Intervention

Working with people, you will find that there is no one theory, practice or strategy that will help solve all the persons issues or problems. As an occupational therapist you have been dual trained, so you can select the best fit for your client.

In this series of 7 blogs, I have illustrated how the OT process can be used over and over again, in a micro or macro context, in any area of practice.

Each blog is designed so each section of the process stands alone, and you can begin at the beginning, middle or at the end, depending on your burning issue.

In this blog I have focused on intervention, the bit that enables the change to occur.

By this point you will have received your referral, and clarified the areas that require an Occupational Therapist. You will have prioritised all the areas that have been identified, consulted with the client and listened to hear the most meaningful difference you could make to their lives.

Now it’s your job to ensure that this is achieved and there is no fail. The way you do this is through activity analysis. So clarifying the activity and breaking it down to its component parts, and then maybe depending on your client breaking it down some more so that the first step is always achievable.

That can be as small as flexion and extension of a thumb, which can be measured by degrees, or as large as applying for a job, which can be measured by someone getting a job, and staying in a job for over 6 months.

This is the absolute core skill of an Occupational Therapist, breaking down activities into achievable steps and working with the client to achieve them. You are using all your skills and abilities to enable, advocate and collaborate with your client so that they are doing something that is meaningful for them.

There are lots of complex batteries and assessments out there, and you can use any of them that you find the most useful. They will all require you to break down tasks, and break them down some more, until they are achievable and record then the progress.

Measuring change and progress is in my next blog – outcome measurement.

If you have any questions or comments I would love to hear from you.

Just email me on margaret@ot360.co.uk or you can visit my website www.margaret@ot360 if you would like a bit more information about me
will help solve the all the persons issues or problems.

7 Steps to Highly Effective Occupational Therapy Practice – Assessment

Referral
Prioritisation
Assessment
Intervention
Evaluation
Outcomes
Reflection

Working with people you will find that there is no one theory, practice or strategy that will help solve the all the persons issues or problems. In this series of 7 blogs I have broken down the OT process that can be used over and over again in a micro or macro context, in any area of practice.

Each blog is designed so that each section stands alone and you can begin at the beginning, middle or at the end depending on your burning issue.

If you are already using an assessment tool which works just fine for you, well done you can skip this blog.

In terms of what to assess as an Occupational Therapist it is vast, as we follow the person from when they wake, to their sleep hygiene before going to bed and everything else in between.

If you have created a referral form from blog 1, and prioritised the areas for assessment in blog 2 you should have a client centred focused area to assess.

Assess means a few things. Once the person has identified what they would like to do to increase their independence you can observe them carrying out the activity and clarify how they currently do it. Then you should be able to identify what’s preventing them from doing it as they would want to, and what steps could be put in place to enable them to achieve their goal.

You can also talk to other people carers, parents, staff etc to build up a picture if the person is unable to give you one theirselves.

In order to do this you need to be highly skilled in your communication, to build a rapport very quickly and be very aware of verbal comments and non verbal signals. This is all part of the initial assessment. Your observation skills need to be excellent, and you need to be present.

This is a time to create a baseline as part of your assessment. A baseline is where the person is when you start working with them.

Where are we now, and where would we like to be, takes you to your intervention which will be discussed in the next blog

If you have any questions or comments I would love to hear from you. Just email me on margaret@ot360.co.uk or you can visit my website www.margaret@ot360 if you would like a bit more information about me

Referral
Prioritisation

Assessment
Intervention
Evaluation
Outcomes
Reflection

Working with people, you will find that there is not only one theory, model of practice or strategy that will help solve all the person’s issues or problems.

In this series of 7 blogs, I have broken down the Occupational Therapy process so that it can be used over and over again, in a macro or micro context, in any area of practice.

The blogs have been designed so that each one stands alone, and you can begin anywhere depending on your current issue.

This second blog in the series is about prioritisation.

There was a reason to start with a referral system. You need a system which helps you to be able to prioritise. Once the referral form is completed you have a list of all the potential areas you could work with your clients. You are then able to stand back and say, ‘ok all this needs doing however I only have 22 hours in the week I need to prioritise my work so I can be most effective.’

You may decide with the team or in supervision that you will prioritise falls or whatever is the most urgent for your clients and team. Who and what you prioritise may also link with your mission statement, NICE guidelines, RCOT standards and the CQC recommendations from any visits.

You will have an overview of your clients and their complexity, and everything that they need. However you can focus on immediate needs and deliver focused intervention.

Over and above this, you can create a waiting list. This may also be used as a rationale for extra staff. It’s clear the other interventions which you could deliver as an Occupational Therapist but haven’t got time evidently need extra therapy time. It’s a clear, transparent system and it will help you to focus your day and weekly priorities.

When more work comes in you have a system to be able to reprioritise, ensuring the priority 1 people get seen first.

For example,

In a care home it may be

Priority 1 is reduction in falls, with basic interventions and suggestions

Priority 2 is increase in independence in washing, dressing and eating

Priority 3 is increase in meaningful activities and constructive routines

Having this structure helps you to negotiate your time. As I said initially it can be overwhelming in MDT meetings to think everything has to be picked up by you relating to function and activity, well if you are only here 22 hours per week you have to prioritise.

In this blog I have focussed on prioritisation as you cannot do everything for everybody all the time. There are only so many hours in the day so get into the habit of prioritising your work into priority 1, 2 or 3.

Within each priority it is then easier to be able to work with the person to identify what is meaningful for them, ensuring you maintain client centred practice in a highly effective way. Right now we are ready for assessment in the next blog.

If you have questions or comments I would love to hear from you. Just email me on margaret@ot360.co.uk or you can continue to explore my website to find out more about me and my work in supervision.

Working with people, you will find that there is not only one theory, practice or strategy that will help solve all the person’s issues or problems.

In this series of 7 blogs, I have broken down the Occupational Therapy process so that it can be used over and over again, in a macro or micro context, in any area of practice.

The blogs have been designed so that each one stands alone, and you can begin anywhere depending on your current issue.

I am starting with referral. I know this is a controversial issue but stay with me, there is a reason for starting here.

Some places operate a blanket referral system, everyone to see the Occupational Therapist This can be overwhelming and doesn’t give you the opportunity to prioritise. Another topic for another blog!

If every  MDT you go to leaves you feeling that there are a million and one thing to do when you come away, you are not alone! If this is you, there is something you can do.

The first thing to do is make a list of everything that you think you should be assessing with your client group. Yes, very single thing that you could assess if you were being a holistic occupational therapist. To be honest, it’s probably probably running around in your head like a runaway train, and usually it will feel a relief to get it all out on paper.

I think it’s crucial to create a referral form with all these areas on, and distribute to the relevant support or qualified staff. This has a number of results.  Firstly everyone will know the wide scope of your job, and people will pause to think, ‘why do I think OT should be involved here?’ Often it helps if a launch happens with training about your role, and function of occupational therapy.

If you feel creating a referral form is impossible, stay with me, just do it for yourself as an exercise in supervision.  Prioritisation is coming next…

If you have questions or comments I would love to hear from you. Just email me on margaret@ot360.co.uk or you can continue to explore my website to find out more about me and my work in supervision.

Today I was attending a study day for yet another model of Occupational Therapy. I won’t say which one, it’s not really relevant. It left me questioning the discussion of yet another model of practice.

As occupational therapists we have all the knowledge, skills and ability to work with difficult hard to engage people. Yet we continue to create models which we can barely articulate ourselves despite all being educated to degree level and then we have to try to explain it to clients and the MDT. Complex words that have no place in any ordinary conversation eg. self differentiation, volition etc that we then have to reinterpret because no one else knows what they mean.

What on earth are we doing?

Use your client centred skills, listen and observe, ask clients what they would like, what they hope would be different. Take time to really listen to what they want and need. Let them be the expert rather than give them yet another label to add to their arsenal.

Explore with them what is meaningful for them, not what happens to be in the cupboard. Break down the tasks, then break them down some more then analyse the activity and work out how to enable the person to change in the direction they have chosen without any option of failing.

Make it a safe space, ensure you engage fully with clients and create a therapeutic relationship. Check out the activity is meaningful, ask them what a difference it would make. Get them to rate theirselves. Believe them, they are an expert in who they are and their experiences

Before and after every group or activity you deliver get clients to rate where they are, and again after the groups or activity what change/difference they have noticed. Give your clients the opportunity to make suggestions for change. Enable autonomy, independence choice and control. This is occupational therapy!

Occupational therapists create change. Believe in your own skills and abilities.

So no I don’t believe we need another model of practice we already have have all we need to deliver the change our clients want and need.

Over the last couple of supervisions I have carried out with a wide range of occupational therapists from regional directors to students. I have had some valuable insights from them about the real added value for OT’s of external supervision.

Because I am independent of the organisation we can identify the direction that you want to go, without an agenda that a manager or colleague would have. We can explore your resilience to carry out your plans or goals, again without the needs of the organisation overshadowing your personal and professional development.

The reason for this is that I don’t come with an agenda, I don’t live in your world. I am completely neutral in exploring your world with you, from your perspective.

Supervision provides a safe, confidential space to unburden yourself of all the worries and challenges of the month. It all goes on the table in front of us. You prioritise the things it would be most useful to pick up, examine, identify the value of, and work out if it’s worth prioritising to talk about. You set the agenda.

I am not your line manager or someone you work with everyday. We don’t go outside the room and revert back to our roles and get on with the day job. Because I am not part of the organisation, your action plan doesn’t have to fit in with the ‘Strategic Plan’. Occupational Therapists I work with tell me that the freedom that brings is incredible, it’s different from any supervision they have had before.

Imagine having an hour or two that is totally dedicated to you, your priorities, your personal and professional development?

Working as a health care professional these days is a high pressured demanding job. It needs some decompression time. Take a moment to think about how are you achieving that for yourself? Do you need a bit of time dedicated to enhancing your personal and professional development?

Think about how you relax, how you keep your occupational balance? Could external supervision be part of that for you?

Have you read my testimonials? Everyone uses the sessions differently, everyone feel in a better place after the sessions.

Imagine if you had external supervision. Tell me what difference could it make to you?

margaret@ot360.co.uk I would love to hear from you.

Referral

Prioritisation

Assessment

Intervention

Evaluation

Outcomes

Reflection

The blogs are designed so each section stands alone and you can begin at the beginning, middle or at the end depending on your burning issue.

Working with people you will find that there is no one theory, practice or strategy that will help solve the all the persons issues or problems.

In this series of 7 blogs I have broken down the OT process that can be used over and over again in a micro or macro context, in any area of practice.

If you are already using an outcome measure which works just fine for you, well done you can skip this blog. If not read on…

Although you might think that measuring outcomes is the last thing you do this is often the place we need to start. It is essential that you provide tangible evidence of the difference you have made for your clients.

If you’re going to show what has changed for clients then you have to use a baseline.

Having a measure is crucial, because after the intervention you will then have two pieces of evidence. One is a score recorded at the beginning of the intervention and the second is a score recorded at the end of the intervention. The difference between these two scores is the difference your intervention has made.

Your baseline can be any standardised assessment or can be as easy as a self rating scale. Self rating is a really, really valuable tool. It gives control to your client. If you feel this is challenging for your clients, have a think around it, we are the best problem solvers.

I have created collages of what it means to be confident with my clients with learning disabilities, and then we created collages of what not being confident meant to them. I put those two images on the wall 5 steps apart and asked people in my group to rate themselves with different tasks. I took photos. At then end of our intervention I repeated the process and everyone had moved position. We all had photographic evidence of change.

Identifying outcomes is absolutely crucial to your practice, because demonstrating that you have made a difference means its worth buying occupational therapy.

Making a difference is the absolute heart of your practice- it’s why we do the job we do.

In the next blog we explore how we can reflect on our practice.

If you have any questions or comments I would love to hear from you.

Just email me on margaret@ot360.co.uk or you can visit my website www.ot360.co.uk if you would like a bit more information about me.

1. Registered with Health Care Profession Council ☑️

2. Member of Royal College of Occupational Therapy ☑️

3. Insurance over £6million ☑️

4. Regular Professional Supervision ☑️

Professional supervision is something we all can forget about when we move to work outside the NHS or Social Services, or when we are working an independent practitioner. It’s easy to let it slide off your ‘to do’ list as there are so many other things to consider.

The Royal College of Occupational Therapists (RCOT) Standards of Professional Practice 2017 state that, ‘as a practitioner, you receive regular professional supervision and appraisal, where you use critical reflection to review your practice.’

It is also recommended by the Health and Care Professions Council, (HCPC).

So apart from from it being part of your standards of practice what are the benefits of professional supervision?

Well forget about having to please your line manager, nodding and agreeing that everything is ‘going fine’, remembering the party line and which side of it you need to be on. Or trying to work out what exactly you are supposed to getting out of peer supervision as you haven’t spoken yet?

Having independent professional supervision gives you autonomy, choice and freedom. Sound good? Wasn’t that why you left you old job?

Is this the time to reflect on your current supervision arrangement, and check out if it is still fit for purpose?

Think about it in these terms…

Do you have the opportunity to decide the agenda, prioritise what you talk about and for how long?

Do you have a bullet point summary of everything you have talked about?

Do you receive this as an electronic or paper copy that you can amend if necessary which has been written down by your supervisor so that you can concentrate, critically reflect and clear your head each month?

Do you have a comprehensive realistic action plan, for the next month?

Is your action plan linked to each of the HCPC standards of practice, so you have 12 pieces of evidence for each standard for your yearly appraisal?

Will you have 24 pieces of evidence to demonstrate how you maintained your CPD all ready for the HCPC October 2019 audit?

I would like to think that my testimonials from qualified Occupational Therapists, and others I have supervised along the way really clarify the huge benefits of having regular professional occupational therapy supervision can have on you personally and professionally. The two are inextricably linked, as we know too well, please feel free to read them www.ot360.co.uk

I would love to hear your all your answers and any questions/comments you may have? margaret@ot360.co.uk

10 Steps to becoming an authentic Occupational Therapist.

1. Listen actively to the person, not the organisation.

2. Hear what the person is saying verbally and non verbally.

3. Translate this narrative into a measurable baseline; is this where you are now?

4. Work with the person to identify where they would like to be.

5. Listen and explore the barriers that they could experience to get to that new place.

6. Develop a partnership and identify how the barriers and beliefs will be navigated.

7. Use the language, symbols and metaphors that you hear your clients using.

8. Pinpoint where the starting point is and crucially, the first non failing achievable step.

9. Provide regular feedback on their achievements/developments and support them in their journey with the all tools you have.

10. When the time is right and they are on the road to independence, let go. Measure the cost benefit analysis of your intervention and feedback to the organisation.