Latest Entries »

Transitions

question signWhen I think of summer, I see this time of year as being the calm before the storm. Things are about to change; people are graduating and looking for their first job, or starting a new course/school year soon. The last few months have been a time of great change for me – I got married, moved to a new country, changed jobs … the list goes on. I’m planning a future post about transitioning to an occupational therapy career in a different country (mainly about finding work and passing the NBCOT exam to work in the USA, it’s a tough one!), but first I wanted to share some of the things I’ve found helpful during a time of transition for me – hopefully it will be helpful for those whose lives may be changing over the coming months.

So what can you do to help yourself when things are uncertain? Here are some things that have worked (with varying degrees of success) for me:

 

  • Make a plan. At times of upheaval, it’s helpful and reassuring to know that you’ve got a plan for what you want to do and how to do it. Have a think about what’s important to you (it might be getting a new job, meeting new people, etc) . Make a list of things you want/need to do (I find nothing happens if I don’t write stuff down) and then do your research about how you can make those things happen. DON’T expect that it will all happen straight away … which leads us to …
  • Be kind to yourself. Acknowledge that you are going through a tough time, and be mindful of this. Find people to talk to about it if you can. You won’t get everything, or even half the things, on your ‘to-do’ list done in a day, maybe even in a week. Don’t be hard on yourself about it, things take time.
  • Get into a routine. We are creatures of habit, and getting into a routine will help you feel like you’re settling in. For me, it helped to use a diary to plan my week, and to get up at a certain time each day.
  • Keep in touch. The wonder of t’interweb has made it incredibly easy to stay in touch with people far away. Being sociable is a good way to help yourself feel better if things are stressful.
  • Volunteer your time. There are numerous benefits to volunteering – it can help you to meet new people, give back to your community, make useful career contacts, make you feel good, amongst other things … and it’s free! Contact your local volunteer centre or look into volunteering through your school/university/employer. There are many websites which can help you find a volunteering post – http://www.do-it.org.uk is a good one if you’re in the UK, or you could just Google charities in your local area that fit with your interests. Speaking of interests:
  • Keep doing what’s meaningful to you. Your occupations will help you feel more like you – so if you really enjoy drawing/playing an instrument/exercise then find somewhere you can continue to do that activity. When I first moved to the States, I was sad that I couldn’t play netball anymore as it’s not really played over here, but then I found that a group of expats had set up a team in a local city. I was so excited! And it was wonderful to play again, as well as meet some great new people.
  • Develop yourself. I found myself with a lot of time on my hands, but very little spare cash. Fortunately there are loads of free courses out there which helped to keep me occupied and also made me feel like I was doing something relevant to my career while I couldn’t work. Check out http://www.coursera.org/courses for free online courses, on just about any subject you can think of, run by various universities around the world.

 

There you go peeps, hope that was useful. It feels good to be back blogging again after a stressful few months 🙂

 

 

COT Conference 2013

It’s taken me a while to get around to reflecting on my trip up to Glasgow for this year’s College of Occupational Therapists’ Conference. For many reasons, which I won’t bore you with. However, three months on, I’m now ready to share my learnings; there’s a link to a PDF of the summary of the sessions I attended at the bottom of this post (11 pages worth; no wonder I felt like my head was about to explode for the entire time I was in Glasgow).  The posters from the conference are also now available online: http://f1000.com/posters/browse?conferenceId=253122499.

Although I’d attended the conference last year, this was the first year I’d presented there. It all seemed like such a good idea when my university tutors were encouraging us to submit our research abstracts in the autumn, and it was really exciting to have the abstract accepted. But now I actually had to present. In front of lots of actual OTs, at a big scary conference. Gulp. Fortunately, I was on in the first session after the opening plenary, which meant I was able to get the presentation out of the way early and concentrate on enjoying the rest of the conference. I thought presenting would be really scary (I get quite nervous) but the steward and the other presenters in the session were all very supportive, and as my friend put it, ‘presenting to a room of smiling OTs isn’t that terrifying actually’. I was nervous at the start of the presentation, but as it went on I found myself getting into it and enjoying myself.  People were listening to my research findings! It felt good to share what I’d found with other OTs; I’d definitely recommend submitting that abstract if you’re considering it 🙂

COT 2013

COT Conference 2013

Still a student?

life is a classroomI’ve been doing a bit of thinking recently about what I should do with my blog (probably post on it more often!). This is mainly because I graduated from my OT course two months ago, therefore making my blog title not technically true anymore, so I’ve been wondering if I should rename it or not, start a new blog on life as a qualified OT, etc etc, blah blah blah. After a bit of pondering, I happened across the following quote:

 

‘There is no end to education. It is not that you read a book, pass an examination, and finish with education. The whole of life, from the moment you are born to the moment you die, is a process of learning.’                                                                                   Jiddu Krishnamurti

 

Obviously a very wise chap. I really like this quote, and it helped me decide to keep the name of this blog – although I’m no longer a student on an OT course, I still have a lot to learn about OT practice and hope I continue to learn and improve throughout my career as an occupational therapist. In a way I still see myself as a student; I’ve definitely not given up buying OT books (as my groaning bookshelf will testify) and I’d recommend the Facebook OT textbooks page, Amazon, Ebay and Gumtree to pick up a few bargains.

I’ve been working as a locum OT on an acute elderly medical ward since I qualified, and this week I had my first supervision session, which really helped me to think about the competencies I would need to evidence for Band 5 OT preceptorship. The supervision session also made me realise that CPD doesn’t have to be scary or a chore – I’m learning a lot in my new role, I just need to find ways to evidence it. I dug out my CPD folder (sadly neglected since I completed my final university assignment) and have set about organising it and completing a few reflections. Although an acute physical setting isn’t necessarily where I would like to work in the long term, through completing the reflections I’ve realised I’m developing skills which will be transferable to other areas of practice. Hopefully this will help me get a permanent job in the future 🙂

Going back through my CPD folder also reminded me how much I learned over my two years as an OT student – my overriding memory of those two years was constantly feeling like my head was about to explode with all the new knowledge. My final thought for today is with all OT students who are on their final stretch of their courses now, stick with it – you’ll soon be finished and free to be OTs, it’s worth it!

Who is the client?

parents_and_childrenThat might sound like an odd question. But, having almost completed my ten week paediatric placement, it’s something that’s cropped up several times and which I’ve debated with the OTs I’ve been working with. Working in paediatrics, the child is obviously the client. Or so I would have thought before I started this placement. However, working within a private clinic and school disctrict in the US, I’ve begun to see that the parents, carers or teachers of the child you’re working with are also the client. They are often able to communicate the needs of their child better than the child could themselves and report on the child’s progress. Just as importantly, they provide the insurance or funding for the intervention and ensure that the child attends the sessions. There is no doubt that involving the parents and carers of a paediatric client is really important.

So what happens if the needs or wishes of the child and the parent are different? What if they have different goals for the treatment, or different motivations for engaging with the intervention? An example of this occurred within the clinic a few weeks ago; the parent of a child with an autistic spectrum condition wanted their child to ‘fit in’ at school and be more popular with other kids, while the child was quite happy at school – although he had few friends, this did not bother him. This is something I’ve been reflecting on as I come to the end of my placement. I’ve realised that my own viewpoint is to be child-centred where possible and try to advocate for the child. I’m aware this could bring me into conflict with the parents though, which could make for a stressful situation for both parties and possibly end the treatment if the parent does not agree with the team’s stance. To make this less likely, the best solution I can see is to thoroughly assess the child’s and parent’s motivations for engaging with the service, and what their respective goals are for the intervention, before any intervention occurs. Sounds easy, but requires both parties to be completely honest and for the therapist to listen and understand both perspectives, as well as putting their own views to one side. It may also be important to manage expectations, so both the child and the parent know what is feasible/achieveable before the intervention starts.

Of course, this kind of conflict of interests isn’t unique to paediatrics – it could apply to any client group in any setting. I’d be really interested to hear other professionals’ thoughts on this, and how they have handled such situations in their practice. Looking forward to hearing any comments 🙂

Kids in America

Four weeks ago, I left lovely Leeds and travelled to sunny California for the final placement of my occupational therapy course. I’m hoping to work in the US in the future, so I was keen to organise a placement that would allow me to gain experience and contacts in this area. The placement is at a private paediatric (hence the retro Kim Wilde-inspired title, apologies for that) occupational therapy clinic which also offers school-based services. The majority of the clients seen at the clinic have autistic spectrum conditions, whereas children seen within the schools may have a variety of different conditions, or may just need extra support to meet the goals identified by their Individualised Education Programme (IEP). So far I’ve really enjoyed the placement, which has given me the opportunity to work with children and young people – something I have limited experience of. Since I started the placement three weeks ago, I’ve had a great range of experiences; I’ve planned and run groups at the clinic with support from my supervisor, assessed children within their school environment and delivered individual interventions tailored to clients’ needs.

If I’m honest, for the first two weeks I thought my head might explode at any minute as there was so much to take in – as well as learning the ropes at placement I also had to learn to drive on the other side of the road (only one vaguely scary incident so far, touch wood) and be aware of the cultural differences between the UK and USA, both with regards to healthcare and in general everyday life. I’m slowly getting used to all this, but it’s taking a while! I’ve picked out a few of my key learning points after reflecting on my placement so far:

  • Communication is incredibly important. Sounds obvious, but it’s easily forgotten, particularly when the clients you are working with may struggle to communicate what they need due to their disabilities. Reading clients non-verbal cues and allowing the session to be directed by the client rather than the therapist are things that I’m getting used to. Also, it can be more difficult to make yourself understood as a foreigner –  I had an interesting experience in the town’s local ‘English’ bar when the staff couldn’t understand my accent! Which leads me on to my next point . . .
  • Don’t make assumptions. As an inexperienced OT, I find it’s easy to assume that clients with the same conditions will behave in similar ways. As I’ve been learning, this is rarely true! Remembering that each client is an individual with different experiences and environmental influences has helped me, I tend to use the PEO model structure which I find useful.
  • Differences can be useful. When working with clients with autistic spectrum conditions, I’ve found that I can use the cultural differences between the UK and USA as a way of teaching acceptance and challenging concrete thinking. For example, one of the clients in the group I ran disagreed with my spelling of ‘tyre’, which is spelt ‘tire’ in the US. This started a discussion about how to deal with other peoples’ points of view, and how it’s OK if people don’t agree with you – different isn’t bad, it’s just . . . different.
  • Take the environment into account. A supportive environment (school, parents, peers, community) can have a great effect on a client, particularly children, who are still developing.
  • Things can change quickly in private practice. Gaining new contracts with different schools/districts can radically change the OT’s schedule at short notice, so flexibility is required. This is good experience for the changes which are happening within the NHS, which may start to resemble the US system with more privatised contracts. Personally, I’m not sure this is a good thing, as during transitions from one provider to another it will be difficult to maintain continuity of care and clients may suffer.

I’m really enjoying my placement so far and would recommend an overseas placement to any OT student – although it did take a lot of organising (my university were really supportive during this process) it’s definitely worth it. I was able to access some funding through the university, so it’s worth looking what might be available to support you if you want to go abroad, and I’d recommend starting the process and expressing an interest a long way (at least 10 months) in advance. Hope this is helpful, I’m sure I’ll be boring everyone with more details of my placement soon 🙂

If I’m being honest, I’ve neglected this blog over the last few weeks. In my defence (or in other words ‘here are a list of my best excuses’) the past few weeks have been particularly stressful; deadlines for submission of my research, abstracts for next years COT conference to write, a placement abroad to prepare for, as well as being in university full time. It makes me a bit tired just thinking about all that stuff.

Thankfully, most of the stuff is now done. Having a bit more time to myself has made me reflect on the effects of stress, and how to cope with them, whilst at the same time still getting all the stuff done. I thought I’d share a few tips that I’ve found useful to reduce stress (in addition to drinking lots of tea of course):

 

  • Use mindfulness. When I first came across mindfulness, if I’m honest, I didn’t really get it. However, I did find the concept intriguing and the more I looked into it, the more sense it made. Being more aware of your thoughts and the world around you is actually quite useful (!). I would recommend a book I found useful which explains the concept well and includes practical exercises which I found calming: Mindfulness, a practical guide to finding peace in a frantic world by Mark Williams and Danny Penman.
  • Be kind to yourself. Being self-critical is counter-productive, but it’s a hard cycle to break out of. If a friend was in the same situation and asked you for advice, would you criticise them? Probably not, so treat yourself how you’d treat other people. It really helped me to acknowledge that the situation was stressful, and that it was ok to feel stressed. And then, in the name of being kind to myself, allow myself to have that cup of tea and slice of cake.
  • You can’t say yes all the time. Learning to say no is a difficult skill, but sometimes it’s better to do a few things well (and not make yourself ill) than try to be all things to all people.
  • Make a to-do list, but with small, easy to achieve tasks on it. Then get them to-done. Sounds silly, but it’s nice to have the sense of achievement that ticking things off a list gives you. Especially if you’re a to-do list junkie like me.
  • Eat the frog. Identify what you don’t want to do, but really need to do. And then do that first. Or . . .
  • Procrastinate. It’s ok – you might get more done than you think. Probably not the things you were meant to be doing though – I generally have no interest in housework, but I always seem to have a very clean house when I have a piece of work that needs handing in. However, procrastination can be useful; it gives you more time to think about things, and by doing other stuff you may come across information that is useful for what you’re actually meant to be doing.
  • Have a balance. I find it very tempting to shut myself away in order to get all my tasks done, so there are no distractions. It’s important to make time to do the occupations that you value though, so that you still feel like yourself. Helping other people is often a good way to help yourself feel better. The more you treat into your own little world of stress, the more stressed you’ll become – it’s a vicious cycle. So take regular breaks and do something you enjoy (back to tea and cake again).

 

These are things that I found helped me, so they might not work for everyone and certainly aren’t based around any evidence. I’m now off to reward myself for finally getting round to writing a blog post, no prizes for guessing what’s next on my to-do list . . .

During a recent taught session at university, the topic of sex and intimacy as a part of occupational therapy practice was discussed. I have to admit this wasn’t the most comfortable session for me, and speaking to my colleagues many felt the same. So why do we find this such a difficult area to address? Studies have shown that occupational therapists recognise that sexuality is within their scope of practice, but that very few actually address it. There may be a variety of reasons for this; the OT may not feel comfortable discussing this with a client, or the client may not feel comfortable discussing it; the OT may not feel it is appropriate; there may be cultural reasons for the OT not addressing this; or the OT may feel they have a lack of training in this area and therefore not feel confident that they could help the client.

From my previous experience in different healthcare settings this is a topic which arises fairly frequently and is often an area that is overlooked by occupational therapists and other healthcare staff, even though clients value sex as an occupation. Despite my own discomfort about discussing sex and intimacy with clients, I would try to put this to one side and be open about addressing sex and relationships with clients; practicing discussing this in a ‘safe’ environment at university helped me to feel more confident that I would be able to do this in practice. However, clients would need to feel comfortable with their occupational therapist before they felt ready to discuss intimate matters. Being open about sexuality is important, but the importance of building a therapeutic relationship with the client first should not be forgotten.

We should also bear in mind that not every client will want to engage in discussions about sex and intimacy and that this may be the case for OTs and healthcare staff too. Should we be advocating for every OT to be comfortable with discussing this topic, or acknowledge that some staff may not be able to/want to? Is it better for staff to be honest about their discomfort about addressing client’s sexuality and therefore refer the client on to another clinician, or for the topic to get swept under the carpet? My feeling is that it is better for the OT to acknowledge their discomfort or lack of experience so that the client can receive the input they need, but by including sex and intimacy as a part of OT education hopefully people will become more comfortable with clients about discussing sex as an occupation. The idea of including sex and sexuality as a part of OT assessments was raised during discussion, which may be a way to help prompt OTs to think about addressing this area with their clients. Other useful points that came out of the session were:

  • To ‘have a radar’ as clients are unlikely to bring up issues around sex and intimacy unprompted, but may allude to it during discussions
  • Be mindful of the language you use, and try to use similar terminology to that used by the client where appropriate so that they feel more comfortable
  • Reassure the client that they are not the only one experiencing issues with intimacy or sex, and that a lot of people with a similar condition may be experiencing similar problems
  • There are practical tips that can be shared with clients to help them engage in sex and intimacy

The session really made me think about how there is still some stigma attached to addressing sex and intimacy, particularly in certain client populations. By acknowledging sexuality as part of OT practice, hopefully clients’ needs in this area can be recognised and met.

I’ve listed a few useful resources below on sexuality:

 

My foray into social media has been quite a recent thing; I only joined Twitter six months ago to advertise the link to my online research survey to potential participants, and would class myself as a technological novice. However digital media and its use in healthcare is a growing area, so to learn more about this and gain some first hand experience from people who actually know what they’re talking about, I attended the Digital Health Hack in Leeds on 30th June. This event was organised by the lovely Claire Jones (@ClaireOT on Twitter) to bring together people who use health and social care services, those who work for health and social care services, and people with computer programming skills in order to develop ideas and tools to improve health and social care.

On the day, a friend and I turned up not really knowing what to expect. What we found was a group of like-minded people keen to find ways to use their skills and knowledge to solve problems experienced by service users and staff. The event was quite informal; everyone was asked to share their ideas on a large whiteboard and from this groups of people who wanted to work on similar projects were formed. At the end of the day, the groups presented their ideas back to everyone, with ideas ranging from a website to allow people to change GP easily, a system to link women who are involved in an activity programme, a website where professionals can share information and a phone app giving reminders about medication. The amount of work done within a few hours was impressive, with the winning idea (GP Hop) being set up as a live website within this space of time.

The event was a great way to meet others who are interested in the use of digital technology and I have summarised my main learning points below:

  • The Northern Technology Institute (NTI) at Leeds Met University is a great, but little known, resource. They provide training, events and courses for people who work with/are interested in working with digital technology, and also have a ‘coworking’ space where people are able to develop their ideas alongside others who have a range of digital technology skills.
  • You don’t have to be able to write or understand computer code to in order to be useful in the world of digital technology. There are lots of techies who know how to do this, but they need projects to work on. People who know about health and social care systems and what would be useful to service users are needed, to come up with the ideas for projects that could be relevant and useful.
  • Digital technology should be integrated into health and social care courses so that students are aware of its pros and cons, and possibilities that exist for it to be applied within current systems.

Occupational therapists need to be aware of the potential that digital media has to support our clients, and not be scared of entering this seemingly alien world. Websites, apps and social media can be used to empower the people we work with, which can only be a good thing.

Many thanks to everyone at the Digital Health Hack and to Claire for organising.

This has been something I’ve been pondering as I travel to and from my placement each day. My journey takes me from a deprived area of a large city, through picturesque countryside villages until I reach an upmarket rural town. I then enter my placement which is within a secure environment.

The contrasts on my journey are stark; although I may be generalising, those living in the villages and the nearby upmarket town are more likely to have access to the things they want and need to do. The people who live nearer the start of my journey may have reduced access to occupational opportunities as they live in a more deprived environment. However, they fair well compared to the clients I work with on placement as the secure nature of the environment restricts access to many occupations.

I’m sure I could spend all day debating the reasons for the disparities I’ve observed (money? environment? education? attitudes?). Although the reasons might not be clear, what is clear is that occupational injustice is present within our society. This occurs “…when participation in occupations is barred, confined, restricted, segregated, prohibited, underdeveloped, disrupted, alienated, marginalized, exploited, excluded, or otherwise restricted” (Kronenberg & Pollard, 2005, p. 66), whereas occupational justice is the enablement of fairness and equal opportunity for participation in occupations (Wilcock, 2006).

So what can we do about occupational injustice? Or should we just accept things the way they are? For me, promoting occupational justice fits well with occupational therapy philosophy, and I found the World Federation of Occupational Therapists’ position statement on human rights (2010) particularly inspiring as it helped me to see that participation in occupation is a human right. Through advocating for clients and raising awareness of the importance of occupation we can promote occupational justice and have a positive impact on the health of our clients. Although this is a challenge, occupational therapists have the necessary skills and knowledge to be successful; this is what I’m hoping to develop on my placement. Wish me luck 🙂

References:

Kronenberg, F. & Pollard, N. (2005). Overcoming occupational apartheid: A preliminary exploration of the political nature of occupational therapy. In F. Kronenberg (Ed.), Occupational Therapy without Borders: Learning from the Spirits of Survivors (pp. 58-86). London: Elsevier Churchill Livingstone.

Wilcock, A. (2006) An Occupational Perspective of Health (2nd Ed.). Thorofare, Slack Inc.

World Federation of Occupational Therapists (2010) Position statement on human rights. [Internet]. Available at: <http://www.wfot.org/wfot2010/docs/WI_04_Elizabeth%20Townsend.pdf&gt;.

I think I can safely say that the College of Occupational Therapists 37th Annual Conference was the single most inspiring event of my (rather brief) occupational therapy career so far. That might sound a bit over the top, but as I’d never been to any kind of conference before I had no idea that I would meet so many OTs who were so passionate about occupational therapy and the inspiring work they do.Image

So, what did I learn from attending three days worth of presentations, seminars, workshops and networking? I could go through this in detail (see below for a summary of all the sessions I attended), but seeing as that could be a bit tedious, here are my key learning points:

  • OTs have the skills and knowledge to be more involved in the public health agenda. Dr Phil Hanlon of the University of Glasgow described how OT could be ‘agents of social change’, addressing health inequalities at a population level, and looking at health not just as an absence of disease. We can improve life for all, not just those who are referred to us.
  • Service users value occupational therapy input. Service users Dorothy Gould and Melanie Reid spoke of the warmth and kindness of OTs, their ‘can do’ attitude and valuable practical problem solving skills.
  • Putting the ‘doing’ back into OT education. Courses often teach a lot of theory, but students value the opportunity to do practical work as this is likely to inform their interventions on placement and when qualified.
  • That although economic times are tough, OTs are well placed ‘at the intersection of health, social care and education’ (Claire Ballinger) to cope with the changes that will inevitably occur. BUT . . .
  • OTs need to get better at marketing themselves and what they do. If we don’t shout about our value and prove it through the use of outcome measures, we won’t be valued.
  • OTs have the skills to move into new areas of practice. Role emerging placements and entrepreneurship can help OTs find jobs in new areas, but this isn’t always something that comes easily (or appeals) to OTs. I attended an amazing session by Nancy Kruser on developing ideas for new community projects and how to write a business proposal to get funding for the idea. There were only two of us in Nancy’s session, which made me reflect that this may not be something of interest to many OTs.

As a conference novice, I also found that I felt a lot more comfortable as the conference went on – on the first day I was definitely a rabbit caught in the headlights, struggling to take everything in and feeling a bit overwhelmed. By the last day though I felt confident enough to engage more in the sessions, asking questions at paper presentations and being more vocal during workshops and seminars. I learnt that organisation is incredibly important, and to read between the lines when looking at the descriptions of sessions, as a session’s title might not reflect what it’s actually about.

For me, one of the main draws of the conference was the opportunity to network with other OTs. As a student, I often feel quite isolated from the OT community as a fair amount of our time is spent in the classroom. It was great to meet other OTs and chat about their research/practice/views on all things OT; the friendliness of occupational therapy as a profession really shone through. I was also fortunate enough to meet some of the wonderful Tweeps who are involved in the #OTalk/#Occhat Twitter discussions, it’s always good to be able to put a face to an online name! The conference did make me reflect on how much social media had added to my own professional development (verdict: a lot) and how it can be used to promote occupational therapy. In fact as Julia Scott, COT Chief Executive, was asking us to promote occupational therapy as widely as possible, the Chief Executive of my local NHS Community Trust was emphasising the good work of OTs – the power of social media demonstrated in a timely fashion 🙂

Image

A full summary of the COT conference sessions I attended is available here: https://docs.google.com/open?id=0B64hoSjoq8n0ekN2YXpsakowQms