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

Tuesday, 21 October 2008

Create your Own Destiny

image: Newstead Abbey Rose Garden oct 08

In October 08 BJOT, Marilyn Pattison asks us to create our own destiny. She states that "we need to distance ourselves even more from the medical model" and that we have much more to offer than the "traditional view" of occupational therapy.
As an OT with 25 years experience working as a practitioner, a manager and now as an educator I have seen many developments and shifts in the profession - but what is happening now seems bigger and potentially more contentious then ever before. I agree with all that she says and welcome the shift in focus and delivery. In fact here at Salford we have been particularly pro-active in facilitating learning opportunities that enable our students to think outside the box and have a more creative approach to the role of the occupational therapist. For example, all of our final year students have a placement in a role-emerging and/or non-traditional area where they do not work alongside an OT on a day to day basis - but have to consider how occupational therapy may fit within the specific environment, for example working in a shelter for the homeless, a south asian women's project or working with charitable organisations such as Scope or Age concern. We have also posted previously on related issues of service provision and- the demise of a profession . that you may want to revisit.
The dilemma seems to me to be how do we prepare current and future occupational therapists to work in a changed world when we are contracted to provide graduates specifically for the traditional environments. By this I mean that students tuition fees are paid for by local consortia who specifically negotiate service level agreements with higher education establishments on how many student places will be provided for health care professions. Therefore, our students still require and indeed experience what could be classed as "traditional" occupational therapy in NHS and social care settings. Students often express anxieties about not knowing enough anatomy and physiology etc and practitioners often expect students to have deep knowledge of conditions specific to any placement.
In a world distanced from the medical model, these subjects and expectations may continue to be eroded (in such an obvious format) from curricula as we focus more and more on occupation, health and well being. Any suggestions as to how we can make the transition smooth both for our students and our practitioners - if indeed you agree with the need to change - would be most welcome.


Sarah Bodell said...

I believe that occupational therapy is about occupation, health and well being as you state. However, like you I recognise (and indeed have been told in no uncertain terms by some clinicians) that expert knowledge in these areas may be seen as more or less valuable depending on the practice setting. How can this be? Perhaps not all OT's are actually practicing occupational therapy?

healthskills said...

If occupational therapists identify 'doing' (occupational performance) as their core domain, and all their clinical efforts are focused on helping ensure that people can 'do' - then I think the profession has no worries. (Provided that the profession CAN demonstrate that what it does is effective...)
If, on the other hand, the profession gets waylaid by arguing about which tools of trade are 'occupational therapy' and whether another profession is 'taking over' and 'doing OT', then it's doomed. By the same token, we don't see nurses arguing that their graduates who happen to work as administrators in aged care institutions, or doctors who end up developing a business in computer-based health records being challenged about whether they are still nurses or doctors, do we?!

To encourage occupational therapy new graduates to have confidence means ensuring they have a really strong foundation in what the profession really cares about, what it does well - and having good knowledge of the scientific principles of the therapeutic interventions occupational therapists draw upon.

Over time, as occupational therapists mature in their individual practice, ongoing learning is inevitably going to become focused on specialist areas. I don't pretend to know anything about how to help people with hip fractures get on and off the toilet, but when it comes to coping with chronic pain? I know quite a lot. And I don't feel worried that I use primarily psychological interventions, because they have the evidence to support them. As long as it means I'm helping people 'do' then I'm 'doing' occupational therapy.
Oh, and I've worked as a health and safety advisor, rehabilitation case manager, primary prevention wellness programme developer, safe handling advisor as well as educator on various health topics! For all of these I drew on some of my OT background, but developed expertise more relevant to that area of practice.

Sarah Bodell said...

You have given me a very thought provoking weeked! Your comment "As long as it means I'm helping people 'do' then I'm 'doing' occupational therapy" left me wondering how other health care professional might view their role in relation to enabling people to "do".
My husband is a psychiatric nurse, and links his interventions to enabling people to "do", The CSP website alludes to enabling people to "do", and my social work friend definitely believes he enables people to do what is important and meaningful to them.
So......who doesn't help people to do?
Clearly, having the goal of enabling doing isn't unique to OT, (if indeed anything is unique to OT) and whilst I agree that getting precious about what we do is unhelpful, being able to articulate our contribution is necessary.
Personally I have felt that I am practising most effectively when I am using occupation as an intervention, as well as a goal.

Jackie Taylor said...

I think that all health professions would say that they help people to ‘do’, by the very process of working towards people being more healthy and able. I guess, actually, that teachers and social workers might also say that they help people to ‘do’. My manager helps me to ‘do’ my job, as does the woman who does my ironing for me. So I’m not convinced that this is a good way of defining what an occupational therapist is. Occupational therapy, as a distinct and specialist profession, is founded on a body of knowledge about the relationship between occupation, health and well-being. There is no other profession which focuses its attention on this cluster of ideas and their consequent therapeutic implications. We inevitably share with other professions some understandings about the way that the mind and body work, but, just like psychologists and doctors, we offer a unique perspective.
I believe that it is important to be clear about the purpose and unique perspective of our profession, and to be aware of the boundaries between what we do, and what others do. Being a professional means knowing what is within, or outside of, one’s limits.
Occupational therapists have long undervalued (to themselves and others) their contribution to patient care. The reasons for this are complex, I think, to do with being a profession which has a natural alliance with humanist, holistic approaches to human complexity (all a bit fuzzy and hard to evidence through positivist methods) and also to do with being a female-dominated profession, looking to align ourselves with more powerful groupings. (sorry about the long sentence – I didn’t know where to end!).
OTs will gain respect when we begin to use our own therapeutic approaches and our own language to describe the work that we do, instead of borrowing from others and apologising for ourselves.

Holly said...

There is alot of emphasis now on OT's moving away from the medical model, but what about those of us that work within a traditional medical setting - the hospital rotations and more traditional NHS OT's? I love the philosophy of striving toward our identity as political, occupation, health and well-being promoters. Sometimes I feel that by adopting this approach I risk of alienating my colleagues within the more traditional NHS and health employment settings, and in fact because I wish to adopt this philosophy (and I work within a traditional role - Intermediate Care) I feel that I am alienating myself!
I don't wish to be polarised from my 'role emerging' colleagues, so my new challenge is to think and act both inside and outside the box!

Angela said...

Hi Holly
Thanks for your comments. This is indeed the dilemma that is facing many occupational therapists as the profession slowly moves towards transition. I'm sorry I don't have any easy answers, and of course you also have a responsibility towards your employer and your contracted duties (and your team). However, I do believe that as Jackie states, we should use our professional language to discuss and highlight our interventions in both medical and social models of care. In this way we can begin to identify clearly what our unique contribution is and could be - and demonstrate this by clear achievement of outcomes.Good luck with your "thinking in and out of the box" let us know how you get on . Maybe you could share some of your experiences here?

healthskills said...

Great responses to my comment about 'doing'!
I suppose I need to define what I mean by 'doing'. 'Doing' is defined quite precisely by occupational therapy as a profession - it typically means purposeful, chosen, activities that in themselves provide a vehicle for fulfilling roles and functions relating to the self and the social context (human and environmental). This is 'occupational performance' - and it's quite a specific definition for occupational therapists.
While other helping professionals help people 'do', they don't have the deliberate focus on purposeful activity that has meaning to the individual-in-context, IMHO. I'm about to blog on this - so perhaps may link to here for further debate!

kapil said...

I recognise (and indeed have been told in no uncertain terms by some clinicians) that expert knowledge in these areas may be seen as more or less valuable depending on the practice setting.
kapil kumar
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