Category: OTalk

OTalk

#OTalk 22nd September 2020 – Occupational Therapy and Older People

Helen OTUK

This week chat will be hosted by the Rotal College of Occupatinal Therapists Specialist Section, Older People @RCOT_OP

General deconditioning in older adults with frailty is a serious and all-too-common problem. According to the British Geriatrics Society, deconditioning includes reduced muscle strength, reduced mobility, increased falls, confusion and demotivation. Immobility can effect continence and constipation, appetite and digestion. As Occupational Therapists, the primary impact of deconditioning can be seen in reduced well-being and cognitive and physical function; in turn this impacts a person’s ability to engage in meaningful activities.

The recent #RightToRehab Twitter campaign brought to light prevalent attitudes of ageism and discrimination towards frail older people in the acute hospital setting and in the community. In the current climate of the Covid-19 pandemic, isolation and immobility has raised further discussion
around deconditioning and the right to rehab in older adults.

As a Specialist Section for Older People we’d love to continue this discussion with an Occupational perspective, and to share ideas and Top Tips for addressing this issue in hospitals and the communities where we work.

The questions for discussion in our #OTalk conversation:

1) What are people’s experiences of seeing the impact of deconditioning on levels of occupational performance in older adults?

2) How can Occupational Therapists support older adults to avoid deconditioning?

3) What intervention approaches are used, and what considerations taken into account, when assessing rehab potential in older people?

4) How is ageism a risk when considering rehab potential for deconditioned older adults?

5) In what ways do Occupational Therapy theory and practice challenge these attitudes?

OTalk

#OTalk 15th September 2020 – Using an asset based approach in Occupational Therapy to promote self-agency and self- management.

Helen OTUK

This weeks chat will be hosted by Sally Scott-Roberts @sallyroberts.

Antonovsky’s (1996) salutogenic orientation (a focus on the origins of health) was proposed as a shift in the way we think about health. It was not intended to replace the more traditional pathogenic (medical) paradigm, that focuses on risk factor reduction, but to compliment it. Antonovsky suggests that people are viewed as being on a health/dis-ease continuum rather than being viewed as healthy or not. Therefore, rather than focusing on the management of a condition and/or the characteristics of a disability, the factors that keep someone nearer the ‘health’ end of the continuum should be explored and where possible engaged. Simply, he proposed a process that focused on the whole of the person, engaging both the person’s and their communities’ resources to further both their individual and collective health and wellbeing. 

Antonovsky’s (1996) proposition of being asset focused was directed at the field of Health Promotion but it can so easily be seen to align with Occupational Therapy. It affiliates well with the underpinning humanistic philosophy of Occupational Therapy; valuing the uniqueness of each person, whilst supporting them to be active agents in unlocking their occupational potential (Stein & Cutler, 1998). Our occupational therapy operational models promote the exploration of the person in context and identify strengths as well as barriers to participation. In doing so it is possible to establish ‘what has worked well and how,’ when someone requests support because they have moved or wish to avoid moving towards ‘dis-ease.’ 

From practice experience, working mainly with people who consider themselves to be neurodivergent, many have become experts in managing their health, often only entering services at a point of ‘crisis.’ At this point in time, they may have lost sight of, or may not recognise, the assets that help to keep them well. In reframing my focus, I have endeavoured to work with people appreciatively, to identify, develop and then mobilise their personal and community assets, with the aim of empowering them to continue to self-manage their health and well-being. This is particularly important, as this group of people, as adults, often remain hidden from traditional health and care services.  

I was hoping that this topic may be of interest to those Occupational Therapists, working with people who live with life-long conditions or chronic disability but also those working to promote well-being in the wider community. I look forward to the chat. 

Questions to reflect upon for the chat: 

  • Is an asset based way of working new or does it just describe the way in which we already work? 
  • Are there interventions we already utilise that have a basis in salutogenesis e.g. Recovery Through Activity? 
  • When might you choose to use asset based interventions and with whom? 
  • What might be the barriers to working in this way?
  • What skill set do Occupational Therapists need to draw upon to work in this way? 

OTalk

#OTalk 8th September 2020 – Cognitive screening (and implications for the MOCA certification).

Helen OTUK

This week the Royal College of Occupational Therapists Specialist Section Neurological Practice – Stroke Clinical Forum are hosting the chat.

In the UK, Occupational therapists, as well as Neuropsychologists use the MoCA widely in stroke care to screen for cognitive impairment. From September 2020, the Montreal Cognitive Assessment (MoCA) requires those carrying out the screen to have undertaken certificated training to obtain a licence for continued use.  Training fees/licence can be purchased for an individual or a service and is available ere: https://www.mocatest.org/. This change has come about through an increase in litigation in the United States where the scores of the MoCA had been used for diagnostic purposes.   

In light of this current change, services are having to review their use of cognitive screens, consider alternatives and undertake the certificated training if they wish to continue using the MoCA.  In this OTalk, the RCOT SSNP Stroke Clinical Forum, alongside colleagues from Neuropsychology will discuss current use of cognitive screens, issues around interpretation and training needs.  

We look forward to a busy #OTalk, with relevance to wider areas of practice and other screening tools.

‘Questions:

Q1. What cognitive screens due you currently use in your service? 

Q2.  At what point post-stroke do you use a cognitive screen and how do you use it ? (from a patient perspective, treatment planning, research)  

Q3. What issues are there in relation to administration and interpretation of cognitive screens (not MOCA specific) (thinking OT, assistants, interface between OT and Neuropsychology)

Q4. What have your services done to date in response to the new requirements around the MoCA? 

Q5.  The stroke forum and BPS are hoping to collaborate to create a guidance / competency framework around tool selection, administration and interpretation to use across stroke teams.  What specific guidance about cognitive screens would you find useful? 

OTalk

#OTalk Research 1st September 2020

Helen OTUK

This months research topic Perspectives on Online Research will be hosted by Nikki Daniels NikkiDanielsOT and will be supported by Jenny Preston  @preston_jenny

Over the past few months, many researchers have found it necessary to change the way they collect data, specifically where face to face methods had been originally planned. The availability of online platforms like Zoom and Microsoft Teams has enabled methods such as interviews, focus groups and consensus planning to be carried out virtually in real time. Text based forums allow research participants to make contributions to a study at a time which suits them best. Whilst some may even have chosen to change their approach completely and moved to survey-based research.


This week, we discuss your thoughts on research participation using online formats that have seemingly increased in use over the past few months. We will discuss the benefits and challenges of taking part in research online and so help researchers to think about how experiences of being
research participants can be enhanced. Whether you are a researcher, a research participant yourself or an advocate for service users recruited to a study, we are interested in your thoughts on the methodological, practical and ethical issues raised when conducting or taking part in research online.

Questions

  1. Have you or your service users had experience of taking part in a study online, been invited
    to take part in a study online, or as a researcher conducted a study online (either during the
    pandemic or prior)?
  2. What do you think were the benefits from your experience? If you have not yet had the
    opportunity to experience such a study, what do you think the advantages could be?
  3. As a study participant or a researcher, what were/are the potential practical challenges?
  4. Designing and carrying out research virtually requires consideration of ethical factors specific
    to an online environment. What specific ethical considerations need to be made and if you
    have been involved in an online study, how were these addressed?
  5. What can researchers do to encourage therapists and/or service users to participate in
    online research and to make taking part in research online a positive experience?
OTalk

#OTalk 25th August 2020 – Improving Disability Representation in OT – #OTalk Series (UK Focus)

kirstyes

Thank you to those of you who attended the Improving BAME Representation in OT chat on July 21st 2020. You can find the blog post and transcript here. On this post we shared some general resources that we thought would be useful for this whole series of chats.

For this chat we are focusing on disability but I’d like to re-highlight the resource we mentioned on intersectionality which recognises that those from BAME backgrounds who also have disabilities may be doubly disadvantaged.

First up – I make no apology for being provocative in this post. I, like I’m sure, many others are, are tired. And angry. Fed up of disability related limitations as being seen as an individual failing and not a societal or cultural one. I have shared some very personal examples. I’m not going to name names because I simply do not believe my experiences are unique. I believe similar things happen all the time. I’ve seen it supporting clients with disabilities with their employers and I’ve witnessed it with colleagues and experienced it myself. I also acknowledge that OTs work within the wider systems of health and social care and some of the experiences people share in the chat may not refer to Occupational Therapists specifically but to others from their workplaces.

From a personal perspective I have now decided to work in independent practice purely because I do not believe that I can maintain good health in employment. I’m not even sure if this is true now but I’ve lost confidence based on my previous experience. I have not felt understood or as supported as I feel I could have been.

I guess some of you will be thinking, why do OTs need to talk about disability representation. Surely as OTs this is something we consider for our clients so it must be second nature to uplift those with disabilities, right?

Not so. Consider the following:

Students with disabilities still have to do 1000 hours of placement and they have a maximum of 5 years to complete the degree. Often placements are scheduled so that to complete at the same time as their cohort, students need to complete full time hours on placements (when in practice they might only work part time) or they run placements through holidays not getting a break.

On most courses and meetings I’ve been in it has been offered and usually taken up (by me too on occasions) to skip a break so we finish earlier. Why is the default to push through? Often you end up finishing at the same time anyway just without having had a break. Not only does this probably make us all less effective, it actively discriminates against those with a number of disabilities.

There often seems to be a ‘we went through it and had it hard’ so they need to as well attitude. So even OTs with disabilities themselves put pressure on students/newly qualified staff to fit in with the status quo. The ‘real world’ defence to bad practices. We should be the change agents when it comes to social injustice.

When asking for flexible start times in an NHS setting due to mental health challenges, I was told ‘You can’t just pick and choose your hours.’ ‘If we do it for you we’ll have to do it for everyone.’ When then proposing a time that I felt was most achievable I was offered 15 minutes before that time or 15 minutes after! I could not understand the reason given for this at all.

Phased returns to work after illness or injury are often time limited and then people are expected to use leave or have a reduced salary in order to continue reduced hours (and then get no break later). When they’d often be paid full time (or half time) when off sick. Where is the forward thinking? There is an ‘I want you all or I want none of you’ attitude rather than understanding that sometimes people need extra time to adjust. Surely it is better to get some hours of a qualified and competent OT than none. How often are ‘Fit to Work’ Notes actually used as such?

Occupational Health – I am fairly sure we have all had variable experience with occupational health departments and support for reasonable adjustments. A major point to note here should be why aren’t more OTs working in Occupational Health, or in job centres?

Some phrases that fill me with fury, frustration or wariness are:

“For the needs of the service”/Flexible working (When it usually seems flexible only one way).

“Resilience” – personal resilience should not be the only way to deal with work place stress.

“Absence Management” – The processes and policies of absence management disadvantage people with disabilities and long term conditions. Often they limit how many days/episodes you have off before pushing you up to the next disciplinary stage despite the validity of your time away. Meetings are meant to be supportive but often come across punitive. ‘You are good when you are here but if you have any more sickness you might lose your job.’ There is no acknowledgement that presenteeism of other staff may directly impact on more vulnerable staff and in many workplaces now you are unable to attend health appointments in work time/have to take unpaid leave to do so. Maybe a question for the new Institute of Public Health to consider. Have such policies impacted the take up of preventative health screenings?

A policy was if you don’t reply to a letter inviting you to an ill -health hearing it would take place without you. No attempts to contact. No checking if you even got the letter. No way to pick up if you actually e-mailed someone who then went off sick so your reply wasn’t seen! Considering oftentimes people are off with mental health challenges this is discriminatory.

Social Media Policing and Ableism: ‘I need to talk to you about some things you put on Facebook when you were off sick.’ (Sick people aren’t allowed lives outside of work – and yes I do know there are some people that take advantage of this but you can see the same attitudes in the PIP and ESA assessment processes).

Union Support – My personal experience with union support have been quite variable. I have had excellent support and support where I think things the employer said should have been challenged more. Unions are now direct gatekeepers to legal support too – they will seemingly only refer cases that they are confident of winning. Not many people want to put themselves through a grievance or tribunal so discriminatory employment processes will continue to happen. You don’t want to be without union support but how can you guarantee they are doing the best for you. Often union reps work for the employer and I do struggle to see how they can maintain an unbiased view, let alone truly be supported with time away from their day jobs to help members. Workplaces also refusing to speak to union representatives to arrange meetings, and the ’sick’ person having additional pressure placed on them as a result.

Other Reading:

Do check out last week’s #OTalk on Ableism and covidled by Susan.
Georgia’s #OTalk on Experiences of the Journey from Service User to a Professional which included an interesting discussion on disclosing disabilities to clients.
My post for the Liberal Democrats Disability Association –  (Other political parties are available!)
This news article on Nursing and Disability
In August’s OT News a group of OTs (Rebecca Twinley, Danielle Hitch, Bill Wong, Michelle Perryman-Fox, Diana Sheridan, Sarah Selaggi Hernandez and Claire A Keogh) have written about their experience of neurodiveristy.
And look out for a forthcoming article exploring the experiences of disabled OTs in Canada and the UK.

Questions to guide this #OTalk

1. We’ll start with a refresher question on last week’s topic? Has the covid-19 pandemic opened your eyes to ableism? Do you think things will change in society/for OTs with disabilities as a result? @SusanGriffithsOT and @Occ4LifeLtd
2. During admissions, recruitment or induction when you hear a student/colleague has a disability what are your immediate thoughts? If you have a disability what are some of the things you’ve been asked? Both that have been helpful and that haven’t been helpful. If you are a recruiter have you been on unconscious bias training? Are interviews even the best method of recruiting? @Occ4LifeLtd
3. Do you disclose your disability? When? To Who? Line Manager, Placement Supervisor, Lecturer or University, Colleagues, Wider MDT, Clients? Why/Why Not? What have your experiences been? @GeorgiaVineOT
4. Is there is difference do you think in how OTs with physical and mental health related disabilities are treated? Do you react differently if a colleague goes off with stress, anxiety or depression, than if they go off with cancer? What about neurodiversity? Invisible vs Visible disabilities? Have you ever been directly or indirectly been accused of faking an illness or disability? Why? How did that make you feel? @SusanGriffithsOT
5. What are reasonable adjustments for OTs, and what aren’t? Why, why not? For example should the 1000 hours placement requirement be adjusted for students with disabilities? Could more placements be virtual? Can start times be flexible? Could absence management policies be amended for those with disabilities/long term health conditions? Should we be looking at different, more accessible ways of delivering OT that might work for both clients and therapists with disabilities? @melissa-chieza
6. Staff Wellbeing is Key to Patient Wellbeing – Discuss @Occ4LifeLtd
7. What’s one action you can take back to your workplace today to level the playing field for colleagues or students with disabilities? @Occ4LifeLtd

Huge thanks go to @GeorgiaVineOT, @SusanGriffithsOT, @melissa-chieza, @ABraunizer and a number of people in the DisabiliOT Facebook group for their contributions.
Kirsty @Occ4LifeLtd and @kirstyes

 

If you’d like to share your story of being an OT working with a disability do consider submitting to ‘We Are OT’