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RCOT2018 Blog 18 #IAMchallengingbehaviour: We all have challenging behaviour, let’s challenge the labels in ‘serviceland’

Sam Sly (@SamSly2), the RCOT-people-with-learning-disabilities-specialist-section’s keynote speaker, shared about the social media campaign #IAmChallengingBehaviour.

Enough is enough, it’s time for change

The campaign starts the conversation that people with learning disabilities are being labelled as having ‘challenging behaviour’ unfairly, leading to extended time spent in hospitals and institutions. This can result in people being prevented from living life to their full potential.

Sam began by highlighting that we all display challenging behaviour in life’s tough times. The difference is that as ‘valuable’ members of society, instead it is said that we are angry, frustrated, or simply ‘having a bad day.’ Therefore, the campaign began as ‘I HAVE challenging behaviour’ but soon changed to ‘I AM challenging behaviour’ as this added action to the movement. It stated that it was time to stand against the unjust labels being put on people with learning disabilities when they express human emotions such as anxiety or fear.

Instead, Let’s talk in….

  1. …normal words:

Sam’s address called on us to consider our language in the realm she calls ‘serviceland.’ This is a term used for the health professionals and spaces that work with people with learning disabilities. Science jargon has replaced human words which can misrepresent and undervalue people with learning disabilities. For example, she discussed the use of the phrase ‘finding the client a placement’ which sounds like a temporary and uncertain place. Why don’t we help a person find a home instead?

  1. …human rights:

Today’s reality is that males and females living with a learning disability in the UK have a life expectancy 14 and 18 years less than the general population respectively. To put this in perspective, it is the life expectancy of developing countries for people living in one of the richest countries in the world.

The badges

5,000 badges with the campaign’s message have been distributed to date which has transported the conversation from social media to MDT meetings and local shops. Gold badges have also been awarded to people going above and beyond to challenge the language we use in practice and everyday life.

Back in the real world

I returned to my placement today and saw in my upcoming training that one module is titled ‘challenging behaviour.’ I’ll make sure to wear my badge loud and proud that day especially 😉

The next step

Make sure to join the campaign by tweeting/facebooking #IAMchallengingbehaviour and think about who you could nominate for a gold badge.

Written by Orla Hughes (@orlatheot)

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RCOT 2018 Blog 17. Sess.87 Education

The two papers presented in this session truly complimented each other, stimulated interesting questions, and resulted in a positive energy amongst delegates for future improvements.

87.1 What students think is best practice when teaching them clinical reasoning in practice education, by Caroline Hills. A study of 3rdand 4thyear Australian students using a qualitative descriptive method.

Caroline, who moved from Australia to Ireland has completed this for her PhD study. She gave a definition of clinical reasoning, then expressed that there is no consensus about the best way to teach it to OT students. The overarching aim was to do a mixed methodology study to investigate learning preferences of OT students whilst on their clinical placements, what was the best thing about being on placement ?. Out of this came an important subtheme of teaching clinical reasoning. Caroline suggested that clinicians are often in a rush to get to the end-point when explaining to students, and that this can result in a lack of deep learning. The semi-structured face to face, Skype and telephone interviews were analysed thematically.

Three main themes resulted.

  1. Talk it through: students wanted the educator to take the time to explain the point, break it down to their level and explain possible alternatives.
  2. How to develop my reasoning; encourage me to think and apply theory, ask me a question to check I have understood.
  3. Preferred teaching and learning approaches for clinical reasoning; make it two way, don’t put me on the spot and give me time to reflect.

The conclusions drawn were that clinical reasoning must be a two way process that this should be graded to aid learning, and that there is a need for a clinical reasoning template. Instead of concentrating on being process led, we will do an initial assessment, then functional assessment, instead it is arguably better to discuss the reasons why each step happens. Another key theme that was discovered, was that concept of belongingness; students value feeling that they belong whilst on placement. There is a lot of evidence within medicine and nursing about this, more is needed within OT.

87.2. Using Q-methodology to identify the factors influencing occupational therapy practice educators offering placements to undergraduate OT students, by Jenny Devers from University of Northampton

Jenny introduces this by saying that practice placements are essential within OT training programs. However, there are rising concerns about placement shortages so there is needs to be a call to find strategies and solutions. Jenny looked at the number of qualified OT’s in practice (38000) and considered the number of OT students (5,500 per year) so felt that really there shouldn’t be a problem, but yet there is, so she was keen to find out why.

A comprehensive literature search gave a range of positive rationale, including that students are energising and a positive influence, but yet there are many negative influences also. Ethics was gained and a range of sites deemed suitable, 16 eligible sites were secured and sent the pack to complete. Participants answered all the questions according to the scale, and they were asked to give comments for the questions that were answered at each end of the scale (most agreed / most disagreed). The data was then transferred back into the matrix. Analysis revealed 3 main themes; strong professional value, student impact and placement support. The recommendations were

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There was an interesting debate in the room with considerations for future improvements, with a key theme of universities and placement providers collaborating closely to build the future workforce.

Written by @imms_eh_OT

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RCOT2018. Blog 16: Occupational Therapy and Complexity: Defining and Describing Practice. Dr Duncan Pentland, 

This much anticipated plenary session, delivered by Dr Duncan Pentland, launched the Royal College of Occupational Therapists’ new publication Occupational therapy and complexity: defining and describing practice. This publication serves as a revision to Occupational therapy defined as a complex intervention (Creek 2003).

The work of Creek is widely used by practitioners and students alike, however 15 years have now passed since this seminal work was published, and we all understand that healthcare is constantly changing and evolving. Our NHS today is continually seeking new ways to improve the delivery of care, alongside advancements in technology, research and treatment modalities.

Our NHS tomorrow will be different to what it is today.  In response, this publication seeks to define and describe contemporary occupational therapy against the back-drop of the ever-changing face of global health and social care. Additional objectives were the creation of a new model of contemporary occupational therapy, and the identification of how this aligns with the concept of complex interventions.

Duncan gave an overview of the methodology and process of the project. To examine multiple perspectives of occupational therapy, three different data collection methods were employed. This included a literature review of 256 papers published between March 2015 and October 2016 describing current practice, a survey of practitioners, educators and students and online focus groups.

Within the model, occupational therapy is defined as a complex and dynamic process undertaken to enhance the health and wellbeing of people. Context is a key focus within the model, with the proposal that occupational therapy is based on the causal assumption that the “doing” of occupations facilitates change within the components of person(s)-in-context.

This context is dynamic across the lifespan of an individual, influenced by lived experience and functional capabilities. Equally important are therapist(s)-in-context, used in plural to represent how an individual may encounter a number of occupational therapists across their life course. Occupational therapy interventions can be viewed as the shared context that occurs when person(s)-in-context and therapist(s)-in-context join together. Contexts work in synergy and the changes that occur restructure the person-in-context.

Within the model, intervention context is formed by implementation content and mechanisms of impact – the wide variety of strategies that occupational therapists use to deliver therapy and the causal factors we understand to facilitate change. On average, an occupational therapist will use 11 different types of practices and approaches with an individual client. Therapeutic changes can be either expected or unexpected, forming transitions or therapy outcomes. It is important to note how this process continues dynamically across the life span for both the individual and therapist alike – their life course has been altered by their experiences of the occupational therapy process. These processes play out against the foundational backdrop of the overall macro-context – which includes environmental, political, technological and global influences. Duncan warned how models do not always explain how therapeutic processes will occur, rather they seek to explain how therapeutic processes may ensue.

Duncan concluded the session by leaving us with the thought that occupational therapy is complex, because people are complex. It is clear that occupational therapy is indeed a complex intervention. Wider theories on complexity have illuminated how complex processes cannot be understood by looking at the individual components, they must be examined as a whole. This is known as systems thinking. As Occupational Therapists we are inherently systems thinkers – we understand the human body to be formed from multiple systems and sub-systems, furthermore the occupational therapy models we use to shape our thinking and practice are comprised of interactive systems. The implementation of boundaries are necessary to examine systems, however this can result in the loss of something significant. Holism is embedded with our core philosophy – herein lies the future challenge for the occupational therapy workforce to describe and explain our practice.

A copy of the full publication, Occupational therapy and complexity. Defining and describing practice, can be downloaded for free by members from the RCOT website.

Written by Cathy Roberts – @CathyARoberts

 

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RCOT 2018 Blog 15 Lessons learnt by an occupational therapy graduate at conference

This year was my third experience of the buzz and pure magic of an RCOT conference. But unlike the last two visits, this year I wasn’t a student.
Before arriving I didn’t think my new non-student status would make any difference to running around the exhibition hall collecting as many free pens as would fit in my bag or rushing from session to session desperate to experience everything. But, things couldn’t have been more different and this year was the year I really felt I made the most of the experience.
So from one new graduate to all of those thinking of attending in the future, here are 5 lessons I’ve learnt.
1. You don’t need to see everything!
For the last two years I’ve run around conference attending back to back sessions.
This year, however, I marked off sessions I wanted to see and decided not to fills the gaps just because I could.  Going for the calmer approach meant I didn’t leave each day feeling burnt out, sessions hadn’t all merged into one and overall I enjoyed it more. So my advice, don’t feel pressured into attending every session, give yourself breaks and you’ll find it a lot less stressful.
2. Have a peek at the posters!
Previously I ran past the posters trying to take them all in. This year I took time, looked at  each of them and read those of interest. I loved the placement journey described as a trip on the a75, considering all the bumps in the road. And Kirstie’s CPD on the sofa. Taking time to really read them was worth it.
3. Talk, talk and talk some more!
As an inherently shy person I’ve often avoided talking to others. I’m that person that awkwardly joins a conversation or doesn’t know if I should join in so I don’t. This year, partly because of my role with RCOT, I embraced my awkward nature and started talking.
Yes, there were a few moments where I stood on the outside figuring out when best to join in but it didn’t matter. Speaking to people, I found out about sessions I didn’t attend, got into interesting debates and networked like I hadn’t before. As much as talking can be awkward at times, I’ve definatley met people that I will stay in touch with.
4. Restore your occupational balance!
The conference bubble is intense and at times overwhelming. It’s important to make time for yourself. It’s ok to walk out the door and go for a coffee and come back later. It’s good to shut your hotel door and turn off your twitter notifications for the night. Those moments, however brief, to restore your occupational balance and get you ready for what you’ve planned next are precious, use them and don’t feel guilty about it.
5. Less is more… with freebies!
I always joke about going to a previous conference and competing over the number of pens I could collect. This year, I didn’t end up going home with more free pens and tape measures in my suitcase then clothes. I swapped 200 pens for less than 20, I picked up leaflets of interest and an occupational therapy car sticker (because why not?). Not only did going home with less avoid an having to find a place to store it all, it meant that I picked up items of value and can remember why i picked them up.
Finally, conference is what you make of it as Julia Scott hinted at in the closing address it’s is a great opportunity for occupational therapists and students to share their work and learn from one another.
Written by @Amie_OT
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RCOT2018. Blog 14.Sess. 91 How I’ve become a better occupational therapist by being a foster carer

This session was led by Esther Day @otesterday from Essex Partnership NHS University
Foundation Trust
The aims of the session were:
  • To address the value of becoming a foster carer
  • To provide insight into the lived experiences of a foster carer for children with complex care needs

Given caseload, time constraints and pressures in the workplace it can become challenging for occupational therapists and students to focus beyond day to day work. Aspects of work, appointments being late or lack of service user engagement can become frustrating. Yet, how many of us have considered this from the other side? How many of us understand what it feels like to be the person attending an appointment be it for yourself or with someone you love?

Esther, occupational therapist currently working with adults with learning disabilities, talked openly and honestly about the day to day challenges of being a foster carer for children with complex needs and the heartwarming insight into the joy and happiness that comes with it.

She started with getting us to consider the little things. Sometimes as an occupational therapist there is nothing we can do, things may happen beyond our locus of control. But that doesn’t mean we can’t make a difference. Simply giving someone the time, listening to them, validating their feelings may not solve the problem but can make all the difference. You don’t always have to provide a solution to provide support.

That’s where working collaboratively comes into play. The best therapy, if implemented at the wrong time, can lose meaning and impact. How do we know what’s going on in a family without talking to them? Yes, we are experts in the field of occupational therapy, but they are the experts in knowing their child, their family situation and potentially the right and the wrong time.

When it came to timing, Esther talked about the challenges of lone caring for children with complex health needs. As she said, sleep is her super power, yet while foster caring, the child becomes a priority. While she has children for respite, limited and disrupted sleep is a way of life for a lot of those caring for children and adults with learning disabilities.

That’s where we play a vital role. It’s time to start thinking about how we can make life easier, how can we ease the pressure of attending appointments and avoid setting carers up for failure. We need to consider family needs, ask them for a prefered location or time of day, be mindful of the families experiences and again, start making a difference by changing the little things.

The expectations and reality of being a foster carer are different, yes it does bring with it a number of challenges. Esther openly talked about a lack of sleep, the hour it takes to get everything ready before leaving the house and the reality of the experience. But ending the session with heartwarming stories of children giggling, crossing the mid line and playing.

At the end of the presentation it was obvious that despite the challenges and realities of being a foster carer it was the good moment and valuable time with the children themselves that made all the difference. As occupational therapists, it’s our duty to remember the little things, listening and work with families that will make life easier for those we work with.

Written by @Amie_OT