Occupational Therapy News OTnews October 2018 | Page 32

FEATURE MENTAL HEALTH
Expanding understanding
Graham Walker discusses his experience of introducing occupational therapy-based
reflective practice within Suffolk Rehabilitation and Recovery Service
N
orfolk and Suffolk
Foundation Trust
(NSFT) Suffolk
Rehabilitation
and Recovery Service, in
consultation with RCOT,
has begun to provide
occupational therapy-
based reflective practice.
This appears to be a
new model of practice, and one
that I feel can help move occupational
therapy forward in terms of how non-
occupational therapy staff perceive
and understand occupational therapy,
as well as numerous other benefits for
occupational therapists and the rest of
the multidisciplinary team. 
During my time working on acute
mental health wards, I attended
a number of insightful and valuable
formulation sessions provided by the psychology
department.
These sessions were aimed at helping staff to
understand, among other things, what factors were
contributing to a person’s current presentation, how
we could potentially engage the individual, and what
psychological interventions or strategies may support the
person in their recovery.
It was during one of these sessions that I began to
question why occupational therapists were not facilitating
similar sessions, where formulations were based around the
person as an occupational being and what this means for
their recovery. 
From here, I spoke to a number of professionals from a
range of professions to get their thoughts about such an
idea. Multidisciplinary team staff were positive about my
proposals, wanting to understand occupational therapy, as
well as occupationally-focused formulation and intervention
better.
With this feedback I looked to identify what was already
being done by occupational therapists; I wanted to find out
if this was already going on, but without the idea having
spread, and what related ideas were already out there that
might form some sort of guidance for best practice or a
protocol.
32 OTnews October 2018
I spoke to a number of occupational therapists* and
it appeared that occupational therapists were often
providing similar formulation sessions to other occupational
therapists, but never outside of the profession.
This had been my own experience, where case
discussions and formulations were often held in
occupational therapy meetings and continuing professional
development sessions.
I had always found these sessions helpful, as there
was so much transferable between one case to another,
and so these shared experiences helped us all grow as
practitioners.
I therefore decided to use these existing ideas and
frameworks, from those I had spoken to, and look to
develop a model to use with non-occupational therapy staff.
I felt that the positive experiences I had had of occupational
therapy case formulations with other occupational therapists
would translate into positive experiences for the rest of the
multidisciplinary team, as long as the model was accessible
for non-occupational therapy staff.
I looked to develop my ideas to the point where I could
begin to trial their use in sessions with staff.
Developing occupational therapy
formulation sessions
Subsequently, I have been running occupational therapy
formulation sessions with my nursing team for the last six
months and although I continue to develop this protocol
they appear to be going quite successfully.
In these sessions, an occupational therapist leads a
discussion with primarily nursing staff, where a current
service user is discussed using an occupational therapy
framework (I am using the MOHO) to guide the discussions.
I am using case formulation documents that were
developed by Sue Parkinson, which help to focus the
conversation on occupation and the individual as an
occupational being.
I think that this is important, as it helps to clearly and
consciously separate from psychology-led formulation
sessions.
These reflective sessions last an hour (running the
session during our ward 2pm to 3pm staff crossover hour)
and they consider what a person does that brings them a
sense of occupational identity, what more they could do for
this, what necessary activities they need to complete to be
as independent as possible, what difficulties there are for