With occupational therapy you CAN… by Wendy Chambers

If I had a penny for each time during my career someone asked me “what is occupational therapy?” I wouldn’t need to be playing the lottery this weekend!

Next week is national occupational therapy week, November 7 – 13^th2016, #OTweek16 for those Tweeters out there.

So prior to its launch on Monday I’m offering you the opportunity to have an insight into this lesser understood, enigmatic profession. So pour yourself a contemplative cuppa and have a read.

Occupational therapy is a science degree-based health and social care profession, regulated by the Health Care Professions Council. It is one of the ten allied health professions. You can train to either degree or masters level, at any of three universities across Scotland.

Occupational therapy takes a whole-person approach to both mental and physical health and wellbeing, enabling individuals to achieve their full potential.

We work with children and adults across a variety of settings including health organizations, social care services, housing, education, re-employment schemes, occupational health, prisons, and voluntary organizations or as independent practitioners.

So what does that mean, what do occupational therapists actually do?

Well, as occupational therapists we think about “occupation” as any activity any of us does day to day, which is important, necessary or which we enjoy.

The range of “occupation” is endless. If I use myself as an example some of my daily “occupations” would be putting on my clothes in the morning, reading my emails at work, making a meal for my family, riding my bicycle.

The occupational therapists job is to consider how, if I was the service user, the changes in my mental or physical health are making it difficult for me to be able to do these “occupations”- the things I want or need to do day to day.

They need to understand what’s important to me in my life? What would allow me to stay in control and live my life my way?

Occupational therapists are adaptors; maybe that chameleon like ability is why people are often unsure what it is we do?

So for example in order to help me to keep riding my bike after an episode of depression the occupational therapist will problem solve and adapt either:

–the activity itself: maybe I should try going out for 10minutes, twice a week, with a close friend who also bikes, somewhere that’s easy to access and doesn’t take long to get there, with a nice coffee shop on the way back

–the surrounding environment and tools I use: maybe a tarmac cycle route would be easier, at a quiet time of day, and my bike could do with a service first so it’s working properly (they help me think through planning and organizing that)

–me: set SMART goals which I can achieve, to keep me motivated, help me think about what I value about biking and help me understand and make the link between doing an activity I enjoy and feeling better about and improving my mental health

So back to that question again “what do occupational therapists do?”

I guess the bottom line is it ends up looking different each time, as we are all different as people and what’s  an important “occupation” to me may not be important to you.

And we work in so many different settings, with different age groups of people, that that also makes what we “do” look different.

Ultimately it isn’t what the occupational therapist “does” that matters, rather what the person ends up being able to do that’s important.

So for occupational therapy week this year I’ll leave you with this thought,

“With occupational therapy you CAN….”

Wendy Chambers is Team Lead Occupational Therapist for Mental Health and Learning Disability Service at NHS Dumfries and Galloway

 

“One Small Step for Dumfries and Galloway, one giant leap for Scotland” by Wendy Chambers

The occupational therapy mental health service is stepping forward this week and sharing their implementation of the Home Based Memory Rehabilitation (HBMR) programme for people with dementia at a National event in Edinburgh.

The event “Connecting People: Connecting Support” is showcasing occupational therapists contribution to dementia post diagnostic support, with the Home Based Memory Rehab programme centre stage, primed for a roll out across 5 other Health Boards in Scotland in the coming months.

Local occupational therapy staff Wendy Chambers and Alison McKean will be presenting during the morning live link session, and also leading along with Lynda Forrest in the afternoon workshop with the 5 Health Boards. The aim is for consistency of delivery for this evidence based occupational therapy intervention across Scotland, contributing to the developing evidence base and promoting best practice in post diagnostic dementia care

The event is being live-streamed and can be watched again at the following link

• video3uk.com/actionondementia
• Click on the EventCast Tab and follow the link called “Connecting People: Connecting Support. Home Based Memory Rehabilitation”

Speakers in the morning also include Mary McGrath, Advanced Clinical Specialist Occupational Therapist from Belfast; current work in Scotland with HBMR is firmly based on Mary’s original research (McGrath and Passmore 2009)

A video of servicer user feedback and opinion of the HBMR programme is also being shown on this day and a link to this can be found at

• https://www.youtube.com/watch?v=VNg5HrFi4_M

This work is also being showcased on the ‘Let’s Talk About Dementia’ Blog:

• www.alzscot.org/talking_dementia

Wendy Chambers is an Occupational Therapy Team Lead at NHS Dumfries and Galloway

 

 

 

 

 

The Home Based Memory Rehabilitation Programme by Emma Coutts

When I took up my post as an Occupational Therapist, within the Mental Health Substance Misuse and Learning Disability Service as a new graduate, I was unsure what to expect!! Having had a placement within the service I was familiar with the client group and the team however coming into this as an OT is very different to being a student! And my first initial thought was ‘what will I be doing as an OT?’

This is where the Home Based Memory Rehabilitation (HBMR) programme comes in! First suggested to myself and Corinna Sidebottom (OT, who started at the same time as me) back in 2012 as a possible piece of work we could develop within the service, who knew the success this would have?!

HBMR was originally developed in Belfast City Hospital in 2007 by Advanced Specialist OT Mary McGrath. It was developed as part of the cognitive rehabilitation approach for the treatment of people with acquired brain injury; however was found to be equally appropriate for the rehabilitation of cognitive deficits, including memory problems due to early stage Alzheimer’s disease.

It has been recognised that the main approach to helping people with memory difficulties to engage within their activities of daily living is to try to find ways to compensate for impaired memory, through memory rehabilitation strategies.

The idea of cognitive/memory rehabilitation interested me – we often associate rehabilitation with the likes of having had a broken bone and regaining the function within the specific limb, but we don’t commonly associate this in relation to Dementia (or at least, I didn’t!).

Cognitive rehab is defined as an individualised approach which should focus on real-life, functional problems a person experiences. Central to this is an understanding of the person’s strengths, abilities and deficits from a holistic approach, which as a profession, incorporates our core beliefs.

So what exactly is the HBMR programme? And how as new band 5s, were we going to develop this and pilot it within our service?

After various meetings we developed a modified version of Mary McGrath’s programme and we were then ready for a 6 month pilot.

Our HBMR Programme

The HBMR programme is a 4-6 week programme, delivered to the client, in their own home with caregiver/family support where appropriate. The pilot programme consisted of 4 sessions:

1. Remember where you have put something
2. Remember what people have told you
3. Remember what you have to do
4. Remembering people’s names and coping in social situations

Each session covered a range of memory strategies such as a memory book, memory board, post-its, safety checklist, using a calendar, medication checklist to name a few. These are all things any one of us could use within our daily lives to remind us of daily tasks.

The key to the programme is the structure and repetition of emphasis placed on the strategies and so each time a new session is delivered, all previous strategies are revisited to ensure the client is using these and is confident in doing so. It is this repetition that encourages new learned behaviours within people with early stage memory impairment and creates the habits that are more likely to be remembered as memory loss continues. 

 

 

 

 

 

HBMR Programme – Pillot Results

Following our 6 month pilot, we compiled our evaluation – which in my opinion not only demonstrated the effectiveness of HBMR but also highlighted that people with early stage Dementia, can learn new skills!!

The graph below clearly demonstrates that following completion of the programme, at 3 month review there was a significant increase in the number of memory strategies clients were using. And as a result, a slight decrease in the number of reported memory difficulties they experienced. 

Our Success!

Since completion of our pilot we have been working on promoting HBMR and how we can further develop this.

A key highlight of the whole process for me has to be winning ‘Best Community Support Initiative’ at Scotland’s Dementia Awards in Glasgow. Although probably the most daunting, as this involved making a small speech!! 

 

Our poster has also won at national events and was displayed within the poster presentation at last year’s Alzheimer Europe conference. 

The HBMR programme also features within Alzheimer Scotland’s ‘Allied Health Professionals Delivering Post-Diagnostic Support: Living Well with Dementia’ Publication which can be found at: http://www.alzscot.org/news_and_community/news/3197_three_new_publications_for_allied_health_professionals

The future of the HBMR programme

We are currently looking at how to develop the programme, with a view to sharing this locally and nationally. Since pilot completion, we have reconsidered the session topics and we have now created additional areas we feel are important to cover. The programme still takes place over 4-6 weeks however now covers the following areas:

1. Remember your priorities
2. Remember what people have told you
3. Remember what you have to do
4. Remember people’s names and coping in social situations
5. Remember to keep your brain active
6. Remember your bearings

We are also considering other possible ways to deliver the programme such as the use of technology.

We have also been looking into the branding of the programme and are looking to have our resources and manual ready within the next few months and as mentioned, we hope to share this both locally and nationally!

I am probably very bias about the programme as I have been involved from the beginning! but I hope reading about the effectiveness of HBMR, has encouraged you to think about the ability to learn new skills in early stage Dementia and how this may impact on future practice…..after all – Dementia is everyone’s business!!

Emma Coutts is an Occupational Therapist with the Mental Health and Learning Disability Service at NHS Dumfries and Galloway.

IDEAS – A Project in Dementia Service Improvement by The IDEAS Team

The three members of the IDEAS team writing today are Fionnuala Edgar, Alison Groat and Lorraine Haining.

At the recent Mental Health Nursing Forum Scotland Awards, the IDEAS team were delighted to lift not only a practice excellence award in the dementia category but received ‘Practice of the Year’ as the overall winner This multidisciplinary team (Nursing, Psychology and Occupational Therapy) was formed in 2012 following a successful bid to the Putting You First fund to address non-pharmacological management of stress and distress in dementia, in line with Scotland’s National Dementia Strategy.

 

(L-R; F.Edgar, L.Haining, M.Born, W.Chambers, R.Warwick, missing from pic A Groat)

 Three members of the team write about their experience of the project to date:

 Lorraine Haining, Advanced Nurse Practitioner writes:

 As the nurse in the team I was extremely pleased to receive this accolade as it acknowledges and celebrates the work and efforts not only of the team but of the Care Homes and supporting services that have made it possible. In my career I have been lucky enough to have had several opportunities to make a positive contribution to changing the way we value and provide care for people with dementia and the IDEAS Project has been another of those vehicles for change.

This multidisciplinary approach lends itself well to holistic care, with each profession providing education and support from their clinical perspective. In terms of Nursing my aim is to promote the prevention of stress and distress symptoms by ensure screening for treatable physical or mental health conditions, ensuring regular reviews of antipsychotics and other psychoactive medications, addressing polypharmacy issues and ensuring effective care planning incorporating all health and medical needs.

A major personal driver for me is that my father has dementia. His experience on the journey has so far been positive and he is coping well with the diagnosis. We have had that difficult conversation about the future and not wanting to be a burden on his family he has opted that we should consider a care home if he is not coping at home so therefore I need to make sure that his positive journey continues if this turns out to be the case and there is no better driver for the best possible outcomes than your love for your family.

Quotes from Staff attending Nursing session:

 

 

 

 

Fionnuala Edgar Clinical Psychologist writes:

In Dumfries and Galloway Mental Health services have been at the forefront of reducing reliance on anti-psychotic medications for stress and distress/challenging behaviour in dementia since 2008. Through the IDEAS team we have been able to be more fully committed to the delivery of support and education to carers working in care homes across the region. This has allowed us to deliver a holistic, person-centred approach that has received overwhelmingly positive results across the region. Training has been based on current guidelines developed by the British Psychological Society (BPS) ‘Alternatives to antipsychotic medications: Psychological approaches in managing psychological and behavioural distress in people with dementia’ (BPS)

From a psychological perspective I have seen a positive shift in carer’s understanding and beliefs about dementia and this will, in no doubt, lead to better quality of life for residents. Staff morale has reportedly increased significantly as carers feel more valued and confident in their role and in their ability to successfully manage stress and distress without the need for psyco-active medication.            

Quotes from Staff attending the Psychology session:

 

 

 

 

Alison Groat, Mental Health Occupational Therapist writes:

As one of three Occupational Therapists involved in the IDEAS project (along with Wendy Chambers and Michelle Born) we feel this Team approach has worked very well. From an OT perspective, we wanted to focus on the Environment and creating opportunities for Meaningful Activity within it.

All Care Homes have been offered the opportunity to undergo a dementia design consultation with OT following completion of The Kings Fund Care Home Environmental Checklist (www.kingsfund.org.uk). Working in partnership with Care Home Staff, immediate environmental changes were identified such as improved signage, improved lighting, and contrast. Some areas have also able to include dementia friendly principles within longer term plans for refurbsihment.

Before and after photos                                                                                          

Change achieved by visually removing door by blending it into the wall has resulted in a marked reduction and on some days a complete removal of this stress for residents.

Staff were also provided with further information and tools on the implementation of meaningful activity tailored to the individual person. SMART Goals were developed with Staff around activities they planned to implement and follow up was offered. A main focus has been on creating the opportunity for normal everyday activity within the environment. We have been delighted to see Care Homes updating Interest Checklists, carrying out more Life Story work and adding everyday activities in to the environment e.g. dusters and sweepers.  We have witnessed excellent examples of meaningful activity already being implemented, which we have been able to share.      

Quotes from Staff attending the OT session: 

 

 

 

 

To date, the Foundation Level Training has been attended by over 600 care home staff and the Intermediate Level Training has been attended by 99 care home staff. We are in the planning stages for the Advanced Level training which will include a Train the Trainers element (for Foundation Level training) thus ensuring the long term sustainability of gains made as the project draws to a close in September.                           

For further information contact:

 Fedgar1@nhs.net; alison.groat@nhs.net; or lorrainehaining@nhs.net

What does work mean to you? by Vicky Widdowson

This week is Occupational Therapy week and with this brings a chance to promote our profession and raise awareness of the benefits of Occupational Therapy (OT).

 As Vocational Rehabilitation lead for our mental health Allied Health Professions (AHP) group I’m choosing to focus on employment.

 What does work mean to you?

 When asked this question it has to be said the first thought that comes to mind is the pay slip that lands on my desk every month.   But beyond this is the thought that while I’m here it’s a good feeling to make a difference along the way.  And out with work although I inevitably find the question of ‘so what do you do?’ is almost always followed by ‘what’s an occupational therapist?!’ I have to wonder what I would say if I didn’t have this job to talk about.  What we do for a living seems like such an important part of our culture I wonder how my clients who don’t work must cope with this question.

 As Occupational Therapists a person’s identity is core and so clients are asked about their work aspirations as part of initial contact.  It is also recognised that Allied Health Professionals play a central role in helping people to return to work and to manage their own health and wellbeing. 

 Within the mental health service work has been done to promote ‘asking the work question’, and with this challenging a perhaps traditional perspective that if people have a mental health condition it is unlikely they will work.

 I’m sure the likes of Ruby Wax, Stephen Fry or The Saturday’s Frankie Sanford would argue that it is indeed possible to make a living while experiencing mental health difficulties.  During my research on celebrities with mental health difficulties I smiled at a quote by Stephen Fry stating ‘1 in 4 people, like me, have a mental health problem.  Many more people have a problem with that.’

 However OT and work is not exclusive to mental health.  There is work across physical OT being done to promote employment, and encouragingly there is now joint working being completed to consider this agenda as a wider Dumfries and Galloway Allied Health Professions Group, based around delivery of the AHP National Delivery Plan.

 A development from this has been the promotion of an Allied Health Professions Advisory Fitness for Work Report.  This stems from a belief that people do not need to be 100% fit to engage with work, and it is a key goal of Allied Health Professionals to enable people to safely remain in or return to work wherever possible.

 How did you feel when you woke up this morning about coming to work?

         1= bad                                            10=good

 I’m sure very few honest people would answer a 10, and so why should we wait for our clients to feel 10/10 before encouraging them back to work?

 

At times however our clients need more than just encouragement to return to work; often they have a number of barriers to cross.  This is where AHP’s unique skills of assessing functional difficulties can be used to work alongside the client to come up with solutions that hopefully will enable a return to work.  The Fitness for Work Report is now an opportunity to record this information in a formal manner, which in itself can be beneficial and empowering for the client.  Over and above this it can also be shared with the GP and a client’s employer.

 In addition to this report, Occupational Therapist’s can use a range of tools to help clients stay in work, return to work or seek new employment.  This work is not always done alone however and often we work with a number of partnership agencies both mainstream and mental-health specific to enable a client to meet their vocational goals.

 It is also worth mentioning that not all of our client’s want to, or indeed are able to work.  I consider myself in a fortunate position within our service that we provide OT vocational input on the grounds that we see the right work as being beneficial to a person’s health and well-being.  A lot of our clients currently feel under pressure due to benefit reforms and mandates to attend work-related services.  We continue to work with clients that want to move forward because this is a goal related to their recovery.

 For those client’s who state work is not a priority, we continue to offer interventions for those who identify goals in relation to engaging in meaningful occupations involving their self-care, productivity and leisure.

 In summary I would hope to point out a few key points:

• Good work is good for your health
• OT’s play a central role in helping people to return to work and to manage their own health and wellbeing
• OT’s also play a key role in helping people to move forward with non-employment focused occupational goals
• Happy OT Week!!!!

 Occupational Therapy

Helping People to Live Life Their Way

Vicky Widdowson is a Specialist Occupational Therapist in Mental Health in NHSDumfries and Galloway