upon Involvement in activities related to the design, planning, delivery and evaluation of services.  Indeed, Involvement should extend beyond the therapeutic process to activities traditionally associated with senior management, including recruitment and strategic and board level activities.

Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Recruitment and Interviewing, developing strategies, staff appraisal, evaluating a service using service users as interviewers, consultation, completing an evaluation questionnaire, commissioning services in partnership with professionals.

  1. Education

COT (2007) advocates the involvement of services users in education:

‘’Involvement of service users in programme design, delivery and evaluation helps to ensure the relevance of curricula and is one of the criteria in the COT standards for education (2004b) against which occupational therapy programmes are measured for accreditation. Higher education institutions (HEIs) must continue to review the effectiveness of service user involvement in their programmes.’’ (p15)

Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Service user lecturers, Sharing stories or personal experiences as case studies, being involved in the design of a course, evaluating content of course.

  1. Research

There is a growing involvement movement within the research community. Indeed, INVOLVE (England) and Involving People (Wales) support and advocate for the role of service users within all research activities.  A number of research teams now have people with lived experience working in an array of capacities within the team.  SURE, the Service User Research Enterprise based at Kings College London is co-directed by Professor Diana Rose, the world’s first Professor of User-led Research.  Information on SURE can be accessed here.

Dependent upon where the Involvement activity lies on the Involvement Continuum, examples include: Service User Researcher’s, Membership of an expert reference group, Research teams, consisting primarily of service users, independent service user researchers who collaborate with academics on a consultancy basis.

5. Service User led organisations and initiatives

To be updated….

 

Questions to think about for #OTalk:

  1. What does ‘service user’ Involvement mean to you?
  2. What Involvement opportunities do you, your service or your organisation provide?
  3. What difficulties / barriers have you faced when trying to involve service users?
  4. What has helped you to involve service users?
  5. How can we make Involvement more meaningful for the people who use our services?
  6. Putting Involvement in to practice: Ideas / Plans for the future!

References

To be updated…

The Numbers

649,847 Impressions
482 Tweets
27 Participants

#OTalk Participants

The chat transcript can be found at this link, or you may prefer to download the PDF. A CPD template is available for documenting your engagement with the chat.

Advertisements

#OTalk 19 August 2014 – Occupational Therapy and the Fire Service

After this year’s College of Occupational Therapists conference, we asked our OTalk community if there were any presentations they’d enjoyed enough to want to follow up with a tweetchat. Thank you to @angie_paul for suggesting this session:

78.2 – Evaluating students’ experiences of a placement within the fire service in Scotland

Stewart E(1), Allan K(2), McIntyre A(3),

The Robert Gordon University, UK(1), NHS Education for Scotland, UK(2), NHS Tayside, UK(3)

I’m happy to announce that Elaine Stewart (@RGUOTStewart) has agreed to share her presentation with us and facilitate this week’s #OTalk with some of her students: Eithne O’Reagan (@or_eithne) and Natalie Crawford (@natalielc93).

Tayside Fire and Rescue Services have been working with Health and Social Care Agencies as part of an initiative to reduce fire deaths in Scotland. Key recommendations from this initiative include closer partnership working with Health and Fire Services to identify, access and share information about groups and individuals most at risk from fire. Shaping teams to work in a truly integrated way requires effective partnerships across agencies (The National Delivery Plan for the Allied Health Professions in Scotland, 2012-2015). Education, training and awareness are factors that are important to achieving effective partnership working therefore a joint placement for two Occupational Therapy students within mental health services and the fire service was developed.

This placement was completed in December 2013 with one Year 3 and one Year 4 Occupational Therapy student from Robert Gordon University (RGU) for a period of 6 weeks.  The students participated in a peer model of supervision and spent time within older people’s mental health services and within the Scottish Fire and Rescue Service.  The placement was evaluated thereafter by NHS Education for Scotland (NES) and a report completed.  Key benefits stated were the promotion of the profession, collaborative and partnership working and autonomy and consolidation of Occupational Therapy core skills.

Following the placement several events including a partnership event in Tayside with Michael Matheson, Minister for Public Health, and the two Occupational Therapy students presented at the College of OT National Conference in Brighton in June 2014.

This is the first type of placement of this nature with the Scottish Fire and Rescue Service and it is hoped with continued partnership, this will be developed nationally as a model with potential additional pilot placements being currently planned in Aberdeen and again in Tayside for November 2014.

Within the twitter chat I would hope to discuss any other examples of practice similar to this in other areas, and also to discuss the opportunities and challenges that a contemporary placement like this can present.  We would be happy to share any of the experiences of this placement opportunity and how any future involvement could be shaped.

I hope that anyone interested will become involved in the chat.  Myself and the 2 students involved in the placement will be available to discuss this and look forward to it.

As usual, the chat will be held at 8pm BST on Twitter, using the hashtag #OTalk. If you’re new to Twitter chats, check out this handy guide from our colleagues over at #anzOTalk.

EDIT: You can read the transcript of the chat at this link, or download the PDF. A CPD template is available for documenting your engagement with the chat.

The Numbers

540,848 Impressions
408Tweets
38 Participants

#OTalk Participants

EDIT: Thank you to Shelagh Creegan (@shelaghahp), Associate AHP Director for Mental Health and Learning Disabilities, for writing a chat summary and sending some additional posters for our information. Please find her summary below (posted as a comment), and check out the posters:

Fire poster CD 2

Fire Safety A0 poster FINAL

Fire Service Placements Knowledge slide

#OTalk Journal Club 2 September 2014.

Journal Club host Charlotte O’Reilly @CharlOTPlay , would like us to consider

Relationships, Sexuality and Occupation.

Thank you to Charlotte for this introduction to the topic.
When I was in my second year studying to be an OT, we were asked to put together a research article. During my project, I came across this journal which I feel I learnt a lot from and shaped a lot of my own research article.I am now working full time as a paediatric OT within a school setting and I volunteer as a governor in a college for adults with learning disabilities.
I feel human relationships and sexuality are a big part of everyday occupation as in life we make/maintain a multi-tude of relationships. Throughout, my research project I came across many journal articles around the topic of romance/sexulaty
and occupations. One written from OT persepctive was of particular interest and I feel it would be interesting to explore the article as a group of OTs. I am hoping to encourage OTs to freely and openly talk about sex, relationships and sexual occupations as sometimes this can be challenging.

Reference:

White, E., Barnitt, R. (2000) Empowered or Discouraged? A Study of People with Learning Disabilities and their Experience of Engaging in Intimate Relationships. British Journal of Occupational Therapy. 63 (6) 270-276.
Abstract:

Vulnerable people constitute the majority of referrals to occupational therapy services, due to age and social, psychological and economic circumstances. People with learning disabilities may fit all these categories. An argument has been put that vulnerable people should not be subjects in research (de Raeve 1994) and that there may be unacceptable risks in being a subject in a socially sensitive research project (Barnitt and Partridge 1999). However, avoiding research with people with learning disabilities would mean that the voice of these clients would not be heard and it is known that they have expressed the wish to be consulted and involved in research (Atkinson 1989).
A collaborative study was carried out with eight adults with learning disabilities who lived in a community residential home. Interviews were completed which dealt with aspects of intimate relationships. Three themes emerged from the interviews: the experience of intimate relationships, the future of a current relationship and the involvement of others in relationships. The findings showed that the people interviewed had a generally positive experience of such relationships. However, while the attitudes of staff and family towards intimate relationships were mostly empowering, some negative views still existed. The results have implications for occupational therapists working with people with learning disabilities.

Discussion points for #OTalk:

• Was having service user’s as subjects in the research effective? Do you feel the needs of the subjects/participants were met throughout the research process? (participants)
• Sexual activity is discussed. As an OT, do you regard sexual activity as an occupation? Do OTs have a role in facilitating sexual needs and relationships? Positives and negatives? (OT & sex)
• Was the research method (semi-structured interviews) effective in meeting the aims of the research? E.g. to establish if service users can be ‘subjects of research’ and discuss relationships. What about the structure of the questions? Appropriate/in-appropriate? (research structure)
• Final paragraph “findings have implications for OT practice and research p275” Is this sufficient information? Has/will reading this journal impact your OT practice in anyway? Positives/highlighted areas for development. (future practice)
• What is your take-away message from the journal and / or discussion?

If there are any other items you would like to include in the discussion please let me know.

Please note that the article chosen is not open source. Please be aware of copyright law.

Details and download of the Reading Record can be found on the Journal (Media) Club Resources page.

Click here for the Healthcare Hashtags transcript.

or here for a pdf of the transcripts: #OTalk – 2nd September 2014