Hello! My name is Imogen.
I am a final year occupational therapy student from Brunel University, and my time at bOunceT was to be my fourth and final placement before graduating. Previously I have experienced a placement working with the elderly in community and two in a hospital setting working with neurological conditions, therefore, I was a little unsure with what an online placement for children and adults with learning difficulties could bring. However, this placement generated multiple unexpected learning opportunities for me such as developing ‘official’ service paperwork, health promotion duties, and gaining a greater understanding of evidence-based practice through reflecting on theory and referencing polices in my practice!
Whilst working remotely with bOunceT, I was able to identify how to conduct the OT process in this setting and interact with it in a way that I did not anticipate whilst being remote. Initially I was able to partake in the first contact with new referrals and guide them through an initial assessment over an MS Teams call. This enabled me to identify which of bOunceT’s services would be the most beneficial for them and to triage accordingly. I was also able to develop how I communicate, my clinical reasoning skills, my therapeutic use of self and how I document these interactions using the clinical settings software and formats. This is encouraged by the following literature (HCPC, 2013; RCOT 2021) which informs the standards of occupational therapy practice:
HCPC – 8.1 be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advice, instruction and professional opinion to service users, carers, colleagues, and others.
HCPC – 10.1 be able to keep accurate, comprehensive, and comprehensible records in accordance with applicable legislation, protocols and guidelines.
HCPC – 14.13 be able to use research, reasoning and problem-solving skills to determine appropriate actions.
RCOT – 4.2.1.1 You are able to explain, and you record, your professional rationale for anything you do for/with or in relation to those who access the service.
There were a few things that I found challenging along the way while completing the first third of the OT process. One was getting to grips with unfamiliar technology, and another was getting to know the services available well enough to communicate them to service users. The main challenge I had here, however, was completing the initial assessment without an official form to guide my questions.
By shadowing an assessment and by completing it multiple times with parents, I was able to formulate through trial and error how this process could be modified to produce a more in-depth and standardised assessment which could ease future staff and students’ apprehensiveness when administering. I was able to communicate this to and collaborate with the team to create an official initial assessment form through weekly meetings. The HCPC (2013) and RCOT (2021) standards consolidate this as good practice through quality assurance:
HCPC – 12.1 be able to engage in evidence-based practice, evaluate practice systematically and participate in audit procedures. HCPC – 12.3 be aware of the role of audit and review in quality management, including quality control, quality assurance and the use of appropriate outcome measures.
RCOT – 4.6.4 Your evaluation takes account of information gathered from other relevant sources, such as carers and/or family, or other professionals.
RCOT – 4.6.8 You use the information you collect, with other national, local, and professional guidance and research evidence, to improve the quality, value and effectiveness of the service/s you provide.
In the second third of the OT process, I was able to fully engage with most of the interventions available. One intervention I was able to really take a lead on that was not restricted by my being online was occupational performance coaching. This was a series of 8 sessions that allowed parents to express what the main concerns were that impacted on them in a confidential and non-judgemental space. Through the use of the COPM, I was able to guide the parents in defining their goals in importance, how they were performed, and their satisfaction with the current performance. Then, using reflective prompts throughout the sessions in open conversations, I was able to guide the parents to dissect their experiences in how to overcome their concerns.
For instance, one of the parents I was working with was able to identify that her child was struggling with how people were communicating with them, which was impacting on their ability to be flexible with their routine – specifically when eating dinner. Through our conversation, the parent was able to generate the solution of changing the language used to move her child’s focus away from time specifics to focus on their sensations instead to inform when to eat. An example of this would be asking their child if they are hungry 10 minutes or so before to get them to focus on their sensation or modelling asking their sibling to act as a prompt for them.
By working with the parents in this way, I was able to teach them occupational therapy skills in how to identify, problem-solve, reflect on, and evaluate issues they may be experiencing. Doing this helps to instill confidence in themselves as all ideas and solutions we discussed eventually came from them. Consequently, this will help in reducing peoples’ reliance on services as well as waiting lists later on.
A challenge I faced when doing this intervention was that coaching was a very new concept to me, therefore, I was quite unsure on how I should address it. To gain more insight into how I could approach the conversations to guide parents, I researched into the concept of coaching and the theory behind the COPM to guide my professional practice. For instance, when using the COPM, client centredness is used to show respect to the client’s needs, recognise their expertise and autonomy, as well as empowering them to make their own goals and encourage participation (Enemark, Larsen, Rasmussen, and Christensen, 2018).
Coaching also utilises client-centeredness within reflection to achieve empowerment and autonomy for the parent to be able to take ownership for the action points for each session. They are also encouraged to take mitigated risks. This is also reinforced by the HCPC (2013) and RCOT (2021) occupational therapy standards:
HCPC – 8.9 be able to listen to a service user’s occupational narrative and analyse the content in order to plan for the future.
HCPC – 15.1 understand the need to maintain the safety of both service users and those involved in their care.
RCOT – 4.5.7 In order to enable carers and/or family to be involved, their requirements and needs are incorporated into the interventions/recommendations, where necessary.
RCOT – 4.5.5 You empower people to maintain their own health and wellbeing and to manage their own occupational needs, wherever possible.
RCOT – 3.6.1.1 You embrace and engage with risk, assessing and managing it in partnership with those who access the service.
By identifying the core theories behind this intervention, I was able to carry them through in my delivery to ensure a successful service.
In my final third of the OT process, I was able to partake in a few school review meetings. Here I was able to see how the individual professions that made up the interagency team worked together to reach the child’s goals. The structure of the session was very similar to Form 6 of the GIRFEC (Getting It Right For Every Child) – an approach in Scotland which frameworks numerous policies supporting children and young people (Scottish Government, 2021). This form supports a holistic way of working by encouraging us to consider factors such as a summary of the progress and impact on the child, key points of the discussion, the views of the child and parent on the progress being made, decisions going forward and if everyone is in agreement with those decisions. Please see the pictures uploaded here to see this form in greater detail. I found this aspect in particular really displays how current policy and legislation had a significantly positive impact on practice.
This is also echoed by the principles and standards of conduct and ethics (HCPC, 2013, RCOT, 2021) which highlight the following:
RCOT -5.7.10 – the need for interprofessional and multiagency collaboration to ensure that well-co-ordinated, person-centred services are delivered in the most effective ways”.
RCOT – 4.5.2 – You develop personalised plans, or recommendations, based on the occupational performance needs, choices, and aspirations of those who access the service, as identified through your assessments.
HCPC – 5.1 – Understand the requirement to adapt practice to meet the needs of different groups and individuals.
This is also encapsulated by the SHANARRI wheel (The Scottish Government, 2017) which showcases the meaning of wellbeing in 8 sections. Being able to shadow this meeting highlighted how collaboration is used to create and maintain professional relationships to ensure universal understanding as well as safe and ethical practice. This is also encapsulated in the following research that reinforces that interprofessional collaboration and interprofessional education as ways in maintaining professional relationships (Hart Barnett and O’Shaughnessy, 2015; Green and Johnson, 2015; Goldsbury, 2018; Smith et al, 2018).
An unexpected takeaway from these meetings was that I was able to identify this as an opportunity for promoting occupational therapy services and knowledge to benefit the client. To be more specific, I was able to highlight a learning resource created by bOunceT called Purposeful play E-learning to other inter-agency teams who wished to develop their own understanding to provide better care for the children in their service. This is consolidated as beneficial to professional practice within the relevant literature below (RCOT, 2021):
RCOT – 5.7.6 – You work with others within your area of expertise to promote knowledge, skills, and safe and effective practice.
RCOT – 5.7.11 – You work and communicate with colleagues and representatives of other organisations to ensure the safety and wellbeing of people accessing services.
Furthermore, this promotion of occupational therapy services to stakeholders ties in with the very definition and core of occupational therapy – to “promote health and wellbeing” (American Occupational Therapy Association [AOTA], 2014; Hocking, 2019; Meyer, 1922 cited by Reitz, S. M., Scaffa, 2020, p2).
If I could offer any tips for tricks for navigating a placement at bOunceT or even online, I would highly recommend doing weekly reflections to continuously learn from your experiences. This will also give you a chance to relate your practice in the week to your learning objectives and can also act as justifying evidence if needed. I would also recommend relating your practice to the HCPC and RCOT standards. I say this as this will help to guide your clinical practice and reasoning skills, and again, will help to evidence-base your progression to your educator. I recommend asking as many questions as you can to your team members as they hold a wealth of knowledge and experience that can facilitate your own understanding and practice. Lastly, I would recommend creating a student starter pack or adding to an existing one as another way of showcasing what you have learnt on your placement. These can be useful resources for you to carry on to your next professional settings and also can be used for your continued professional development portfolio.
Overall, I feel my placement at bOunceT has taught me a multitude of new skills, enabled me to consolidate and expand my knowledge, as well as instilled confidence in me for when I finally enter the world of occupational therapy as a fully qualified professional practitioner.
Thanks for taking the time to read this,
Immy
This blog was first published by bOunceT. Read the original here.