A new partnership between a community acquired brain injury service, Northumbria University and a residential care home has created a unique learning opportunity for final-year OT students.
People with acquired brain injuries (ABI) who require residential care often present with highly complex physical, cognitive, emotional, behavioural and communication needs.
The move into a care environment can happen at a relatively young age for people with ABI and our own practice experiences led us to understand that this can have far-reaching impact on individuals and their families.
Furthermore, people can experience a decline in occupational engagement when they move into care homes and there are recognised issues of long periods of inactivity or passivity and limited social interaction (Dancewicz and Bissett 2020).
The annual economic costs of ABI in the UK have been recently estimated at £43 billion, with some of this cost attributed to limited investment in longer-term rehabilitation and social care provision (APPG for ABI and UKABIF 2025).
Although occupational therapists do have a history of working within residential care settings, in the UK it is difficult to gain an up-to-date picture of services. Anecdotally we know that involvement may be limited to episodic intervention, reactive to priorities and risks.
Furthermore, with this type of episodic intervention, visiting health professionals may not have opportunities to get to know residents or staff and may provide written reports which are difficult to share with all involved.
Providing services into, rather than as part of a care home can act as a barrier to embedding practice and enhancing the skills of the workforce.
Ideas to bridge this gap were discussed between a Community Acquired Brain Injury Service (CABIS) in the Northeast of England and practitioners from Abbeymoor, a residential care home for people with brain injuries and other neurological conditions.
The teams reflected on the benefits of working together, but that this joint working was often limited to initial problem solving when residents moved into the care home, perhaps followed by advice to family and staff and then potential troubleshooting if risks or issues emerged.
There was a desire to work in a more integrated way; developing a deeper understanding of residents’ occupational needs and to promote an enabling environment, giving opportunities for engagement in meaningful activity.
It was this desire to get to know residents, to work on a daily basis with staff, and to take a proactive approach to identifying occupational needs and goals that motivated everyone involved to plan a student learning opportunity embedded within the care home environment.
What did we do?
The teams from CABIS and Abbeymoor, alongside an academic tutor from Northumbria University, planned a final year placement opportunity for two BSc occupational therapy students, Elicia Bordoley and Chloe Stockdale.
Working more closely with communities and putting occupation at the forefront of practice is aligned to RCOT’s Workforce Strategy (RCOT 2024) and we saw this as a way to equip our future practitioners with these experiences and perspectives.
Using The AHP Principles of Practice-Based Learning (CSP and RCOT 2023), we began planning the placement to provide learning opportunities across the four pillars of professional practice. Placement objectives included:
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Following the occupational therapy process to assess needs and give opportunities for meaningful activity.
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Facilitating learning and development for Abbeymoor staff in person-centred and meaningful occupations for people with ABI.
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Developing evidence-based reasoning to plan safe, effective and ethical interventions.
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Promoting the occupational therapy role and acting as a role model to others.
One strategy used during the planning stage was that an occupational therapy student on an existing traditional placement with the CABIS team spent one day a week within Abbeymoor. This student contributed to placement planning meetings by sharing a real-world perspective
of what the placement would feel like for students and what the enablers and challenges could be.
During this time, they also produced an induction pack for the students who would be allocated to the placement.
Development across four pillars of practice: the student perspective
At the start and end of the placement, both students gave consent to have audio-recorded discussions to capture their experiences. Evaluations can often rely on retrospective interviewing, but we felt it was important to hold these discussions in real-time.
Within these discussions, Chloe and Elicia were asked to reflect on their knowledge and skill development using the RCOT Career Development Framework (RCOT 2022) to recognise change that may occur during the placement.
They also shared reflections about expectations at the start of placement and enablers and challenges in relation to their learning. Finally, they shared their own recommendations for the future development of the placement.
Putting a numeric value on development can be difficult and is not proposed here as a sensitive measure of change (see table). However, using these ratings as a focus of discussion, this led to deeper reflections about personal and professional development.
In relation to evidence, research and development, at the start of the placement both students felt their own experiences were limited in this area and both made links to the fact that they had not completed their final year dissertation, or had any involvement in what they called ‘primary’ or ‘formal’ research.
But at the end of the placement, they both discussed their development as evidence-based practitioners, making links to carrying out an audit aligned with RCOT’s Living well in care homes guidance (RCOT 2023) and discussing the need to look for evidence to support quality improvement ideas.
Similarly, and when discussing the leadership pillar, the discussions at the start of the placement perhaps tended to focus on what they had not experienced so far, with Chloe reflecting that she felt her score was relative to not seeing herself as showing leadership and autonomy and having close supervision and support on previous placements.
But by the end of placement both students reflected development in this pillar, discussing how they had acted as a role model to others and advocated for the occupational therapy profession.
Table: Before and after evaluation of knowledge and skills – numbers indicate selfevaluation of career levels in the RCOT Career Development Framework
Co-producing service improvement ideas with residents, family members and staff by being embedded within the service was also linked to development of leadership skills.
Don’t put too much pressure on yourself and make sure you look after your own wellbeing. Know it’s okay not to know everything and focus on the core skills you are developing. It’s a privilege… I feel lucky to have had this opportunity.”
Both students reflected on key developments in their professional practice, emphasising opportunities to utilise and enhance their core occupational therapy reasoning and skills such as observation, assessment, analysing activities and risk-enablement.
They also reflected on facilitating individual and group activities that were centred on occupation.
In relation to developing her understanding of the occupational therapy process, Elicia reflected that having to start it themselves and work all the way through it in an autonomous way not only improved her understanding, but will help her to translate this to new situations in future. They shared that by the end of placement, they had greater trust in their own reasoning.
Both students also reflected on the positive contribution they felt they had made to Abbeymoor residents and staff, with some examples including helping to increase the focus on meaningful occupation and identifying training needs of staff. They linked these examples to the facilitation of learning pillar.
Finally, both students felt that by the end of placement they could talk in more depth about their knowledge, skills and experiences, with Elicia highlighting that she felt she understood the pillars of practice better.
Key successes
Some of the key achievements mentioned by the students can also be viewed as some of the key successes for CABIS and for Abbeymoor. These included increased opportunities for residents to engage in meaningful occupation and an increased range of resources for staff to use within group and individual activities.
Louise Watson, Registered Manager at Abbeymoor Care Home, discussed that the students initiated impactful changes during their placement, such as developing orientation and communication boards and helping individuals to personalise their rooms, which has helped to develop person-centred care.
The students provided education to staff about how cognitive issues after ABI impact on people’s ability to engage in daily activities and aspects of their daily routines.
For the students, they highlighted the experience of autonomous working as a benefit of the placement, reflecting that the experience had helped to prepare them for their first roles as qualified practitioners.
The less direct model of supervision encouraged autonomy and not having someone with them all of the time lessens the ‘big jump’ to being a registered occupational therapist.
Chloe also highlighted how being on placement with another student developed her ability to see things from multiple perspectives and, in her words, to see ‘it’s not all about you on placement, which mirrors working in a multidisciplinary team in practice’.
Elicia added that the daily peer support from another student on this placement will help her to think about using different sources of support in future, not just from people in more senior roles.
Challenges and barriers
Reflecting on some of the challenges linked to student wellbeing on placement, we’ve already noted that that people can experience limitations and decline in occupational engagement in care homes, and both students did share that they found this emotionally challenging.
This perhaps felt more difficult to work through at times without the day-to-day support of an occupational therapy educator.
Both students also contemplated other wellbeing challenges, such as putting a lot of pressure on themselves, or sometimes feeling thrown in at the deep end. By the end of placement, they recognised how some of these experiences had contributed to their resilience and development, but recognised that it can feel difficult at the time.
Chloe and Elicia also considered the limited structure during the early stages of their placement and linked this to not having direct supervision from an occupational therapist, limited understanding amongst staff about their role, and almost having too many ideas and not knowing where to start.
Lisa Pullen, an OT within CABIS, shared that this was also a challenge for her in her role as practice educator. Partly influenced by her desire to support with increased structure, and wanting to be responsive to student wellbeing needs, Lisa made adjustments to how she was facilitating supervision, offering individual time alongside joint meetings and increasing her own and wider team availability outside of scheduled supervision time.
This was valued by the students, but had an impact on time-management and workload for Lisa during the placement.
Suggestions for future placements
As part of the concluding stages of the placement, Chloe and Elicia worked alongside CABIS and Abbeymoor staff to produce resources and recommendations for future placements.
These resources include ‘handover crib sheets’, which contain suggestions and ideas for student involvement. The team has also developed a four-week induction plan to include specific training in health and safety, information governance and IT systems, and opportunities to shadow staff across CABIS and the Abbeymoor team.
Simple yet impactful resources such as staff names, roles and uniforms have also been included in induction information to help with settling in.
During the induction period, students will be asked to prepare a presentation on the benefits of occupational therapy in a care home setting to help give structure in the early stages, and to facilitate communication with staff about the potential of the occupational therapy.
The requirement to carry out reading and research for the presentation will also have the added benefit of emphasising the importance of evidence-based reasoning as students work through some of the early feelings of not being sure where to start.
Chloe and Elicia have now completed their occupational therapy programme and are working in their first roles as registered occupational therapists. However, they have also offered informal peer support and mentoring to the next students, further evidencing their leadership and facilitation of learning skills. We hope that this offer of peer-support becomes a rolling part of the placement plan.
And finally, when asked ‘What would you say to students preparing for diverse placements?’ Elicia said: ‘Learn to be comfortable with being uncomfortable. Focus on learning where you are right now, and reflect on how this connects to occupational therapy.
‘Seek out support that can help you grow, and use this time to build self-awareness, connect with your values, and trust that each experience is shaping your development as a thoughtful, effective occupational therapist and person.’
While Chloe added: ‘Don’t put too much pressure on yourself and make sure you look after your own wellbeing. Know it’s okay not to know everything and focus on the core skills you are developing. It’s a privilege… I feel lucky to have had this opportunity.’
Chartered Society of Physiotherapy and Royal College of Occupational Therapists (2023). AHP Principles of Practice Based Learning. Available online 
https://bit.ly/4g8XFyE [accessed 2 May 2025].
Dancewicz EA and Bissett M (2020) Occupational therapy interventions and outcomes measured in residential care: A scoping review. Physical and Occupational Therapy In Geriatrics, 38(3): 230-249.
https://bit.ly/4mMJ9yU.
Royal College of Occupational Therapists (2024). Occupational Therapy Workforce Strategy 2024-2035. Available at
https://bit.ly/3VqKxuS [accessed 2 May 2025].
Royal College of Occupational Therapists (2023) Living well in care homes. Available at
https://bit.ly/3JAtRPf [accessed 2 May 2025].
Royal College of Occupational Therapists (2022) Career Development Framework: Guiding Principles for Occupational Therapy (2nd edition). Available at https://bit.ly/461gpv4 [accessed 2 May 2025].
The All-Party Parliamentary Group for Acquired Brain Injury and The United Kingdom Acquired Brain Injury Forum (2025) The cost of acquired brain injury to the UK economy. Available at
https://bit.ly/4m0o9n7 [accessed 21 May 2025].
Words LISA PULLEN, JANE WALKER, Occupational Therapists from Cumbria, Northumberland, Tyne and Wear Community Acquired Brain Injury Service, LOUISE WATSON, Registered Manager, Abbeymoor Care Home, ELICIA BORDOLEY, CHLOE STOCKDALE, BSc Occupational Therapy Students, Northumbria University, and GEMMA BRADLEY , Assistant Professor in Occupational Therapy, Northumbria University