#OTalk – 7th April 2015 – The Role of the Occupational Therapy Assistant.

Thanks to @ForensicDetail & @OTontheTracks for suggesting this weeks chat and offering to host the chat.

The chat will be at our usual time of 8pm UK click for different time zone conversions

The role of an occupational therapy assistant (OTA/TI/OTSW) is a varied one; impacted by the setting, client group and the individuals experience. COT states “Occupational therapy support workers (also known as occupational therapy assistants/rehabilitation assistants/technical instructors) assist registered occupational therapists in their day-to-day duties.”

OTAs undertake practical tasks to aid the OT in providing therapy to clients/patients but are not qualified in the theoretical knowledge (Alaszweski & Meltzer, 1979 cited in Creek 2007); Does this mean OTs need to oversee OTA as they do their role if they are to ensure the occupational therapy a client received is evidence based.

I (@OTontheTracks) worked as an OTA before starting my OT degree and have encountered OTA’s in various placement settings over my first year. Forensic Detail has recently had OTAs introduced to her team and is interested in how they are supported and their role developed.

We thought it would be interesting to host an #OTalk on the role of OTAs, as this would allow for a greater understanding of the varied role in different settings. To guide the discussion we have come up with some questions to consider:

1. What is the role of an occupational therapy assistant in your setting?

2. What are the pros and cons of standardising the job description of OTAs?

3. How are OTAs supported in their role in your settings?

4. Are OTAs used within your setting to support students on placement with you?

We are looking forward to the discussion on Tuesday. See you there between 8-9 pm.

References

Creek, Jennifer, and Anne Lawson-Porter, eds. Contemporary issues in occupational therapy: reasoning and reflection. John Wiley & Sons, 2007.

COT (2011) ‘Become an OT Support Worker.’ Accessed 27 January 2015. Available at: http://www.cot.co.uk/support-workers/become-ot-support-worker

Here are the resources to assist in using the chat for your CPD.

Post chat updates:

The Numbers

641,228 Impressions
335 Tweets
39 Participants

#OTalk Participants

Online transcript: Healthcare Social Media Transcript

PDF transcript: #OTalk – Healthcare Social Media Transcript 7 Apr 15

#OTalk – 31st March 2015 – Focus on Models: Vona du Toit Model of Creative Ability

Although it’s hard to pick favourites, the Focus on Models series is one I’ve enjoyed and have been looking forward to developing further. I’m very excited to announce that the next model we’ll be exploring is the Vona du Toit Model of Creative Ability.

I discovered this model during one of the SOTLS conferences, and liked it so much I paid to go on the training by Wendy Sherwood. My appetite wasn’t satiated, so I arranged to do my final placement at the Welland Centre. It was a fantastic experience, one which still influences my practice. Although the model can take some time to get your head around, it’s well worth the effort, and there’s a wealth of information on the VdT MoCA Foundation website.

So without further ado, here’s Alison (@amkane87), Sarah (@vdtmocaot) and Roshni’s (@KhatriRoshni) pre-chat blog post!

-Clarissa (@geekyOT)

VdT MoCA #OTalk Blog

The Vona du Toit Model of Creative Ability (VdTMoCA) is a developmental and recovery based model of occupational therapy practice that was developed in the late 1960’s in South Africa. It is based on the theories of motivation, action and normal development. Central to creative ability theory is the belief that human beings progress through developmental levels of behaviour and skill development and are motivated to develop these in a sequential manner. As Occupational Therapists, we know that in order to effectively treat someone, we need to understand their current level of occupational functioning. The model identifies that motivation governs all action, therefore in order to understand somebody’s developmental level of motivation, their actions need to be observed. The model describes specific occupational performance (actions) and corresponding levels of motivation to enable a therapist to identify an individual’s current level of functioning – their level of creative ability – and provides accompanying specific treatment principles to elicit growth to the next level of creative ability. Creative ability develops within four specific occupational performance areas which are social ability, personal management, use of free time and work ability.

The model is extensively used by South African OT’s and was introduced to the UK in 2004. Since then, Wendy Sherwood (OT and Educator) has been championing the model in order for it to have gained popularity, particularly in mental health and forensic services. Since 2012 Wendy has led the Vona du Toit Model of Creative Ability Foundation UK (VdTMoCAF) to support the community of OT practitioners interested in the use and evidence base of the model. One initiative of the VdTMoCA Foundation is the development of Centres of Excellence in the use of the model who share their practice with others. You can find out more about the model and the work of the foundation at www.vdtmocaf-uk.com

The Berrywood and Welland Adult Acute Mental Health Services at Northamptonshire Healthcare NHS Foundation Trust are the first centre of excellence in the model and have regular open days, welcoming OT staff who are interested in learning more about the model. The Tweet chat hosts are Alison Kane who is currently working as an Occupational Therapist at the Berrywood Hospital, Sarah Wilson who is the OT manager over these services and a VdTMoCAF director, and Roshni Khatri who is a lecturer at the University of Northampton and has used the VdTMoCA in Neuro and Paediatric areas of practice.

Common terms;

Creative Ability; one’s ability to change in response to life’s demands- the creation of oneself (Sherwood, MCAIG 2010).

Creative capacity; total creative potential in an individual.

Useful links;

VdTMoCAF website link

VdT MoCA Open Resource

Post-Chat Update

Thank you to everyone who joined in the chat.

The Numbers

888,751 Impressions
613 Tweets
46 Participants

Sarah has compiled a Storify about the chat which you can read at this link. You can also find the transcript at Healthcare Hashtags, or download the PDF.

Remember to document your participation in your CPD Portfolio. Check out our ‘OTalk and Your CPD‘ page for more info.

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#OTalk – 24 March 2015 – Outcome measures: if there could be only one

Please join us and Katrina Bannigan @KatrinaBannigan on the 24th March 2015 at 8pm UK.

Katrina has written an introduction to the chat on her blog here.

#OTalk Outcome measures…if there could be only one?

Just back from annual leave and remembered I have been given the opportunity to host #OTalk tomorrow to discuss outcome measures. This is not a general discussion about outcome measures but to consider outcome measures in the context of The IHC Plymouth Case Study Project* **.

The aim of The IHC Plymouth Case Study project (#IHCPlymCaseStudy) is to collect single case (n=1) studies using a common framework so that they can be pooled to create larger studies. The challenge is to find an outcome measure that every occupational therapist can realistically use so that the single cases are comparable. A review of measures suggests that the Goal Attainment Scaling-Light (GAS-Light), a simplified version of Goal Attainment Scaling (GAS) designed to be usable in routine clinical practice, is the best choice for this project. The rationale for this choice is:

– it is goal-orientated so it is compatible with occupational therapy practice whatever the field.

– it has been designed for use in clinical practice so it has greater utility than the GAS

– it is free to use.

– the scoring enable comparisons to be made between cases.

– it can be used easily in conjunction with other measures.

At recent conferences to discuss the common framework for collecting case studies the delegates agreed that the GAS-Light should be used when collecting data for The IHC Plymouth Case Study Project.

So I am interested in hearing your views on:

(a) What outcome measure do you think every occupational therapist who contributes to The IHC Plymouth Case Study Project should use so that the case studies collected are comparable?

(b) Does the GAS-Light, especially if the goals written have an occupation focus, seem like a workable option?

Please join #IHCPlymCaseStudy for the #OTalk tweetchat at 8.00-9.00pm 24th March 2015

References

GAS – Goal Attainment Scaling in Rehabilitation See http://www.kcl.ac.uk/lsm/research/divisions/cicelysaunders/resources/tools/gas.aspx

Notes

*You may have heard this called the N=1 study but I decided, after discussing it with Sam Shann (VP (Finance) WFOT), to change the project name to case study; its so that the project has greater international appeal.

**You may not have heard of the project at all. That is not surprising the project is in its infancy. This blog post is the first blog post. A Facebook page (https://www.facebook.com/TheIHCPlymouthCaseStudyResearchProject) has been set-up but at a recent conference it was highlighted that some people cannot use Facebook because of the firewall in their organisation. Information will be posted on this blog and Facebook to make information about the project available to the widest group of people.

http://katrinabannigan.typepad.com/blog/2015/03/otalk-outcome-measuresif-there-could-be-only-one.html

Post-Chat Update

Thank you to everyone who participated in this very busy chat.

The Numbers

1,010,504 Impressions
609 Tweets
73 Participants

You can read the transcript of the chat at this link or download the PDF. Remember that you can also evidence your participation for your CPD portfolio – check out our CPD resources page.

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Position Open – #OTalk Student Digital Leader Intern

#OTalk Student Digital Leader Intern (17/18) Position Open

#OTalk is a community that welcomes students alongside practitioners and academics, recognising the vital role students can play in bringing fresh knowledge, innovation and enthusiasm to the community.

To foster this collaboration, in 2015 #OTalk introduced the position of Student Digital Leader. This Intern role offers a student the opportunity to become involved in the running of #OTalk for 6-12 months whilst receiving mentoring in digital leadership from the team.

Being part of the #OTalk team allows you to be creative, innovate and work as part of team. As a Student Digital Leader Intern these are some of the activities you could be involved in and be responsible for during your internship:

OTalk Project.

As part of your internship we hope you would be able to contribute in an innovative way to the #OTalk community by undertaking some form of project. This will be agreed between yourself and the rest of the OTalk team after you join the team.

OTalk Blog – Transcript posting.

To support the team in posting blog transcripts on the blog posts within 48 hours of a chat and sharing this with the #OTalk community on the social media platforms.

OTalk Facebook.

To monitor the facebook page, replying to comments and ensuring blogs have been shared within other relevant pages and groups (e.g. 4OT groups and Student Occupational Therapy groups/pages)

OTalk Twitter – Promoting.

To regularly tweet from OTalk and personal accounts to promote the chats and other related activities.

OTalk Twitter – Follows.

To review follows on the OTalk Twitter account, block spam accounts and to follow back/create lists for the OTalk account.

OTalk Twitter – Hosting.

To host a minimum of one chat during the internship and to support an additional two chats with guest hosts (Training will be provided – more can be hosted as desired).

Promoting OTalk.

To take and create opportunities to promote #OTalk and the benefits of professional social media use within university populations and regional/geographical networks.

OTalk Experience Summary.

Along with the OTalk crew, write up an account of the experience of interning for publication. This can be done in a range of ways and we are open to finding new and creative ways to share this experience Our first intern Kelly did this by displaying a poster at #COT2016 and our second Kirstie wrote a piece with Kelly for OTNews.

OTalk Development.

Engagement in online team meetings to review chat effectiveness, suggest future development and feedback on the relevance of OTalk for students.

Interns ideally need to be:

Excellent communicators
Familiar with the use of twitter
Familiar with the use of gmail, google calendars and google drive
Familiar with the use of skype
Familiar with wordpress blog editing dashboard
Able to create PDFs of transcripts and certificates
Available on Tuesday nights between 8pm – 9pm at least once a month
Available for 30 minutes on Thursday or Fridays to post chat transcript
Able to access the Internet and have a laptop/smartphone that will enable blog editing and twitter/Facebook access.
Passionate about the occupational therapy profession
Promoters of the positive application of social networking for professional development
Responsible and professional in their use of social media (social media accounts of applicants will be reviewed as part of the application process)
Engaging with CPD on a regular basis

Training to use the relevant software will be provided so please still apply if you meet most of the outline above.

If you are interested in this position please send the following information to otalk.occhat@gmail.com:

A personal statement of no more than 500 words demonstrating your suitability for the internship.
A Biography of between 100-200 words (that includes your name and university, and a link to your LinkedIn profile) [Write this as if you are introducing yourself to the OTalk Community on the blog].
Your skype username.
The name and e-mail of a referee who can be contacted if you are invited to interview.

Please direct any queries to the our email or DM us on Twitter at @OTalk_

The closing date for applications is Tuesday 28th November at 23:59.

Shortlisted applicants will be invited to a skype interview in December and will be in post by January 2018.

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#OTalk – 17th March 2015 – Therapeutic Modes (Therapeutic Use of Self)

Last year, Bob Collins hosted an #OTalk called ‘Interpersonal Skills: Intangible or Teachable‘ (click the link to read more – opens in a new window). Building on this discussion, Hazel Clerkin (@hazelclerkin) will be hosting this week’s #OTalk about the therapeutic modes from Taylor’s Intentional Relationship Model. Hazel was the first person to introduce me to the model – something I now regularly use to reflect on my practice – so I’m pleased she’s agreed to host this chat.

– Clarissa (@geekyOT)

Therapeutic Use of Self

Taylor (2008, p.14) identifies the aim of therapeutic use of self (TUS) in practice is to facilitate the therapeutic relationship and in turn facilitate a clients occupational engagement, thus increasing therapy outcomes. Davison (2011) highlights that “the values concepts and skills required for therapeutic use of self are fundamental to entry level practice and should be taught in a student-centred, active manor”, however extensive education in TUS is not typical in most occupational therapy programmes (Bailey & Cohn, 2001; Ledet, Esparza & Peloquin, 2005; Peloquin & Davidson, 1993; Sands, 1995).

Taylor (2008) developed the Intentional Relationship Model to deliver TUS and how it can be utilized to promote occupational engagement and promote positive therapy outcomes. This model offers a set of concrete tools and interpersonal skills in TUS. “Therapeutic Modes” which are advocating, collaborating, empathising, encouraging, instructing, problem solving can be used by the occupational therapist to facilitate TUS. The modes should be adopted and vary, according to client characteristics, therapeutic responding and interpersonal reasoning. The modes promote the therapist’s ability to establish and maintain relationships with clients and manage possible difficult behaviour to achieve optimum therapy outcomes

Clarissa and I designed a role play workshop using six modes of TUS, advocating, encouraging, instructing, problem-solving, empathising and encouraging as outlined by (Taylor, 2008). We delivered the workshop to occupational therapy students, and assisted them to integrate each of the modes through a role play case study. The results of the workshop indicate that students perceived skill level in TUS increased after participating in the role play workshop.

It should be noted that this increase was statistically significant for problem solving, collaborating, instructing and advocating modes and not significant for empathising and encouraging modes. This study indicates a need for further research into effective deliverance of skills to occupational therapy students such as empathising and encouraging within the therapeutic relationship.

Therapeutic Modes (Taylor, 2008, page reference to follow)

Advocating Mode

Facilitate and consult
Ensure opportunities for participation and access
Legal rights, barriers, obstacles to independence
Approach interpersonal difficulties by adjusting and accommodating the needs of the client.

Collaborating Mode

Therapist to make decisions jointly with clients, involve clients in reasoning about therapy, and expect clients to participate actively in therapy.
Facilitate the clients active participation in therapy
Encourage the client to make more decisions in therapy
Inform the client they are responsible for the outcomes of therapy
Define the therapeutic relationship as a shared effort to explore and pilot test new goals or skills
Insist that the client provide direct and honest feedback about his or her experience in therapy
This mode works well with client who are excessively dependent, symptom focussing, resistant, denial, difficulty with rapport and trust.

Empathising Mode

Therapist to strive to understand the client’s interpersonal needs and perspectives as accurately as possible. Paying particular attention to client’s emotional experiences.
Articulate the clients need or perspective, so the client feels heard
Strive to understand the behaviour from the clients perspective
Validate the need of the client.
This mode works well with clients who are manipulative, excessively dependent, symptom focussing, resistant, and denial, difficulty with rapport and trust, hostility towards the therapist.

Encouraging Mode

Therapist to compliment, applaud, and cheer. Rejoice and celebrate when clients are successful.
Instils clients with hope, courage, will, participation and perform
Examine the extent to which a client values and are interested in a given activity.
Focus on selecting and altering activities to make them more appealing, pleasurable and attractive
Frequent use of positive reinforcement, positive feedback, humour, entertaining antics, cheering, coaxing, compliments, applause, motivational words.

Instructing Mode

Therapists to emphasise education in clients.
Label and define the negative behaviour for the client so they are aware of it and they are aware you are aware of it
Set a limit on the behaviour
Highlight the negative consequences of the behaviour for the therapeutic relationship and the outcome of therapy
Teach alternative more adaptive ways the client can get their needs met within the relationship.
This mode works well with emotional disengagement, passivity, isolative, difficulty with rapport and trust, hostility

Problem Solving Mode

Ask the client strategic questions
Discuss the advantages as well as the negative consequences of the clients behaviour
Negotiate with the client to find an alternative way of obtaining gratification of his or her needs.
This works well with resistance, emotional disengagement, isolation, passivity.

Questions

Q1. Have you come across the Intentional Relationship Model before? What are your thoughts on it? How might this theory be useful?

Q2. Thinking about the various therapeutic modes, are there any that you are more comfortable with? How do you think you developed skills in these modes?

Q3. Do you believe therapeutic use of self can be taught? How can we support students to develop skills/confidence in this area? What do you think of the idea of using role play?

References

Bailey, D.M. & Cohn, E. (2001) ’Understanding others: a course to learn interactive clinical reasoning’, Occupational Therapy in Health Care, 15, pp.31-46.

Davidson, D.A. (2011) ’Therapeutic use of self in academic education: a mixed methods study’ , Occupational Therapy in Mental Health, 27, pp.87-102.

Ledet, L., Esparza, C.K. & Peloquin, S.M. (2005)’The conceptualization, formative evaluation, and design of a process for student professional development’, American Journal of Occupational Therapy, 59, pp. 457-466.

Peloquin, S.M. & Davidson, D.A. (1993) ’Interpersonal skills for practice: an elective course’, American Journal of Occupational Therapy, 47 (3), pp.260-264.

Sands, M. (1995) ‘Readying occupational therapy assistant students for level II fieldwork : beyond academics to personal behaviours and attitudes’, American Journal of Occupational Therapy, 49 (2), pp.150-152.

Taylor, R.R. (2008). The Intentional relationship: occupational therapy and use of self. Philadelphia: F.A.Davis Company

Post chat updates:

The Numbers

1,242,362 Impressions
622 Tweets
56 Participants

#OTalk Participants

Healthcare Social Media Transcript (online).

PDF of Transcript. #OTalk – 17 Mar 2015

1 Comment Leave a comment

#OTalk – 10th March 2015 – OT in CFS/ME Rehab

The chat on the 10th March 2015 8pm GMT (click to check your local time) will be hosted by Ria Lonsdale @LonsdaleR. Ria has provided the follow as in introduction to the chat.

Looking forward to the chat.

Hello #OTalk Community!

I have put together some brief notes on Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) for those not too familiar with the condition so that as many people as possible can join in. For those already in the know you can skip to the Q’s.

A brief overview of CFS/ME

CFS/ME is a complex long term health condition, with multiple and varying symptoms. The condition has been observed in medicine for over a hundred years but has had several names and labels. The cause of CFS/ME has been widely debated over the years, with some historically believing it was a disorder of the mind. Although the exact cause of CFS/ME remains unclear, it is now formally recognised as a medical condition. Recent research suggests a likelihood of multiple causes of CFS/ME and potential for sub-types.

Symptoms

Unremitting fatigue Nausea Information processing deficit

Muscle/joint pain Malaise Digestive problems

Sleep disturbances Poor memory Concentration difficulties

Word finding difficulties Delayed recovery Headaches

Loss of balance Light/noise/smell sensitivities Dizziness

(not an exhaustive list)

Impact of CFS/ME

Limited ability to engage in Occupation

Loss of role, loss of employment/education, dependency, grief

Social isolation, avoidance

Anxiety, depression, other mental health difficulties

Discrimination, labelled, misunderstood, disbelieved

Treatment

There is presently no cure or medical treatment for CFS/ME. NICE Guidelines (2007) and findings from the PACE Trial (2011) recommend a rehabilitation approach utilising a combination of therapeutic interventions. This includes the principles of CBT, Graded Exercise and, Activity Management.

Occupational Therapists play a key role in the rehabilitation process.

Broadly the aim of therapy is to:

Acknowledge the individuals symptoms and the impact on their occupational performance and quality of life
Develop the individuals’ understanding of the condition
Support the individuals’ acceptance of the condition
Develop the individuals’ understanding of how their lifestyle choices and behaviours may perpetuate their symptoms
Support the individual to learn self-management techniques to stabilise symptoms
Support the individual to utilise the principles of grading to slowly increase activity tolerance and occupational performance
Facilitate the individuals development of a Personal Management Plan and Relapse Management Plan
Empower the individual to live life inspite of the condition

Questions:

Who has or is working with people with CFS/ME? What setting? What interventions have you been using?
For many the diagnosis of CFS/ME is a relief as they have spent many months/years being passed around different health professionals, or simply being dismissed. For many the diagnosis can be earth shattering, and it is not uncommon for individuals to continue to seek an alternative diagnosis, one that is perhaps better understood and/or treatable. How can OT’s support the acceptance process?
Individuals with CFS/ME can often fall into a “boom and bust” pattern of behaviour. This is characterised by over-exertion that leads to an exacerbation of symptoms and a delayed recovery. Continuing to exist in a “boom and bust” pattern will ultimately perpetuate symptoms and make it more difficult to manage the condition. What interventions can OT’s use to stabilise CFS/ME symptoms? Activity Management?
Once symptoms are more stable, the principles of grading can be used to slowly increase an individuals’ activity tolerance. How can OT’s support individuals to understand and use grading?
How do OT’s empower individuals to continue using self-management strategies into the future?

Helpful Resources:

NICE, (2007) Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: Diagnosis and Management of CFS/ME in Adults and Children, Manchester:NICE

White, P., Goldsmith, K., Johnson, A., Potts, L., Walwyn, R., DeCesare, J., Baber, H., Burgess, M., Clark, L., Cox, D., Bavinton, J., Angus, B., Murphy, G., Murphy, M., O’Dowd, H., Wilks, D., McCrone, P., Chalder, T., Sharpe, M., on behalf of the PACE trial management group, (2011) Comparison of Adaptive Pacing Therapy, Cognitive Behaviour Therapy, Graded Exercise Therapy, and Specialist Medical Care for Chronic Fatigue Syndrome (PACE): A Randomised Trial, Lancet, 377:9768:823-836

Taylor, R., O’Brien, J., Kielhofner, G., Lee, S., Katz, B., Mears, C. (2010) The Occupational and Quality of Life Consequences of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis in Young People, British Journal of Occupational Therapy, 73:11:524-530

Burley, L., Cox, D., Findley, L., (2007) Severe Chronic Fatigue Syndrome (CFS/ME): Recovery is Possible, British Journal Occupational Therapy, 70:8:339-344

Hughes, J., (2002) Illness Narrative and Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Review, British Journal Occupational Therapy, 65:1:9-14

Hughes, J., (2009) Chronic Fatigue Syndrome and Occupational Disruption in Primary Care: Is there a Role for Occupational Therapy?, British Journal of Occupational Therapy, 72:1:2-10

Pemberton, S., Berry, C., (2009) Fighting Fatigue: Managing the Symptoms of CFS/ME, Hammersmith Press Limited

Cox, D,. Cox, B.,(2000) Occupational Therapy and Chronic Fatigue Syndrome, John Wiley and Sons

www.actionforme.org.uk – Action for ME

www.meassociation.org.uk – ME Association

www.bacme.org – British Association for CFS/ME