#OTalk Chat – 28th April 2020 – Groupwork in Dementia Care

Therapeutic groups can have many benefits if they are well considered and maintain a person-centred approach (Beynon-Pindar, 2017). Enabling meaningful activity for those with dementia will prevent occupational deprivation (Harmer & Orrell, 2008), minimize boredom (Welton, 2013) and enhance pleasure and quality of life (Vernooij-Dassen, 2007). Groupwork is a dynamic and cost-effective tool in Occupational Therapy practice, for both intervention and evaluation (Creek & Lougher, 2011).

Co-production is the collaboration between people who run a service and the people who they support. Co-production gives service users, family members and carers more control in the care and support they receive (SCIE, 2015). Co-production acknowledges that the individuals using services have knowledge and experience of how services can be improved – recognizing people as assets and equal partnerships (Boyle, Slay & Stephens, 2010).

I recently started my role-emerging placement, where I am working with Older Adults, the majority of whom have Dementia. The task / expectation was for me to plan, implement and evaluate a group with this client group. I have spent the first few weeks scoping the placement, getting to know the client group and understanding their needs and preferences (the essential first step of planning a group!)

It is important to consider that the carers of those with Dementia are also the client. Interventions for dementia affect family carers as well as the client themselves, indicating that clinical decision-making needs to be informed by the impact on carers’ quality of life too (Oyebode et al., 2019). 

To ensure carers can fully engage in providing dementia care, they deserve to receive support and have their needs addressed. Looking after family carers can be done by maximizing their abilities and minimizing their burden (Wesson et al., 2017).

Unfortunately, due to the current situation (COVID-19), things have had to change in terms of the placement – I am now going to be completing written detailed plan of what I would have done. I am passionate as ever about working with people with dementia and their carers. 

I am so interested to hear your thoughts and experiences of planning and implementing groups – whichever client group it has been with – all knowledge and advice is welcomed!

Thank you to Margaret (margaret@ot360.co.uk) for our in-depth discussions and your help in writing this, it is very much appreciated!

Questions:

  1. To start as an OT, what skills do you believe are essential in researching, planning and delivering a successful group?
  1. How do you ensure your groups are different from other non OT led groups that may be being delivered in a service?
  1. How have you noticed participating in group work can make a difference with people with dementia and/or their carers?
  1. How did you measure the difference being part of a group has meant to people?
  1. Meaningful activity’ is at the heart of what we do, what has been the content of the sessions when you have delivered groups for either people with dementia and/or their carers?
  1. To finish in general what are the positives of delivering group work with people who have Dementia and/or their carers?

References

Beynon-Pindar, C. (2017). Group work in Occupational Therapy: Generic Versus Specialist Practice. Occupational Therapy Evidence in Practice for Mental Health, 59.

Boyle, D., Slay, J., & Stephens, L. (2010). Public Services Inside Out: Putting Co-production into Practice. London: New Economics Fooundation.

Creek, J., & Lougher, L. (2011). Occupational therapy and mental health. Elsevier Health Sciences.

Finlay, L (2002). Groupwork in J. Creek (ed) Occupational Therapy and Mental Health. Edinburgh: Churchill Livingstone

Harmer, B. J., & Orrell, M. (2008). What is meaningful activity for people with dementia living in care homes? A comparison of the views of older people with dementia, staff and family carers. Aging and Mental health, 12(5), 548-558.

Oyebode, J. R., Pini, S., Ingleson, E., Megson, M., Horton, M., Clare, L., … & Wright, P. (2019). Development of an item pool for a needs-based measure of quality of life of carers of a family member with Dementia. The Patient-Patient-Centered Outcomes Research, 12(1), 125-136.

SCIE. (2015). Co-production in Social Care: What is it and how to do it.

Vernooij-Dassen, M. J. F. J. (2007). Meaningful activities for people with dementia.

Wesson, V., Chiu, M., Feldman, R., Nelles, L. J., & Sadavoy, J. (2017). Dementia and caregiving.

#OTalk 21st April – Reading as a Meaningful Occupation: Can the Books We Read Improve Our Practice?

This week’s chat will be hosted by Rebecca Crouch (@RebeccaCrouch), who invites us to consider the impact of narratives on our practice:

During a time when our engagement in meaningful activities has been disrupted, many have turned to reading, a daily activity which can be facilitated by our bookshelves, our phones (as newsfeeds, ebooks or audiobooks) or via online stores.

What this activity offers us, will vary according to reader preferences and their choice of genre. Fiction or non-fiction, romance or horror, auto-biographical or self-help, the possibilities are endless.  Publishers have even reported sales boom in novels about fictional epidemics (Flood 2020). 

Narratives are the bedrock of a good story. They are also prominent in the headlines of the news we consume, political speeches we listen to and are an essential part of our daily practice as occupational therapists. 

In occupational therapy, being able to elicit personal stories can help practitioner’s understand an individual’s point of view and personal experiences, to identify needs and preferences, and to better understand the individual as an occupational being (Mattingly and Lawlor, 2009). In occupational therapy literature, establishing narratives through assessment has been found to support practitioners to build rapport and support clients in collaborative goal setting (Apte et al, 2005), in clinical reasoning (Mattingly 1991) and is a commonly used approach in our research (Moore, 2017). 

For this OTalk, I would like to invite participants to think about the important role narrative has both their practice and in the content they consume, and in particular, books. 

  1. What is your understanding narrative and the role in plays in occupational therapy? 
  2. How important are narratives in your practice? And how do you illicit these? 
  3. As an occupational being, would you personally describe reading as a meaningful occupation?  
  4. What we can learn from narratives in the books we read and can this inform our practice?
  5. If you had to recommend a book/s to read to the other people in today’s OTalk, what would it be and why?

References

Ashwini Apte, Gary Kielhofner, Amy Paul-Ward & Brent Braveman (2005) Therapists’ and Clients’ Perceptions of the Occupational Performance History Interview, Occupational Therapy In Health Care, 19:1-2, 173-192, DOI: 10.1080/J003v19n01_13

Flood A (2020) Publishers report sales boom in novels about fictional epidemics, The Guardian, Thu 5 Mar 2020 

Mattingly C and Lawlor M (2009) Learning from Stories: Narrative Interviewing in Cross-cultural Research, Scandinavian Journal of Occupational Therapy, 7:1, 4-14, DOI: 10.1080/110381200443571

Mattingly C (1991) The Narrative Nature of Clinical Reasoning, American Journal of Occupational Therapy, November 1991, Vol. 45, 998-1005. https://doi.org/10.5014/ajot.45.11.998

Temple Moore (2017) Strengths-based narrative storytelling as therapeutic intervention for refugees in Greece, World Federation of Occupational Therapists Bulletin, 73:1, 45-51, DOI: 10.1080/14473828.2017.1298557

#OTalk 14th April – Social Prescribing and the future of Occupational Therapy

This week @adamjacksonot is hosting this is what he has to say.

Hi, I’m Adam – A little bit about me… I’m a 3rd year student at the University of Derby, finishing this June.  I have been on quite a varied placement set, including:  Rampton Hospital, Kingsmill Hospital – Stroke Unit and Ash Green Specialist Community Learning Disability Service.

My interest in Social Prescribing (SP) began when it was briefly mentioned in our first year at University – later sharing an edit of a particular diagram of The Social Prescribing Process that now has just over 42,000 twitter impressions.  This created quite a conversation around the understanding of SP and OT and thus began my curiosity in OTs potential role.

My current literature review and research proposal is looking at the current Evidence-base and Outcome Measures used to gauge the efficacy of Social Prescribing schemes and exploring OT’s potential contribution in supporting the evidence-base and sustainability of this ever-growing healthcare agenda.  

Hopefully this OTalk can develop our understanding of its current application in practice and gather thoughts on the potential role or implication for future Occupational Therapy practice.

Social Prescribing

  • ….is a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services.​
  • Recognising that people’s health is determined primarily by a range of social, economic and environmental factors, social prescribing seeks to address people’s needs in a holistic way. It also aims to support individuals to take greater control of their own health.​
  • ….can involve a variety of activities which are typically provided by voluntary and community sector organisations. Examples include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice and a range of sports.​

Kingsfund (2019)

Social Prescribing is not a new concept, as such – nor is it exclusively eluding Occupational Therapy –  RCOT have long been campaigning for the voice of Occupational Therapists to be heard within Social Prescribing and there are examples of success when Occupational Science and Occupational Therapy involvement is supporting the development of the agenda (for example; Salford Prescribing Hub).  However, almost consistently, current literature and research into Social Prescribing schemes, does not yet acknowledge or involve Occupational Therapy or Occupational Science.   Instead, concluding that whilst continually perceived as beneficial by the patient, lacks a solid evidence base or outcome measure – in turn questioning it’s sustainability.

Though Occupational Therapy was not initially listed as a profession to be funded under Social Prescribing schemes within Primary care (NHS England, 2019), there has been a lot of recent movement towards including and developing the role of Occupational Therapy in Social Prescribing.  This included the ‘Driving Social Prescribing Forward: AHPs Framework’, followed by the ‘Public Health England: Social Prescribing AHP Strategic Framework’.  `Most recent change saw OT being formally named in the new GP Contract (Department of Health and Social Care, 2020) – allowing for Primary Care funding of Occupational Therapists to potentially support and develop SP Schemes within them.

Alongside this, there is also growing conversation and change within OT curriculum in the UK, to explore and adapt to this changing landscape of healthcare.  Canadian and Australian Occupational Therapy has led the way on developing and analysing the opportunities Social Justice and Community (or Social) Occupational Therapy can provide – creating intervention on a Public Health level in response to personalised care and preventative care agendas, as mentioned by WFOT.

Thew et al (2017) highlighted the potential for Social Prescribing as an Emerging Role within Occupational Therapy.  Is this change of approach in mainstream health services, an opportunity to see the return and resurrection of core Occupational Therapy practice?

Questions I would like to consider:

  1. What is your/ your teams current understanding a) Social Prescribing and b) it’s link/relationship with Occupational Therapy?
  1. What are your experiences with Social Prescribing Services/ Agenda; either directly or indirectly? (ie working within a scheme or come across it in training, conferences, education etc)
  1. As the interest in OT for Public Health grows and Community or Social level Occupational Therapy increases; Do you think Occupational Therapy is able to rise to the challenge, and why – if not, what are the barriers?
  1. There appears to be little research, if any literature at all, on Occupational Therapists within Social Prescribing Services – Why do you think this is?
  1. Occupational focus and Holistic practice are at the core of Occupational Therapy profession.  How do you think the ‘shifting and sharing’ of this knowledge and evidence base will shape the future of Occupational Therapy practice?

References

Department of Health and Social Care (2020) 15 Billion to Deliver Government Commitment for 50 Million more General Practice Appointments, Available: https://www.gov.uk/government/news/15-billion-to-deliver-government-commitment-for-50-million-more-general-practice-appointments (Accessed: 21/02/20)

Dyson B (2014) The University of York Centre for Reviews and Dissemination. Evidence to inform the commissioning of social prescribing, Available: http://www.york.ac.uk/media/crd/ Ev%20briefing_social_prescribing.pdf  (Accessed: 21/02/20)

NHS England (2014) Five-year forward view, Available at: https://www.england.nhs.uk/wp-content/uploads/2014/10/ 5yfv-web.pdf (accessed 23/11/19)

NHS England (2019) Social prescribing link workers: Reference guide for primary care networks, Available: https://www.england.nhs.uk/wp-content/uploads/2019/07/pcn-reference-guide-social-prescribing.pdf (accessed:21/02/20)

Thew M et Al (2017) Social prescribing: An emerging area for occupational therapy, British Journal of Occupational Therapy, Vol. 80(9) 523–524, DOI: 10.1177/0308022617700905 

Kingsfund (2019) What is Social Prescribing? Available: https://www.kingsfund.org.uk/publications/social-prescribing, (accessed 23/11/19)