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

Monday, 19 January 2009

Core Values or Core Skills ?........... You decide

Here is a post that is long overdue - I have been meaning to share these thoughts with you before now - I guess I am finding it hard to "verbalise" my thoughts but then I decided that I would just write them down and offer them for discussion and debate.
It stems from a session I was running with our third year undergraduate students, preparing them to go off to their role-emerging placements before Xmas. The session was discussing how one might offer explanation of what OT is and what an OT might offer the new team to a potentially brand new audience. Of course this seems to be an everlasting debate and one that has proved difficult for as long as I've been an OT (25 years) and before that too.
Anyway, I was offering the idea of using our core skills to define ourselves by and to identify those things that make us unique and asking students to offer their understanding of our core skills. Many were suggesting such things as client-centred, holistic, collaborative, groupwork etc and I jumped in with the view that these are not core as they could be said to be practiced by many other health and social care professions and offered my own understanding of core skills being the use of graded activity as a therapeutic tool, activity analysis , focus on occupational performance etc.
The wind was quickly taken out of my sails when a student pointed out that COT, in their briefing of 2006 (Definitions and Core Skills for OT) identify core skills as " expert knowledge and abilities shared by all OTs" and uses Creek's (2003- OT as a complex intervention) definition that states that our core skills are built around occupation and activity but then lists collaboration, assessment, enablement. problem solving and groupwork as part of these. Teach me to keep upto date with my reading I thought. However, I have since reflected on this and I do have some concerns that maybe, in order to end this debate we need to identify what is meant by "core" does it mean unique to a profession, or does it mean core as in the fundamental values of a profession? These may seem similar and possibly a pedantic exercise, but I believe that they are different and cause confusion when establishing the unique contribution and value that an occupational therapist can bring to a client and/or an organisation (see current discussions on our blog for another post discussing similar issues).
Maybe we need to talk about Core Values and Core Skills - I'd be interested to hear your views on this - please feel free to press the comment button and add to the discussion.

image created using Crappy graphs


Anne Marie said...

We had a presentation in our department last year which covered some of this ground. For the life of me I can't remember who it was, but her research was qualitative work on defining the nature of occupational therapy. I think that sometimes we do have to define oursleves by what makes us distinct or else it is hard in a multi-disciplinary team for people to know when they can particularly access our skills.

With regards to what makes a definition in general, I am not a linguist, but I went along to a workshop on developing a set of definitions of terms for medical education. Our group tried defining 'sympathy'. We ended up with a set of words whiich were not in any way unique to sympathy, such as emotion, and I don't think would have helped you understand the term.
So I think you have to be careful and you are very right to start the debate.

Buckeyebrit said...

It's an oldie but a goodie (great students by the way!). Here is the link to Jennifer Creeks "OT as a complex intervention".

My personal feeling is that we apply our core skills (which may in part be generic) to our core belief which is unique (humans as occupational beings, occupation as central to wellbeing).

The thorny issue of how OTs define the profession is inherent in its own exisistance. To understand OT you have to be involved in the occupation of occupational therapy. Lost yet? I was fortunate enough to be at a study day with Jennifer just before Christmas and she made a simple but impactful observation. The only clear way to explain is for someone to try to mimic the work of an OT, or to be the recipient, or to sit alongside the process. In other words to use engaging with the occupation of occupational therapy.

Is that too much to ask? How can pragmatically do that to promote the profession?

Would it be a pushing it so say that many people have a more clear view of say (Anne Marie!)a GP as everyone has seen a GP at some point, they know when they would go and the gist of what will happen. They have sat alongside and been a recipient of that care. They have experienced the occupation of a GP appointment/intervention.

Hope that makes some sense and isn't too garbled - I'm trying to hold a baby on my knee and type at the same time!

Anonymous said...

I wonder if I can add some reflections as one who has been quite absent from 'traditional' occupational therapy roles for quite a few years, and returned, a bit like a prodigal son, to 'owning' that much of what I do is about occupation.
The thing that has struck me time and again during my different employment roles is how many people would say 'oh but you're really doing occupational therapy' when I talked about what I did.
The roles I've had include:
- accident rehabilitation case manager
- health and safety advisor
- musculoskeletal health advisor
- workplace rehabilitation
- safe handling advisor

The common denominator of most of these is that it's about the workplace - and that's all about 'occupation' in both the occupational therapy sense, and in the general use sense. It's also a lot about pain but that doesn't really count.
The other common denominator is that behaviour, attitudes, motivation, and all things psychological are also present in all of these things.
So - on one hand my paid work has always been 'occupational' in focus, and on the other, it's also been about 'psychology'.
The aspect that I now accept is that I bring this to all my roles:
- the value of people choosing to be actively involved in doing (purposeful activity)

I didn't use some of the central 'skills' of occupational therapy in these roles, and most especially I didn't use graded activity, occupational behaviour analysis, or some of those other grand things that occupational therapists have a skills unique to the profession.

But I did have the humanist value that people, if they choose to, should be able to engage in values-driven, goal-directed purposeful activity, and to function well in those roles they adopt.

So I'm guessing that my belief is that occupational therapists unique contribution to a team is that occupational therapists value helping people engage fully in their chosen occupational behaviours. HOW occupational therapists achieve that is really up to the evidence-base, which as we know, changes over time as more research is conducted.

Anonymous said...

In dictionaries when "core" is used as an adjective, as in "core skills", it means "essential" and of central or fundamental importance. So any skill that no OT should be without would count as a core skill.

Lots of these may be shared with many professions, but they are all neccessary for the OT.

If we are looking to define "THE ESSENCE of OT" it is necessary to consider the core skills of an OT, as well as which are skills unique to OT.

Anonymous said...

Well said, anonymous!

Emma said...

This is a topic that is never going to have a specific answer!!
I was one of the student's in the session that Chris ran which may have started this debate and it was confusing!! My opinion changed on more than one occasion just within that seesion!

In my view, even though there are aspects of OT that are unique to our practice such as graded intervention and activity analysis, could it be that other professions use these, just in a different way or call them by a different name?

Could it be that it is our philosopy that is unique and that it is these views that make the way in which we work different?
Take assessment for example. A person may have a specific condition, illness or dysfunction and some professionals, when completing their assessment will focus poorly on that. However, when an occupational therapist completes their assessment they not only look at the dysfunction but all the other factors, both internal and external to the person, that may affect the dysfunction or be effected as a result of the dysfunction. This comes as a result of our philosophy that every person needs to he assessed individualy and that everybody is a unique being.

I feel that the way we word things is important. To me a core skill is something that is essential in order to complete our role and achieve our goals for intervention. These skills can be those that are unique to the profession but also those that may be used in other professions. They are still essential skills for occupational therapy but we are not the only one's who use them.

Occupational Therapist's do have skills unique to them but different terminology or phraises need to be decided upon.

Emma said...

Angela's session, I apoloise!

Anne Marie said...

It's been really interesting following this discussion.

The puzzle of how to define OT in this instance started from thinking about how to talk to others, who do not understand an OT's role/potential, and explain to them what as OT can contribute.

In this instance I still think that some emphasis has to be placed on what makes an OT distinct to other health care professionals as well as the generic skills.

The conversation around the 'essence of OT' is different. That is a conversation that is for (probably) an internal audience.


Angela said...

Thankyou all for your discussion and comments. It is clear that this is an issue that won't go away and is not easily resolved. It's been good to get others' perspectives on the issues.
I like the idea of contemplating the "essence" of OT (thanks @anonymous for that). I also thank @Buckeyebrit for an approach that makes obvious sense - by being a recipient we explain through "doing" (and therefore through occupation) and thus confirming a long held belief of mine that occupational therapy should be everywhere and not just in the health care arena - then we would ahve less need to constantly feel the need to explain ourselves.

Ann said...

From across the pond, greetings!
I have been wondering for some time about this same issue….and will give you somewhat of an American perspective, so please bear with me….in the early 1980s Joan Rogers was our Slagle lecturer and she pointed out to us that one of the problems we have as a professional community is that our profession developed without a paradigm. This was a concern, because professions are defined by their paradigm, an underlying unifying philosophical shared belief that also explains the reason for being (as a professional community). IN the US, at the time, this launched a group of scholars to develop theory that responded to Roger’s charge to us as a professional community.
From this emerged many occupation based theoretical explorations: Occupational Science, MOHO, the Model of Clinical Reasoning (Mattingly & Fleming), etc. However, after all of these theoretical developments, we, as a professional group, failed to take any official action to adopt a paradigm. In the US, as I expect is the case in many other countries, the policy making group of our Association never foresaw the need to take official action that could adopt the paradigm.
The internet happened. The aftermath has been a period of more direct international communication amongst occupational therapists. The internet really has altered our lives in ways that perhaps we never imagined. The international dialogue has resulted in an interesting shift.
As an American observer, it seems to me that many occupational therapists worldwide have adopted occupational science as the paradigm for the profession. (You are all free to tell me that I am mistaken….but this is my observation nonetheless).
I have been an occupational therapist for over thirty years. For 26 of those years, I was practicing in hospitals, home care and private practice in the community. At the age of 50, I earned my clinical doctorate in OT. I have always loved the process of what I have done day to day to make a difference in people’s lives, but it has always gnawed at me that: we don’t often identify ourselves in our professional roles (I mean when we meet someone and say our name, how many of us actually say “I am ____, an occupational therapist.”); we often don’t correct people when they misname us by another professional title (‘oh, you know the nurse, or PT or…..); and that we get caught in the ‘muck and mire’ of explaining occupational therapy.
Within this year, I have begun participating in the Society for the Study of Occupation (SSO). This group is trying to study and to generate an underlying theory and philosophy of the concept of ‘Occupation’. It’s looking at the concept with a set of ‘different eyes’….and I have to admire the efforts of those who have begun this work.
Yet, I too am still concerned that we don’t have a simple explanation for explaining what we do and for people to just know that what we do is very important. Perhaps it’s the difficulty explaining the extraordinary that is embedded in the ordinary tasks or activities of meaning in which we engage people….and what accomplishment of those mundane tasks can mean to someone who hasn’t been able to do them for some time….if ever….

I ask my students how many of them are comfortable visiting with people and listening to them to see what is important and meaningful to them, day in and day out in a mundane, day to day existence. I think being someone who enjoys a good visit is core to who we are as people within this professional group….after all, occupations are a relative value to each of us. The ability to do what is meaningful is the core value. Participation, enablers, terms such as these are important to allow us to converse in the language of the ICF and to explore new roles for us as a professional community to be a part of the future models of healthcare that includes public health and community health as well as our continuing involvement working with groups and individuals to promote development or restoration of meaningfulness in life, in cultural context and in a modern anthropological sense. If we accomplish this, then many of us believe that the ability to be occupationally engaged is a human right and has a social justice value.

At least that’s the way I see it…..

Ann Burkhardt, OTD, OTR/L, FAOTA
Director, Post-Professional On-Line Masters Degree Program
Occupational Therapy
Quinnipiac University
275 Mt. Carmel Ave.
Hamden, CT.06518

Angela said...

@Ann thanks so much for your thoughts - sometimes it's good to look at the historical perspectives of where the profession has come from as well as where it may be travelling. I like your phrase "extraordinary embedded in the ordinary" - maybe this is a clearer way to begin to explain what we do? The work of the SSO sounds interesting and I wonder if there are any details published to date?

Karen said...

I like "extraordinary embedded in the ordinary" as a new AOTA slogan or at least a t-shirt for OT month!!

I was hoping a Slagle lecture would show up in comments...I did a paper/presentation on the 2005 Slagle lecturer, Suzanne Peloquin, who used a lot of thoughts from "Ora Ruggles", and Ms. Ruggles belief that "you should lead with the heart, as well as the hands".

I *strongly* recommend anyone interested in OT read "The Healing Heart" about Ora Ruggles, by John Carlova. Yeah, I'm a little obsessed with how cool she was, very inspirational.

Someone else commented on how our core skills are a component of our core beliefs...I liked that. A lot of good thoughts. I was impressed with how many comments you got!!

Keep up the thought-provoking posts. :)

Karen said...

Ok wait, I've got it...an OT shirt that says "We put the EXTRA in ordinary" :)

Angela said...

@Karen, thanks for your comments, I will indeed try to get hold of and have a read of "The Healing Heart". Love the idea for the T-shirt slogans - maybe we should contact ATOA and COT!

Anonymous said...

I remember when I first started in the health profession I was sitting in a large room full of trainee nurses, support workers, medics, OTs attending a diversity course. We had loads of lectures which were very informative. However a disabled lady took the stage and started to discuss her disabilities and her experience of health care. Her personal story left a mark on all there and at the end of her discussion she asked if there were any questions. The usual questions came reeling in and I sat there taking all on board. Then there was an awkward lull in the questioning and I said to her that I was new to health care and was wondering if there was one thing I or anybody else could have done that would have made a difference to her what would it have been. She pondered for a minute then said emphatically "listen". Another pause then listen again. She went on to say that in the early days no one really listened to her to find out what she really wanted. She had a diagnosis and that diagnosis defined how she was treated. There was no one to listen to her and no one to advocate on her behalf.

This was a core skill that became fundamental to my practice and so far has served me well. I think the core skills needed by OTs have to start with this one and then hopefully the rest will follow.

I am just starting my second year at Uni and recognise a real concern for the future of OT from my peers. The need to identify what makes us so different from all the other professions appears to be agenda number 1. We are different. We are counsellors, psychologists, nurses, physio's, social workers, and a host of other professions all rolled into one and I feel we are desperately trying to avoid the "Jack of all trades" label.

Occupation I feel is the key word here.

'My personal feeling is that we apply our core skills (which may in part be generic) to our core belief which is unique (humans as occupational beings, occupation as central to wellbeing)'. Well said Buckeyebrit

As long as our focus remains on Occupation then all our core skills will follow accordingly, which they are.
There are many definition of OT core skills and all more or less say the same things but in different ways however the need to educate the general public to what our profession does is important. We need to agree as one on a definitive description which is easy to understand, unambiguous and simple.
It can be very embarrassing sometimes trying to explain our roles, however, I always finish my descriptions with 'I care'. This appears to elicit more positive responses than anything else.

Cmon OT's lets start speaking the same language.

I probably haven't answered the question, (a criticism frequently thrown my way)but I hope I have expressed my frustrations appropriattely .