Supervision #OTalk 30th September 2014

#OTALK 30TH SEPTEMBER 2014
Guest hosted by @ForensicDetail and supported by @GillyGorry

SUPERVISION

Context

Supervision is demanded by COT and the HCPC; a professional and ethical requirement to ensure standards are being met. The supportive aspect is less commonly cited in official documents, but emerges in the literature as the most vital from the perspective of clinicians. It provides reassurance when feeling underappreciated in physical settings (Robertson and Finlay 2009), and provides much needed emotional space to reflect in mental health settings (Edwards and Burnard 2003).

Following the experience of feeling dissatisfied by the supervision, I undertook my own learning about types and models of supervision. This knowledge shapes supervision I request, and also the supervision I deliver. Aiming to provide supervision of good quality and which meets the needs and expectations of the supervisee is a dynamic challenge but awareness of different models and approaches to supervision gives flexibility to adapt to the supervisee without feeling bound by one particular model.

Defining supervision

There are several different, contradictory and confusing definitions for supervision of health care professionals, further complicated by the lack of clarity about whether managerial and professional supervision should be separate entities, and whether clinical and professional supervision are the same.

In addition, different professions tend to develop their own way of conducting supervision based on their therapeutic approach, and different specialties within Occupational Therapy, in my experience, have equally divergent approaches.

Models

On reviewing available literature, there is a range of models devised to guide the supervisory focus. These also stem from different professional spheres but provide a useful means of conceptualising and guiding supervision. These include developmental models, functional models, systemic models, process models and ‘key issues’ models.

Using a model has advantages, though each specific approach has its own pros and cons

Challenges in supervision

Within the literature, staff report supervision is a poor use of time, it does not meet their needs, or they expect something other than what is provided (e.g. Sweeney et al 2001, Morley 2008). I frequently come across the dichotomy of receiving both managerial supervision and clinical/professional supervision from the same person. This can be problematic when it limits the supervisee’s capacity for being open for fear of managerial consequences, being viewed as incompetent or other related fears. However, the small pool of supervisors available in a workplace or nearby can make this an inevitable position.

Similarly, supervisors report feeling ill-equipped to provide supervision, having only personal experience to guide their practice – that may not have been a positive of beneficial experience. My knowledge stems from being a supervisee and what I find helpful. My clinical experience has made me practiced in formulating the difficulties a supervisee may encounter and informs the approach I take supporting development. That said, not every supervisee values and responds to the same approach, requiring a great degree of adaptation when faced with supervisees with very different supervisory needs.

Reflection points

So for #otalk have a think about your own experiences as both supervisee and supervisor… the following may be a good place to start…

What is the point of supervision?
What do you consider ‘good’ and ‘bad’ supervision and why?
What approach to supervision do you take and why?
How can you get the most out of supervision?

References / Biblography

BERNARD and GOODYEAR, 1992

DREYFUS, H.,L. and DREYFUS, S.,E., 1986. Mind over Machine: the power of Human Intuition and Expertise in the era of the computer. Free Press
EDWARDS, D., and BURNARD, P., 2003. A Systematic Review of the Effects of Stress and Coping Strategies used by Occupational Therapists Working in Mental Health Settings. The British Journal of Occupational Therapy, 66(8), pp. 345-355.
GOLDHAMMER et al, 1993.

HOLLOWAY, E., 1997. Structures for the analysis of teaching and supervision. In: Watkins C.,E., 1997. Handbook of Psychotherapy Supervision. John Wiley and sons Ltd.

HAWKINS, ., and SHOHET,

MORLEY, M., RUGG, S. and DREW, J., 2007. Before Preceptorship: New Occupational Therapists’ Expectations of Practice and Experience of Supervision. The British Journal of Occupational Therapy, 70(6), pp. 243-253.

PROCTOR, B. 1994. Supervision – competence, confidence, accountability. British Journal of guidance and counselling, 22(3)

ROBERTSON, C. and FINLAY, L., 2007. Making a Difference, Teamwork and Coping: the Meaning of Practice in Acute Physical Settings. The British Journal of Occupational Therapy, 70(2), pp. 73-80.

STOLTENBERG, C.,D. and MCNEILL, B.,W. 1997. Supervision from a developmental perspective: Research and Practice. In Watkins C.,E. 1997. Handbook of Psychotherapy Supervision. John Wiley and sons Ltd.

STOLTENBERG, C.,D. and DELWORTH, M. 1987. Supervising Counsellors and Therapists, San Fransisco: Jossy -Bass

SWEENEY, G., WEBLEY, P. and TREACHER, A., 2001. Supervision in Occupational Therapy. Part 3: Accommodating the Supervisor and the Supervisee. The British Journal of Occupational Therapy, 64(9), pp. 426-431.

#OTalk – 23 Sep 2014 – #OTalk – End of Life Care: What should Occupational Therapists be Concerned with?

In preparation for this week’s #OTalk Kim Stuart @KimStuartOT would like us to think about our role in end of life care.

Dying matters – the role of the occupational therapy in end of life care

I would like to start by asking you some questions :

…..”What defines you?” “What is that you see when you look in the mirror?”

Photographer Tom Hussey photo series captures Reflections of Young and Old http://www.lifebuzz.com/reflections/#!PkaTW and is a poignant reminder that occupation matters and is a constant thread through life as you approach death.

So if as occupational therapists we believe that occupations are the fabric of life (Hammell 2008, Wilcock 1998) then should it follow that they are also the fabric of death and of equal concern for those approaching end of life and our profession.

End of life is an inclusive term that encompasses a range of dying trajectories and can be considered from a medical perspective as the symptoms or impairments resulting from the underlying irreversible disease that require formal or informal care and can lead to death (National Institute of Health 2004).

In the UK between 2012 and 2030 the annual number of deaths is predicted to increase by 17%.People are dying at an older age with increasingly complex health and social care needs and indications are that there is little or no increase in public spending in the provision of care; therefore innovation and flexible solutions to delivering and meeting the public’s expectation of high quality care that addresses their needs is a priority. How can occupational therapy be part of this delivery of care and what should the focus of our services be?

The knowledge that you have made the transition to end of life can have a profound effect on a person’s self worth, expression, identity and occupational life (Unruh and Elvin 2004). In writing about her experiences of living with cancer Diana Rabinovitch’s Take off your Party Dress catalogues the impact of diagnosis, treatment and care on her life “I want my life back….They say it’s an intrusive disease, but they don’t explain that part of the intrusion is because of the nonstop medical appointments, the incessant disruption of my hard worn routines” As l read her autobiography it reminded me of many conversations I had in practice working with people approaching death; seeing the impact of occupational losses compounding and worsening life before death.

In a moving article discussing personal loss Forhan (2010) using the work of Hoppes (2005b) gives a personal insight into occupational transitions of loss and bereavement. There are 4 phases of occupational transition explored

Occupational maintenance where by occupation is maintained whilst the gravity of the loss is denied
Occupational dissolution whereby everyday occupations become devalued and may lose meaning
Occupational ambivalence where participation in occupation is part of a routine but lacks emotion/meaning or connection to the occupational form
Occupational restoration and adaptation is concerned with re-engagement in living; integration of loss into new/existing occupations to celebrate and achieve a cohesion with “new” self.

So I ask you reflect on working with patients past or present who may have been approaching death, whether living with a chronic illness, elderly or acutely unwell or perhaps working with someone who has been bereaved and consider how this impacted on their occupation and what you did to address it.

All too often I have seen these groups of people overlooked by occupational therapy when so much can be done to enable people to live the fabric of their life.

The questions for the chat will be around

What experience of working with people who are either approaching end of life or bereaved have you had?
What do you think the current role of occupational therapy is in working with these groups of people?
What are the challenges and opportunities for occupational therapy to engage with this group of people?
What do you need to be able to do this?

Click for time zone conversions for the chat.

References

Hoppes, S. (2005b). When a child dies the world should stop spinning: An autoethnography exploring the impact of family loss on occupation. American Journal of Occupational Therapy, 59(1), 78–87.

Forhans, M. (2010) Doing, Being and Becoming: A Family’s Journey Through Perinatal Loss American Journal of Occupational Therapy, January/February 2010, Vol. 64, 142-151. doi:10.5014/ajot.64.1.142

Unruh A and Elvin C (2004) In the eye of the Dragon: women’s experiences of breast cancer and the occupation of Dragon Boat racing. Canadian Journal of Occupational Therapy 71 (3) pp 138-149

Post chat update.
The online transcript can be found here: Healthcare Hashtag.
PDF Transcript: #OTalk 23 Sept 2014

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#OTalk Journal (Media) Club 7th October 2014.

As we have been running Journal (Media) Club for one year now we thought it was a good time to review how the community feel it has gone and get your thoughts and ideas on how to move forward into 2015.

Here is a link to all the topics so far:

October 2013 – September 2014.

Some ideas of things to think about as we review the last year…

Have you attended any Journal (Media) Club chats?
Do you access the posts on the blog?
What do you think of the format?
Monthly? (1st Tuesday of every month?)
Should we continue?
Have you used the articles or chat for your CPD?
What would you like to change?

We look forward to discussing this with you all and planning how we take Journal (Media) Club into 2015.

If you have thoughts and can not attend on the 7th October 2014, please comment below. We would like as many of the community to have input as possible.

Thank you.

The #OTalk Team.

Helen @Helen_OTUK, Clarissa @GeekyOT, Kirsty @kirstyes and Gillian @GillyGorry

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#OTalk – 16 September 2014 – The role of occupational therapy working with transgendered individuals

Thank you to Hannah Webster @otgeekHannah for volunteering to host this chat. Below is Hannah’s introduction to the topic. Looking forward to chatting with you all.

Rationale

The role of occupational therapy working with transgendered individuals – this was my business proposal for my final year of study (Bsc) and it has continued to be an area that fascinates me. I did not see this work as an assignment; I saw it as the future of occupational therapy.

Who is the service-user, what do they aim to achieve in life, what can’t they do now that they once loved, what do they believe in and what is important to them?

These are the questions we answer on a daily basis with our service-users as occupational therapists. We provided person and client-centredness and in doing so we create a therapeutic relationship whereby interventions can become successful.

However, as a profession, could we tackle the need of “I can’t cope being a man but I don’t know how to be a woman, can you help with that?”

This twitter chat aims to explore the role that occupational therapy could undergo assisting transgender individuals to live their life how they wish to.

Background

Identifying as transgendered or being diagnosed with a gender identity disorder has been known to result in occupational deprivation and conformity; gender identity is often stigmatised throughout particular occupations and activities of daily living. Prior to identifying or ‘coming out’ as trans, individuals often engage in gender ‘congruent’ occupations and activities in order to reinforce a particular gender and/or to demonstrate to their wider friendship groups / work colleagues / family members that they are ‘normal’ and ‘happy’. However, when the time comes to transition into the transgendered lifestyle, these gender congruent activities can be challenged.

Our gender and social roles play a tremendous part in our lives; the places we work, the clothes we wear, the fragrances we use, how we speak, how we walk and how we behave. But, if you were transitioning from a man into a woman, how would you start adjusting to this lifestyle, how would you express to work that you can no longer use the male toilets, or how would you explain to your son that daddy is no longer a man? –These are only a few areas that are affected by changing ones gender.

With this transition comes a great commitment; living in the desired gender for at least 2-years is essential to be legally known as the opposite sex, and gender reassignment / conforming surgeries are often seen as the answer to physical and emotional [gender-related] confusion and discomfort however have often been found to provide minimal relief and do not meet the expectations of the individual.

Each [trans] individual is unique and their needs can be complex, current healthcare provision for a trans person is as follows: (not necessarily in this order and not every trans-person will receive all provisions)

Psychotherapy
Speech therapy
Hormone therapy
Gender conforming surgery
- Removal of the biological gender identities – e.g. breasts and uterus
- Alterations of the physical body in order to meet the society or individuals’ ideology of the opposite sex – e.g. peck implants and cosmetic surgery
Genital reassignment surgery (full)

As you can read, the options for a trans-person, who has completed two or more years of committed living as the opposite sex, primarily surrounds physical alterations – which for some individuals will prove to be 100% effective, however there are others who may not wish to undergo surgery – what will they receive? Also, what support is available to individuals within those two years of committed living?

People identifying and living as trans are likely to experience discrimination, low self-confidence, social isolation, depression and anxiety, and occupational deprivation – surely this meets the criteria for occupational therapy?

Suggested themes of discussion

Social roles vs gender roles: We value people’s social roles (e.g. getting back to work so I can be the breadwinner once again) as a profession, had anyone considered the value of gender roles and how they can empower and diminish our confidence?
Working with trans-individuals to address their occupational deprivation
The occupational challenges faced by the trans community
What can our role be: gender role transitioning
1. Graded exposure of desired gender
2. Exploration of gender ideology
3. Presenting and living as the desired gender
4. Other: please contribute any ideas for discussion.

I hope everyone enjoys my Otalk on 16^th September 2014, anyone seeking references for this post can access them directly through me; this work is largely based on my ‘dissertation’ and I would appreciate acknowledgement and consent if this information is to be used externally from the Otalk community, blog and hashtag(#).

Many thanks

Hannah Webster, graduate Occupational Therapist and Reablement Officer for Mind

@otgeekHannah

Post chat updates:

Healthcare Hashtags Transcript.

PDF Transcript: #OTalk – 16 September 2014

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#MDTChat 10th September 2014 – World Suicide Prevention Day #wspd

Please note that this chat will be about suicide. If you need to talk to someone, follow this link to find a helpline in your country. The same website has information if you are concerned about someone else. The Samaritans website also has a range of information, including how to start a difficult conversation, or what to do if you’re concerned about a friend on Facebook.

There will be no #OTalk chat on Tuesday 9th September, as we will be joining other professions on Twitter on the 10th to support World Suicide Prevention Day (#wspd), part of a 24-hour tweetathon with Dr Alys Cole-King. We will be using the hashtag #MDTChat, and the chat will run from 8-9pm BST (click here for your local time).

Here’s an excerpt from the pre-chat blog post, which can be found on the PhysioTalk website:

Healthcare professionals and suicide prevention

Suicide is complex with psychological, social, biological, cultural and environmental factors involved (IASP, 2014). For example, physiotherapists and occupational therapists commonly work with people who experience suicidal ideation, which can be associated with physical as well as mental illness. This can include physically disabling or painful illnesses including chronic pain, significant sports injuries, traumatic brain injury, and spinal cord injury. Treatment sessions with patients can provide an invaluable opportunity to notice distress, ask questions and respond appropriately – potentially saving a life.

During this chat we want to think about the some of the situations where we might come into professional and personal contact with someone who is thinking about suicide, what you can do to help, and sources of support to help you do this.

Connectedness can also be understood in terms of clinical care and we’d like to explore how connectedness between AHPs, nurses, primary care and other local health and social care services can help people who are in distress, and what we can do to improve communication and collaboration at a local level.

“Every encounter with a suicidal person is an opportunity to intervene to reduce their distress and, potentially, to save a life” Dr Alys Cole-King.

Sophie (@sophalexanderOT), an occupational therapist working in a crisis resolution and home treatment team, has written a reflection about her role in preparation for the chat as she can’t be there on the night:

Occupational Therapists working with people who have suicidal ideation

My first post as an Occupational Therapist after graduating was in a Crisis Resolution and Home Treatment team and shortly after starting I realised how many people were experiencing thoughts of suicide and how many of my caseload wanted to end their lives. The mental health foundation identified that around 4,400 people end their own lives in England each year, and at least ten times that number attempt suicide.

After working within Crisis Resolution and Home Treatment (CRHT) for 10 months I completed a course relating to assessing suicide risk in adults, and this confirmed to me the importance of my role, of Occupational Therapists, within theCRHT setting. During the course we explored factors that can increase suicide risk which included social isolation, role change, and hopelessness, unable to identify/utilise coping skills, and physical health and/or mental health difficulties. These factors are areas that Occupational Therapists can offer support in and it made me question why Occupational Therapists aren’t always present in Crisis Resolution and Home Treatment teams. Whilst working within the team I have identified that initially whilst people are in mental health crisis, they are not always able to engage with Occupational Therapy, but that the period afterwards whilst supported by Home Treatment service, Occupational Therapist’s can explore with people the factors that caused/ increased thoughts of suicide, exploring with them their social networks, their roles and helping them to identify a reason for living, something that is meaningful to themselves.

I believe that whilst all members of the multi-disciplinary team (MDT) offer full assessment and support relating to suicide prevention, I feel that Occupational Therapists can offer a different view and specialism to the team and the approach to suicide prevention.

People I support at work are in mental health crisis, and that doesn’t mean that they all have suicidal ideation, and often our work in CRHT involves supporting people before they experience suicidal thoughts. This includes looking at ways to manage their mental health deterioration, and also using occupation as a form of time out from mental distress, and also as a meaningful distraction to aid recovery.

Unfortunately I am at work whilst the OT talk is taking place, although I will try to catch the end of it and chip in where I can. Feel free to contact me if you have any questions about my post.

EDIT: Unfortunately, I was unable to attend this chat as I was at work, but I’ve seen it described as “thought provoking”. The Numbers indicate a well-attended and wide-reaching chat, with 84 participants and 1,051,921 impressions. Check out the PhysioTalk Blog for analytics and transcript. Thank you to everyone who participated!

An #OTalk CPD template is available for documenting your engagement with the chat.

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