OTalk

#OTalk Research 6th April 2021

Who do you think you are? Doing, being and becoming a pragmatic researcher-practitioner – a personal reflection.

This chat will be hosted by Sarah McGinley @sarah_lou2222 and Rachel Dadswell @DrRachOT1 

As occupational therapy students and therapists we are all aware of our personal and professional responsibility to acknowledge and examine our own values, beliefs, attitudes, assumptions, decisions and actions across clinical, educational and research contexts (Royal College of Occupational Therapists, 2021; Cunliffe 2016). Having worked in clinical practice for several decades between us, Rachel and I felt secure and firmly rooted in what we see as the underpinning philosophy of OT; the human right to engage in meaningful occupations to maintain and sustain positive physical and mental well-being (Townsend et al., 2002). However, when we entered the realms of education and research as novice researchers, we were challenged to consider our assumptions about how knowledge is generated and utilised, as well as our perception of what reality, being and existence is (Kinsella & Whiteford, 2009; Mack, 2010). Having never explicitly been asked to consider our own philosophical assumptions in clinical practice, this opened up a whole new world that was unfamiliar, overwhelming and somewhat intimidating.  Words such as epistemology, ontology and paradigmatic thinking were new to us (see attached poster for definitions of research language) and took us on a journey of ‘doing, being and becoming’ researcher-practitioners (Wilcock, 1998). 

The philosophical roots of OT demonstrate justified parallels with several philosophical paradigms (a lens through which we view the world). Using the poster as an illustration, we offer just one example of how the paradigm of pragmatism has helped us to understand who we are, what we do and how we view the world. Pragmatists argue that social reality cannot be understood through a singular world-view, suggesting a pluralistic approach that adopts mixed methods as a means of understanding human behaviour, beliefs and resultant consequences is needed (Kivunja & Kuyini, 2017). This quote from one of the founding educational philosophers of pragmatism – “it is through what we do in and with the world that we read its meaning and measure its value” (Dewey, 1959, p19) – demonstrates how pragmatism offers a shared view of the world that we feel aligns well with the core concepts of OT:

  • Person – shared views of humanism, holism and autonomy.
  • Environment – values the lived experience, focuses on practical engagement and the need to learn in a social context and interact with the natural environment.
  • Occupation – emphasises experiential learning and links occupation to meaningful and active participation. 
  • Research in education and practice – rejects a pure scientific approach and calls for alternative, yet scientifically feasible methods in the social sciences. 

(Schwartz, 1992; Townsend et al, 2002; Yerxa, 1992, 2009)

Literature suggests the profession struggles to succinctly describe OT in a uniform way, possibly connected to a lack of agreement around what constitutes its core values and connection with the founding philosophers  (Kinsella & Whiteford, 2009; Yerxa, 1992). This is unsurprising if as students, clinicians, educators and/or researchers we are not routinely encouraged to understand or make explicit our own philosophical assumptions at every stage of our personal and professional development.  If we are to be understood by registrants and the wider society, we feel it is imperative that philosophical language and paradigmatic thinking is introduced and made accessible to us as students, with critical reflection encouraged throughout all career pathways. We would love to know your views on this…….

Question 1: What do you understand by the term philosophical assumptions (and why is it important to consider them)?

Question 2: Do you feel comfortable debating the philosophies that underpin our profession? If not, why not?

Question 3: Have you ever been encouraged to consider your own philosophical position in practice, education or research?

Question 4: Can you share with us your philosophical position and how or why you came to this point?

Question 5: What would encourage you to explore your philosophical position in practice, education or research?

Question 6: Has your philosophical position changed or evolved over time? If so, how?

References:

Royal College of Occupational Therapists. (2021). Professional standards for occupational therapy practice, conduct and ethics. London: RCOT www.rcot.co.uk/publications/professional-standards-occupational-therapy-practice-conduct-and-ethics 

Cunliffe, A. L. (2016). “On Becoming a Critically Reflexive Practitioner” Redux: What Does It Mean to Be Reflexive? Journal of Management Education, 40(6), 740–746. https://doi.org/10.1177/1052562916668919

Dewey, J. (1959). The School and Society (4th editio). Chicago: The University of Chicago Press.

Kinsella, E. A., & Whiteford, G. E. (2009). Knowledge generation and utilisation in occupational therapy : Towards epistemic reflexivity. Australian Occupational Therapy Journal, 56, 249–258. https://doi.org/10.1111/j.1440-1630.2007.00726.x

Kivunja, C., & Kuyini, A. B. (2017). Understanding and Applying Research Paradigms in Educational Contexts. International Journal of Higher Education, 6(5), 26–41. https://doi.org/10.5430/ijhe.v6n5p26

Mack, L. (2010). The Philosophical Underpinnings of Educational Research. Polyglossia, 19, 5–11.

Schwartz, K. B. (1992). Occupational Therapy and education: A shared vision. American Journal of Occupational Therapy, 46(1), 12–18.

Townsend, E., Stanton, S., Law, M., Polatajko, H., Baptiste, S., Thompson-Franson, T., … Campanile, L. (2002). Enabling Occupation: An Occupational Therapy Perspective (Revised Ed). Ottawa: Canadian Association of Occupational Therapists.

Wilcock, A. (1998). Reflections on doing, being and becoming. Canadian Journal of Occupational Therapy, 65(5), 248–256.Yerxa, E. J. (1992). Some implications of Occupational Therapy’s history for its epistemology, values and relation to medicine. American Journal of Occupational Therapy, 46(1), 79–83.

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OTalk

#OTalk – 30 March 2021 – Exploring the purpose of OT in prisons

This chat will be hosted by Deborah Murphy @Murphlemurph 

When tasked with transforming a leisure-based day service in a prison to being an Occupational Therapy led therapeutic service in 2014, I searched for evidence to base my service design on. To my surprise there was almost nothing written about Occupational Therapy in prisons, and it was necessary to develop a ‘service model’ through trial and error. Although I had brought along over a decade’s clinical experience from forensic hospitals, it was evident that prisoners and OT’s within prisons had unique needs and aims. 

In contrast to the very slow turnover of men with ‘severe and enduring’ mental health needs within forensics, working in a remand prison demanded prioritising need within a rapidly changing population of 1300 prisoners.  It became apparent that our service needed to be responsive to men with multiple complex needs.  Alongside those with mental health issues, prisons have an over representation of men on the autistic spectrum, and other neurodevelopmental disorders, ADHD, personality disorder, and brain injuries.  We are much more likely to encounter those who are acutely suicidal and self-harming, and those with presentations related to acute emotional trauma.  Many have multiple complex social problems including family breakdown, immigration issues, problematic substance use, homelessness which are of immediate concern.

In 2017 the RCOT produced a factsheet related to OT in prisons, however none of the evidence presented related to the English prison context.  The research presented referred to 3 UK studies, but these were all examples from forensic services, a system very different to that of prisons, one was US prison and focussed specifically on an interdisciplinary substance use program from 13 years previously, with limited transferability to contemporary mental health practice in the UK, and one was from a Singaporean prison.  Closer to home (a fantastic) initiative of an OT setting up a choir in a prison in Belfast is mentioned, but such a niche example held little in the way of guiding our general practice.  I wondered how as OTs in prisons we might be able to build a more local relevant knowledge base?

Over the past 7 years I have assertively networked with OT’s across the UK and beyond in attempt to establish whether I am developing my service along principles consistent with other OT’s.  It has become increasingly evident that OT’s in prisons are a disparate bunch, with no coherent model of practice.  Although many are doing fantastic work in their own spheres, what we offer is largely subject to the trends of the geographical area, and the motivations of the service managers in that area.  

Against this backdrop we joined forces with the RCOT forensic special interest group in 2020 and the forum was renamed the #ForensicPrisonForum to acknowledge our diversity.  In recognition of our unique needs we also formed a ‘splinter’ group of OT’s who work in diverse areas of the justice system.  This justice-based OT forum #JBOT is not affiliated to our professional body and is open to anyone and everyone with an OT role related to the justice system.  Here we can consider how we develop our practice and create an evidence base in the numerous new and exciting roles which OT is expanding into within the justice system.  We hope to use our considerable shared practice experience to create guidance for others entering into these roles. 

We are keen to promote the diversity of our roles and to reach out to students and practitioners interested in this area of work.  I decided to bring some of the questions we commonly consider to this broader forum at #OTalk and look forward to hearing people’s thoughts and views.

Question 1. What interested you in coming along to tonight’s talk? What might you find appealing/unappealing about working in a prison setting and what made, or might make you consider working in this area? 

Question 2. What historical, social, psychological factors do you feel might impact people’s life ‘choices’ & contribute to their committing criminal offences? Do you have examples of approaches/ interventions OTs might use to increase the life chances of those in prison?

Question 3. Unconditional positive regard can be challenging when faced with those who perpetrate particular offences. How might we manage more difficult feelings in our practice, and how might such feelings influence the service we provide as OT’s? 

Question 4.  It is generally accepted in the Criminal Justice system that preventing reoffending is a poor measure of therapy outcomes, due to complex social factors motivating offending; So what outcomes might OTs look for to measure success? What might a good outcome look like?

Question 5.  Many people believe those in prison are unworthy of our time & attention. How might we persuade people (including prison personnel) that those in prison are worthy of healthcare generally & OT specifically? What might we say about the occupational needs we are meeting?

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OTalk

#OTalk 23rd March 2021 – The Role of Occupational Therapy in ICU

This week Aisling Durkin @ais_d will be hosting #OTalk.

In the past year the role of Occupational Therapists (OTs) in the critical care setting has been brought to the fore.  A number of OTs found themselves redeployed to ICU during the pandemic, working in both established teams as well as in units that previously had no occupational therapy presence.  Roles varied with OTs providing early assessment and rehabilitation (Borgstein, 2020), recruiting, training and organising proning teams as well as working in nursing support roles (Royal College of Occupational Therapists, 2020).  As business begins to return to normal in health services, many occupational therapy and critical care teams are looking at ways to establish and develop occupational therapy service provision in this setting.   

The importance of occupational therapy in the Critical Care setting has long been recognised by the Faculty of Intensive Care Medicine (2015, 2019) and early rehabilitation in this setting is clearly linked to better outcomes for patients (Tipping et al, 2017).  A recent article in the OT News (Borgstein, 2020) also explored the cost effectiveness of an occupational therapy service on ICU, identifying that the cost savings of 20 bed days on ICU would fund a single band 6 occupational therapist for the year.  Despite this, the evidence has not historically translated to funding for occupational therapy services (Firschman, 2019).  In order to explore strategies to establish these services we would like to put forward the following questions for discussion;

1.      What do you think the role of occupational therapy is in critical care? 

2.      What training have you had or do you think we need to work in Critical Care? 

3.      How can we raise the profile of occupational therapy in Critical Care Services? 

4.      How do we keep occupation at the centre of what we do in critical care? 

5.      What can we do to strengthen the evidence base for occupational therapy on ICU? 

Borgstein, C (2020) Occupational therapy in critical care – a case for change. OT News, July 2020. P- 44-46. London: Royal College of Occupational Therapists.

Firshman, P (2019). The occupational therapy role in critical care. OT News, April 2019. P16-18. London: Royal College of Occupational Therapists.

Intensive Care Society (2015) Guidelines for the provision of intensive care services. London: Faculty of Intensive Care Medicine.

Intensive Care Society (2019) Guidelines for the provision of intensive care services. 2nd Ed. London: Faculty of Intensive Care Medicine.

National Institute for Health and Care Excellence (2017) Rehabilitation after critical illness in adults. Quality standard [QS158]. London: NICE. Available at: Overview | Rehabilitation after critical illness in adults | Quality standards | NICE

Royal College of Occupational Therapists (2020) New Occupational Therapy Team leads crucial critical care training, OT News, July 2020. P-9. London: Royal College of Occupational Therapists.

Tipping, C.J., Harrold, M., Holland, A., Romero, L., Nisbet, T. and Hodgson, C.L., (2017). The effects of active mobilisation and rehabilitation in ICU on mortality and function: a systematic review. Intensive care medicine, 43(2), pp.171-183.

Ward, G. and Casterton, K. (2020).  The impact of the COVID-19 pandemic on occupational therapy in the United Kingdom.  Education and Research. London: Royal College of Occupational Therapists.

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OTalk

#OTalk – 16th March 2021 – OT Time Out – A Virtual Support Network for Newly Qualified OTs

This weeks chat will be hosted by Laura Rossiter @OTTimeout1

It is understandable that upon entering clinical practice we can experience a plethora of emotions. These can range from excitement and pride to anxiety and fear. Working in the healthcare sector can be challenging and exhausting for anyone, regardless of how long they have been in the role. Limited experience and that little word beginning with C and ending with 19, can certainly exacerbate any concerns that newly qualified OTs (NQOTs) have.

In these uncertain and unprecedented times, many NQOTs are starting new posts working remotely, interacting with not only service users that they have never met but colleagues too. They are working in psychologically demanding, traumatic situations with reduced opportunities for supervision and support, and without a point of reference for knowing what that setting was like pre-COVID. How much does real-life Occupational Therapy practice during a pandemic differ from services pre-COVID and then again from the theory and models we are taught in our training?

The Elizabeth Casson Trust has awarded a grant to The University of Southampton to create a virtual support network for the 1,120 NQOTs across the UK. We have called this network OT Time Out. On two dates each month, OTs can attend meetings for free over Microsoft Teams with up to seven other OTs. Meetings are facilitated by members of the OT Teaching team at the University of Southampton. OTs can discuss any concerns – do they feel happy and well? Do they have a good work-life balance? Do they feel supported? Are they able to manage stress? Are they enjoying their role? This is a place for honest and supportive listening and discussion where every OT is welcome.

We invite you to attend our OTalk on 16th March to talk about the needs of NQOTs and the network that we have set up.

  1. What did it feel like when you entered practice as an OT?
  2. What does it feel like (or what do you think it feels like) to enter practice during COVID-19? 
  3. What would you like from a virtual support network for newly qualified OTs?
  4. What can workplaces do to support newly qualified OTs?

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OTalk

#OTalk – 9th March 2021 – The role of occupational therapy in the charity sector

This chat will be hosted by Dr Naomi Graham @growinghopeuk.

The COVID-19 pandemic seems to have heightened the awareness of health and wellbeing needs across our nation and the need for intervention, particularly for the most vulnerable. Researchers such as Horridge et al. (2019) and Stuckler et al. (2017) discussed the impact of austerity on health and wellbeing for various populations. Horridge et al. (2019) reported that families of children with additional needs have experienced a cut in therapy services across the past ten years. The National Autistic Society (2020) found in a survey during COVID-19 that 1 in 5 families had to reduce their work during lockdown so that they could care for a family member who has autism.

As a children’s occupational therapist experiencing first-hand the service cuts for the families I was working with I decided to found a charity in 2017 – Growing Hope (@growinghopeuk). Growing Hope provides free therapy for children and young people with additional needs in partnership with local churches across the UK. We aim to grow hope for children, hope for families and hope in Jesus. Growing Hope is open to all individuals regardless of their background and beliefs. We have set up a model which aims to use local communities existing resources (such as space within churches) to provide free healthcare services for families of children with additional needs. We are trying to provide a holistic approach and therefore run groups for siblings and parents and carers to discuss and process their experience.

We now have two local clinics in King’s Cross and Brockley, London, and we have potential clinics in cities outside of London in the pipeline to launch in 2021. As a charity we want to be working with children’s occupational therapists, physiotherapists, speech and language therapists and other members of the MDT so that we can support the families who are currently missing out. We want to find out about other charities who are providing occupational therapy and how charities can work with existing NHS therapy teams in order to best support the clients we work with.

Questions:

Are there other charities who are providing occupational therapy for free to meet a gap for their client group?

  1. What are the benefits of responding to client needs through the charity sector?
  1. What does the occupational therapist role in the charity sector look like?
  1. How can therapists working within the charity sector connect with NHS teams to provide further intervention for individuals who need support?
  1. What has the impact of COVID-19 been on your client base? How have you seen austerity play out for clients that you’re working with?

References:

Horridge, K.A., Dew, R., Chatelin, A., Seal, A., Macias, L.M., Cioni, G., Kachmar, O., Wilkes, S. and (2019), Austerity and families with disabled children: a European survey. Dev Med Child Neurol, 61: 329-336. doi:10.1111/dmcn.13978

National Autistic Society. 2020. Left stranded: The impact of coronavirus on autistic people and their families in the UK.  [Online] . [29 September 2020]. Available from: https://s4.chorus-mk.thirdlight.com/file/1573224908/63117952292/width=-1/height=-1/format=-1/fit=scale/t=444295/e=never/k=da5c189a/LeftStranded%20Report.pdf

Stuckler, D., Reeves, A., Loopstra, R., Karanikolos, M., McKee, M., (2017) Austerity and health: the impact in the UK and Europe, European Journal of Public Health, Volume 27, Issue suppl_4, October 2017, Pages 18–21, https://doi.org/10.1093/eurpub/ckx167

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