Disclaimer: The opinions expressed in this blog are entirely our own and not necessarily those of our employer or any other occupational therapist.

Wednesday, 24 October 2007

The demise of the profession?

A student was telling me an all too familiar story yesterday about some training that she had attended whilst on placement that was called something like 'neuro-cognitive therapy'. The course was run by a psychologist who was introducing the multi-disciplinary team a 'new' way of working with individuals with psychosis based on the evidence that many people with psychosis have temporal and frontal lobe abnormalities. The 'new' way of working was to therefore help the individual to adapt their environment so that there was less stimulation, especially when they wanted to improve their concentration for a specific task. The training also looked at ways that tasks could be broken down, cues could be used to aid processing issues and so on. The student reported that the OTs that were present put it to the psychologist that what she was talking about was simply 'OT' to which she agreed. SO WHY AREN'T OTs DOING THIS TRAINING why are the psychologists doing this. As I listened to the student's story I found myself becoming increasingly angry as not only did it reflect a story that an OT had told me the week previously but it also reflected my own experiences within the clinical field.

So what is happening? Does this happen around the world or just in Britain? It seems to me that OT as a profession has always lacked the status or profile of other health care professionals (who ever knows what an OT does!) but what are we doing about other professionals taking the work that we have done since day one, putting a new spin on it, making it the new 'sexy' thing to be doing and gaining the credit for it.

OTs should be doing this work, we should be having the credit, so why aren't we??


Graeme said...

Hi Kirst,

Good post and some good questions.
I am a psychologist working in a School of Occupational Therapy after several years working in a Rehabilitation Unit (mostly acquired brain injury) and have witnessed the marginalisation of professions. While I agree that the case you describe is the work of OT I would also like to point out that it is also the work of a Psychologist. What I would have thought would/should happen though is that the Psychologist has specialist skills of assessment and (perhaps) developing or informing a rehab plan but the OT would be the person who has specialist knowledge in designing and monitoring such a plan. Every profession is guilty of the behaviours you have outlined and I think it is down to
a} the way they are taught i.e. no cross fertilisation
b) politics in the health system and resource grabbing
c) professionals not being very good at promoting themselves

I think it is a huge challenge for people to work in a collaborative way and truely work in a interdiscipliniary fashion.

Kirsty said...

Hi Graeme,

Thanks for posting a comment it's good to see that a psychologist is looking at our blog.

I agree with your comments entirely as i have had some very good clinical experience working with other disciplines, psychology in particular, that has been able to draw on the strengths of each profession.

Reading your comments made me consider my 'rant' and reflect on the fact that my frustration is really directed towards my own profession not others. OTs need to do more to promote the work that they do and need to be proactive in looking for new opportunities outside of the traditional setting.

I am hopeful that this can and will change as the newer generation of OTs are entering a very different working environment and I believe in order for the profession to 'survive/thrive' they will naturally look further afield.

I am also confident that here at Salford we are equipping our students with the skills and confidence that they will need in order to develop the profession as a whole and to individually be able to work with people in an truely holistic way.

Adiemus (Bronnie Thompson) said...

Arrrggghhh! I'm going to stick my neck out here (ooops! And wait for it to be chopped off). Occupational therapists are incredibly sensitive about people 'poaching' their work - could I suggest a new way of viewing ourselves and others?
What would it be like if we thought instead of 'what is my role' and more about 'what can I offer this person and the team'? That way we view the person as part of the team, and our contributions as an offering rather than a grab at what is 'mine'...
Take a peek at my blog for a longer rant - http://healthskills.wordpress.com/2007/11/12/chronic-pains-favourite-tools/ for my take on 'interdisciplinary' functioning.

I think it's high time all health professionals recognised that there are an awful lot of generic skills that we all use - and division of labour isn't always best for the person we're working with. Overlap is great for ensuring the person is getting a consistent message - provided everyone agrees and uses the same model!! - and overlap ensures reinforcement of the treatment principles. It's good for us to also remember that we develop skills after graduation - and in many cases, these skills transcend 'typical' professional 'roles'.
cheers - and thanks for the thought-provoking post!

Paul Bibby said...

Hi Kirsty,

I came across your blog whilst looking at the University website. I can see you posted your comment last year so I’m a little behind but better late than never I guess!

There’s no doubting your frustration judging by your comments and it’s a feeling that I share too. So why aren’t OTs doing the kind of work that you mention? Professional profile, or lack of it, is certainly a big issue in my experience. On the whole, I don’t think that as profession we communicate effectively to other health workers what it is that we do. I accepted quite early in my training that promoting occupational therapy has to be an ongoing part of our role. Sometimes it falls on deaf ears, sometimes I’m sure it irks people (“that cocky OT is off on one again!”) but we have to toughen up and be less sensitive, less insecure about the fact that we probably do have to shout more loudly than other professions for people to understand the benefits of what we do. And we have to be persistent too. If people don’t hear it the first time we have to tell them again about our successes. There are things we can do on a practical level. For example, I’ve written a short article for inclusion in our Trust’s monthly newsletter about a cycling group that I’ve just started for service users – I was sure to mention occupational therapy! I’ve held ‘training’ sessions for support workers in my service, which educated them on the OT process and how we all could work more effectively using the process as a framework to improve clients’ functioning. I believe sometimes we have to put ourselves out there to be challenged by others. I invited the support workers to disagree with me if they did not feel my suggestion, of what for them was a new way of working, would benefit the clients – no one did…on that occasion! We should see people challenging us professionally as a positive thing – it merely gives us the opportunity to hone our discussions about the uniqueness of occupational therapy. But we have to put ourselves in to situations were we can be challenged in the first place. We can’t afford to be shrinking violets can we.

I’m currently attempting with a colleague to get an article published in the BJOT. Our opinion piece argues that OTs in mental health are being compelled to work more and more generically (are psychologists under pressure to work this way?) and as such, clients are losing out on the valuable benefits of what OT has to offer. Sure, working generically can be great for an individual’s professional development and we can and do bring the OT philosophy to other areas of practice, such as care co-ordination – but I argue that it’s not OT when delivered this way. Interestingly, I thought that attempting to get the article published in the BJOT would be preaching to the converted, but discussions with some (not all) of my occupational therapy colleagues suggests this not to be the case. Some OTs have told me that they enjoy the variety of being able to work generically. But what could be more varied than occupational therapy? It is such a unique and diverse profession that has the potential to touch EVERY area of human existence. After all, we are all always engaged in an occupation. Even though I’m starting to move into a managerial role, I still sign all my correspondence as an occupational therapist. That’s what I am first and foremost, not a manager or a care co-ordinator. (This sounds like I’m almost ranting now!).

I’m certainly not saying that I have all the answers. Sometimes I still feel like a novice therapist with huge gaps in my practice and knowledge. But that does give me the opportunity to consider myself as belonging to the ‘newer’ generation of OTs that the excellent tutors at Salford University are producing. Fear not, there are others like me out there who share the same principles and philosophies, who are striving to promote our profession. I hope that reading this has made you feel less frustrated.

Sarah Bodell said...

Hi Paul,
I totally agree with your views on generic working. I have sat so many times with students who are on placement and who are struggling to see how a particular "specialty" can be described as occupational therapy.
They feel that they are misunderstanding something, and are often hesitant to express their doubts but once the question has been raised (usually by me) the relief is immense. I have seen this is mental health, in hand therapy and in discharge facilitation services to name but a few. I support the publication of your paper, and look forward to reading it.

With regard to the issue of promoting OT, I'm more inclined to thing we should just get on with doing what we do well and lead by example. Naive or world weary maybe, but which other profession either acknowledges that it is so profoundly misunderstood or spends so much time explaining and justifying itself?

I'm interested in your thoughts?

Kirsty said...

Hi Paul,

Thanks for your comment, reading it does help to reduce some of my frustration and it always makes me smile to know that there are plenty of other OTs out there who work hard to maintain, or rather improve, the profile of the profession. As an OT who previously worked in a CMHT I completely agree with your coments about generic working and I have often spoken out quite loudly against the drive to create more generic workers. Where is the evidence to show that generic working is the most effective way to work with clients? How is this effectiveness being measured, if at all?

Your other comments have inspired me into writing another post so have a look at that and I look forward to further comments.

Paul Bibby said...

Hello Sarah and Kirsty, and thanks for your replies to my post.
I agree with you, Sarah, when you say that occupational therapy does spend a lot of time explaining and justifying itself. As if to prove the point, only this month in the BJOT there’s an article entitled “a simple trick to market ourselves”, so I guess it can appear that the issue has almost become an obsession within our profession! Your comments about leading by example also made me reflect on my own clinical experiences. For example, a CPN I worked with on a previous team told me how he had put together a graded programme for one of his clients, aimed at gradually exposing the client to a feared situation. The CPN had apparently seen how I had successfully employed this approach with one of my own clients, and had adopted it himself. So merely getting on with undertaking occupational therapy is, I agree, one way of promoting what we do.
Yet the issues of generic working and promoting the profession, in mental health at least, seem inseparable to me. I think it’s because I perceive the profession to be undervalued by many managers and policymakers that I feel I have to be so vocal. I’ve heard some managers and heads of service, none of which were OTs, seemingly pay scant regard to occupational therapy. Are we often undervalued because we are misunderstood? Or are there other factors at work? I can’t say for certain. It does though feel so difficult to try and influence change in the Health Service from the bottom. I think that’s why I’m happy to sacrifice some of my clinical practice if it means I might be able to bring more influence to bear at a managerial level. Perhaps we need a balance of leading by example through getting on with occupational therapy, but at the same time reminding others of the unique benefits that we have to offer?

Sarah Bodell said...

I think that sounds like a plan! Paul, if you want to use the blog to put up "front page" posts, let Angela or I know and we can sort it out for you. Clearly this is a topical issue and may be worth exposing to wider debate.

Paul Bibby said...

Hi Sarah, sounds like a great idea! Would you be able to go ahead and do that? Would certainly be interesting to hear other people's views.

Angela said...

Hi Paul
If you can email me then I can use you email address to give you posting rights on our blog and you can upload what you need to.

Paul said...

I've been deciding which blog to add this comment to in order to provide me with some catharsis and have decided to post it here...
I was told recently about this comment, made by a Community Mental Health Team manager, at a presentation being made by the Clinical Lead OT about a restructuring of Occupational Therapy services in our area.
The comment was "Why should I employ a band 5 Occupational Therapist to take a service user out for a cup of tea when I could employ a band 3 support worker to do the same thing?".
After I'd overcome an overwhelming urge to swear, I reflected calmly (almost). Can we really afford to sit back and hope that managers such as these develop an appreciation for Occupational Therapy merely by observing what we do? Surely this reinforces my position that we need to be more proactive and vocal in communicating to other professions the benefits of Occupational Therapy?

Kirsty said...

How did you manage not to swear or thump this person Paul! To me this is symtomatic of us as a profession and of the fundamental principles of OT. We, and so many others, know that we make a difference and you do need to do a BSc (Hons) to qualify so it can't be that simple, but how do you easily quantify or 'sum up' what it is we do? We need to capture and bottle up that magic 'OT' ingredient so that we can easily illustrate to such managers the difference between having a cup of tea with an OT and having one with a support worker.