Occupational Therapy News OTnews April 2019 | Page 28

FEATURE VOCATIONAL REHABILITATION
As service users progress through the medium and
low secure settings, community integration via Section
17 leave is supported by their occupational therapists
to explore more challenging roles within the smaller
café environments, providing insights into what larger
commercial workplaces would require.
Café on the Hill provides a real work environment that
helps build skills and confidence while supporting service
users to reach their full potential in a public-facing café.
Initial stages of the secondment involved:
• observing all cafés to establish the demands of the
environments and support offered by activity co-
ordinators and café work supervisors;
• establishing weekly meetings with the education
lead to identify referral processes, how people begin
working at Café on the Hill, how they progress,
how their skills are reviewed and if qualifications are
achieved; skills growth within each role through detailed task
lists.
Café work supervisors needed support in developing
skills and confidence in incident reporting and recording
entries in service users’ electronic healthcare record,
and the provision of industry standard Barista training to
service users and staff was identified as a final need.
• meeting with senior occupational therapists to seek
views and guidance on areas requiring improvement,
along with identifying effective structures within
internal vocational programmes; and
• offering regular supervision and support to café work
supervisors to identify their needs as a catering outlet
and in supporting service users.
Needs were identified in two distinct areas; the clinical
perspective and the environmental and financial
development. A simple structure was embedded, guaranteeing
both educational and clinical oversight for referrals,
ensuring service users remain supported throughout
interviews, and employment within the service while
gaining relevant work experiences and transferable
qualifications.
The implementation occurred over a six-month
period, with revisions made to the clinical procedure until
the team and service users were content.
For example, it became clear that the induction
phase was vital and could not be rushed. Additionally,
occupational therapists became more frequent visitors
to the café to seek feedback.
A database was produced and qualifications attained
were mapped, and a range of detailed task lists were
developed to structure the roles across the vocational
pathway and ease identification of skills requiring more
time or support to master.
Café work supervisors were more clinically involved
in feedback and incident management, while barista
training was provided and service users were able to
develop industry standard skills.
The clinical perspective
This relates to how service users come into and
through the service, how they are supported and skills
developed.
It was decided that a comprehensive clinical
procedure was required, to ensure that clinical standards
are maintained, with best possible outcomes for service
users identified and achieved.
A clear referral process from the forensic service was
needed to ensure that risks are fully communicated
to café work supervisors, along with interviews taking
place to replicate the typical processes individuals
would encounter when applying for employment in the
community.
Other needs included a regular review pattern with
ward occupational therapists and service users, to
guide goal setting and achievement of transferable
qualifications, and the establishment of a referral
database, to enable a clear audit trail of service users’
involvement, their achievements and providing a method
for monitoring throughput.
In addition the need for a structure to encourage
rotation of service user roles with identified work
stations was identified, alongside the identification of
28 OTnews April 2019
Significant outcomes
During the 15-month secondment, a clinical procedure
was developed for the external vocational areas in West
London NHS Trust’s forensic service (Café on the Hill,
car valeting and Billet’s Hart Allotment).
This was completed during several workshops with
occupational therapists and café work supervisors,
ensuring the process was thorough and robust,
but also supportive of service users’ pathways and
development.
Environment and financial requirement
The environment and financial requirement to generate
income included:
• seeking opportunities to increase revenue and
compete with other local cafés;
• customer survey use to ascertain consumers’ views;
• introducing a new health bar to provide a lower level
of tasks for service users coming into catering, and
to offer staff, visitors and service users healthier
options, alongside offering a fruit delivery service to
forensic wards;
• identifying changes to the main café menu to include