#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)

#OTalk Research 7th April 2020 Overcoming Barriers to Engaging in Research

This weeks OTalk Research is hosted by Suzanne Simpson @SimpsonResearch here is what she had to say. 

 

During my time at my first NHS trust I developed an interest in the invisible injuries patient’s experience as a result of an acquired brain injury (ABI) thanks to some inspiring colleagues. As a band 6 I developed my knowledge and skills in cognitive assessment and intervention alongside neuropsychologists and experienced occupational therapists. I started to see the inequality in the care available to those with physical impairments compared to cognitive impairments, with the latter often missed by the multi-disciplinary team or not able to access appropriate rehabilitation (Benedictus et al, 2010; Turner-Stokes, 2003; Sinclair et al, 2014). My interest in ABI and cognitive impairments continued as I worked for other trusts eventually leading to me working at The Walton Centre. 

One afternoon in 2015 my therapy manager asked whether any staff members would be interested in applying for a part time funded MRes. My thought: ‘I can’t; I’m not clever enough’ as I had flashbacks to my undergraduate days. With lots of encouragement and support from the team I applied, was interviewed and I was offered one of only two funded places. The bulk of the course focused on the completion of a research project requiring full NHS ethical approval. I chose to carry out a feasibility study exploring the use of a cognitive functional screening tool I’d developed. The outcome of the study was that the tool required development to establish its validity and reliability. However within The Walton Centre the tool is used by members of the MDT (Vascular Nurses, Trauma Therapy Coordinator) in collaboration with the occupational therapists on the ward to inform referral for further functional assessment. From a personal perspective I loved the experience of leading my own research and changing practice, I wanted more! The research bug had well and truly taken hold. I graduated from Edge Hill University with a Masters in Clinical and Health Research in 2018.

Fast forward to March 2020. I’m working in a unique and innovative new role implementing evidence based practice and influencing service developments with the aim to improve the psychological wellbeing of people living with motor neurone disease. Alongside this role I’m the trust’s Making Every Contact Count Lead, supporting staff to help our patients lead healthier lives. Both roles use a lot of the skills I developed during my MRes. I’m proud to say I currently hold an honorary research associate role with Liverpool University and I was awarded a National Institute for Health Research NHS Research & Development North West Bridging Scheme. I’m involved with the North West Coast Applied Research Collaboration and I’m contributing to their work around social prescribing an area I’ve developed a keen interest in. Alongside Salford University Occupational Therapy they are supporting me to build an application for a doctoral fellowship.

In 2019 the Royal College of Occupational Therapists published the RCOT Research and Development Strategy 2019–2024. In recognition of the changing landscape the strategy states that ‘it is crucial that we use evidence-based interventions, robustly evidence the impact and the cost-effectiveness of our services, and continue to expand the evidence base, particularly as the scope and nature of practice evolves. Engaging in and with research is therefore central to the role of every occupational therapist in the UK, wherever they work.’

There is considerable evidence of the challenges that occupational therapists face when trying to engage in research and these have been discussed in previous #OTalk Research chats.   There is however less evidence of how to overcome such challenges.  This #OTalk Research chat will explore some very practical approaches through my own individual journey with the hope of inspiring and generating creative solutions to support others.  You never know you might catch the research bug too. 

Questions:

  1. What is inspiring/what inspired you to get involved in research?
  2. How did you take your ideas or clinical questions forward?
  3. How have you overcome the challenges in your own areas?
  4. What helped i.e. who/what/how/when?
  5. What have you learned that might help others?
  6. What would be your one top tip to any occupational therapist considering involvement in research? 

#OTalk 31st March 2019 – Occupational Therapy’s role in Domestic Violence

@Alannah_OT is our guest host this week this is what she has to say

This topic is sensitive and difficult and I want to ensure that the appropriate warnings are in place for conversations that may take place during this OTalk for anyone who has experienced domestic violence.

Last year I wrote an essay for one of my final assignments in my degree. We were given the opportunity to choose an area of practice that may be considered contemporary or role emerging. I chose to write on the topic of what an occupational therapists role would look like working with survivors of domestic violence and trauma. It is an area that I wanted to educate myself on but also to understand what services and support look like for survivors. I have summarized my findings below.

Domestic violence  is serious issue in society, where human rights are not fulfilled which emphasizes he restriction of participation in meaningful occupations (Townsend et al., 2010). Domestic violence is a pattern of incidents of controlling, degrading, threatening, and violent behaviour (Women’s Aid, 2018), that an estimated 70 percent of women worldwide have experienced in their lifetime (WHO, 2013; UN Women,2018). Syron (2010) suggests that domestic violence disrupts an individual’s participation and engagement in meaningful occupations, daily living and social interactions, causing survivors to experience aloss of empowerment, self-esteem, loss of identity and quality of life (Underwood, 2009; Dysinger et al., 2015).Occupational therapists have person- centered, therapeutic reasoning, and analytical skills to address occupation-related and well-being concerns of survivors of domestic violence (Dysinger, 2011; Dysinger, 2015), facilitating an individual’s ability to participate in meaningful occupations, leisure, work, play, and activities of daily living (Helfrich et al., 2006; Underwood, 2009; Jahaverian, 2010). Though there are occupational therapy roles that involve domestic violence history or trauma, there is limited evidence to demonstrate the success in practice or where these practices are taking place.

A survey completed by survivors showed inconsistent care in services across the UK, with many areas offering generic services without specialized input (Coy et al., 2009; Roddy, 2013). Wilson, Fauci, and Goodman (2015) suggest bringing trauma-informed practice to domestic violence programs, which develops goals and needs from an individual’s experience of trauma and considers their choice, control, and safety. This topic exposed gaps in current practice, revealing that occupational therapists may have inadequate knowledge and negative views about the area of domestic violence and unwilling to veer away from traditional practice (Hammell, 2018).

The aim of the OTalk is to encourage a conversation around occupational therapists experience, knowledge, views, and skills in working with individuals who have experienced trauma through domestic violence.

  1. Do you have any experience working with individuals who have experienced domestic violence? If so, what setting?
  2. What do you think are the occupational disruptions of survivors of domestic violence?
  3. What do you think the occupational therapy role can provide for survivors or people who are currently experiencing domestic violence?
  4. Do you think  occupational therapists could do more to explore and implement trauma-informed care for this population?
  5. What do you think are the key challenges of implementing occupational therapy in domestic violence services? If so, how could this be challenged?

References:

Hammel, K. (2018) ‘Opportunities for well-being: The right to occupational engagement’, Canadian Journal of Occupational Therapy, 84(4-5), pp. 209-222. Available at: http://journals.sagepub.com/doi/full/10.1177/0008417417734831(Accessed: 4 November 2018).

Jahavarian-Dysinger, H., et al. (2015) ‘Occupational Needs and Goals of Survivors of Domestic Violence’, Occupational Therapy in Healthcare, 30(2), pp. 175-186. Available at: https://www.tandfonline.com/doi/abs/10.3109/07380577.2015.1109741 (Accessed: 2 November 2018).


Javaherian-Dysinger, H. and Underwood, R. (2011) ‘Occupational Therapy Services for Individuals Who Have Experienced Domestic Violence’, American Journal of Occupational Therapy, 65(6), pp. S32-S35. doi:10.5014/ajot.61.6.704.

Javaherian-Dysinger,H. and Underwood, R. ( 2011 ) ‘Occupational therapy services for individuals who have experienced domestic violence’, American Journal of Occupational Therapy, 65(6), pp.32-45.

Syron,C. (2010) ‘The Role of Occupational Therapy with Domestic Violence Survivors’, Emerging Practice CATS, 2. Available at:https://commons.pacificu.edu/cgi/viewcontent.cgi?referer=https://www.google.co.uk/&httpsredir=1&article=1003&context=emerge(Accessed: 30 October 2018).

Underwood, R. (2009). Care of self: Construction of subjectivities of low-income, female survivors of domestic violence as they pursue postsecondary education. University of Georgia: Athens.

UN Women (2018) Facts and figures: Ending violence against women. Available at: http://www.unwomen.org/en/what-we-do/ending-violence-against-women/facts-and-figures(Accessed: November 12 2018).

World Health Organization (2018) Violence Against Women. Availabe at: http://www.who.int/news-room/fact-sheets/detail/violence-against-women (Accessed: 7 November 2018).

Women’s Aid (2018) What is Domestic Abuse?. Available at: https://www.womensaid.org.uk/information-support/what-is-domestic-abuse/ (Accessed: 7 November 2018).

#OTalk – 24th March 2020 – Experiences of the Journey From a Service User to a Professional.

This week @GeorgiaVineOT and @margaretOT360 will be hosting here is what they had to say.

Being able to empathise rather than just sympathise with a service user will enable a better therapeutic relationship but, when the understanding is so strong it can be challenging to deal with the emotional response.

I’ve always been open about that fact that I’ve had occupational therapy input when talking with service users, and I always will be, although, because I have had occupational therapy myself it holds me back during intervention implementation.

Anyone who knows me well knows that I am very determined and like to aim high in anything I do especially when it comes to my studies, but this emotional barrier is proving to be more difficult to get over than I initially thought.

I’ve had OT input ever since I was born and have always been a service user so, it’s hard to believe that I’m suddenly playing a collaborative role in the professional decision-making process. It’s okay that I feel this way and I’m grateful that my previous educator pointed this out as without her input I probably wouldn’t have realised it was holding me back so much and that’s even worse. This is because if I didn’t know what the problem was then how could I have done anything about it? Not that I’ve reflected I think I was holding back as I didn’t believe in my professional capabilities since I’vealways been the service user. Although I’m not a service user now it’s still hard to believe that I’m the professional as the tables have been completely turned.

Supervision is key, placement is a massive learning opportunity and, it enables me to make more sense of my situation and gain insight into what my limitations are going to be in the world of work.

Due to my disability being so visible I can’t make a clinically reasoned decision to disclose.

I’m always going to get questions about my disability and my capabilities within occupational therapy. These questions don’t annoy me as such because me disability is always going to be the elephant in the room, we all know how diverse OT is, so I know there is a role out there for me. However, I’d be lying if I said that at times, I don’t question myself about my future role.

Am I a service user, a student, a healthcare professional or all 3? At times I get confused over who I am, and which role plays the biggest part. Am I lacking in confidence because I’m a student or is it because I’ve been on the other side of the fence? I’m still working on this transition as it’s not going to happen overnight and will be a slow process.

As a second-year student this transition needs to happen sooner rather than later, because I have only got one more placement left after this one, and I want to feeling competent.

Now, I am doing a ground-breaking, virtual placement my confidence has grown, as I now know the area of OT that I want to work in, but due to that nature of my virtual I’ve had minimal contact with services users. In which this makes me feel a bit apprehensive for my next placement as when I go on placement it will be over a year since I’ve had face-to-face service user contact.

I want to leave the course feeling like I gave it my all with my personal experiences adding to my journey.

I wanted to do an OTalk to ask questions to those who may have had similar experiences, to enable me to make sense of my situation in order for me to reflect on my past, present and future as part of my placement experience …

Q1. What experience do you have of being a service user e.g. family members, personally, or an extended family member?

Q2. How does this experience effect your own views on the delivery of occupational therapy and its values?

Q3. Have you ever been in a situation as a therapist where you’ve had to disclose your own experiences of being a service user, if so, how did this affect the outcome?

Q4. What is the most useful piece information you could share with the OT community, about your experiences to enhance practice?

Q5. What online communities are you or your client’s part of, and how is access to these communities useful to you?

#OTalk 17th March 2020 – Student vision and internationalisation with @SPOTeurope

This week SPOT EUROPE BOARD @SPOTeurope are hosting here is what they had to say

As the SPOT Europe Board, we aim to encourage and increase internationalisation and OT student connection across Europe, as well as ensure students voices are heard in the development of Occupational Therapy education. We are passionate about using the board to connect with other students to exchange experiences, opportunities, knowledge and ideas.

The idea was developed at the European Network of Occupational Therapy in Higher Education (ENOTHE) Congress and since then has made huge progress! SPOTeurope is run by students for students and, as such, thrives on new students getting involved.

Questions.

What does internationalisation mean to you and what opportunities have you had in your curriculum / practice for this


What is your vision for internationalisation? And how could this impact your studies /practice.

Has your vision of internationalisation changed since starting your studies / practice?

What opportunities do you wish you could have for internationalisation? What skills and challenges are there to this?

The SPOTeurope Board

Post chat updates:

Online transcript from HealthCare#

PDF of transcript: #OTalk 17 March 2020

The Numbers

2.170M Impressions
412 Tweets
31 Participants

#OTalk Participants

 

 

 

OTalk – 10th March 2020- The third sector: experience of a newly qualified OT. 

This week out host is Sophie Cresswell @93SophieC here is what she has to say.

This time last year I was taking the final steps in my Occupational therapy degree, ready to don my green trousers and enter the wonderful world of OT!  During my training I was lucky to have placements in a broad range of settings from paediatrics to palliative care which helped me to develop my clinical reasoning and ‘bread and butter’ skills. A notoriously difficult area to get a placement in was complex learning disabilities and PMLD, this is where my previous role as a support assistant had given me insight into the OT role with this population. 

When an opportunity came up for a band 5 position at a specialist college for young adults with complex physical, learning and communication needs I jumped at the chance. A year on and I am loving the diversity of clinical input and the opportunity for creativity that the role offers.

Around 60% of occupational therapists work within the health sector, providing essential input to individuals from all walks of life. Occupational therapists are becoming an integral part of diverse services such as in charities, ambulance services and within community centers. In recent years, strategies and initiatives such as the NHS five year forward have placed focus on preventative measures and supporting individuals to remain healthy and independent in their own homes wherever possible.

In response, occupational therapists are working in more diverse and non-traditional settings than ever. However these posts are generally less accessible to newly qualified therapists, often requiring direct experience in the field or several years of practice under the belt.  

This chat aims to explore the options and opportunities for newly qualified therapists in a range of diverse settings and examines how we can create more opportunities and develop as a practitioner in a non-traditional setting. The following questions will be considered:

  1. What are the main factors influencing/that did influence your first post as a newly qualified?
  • Direct experience of entering 3rd sector
  1. What are the possible benefits and challenges of entering a static, 3rd sector post as a newly qualified practitioner?
  1. What do you think could be done to open up doors for newly qualified therapists in 3rd sector settings?
  1. What resources and strategies could you use as a newly qualified to support your development as a practitioner in a non-traditional setting – where formal preceptorship may not be available?
  • RCOT resources
  • Peer supervision 
  • Keeping up with CPD events e.g. the OT show

 

Post chat updates

Online transcript from HealthCare# Project.

PDF of transcript #OTalk 10 Feb 2020

The Numbers

858.453K Impressions
263 Tweets
52 Participants

#OTalk Participants

#OTalk Research 3rd March 2020 – What is commercial research and is there a role for occupational therapy?

This #OTalk will be led by Dr Jenny Preston, Consultant Occupational Therapist @preston_jenny

Research studies are generally classified within two main categories:

  1. Commercial
  2. Non-commercial

Commercial research is the term used to describe studies that are sponsored and funded by pharmaceutical companies or biotech industry for commercial purposes.  If the study is sponsored by the NHS or an Academic Institution then it is defined as non-commercial research.  

Clinical trials are essential to the development of beneficial treatments for NHS patients as the consumers of medicine and healthcare.  Clinical trials supported by the pharmaceutical industry play an important part in keeping the NHS at the forefront of modern treatments and research (NHS R&D Forum, 2005).  In addition, commercial research activity offers clinicians early access to the latest technologies for diagnosing and treating disease and is essential for the development of new medicines and healthcare technologies.  

Research active occupational therapists are more likely to engage in non-commercial research studies although there are increasing opportunities for occupational therapists, as part of clinical research teams to become involved in commercial research.  The Government is committed to promoting partnerships between the NHS and other funders of R&D, for the benefit of the health and wealth of the nation. The NHS is encouraged to support commercially sponsored research and views it as an opportunity to: 

  • Participate in drug and device development 
  • Evaluate new equipment 
  • Become involved with the development of improved treatment for current and future NHS patients 
  • Promote partnerships between the NHS and commercial research sponsors
  • Generate income for re-investment back into research, facilities and patient care 
  • Attract and retain staff 

Research-active NHS Trusts that value participation in commercial research as an element of their clinical research portfolio should ensure that their management arrangements can support the necessary work involved in negotiations and trial co-ordination. A Trust must recognise that for the pharmaceutical, device, or equipment industry to consider the Trust a suitable site to participate in commercial clinical trials, it must be able to demonstrate that it can (NHS R&D Forum, 2005) : 

  • Provide the service that the sponsor requires 
  • Provide the service to an appropriate level of quality 
  • Provide the service at the right price 
  • Ensure the sponsor is made aware of the service that is available 

Throughout this chat we will consider the potential opportunities for occupational therapists to become involved in commercial research through discussion of the following questions:

  • Do you have any experience of commercial research?
  • What sorts of tasks were you involved in?
  • How did you get involved in commercial research?
  • What were the benefits and challenges?
  • Are there any ethical concerns or conflicts of interest for occupational therapists?
  • Is there any additional training required to engage in commercial research?

POST CHAT

Online Transcript

#OTalk Transcript March 3rd 2020

The Numbers

226.226K Impressions
40 Tweets
12 Participants
32 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants