#COT2017 S5: Unlocking potential: occupational case formulation in a prison setting

The popularity and interest in this session was immediately apparent, arriving almost 30 minutes early there were already quite a few people in the room. Quickly a workshop that originally planned for 25 attendees was bumped up to 40 and in the end almost 100 people attended.

The session aimed to demonstrate how the introduction of case formulations had benefitted an occupational therapy service based in a Scottish prison. The session highlight the many barriers faced by professionals working in both prison and forensic settings. In particular the difficulty of setting goals and providing opportunities in a service that is focused on ‘control, security and containment’.

The introduction and exploration of the process of case formulation and the theory behind it was extremely beneficial. Occupational identity and occupational competence were explained in the context of case formulation. Although many of us will be aware of MOHO we are often used to associating it with concepts such as ‘volition, habituation etc.’ Exploring the use of MOHO through the use of occupational identity and competence provided a new perspective that will be beneficial to my practice.

One of the benefits of case formulation is that unlike many other assessments that may create a score or fit an individual into a box, case formulation allows the therapist to create a narrative about the individual. This not only makes it easy for non-occupational therapy staff to read but it also makes it accessible for the client/service user themselves.

Although it would be hard to outline everything I learnt from this session I’ve comprised a number of ‘top tips’ that might be helpful for anyone interested in case formulation:

  1. The introduction should be ‘quick’ and easy to read. It should provide information regarding; name, age gender, brief history of health conditions, forensic/offending history, reason for referral and occupational assessment completed.
  2. Using references for assessments demonstrates that you know what you are talking about and adds authority
  3. Use man/woman not male/female
  4. It’s ok to use the term ‘feel’ e.g. Joe Bloggs feels that they struggle with attention and concentration
  5. Break up the sections as it helps to identify themes
  6. Make sure that you know how an individual feels about the themes and don’t make assumptions.
  7. Keep occupational identity and occupational competence separate – whilst it’s easy when writing to switch between the two it makes it harder to follow.
  8. Use everyday language
  9. Make sure to include the positives
  10. Have a maximum of 4 issues to be addressed – it is much better to have larger areas that need addressing that to have a lot of issues as it reduces the chances that you ‘won’t get round to it’
  11. A summary statement that should consist of 3 lines – this is your brief commentary on what going on with your client.

My final thought for this session was in regards to something said by Sue Parkinson said during the session; that it can be difficult for those of us who work in mental health to identify how long it will take a client/service user to be able to do something. And that just because someone has not done something for many years does not mean that they can’t do it. In addition she highlighted that we must remember and that I’ll end this entry with: that

many people can do wonderful things but sometimes that environment doesn’t support them”.

By Ailsa Mulligan (@Ailsa_Claire)


#COT2017 S38: Spirituality embedded into acute adult health occupational therapy

IMG_0446Spirituality: the hole in holism?

‘I just thought you did rails and commodes’ said a nurse to an Occupational Therapist participating in Jones’s study ‘Spirituality embedded into acute adult practice.’

Another participant stated that observing spirituality in their practice would be ‘trying to find a needle in a haystack.’ Jones challenged that omitting spirituality creates a hole in our holistic practice, often caused by lack of a clear definition and increased pressures in acute settings.

Spirituality, once a term reserved for religious faiths, is now broadened to include bringing hope, meaning, and purpose to patients. As Occupational Therapists, we aim to treat them as unique spiritual beings, looking at their meaning and purpose, while addressing their well-being, suffering, and quality of life through occupation.

Through observing and interviewing two Occupational Therapists, spirituality was found in acute care through:

  • Valuing the individual

Spirituality was observed in how the participants carried out person-centred care, their communication with patients by delivering information with sensitivity, keeping the individual in the decision-making process, and considering the occupations that are meaningful to each client.

  • Supporting patients to maintain health and well-being

This is achieved through continual exploration of where clients find hope, for example, Jones mentioned a service user not engaging in therapy until knitting was suggested.

  • Recognising spirituality as a dimension of holistic practice

Spirituality as part of our holistic practice meant conversations facilitated hope and open ended narrative assessments teased out patients’ values.

  • Personal and Professional influences: core values – essence of being an OT.

To the participants’ reassurance and to today audience’s relief spiritually is found in acute care due to the essence of our profession, helping people find meaningful activity in their lives, taking into account their beliefs and values.

As a student just finished my first placement, I found this useful to not over-complicate using spirituality in practice. We can continue to seek what is meaningful in each client’s life.

Janice Jones London Southbank University (Twitter handle: @JaniceJ6873404)

Blog Squad writer: Orla Hughes (Twitter handle: @orlatheot)


#COT2017 S35: RCOT insights. Media Relations for Occupational Therapists

20170619_163148In my former life I worked in Arts Press, so it was natural for me to want to attend this session and start to think about how I could use my skills from my first career to better support my new adventure as an Occupational Therapist.

The session began with an introduction from RCOT’s Head of Media Relations, Andrew Sharratt. He talked about what the RCOT have been doing over the past year since last year’s conference message to “be loud and proud”, and the current drive to increase the number of people telling the story of the profession.

Getting involved in coverage of everything from Brexit to winter pressures, the RCOT media team have certainly been busy. There was mention of an upcoming campaign, ‘Living, Not Existing’, which will talk about Social Care and Occupational Therapy and come complete with a toolkit to help Occupational Therapists tell their story to the press. This follows the ongoing work the Improving Lives, Saving Money campaign has been doing since it was launched in 2015. Andrew’s introduction ended with an important point; media relations is not just PR and spin doctoring, it’s a way to help commissioners and service leaders understand what Occupational Therapists are about and promote the important work we do every day.

Next to speak was Madeleine Pinkham, Media Relations Officer for NHS Improvement. Madeleine started by asking how many people knew their Communications Team – a question that made me consider my own lack of engagement at the Trust I work for – and outlined the role of a press officer. Their role includes managing the public’s expectations, sharing the work that we do with patients and the wider community, and a whole host of things such as events, web presence and more. What I took most from Madeleine’s section was the need for Occupational Therapists employed in health and social care to engage with their communications team. If we want to get the word out there about Occupational Therapy we need to tell them because, in Madeleine’s words, “without the work you do, an NHS press officer has nothing to talk about”. She urged us all to invite our communications teams to come and see what we do in frontline services, even suggesting we “spam them” at every given opportunity.

Madeleine also made reference to the new series of BBC2’s Hospital, due to start on Tuesday 20th June 2017. She acknowledged that they had “missed a trick” with the first series, which did not capture enough of the work done by therapies staff. Apparently this has been addressed in series two so I look forward to seeing the results, especially as figures quoted state that the first series had 2.5 million viewers per episode so the potential for more people across the UK to see what Occupational Therapy has to offer is huge.

Finally came David Brindle, Public Services Editor for The Guardian who started by saying that blogging and vlogging were the new face of journalism and that it was online that most young people are now consuming their media. The overarching message here was that although online media is a growing area, print media does still seem to have a more esteemed position in the mass mindset so should not be neglected. He called for frontline staff to consider interaction with the media because it is “the voice of the professional and voice of the service user that bring a piece to life”. Communications teams can help manage these interactions, and advise on the most appropriate media outlets to take a story to.

Given that it was acknowledged that online media is on the rise, and traditional media in steep decline it did feel strange to not have anyone there to discuss engagement with the ‘new media’ world. However, in questions Andrew did say they had decided this was a subject in its own right, so I hope to see this addressed at future conferences.

This session followed on beautifully from the central message of the Casson Memorial Lecture, to ‘Publish! Publish! Publish!’, and reaffirmed my belief that this should not just mean publishing research. As Occupational Therapists we need to consider how we engage the public and people in positions of power to ensure they understand what we do and how it can help drive ongoing improvement in health and social care. A fitting to end to an inspiring day!

By Ayla Greenwood, @AylaOT


#COT2017 S25: Transforming healthcare for homeless people: the value of occupational therapy

So here it is, my first blog from #COT2017 and what a start it has been – frenetic, energetic and inspiring. And the latter can certainly be applied to this session, which concentrated on the work of three OTs in non-traditional roles within a traditional setting.

Sophie Koehne, Dan Lescure and John Sapani all work for KHP Pathway Homeless Team in London. Sophie and Dan are based at South London and Maudsley NHS Foundation Trust (SLaM for short) – in an inpatient mental health setting – while John is based in an MDT at Guys and St Thomas’ Hospital.

Having worked in a local authority homelessness team in a previous life, I was aware of some of the issues, and was intrigued by the opportunities for occupational therapy.

The trio began by setting the context of homelessness, which covers more than rough sleeping. It can take the form of temporary accommodation, squatting, ‘sofa surfing’, among other scenarios, and can be caused by many factors. The presenters referenced the recent tragedy at Grenfell Tower, which has left many people in a vulnerable situation with housing.

Homelessness is more than not having a stable roof over your head: there are legal and social implications; it can be isolating and destructive. Not only that, but in the past 5-10 years, homelessness has become seen as a health issue. The presenters outlined some eye-opening statistics: the average life expectancy of a homeless man is 47, while for women it is 43, compared with 77 and 82 respectively for the general population.

Mental health problems are prevalent in this population, although undiagnosed in many. In fact, delayed treatment and diagnosis of many health issues is common within those who are homeless. This is not helped by a lack of access to services, such as registration with a GP. Homeless people are more likely to access healthcare via A&E and be admitted to hospital. And, without proper planning and coordination for discharge, health issues may not be recognised or tackled. Health issues common in homeless people include early ageing and trimorbidity (mental health, physical health and substance misuse).

So, the aim of the team from their respective bases is to improve health outcomes and safe discharge by targeting frequent attendees to hospital. This is achieved through advice, recognising health needs, advocacy, and encouraging reintegration into society. Of course, challenges were identified with working with such a transient population: a lack of identity documents, financial insecurity, a lack of recourse to public funds, and discharge (frequently self-discharge) before housing support can be investigated.

But why OT? The practitioners explained that their dual training was a clear benefit when working with homeless people, because of the potential impact of their living situation on both their physical and mental health. Occupational therapy skills came into play, particularly in the ability to see the impact of a change in environment. While the medical team were looking at straightforward discharge planning, the team were thinking more widely about how the person may have to cope on the street, or in alternative accommodation. They were also experienced in working in a multiagency and multidisciplinary environment.

The presenters talked about their transitional work, supporting people before and after discharge, with the aim of reducing readmission.

A recent service evaluation by a health economist has shown value in their work: reducing length of stay by 24%, reducing readmission (although not across all sites – the presenters noted that in some places they had been so helpful, people had returned for more support!). Two case studies illustrated how the service had supported people through holistic assessments, setting goals and support through discharge.

If there was one take away for me, it was learning on the value of therapeutic use of self. The key with this client group is to establish rapport. People are being given opportunities to engage in occupations that they haven’t been able to without stable accommodation: cooking a meal, watching TV, getting a good night’s sleep.

But their work doesn’t stop there. Future plans include in-reach to hostels and working with OTs there, exploring experts by experience – homeless people who have turned their lives around – and expanding a network of OTs working in similar settings. If you’re interested – I am sure they would be keen for you to get in touch.


Bev Goodman
1st year prereg MSc student at the University of Essex


Department of Health (2010) Healthcare for Single Homeless People. Online at https://www.housinglin.org.uk/_assets/Resources/Housing/Support_materials/Other_reports_and_guidance/Healthcare_for_single_homeless_people.pdf [Accessed 19 Jun 17]

Crisis (2014) Turned Away: The treatment of single homeless people by local authority homelessness services in England. Online at: https://crisis.org.uk/media/20496/turned_away2014.pdf [Accessed 19 Jun 17]



#COT2017 S28 Older People

Two knowledge speakers presented their research projects relating to occupation for older people.

20170619_143402First up, Corinne Hutt “The lived experience of engagement in occupations by older people”.  A fascinating exploration of the role of occupation for those experiencing bereavement. Very much an under researched area but an issue facing many of our service users. Corinne spoke sensitively and insightfully about her research findings, that grief led her participants to “retreat to the familiar”, “take stock” and then “take themselves forward”. It was fascinating to consider the role of occupation within this, in particular applying the “continuing bonds” model (Klass, 1996). Corinne highlighted that people who go through an expected bereavement need to revise their occupational repertoire and how this takes time.

What resonated for me was Corinne’s notion of death changing relationships with the deceased, not ending them and that is my personal view too. Also the need for the bereaved to talk to people in their day to day life, so often the bereaved can be excluded due to the awkwardness of others, surely it’s time this stopped. Death and loss often remain taboos in British culture, but such common experiences need to be discussed and no-one should be excluded due to a bereavement.

Corinne talked about applying her work to other areas of loss and different types of bereavement, I think that would be great. For occupational therapists to lead the way in thinking about the role of occupation in bereavement as a healing factor, would be great. In discussing this talk with my colleague @natlouj we felt occupational therapists would have a lot to offer the recently bereaved in primary care services to prevent occupational revision becoming occupational deprivation.

20170619_144526Next up, Sam Whiting “Social groups – exploring occupational engagement in men”.  Sam focussed her research on the impact of ageing on participation in occupation in men, very much an under researched population in comparison to older women. Sam’s focus groups led to her findings that  for men, social groups related to “the four walls – combatting loneliness and social isolation”, “social interactions – the importance of camaraderie”, “reminiscence and the yesteryears” and “productivity”. Sam described how older men face so many barriers to occupational engagement, including shyness from joining groups but that they reported occupation as a powerful way to combat loneliness.

By Laura Di Bona @SheffOTCA