#OTalk 16th June 2020 – Leadership? What me!

This week Natalie Jones @natlouj and Dee Christie @OTinretirement will be hosting this what they had to say. 

growth mindset

In 2018 Karin Orman RCOT’s Lead Professional Advisor posted a blog about Leadership in Occupational Therapy, challenging us ‘to think differently about how we grow leadership within the profession and to start thinking about ourselves as leaders.’ Karin hits on an issue which is important to me. “We may have, in many areas of practice, lost our traditional management structure but that does not have to mean we lose leadership within the profession”. 

I recently wrote an article about this in OTnews (Jones 2019) describing my voyage into professional leadership. This challenge from Karin resonates with my experience of therapy management structures. Over the last ten years we have moved towards integrated teams and allied health professional leadership has taken root. Which means single profession line management is no longer the ‘norm,’ you are more than likely to be managed and led by someone from another professional background and this brings both challenges and new opportunities. Occupational Therapists that don’t have a professional led talk about ‘not having a voice’, or the ‘OT voice is not loud enough’.  This makes it more important to think about and reflect on opportunities to lead and influence, regardless of the organisational structures you work in.

It’s no accident that the 3rd pillar of the RCOT Career Development Framework is leadership. It starts at entry level where newly qualified OTs can act as role models to promote the profession and find ways to lead by sharing their unique contribution to occupational therapy. Right through to level nine where executive leadership is described as ‘Lead and influence the political and economic

climate, locally, nationally and internationally, which impacts on service delivery’.  The last column in the framework is titled ‘mind-set’. It’s this word that I would like us to reflect on in today’s #OTalk. 

What is a leadership mindset? Do you have one? You might recognize the traits in yourself or others? It’s interesting to reflect firstly on ‘what does a good leadership mind-set look like?’ You will have positive roles models that have influenced your career, you will have also experienced the converse and perhaps can describe what this looks and feels like. It’s worth taking some time to explore what qualities and values you would like to lead with? Once you have identified these you can then think about creating opportunities for yourself to develop your skills and knowledge aligned to your leadership aspirations, thereby creating ‘the leadership mind-set’. 

All too often I have observed excellent Occupational Therapists at all levels in their career, that have a lack of self and professional confidence. Despite the apparent evidence of competence, the imposter syndrome (IS) hits.  Chris Lake describes imposter syndrome (IS) in his blog on leadership and self-doubt. https://www.leadershipacademy.nhs.uk/blog/leadership-doubt-and-humility/

“You’ll remain convinced that you do not deserve the success you’ve achieved, dismissing this as luck or fortuitous timing”. Psychologists might describe the phenomenon as ‘failing to internalise your accomplishments, unable to believe that you yourself are deserving of the position you’ve achieved’. How often have you brushed off a complement? Chris offers some tips for when IS strikes, ‘believe that it’s normal and look around the department at those you admire, and know they’ll experience this too’. 

If you identify with imposter syndrome, how do you build personal and professional confidence so that you feel able to take leadership opportunities when they come along? What tips do you have to share with others about how you have overcome the nagging and disabling self-doubt? If you were mentoring yourself on leadership mind-sets and building self-confidence ‘what would you tell yourself’? If you’re not able to hold up the mirror and do some self-reflection, what about getting a leadership mentor?  A mentor with the experience, skills and knowledge to provide you with constructive feedback and a friendly listening ear. They don’t need to be from the same profession as you. A mentor is someone who will nurture you as a leader, help you see different perspectives and at times help you wrestle with the imposter syndrome monster who lives under the bed. I have had several mentors and role models which haven’t been Occupational Therapists, however they have brought to the relationship many other skills, qualities and experiences that were valuable and supported my leadership development. 

Perhaps you are already on the leadership journey and can share with the #OTalk community some examples of ways in which you have developed as a leader? What strategies have you tried and tested in your leadership journey so far? 

What opportunities are there for you to experience leadership in your role. Novel and new opportunities open you up to situations and people you would normally not get exposure to. What about trying a ‘shadow board’ where you emulate an executive board with peers using the same papers and have your own ‘mini’ board to experience what the conversations might be like and explore new points of view? These experiences could add richness to your leadership development, gaining new skills and knowledge. 

Occupational Therapists are natural problem solvers and with a dash of creativity I’m sure you can contribute ideas for others about how to develop learning opportunities and environments, which will be added value to the leadership voyage. So, if we put our collective brains together, can we come up with some new and novel activities for continuing professional development, to enhance leadership skills and knowledge?

There have never been more opportunities for Occupational Therapists to move into leadership roles. From leading a Band 5 peer support group, to pioneering in a new and emerging roles, to AHP Director roles in the NHS and Principle OT roles in Social Care. Stuart Palma, Head of Allied Health Professions (professional leadership) at NHS England and NHS Improvement produced some recommends that the NHS starts to explore having Chief AHP within their organisations, creating greater visibility at board level. There are already OTs taking up these positions. https://improvement.nhs.uk/resources/investing-chief-allied-health-professionals/  we must be ready!

So why is ‘mind-set important in leadership? A growth leadership mind-set is a belief that you can change, develop and improve your leadership skills. Research has shown that those with a growth ‘mind-set’ are mentally prepared to take on challenges, adapt to feedback and adopt effective problem-solving’.  As a leader I am continually learning and motivated towards self-improvement. Mastering leadership skills to create a toolbox which helps with mental preparedness when engaging with new and difficult situations. I am opening minded about taking opportunities that don’t always come with the ‘OT’ job title. Stepping out of the professional comfort zone is a risk, but it can work out to be the best risk you ever took. Last year I took an opportunity to work in an integrated care system workforce hub, to support workforce innovation and development This was completely different to anything I’d ever done before but I found my self-utilising every skill in the tool box labelled ‘leadership’. I managed to influence the development of Occupational Therapy roles in primary care, which resulted in a primary care network employing an OT for a frailty project. A ‘small change’ which I hope will have a ‘big impact’ and ripple effects for years to come. 

Experience of leadership coaching has taught me that taking time to reflect and explore my own leadership mind-set is a good starting point for a developing leader. Opportunities for OTs to be ‘loud and proud’, have their voice heard and be present in the room are abundant but we need to first of all create ‘a leadership mind-set,’ to be able to grasp and seek out these opportunities.

This #OTalk is in collaboration with Dee Christie Chair of the Elizabeth Casson Trust. https://elizabethcasson.org.uk/about-us/ The trusts strategic intensions include helping to develop leaders in occupational therapy with the capability of taking the profession forwards within the context in which it needs to operate. The Elizabeth Casson trust considers leadership within the profession to be the ability to envision, articulate and clearly demonstrate by example the scope and benefits of occupational therapy to individuals and society as a whole thereby positively promulgating the profession to as wide an audience as possible”.

Questions 

  1. what does good leadership ‘mind-set’ look like? 
  2. How do you build personal and professional confidence so that you feel able to take leadership opportunities when they come along?
  3. What strategies have helped you develop as a leader? 
  4. What novel activities have you used as part of your continuing professional development to enhance your leadership skills and knowledge? 

Why is leadership such a hot topic for occupational therapists right now? Karin Orman 23rd of April 2018 https://www.rcot.co.uk/news/why-leadership-such-hot-topic-occupational-therapists-right-now 

Jones, N (2019) The Voyages of Professional Leadership. OTnews 27(11): 22-24.

 Chief Allied Health Professions Officer’s Team (2017) AHPs into Action. Using Allied Health Professions to transform health, care and wellbeing. Available at https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf (accessed 26 March 2019).
Google Scholar

Faculty of Medical Leadership and Management (2018). Barriers and enablers for clinicians moving into senior leadership roles. Available at https://www.gov.uk/government/publications/clinicians-moving-into-senior-leadership-barriers-and-enablers (accessed 7 January 2019).
Google Scholar

Royal College of Occupational Therapists (2017) Career Development Framework: Guiding Principles for Occupational Therapy. London: Royal College of Occupational Therapists. Available at www.rcot.co.uk/careerdevelopmentframework (accessed 27 February 2019)
Google Scholar

#OTalk – 9th June 2020 – The Occupational Therapy role in Epilepsy assessment and intervention

This week @GarroneJuliana is hosting.

I thought the topic of the role of Occupational Therapy in epilepsy would be a valuable one to discuss. Throughout my MSc it was not discussed in great detail and I would love for people to share ideas with one another on this topic. As part of my education I completed a research project (thematic analysis) looking at quality of life in youth with epilepsy. It was a valuable project that opened my eyes to the various areas where OT can be involved with those who have epilepsy. It highlighted how a range of occupations can be impacted by a diagnosis of epilepsy. Additionally, I am currently completing a Community Development placement at an Epilepsy non-profit in Canada. Our project is to create a “Personalized Seizure Plan” focusing on how an individual’s occupations are impacted by epilepsy so they can education their caregivers, teachers, health care professionals, etc.

 

Epilepsy and its varied seizure types effect the physical, social, emotional, spiritual, recreational and vocational functioning of individuals and their families (Clerico, 1989). Occupational therapists can help find out why people have problems with activities of daily living and teach them ways of adapting or compensating for the problems (Epilepsy Foundation). In addition to the physical and social implications of epilepsy, epilepsy affects cognition, mood, affect, memory and attention (Motamedi & Meador, 2003).

 

I believe Occupational Therapists should be a necessary health care professional involved in the care of those with epilepsy. Our role as client-centered practitioners can be utilized extensively in this area. Advocating for ourselves as clinicians in epilepsy care, as well as our clients is vital.

 

Questions:

  1. What does quality of life mean to you?
  2. What is your understanding of the OT role in epilepsy care?
  3. How can we promote a need for OTs to work with this population?
  4. What occupations are most affected by epilepsy?
  5. Does the OT role differ when comparing the broad range of epilepsy types?
  6. How can we advocate for the role of OT in epilepsy?

 

Thank you for your time!

-Juliana

#OTalk 26th May 2020 – How important is Posture Management?

This week Lauren Osborne @LaurenOsborneOT is hosting here is what she had to say,

I’ve just completed my MSc in Rehabilitation and Posture Management and my dissertation was a scoping review looking at “What is the evidence for 24 hour posture management?”. I concluded from the literature that posture management is a pre-requisite to occupational performance and therefore, I feel that it should be central to our work as OTs when working with people with complex physical disabilities. I would like to see it as part of the pre-registration OT training and to develop national guidance and NICE guidelines. I believe that posture management is a safeguarding and human rights issue because the people who need it are unable to change position independently and therefore rely on others to protect their body shape from distortion caused by gravity, which can have devastating effects through the development of skeletal deformities and contractures, leading to compromised respiration, digestion etc.
My questions for the discussion are:
1. What is your understanding of the term 24 hour posture management?
2. Did your pre-reg course include any training on posture management and/or positioning for people with complex physical disabilities?
3. How confident would you feel to assess a person for postural seating or night-time positioning equipment?
4. When assessing people’s ADLs, do you consider their posture e.g. can they sit unsupported to use their hands freely? Can they hold their head up to see?
5. If someone is unable to sit upright with their arms free and hold their head up, how can we as OTs best support them to engage in activity?
6. What could you do in your setting to increase awareness and knowledge of the importance of posture management?

#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 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)