The Role Of An Occupational Therapist

The Role Of An Occupational Therapist Health care like health itself is a dynamic process which can be subject to change over time. There are an increasing amount of tensions within medicine between various groups of health care practitioners, and between the evaluation of treatment and responding to patients views. This reflects the different strains and demands bearing down on medicine from numerous quarters. I am interested in exploring from the counsellors perspective, in this case the occupational therapist, what exactly they do in an effort to socialize people back into society. For example looking at the role of occupational therapist and the patients environment: physical access to buildings; availability of family and monetary support for living at home. To answer the above question I examined areas such as what is the doctor-patient relationship or in this case the occupational therapist-patient relationship, drawing on Goffmans (1969) work, who states we all play roles throughout our lives, we present ourselves to society, and we are socialized to these roles throughout our lives, especially in childhood. Society has given us our roles- doctor, patient, sick role, etc. and we as actors can perform the role. I also looked at Occupational therapies link to Functionalism, concentrating on Durkheim and Parsons and also drawing on the work of Marx and Weber and how Marx led to the acknowledgment in occupational therapy that labour is the collective creative activity of the people. Description of the research strategy For my research into how occupational therapy contributes to the promotion of health in society, I chose to use qualitative research and in this case qualitative Interviewing. Several researchers have argued that structured interviews are unnatural and restrictive. Informal interviews get deeper. Therefore I used semi-structures face to face interviews. I feel that using semi-structured in depth interviews allowed me use a more open framework, allowing a focus on the conversation and the topics that the interviewee brings up. I started with more general questions and topics to allow the conversation to build up a relationship so the participates felt comfortable and at ease so that they could talk about some sensitive issues if they arose. Semi structure interviews are less intrusive then other methods of research. They allow us to not only gather answers but also reason for the answers, therefore giving a more comprehensive analysis into this area. Therefore I found the major benefi ts of this type of interviewing where that: It is less intrusive to those being interviewed. This is because the semi-structured interview encourages two-way communication. Those being interviewed can also ask questions of the interviewer and feel as though they have their own input. Using this type of interviewing confirms what is already known but also allows the opportunity for learning other information outside of whats being asked. Conducting semi-structured interviews often will provide not just answers, but the reasons for the answers. When individuals are interviewed they tend to open up more and feel more at ease to talk about sensitive issues. (Silverman: 2001) Access I found access to interviewees a little difficult. Getting contacts was the first step, which was done through another occupational therapist I know who passed on a number of email address of willing participants. Once contacted it was difficult to arrange meeting points, days, and times that suited all, but all these issues where overcome and two interviews were successfully scheduled. Ethical considerations Mason (1996) puts forward ways to deal with ethical issues in qualitative which I tried to follow throughout this pilot. This included, deciding what is the purpose(s) of my research, e.g. self-advancement, examining which individuals or groups might be interested or affected by your research topic- in this case it would not be ethically sound to interview the patients themselves as there seen as a vulnerable group, and considering what are the implications for these parties of framing your research topic in the way you have done (1996:26-30). The main ethical considerations I took when interviewing the Occupational therapist, was that before the individual became a subject of research, he/she was notified of: à ¢-  My aims, my methods, my expected benefits and possible hazards of the research I was conducting. à ¢-  I made it clear to the interviewee of his/her right to abstain from participation in the research and his/her right to end at any time that they feel necessary to do so. à ¢-  The confidential nature of his/her answers. I also made it clear during my researching, that no individual would become a subject of research unless they have been given notice and that they freely consent that they would like to participate. No pressure of any kind was used to persuade an individual to become a subject of my research. I will make sure that the confidentiality of individuals from whom I gather my information, shall be kept strictly private. I also stated that at the end of my research any information that would reveal any person involved in the interviewing, will be destroyed, unless already consented that this precise information will be used. http://www.idrc.ca/eepsea/ev-65406-201-1-DO_TOPIC.html Evaluation of Research Process One important use that pilot studies have in qualitative research is to develop an understanding of the concepts and theories held by the people you are studying- what is often called interpretation. This is not simply a source of additional concepts for your own theory, ones that are drawn from language of participants; this is a type of concept that Strauss (1987, pp. 33-34) called in-vivo codes.2 More important, it provides you with an understanding of the meaning that these phenomena and events have for the people who are involved in them, and the perspectives that inform their actions. These meanings and perspectives are not theoretical abstractions; they are real, as real as peoples behaviour, though not as directly visible. Peoples ideas, meanings and values are essential parts of the situations and activities you study, and if you dont understand these, your theories about thats going on will often be incomplete or mistaken (Maxwell, 2004a: Menzel, 1978). Looking at my research questions, through my pilot study I found I had problems in developing the questions as I often got confused between intellectual issues- what I wanted to understand by doing the study- and practical issue- what I wanted to accomplish. According to LeCompte and Preissle, distinguishing between the purpose and the research question is the first problem in coming up with workable research questions (1993, p. 37) I decided to focus on three kinds of questions that are suited to process theory, rather then variance theory. For example I tried to base my research questions around (a) questions about the meaning for events and activities to the people involved in these, (b) questions about the influence of the physical and social context on these events and activities and (c) questions about the process by which these events and activities and their outcomes occurred. For example What does your typical working day involve? Because all of these types of questions involve situation-specific phenomena, they do not lend themselves to the kinds of comparison and control that variance theory requires. Instead, they generally involve an open-ended, inductive approach in order to discover what these meaning and influences are and how they are involved in these events and activities. Decisions about where to conduct my research and whom to include were an essential part of my research methods. I found sampling to be problematic for the qualitative research pilot, because it implies the purpose of representing the population sampled. It ignores the fact that, in qualitative research, the typical way of selecting settings and individuals is neither probability sampling nor convenience sampling. Instead it falls into a third category, known as purposeful sampling (Patton, 1990, p.169). This is a strategy in which particular settings, persons, or activities are selected deliberately in order to provide information that cant be gotten as well from other choices. For example, Weiss argued that any qualitative interview studies do not use samples at all, put panels people who are uniquely able to be informative because they are expert in an area or were privileged witnesses to an event (1994, p.17); I used this form of purposeful selection by choosing full trained Occup ational Therapists to interview. I think selecting those times, settings and individuals that can provide you with the information that you need in order to answer your research question is the most important consideration in qualitative selection decisions. On the negative side, I feel as though one of my interviews suffered slightly due to it been chosen because of its convenience of where and when the interview could take place. Although convenience and cost are real considerations, they should be the last factors to be taken into account after strategically deliberating on how to get the most information of the greatest utility from the limited number of cases to be sampled. Convenience sampling is neither purposeful nor strategic and I feel as though a different individual could have brought more information to light had I chosen more wisely (Patton, 1990, p. 181) If conducting this study again I think I would test out the use of participation observation. In this case it would be of that in an open setting, usually public and in this case a hospital. Gold (1958) states that, when using this technique the participant observer enters the setting without intending to limit the observation to particular process or people and adopts an unstructured approach. Occasionally certain foci crystallise early in the study, but usually observation progresses from the unstructured to the more focused until eventually specific actions and events become the main interest of the researcher. It is important to differentiate between significant and relatively unimportant data in the setting. I also feel several other valuable things were brought to my attention on conducting this pilot study. I found that I need to revise my interview guide, adding questions about issues I hadnt realised were important, such as asking respondent to go through a typical day. I also discovered additional useful questions, such as asking participants to describe specific medical terminology that would illustrate what they had been saying. For example, probing more around phrases such as sensory function, neuromusculoskeletal function, body structure, and client centred. I found that taking a step back and listening to participants experiences in new ways was very important to the collection of the data and feel as though in the future it will help me if I put everything know about Occupational Therapy to one side and do the interview as if I know nothing about this area. Codes Equipment Environment Medical language Patient Life Intervention Medical OT/Patient Academic Skills OT/Patient Social- Work Physical- Work Role of Occupational Therapy In qualitative research, the goal of coding is not to count things, but to fracture (Strauss, 1987, p. 29) the data and rearrange them into categories that facilitate comparison between things in the same category and that aid in the development of theoretical concepts. Above is a diagram of the codes produced after my interviews once the data had been worked through in a systematic manner. Through doing this, many connections were highlighted. For example, looking at the codes Medical Language and Medical OT/Patient. Basically, all patient information, evaluations, and interventions must be documented.(Interview 1, p.3) ..Help them overcome the effects of disability caused by physical or psychological illness, ageing, or accidents (Interview 2, p.2) Therefore this process of coding is the process of combing the data for themes, ideas and categories and then marking similar passages of text with a code label so that they can easily be retrieved at a later stage for further comparison and analysis. Coding the data makes it easier to search the data, to make comparisons and to identify any patterns that require further investigation. http://onlineqda.hud.ac.uk Main Findings After conducting this pilot study and fieldwork, I found that Occupational therapy and Sociology are two completely different sciences. While this is true they encompass a strong underlying relationship. According to Alice J. Punwar and Suzanne M. Peloguin, Occupational therapy is a diverse profession and is hard to define because it has undergone many changes since its beginnings. Early definitions emphasize the use of occupation as a remedial activity to help restore the individual to an improved state of physical and mental health. Now occupational therapy is defined as the use of purposeful activity or interventions designed to achieve functional outcomes which promote health, prevent injury or disability and which develop, improve, sustain, or restore the highest possible level of independence of any individual who has an injury, illness, cognitive impairment, psychosocial dysfunction, mental illness, developmental or learning disability, or other disorder or condition. It inclu des assessment by means of skilled observation or evaluation through the administration of interpretation of standardised or nonstandardised tests and measurements. On the other hand Sociology is understood as the study of human social life, groups and societies (Giddens: 2001) coalescing both of these definitions. Durkheim and Parsons are two of the main theorists whom contributed to the elements of functionalism. Each society has particular social needs or functional prerequisites that must be met in order for the society to strive and survive. Included in these prerequisites, is the need to reproduce new generations, meaning the need for food, clothing, control conflict and the maintenance of social order and of social solidarity. Societies achieve these social needs by developing structures and institutions that have valuable functions. The purpose of any activity or structure is the roll it has in the maintenance of society itself. Society can be viewed as one main structure wit many interrelated and inter-pendent parts. For example, the family, economy and education all work together in an effort to help society survive. Institutions can be seen as being beneficial to societies as the institutions exist for survival of societies. Most literature suggests that they shouldnt come under criticism and instead should be supported. Relating this back to occupational therapists, they should be seen as having a positive role in society. Within a functionalist perspective, roles and social roles are important. The belief is that individuals are socialised through these social roles into society, parent, student, occupational therapist. These social roles largely determine an individuals behaviour. Looking at Kavanagh Faves (1995), two occupational therapists working with homeless people, they stated that Roles are a source of identity and are the frame work of everyday life. Sociologists and Occupational therapists have put this view under criticism. They have argued against the determinism inherent in this view. Mocellin (1995) is an occupational therapist who believes the focus on roles to be stereotyping and that carrying out occupational roles, for example that of a housewife, may not always be therapeutic. Looking at Talcott Parsons model of roles and his theory of the Doctor-Patient relationship, in Bury, M. (2005), he began with the idea that being sick/ill was a type of dysfunctional deviance and that this required reintegration with the social organism. Being ill allows individuals to be excused from their occupation and other responsibilities such as looking after the family, cooking and cleaning. This was seen as potentially detrimental to social order if it wasnt controlled. The development of Parsons sick role was seen as being essential to controlling this deviance to make being ill a transitional state back to the individuals usual role. For Talcott Parsons, Physicians demonstrate Parsons the shift to affect-neutral relationships in contemporary society, with physician and patient being protected by emotional distance. Medical education and social role expectations teach normative socialization to Occupational therapist to act in the interests of the patient instead of their own material interests, and they are lead by an egalitarian universalism instead of a personalized particularism. Physicians have mastered a body of technical knowledge, it is seen as functional for social order to permit physicians professional autonomy and authority, controlled by their socialization and role expectations. Weber and Marx, look at how people exist within the world and are concerned with how that existence is shaped. Marx believes that the problems in society come from different social organisations instead of being a natural phenomenon. This is what is meant by people being constrained by circumstances, but it is important to remember the other element that stresses peoples ability to act. Drawing on earlier work of the philosopher Hegel, Marx identified that we create ourselves in a historical process, of which the motive force is human labour or the practical activity of men living in society (Bottomore Rubel 1963, p.18). Marx noted how the division on labour traps us into particular lifestyles or activities and the influence of Marx led to the acknowledgment in occupational therapy that labour is the collective creative activity of the people (Wilcox 1993) Conclusion After conducting this pilot study it is clear that my research question is still unanswered but it has provided me with ideas, approaches and clues I may not have foreseen before conducting this study. I feel this may increase the chances of getting clearer findings in my main study and has permitted a thorough check of my planned statistical and analytical procedures, giving me a chance to evaluate their usefulness for the data. I also feel it has greatly reduced the number of unanticipated problems as I now have an opportunity to redesign parts of my study to overcome these difficulties again. Overall, carrying out this smaller scaled study will hopefully lead to a rich and in-dept qualitative research project, and the end result being my research question being answered in great detail. The role of an Occupational Therapist The role of an Occupational Therapist The following essay will give a critical evaluation of the role of an Occupational Therapist (O.T) within vocational rehabilitation in the private mental health setting. Firstly the essay will describe a critical analysis of vocational rehabilitation and the added value of an O.T within this setting. Secondly it will analyse the trends within vocational rehabilitation and how these relate to O.T philosophy and core tenets, thirdly an examination of concepts of management that relate to vocational rehabilitation and finally a justification of the identification of a model relevant to vocational rehabilitation. Work can be seen as being an important part of health and wellbeing and also social inclusion. Waddell Burton (2006) suggest that work is therapeutic, helps promote recovery and rehabilitation. Leads to better health outcomes, minimises physical mental and social effects of long term sickness absence and worklessness, decrease the chances of chronic disability, long term incapacity from work and social exclusion. Also promotes full participation in society, independence and human rights, reduces poverty and improves quality of life and wellbeing. Work can be divided into four different areas: paid (contract, material reward), unpaid (housework, caring, volunteering), hidden (illegal, morally questionable) and substitute (sheltered workshop, work projects, day centres) (Ross 2007). The demand for work is extremely high due to the amount of people that are living. Compared to other countries, the United Kingdom employment figures are high with people being employed with a health related condition increasing (Department of Health 2008). It has been estimated that 175 million days were lost in 2008 due to illness with 600,00 people turning to incapacity benefit. (Department of Health 2008) It has been shown that 40% of medical certificates issued have been related to mental ill health with the average time off working being 15 weeks. (Department of Health 2008) Work has been shown to be good for your health and employers who adopt a good approach to health, by protecting and promoting it, are important in stopping illness from occurring. This is an area in which O.Ts can provide a key role in supporting and maintaining people back into work or who are already in work to stay there. Vocational rehabilitation is important. This has been shown in the governments new mental health strategy No Health Without Mental Health (Department of Health 2011). One of the aims is working to help people with mental health problems to enter, return to employment and stay in it. The application of O.T within this area is important as our core philosophy is to enable individuals to engage in meaningful occupations, therefore there is a key role for O.Ts to play within vocational rehabilitation. The following quote demonstrates that meaningful engagement in occupation can be important, which reflects O.Ts core ethics and philosophies. Not everyone wants to be employed but almost all want to work, that is to be engaged in some kind of valued activity that uses their skills and facilitates social inclusion (College of Occupational Therapist 2007 p9). Currently within vocational rehabilitation, employment specialists are trained in advice and guidance and REC level 3 advanced certificate in recruitment practice. Employment specialities tend not to be mental health professional but have skills in vocational rehabilitation or industry experience (Waghorn 2009). O.Ts already have these skills and also can add a holistic client centred approach from an occupational perspective. O.Ts can also add an educative approach, combine medical and occupational models and use activity analysis. They can assess occupational function/performance, build therapeutic relationships, carry out psychosocial assessments and interventions, cognitive evaluation and training, help with work life balance for the client and work with clients strengths. (Waghorn et al 2009, Devline et al 2006 Joss 2001, cited in College of Occupational Therapist 2007 p15) An O.T can bring seven core skills to vocational rehabilitation: collaboration with the client e.g. building therapeutic relationships, assessment e.g. Model of Human Occupation Screening Tool, enablement, problem solving, using activity as a therapeutic tool, group work and environmental adaptations e.g. graded return to work (Duncan 2006 p45) Current themes and drivers within mental health are social inclusion, return to work agenda, recovery. Social exclusion happens when people are unemployed have poor skills, low incomes, poor housing, high crime, bad health and family breakdown (social inclusion and co-production 2011) A report called Mental Health and Social Exclusion was published in June 2004 by the Office of the deputy Prime Minister. It aimed to improve the lives of people with mental health problems by getting rid of obstacles to employment and social participation. There are five main reasons why social exclusion occurs for people with mental health problems. Firstly stigma and discrimination, in which an O.T can help by activity speaking to employers about mental health and how reasonable adjustments, could be made. An O.T can help by increasing low expectations, help promote vocational and social outcomes, help provide ongoing support whilst in employment by regular outreach appointments and help access basic services e.g. dry runs on transport, membership to sports centres (Office of the deputy Prime Minister 2004). Overall an O.T can help people remain in their jobs longer and return to employment faster and manage the work environment better by grading work, breaking down activities and rebuilding them step by step and making adaptations to the work environment for example. Another trend is recovery. Recovery is building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems (Slade et al 2008). Recovery encourages people to develop relationships which give their life meaning. There are five stages of recovery: moratorium (withdrawal, loss, hopelessness), awareness (realisation), preparation (strengths and weakness regarding recovery), rebuilding (positive identity, goal and taking control), growth (living a meaningful life, self management of illness, resilience, positive sense of self) (Andresen, Caputi Oades, cited in Slade et al 2008). Satisfying work supports recovery and as such O.Ts can have a great impact here by ensuring clients are in jobs they really enjoy and able to cope with the work demands. By working in a client centred way, listening, help identify and prioritise personal goals for recovery; identify examples of own lived experience. Also pay attention t o goals which will enable the service user to get back into work, suggest non-mental health resources (friends, contacts, organisations), encourage self management of problems, discuss what the service user needs in terms of psychological treatment, convey an attitude of respect and continue to support, an O.T can help a service user to achieve their ideal job. The return to work agenda is about helping people in and/or return to work. O.Ts can aid this by grading work activities e.g. working hours to start with 16 hours per week and gradually increase by 5 hours per week until full time hours are achieved for example. Also by providing support whilst in job by light touch support, setting up group work activities and training the service user. A practice called place then train helps increase motivation and confidence by placing someone in work and then training them instead of the other way around. It improves employment outcomes and peoples mental and physical health over a long period of time (Centre for Mental Health 2011). Its philosophy emphases rapid job searching, individualised job placement in work followed by on-the-job training and ongoing support (Twamley et al 2008). Currently the concepts of management in vocational rehabilitation within the private mental health sector follows the following structure: Area manager Service lead Employment specialists Volunteers With the introduction of an O.T manager the following structure will be placed: O.T Manager Band 5/6 O.T Employment specialist/ Volunteers O.T.A Referrals will either come from people themselves or via the community e.g. mental health teams, doctor surgerys, job centres. With new referrals the degree of risk, impact of O.T on service user, consequences of service user not receiving treatment, length of waiting time and the appropriateness of skills and abilities will be considered. To get people on board for the change in management, people will be listened to for their points of views, concern will be shown, the manager must be approachable e.g. leaving door open and using positive body language, change will be promoting in a positive manner e.g. it will benefit the patients and questions will be encouraged, integrity and charisma will be shown, also have a good ability to communicate, set direction and unify and manage change. The Lewins stages of change (Mullins 2007) will be adopted where first unfreezing will take place followed by moving and then refreezing. Unfreezing is about getting ready to change by understanding that change is necessary and moving out of comfort zones. Its about weighing up benefits and negatives of the change. Moving or change is when people are unfrozen and decide to move toward a new way of working. This is often the hardest for people and support is needed. Refreezing is stability once the changes have been completed. These changes have been accepted and become the norm. People create new relationships and become comfortable with the new routines. The O.T manager will provide supervision to the band 5/6 O.T and have supervision from a paid outside O.T at that equivalent level. The Band 5/6 O.T will have supervision from the O.T manager and the Occupational therapy assistant (OTA) / employment specialist and volunteers will be supervised by the band 5/6 O.T. Volunteers will be looked after by the OTA. Management will be in a democratic style by listen to people opinions and having staff work with the manager, not against. Make sure that management set examples by dressing correctly, not being late for work; develop an image, project self confidence, influence others and establish personal authority (Martin et al 2010). Also address self management by managing time, self and case load e.g. size up task, knowing themselves (need for breaks, strengths and weakness), prioritising and planning control(keeping a dairy, decreasing interruptions). Bad management will be discouraged such as not resolving problems, criticising staff, poor decision making, disorganisation, failing to deal with staff issues, done give recognition, inflexibility, and have an uncaring attitude and poor communication skills (Moore et al 2006) Management will consider professional duties and responsibilities such as the code of ethics, continues professional development (competence), health and safety (risk assessments) and deal with the present. A number of factors may influence management style: confidence in staff e.g. their abilities, need for certainty (risks of handing over control), personal contribution and stress (overload, worry, pressure) (Martin et al 2010). The justification of a model relevant to vocational rehabilitation is the Model of Human Occupation (M.O.H.O). M.O.H.O looks at peoples motivation (volition), routine planning (Habituation) and the influence of environment on occupation (performance capacity). Some of these areas will be affected by the service user. Volition is the thought and feelings we adopt whilst doing things. This involved three areas: personal causation, value and interest. To change motivation these areas will need to be addressed. By looking at the service users present and potential abilities relating to work and how able they are to bring about work (what is good, right and important) e.g. security, accomplishment and interests, having positive feelings associated with working. Habituation looks at reoccurring patterns of behaviour that make up our daily routines. A service user can change their habits by learning new ways of doing occupations and by changing their perceived role to one of a worker/bread winner. Performance capacity is how the musculoskeletal, neurological, cardiopulmonary and other body systems are used during performance. If there is a problem in performance capacity, the environment must be addressed. Work is an increasing important aspect in our lifes. Some of us live and breath work spending the majority of our waking hours working. Work gives us a sense of identity, an occupation, money to spend. It also provides us with a role in the community helping others with our knowledge in a particular area. Work provides us with a purpose, includes us within society preventing social exclusion, increases self esteem and gives us a role/meaning within society. Definition Work can be seen as the idea of doing, either mental or physical, giving an economic reward, social interaction, the structuring and organisation of time, opportunity for social interaction, contribution to society and self identity (Baker Jacobs 2003) What can Occupational Therapy offer that is different? Occupational Therapy can offer an approach which looks at the whole of a person by putting the client at the centre of their treatment from an occupational perspective. Occupational therapists can also educate people, focusing on independence and ensuring participation in meaningful activities. Occupational Therapists are able to combine medical and occupations models. This means they can look at the impact that physical, social and cultural environments have on everyday activities. Patch Three The following patch will give a critical evaluation and analysis of social policy, legislation and ethical issues impacting on vocational rehabilitation in a report style. Legislation No Health without Mental Health (Department of Health 2011) The government is helping people with mental health problems to enter, stay in, and return to employment. This can by achieved by using light touch support, increase confidence in returning to and remaining in work, help manage conditions and help the interaction between appropriate work and well being. It consists of six main objectives: more people will have good mental health, more people with mental health problems will recover, more people with mental health problems will have good physical health, more people will have a positive experience of care and support, fewer people will suffer avoidable harm and fewer people will experience stigma and discrimination (Department of Health 2011 p6). Its outcome strategies is to focus on how people can be best empowered to lead the life they want to lead, to keep themselves and their families healthy, to learn and be able to work in safe and resilient communities and how practitioners can be supported to deliver what matters to service user. Occupational Therapists can provide high quality employment support which will include building confidence in returning to and retaining work, changing employers and service users beliefs, that they can perform the job and their condition is manageable. Support Interaction between appropriate work and wellbeing and help employees to make appropriate recruitment decisions and manage workplace health. New Horizons (Department of Health 2009) This mentions that work can be good for mental health and wellbeing and support recovery. Those who are unemployed are at an increased risk of developing mental illness and benefit from early support. Employment should be seen as an important outcome to the treatment of mental illness in health care settings. O.Ts can help change attitudes to mental health, can improve health and wellbeing in work, provide swift intervention when things go wrong, coordinate help tailored to individuals needs and build resilience from the early years and thought working lives. Health, Work and Wellbeing Caring for Our Future (Department of Health 2005) Suggests that work is recognised by all as important and barriers to starting, returning to or remaining in work are removed. For people to remain in and return to work, that healthcare services meet the needs of people of working age. That health is not affected by work and good quality advice and support is available. Ensure work offers opportunities to promote health and wellbeing and access to the retention of work promotes and improves population, people with health conditions and disabilities are able to optimise work opportunities and people make the right lifestyle choices from an early age. O.Ts already recognise the importance of work for their patients wellbeing and can provide the assistance necessary to fulfil their key roles in helping patients to remain in and return to work. O.Ts can help people return to work following and absence by employment advice and helping to find a suitable job by adapting the work place environment e.g. time flexibilities. National Skills Framework 5 years on (Department of Health 2004) Help to prevent social exclusion in people with mental health problems, improving their employment prospects and opposing stigma and discrimination. O.Ts can help prevent social exclusion by building confidence, motivation and skills, speak to employers about mental health and how reasonable adjustments could be made, help provide ongoing support whilst in employment and help reduce stigma and discrimination by educating people. Working for a healthier tomorrow (Department of Health 2008) Is concerned with the health of people of working age (females 16 to 59 and males 16 to 64). Identifies factors that prevent good health and changes in attitudes, behaviours and practices. Three main principal objectives: prevention of illness and promotion of health and wellbeing early intervention improvement in health of those out of work O.Ts can prevent illness and promote health and wellbeing by using activity as a therapeutic tool, ensuring early intervention and help those out of work by doing group work to build confidence, motivation and reduce anxieties. Ethics There are at least five potential ethical issues which may be encountered within vocational rehabilitation in a private mental health charity organisation. These are confidentiality, consent, autonomy and welfare, human rights, issues of power and control (College of Occupational Therapists 2005): Confidentiality Safeguarding of confidential information relating to clients, only disclose information when client has given consent, there is a legal justification or it is in public interest to prevent harm. Only disclose to third parties if there is a valid consent or legal justification to do so. Keep all records locked away securely and only make available to those who have a legitimate right or need to see them. Clients can see their records and prior to producing material, issues of confidentiality will be addressed. Use the confidentiality model: Protect (look after information), inform (ensure service user is aware), provide choice (allow service user to decide if information will be disclosed and improve (look for better ways to protect, inform and provide choice) (Department of health 2003) Consent Making sure the client has the capacity to consent. The 2005 Mental Capacity Act makes provision for people who are thought to lack capacity to make their own decisions. It has five key areas: a presumption of capacity every adult has the right to make choices and must be assumed to have capacity to do so unless it is proved otherwise; the right for individuals to be supported to make their own decisions appropriate help must be provided before anyone suggests that they cannot make their own decisions; that individuals must retain the right to make what might be seen as eccentric or unwise decisions; Best interests anything done must be in the best interest for the service user and Least restrictive intervention anything done should be the least restrictive of service users basic rights and freedoms. (Department of health 2007) Autonomy and welfare Respect clients autonomy and promote dignity, privacy and safety of client. Give patients the right to make choices and decisions about their own healthcare and independence. Provide sufficient information to enable them to give informed consent and in a language that can be understood. Make sure client understands the nature, purpose and likely effect of intervention and acknowledge refusal. Human rights A right not to be discriminated against regardless of persons religion, sex, race, colour or mental health A right to respect for private and family life e.g. medical record keeping, parental involvement, collection of data A right not to impact on the individuals freedom of thought, expression or conscience e.g. spoken language and access to interpreters Issues of power and control Respect individuals, enable client to take power and promote partnership Management of Quality Issues Quality assurance The service provided will ensure that it meets the needs and expectations of clients and communities, that there is an understanding of service delivery systems and its key services, that data is analysed, problems are identified, performance is measured and that a team approach to problem solving and quality improvement is used. Clinical Governance Involvement Make sure service users, carers and public are involved within the service by holding focus groups, open days, suggestion boxes, questionnaires, panels e.g. to find out opinions on waiting times, attitudes of staff and the physical environment Risk management Establish what could go wrong and rank this. Think how probable it is likely to occur, what can be done about it and what action should be taken if incident happens again (Health Safety executive 2006). E.g. service users deliberately harming herself in occupational therapy session or a spillage on the floor. The Healthy and Safety at Work Act (1974) states that it is the duty of the employer to ensure so far as is reasonable practical, the health, safety and welfare at work of all his employees (section 2 (1) Health and safety at work act 1974). Although it is the duty of the employee to take reasonable care for the health and safety of him/her and others who may be affected by his/her acts of omission and to co-operate with their employer in regard to any duty or requirements imposed (section7 Health and Safety at Work Act 1974) Clinical audit Identify topics relevant to vocational rehabilitation e.g. referral response times, set standard (3 days), collect data (computer package), analyse data (if standard not met then why) and implement change. Other examples may be how the service compares with standards set by other clinical governance activity. Clinical effectiveness Ensure that all treatment is up to date and based on evidence based practice, National Institute of Clinical Excellence and National Service Framework guidelines. Staffing and staff management All staff recruited have the skills and qualifications needed to do the job e.g. that they are Health Professional Council (HPC) registered, induct them, give supervision and appraisal and deal with poor performance. Also supervision on a regular basis and appraisal once a year. Use an indirect approach which is more centred around the person, talk less and listen more, provide a supportive relationship, ask questions, accept and use ideas, reflect and summaries ideas (Enthwistle 2000) Education, training and Continues Professional Development (CPD) Ensure mandatory training is given e.g. fire training, child protection, health and safety. Complete CPD portfolios and HPC audits; provide training and opportunities to enhance CPD such as visits to another vocational rehabilitation service. The HPC (2011) states five standards for the CPD. A registrant must maintain: an up-to-date and accurate record of their CPD activities demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice make sure that their CPD has contributed to the quality of their practice and service delivery ensure that their CPD benefits the service user present a written profile containing evidence of their CPD on request Use of information systems Use information systems to record treatment sessions that service users attend, time spent preparing treatment sessions, time spent on phone calls to service user and time spent in case discussions. Also handling patient identifiable information by applying the data protection act and locking information away. The data protection act implies that anyone collecting personal information must fairly and lawfully process it, process it for limited, specifically stated purposes, use the information in an adequate relevant and not excessive way, use information accurately, keep information on file no logger than necessary, process information in accordance with legal rights, keep information secure and never transfer information outside U.K without adequate protection (Direct Gov 2009) Patch Four The following patch will provide a reflective narrative of the learning experienced throughout the module utilising the Gibbs reflective cycle. This has been developed from Kolbs ideas and develops the features of the experience-reflection-action cycle (Jasper 2003): Description Action plan Feelings Reflective cycle Conclusion Evaluation Description The Gibbs cycle consists of six stages and asks a series of questions about the experience. Description stage is what happened, feelings stage is what where you thinking and feeling, evaluation stage summarises what is good and bad about the experience, description stage involves making sense of the situation, conclusion stage is what else could have been done and the action plan stage asks if the situation arose again, what would you do. To begin with the whole assignment seemed extremely daunting as I had never participated within a role emerging placement/role before. I had also never completed a patch work text and knew very little of both. As part of the assignment we were asked to discuss ideas with peers. I felt it was a good idea to share information with others and thought that this would be an ideal opportunity to reflect on things I was not sure about and where to go for more information. Whilst discussing ideas with my peers I was thinking how what we had discussed would fit into my assignment and in what patch. It made me feel a little more comfortable sharing with other as we could bounce ideas and thoughts off each other. I feel other peers also felt that group discussions were useful and helpful. From start to finish I felt good about discussing information and still feel that this was of great benefit to all of us. Exchanging views helped put things in some kind of order and others could help in areas where I had difficulties. I do not feel there was anything negative about this experience in general. Sharing ideas with others went well as we all had views to share. To contribute, I helped others to see what went in each patch and gave ideas about the assignment. Overall there is not much I would have done differently with this peer review work. The aim was to share and discuss information and this was done successfully. If I were to do peer review work again I would do the same by sharing ideas and information with others. During my visit to a vocational rehabilitation setting I got to see how the service was run, where referrals come from, meet staff and service users and view leaflets. Upon arrival I felt overwhelmed by information and was intrigued about the service. I was thinking how I could relate this to my assignment and what role an occupational therapist would play within such a service. The service manager, who showed me around, knew about occupational therapy as previously they had worked as an assistant in such a role. This made me feel happier as I could share some ideas with them. I felt the visit went extremely well and it was a positive learning experience. From the start I felt comfortable about visiting the service and knew I would collect lots of relevant information from it. Access to information and ideas was the most significant factor for me. Actually seeing a vocational rehabilitation service running was a great inspiration and thought provoking for me, as I could see where parts of my assignment would fit in. I feel the whole visit went well and managed to collect a lot of relevant information. To complete patch work two we were asked to produce a leaflet aimed at our intended service users. I found this patch difficult because selecting relevant information was not easy e.g. font, colours, headings, content, pictures. When I first started the leaflet I had previous knowledge from another module, so had an idea how to construct the framework. I was thinking what type of content would go into the framework of the leaflet and how. Others mentioned that the leaflet should be easy to read and with bullet points, pictures and a calming background. I felt this would be a good idea, by aiming the leaflet at my service user group in particular. I thought that the leaflet was starting to take shape and it was aimed at who it was intended for. To start with I felt a little lost as to what to so but with help from my peer review group I eventual found a way. The most significant thing to me was being able to reflect ideas with other people about the leaflet. I feel that putting the leaflet together was a good experience as it has taught me how to present information to a targeted audience by using easy to understand phrases rather than jargon. Also working in peer review groups was a good experience as we were able to share ideas with each other and share information. The only thing that didnt go so well was working out how to transfer the leaflet from publisher to a word document, also slimming down the content without vital information being lost. I feel the leaflet went well and managed to collect and produce the correct information. Others did help by offering encouragement and ideas which aided me in producing the leaflet. I realise now that I should have consulted my peer group earlier to starting the leaflet as their ideas helped and guided me. To complete patch three we were asked to critically evaluate and analyse social policy, legislation and ethical issues impacting vocational rehabilitation. I found writing this patch extremely difficult as I had no idea of legislation, ethical issues and quality issues relating to this subject. When I started this patch I felt very nervous and worried as to how I would find such information. I was wondering how I would go about doing this patch and what was involved. When I was looking for information I found a vast array. I had to sieve through relevant legislation and apply it to