#COT2017

#COT2017. S74 The value and meaning of a drop-in centre for asylum seekers and refugees

IMG_0475Asylum seekers and refugees face significant occupational deprivation and barriers to integration, access to healthcare, a stressful lack of clarity around their status, poor housing conditions, prohibitions on work and restrictions on how they can spend their small allowances.

 

The team at York St John University wanted to explore the value and meaning of aIMG_0472 drop-in service in Stockton, which offers social and emotional support to asylum seekers and refugees, and to explore the occupational preferences of service users.

Final year students at York St John are offered opportunities for involvement in real-world research. Ten students were involved in this project, and the presenters highlighted the diversity of their research team as one of the project’s strengths. The students also undertook cultural awareness training ahead the project, which was crucial to aid understanding of how people tick in their own environment.

On an initial visit to the centre, the team found a hectic, chaotic, crowded, but fundamentally joyful, multicultural environment, which offered services including a clothing and food bank, English classes, sewing machines to adapt clothing, opportunities for social interaction, hairdressing, crafts and volunteering. This initial visit was an informal opportunity to establish rapport. A gatekeeper then took the task of selecting people to take part, who had free choice on participation.

Two team members travelled up each week to interview two participants: a format deliberately chosen to avoid replicating the feel of a Home Office interview. Two of the researchers could conduct interviews in Urdu: removing the language barrier and need for a translator.

The interviews resulted in hours of rich recorded content from 7 women and 11 men, ranging in age from 31 to 60. The strongest theme to emerge was the sense of community and integration. The need for meaningful occupation also arose: opportunities at the drop-in centre were highly valued. Another key theme was altruism – the research highlighted how people in vulnerable situations themselves were driven to help others after receiving assistance.

One of the surprising insights was the impact of the taxi drivers who transported people from the Home Office centres to the drop-in, who had been a font of knowledge for many of the interviewees.

Those being interviewed also identified areas they wanted to develop, such as better support for women with children. They were not asking for help, but wanting to progress their own community, make a contribution and have productive activities on offer.

Future plans include further research with a focus on support for women and children. This will be achieved with the involvement of an advisory panel of women from the drop-in, to identify occupations that might be beneficial, and to run them.

The presenters highlighted the relevance of the Kawa model for working with this population. The model was specifically designed to consider the needs of those from collectivist cultures.

Key for me, was the researchers’ overriding focus on a philosophy of research ‘with’, not ‘on’ people, and their desire to coin the term ‘compassionate research’, where research is carried out in collaboration with participants, for their benefit.

Written by Beverley Goodman
1st year pre-reg MSc student at the University of Essex
@BevG_studentOT

#COT2017

#COT2017 S72: RCOT Insights – Working in prisons-how occupational therapy can have the biggest impact

This session was used for people to give feedback and ideas about a new document, which is due out in September about Occupational Therapy in prisons. This is as part of the RCOTs campaign ‘improving lives, saving money’.

The session was used to show some of the draft copies of the document and Karin Roman, Professional Practice Manager RCOT, gave a brief overview of the point of the report and the recommendations included in it, as well as the rationale behind the recommendations.

It is due to be a short document that currently has 2 recommendations on it so far. Karin spoke about the importance of speaking the language of the commissioners and writing in the language of commissioners, which is partly why the document is being kept short – to help us get a foot in the door, which we can then use to explain our role in prisons further.

We can have a diverse role in prisons. One recommendation which I found really interesting was the suggestion that we, as occupational therapists, could be involved right from the beginning, in the design of current and future prison estates, to help minimise potential environmental risk. This appealed to me as a new and innovative idea and an emerging area in occupational therapy practice.

Karin then passed over to Lisa Jamieson, an occupational therapist working currently in a prison. Lisa then spoke about her work life in HMS Grampian. There are 15 prisons in Scotland and only 2 occupational therapists currently working in them, so it is still a very new and emerging service for Scotland.

Lisa argued that she is not a mental health occupational therapist, as she was employed to be, but is in fact a ‘prison occupational therapist’ whereby, in a non-traditional setting, she is able to use her full scope of core therapist skills.

Lisa takes an occupational approach in engaging her service users, which allows her to access the co-morbidities that other health services have been unable to unearth. She currently uses MOHO as her model of practice, and some of the assessments spanning from this. Lisa spoke about how she feels proud that she is delivering a service which is so valued that often she is being used in a consultant role, to give her ideas and advice about other services. She also revealed her figures over the year. Attendance to her service is around 88% and she spoke about how 100% of service users felt that the occupational therapy service was excellent or very good. Lisa also shared a quote which was said about her service, which I think we could use in all aspects of occupational therapy: “Occupational therapy is so far outside the box, you can’t even see the box, and that works here”.

After Lisa had shared her insights, there was a small time for discussion. Karin asked if there was anybody in the room currently working in the prison setting, and although there was a small contingent, the majority of the people in the room were like me, completely new to this area. We therefore discussed if we felt the recommendations made sense and would be clear enough for others who are not working in the field.

Overall, it was another fantastic and informative session and I am looking forward to the new document being released in September, showing the value of OT in prison settings.

Written by Katie Gabriel

#COT2017

#COT2017 S31 – On your bike

As someone who prefers life on two wheels, and whose husband is verging on MAMIL status (if you’re not sure, I’ll leave you to Google), I could not help but be drawn to this session. OT + cycling = a dream combo for me.

Michael Feignton of Devon Partnership NHS Trust opened the session by presenting his research on the value of cycling, and was rightly pleased to point out that he’d recently met the call to action from Diane Cox’s Casson lecture: to ‘publish, publish, publish’!

Michael’s opening message was that, despite being within the domain of occupation, physical activities have often been overlooked as a concern of occupational therapy. In fact, one audience member noted how a fellow professional had described this as a concern for physios alone.

Michael’s literature review had found much research into exercise, but little about sustaining engagement. Michael reported a lack of exploration into the meaning of physical activity, and identified a need for more evidence around adherence. Sustaining engagement is a universal theme in OT, and is particularly pertinent to physical activity, where it is common to sign up then give up: Michael referenced the tendency to sign up to a January gym membership, only to never attend.

Michael referred to five themes in the occupational science literature relating to the meaning of occupations: connecting with others; enjoyment; developing physical and mental wellbeing; achieving goals; providing structure and routines.

Seven people, all keen and regular cyclists, were recruited to Michael’s qualitative study, with the requirement that they were reflective in nature: people who could access and verbalise their thoughts, and tolerate being with him throughout the interview (Michael’s words!).

From semi-structured interviews, Michael identified three key findings on the value of cycling to these individuals. These focused on the feelings and thoughts surrounding cycling (sheer joy, enjoyment, sensory, freedom and release, and getting healthy); the experiences of belonging and community; and the occupational identity of being a cyclist.

One of the male interviewees expressed that cycling with a friend provided a space to talk about deep and meaningful issues – which may not have otherwise surfaced.

Michael noted that even talking about their occupation had people buzzing – this had me wondering whether this is something unique to cycling, to physical activity, or whether this reflects passion for an occupation?

A key factor in the analysis was that sustained participation relied on participants having a repository of meanings for their chosen occupation. It must be about more than just fitness – and beyond ‘prescribing’ exercise – this is not enough to keep people engaged. Other aspects must be present, whether it is the sense of community and belonging an occupation brings, or its contribution to occupational identity. A valuable insight that paves the way for further research and exploration.

Next up were two facilitated posters. Janet Paske, a student at Sheffield Hallam University, presented: The occupation of cycling: an intervention for patients in rehabilitation and recovery? Janet highlighted how cycling can help to mitigate impairment, citing a person with facial disfigurement who was ‘freed’ by this form of transport, rather than being stared at by other passengers on the bus.

Janet highlighted how cycling can be socially inclusive, and discussed the range of bicycle options out there, such as hand cycle attachments for wheelchairs, trikes and electric bikes. Janet relayed her own experiences working with service users on one to one lessons, group rides, map reading and road sign identification, and referenced cycling charities and support.

Finally came Laura Dickson of NHS Lothian and her poster Promoting cycling and walking in the psychiatric rehabilitation setting, which charted the creation of a cycling programme with mental health inpatients. Laura cited the generally reduced physical health and life expectancy of people with mental health issues.

Laura called in a local organisation to support service users with fixing up bikes that had been left abandoned in the grounds of the Royal Edinburgh Hospital, where she is based. This gave participants a stake in the activity – being able to use what they had fixed – which, in turn, encouraged participation.

Laura referenced her insight into the risk assessment involved in a cycling programme: not only considering road safety, but also safe use of tools. But challenges aside, cycling sessions within the confines of the hospital grounds led to increased physical activity, confidence and skills, and provided a gentle form of exercise that did not mimic symptoms of anxiety, as a gym session might.

Written by Bev Goodman
1st year pre-reg MSc student at the University of Essex
@BevG_studentOT

#COT2017

#COT2017 S57 Elizabeth Casson Trust. Professional Leadership.

This was a fascinating and energising session led by the team from the Elizabeth Casson Trust which obviously touched a topic close to the heart of many at conference. This was evidenced by over 150 delegates in the room.

The session was introduced by Anne Lawson Porter, a Trustee of the Trust, who outlined the work the Trust is undertaking with regard to supporting the development of leadership capability within Occupational Therapy.

Anne provided an insight into how the focus of the Trust’s work has evolved recently to include an emphasis on not only furthering occupational therapists (a focus on the individual through its individual awards) but also on ‘furthering occupational therapy’ (the profession). The Trust has recently undertaken a review of its strategy and has published 3 clear strategic intentions the second of which is as follows:

HELP DEVELOP LEADERS IN OCCUPATIONAL THERAPY WITH THE CAPABILITY OF TAKING THE PROFESSION FORWARDS WITHIN THE CONTEXT IN WHICH IT NEEDS TO OPERATE
OBJECTIVES
  • Explore, develop and implement as appropriate partnerships between occupational therapists and relevant national organisations that promote leadership
  • Explore, develop and implement scholarships, fellowships and other formal learning opportunities to enhance and support leadership and professional growth across the profession

Anne went on introduce Caroline Waters who is working with the Trust on this strategic intention.  Phase one of the work involved talking with OTs from across the  profession about their leadership experiences and needs. Caroline talked for a short time on some of the challenges that were identified in this phase of the work. she also described some of the needs that were identified. These are summarised in the slide below.

 

IMG_0301

The second half of the workshop was spent exploring some of the Trusts current thinking about the work it can undertake in this area. This includes

  • The production of branded material about the value of OT
  • Specific work focused on building capability with a focus on skills
  • Providing support for the future – mentoring and coaching
  • Network building to overcome personal and geographical isolation
  • Creating hubs and spokes of leadership expertise

One of the challenges identified with regard to this work is how to create a model that is sustainable.

The second half of the session posed two questions central to taking this work forward into implementation:

  • How could phase 3 (implementation) be delivered to meet your professional leadership needs?
  • How could professional leadership be sustained over time?
    • would you be willing to invest in your professional leadership future by paying a fee?
    • what other suggestions can you propose?

Judging by the amount of discussion in the room there were lots of ideas about this. There was a long line of people at the microphone wanting to contribute their thinking which is always great to see.

This session is being written up and will be published in OTN and so if you are interested in this work and want to find out more keep an eye out for the article. It will also explain how you can become involved.  This is a really exciting piece of work relevant to every single one of us.

Written by @lynnegoodacre