Author: lgpersonaldev

So here it is, my first blog from #COT2017 and what a start it has been – frenetic, energetic and inspiring. And the latter can certainly be applied to this session, which concentrated on the work of three OTs in non-traditional roles within a traditional setting.

Sophie Koehne, Dan Lescure and John Sapani all work for KHP Pathway Homeless Team in London. Sophie and Dan are based at South London and Maudsley NHS Foundation Trust (SLaM for short) – in an inpatient mental health setting – while John is based in an MDT at Guys and St Thomas’ Hospital.

Having worked in a local authority homelessness team in a previous life, I was aware of some of the issues, and was intrigued by the opportunities for occupational therapy.

The trio began by setting the context of homelessness, which covers more than rough sleeping. It can take the form of temporary accommodation, squatting, ‘sofa surfing’, among other scenarios, and can be caused by many factors. The presenters referenced the recent tragedy at Grenfell Tower, which has left many people in a vulnerable situation with housing.

Homelessness is more than not having a stable roof over your head: there are legal and social implications; it can be isolating and destructive. Not only that, but in the past 5-10 years, homelessness has become seen as a health issue. The presenters outlined some eye-opening statistics: the average life expectancy of a homeless man is 47, while for women it is 43, compared with 77 and 82 respectively for the general population.

Mental health problems are prevalent in this population, although undiagnosed in many. In fact, delayed treatment and diagnosis of many health issues is common within those who are homeless. This is not helped by a lack of access to services, such as registration with a GP. Homeless people are more likely to access healthcare via A&E and be admitted to hospital. And, without proper planning and coordination for discharge, health issues may not be recognised or tackled. Health issues common in homeless people include early ageing and trimorbidity (mental health, physical health and substance misuse).

So, the aim of the team from their respective bases is to improve health outcomes and safe discharge by targeting frequent attendees to hospital. This is achieved through advice, recognising health needs, advocacy, and encouraging reintegration into society. Of course, challenges were identified with working with such a transient population: a lack of identity documents, financial insecurity, a lack of recourse to public funds, and discharge (frequently self-discharge) before housing support can be investigated.

But why OT? The practitioners explained that their dual training was a clear benefit when working with homeless people, because of the potential impact of their living situation on both their physical and mental health. Occupational therapy skills came into play, particularly in the ability to see the impact of a change in environment. While the medical team were looking at straightforward discharge planning, the team were thinking more widely about how the person may have to cope on the street, or in alternative accommodation. They were also experienced in working in a multiagency and multidisciplinary environment.

The presenters talked about their transitional work, supporting people before and after discharge, with the aim of reducing readmission.

A recent service evaluation by a health economist has shown value in their work: reducing length of stay by 24%, reducing readmission (although not across all sites – the presenters noted that in some places they had been so helpful, people had returned for more support!). Two case studies illustrated how the service had supported people through holistic assessments, setting goals and support through discharge.

If there was one take away for me, it was learning on the value of therapeutic use of self. The key with this client group is to establish rapport. People are being given opportunities to engage in occupations that they haven’t been able to without stable accommodation: cooking a meal, watching TV, getting a good night’s sleep.

But their work doesn’t stop there. Future plans include in-reach to hostels and working with OTs there, exploring experts by experience – homeless people who have turned their lives around – and expanding a network of OTs working in similar settings. If you’re interested – I am sure they would be keen for you to get in touch.

 

Bev Goodman
1^st year pre–reg MSc student at the University of Essex
@BevG_studentOT

 References

Department of Health (2010) Healthcare for Single Homeless People. Online at https://www.housinglin.org.uk/_assets/Resources/Housing/Support_materials/Other_reports_and_guidance/Healthcare_for_single_homeless_people.pdf [Accessed 19 Jun 17]

Crisis (2014) Turned Away: The treatment of single homeless people by local authority homelessness services in England. Online at: https://crisis.org.uk/media/20496/turned_away2014.pdf [Accessed 19 Jun 17]

 

Two knowledge speakers presented their research projects relating to occupation for older people.

First up, Corinne Hutt “The lived experience of engagement in occupations by older people”.  A fascinating exploration of the role of occupation for those experiencing bereavement. Very much an under researched area but an issue facing many of our service users. Corinne spoke sensitively and insightfully about her research findings, that grief led her participants to “retreat to the familiar”, “take stock” and then “take themselves forward”. It was fascinating to consider the role of occupation within this, in particular applying the “continuing bonds” model (Klass, 1996). Corinne highlighted that people who go through an expected bereavement need to revise their occupational repertoire and how this takes time.

What resonated for me was Corinne’s notion of death changing relationships with the deceased, not ending them and that is my personal view too. Also the need for the bereaved to talk to people in their day to day life, so often the bereaved can be excluded due to the awkwardness of others, surely it’s time this stopped. Death and loss often remain taboos in British culture, but such common experiences need to be discussed and no-one should be excluded due to a bereavement.

Corinne talked about applying her work to other areas of loss and different types of bereavement, I think that would be great. For occupational therapists to lead the way in thinking about the role of occupation in bereavement as a healing factor, would be great. In discussing this talk with my colleague @natlouj we felt occupational therapists would have a lot to offer the recently bereaved in primary care services to prevent occupational revision becoming occupational deprivation.

Next up, Sam Whiting “Social groups – exploring occupational engagement in men”.  Sam focussed her research on the impact of ageing on participation in occupation in men, very much an under researched population in comparison to older women. Sam’s focus groups led to her findings that  for men, social groups related to “the four walls – combatting loneliness and social isolation”, “social interactions – the importance of camaraderie”, “reminiscence and the yesteryears” and “productivity”. Sam described how older men face so many barriers to occupational engagement, including shyness from joining groups but that they reported occupation as a powerful way to combat loneliness.

By Laura Di Bona @SheffOTCA

 

 

I have always wanted to learn how to crochet, so I naturally jumped at the opportunity when I saw this occupation station on offer. I am a knitter, and have knitted various projects throughout the years, but have never quite mastered the art of crochet yet. I was glad I attended early, as unsurprisingly this session filled up quickly. Helen was a great facilitator in attempting to teach a large class to crochet, luckily there were also some more experienced people in attendance who were also able to teach us the basic stitches.

We were provided with detailed instructions as well as an attractive powerpoint. However, even with these, I wouldn’t say crocheting is a skill I will be adding to my cv any time soon! I struggled almost immediately with how to hold my wool and the crochet needle, and my first attempt at a chain went awry. I was hoping my skills as a knitter may be able to be translated into this project, but to no avail. Conversely, I struggled with the exact same problems I struggled with when I first began to knit, namely that my tension was wrong, so I ended up with some really tight stitches and some far too loose stitches. This created a rather wobbly looking square by the end of it, in fact if we’re perfectly honest, I ended up with an uneven circle. I gave up after one round, I claimed it was to give others a chance to use the hook (as it was so busy there weren’t enough to go around). The truth was, I wasn’t finding it relaxing at all and I could have been there all night trying to master even that basic stitch.

Overall, I did enjoy the opportunity to learn, and can see why it would be relaxing as eventually I assume you get to a stage where you do not need to concentrate as much, similar to the stage I am now in with knitting. It was good to see a mix of abilities in the occupation station, with some having lots of experience already and others that were struggling as much as me.

The occupation stations are a great idea and I hope this is something they carry over into further conferences and develop further!

Katie Gabriel

@Katie_Next

With perinatal health being a particular interest of mine and having recently completed a university assignment on this, it was a perfect opportunity to attend and hear about the two papers being talked about in this session. There was a good mix as one paper focused on the experiences of disabled women in the perinatal period and the other was looking into the priorities in mental health.

Firstly, it was great to hear about Bethan Collins research into the experiences of disabled women during the antenatal and postnatal period. She highlighted the fact that disabled women tended to have significantly less positive experiences in this period and part of this study showed that the literature backed this fact up.

Bethan highlighted that the key findings of her research focused on service users satisfaction with the care they received; their choice in care; the continuity of carer and being listened to and treated as an individual. Bethan highlighted how we, as occupational therapists, could have a bigger potential role in this period.

I was particularly disappointed to learn that where occupational therapists had been involved in the antenatal period, it was largely focused on equipment giving and that there was very limited occupational therapist input in the postnatal period. This research also showed that many service users wanted more input about the actual parenting, rather than equipment. Bethan spoke about how often these women felt that people were not considering them when giving advice, and sometimes they would have liked to have been in touch with others with the same condition for reassurance and guidance.

These all seem like basic ideas, but the fact that they are not happening shows that the women need us, as a holistic profession, to advocate for their needs. We are a client-centred profession, perhaps more so than many of the others, and we can use this to our advantage in supporting women through-out pregnancy and early parenting experiences.

The second part of the session was delivered by Sarah Maris-Shaw, with a personal perspective added by service user Sarah Gosset. Their aim was to raise awareness of mental health priorities in perinatal settings, with a focus on co-occupations.

Firstly, they started out with some shocking statistics. 23% of mental health related deaths can be attributed to mental health and yet there are only 16 mother and baby units across the country, whilst 40% of people experiencing perinatal mental health would not receive any specialist care (check out Maternal mental health Everyone’s Business for more information).

The practice Sarah works in focuses on preventative work, so they can work with people with mental health concern, not necessarily a diagnosis. This seemed important to me as it is proactively working with people to prevent future poor mental health developing. The group which runs as part of this service focuses on co-occupations. For those of you who, like me, did not really know what this word means, it means that the occupation would not occur without the interaction of the other person. For example, the co-occupation of feeding a child or playing with a child. In this circumstance, both parent and child have to learn about the co-occupation. This is why it is important to explore these within the group. It was also fantastic to hear a personal perspective from Sarah about how the group had helped her and the importance of it. There really is no better feedback than direct from a service user!

Both of these sessions were exciting to be a part of and I hope it inspires more occupational therapists to really be involved in this area, particularly with Sarah Maris-Shaw highlighting the NHS five-year forward view for mental health, which specifically mentions occupational therapists in the perinatal period – what better time to get involved?

Written by Katie Gabriel – @Katie-Next

Follow them on Twitter:

Sarah Maris-Shaw – @sarahmarisshaw

Bethan Collins – @Bethanhc

Elizabeth Raby and Ela Neagu, designers from the Helen Hamlyn Centre for Design , ran this workshop and gave a brief overview of the work of the Helen Hamly Centre which is part of the Royal College of Art.

The key areas of work undertaken by the Centre are related to social and global issues, healthcare and age and diversity and the focus of this workshop was on a project being undertaken in collaboration with Arthritis Research UK  Support Systems.

This project has been informed by the fact that a lot of people with arthritis are unaware of the products available to support them in undertaking ADL, finding out what exists, how it might be of help and where to get it from. The focus of the project is on the smaller items of equipment costing under £50.

Support systems is a two year project coming to completion in the autumn and during this time people with arthritis, clinicians and experts have been involved in its development as well as a number of networking sites. Over this time information has been gathered via a range of methods including workshops, interviews, card sorts and user testing. Cultural probes were also used to ensure that the views of hard to reach groups have been included.

Key findings of the work include: that the majority of information about products is passed by word of mouth and people learning from experience; that people are pretty creative in coming up with their own solutions if a product can’t be found and, something that will be familiar to OTs, there is stigma associated with product use.

One of the issues raised is that even if people find their way to an equipment catalogue the way information is presented currently means that it may still not be obvious what a product is for.

So how to make it easier for people to find out information about products?

A great question and really interesting to see how this has been approached from a co-created collaborative approach. During the session we were asked to input our views on a range of questions arising from the project and given an insight into some of the ideas that are being tested. These included things that will be familiar such as

• Databases
• Information sheets e.g. Top 10 gadgets for your home….. under £50
• Video tips – on how to use specific items of equipment e.g. using a helping hand or how to adapt things yourself – e.g making handles of cutlery easier to hold

and some things that are new and innovative

A Chat BOT – which takes users through a series of questions to arrive at suggestions of possible products

It was great to have an opportunity to find out about the project and also input into some of the ideas. All of these are at prototype stage and will provide ARUK with new ideas about how it can work more closely with people with arthritis to support people with arthritis in identifying products more easily to maintain their independence.

Written by @LynneGoodacre