#OTalk 13th March – What does the term participation mean in mental health?


This weeks #Otalk is on the topic of “Participation” and will be hosted by Tori Wolfendale (@Tori_Doll).

Tori Wolfendale is a Specialist Occupational Therapist working within an intensive rehabilitation mental health environment. At present, she is involved as the Research Director for the VdT Model of Creative Ability Foundation UK and is also a member of @MOT1ON_Research – she has a keen interest in contributing to the evidence base for Occupational Therapy interventions, focusing predominantly on the implementation of the VdT Model of Creative Ability within adult mental health services.

What is the Mental Health Occupational Therapy Interventions and Outcomes Network (MOTION)?

@MOT1ON_Research was set up by Dr. Mary Birken in April 2017 to bring together Occupational Therapists interested in adult mental health intervention effectiveness research in the UK. This was as a result of the review of “Recovering Ordinary Lives: the strategy for occupational therapy in mental health services 2007 to 2017”, (College of Occupational Therapists, 2006) whereby it was identified that a key concern for Occupational Therapists working in mental health is the lack of quantitative evidence of effectiveness of sufficient rigour to be included in clinical guidelines, such as those produced by the National Institute of Clinical Excellence (Smyth, 2014). Commissioners also identified that demonstrating evidence of effectiveness and cost effectiveness is a priority for Occupational Therapy in mental health. To respond to the need to carry out rigorous research to test the effectiveness and cost effectiveness of Occupational Therapy in mental health, MOTION was developed. The aim of MOTION is to bring together Occupational Therapists interested in researching this topic to tackle the common barriers to carrying out effectiveness research in this area, for example, lack of agreement on outcomes and outcome measurement, and Occupational Therapists working generically in community mental health services.

MOTION has recognised that the concept of ‘participation’ is increasingly becoming an important outcome for assessment in many fields, including development, disability and policy implementation. However, selecting specific instruments to measure participation has been a significant problem due to overlapping conceptual definitions and use of different theories. Furthermore, following the first meeting of the MOTION working groups, which focuses on participation as an outcome measure and measures of participation. The aim of this particular working group is to explore the literature on participation and outcome measures within adult mental health services. As a result, in order to obtain an understanding of what the term ‘participation’ means within mental health services from an occupational therapy perspective, MOTION decided to explore this topic within the #OTalk forum.

For more information about MOTION, please visit:

https:// motionresearch.wordpress.com

How is participation recognised within existing literature?

Occupational Therapy is a client-centred health profession concerned with promoting health and wellbeing through occupation. The primary goal of Occupational Therapy is to enable people to participate in the activities of everyday life. Occupational Therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement (WFOT, 2012).

Rice (2011) states that Occupational Therapy is concerned with the meaning that individuals’ place on activities and occupations that are carried out in their daily routines. Participation in these activities is influenced by an individual’s motivation, experience, abilities and limitations. Occupational Therapists are therefore trained to evaluate a person’s abilities and limitations in a variety of life spheres in order to establish a baseline performance which is used to plan for treatment and is then evaluated using a specific outcome measure – within the current service that Tori is working in, the Activity Participation Outcome Measure (APOM) is used to measure the outcome of specific domains, including; processing skills, communication and social interactions skills, life skills, role performance, balanced life style, motivation, self-esteem and affect.

Clinically, a person’s role participation becomes the focus of the Occupational Therapist when disability-related limitations affect a person’s capacity to participate in desired and meaningful roles. Occupational Therapists aim to assure that persons with a disability have the motivation, opportunity, and capacity to overcome disability-related limitations and participate in social life. The International Classification of Health, Disability and Function (ICF) defines participation as “involvement in life situations” different than it defines activities which are “the execution of a task or action by an individual”. Furthermore, the ICF states that participation naturally occurs when clients are actively involved in carrying out occupations or daily life activities they find purposeful and meaningful. More specific outcomes of Occupational Therapy interventions are multidimensional and support the end result of participation. Despite the difference in definition, the ICF places both activities and participation together within existing literature – this ambiguity has resulted in an entire thread of literature as rehabilitation researches seek to identify ways to approach the measurement of participation.

Questions to consider within the #OTalk chat:

Q1: What does the term ‘participation’ mean to you/your service users?

Q2) Is participation an important measure within mental health services, if so how?

Q3) Do you consider occupational participation throughout the occupational therapy process, if so how?

Q4) How does the physical, social, cultural environment impact on participation within inpatient and community mental health services?

Q5) How do mental health services define ‘participation’ in meaningful occupation?


College of Occupational Therapists. (2006), Recovering Ordinary Lives –the strategy for occupational therapy in mental health services 2007-2017. London: COT.

Rice, C., M. (2011). The development of an assessment protocol for activity participation in those suffering from mental illness The development of an assessment protocol for activity participation in those suffering from mental illness.

Smyth, G. (2014), “Recovering Ordinary Lives: the success, challenges and future”, Occupational Therapy News, Vol. 22, No. 9, pp. 22-23.

World Federation of Occupational Therapists. (2012). Definition of Occupational Therapy. Available: http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx. Last accessed 15th January 2018.

Post Chat

Online Transcript

#OTalk Healthcare Social Media Transcript March 13th 2018

The Numbers

936.728K Impressions
374 Tweets
53 Participants
299 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants

Data for #OTalk can be up to 15 minutes delayed



#OTalk Research – Tuesday 6th March: The National Institute for Health Research Integrated Clinical Academic Schemes (ICA): An opportunity for Occupational Therapists

March’s #OTalk Research is being hosted Professor Pip Logan and supported by Jenny Preston from the #OTalk Research team.


The National Institute for Health Research Integrated Clinical Academic Schemes (ICA): An opportunity for Occupational Therapists


This talk will cover a number of issues related to the National Institute for Health Research


The National Institute for Health Research celebrated its 10 year anniversary in 2016. Their strap line is Improving Health and wealth of the nation through research. It is the largest national clinical research funder in Europe with a pot of £1 billion per year. It is funded by the Department of Health and Social Care and has a number of different strands. One of the key aspects is that it is not just research for the National Health Service it is a place for occupational therapists working in social care, local authorities and charities to get involved. Through supporting research, infrastructure, training researchers, training clinical academics, disseminating research and implementing it into practice the NIHR provides a place for occupational therapists to complete masters, PhDs, advanced training leading to Professorships and consultancies.


The 2016 Strategic Review of Training looked proactively at future training needs. It acknowledged that there has been considerable changes in healthcare needs and technological advances, as well as changes in the nature of the academic workforce. Approval was given to the development and delivery of an NIHR Academy Strategy ensuring that the NIHR Academy both meets the needs of the wider research community and other key stakeholders now and in the future, and is fully and dynamically linked with NIHR and DH strategy. This document states that professions such as occupational therapy are areas that the NIHR would like to support, however very few applications come from occupational therapists.


The Integrated Clinical Academic Schemes (ICA), which is a dedicated strand for Nurses, midwives and AHPs is part of this Academy and I am the Lead Advocate for the Occupational Therapists and therefore link the Royal College of Occupational Therapy with the NIHR. I have a team of five other Occupational Therapists and we are here to help you become clinical academics. Plus I also chair one of the committees that reviews the Doctoral training applications and I sit as a member on the Health Technology Board. If an occupational Therapist applies to the NIHR to do a fully funded PhD, and I am not conflicted, than I will see the application and most likely get to review it and interview the candidate. However we get so few applications from occupational therapists.


For example of the NIHR ICA awards 40% are held by physiotherapists, 17% by dieticians, 14% by dieticians and only 12 % by Occupational Therapists.


When this is compared to the HCPC register we see that of the AHPs, 40% are physiotherapists, 29% are occupational therapists, 12% are speech and language therapists and 7% or dieticians.


Host Bios
Tina is co-Chair of the Wessex PIN as well as being Chair of the NIHR Involve Advisory Group, and a long time survivor researcher.

Claire is also co-Chair of the Wessex PIN, an OT at heart and passionate about co-production in research.

The Wessex Public Involvement Network (PIN) is a multiagency research partnership that works with the public co-productively seeking to improve all our research endeavours in the region.



  • Have you applied or thought about applying for a personal award or a project grant to NIHR? how did you get on?
  • Compared to other AHPs OTs are the least likely to apply for NIHR research funding. Why do you think this is?
  • How can I and other Profs encourage OTs to believe in themselves like the other AHPs and come forward to apply for NIHR funding and fellowship?

Post Chat

Online Transcript

#OTalk Healthcare Social Media Transcript March 6th 2018

The Numbers

1.597M Impressions
425 Tweets
49 Participants
340 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants


#OTalk 27th February – Trans, non-binary and gender identities in occupational engagement.

This weeks #Otalk is on the topic of “gender identities in occupational engagement.” and will be hosted by Rebecca Swanson (@75Rebecca) and supported by Eden Dowers.


Eden Dowers: Eden is a non-binary occupational therapy (masters) student living and studying in Melbourne, Australia. Their interest is in developing transgender-positive practice, highlighting the need to create more complex concepts of identity and multiple ways of becoming.

Rebecca Swenson: Rebecca is a lecturer in occupational therapy at London South Bank University. She is currently undertaking UKOTRF funded research into the lived experience of those who define as trans, non-binary or genderqueer, exploring the relationship between occupational engagement and identity expression.

Here’s what they had to say…

There has been a recent and profound shift in the understanding, and recognition, of transgender and non-binary identities. This is reflected in potential changes to legislation, namely the Gender Recognition Act which would make it easier for those who define as trans or non-binary to self-declare their gender rather than undergo the arduous legal and medical processes currently in place.

Whilst attitudes and legislation may be changing, those who are trans and non-binary can face hostility and discrimination and there remains misinformation about these communities particularly with regards to health needs. In 2016, the parliamentary Women and Equalities Committee published the results of their Transgender Equality Inquiry which examined the ways in which transgender people have yet to achieve full equality and involved the scrutiny of practice across health and social care professions. The report states that the NHS is failing to protect the rights of trans people, due in part to lack of knowledge and understanding from clinicians of the health needs of these communities.

With these proposed changes to legislation and an increasing number of people defining as trans and non-binary, as reflected in the significant increase of referrals to Gender Identity Clinics, it is timely to discuss gender identities in relation to practice. This will be an opportunity for the OTtalk community to discuss best practice and the positive role that occupational therapy can play in enabling those who are trans or non-binary express their gender and live a life authentic to them.

Post chat

Online Transcript

#OTalk Healthcare Social Media Transcript February 27th 2018

The Numbers

1.736 M Impressions
479 Tweets
54 Participants
383 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants



#OTalk 20th February 2018 – Employing OTs with seen and unseen impairments.

This weeks #Otalk is on the topic of “Benefits & myths of employing OTs with seen & unseen impairments” and will be hosted by Lynsey McClean (@LynseyMcc_OT).

The views and perspectives of colleagues have a significant impact on occupational therapists with impairments and disabilities, particularly in relation to job satisfaction and success. As occupational therapists work with clients with impairments and disabilities it would be presumed that they would have positive attitudes towards fellow employees with impairments and disabilities. However, previous research has highlighted that this is not always the case, with reports of bullying, discrimination and negative or unsupportive attitudes, which can negatively impact upon occupational therapists, and other health care professionals (HCPs) with disabilities’ self-esteem, self-confidence and self-worth (Velde, 2000; Bevan, 2014; Chacala et al., 2014).

Other studies have explored what staff perceive to be as issues with employing a person with an impairment or disability an as an occupational therapist or other HCP (Grainger, 2008; Aaberg, 2010; Wood and Marshall, 2010; Hibberd, 2011; Hargreaves et al., 2014).

Nonetheless, studies on managers of HCPs and qualitative studies which explored the experiences of occupational therapists and HCPs with impairments and disabilities have all challenged these assumptions and highlighted numerous unique benefits they offer (llingworth, 2005; Hernandez et al., 2008; Wood and Marshall, 2010; Neal-Boylan, 2012).

Some questions to consider…

  1. What do you think the potential benefits are of employing someone with an impairment or disability as an occupational therapist?
  2. Do you think there are potential issues of employing someone with an impairment or disability as an occupational therapist? If so what are they?
  3. Why do you think someone might not disclose their impairment or disability at work?
  4. How can you (or we) positively challenge and change colleagues’ negative attitudes towards fellow employees with an impairment or disability?

Post Chat

online transcript

#OTalk Healthcare Social Media Transcript February 20th 2018

The Numbers

1.621M Impressions
471 Tweets
45 Participants
377 Avg Tweets/Hour
10 Avg Tweets/Participant

#OTalk Participants



#OTalk 13th February – When we’re busy helping others how can we make time to look after ourselves?

This weeks #Otalk is on the topic of “occupational balance” and will be hosted byAmie Mowlam-Tett (@Amie_OT).

Here is what Amy had to say…

Personally, this topic is one close to my heart; during the second year of my MSc I experienced a number of personal setbacks, including the death of a close relative. At one time I couldn’t imagine myself qualifying, it took peer support and time to balance my occupations, remembering time for myself and I did it. I qualified. More importantly, I learnt a lot about balance and need for ‘me’ time. I want to share my experiences and get talking about the importance of our own health and wellbeing when so much of our times is focused on the health and wellbeing of others.

Wilson & Wilcock (2005) addressed the topic of occupational balance in student populations, finding time, money and stress to occupational imbalance and negatively affect wellbeing. Similarly, Clouston (2014) found Occupational Therapists often prioritised their workload and studying over leisure occupations negatively impacting on occupational balance and overall wellbeing.

With months to go before the end of the course for students, it’s easy to become focused on work and neglect time for yourself. I am asking you to take a break, breathe and think about your own wellbeing. Let’s talk about balance, what it means to us and come up with strategies to help keep that work-life balance healthy. This isn’t just for students, for clinicians, it’s a perfect opportunity to share your experiences, hints or advice and maybe pick up a few tips too.

Some questions to consider:

  1. What does occupational balance mean to you?
  2. How important is occupational balance in your daily life?
  3. How well balanced do you feel your occupations are? (eg work/studying and home-life)
  4. What most affect your occupational balance?
  5. How do you create occupational balance, what strategies do you use?
  6. What tips do you have for students about to qualify?
  7. If you could change one thing about your occupational balance what would it be?


Clouston TJ (2014) Whose occupational balance is it anyway? The challenge of neoliberal capitalism and work–life imbalance. British Journal of Occupational Therapy. 77 (10) 507–515.

Wilson L & Wilcock A (2005) Occupational Balance: What Tips the Scales for New Students? British Journal of Occupational Therapy. 68 (7) 319–323.


Online Transcript

#OTalk Healthcare Social Media Transcript February 13th 2018

The Numbers

2.031M Impressions
612 Tweets
110 Participants
16 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants


#OTalk Research: Tuesday 6th February ‘The road less travelled? Supporting occupational therapists to conduct RCTs’

‘The road less travelled? Supporting occupational therapists to conduct RCTs’

This week’s OTalk Research is on the topic of conducting RCTs in occupational therapy and will be hosted by Avril Drummond (@AvrilDrummond1). Avril is Professor of Healthcare Research and Director of Research at the University of Nottingham, with a specialist interest in conducting randomised controlled trials (RCTs).

Here’s what Avril has to say ….

The term Evidence Based Practice (EBP) is used widely in both education and clinical practice. However, the reality is that evidence can mean slightly different things to specific groups who recognise different levels of quality; some advocate the traditional RCT evidence as the gold standard whereas others feel qualitative research is richer and more informative. However, although bodies who produce national clinical recommendations (such as NICE), are appreciating qualitative research much more than before, ultimately RCT evidence is the basis for many of their recommendations.

There are clear merits for using qualitative and quantitative methodologies and, increasingly, mixed methods. The bottom line is always what question is being answered. However, nonetheless, my impression is that OTs are more inclined to be involved in qualitative research (although I admit to having no hard evidence to back this up!). This might be for many reasons; a belief that the profession aligns itself more naturally with qualitative methodologies, more perceived difficulties in conducting RCTs and perhaps more bias in OT training towards ‘softer’ research. Yet generating RCT evidence is vital given that so many regard this as the gold standard – and fundamental to funding an intervention. Even results from small, underpowered RCTs can be used in meta-analysis to produce clear recommendations.

So the topic of this OTalk Research is RCTs. Here are some questions to consider:

  • Do you think OTs are more likely to do qualitative research? Why is this?
  • What is challenging for OTs about conducting RCTs?
  • What would make OTs more confident in conducting RCTs?
  • Has anyone been involved in an RCT? How did you get involved?
  • What would help more OTs to get involved in conducting RCTs?
  • What are the benefits of being involved – individually and for the profession?

Note that the topic title is the road less travelled (from the Robert Frost poem). The actual full line reads ‘Two roads diverged in a wood, and I- I took the one less travelled by, And that has made all the difference.


Online transcript

#OTalk Healthcare Social Media Transcript February 6th 2018

The Numbers
3.518M Impressions
423 Tweets
54 Participants
338 Avg Tweets/Hour
8 Avg Tweets/Participant

#OTalk Participants


#OTalk 30th January – Professional Boundaries- Where do we draw the line?

This weeks #Otalk is on the topic of “professional boundaries” and will be hosted by Bob Collins and Jo Southall (@BobCollinsOT and @JBOccyTherapy).

 With a bit of help (as we couldn’t resist it!) from:

Anne Keen: Professional Advisor – Professional Practice Enquiries Service, Royal College of Occupational Therapists: @annekeen55 @EnquiriesRCOT

Dr Stephanie Tempest: Professional Development Manager, Education and Research Team, Royal College of Occupational Therapists: @setG75

Heres what they had to say…​

“How much should I disclose about my own life to service users? What constitutes ‘therapeutic use of self’ and what is telling people too much?

How do I balance my existing friendships with line management responsibilities now I’ve been promoted to lead the team (who by definition have become my service users)?

Is it ok to give informal advice to my best friend to help him look after his mum?

Can I be friends, in the real or virtual world with my service users?

What do I do if I feel an attraction to someone who I met through professional channels?”

The idea for this #OTalk grew from discussions during an #OTalk last year (we’ll blame Bob!) and from reflections on previous ones, so we thought we’d host an event to talk about professional boundaries in occupational therapy. But we won’t be giving concrete advice or indeed directly answer the questions above. Rather, we aim to:

  • Encourage debate on the meaning of what professional boundaries means to you;
  • Create some space to share some reflective questions and ideas that may help us to think about where we, as individuals, draw the line;
  • Discuss the options on what to do if we have concerns.

But first of all, let’s define what we mean by ‘service user’. The Health and Care Professions Council (HCPC 2016) use a broad definition:

Service user: Anyone who uses oris affected by the services of registrants… (HCPC pg. 31 2016)

So, service users could be those we traditionally think of in the clinical settings or equivalent. But they can also be our staff, students, research participants, professional body members and so the list goes on.

When we provide services to anyone, we hold responsibility and power through therapeutic or professional relationships. As we know, with this privilege comes a duty of care in order to keep people safe from harm. We must not abuse the power we hold; we need to remain aware of the nature of the relationships and know how to interact in a way which maintains integrity.

To support us, we are bound by a number of standards and principles including:

  • HCPC (2016) Standards of conduct, ethics and performance
  • RCOT (2015) Code of Ethics and Professional Conduct

So, we’re looking forward to thinking about what these standards and principles look like in practice; to sharing reflective questions with each other to support our professional judgements; and discussing what to do if we have any concerns.

Best wishes,
Bob, Jo, Stephanie and Anne

Further resources:

HCPC (2016) Standards of conduct, ethics and performance: http://www.hcpc-uk.org/assets/documents/10004EDFStandardsofconduct,performanceandethics.pdf Accessed 9th January 2018

HCPC (2016) Guidance on conduct and ethics for students: http://www.hpc-uk.org/registrants/standards/students/ Accessed 9th January 2018

Nolan (1995): https://www.gov.uk/government/publications/the-7-principles-of-public-life (accessed 17th January 2018)

RCOT (2015) Code of Ethics and Professional Conduct https://www.rcot.co.uk/sites/default/files/CODE-OF-ETHICS-2015_0.pdf (accessed 17th January 2018)

HCPC (2017) Guidance on social media http://www.hpc-uk.org/assets/documents/1000553EGuidanceonsocialmedia.pdf accessed 17th January 2018)

RCOT Professional Practice Enquiries Service https://www.rcot.co.uk/practice-resources/professional-practice-enquiries-service/about-professional-practice-enquiries-service

Post Chat

online Transcript

PDF #OTalk Healthcare Social Media Transcript January 30th 2018

The Numbers

2.330M Impressions
753 Tweets
82 Participants
602 Avg Tweets/Hour
Avg Tweets/Participant

#OTalk Participants

Data for #OTalk can be up to 15 minutes delayed