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RCOT 2018 Final Blog 20. Thank You

This is a short final blog with a very important message……

“Thank You” to all of the members of the blog squad who have given up some of their valuable conference time to provide personal insights into some of the sessions they attended and some of their conference experiences.

You can find out who they are and a little bit about them here. But for now lets thank

  • Marie Baistow
  • Elspeth Clark
  • Faye Dunford
  • Catherine Gray
  • Orla Hughes
  • Rachel Imms
  • Catherine McNulty
  • Amie Mowlam-Tette
  • Cathy Roberts

Everyone has included their personal Twitter handle at the end of the blogs they have written if you want to make contact.

It’s not easy to try to distil the essence of conference sessions, especially some of the main keynotes, but, having read them all, they have done a fabulous job.

Not only have they been writing away but also over coming a range of different technology challenges, batteries going flat, computers not connecting to wifi, photos not sending etc etc.

So on behalf of us all Thanks Guys – you’ve done a great job.

Written by Lynne Goodacre @lynnegoodacre

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RCOT 2018 Blog 19  Sess. 57: Degree Level Apprenticeships for occupational therapy – a way forward for our profession?

This session was led by Dr Theresa  Baxter Sheffield Hallam University, Sue Waters Coventry University, Anita Cooper United Lincolnshire Health NHS Trust.

The aim of the seminar was to explore the development of degree apprenticeships in occupational therapy. A new development for the profession, and with the loss of commissioning for health courses (HEE 2016), one which may prove to be an opportunity to secure a workforce for the future.

The seminar began with Anita Cooper greeting the audience with ‘Hello my name is Anita’  she continued to introduce Theresa Baxter from Sheffield Hallam University and Sue Walters from Coventry University. They have all been working with the trailblazer group on developing the occupational therapy degree level apprenticeship.

Anita spoke of the history and the initial driving force behind this innovative opportunity. This included:

  • the loss of commissioning / education bursaries
  • reduction in students applying to universities to take up occupational therapy training programmes
  • concerns for Lincolnshire a large rural county where recruitment has historically been problematic
  • needing to make decisions for the future provision of occupational therapy services in Lincolnshire
  • the apprenticeship levy means all employers over a certain size will pay 1% Apprenticeship Levy. This includes all NHS Trusts. The only way they can benefit from the levy is to employ apprentices which subsequently enables the employer to draw down from those funds.

A link was drawn to Nick Pollard’s comments from his Elizabeth Casson Memorial Lecture of the need grow and promote diversity within profession. Developing the apprenticeship model would essentially enable people who would otherwise not be able to undertake their occupational therapy training to do so.

I can directly empathise with this situation. Employed as an occupational therapy support worker in Lincolnshire NHS mental health services I had the opportunity to undertake my occupational therapy degree as a part-time student with University of Ripon and York St John (known now as the University York St John). For me this was totally life changing.

Post graduation, I continued to work in Lincolnshire NHS.  Currently I am employed as Associate Lecturer with Sheffield Hallam University and now completing my MSc. Over the last 11years I have worked with the Sheffield Hallam University Lincolnshire based in Grantham, Practice Based Learning (PBL) occupational therapy students, (there is also a physiotherapy PBL programme). The programme is coming to an end, due to loss of commissioning / bursaries etc., as noted earlier. Students on the programme have come from a wide range of mostly support worker backgrounds and bring a rich diversity of knowledge skills and experience, which is of great benefit to both occupational therapy and physiotherapy services for Lincolnshire and beyond.

Anita mentioned working with Lincolnshire talent academy. She spoke of having much enthusiasm for such a proposal and the opportunities it could offer the profession. On a humourus note Anita  mentioned naivety, as initially she didn’t realise that this would lead to the national development for the profession and the amount of work this would involve. It is very clear to see her passion and commitment to developing the apprenticeship programme.

Theresa went on to talk about the work of the trail blazer group and how they set about making sense of a very new way of developing a teaching programme that would fit with the requirements the Institute For Apprenticeships (IFA), Health Care Professions Council (HCPC), Royal College Occupational Therapy (RCOT) and College Physiotherapy and also the employers of such apprentices, this included needing to gain the support of numerous stakeholders who would be committed to such a programme. This task is simply awe inspiring, I can only think that Theresa, Sue,  Anita and other members of the trail blazer group must have used every ounce of knowledge, skills, expertise and creative thinking in their combined tool bags to bring this amazing apprenticeship programme together.

A number of challenges have included needing to hold on to the word of occupation within the document. The IFA had insisted it should state activity. Standing firm, the word occupation (core to profession of occupational therapy) was finally accepted and is now an agreed term, part of the outline standards document. No mean feat as this is strictly limited to three A4 sides and 12 point Font. No room for squeezing in extra phrases or words.

Careful on-line consultation with subsequent meticulous analysis of all returning comments gave further amendments to the standards documents.

The Apprenticeship standards documents critically is required to map all the standards of proficiency as stated by HCPC.

The IFA finally accepted the standards document on 23 May 2018. This is very hot off the press news and an amazing achievement in a short time scale.

This degree level apprenticeship for occupational therapy essentially is the same as BSc Hons degree with HCPC accreditation and RCOT. It is 360 credits

The end point assessment EPI is approached differently to meet the specific requirements of IFA. It is the final assessment as it obviously states, with specific modes to ensure it is approved under IFA.  The trail blazer group have needed to discuss and carefully negotiate to make all of this come together.

Small group discussions around the potential benefits and challenges of such an apprenticeship for occupational therapy were encouraged and this was followed by opportunity for questions to be put to Theresa, Anita and Sue.

Some of the topics covered:

  • Apprentices will be earning a wage while they are studying. Therefore this enables people from variety of backgrounds to apply and importantly without the burden of the usual student debt. Getting paid is a big plus.
  • Student experience, it may well be different from other occupational therapy programmes but there are already a range of programmes such as full time BSc Hons, Pre-reg MSc, part-time degree courses, this can be seen as just another route which widens accessibility for occupational therapy training. Variety in training programs means different opportunities and will only strengthen diversity for the profession. This apprenticeship programme will have its own benefits and challenges for students. Those students who wish to choose a course which also enables what may be called the student experience may well choose a full time programme.
  • Loyalty of graduates to their initial employers. This was explored at length and reminded me of similar discussions about the PBL programme The reality agreed is that the PBL graduates, the majority have stayed in Lincolnshire and continue to work in occupational therapy services. It is expected that the apprenticeship graduates will follow a similar path.
  • Student Practice Placements, will there be enough out there for them? A resounding yes!! Plenty of capacity.

This is a fantastic opportunity for the occupational therapy profession, physiotherapy will be also taking this opportunity. It is one brilliant way forward to grow the occupational therapy profession, to promote diversity in our students, new graduates, future experienced occupational therapists and educators.

I reflect now again on my own occupational therapy 4yr part time degree, I was so excited and full of enthusiasm, hungry for my learning opportunity. I think of the people I have worked with over many years and now as Associate Lecturer I can continue to influence the next generation. I think that I have proved my worth along the way and will continue to do so, a good return on the initial investment

All the best for the occupational therapy Apprenticeship Degree Programme !! And finally we owe thanks to the Trail Blazer Team.

This blog has been written by Catherine McNulty find me on Twitter @cathymc9781

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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

Screen Shot 2018-06-14 at 20.43.20

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