Occupational Therapy News OTnews February 2019_Joomag | Page 27

SERVICE DEVELOPMENT FEATURE
At this point, it became clear there was an appetite for
occupation: managers expected around 60 staff to attend the first
session, but ended up with over 100.
Says Elizabeth: ‘If you’re working in a team on your own, and
the rest of the team is physiotherapists and you never meet an
occupational therapist, it is like going to conference – you leave
completely energised.
‘It’s the feeling of bringing people together. We’ve got one voice
and are unique; it’s that togetherness thing.’
Nicole Walmsley, clinical specialist occupational therapist for
stroke and neurology, who has led on much of the new approach,
adds: ‘Just bringing occupational therapists together like that,
and the chatter and energy it brought about, was fantastic. And
it wasn’t about just physically bringing them together; there was
unity and belief in what we do.’
The department voted on which model to pursue, and the
Canadian Model of Occupational Performance and Engagement
(CMOP-E) was chosen as the new model of practice.
Deploying the model
The model and measures were purchased and circulated to staff,
but while everyone came together for those all-trust sessions,
individual services took on the task of making change themselves.
Nicole says that the project has been a real exercise in helping
staff to lead on making the difference, rather than forcing a top-
down approach they are not invested in.
She says: ‘Change isn’t by telling people “you need to do this”.
It’s about getting staff to want to change and identify that they want
to change.
‘That’s where I’ve learnt that it’s not about saying “you now need
to do this with your teams”, it’s about saying “this is what we could
be doing, it’s up to your services to develop and change how you
see fit”.’
The approach has also been embedded in the day-to-day
paperwork that staff use. The trust created occupation-focused
Black et al (2019) conducted a scoping review
to investigate how the concept of occupational
engagement was defined, used and evaluated within
occupational therapy/occupational science literature.
Databases were searched for papers, published
between January 1993 and June 2017, where
occupational engagement was the primary focus or
outcome and a definition of the term was provided. A
total of 1008 articles were identified, of which 26 were
selected for inclusion in the review. Findings included
that definitions across studies were fragmented and
inconsistent and, with the exception of mental health,
measures used to evaluate occupational engagement
also varied. The authors identify the need for a
common definition and accurate and reliable
measures of occupational engagement.
physical and mental health, adult and paediatrics, and from
general roles to more specialist teams.
A service evaluation showed that there were as many ways of
working as there were teams. A wide variety of models were used
by staff, but what was common among them was that they only
partially used occupation to explain their role.
The documentation people used in everyday working did not
seem to support an occupation-focused approach. And the
majority of staff felt there were barriers preventing them putting
occupation at the centre of their practice; time, generic roles and
a lack of understanding by colleagues and patients topped the list.
An evaluation with patients found similar problems.
Many patients could not tell the difference between what
physiotherapists and occupational therapists were doing for them.
With the prospect of a single approach for the whole service
on the cards, it was decided to bring as many occupational
therapists from across the trust together to learn about and
discuss the issue at a series of events.
Reference
Black MH, Milbourn B, Desjardins K, Sylvester V,
Parrant K, Buchanan A (2019) Understanding the
meaning and use of occupational engagement:
findings from a scoping review. British Journal of
Occupational Therapy, Jan 19. [Epub ahead of print]
standards of practice, with an agreement in place for the whole
department to use them.
All case presentations have to include the model, documentation
from assessment to supervision must have an occupation focus,
and all new staff have to complete online training in CMOP-E.
A statement on the approach is going in all new job adverts to
make sure that new recruits understand what they are signing up
for from day one.
The changes have led to patients getting more of a sense of
what occupational therapy is.
‘Some staff did not explain the role before because of the acute
nature and fast pace of the setting,’ says Nicole. ‘You might have
just gone in and introduced yourself before firing questions. But
actually taking the time to explain your role and starting with what’s
important to you has led to quite positive change.’
The results
A second round of service and patient evaluations are now being
analysed and the results will be out in due course, but casual
feedback from patients suggests they understand the approach
too.
‘Thank you for allowing me to tell you about myself and what is
meaningful to me’, said one.
Says Nicole: ‘I think staff feel much more confident in articulating
occupational therapy roles… [and] they have a sense of identity,
especially in services where they are not in such great numbers
elsewhere in the trust.
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