OTA Connections Spring 2021 by Occupational Therapy Australia

Supporting all people to engage in activities they find meaningful

SPRING 2021 | VOL 18 ISSUE 3

Brighter Futures

Print Post Approved PP340742/00147 ISSN 1832-7605

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Empowering telehealth in hand therapy Physical activity, the forgotten occupation? The potential impact on client mental health, and the role for OT.

OTs facilitating a brighter future for people from refugee-like backgrounds

B O N U S L I F T O U T: O T W E E K 2 0 2 1 P O S T E R

CONTENTS

ABOUT CONNECTIONS

Connections is a publication of Occupational Therapy Australia (OTA), the peak body representing occupational therapy in Australia. CONTACT US

Occupational Therapy Australia ARBN 007 510 287 ABN 27 025 075 008 5/340 Gore St, Fitzroy, VIC 3065 T: 1300 682 878 E: info@otaus.com.au W: www.otaus.com.au

CONTRIBUTIONS

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Highlights from the 29th National Conference and Exhibition

DESIGN

Perry Watson Design

NEWS

DISCLAIMER

This newsletter is published as an information service and without assuming a duty of care. It contains general information only and, as such, it is recommended that detailed advice be sought before acting in any particular matter. The materials included in this newsletter by third parties are not attributable to Occupational Therapy Australia, and are not an expression of Occupational Therapy Australia’s views. Occupational Therapy Australia is not responsible for any printed expressions or views in any third parties’ inclusions. Any enquiries regarding inserts, advertisements or articles placed by these third parties should be directed to them.

FEATURES

President’s report

Vale Colleen Mullavey O’Byrne

2021-23 Strategic plan

CEO’s report

Our journey to understanding is more than our Reconciliation Action Plan

Positive change and a growing presence

Highlights from the 29th National Conference and Exhibition

Challenges of technology’s brave new world

OTA awards recap

Physical activity, the forgotten occupation?

Mobile work and cyber safety

The benefits of supervising overseas-qualified therapists

14 steps to smarter goal-setting

Our journey to understanding is more than our Reconciliation Action Plan

Hands turn to telehealth

A brighter future for refugees

Self-awareness, cognition and function in post-stroke recovery

Are you paying your staff correctly?

CPD updates

Inspired insights from the opening day of the 2021 National Conference

WFOT update

CONNECTIONS SPRING 2021 3

PRESIDENT’S REPORT

President’s report Associate Professor Carol McKinstry | OTA President

fter a few highs from the recent OTA 29th National Conference and Exhibition, the decision to scrap independent assessments for NDIS participants, and presenting to the Senate Standing Committee on Community Affairs, this issue’s theme “Brighter Futures” really resonates. Our future is certainly looking bright. It has been a great few months for OTA, and a wonderful reward for our staff and many volunteers who are passionate about our profession and organisation. We are a valued and relevant profession making a serious contribution to society—especially to our clients. In early July, I presented to the Australian Parliament Senate Standing Committee on Community Affairs which was examining the administration of registration and notifications by the AHPRA and related entities under the Health Practitioner Regulation National Law. Michael Barrett had prepared a detailed and insightful written submission and OTA was invited to meet with the committee. Unfortunately I, and all the senators, could not be in Canberra due to Covid-19. However, presenting virtually with the Australian Physiotherapy Association and Australian Association of Social Work highlighted to me a number of positive features of our profession. We enjoy a strong relationship with the Occupational Therapy Board, meeting regularly for open and honest discussions. As a profession we have few notifications or complaints, so, unlike other professions, this was not the focus of our written submission. We often take for granted that we are a registered health profession, however, after hearing the ongoing plight of the social workers who do not have registration, I won’t be taking this for granted again.

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We are a valued and relevant profession making a serious contribution to society - especially to our clients

The senators had clearly read our submission and wanted to focus on our recommendation to avoid duplication, particularly the need for occupational therapists working in areas such as the NDIS to meet similar compliance requirements to what they already do for AHPRA. It was really heartening to be selected to meet with this committee, which obviously thought we had something of value to add. We also recently received a letter from the Royal Australian College of Rehabilitation Physicians wanting to work closely with us into the future. This is a welcome invitation to make improvements for the people we work with. Our recent national scientific conference was a huge success and highlighted how far our profession has come. The range of topics, the high-quality research being conducted and the emphasis on the need to demonstrate the impact of research and use evidence in our practices was evident. Research covered the whole life span of those we work with, a range of traditional and emerging areas of practice, a focus on occupational science and deprivation, and how we contribute to improving quality of life for those who are marginalised or vulnerable. Innovative ways of teaching occupational therapy students and preparing our future occupational therapists were emphasised. There were many presentations on how we have adapted

and responded to Covid-19, especially the use of technology and telehealth. It was wonderful to see presentations by up-andcoming researchers, clinicians, research fellows and international presenters. Our keynote speakers gave us much to think about, yet emphasised the strengths of our profession in meeting current and future challenges. Marilyn Pattison’s keynote “You’ve Got This” summed things up brilliantly. While everyone missed the opportunity to meet in person, our hubs gave us some face-to-face time and we are looking forward to meeting up in Cairns in 2023! Congratulations to our newly inducted Research Fellows Prof. Pamela Merridth, A/Prof. Mandy Stanley, Prof. Reinie Cordier and Prof. Iona Novak and our life members Marilyn Pattison and Dr Angela Berndt. Many thanks to our conference convenor Prof. Iona Novak and scientific committee convenor Prof. Stacey George. As part of the conference, we also had presentations from Michael Barrett on our lobbying efforts and success and our CEO Samantha Hunter on our exciting strategic projects. With our refreshed strategic plan, the board is confident the time is right to invest in our profession and association to further our ambitions. Our future has never looked brighter.

2021-23 Strategic plan

OUR VISION People and communities are engaged in occupations that bring meaning and purpose to their lives, fostering health, wellbeing, participation and inclusion.

OUR PURPOSE OUR STRATEGIC FOCUS AREAS

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OTA represents, supports, strengthens and resources the continually evolving occupational therapy profession.

We position occupational therapy for strategic influence to enhance awareness of, access to, and impact of the profession. We support and resource occupational therapists to deliver optimal outcomes for individuals, organisations and communities. We are a high-performance organisation resourced by quality people, systems and governance, meeting the evolving needs of our members.

1.1 We influence decision-makers and the community to invest in and benefit from occupational therapy as an integral part of good health and social outcomes.

2.1 We foster and resource a culture of global best-practice, thought leadership and lifelong learning in the profession and its operating environment.

3.1 We deliver a continually expanding suite of valued benefits for our members, the profession and the nation, in order to support our purpose and enhance our capability.

1.2 We develop and sustain relationships to ensure the profession proactively contributes to key practice, policy and legislative issues.

2.2 We invest in appropriate credentialling, support and workforce development initiatives.

3.2 We build the international profile and reputation of the organisation and its purpose to support our members and maximise our impact.

1.3 We invest in evidence-based research to demonstrate and measure impact of occupational therapy. 1.4 We enhance the profession’s capacity and capability to systemically advocate for clients and the profession.

2.3 We develop and deliver flexible contemporary learning opportunities in all areas of the profession. 2.4 We develop leadership, community, business, governance and support capability across all the profession. 2.5 We embed and progress cultural and community diversity through recognition, respect and inclusion in all demographics and communities.

3.3 We embed best practice contemporary governance and operational standards across all our activities nationally. 3.4 We invest in all our teams of staff, volunteers and other supporters in order to enrich engagement, participation and capability. 3.5 We invest in digital transformation to enhance and transform our impact.

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CEO’S REPORT

CEO’s report Samantha Hunter | OTA CEO

A clear path in uncertain times

hile the times may seem uncertain locally and globally, looking to the horizon we are optimistic about the opportunities ahead for the profession, and celebrate the continued progress the association has made over recent years. As we continue to ride out and respond to the ongoing challenges the pandemic presents, we will also look to the future and to executing on an exciting program of work. Working with the Board of Directors over the past year I am pleased to have finalised the new Occupational Therapy Australia strategic plan, which will set the course for the association to continue to grow our membership, our influence and our impact. This plan hinges on three pillars. First, the association will look outwards, at our place in society, our impact on our clients and communities, our influence and our relevance. The second pillar focuses us on our members and the profession at large, ensuring we support, protect and

promote our members by providing timely support, advice and resources. The third pillar is one that looks internally to ensuring the OTA team, volunteers and members have the necessary tools, technology and training to work collaboratively, productively and effectively, and to provide contemporary platforms for our members. The Occupational Therapy Australia Strategic Plan is accompanied by an ambitious operational plan that will allow the association to deliver enhanced advocacy, professional practice benefits and advice, sector thought leadership, and a growing profile for occupational therapy to the audiences that matter: our members, communities and decision-makers. With an active and growing membership, an increasing number of professional staff and a strong direction set by the Board of Directors, we are looking forward to the exciting opportunities emerging in allied health.

… members can expect OTA to represent the profession with strength and fortitude on issues that matter

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As we enter our second decade as a national association, members can expect OTA to represent the profession with strength and fortitude on issues that matter, whether that be on government advocacy or issues of social justice that affect the broader community. We are working on expanding the program of member benefits, and the tools, training and advice we offer to you. We are looking outward at opportunities to engage with consumers, with our allied health and other colleagues and with the media to bring greater understanding of the breadth, depth and life-changing impact of occupational therapy. A bright future lies ahead for the OTA in championing occupational therapy. As we are on the cusp of great change and continued global flux, there has never been a more important time for occupational therapists, and never a more important time to be part of the association that supports the profession. The team at OTA is looking forward with enthusiasm to the future, and we thank you for being with us on the journey.

VALE

Vale Colleen Mullavey O’Byrne Prepared by Anne Cusick and Colleen Harris

Collen Mullavey O’Byrne was one of the longest-serving and most influential occupational therapy educators in Australia

olleen Mullavey O’Byrne, one of the longest-serving and most influential occupational therapy educators in Australia, died in June, aged 84. Colleen completed primary school in the village of Mullengandra, NSW. She went to high school at St Joseph’s Ladies College in Albury, winning a commonwealth university scholarship in 1954. Colleen used her scholarship to study a Diploma in Occupational Therapy, which was awarded in 1958. For the next 10 years, she worked as an occupational therapist at Cairns Base Hospital (1960), Royal Prince Alfred Hospital (1959, 1967-68) and St Vincent’s Hospital in psychiatry and cardiopulmonary rehabilitation (1961-66) where she was Occupational Therapistin-Charge (1964-66). Colleen had her first experience of research (1966-67) with a funded National Heart Foundation project on “The Working Problems of the Housewife Suffering from Heart Disease”.

In 1969 Colleen entered the education sector, teaching in the Diploma of Occupational Therapy program at the NSW College of Occupational Therapy, Sydney (1969-71), then in the NSW College of Paramedical Studies (197274) which brought together a number of independent allied health institutions. In 1975 Cumberland College of Health Sciences was established incorporating programs from the paramedical college. In all three organisations Colleen was a senior member of the teaching staff, leading the profession in the transition from diploma to degree-level education. In 1983 she became Head of the School of Occupational Therapy at Cumberland College, actively promoting occupational therapy in a competitive multidisciplinary environment and building occupational therapy academic staff capacity in readiness for the honours, postgraduate and research training to come. In the early 1990s Cumberland College was integrated into the University of Sydney. Colleen positioned

occupational therapy as a research-informed and practice-engaged discipline, offering undergraduate and postgraduate programs. As a scholar herself, Colleen completed postgraduate work at Macquarie University and interdisciplinary research in culture, cultural competency and intercultural practice–which was visionary for its time. Her leadership was recognised by the University of Sydney in her promotion to associate professor in the mid-1990s– making Colleen the first occupational therapist in NSW to achieve this level of academic prestige. Colleen stepped down as Head of School in 1998. In November 2005 Colleen was appointed honorary associate professor in recognition of her superior contribution across all fields of academic endeavour for a sustained period. Vale Colleen Mullavey O’Byrne, a wise, visionary and kind humanitarian who led in scholarship and education at local, national and international levels and made a difference in the world.

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P O L I C Y, L O B B Y I N G & A D V O C A C Y U P D A T E

Positive change and a growing presence Michael Barrett, OTA General Manager, Government and Stakeholder Relations

his issue’s theme “Brighter Futures” is appropriate given that, as I write, occupational therapists and their clients across Australia are applauding the recent decision by disability ministers to abandon NDIS independent assessments. All who opposed independent assessments as envisaged by the National Disability Insurance Agency have good cause to celebrate. OTA fought the proposed individual assessments with great determination, skilled advocates, and, most importantly, irrefutable evidence. At first glance, it is terrific news. An NDIS architect and compelling critic of independent assessments, Professor Bruce Bonyhady, said OTA’s submission to the Australian parliament’s Joint Standing Committee was “immensely powerful”–and OTA sincerely thanks the scores of members who supported its long campaign to defeat independent assessments. It was their clinical evidence–and passion–that won the day. However, a note of caution. The NDIS is costing more than envisaged, and over time is likely to cost even vastly more–all at a time of historic budget deficits. As governments strive to pull in the reins, we are likely to see new ways of cutting costs. We must remain vigilant to ensure these do not come at the expense of client care or the professional responsibilities of our members. We are pragmatic enough to realise that if the NDIS is to be sustainable, some form of eligibility screening process will ultimately be introduced.

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We know the Morrison government is convinced of this and, significantly, any future Labor government will also have to oversee a screening process that ensures access and equity without rendering the scheme unsustainable. The important thing, surely, is to develop a screening process that also allows the NDIS to remain true to its foundational principles: principles such as scheme co-design, reasonable and necessary supports, and enhanced choice and control for participants. In the spirit of co-design and collaboration, we will work with our colleagues at Allied Health Professions Australia to facilitate the work of the NDIA–an agency that must become genuinely consultative if it is to regain the trust of the sector. We have already recommended a screening process that is effective, evidencebased, and, most importantly, involves a comprehensive assessment conducted by a discipline-specific allied health professional the client knows and trusts. So, in terms of the NDIS, the future does appear brighter, but we must remain vigilant. The future is certainly a little brighter for Australian war veterans and widows who scored an occupational therapy victory in the May 11 federal budget. After almost 20 years without a meaningful increase in the fee paid to occupational therapists, the Department of Veterans’ Affairs has raised it 27 per cent. While modest in the context of a multi-billion-dollar budget, it is hugely important in making work sustainable for this

particularly dedicated group of occupational therapists and their clients. Until now, many of these experienced occupational therapists had worked at a loss–continuing out of loyalty to long-standing and highly complex clients–and had survived through cross subsidies from more viable work. OTA fought long and hard for these members, raising the issue at every opportunity, and even establishing a standalone website that declared: “This is not the way a grateful nation treats the people who treat its veterans.” OTA acknowledges those members who worked with veterans from the goodness of their hearts for so long, and who helped us campaign for a fairer deal. Once again, we know this fight is not over, and we must ensure a fee schedule never becomes so outdated again. The federal budget has unprecedented expenditure on mental health and suicide prevention, which emerged as urgent problems long before natural disasters and the Covid-19 pandemic threw them into even sharper focus. After a year’s delay due to Covid-19, the federal government late last year released the findings and recommendations of the numerous committees reviewing aspects of the Medicare Benefits Schedule. The committee charged with reviewing mental-health-related items (i.e. BAMHS) was unable to make decisive recommendations, opting instead to recommend another review. Significantly, it recommended that the make-up of the new

P O L I C Y, L O B B Y I N G & A D V O C A C Y U P D A T E

... the future does look bright but we must remain vigilant committee be more professionally balanced– an acknowledgement that the former review was dominated by the psychology profession. While good news for OTA, it will require mounting arguments we have already made, often in front of hostile audiences, for up to another year. However, substantial funding has been committed to diverse initiatives too numerous to list here. Conscious of this rare opportunity to raise awareness of the unique role that occupational therapists play in the delivery of mental health care, the OTA board has approved development of a white paper to explore the best way to make a compelling case to decision-makers. Scoping work on the white paper is already under way. There was also unprecedented expenditure on aged care, largely in response to the recommendations of the Royal Commission into Aged Care Quality and Safety. Our submissions to that royal commission emphasised the need to ensure that residential aged care facilities provided a decent quality of life–and the key role that occupational therapists should play in achieving this. For too long, occupational therapists have been denied the right to bring the full range of their clinical expertise to bear, often only practising massage because the old Aged Care Funding Instrument rewarded it. This was professionally frustrating and a personal tragedy for residents. However, we also reminded the royal commissioners that most of our population will age at home, and their homes must be safe and fit for purpose. Here, of course, occupational therapists have a crucial role to play. We stressed–as we do whenever we can– that falls prevention should rank alongside

obesity and road safety in the national consciousness. Falls end lives prematurely, place a huge strain on our overstretched health systems and are largely preventable. On a related matter, on Friday, 30 April, Australian building ministers agreed to include mandatory minimum accessibility standards in the National Construction Code–to the Silver Level. The Gold Standard will also be included in the code as a technical referral, meaning states and territories can decide to upgrade to Gold Level voluntarily. From September next year, all new houses will in theory be required to be built to the new standard. OTA was a key player in the fight for greater accessibility in new Australian residential dwellings, encountering fierce resistance from the construction industry. OTA lobbied all nine building ministers, arguing that accessibility standards would be of lasting value to all Australians for generations to come. A small team of OTA members also met senior public servants to make the case. OTA thanks these members for their fine work. We also signed up to the Building Better Homes Campaign, a coalition of interested parties largely driven by the Summer Foundation. As the campaign notes: “While there is still work to do to secure a mandatory gold standard, this is a big win for people with disability, seniors and indeed all Australians.” Regrettably, some dissenting jurisdictions are likely to refuse to implement the new standards, so lobbying work goes on under the auspices of the Building Better Homes Campaign. All of these new or expanded initiatives will

require thousands of extra occupational therapists at a time when there is already a worsening shortage. Despite new undergraduate courses being established almost every year, those graduating often do so with multiple job offers awaiting them. OTA members operating larger practices routinely tell us they cannot fill job vacancies, despite often very generous packages. Two things are abundantly clear. First, this problem is going to become even more pronounced as more Australians join the NDIS and, in particular, our population ages. Whether opting to age in place or move into a residential aged-care facility, Australia’s rapidly growing elderly population will need the expertise of occupational therapists to ensure their physical safety, health, mental well-being and quality of life. Second, the workforce shortage will present new opportunities for individual practitioners while posing profound challenges to the profession as a whole. How do we rapidly increase the number of occupational therapists without compromising the quality of care being delivered? How do we protect the occupational therapy scope of practice in the face of incursions by other allied health professions? How do we ensure overseas-trained clinicians continue to meet Australia’s rigorous professional standards, and then have the clinical supervision and support they need? In one sense this challenge is not a bad thing. It shows the value of occupational therapy is being recognised at last–and, accordingly, demand for services is outstripping supply. This points to an even brighter future for the profession.

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P R O F E SS I O N A L P R A CT I C E & STA N D A R D S U P D AT E

Challenges of technology’s brave new world Carol Jewell, Acting National Manager Professional Practice and Development

he pioneers of our profession showed remarkable vision and foresight in steering the course of occupational therapy in Australia. Elspeth Pearson (1926-2015) was one of these pioneers. She was known for her single-minded lifetime commitment to the growth and development of the profession, and for supporting its emerging leaders. Occupational therapy surfaced at a time when disability was not well understood and people with disabilities were often institutionalised (Poulden and Oak, 1990). In these times, people with disabilities had limited opportunities to take part in meaningful activities, and quality of life was barely a concept. Early pioneers of our profession set clear expectations that people with disabilities had the capabilities and rights to lead fulfilling lives, and be afforded the same opportunities as people in the broader community. The profession has rapidly evolved. However, the fundamental principles of occupational therapy practice and the agenda set by our pioneers is more relevant than ever. Elspeth Pearson was a member of the first cohort of occupational therapists to be trained in Australia and was well known for her pioneering work in mental health. Her deeply significant and compassionately held humanistic beliefs underpinned all aspects of her work, and she was awarded the first Victorian Public Service Award for her contribution to psychiatric services. She was an inspirational leader who had a clear vision for occupational therapy in Australia

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... fundamental principles of occupational therapy practice and the agenda set by our pioneers is more relevant than ever.

“

To have my aspirations not only recognised but supported by the Elspeth Pearson Award has been an incredible honour and has made me even more determined to achieve my goals – Stephanie Porter, Elspeth Pearson Award winner 2020

and a strong commitment to developing and nurturing occupational therapists throughout their career. Her commitment to the profession lives on through the Elspeth Pearson Award which supports and inspires early career occupational therapists to achieve their aspirations and fulfil their potential as emerging leaders of the profession. Our emerging leaders will be entering a period of rapid societal change as the digital revolution takes hold. Advances in information and communications technology, rapidly developing technologies such as 3D printing, robotics, artificial intelligence, and autonomous vehicles will substantially change the landscape in which we all operate (Liu, 2018). These technological changes have the potential to enable people with disabilities to fully take part in meaningful activities with self-determination and autonomy. If this technology is accessible to

people with disabilities it has the potential to substantially change their experience of disability and the way in which disability is viewed in society as a whole. However, while the therapeutic possibilities are endless, these technological changes also have the potential to disrupt the occupations and livelihoods of people with disabilities and the broader community as a whole. Occupational therapists implicitly understand how disruption to meaningful occupation and participation affects health and well-being. Our expertise and understanding of human occupations, coupled with our clinical reasoning and creative solution-focused problem-solving, positions us well to contribute to the discussion, design and implementation of new technologies for the betterment of all (Liu and Mihailidis, 2019). This is our opportunity to take up the mantle and be a prime mover in promoting community

P R O F E SS I O N A L P R A CT I C E & STA N D A R D S U P D AT E

“

I want my career to focus on helping individuals with an acquired brain injury and mental illness achieve the most during their time in rehabilitation. – Stephanie Porter, Elspeth Pearson Award winner 2020

health and well-being in this fast-changing world (Hyett et al., 2015)—an opportunity to create brighter futures for people with disabilities and the broader community.

pioneers of our profession almost a century ago. Are we ready to embrace a brighter future? With the conviction and commitment we see in our emerging leaders, I believe we are.

The occupational therapy profession is wellpositioned to take a substantial leadership role in promoting health and well-being through meaningful occupation in this rapidly evolving world—a world in which the fundamental principles of occupational therapy personcentred care are as pivotal to our practice now as they were when they were embedded by Elspeth Pearson and the many other inspiring

Further information about the Elspeth Pearson Award is available on the OTA website.

OTA extends its sincere thanks to Alan Pearson who has been the family representative of the Elspeth Pearson Trust since it began. He has made a significant personal commitment as principal lead of the trust to ensure the award provides support for early career clinicians who have potential to make substantial gains for the people they work with and for the profession as a whole. Alan has unquestionably carried out these duties with the same dedication and passion for the profession that Elspeth Pearson held. We wish him well in his retirement from this role.

References can be viewed by scanning the QR code

BECOME A REMOTE VOLUNTEER Explore the world from home and help support change in developing countries by volunteering with the Australian Volunteers Program.

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F EP ADT CU ARLEE N D A R C

CPD updates SEPTEMBER – DECEMBER 2021

To support clinical decision making, continued learning and professional engagement, OTA offers a range of evidence-based CPD webinars, workshops and online resources. To browse and register for upcoming CPD events, visit: otaus.com.au/cpd Webinar Series & Workshops Online Date

Format

Course

Area of Practice

1-29 Sept

Webinar Series

Stroke Recovery

Neurological Conditions

1-2 Sept

Workshop Online

Leadership for Health Professionals

Leadership/ Management, Non Clinical PD

7-Sep

Workshop Online

Home Modifications: Introduction

Modifications / Access

8-Sep

Workshop Online

Home Modifications: Advanced

Modifications / Access

10 & 17 Sept

Workshop Online

Learn the CO-OP Approach

17, 23, 24 Sept

Workshop Online

15-Oct

Workshop Online

OT with Children: Principles of Assessment & Intervention Home Modifications: Bathrooms

Disability, Knowledge Translation, Neurological Conditions, Occupational Rehab, Paediatrics, Rehabilitation Paediatrics

18-Oct

Workshop Online

Home Modifications: Introduction

Modifications / Access

19-Oct

Workshop Online

Home Modifications: Advanced

Modifications / Access

18 & 19 Oct

Workshop Online

Older Adult Care

8 & 9 Nov

Workshop Online

Care of People with Dementia in their Environment “COPE” Program Professional & Clinical Supervision

Modifications / Access

Leadership/ Management

Elearning – Recorded (CPD Library)

Area of Practice

Aboriginal and Torres Strait Islander Cultural Competence Course

Cultural Competency, Non Clinical PD

Introduction to Sensory Approaches for Mental Health

Mental Health inc forensic AOD and refugee

Narrative Storytelling: Facilitating Positive Identity Growth

Multiple areas of practice

NDIS 101

NDIS

NDIS Assistive Technology and Home Modifications

NDIS

Supporting People with ASD & Their Families

Paediatrics

Talking Toileting

Paediatrics

Occupational Therapy in Pressure Injury Assessment and Management OT Comprehensive Functional Assessments in the Context of the Disability Sector Trauma-informed Aboriginal and Torres Strait Islander Cultural Capability

Acute Care Rehab/Hospital, Assistive Technology, Disability, Older Adult, Pallative Care and Oncology NDIS Cultural Competency, Non Clinical PD

National Conference Events Date

Event

Area of Practice

9-10 Jun 2022 Conference & Exhibition

OT Exchange 2022 [Melbourne, VIC]

Aged Care, Disability, Knowledge Translation, Occupational Rehabilitation and Paediatrics

21-23 Jun 2023 Conference & Exhibition

OTA 30th National Conference and Exhibition 2023 [Cairns, QLD]

All areas of Occupational Therapy

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F E AT U R E

Smoking ceremony at IAHA Cultural Responsiveness Training 2019

Our journey to understanding is more than our Reconciliation Action Plan Occupational Therapy Australia

ur journey to understanding has no defined end. It is a continuum of learning, growth and maturity. Just as a tree has many branches, our Reconciliation Action Plan will flourish and grow over time. The Reflect RAP endorsement formalises our reportable commitments to reconciliation with Reconciliation Australia. This includes improving internal structures, reviewing cultural learning needs and implementing appropriate governance. The Reflect RAP will ensure we improve opportunities to increase understanding and build and show respect for Aboriginal and Torres Strait Islander cultures and histories. The Reflect RAP is part of our commitment and links to our strategy to “embed and progress cultural and community diversity through recognition, respect and inclusion of all Australians in all demographics and communities”.

Bundyi–Girri In early 2020, just before Covid-19, a group of OTA staff including CEO Samantha Hunter undertook an immersive program with Bundyi-Girri. The program encouraged us to actively learn and authentically explore our own personal relationship to First Nations people and reconciliation. Indigenous-led and owned Bundyi-Girri guided our team to develop skills to engage meaningfully in reconciliation. The Bundyi-Girri program builds upon cultural awareness, providing our team with the fundamental skills to develop an active, authentic relationship with Indigenous people, knowledge and country for respectful engagement. OTA aims to continue to strengthen its relationship with Bundyi-Girri and explore opportunities to share this experience with others.

Indigenous identifier question In 2020 our database fields were changed so members can now answer a question about Aboriginal or Torres Strait Islander identity. We are now collecting this information to help better understand our membership. We know there are occupational therapists in Australia who identify as Aboriginal or Torres Strait Islander, and by asking this question we can work towards providing culturally safe and welcoming experiences for all members and develop appropriate resources. As we consider, develop and evaluate workforce strategies in the coming years, we can look to partner with appropriate organisations to develop and co-design pathways for more occupational therapists who identify as Aboriginal or Torres Strait Islander.

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F E AT U R E

The format of the question and options of answers is based on Australian Institute for Health and Welfare National best practice guidelines, consultation with Indigenous Allied Health Australia (IAHA) and a review of the question format of similar associations and organisations. A number of strategies to assist our journey to understanding encourages the association to extend an invitation to work collaboratively with Aboriginal and Torres Strait Islander members. This gives voice to how the association can approach reconciliation and celebrate and highlight achievements.

Learning and development Recognising that cultural safety training is a core requirement for registration, OTA supports learning and development: • During 2019, OTA in partnership with IAHA gave members and staff the chance to undertake cultural responsiveness training to reinforce our commitment to being, knowing and doing. • The Aboriginal and Torres Strait Islander cultural competence online course provides foundation-level knowledge in Aboriginal and Torres Strait Islander history, cultures and societies. • The trauma-informed Aboriginal and Torres Strait Islander cultural capability online course is designed as an introduction to trauma and its impacts on Aboriginal and Torres Strait Islander people and is an extension to the cultural competence course. These online courses are provided through the Centre for Cultural Competence Australia–a majority Indigenous-owned organisation dedicated to the training and development of individuals and organisations.

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National Conference and events Our national conference and large-scale events have had a long-standing commitment to respectfully acknowledging the traditional owners of the lands in which we have conducted business. From Welcome to Country ceremonies to panel discussions and heartfelt yarns, our major events are designed and curated to inspire and challenge thinking. This year’s conference was no exception.

Keynote speakers Michael Kirby’s inspiring address cast a spotlight on the challenges facing occupational therapists and their communities who identified as Aboriginal or Torres Strait Islander He detailed Australian history including the incarceration of Aboriginal and Torres Strait Islander people and encouraged us to “provide a voice, listen sincerely and without the disdain and find ways to respond”.

President Carol McKinstry’s “Conversation with Aunty Lyn Warren” provided social narratives that enhanced our shared understanding. What a privilege. Thank you, Carol, for introducing us to your friend and reminding us all about the power of connection and relationships at the core of community engagement. Aunty Lyn reminds us all to build rapport and take time to be with people and have genuine interactions. Her stories were inspirational and full of advice we can apply in a range of settings.

Professor Gregory Phillips from the Waanyi and Jaru Aboriginal Australian people spoke on unconscious bias and informal beliefs. He encouraged our workforce to develop knowledge and capability and unlearn the history lessons taught to previous generations. Professor Phillips challenged our thinking around racism, race relations and cultural safety, and decolonisation, and inspired health professionals towards a better Australia.

Over 40% of our members have voluntarily updated their profile and responded to the Indigenous identifier question.

Our learning, our growth and the respect we show is our responsibility. As a profession we can lay a framework, but it is up to each occupational therapist to seek education, explore opportunities and to respectfully discover their own connection to reconciliation and First Nations people.

The Reflect RAP is part of our commitment and links to our strategy to “embed and progress cultural and community diversity through recognition, respect and inclusion of all Australians in all demographics and communities

A O TJ

Inspired insights from the opening day of the 2021 National Conference Jacki Liddle, Board member of the Australian Occupational Therapy Journal

he 29th National Conference and Exhibition differed from the conferences that went before – like many things in recent times. Adaptations were made, and a hybrid of in-person hubs and online participation occurred on the first day with a single stream of important presentations. While the subsequent days of the conference had many opportunities for learning and showcasing excellent work within the occupational therapy community, I will focus on lessons from this first day. We were privileged to hear from (in temporal order), an international jurist, educator and QC (Hon Michael Kirby), a proud Youta Youta woman, Elder and advocate (Aunty Lyn Warren), health professionals and COVID-19 survivors (Annie McCluskey and Karl Shurr), leaders of international occupational therapy associations (Giovanna Boniface (Canada); Dianne Cox (UK), Wendy Hildenbrand (USA), Carol McKinstry (Australia); living experience experts and advocates (Caleb Rixon, Dennis Frost, Grace McLoughlan, Carl Thompson) and Waanyi and Jaru medical anthropologist and change leader in cultural safety, race relations and decolonisation (Prof Gregory Phillips). While each speaker shared their own distinct messages and perspectives, there were shared themes. Speakers made recommendations for actions that could be started now, and then built upon to create lasting and needed change. To reach our brighter futures for our clients and communities, (and critically to meet unmet needs and address inequities) we were encouraged to: 1. Know our history and ourselves: as a professional, individually and on the lands on which we live and work. We need

to critically engage with our history, our cultures and understand the impacts on the current context. Active reflection on our beliefs, practices and experiences is required for effective practice. 2. Listen – really listen within our practice and take more time to engage. Use open and genuine listening, rather than rushed, formal engagement. Listen from an informed place to engage in the ways that people need and wish to communicate. Part of listening will be sharing some of ourselves and making genuine and warm connections. Putting ourselves out there and trying things can go a long way to building mutual respect in therapeutic relationships. 3. Apply a human rights framework. Regardless of the occupational therapy models that are applied within research and practice, the relevance of a human rights underpinning to all of our work is clear. We need to be aware of human rights declarations, reflect on who is being excluded from our services and spaces, and build our appetites for advocacy and dismantling unjust systems to make sure we are supporting the rights of all people. 4. Create solutions together. In building upon these previous recommendations, codesign or partnership approaches with those who engage with occupational therapy services were strongly recommended. Recognising and valuing lived expertise and other knowledges that are required in creating meaningful educational, clinical, research and systemic approaches. Above valuing and working together, openness to co-creating and applying frames of reference and definitions of (and means of measuring) success is required.

The Australian Occupational Therapy Journal has published research works related to all of these important areas over the years including reflective practice1, listening and connection2, human rights3 and participatory evaluation and design4. Importantly, as the conference showed us, new insights are likely to come from including diverse investigators, methodologies and frames to examine the issues. We expect to see more cross-disciplinary approaches, critical methodologies, anthropology, law, Indigenist and participatory methods in future works. We also anticipate more lived experience experts as co-authors, and in active research roles. Recent works in the journal indicate that while occupational therapists have been active in applying participatory methods (for example, in education5 and in health research6), reviews found the engagement has not always been as shared and complete as it could be. The enhanced and genuine engagement with lived experience experts is a current priority of the journal. As clinicians, researchers, advocates and community members – we can only build a brighter future by collaborating together. About the Author Dr Jacki Liddle is a Board member of the Australian Occupational Therapy Journal (and a member of the Scientific Committee of the 29th AOT Conference)

References can be viewed by scanning the QR code

CONNECTIONS SPRING 2021 15

WFOT REPORT

WFOT update Occupational narratives The occupational narratives project, led by Professor Gail Whiteford, is a collaboration between WFOT, occupational therapists and occupational scientists around the world. The aim is to represent people in naturalistic, formal and institutional settings from all backgrounds, ability levels, ages, socioeconomic and sociocultural backgrounds as they engage in everyday “doings”. The hope is to broaden perspectives of occupation and sense of belonging to the global community. Instructions are easy to follow and you can simply record your video on your phone. OTA members can contribute to the collective stories of “how and why we do” in the world by uploading your own story. Visit occupational-narratives.wfot.org/about/

World Occupational Therapy Day This year’s World Occupational Therapy Day promotes and celebrates diversity and inclusion as we work together to build community and resilience. You can share the theme and materials to recognise the importance and value of occupational therapy. OT Week 2021 in Australia is being held from 25 to 31 October to include World Occupational Therapy Day. Watch for promotional materials available soon on the WFOT and OTA website to assist with planning your OT Week activities.

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Asia Pacific congress The 7th Asia Pacific Occupational Therapy Congress, hosted by the Philippine Academy of Occupational Therapists, has been rescheduled to November 2021. The congress theme is “Celebrate Occupation. Celebrate Life” and it aims to showcase the positive impact of occupational therapy on people’s lives. The conference is online and registration is open now. Visit apotc2020.com/

WFOT REPORT

Conference Reflections Dr Emma George, WFOT 1st Alternative Delegate

s expected, the #OTAUS2021 conference celebrated the work, achievements and progress of our profession. For those of us who followed discussions online in the conference platform, and on Twitter, it was inspiring to participate in such thought-provoking and challenging topics. Michael Kirby highlighted the importance of human rights. Professor Gregory Phillips outlined the effects of racism in Australia and implications for health services. The discussion forum alongside Karen Whalley Hammell’s keynote had us wrestling with colonisation, neoliberalism and the need for advocacy. As I sift through my notes from the conference, I am reminded to look back at history and reflect on where we have come from. To look within and address issues of white privilege and racism. To look out at the breadth and depth of services we provide and how we keep occupation at the heart of what we do. And to look forward, recognising the potential of the profession to meet the needs of individuals, families, communities and populations. In the WFOT Bulletin, Duncan, Sinclair and Creek (2021) cast a vision for occupational therapy that responds to rapid social global change and aligns with the United Nations Agenda 2030 for sustainable development (available at: sdgs.un.org/2030agenda). They proposed that occupational therapy target social determinants of health and be based on principles of equity, solidarity and justice. This would address issues such as poverty, inequality, climate change, violence and mass human migration. Actions to turn this vision into reality are outlined in the article. As members of OTA and the WFOT, you can access WFOT bulletin articles online at wfot.org/bulletin.

As the dust settles on the whirlwind of a national conference from the comfort of my own kitchen, I will continue to look back, look within, look out and look forward.

References can be viewed by scanning the QR code

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CONNECTIONS SPRING 2021 17

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Highlights from the 29th National Conference and Exhibition

rom 23-25 June, OTA held its first fully virtual National Conference and Exhibition. Nearly 1000 participants from Australia and 12 other countries engaged online as well as meeting face to face at five engagement hubs to share “Inspired Insights for Brighter Futures”. When the dates and destination were announced at the close of 2019, nothing could have prepared us for the world events that followed and how they affected the way we work, live, learn and network. Over the past 18 months, the events team with support from the board and organising and conference scientific program committees navigated through the planning to ensure the safety and quality of learning remained top priorities. The impact of Covid-19 meant the delivery

of the event transitioned from face to face in Cairns to hybrid, to virtual with engagement hubs. This meant completely changing the program format and ensuring the final outcome would deliver an event that enabled our participants to learn and engage–the two main reasons for attending our national conference. We can proudly say the national conference did deliver, and proved incredibly enriching for all involved. We offer our sincere gratitude to the many speakers, delegates, volunteers, exhibitors and sponsors who rode the wave with us and contributed to the conference’s overwhelming success. Over the following pages is a selection of the key stats, photo highlights from the engagement hubs and quotes from our participants about the conference.

Jessica Francis, Chair of the NSW Divisional Council.

29TH NATIONAL CONFERENCE AND EXHIBITION 2021

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PROGRAM STATS

KEYNOTE PRESENTATIONS

INVITED SPEAKERS

EXTENDED ORAL PRESENTATIONS

137

Sydney Engagement Hub

REGISTRATION

37 12

VIC 263

ACT 13

WA 92

NSW 217

SA 68

TAS 12

QLD 237

NT 5

INT’L 37

INTERNATIONAL REGISTRATIONS COUNTRIES Canada, Hong Kong, Japan, New Zealand, Philippines, Puerto Rico, Singapore, Spain, Sweden, Taiwan, United Kingdom, United States of America

141

ORAL PRESENTATIONS

43 ePOSTER DISPLAYS

ePOSTER SPOTLIGHT

107

WORKSHOPS

EDUCATION DAY

736

ABSTRACT SUBMISSIONS

*INCLUDING 35 INTERNATIONAL SUBMISSIONS

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Supporting

#THISISOT OCCUPATIONAL THERAPY

INCLUSION

PARTICIPATION

OTAUS.COM.AU/OTWEEK

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SPONSORSHIP & EXHIBITION STATS

VIRTUAL EXHIBITORS

The virtual platform exceeded my expectations of this conference. Being virtual for four days worked really well and I engaged the whole time. Thank you, OTA, for pivoting to continue to provide this event. Cate Hilly, Canberra University Perth engagement hub

ENGAGEMENT HUB EXHIBITORS

Perth engagement hub

Adelaide Perth

Brisbane

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SOCIAL MEDIA/ ENGAGEMENT STATS/ HIGHLIGHTS AS PER CLOSING

Sydney

6.128M Impressions

Melbourne

ENGAGEMENT HUBS ON WEDNESDAY

Sydney Engagement Hub

Perth engagement hub

1,935 Tweets Brisbane Engagement Hub

As a student, it’s been an extremely enriching three days of conference. The ability to network with people passionate about their field of work and finding out more about how we can collectively build on and improve ourselves as service providers has been wonderful. I’m looking forward to graduation and work! (UQ student)

234 Participants 8 Avg Tweets/Hour

Sydney Engagement Hub

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OTA awards recap A number of awards were presented at the 2021 National Conference to members for their contributions to occupational therapy. OTA congratulates the award recipients for their ongoing service to the profession.

Honorary Life Membership The Honorary Life Membership Award is granted to Occupational Therapy Australia members who have shown meritorious services in the field of occupational therapy while displaying exemplary contributions in support of the Association. This year the Board approved conferring Honorary Life Membership to two of its long-term members Dr Angela Berndt and Marilyn Pattison.

Dr Angela Berndt

Marilyn Pattison

Occupational Therapy Australia Research Awards

The Occupational Therapy School of Victoria Clinical Awards

These awards acknowledge an occupational therapist’s contribution towards the advancement of the research base of occupational therapy. There are awards in four categories:

Research Team The Brain Recovery and Rehabilitation Research Group

Thanks to the generosity of the trustees of the Occupational Therapy Trust Fund, this newly established award will provide OTA members with opportunities for growth and development. This year there are three recipients:

Early Career Researcher Kylie Wales

Clinical Researcher Karen Arblaster

Mid Career Researcher Tamara Tse

Lisa Knightbridge

Rebecca Smith

Danielle Hitch

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OTA awards recap continued Occupational Therapy Australia Research Academy Conferment of Fellows

The Occupational Therapy Australia Research Academy has been established not only to recognise scholars in the profession, but also to enhance research capacity building in the profession. The following were announced as 2021 Fellows:

Professor Reinie Cordier

For 20 years Reinie has led research for developing playbased interventions in children with developmental disorders. He developed the first observational assessment of pragmatic language skill, which is fundamental to developing psycho-social and play skills. A focus of his research is how to ensure that people from different populations and social strata experience participation, remain engaged, and live socially connected and healthy lives. He produces evidence for the effectiveness of occupational therapy interventions in different populations. His work is applied and intended to influence practice, so he researches service-delivery arrangements and intervention techniques in terms of how well they achieve such outcomes. Much of his work is interdisciplinary and he advocates for the expansion of conventional occupational therapy practice areas to include children who have been exposed to domestic violence, and developing life skills for young people leaving care.

Professor Pamela Meredith

Professor Meredith’s early clinical experiences in child and youth mental health simulated her motivation to understand how characteristics and

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experiences originating in childhood are linked with physical and mental health outcomes throughout life. To this end, she has focused on how attachment and sensory patterns, developed and evident early in life, are related to longer-term health behaviours, health conditions and treatment outcomes. Related to this aim, Professor Meredith’s research focuses on: • Parenting and child trauma; • Persistent/chronic pain; • Burnout; • Mental illness and substance use; and • Palliative care, grief, and loss. Attachment and sensory-informed approaches are widely recognised as underpinning more individual, person-centred and trauma-informed care, which optimise quality-of-life, health and engagement outcomes throughout the life span. The goal of this work is to provide evidence and insights to inform clinical reasoning and the therapeutic process, including prevention, early intervention and evidence-based practice.

Professor Iona Novak

Iona’s research discovers, tests and translates new treatments in priority areas identified by people with cerebral palsy. Her major research contributions are in: • Inventing an evidence rating system with traffic light colour codes to help parents, clinicians and policymakers discern effective from ineffective treatments. The work has been implemented in 24 countries; • Leading and implementing a world-

first clinical practice guideline for the early diagnosis of cerebral palsy. Diagnosis previously occurred from 12-24 months of age but is now possible at three months, enabling early intervention and parent support; • Establishing home programs, botulinum toxin, CO-OP and stem cell treatments for cerebral palsy; and • Co-founding the Australian Register, which recorded a 30 per cent reduction in the rate of cerebral palsy, conferring $2 billion in savings. She is known for blue-sky thinking, leadership of global collaborative endeavours, translation of treatment from benchto-bedside-to-healthcare-to-policy and capacity-building new talent.

Associate Professor Mandy Stanley

Mandy is Associate Professor in Occupational Therapy at Edith Cowan University and holds an adjunct position with the University of South Australia. Since completing her PhD in 2006 she has developed an international reputation for her expertise in qualitative research methodologies, and is known for her contribution to occupational science and occupational therapy education. She has attracted $3.6 million in research funding and published more than 60 peerreviewed journal papers and book chapters. Professor Stanley chairs the Editorial Board of the Journal of Occupational Science and was an Associate Editor for nine years. She has a passion for research that seeks the perspective of consumers and for developing research capacity in occupational therapists. Mandy is an active supervisor of higher-degree and under-graduate research students and collaborates with researchers in Sweden, Ireland, New Zealand and Canada.

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Sylvia Docker Lecture 2021 The Board of Occupational Therapy Australia is delighted to announce Professor Lindy Clemson as the recipient of the 2021 Sylvia Docker Lecture Award. As Professor of Ageing and Occupational Therapy at the University of Sydney, Lindy is well known nationally and internationally among clinicians and researchers concerned with providing services for older people. Given the challenges of population ageing in Australia and elsewhere, her contribution to giving occupational therapy a voice in the multidisciplinary world of developing services for older people has been consistent for years. Her work has ensured the role of occupational therapy is promoted and valued. In 2017, Lindy was awarded an inaugural Fellow of the Occupational Therapy Australia Research Foundation (FOTARA). Her publications, highlighted in Cochrane Reviews, have influenced practice and

policy. Her research has explored multimethodology inquiries, intervention trials and implementation science. She is leader of the Active Ageing Research Node, Charles Perkins Centre, an investigator on the Centre of Excellence for Population Ageing Research at the University of Sydney, and an Honorary Professor at Nottingham University in the UK. Lindy is a positive role model for students and mentored many in evidence-based practice, student research projects and falls prevention topics. Her commitment to education is further demonstrated by her record of successful high-degree research supervision which continues today. Her PhD students have made significant contributions to occupational therapy in falls prevention, occupational therapy discharge planning and functional assessments, illuminating the cost benefits of occupational therapy, validating functional cognitive

assessments, and testing dementia re-ablement programs. They have also been forging new directions as clinical researchers, and many of her HDR students have developed careers as educators or clinician leaders. Lindy has demonstrated her strong community service to occupational therapy in Australia having been on the Editorial Board of the Australian Occupational Therapy Journal, and in multidisciplinary leadership roles such as the Executive of the Australian and New Zealand Falls Prevention Society, and the Editorial Board of the US Journal of Aging and Health. Locally, Lindy has held Director roles for the Independent Living Centre of NSW from 2001-09 and is a life member in recognition of her service. Lindy presented her lecture Relevance and Resilience: A bright future for occupational therapy at the 2021 Occupational Therapy Australia National Conference.

As well as the awards presented at the 2021 National Conference, OTA acknowledges the following grant recipients.

Elspeth Pearson Award

OTARF direct grants

This award enables recipients to advance their clinical skills and expertise through access to professional development. It has been made possible through the generosity of Elspeth Pearson’s family and the Elspeth Pearson Estate. The 2021 award recipient is Abbey Walker

The Occupational Therapy Australia Research Foundation grant scheme aims to generate research knowledge relevant to occupational therapy practice, and support the research capacity and career development of Australian occupational therapists. Research output is expected as a result of completing a project funded by this grant scheme. There are two recipients for the 2021 OFARF DGR grant: Lorrae Mynard, Dr Miia Rahja

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Physical activity, the forgotten occupation? Dr Jessica Hill, Associate Lecturer in Occupational Therapy, University of Queensland

he World Health Organisation describes physical activity as “any bodily movement by skeletal muscles that requires energy expenditure” (WHO, 2020). Physical activity is mostly considered to involve sporting and leisure activities such as team sports or going to the gym. However, it more regularly involves incidental activities such as taking the stairs, walking to work or school, playing on a playground or even doing one’s own grocery shopping. Research recognises the benefits of regular physical activity, such as reduced risk of chronic health conditions, and improved musculoskeletal and cognitive abilities and mental health (Australian Institute of Health and Welfare, 2020; Fruhauf et al., 2020). Physical activity is also said to help increase self-esteem, social interaction and a sense of belonging (Bragg and Pritchard-Wiart, 2019). However, despite this, the rate of engagement in physical activity in Australia continues to decrease. The most recent data suggests 26 per cent of children aged five to 11, 8 per cent of adolescents aged 12 to 15, and 15 per cent of individuals aged 18 to 64 meet recommended physical activity guidelines (Australian Institute of Health and Welfare, 2020). This is further reduced for people with disabilities. A 2019 report found that people aged over 15 with disabilities were 72 per cent less likely to take part in the recommended amount of physical activity for their ages compared with peers without disabilities (Australian Institute of Health and Welfare, 2019).

Link to mental health and well-being Another concerning statistic is the increasing incidence of people being diagnosed with a psychosocial disability. A 2018 report found

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... occupational therapists had an important role in supporting clients to engage in regular physical activity by reframing what physical activity could look like for each individual that 20 per cent of the Australian population was diagnosed with a mental or behavioural condition—a 4 per cent increase from 2015, including a 1.9 per cent increase for anxietyrelated conditions and 1.5 per cent increase for depression specifically (Australian Institute of Health and Welfare, 2021). Equally concerning, of the 746,000 Australians claiming the Disability Support Pension, 36.4 per cent recorded a psychiatric or psychological condition as their primary medical condition, the biggest category of claimants (Australian Institute of Health and Welfare, 2021). This has been suggested to be rising 6.5 per cent over 10 years. Within the field of mental health, the benefits of physical activity have been seen in people diagnosed with mild to moderate depression and anxiety, schizophrenia and substance misuse (Cole, 2010). However, while increasing physical activity may be seen as a cost-effective, non-pharmacological way to improve mental health, is it as simple as just moving? Authors of the book Psychology of physical activity, determinants, well-being and interventions (Biddle, Mutrie and Gorely, 2015) highlight that whether people engage in regular physical activity involves complex psychological, social, environmental and biological factors—all of which need to be fully understood in order to support a client’s needs. Thus a holistic view is necessary.

That’s where we come in Since the NDIS was introduced, an increasing number of clients have been diagnosed with psychosocial disabilities and able to access services such as occupational therapy that would not have been financially viable in the past. Most recent reports from the NDIS show that 16.7 per cent of participants seek support for psychosocial disability (National Disability Insurance Agency, 2019). In my private practice, I see an increasing number of adolescents and young adults access occupational therapy to support their psychosocial disabilities. When working with this population, it became clear they predominantly took part in sedentary activities, specifically involving technology, with little to no engagement in planned or incidental physical activities. Additionally, this physical inactivity negatively impacted several areas of daily occupation including self-care, home-management, community and social participation, and education and employment. My clients frequently report pain, fatigue and overall lack of motivation. As I tried to refer these clients to physiotherapy, exercise physiology or personal training sessions, I watched them disengage as they struggled with the perceived difficulties of finding the confidence and motivation to plan and book sessions, engage with unfamiliar people and places, undertake the

F E AT U R E

recommended exercises and changes to lifestyle, and follow through at home. The American Occupational Therapy Association recognises physical activity as an instrumental part of daily living and an occupation that occupational therapists have been involved with since the conception of the profession (American Occupational Therapy Association, 2014; Cole, 2010). Grounded by underlying theory with a specific focus on facilitating participation in meaningful occupations, occupational therapists specialise in working with the whole person and understanding the complex and dynamic interactions between the individual, their environment and their daily activities (American Occupational Therapy Association, 2015).

Within a qualitative study completed by Cole (2010), the author aimed to better understand participation in physical activity by individuals diagnosed with a psychosocial disability through the lens of the Model of Human Occupation. Findings suggested that while participants reported an interest and intent (volition) to be more active, barriers included perceived physical capacity, the environment and lack of physically active habits within their current lifestyle. The author suggested occupational therapists had an important role in supporting clients to engage in regular physical activity by reframing what physical activity could look like for each individual. Working to adjust individual expectations of physical activity,

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and grading the task to provide just the right amount of challenge with small but frequent steps, may help improve an individual’s outlook. As people begin to experience small achievements, they feel more competent within their daily activities (Cole, 2010). This may involve changes as small as removing the remote control from the home so the individual has to stand and walk to change the television channel. Actively working with clients to habituate lifestyle physical activity has been identified as one of the best protective factors for individuals sustaining more active lifestyles. Cole (2010) highlighted the importance of occupational therapists working with clients to make these small but manageable changes within everyday routines so the new behaviours became automatic (Cole, 2010). This may start by developing a routine in which the client walks to the end of the street and back before eating breakfast, and gradually grading this to the client negotiating public transport so they can walk to the bus or train to attend appointments instead of driving. Finally, occupational therapists understand the environment in which the client resides and are therefore able to ensure it is easily accessible, while also providing supportive social connections (Cole, 2010). This may involve working with the whole family to incorporate active habits into the family routine.

PRELIMINARY PROGRAMME Available online now* EARLY BIRD REGISTRATION Closes 23 September

support engagement in physical activity. Physical intervention remains the primary focus of physiotherapists, exercise physiologists and personal trainers. To support the client’s motivation to take part in physical activity, mental-health-specific interventions—like cognitive behavioural therapy from a psychologist—are still required to address the underlying features of their diagnosis. With the goal of enhancing physical and mental well-being, and therefore participation in all areas of daily occupation, occupational therapists have an equally important role to play in assisting clients to successfully incorporate regular physical activity into their daily routines in a way that is successful and sustainable long-term. About the author Dr Jess Hill is an Associate Lecturer in Occupational Therapy at The University of Queensland and has seven years’ experience working with children and adolescents in private practice. Jess has completed additional education in personal training to facilitate her understanding of how occupational therapists might be able to facilitate increased engagement in physical activity with clients to support their mental health and well-being.

It takes a team

*subject to change

www.oceaniaseatingsymposium.com

When working with clients with psychosocial disabilities it is important to recognise the need for inter-professional practice to

References can be viewed by scanning the QR code

CONNECTIONS SPRING 2021 27

F E AT U R E

Save the Date

OT Week 2021 OT Week is an opportunity to celebrate the unique value of occupational therapists and how they contribute to improving the quality of life for so many people. OT Week 2021 is from Monday 25 October to Sunday 31 October. OT week is scheduled to coincide with World Occupational Therapy Day, which is held on 27 October. Last year, our theme was Resilience: Supporting our communities to rebuild, recover and reengage. We reflected on the value of occupational therapy in supporting disaster recovery and on how we can build personal and professional resilience.

This year the OT Week Theme is Occupational Therapy: Supporting Participation, Inclusion and Independence. You can get your copy of the OT Week 2021 poster as a lift-out in the centre of this edition of Connections or as part of a suite of digital resources available from otaus.com.au/ otweek. We encourage you to display the poster in offices, waiting rooms, classrooms and

#THISISOT OCCUPATIONAL THERAPY

elsewhere to help promote the positive impact of occupational therapy in our communities. This year, OTA will be supporting members to host their own OT Week celebrations by engaging Hampers with Bite to supply OT Week morning (or afternoon) tea hampers. Details of how you can pre-order your hamper are on our website otaus.com.au/otweek.

INCLUSION

Supporting

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25-31 OCTOBER

INDEPENDENCE

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OTAUS.COM.AU/OTWEEK

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Mobile work and cyber safety Aon

Staying cyber safe while working remotely It is a sad state of affairs when a global virus proves to be a nexus to computer viruses. However, one of the immutable laws of the universe is ringing true: “Out of disaster comes opportunity.” Unfortunately, in this case, the opportunity is being taken by cyber criminals ramping up their phishing efforts and taking advantage of the uncertain times. As a small-business owner, while your priorities now may be your personal health and hygiene and the well-being of your employees, it may also be time to brush up on some digital hygiene habits to prepare your business for this newly emerging wave of threats.

Be on the alert for phishing emails and websites Criminals are crafting emails and websites purporting to provide information on a vast range of important topics, such as health reports, travel advisory updates, flight cancellations and school closures, just to name a few. Some of these communications are skilfully crafted, making it difficult to identify them as a phishing email or website. Be on the lookout for emails or websites that ask you to click on suspicious links or request sensitive information such as log-in details, credit cards, passwords, passports, health details or addresses—and ensure you’re raising this awareness with your staff.

Test your remote working capabilities and policies Testing your remote working capabilities should be part of a regular Business Continuity Plan. In the current environment, it is recommended that businesses ensure all staff understand the protocols when working remotely. Testing your capabilities is an important step, as individuals may not be aware of all policies,

procedures and protocols. It is essential that appropriate security functions have been implemented and are functioning correctly, such as Multi-Factor Authentication and Virtual Private Network (VPN). Take this opportunity to ensure your employees genuinely understand the importance of protecting your business data—and understand their responsibilities when it comes to hard drives and file encryption in storage and in transit. Brief your staff members on home network best practices, including the use of non-default router and Internet of Things passwords.

WiFi may be your enemy Unfortunately, public and personal WiFi networks may be compromised in certain circumstances. Delete WiFi credentials from your device as soon as you disconnect and enforce a strong password to your router (ensure it has been changed from the default password). Where possible, operate within a VPN.

Check your insurance If you/your employees are now working remotely, there may be a heightened risk of cyber threats. Further, there may be more information-sharing between your business network and employees’ personal systems not previously anticipated. If you have cyber insurance, it’s worth contacting your broker to confirm whether cyber attacks that occur while working remotely are covered, and clarify whether you have any additional obligations or need to disclose any of your policies, practices and procedures on remote working.

What you can do as a small business

attacks where criminals attempt to exploit the current situation. These include among others: • Coronavirus phishing scams preying on fear and confusion about the virus; • Phishing and scam websites themed around the pandemic; • Exploitation of leading corporate VPNs with major vulnerabilities; • Ransomware attacks on hospitals in which scammers anticipate the urgent need to function will push administrators to pay ransom amounts. There are actions you can take to help combat cyber attacks. 1. Ensure work-from-home employees understand how to configure and connect to your VPN providers and avoid split-tunnelling; 2. Plan fallback measures for phone-based and off-net communications and work as many VPN providers may encounter scaling issues as large numbers of users join; 3. Ensure the computers and devices that work-from-home employees use are updated with the most current system and application versions; 4. Assess your cyber security resilience plans/incident response plans and ensure that cyber insurance limits are appropriate for any potential financial impact as the result of a cyber attack. About the author Aon is a leader in risk and insurance broking and arranges a range of insurance solutions for occupational therapists. As the preferred insurance broker to OTA, Aon is proud to provide cover for OTA members and its number of clients continues to grow. If you’d like to find out more about Aon or get a quote, please visit aon.com.au/ota, call 1800 805 191 or email au.ota@aon.com.

Awareness and proactive action makes a difference. We have witnessed a variety of CONNECTIONS SPRING 2021 29

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The benefits of supervising overseas-qualified therapists Jan Erven, Director OTC and Chair OTC OQAC

he Occupational Therapy Council of Australia (OTC) is an independent not-for-profit organisation that aims to ensure standards of education, training and assessment of occupational therapists are maintained and developed so the public is assured of safe and proper practice. The OTC has been appointed by the Occupational Therapy Board of Australia (OTBA) to be the independent organisation to assess the qualifications and

skills of overseas-qualified occupational therapists wishing to practise in Australia. As part of the assessment process to gain registration in Australia, an overseasqualified occupational therapist must undertake a period of supervised practice with a registered occupational therapist who has held general registration in Australia for a minimum of two years and also has a minimum of two years’ practice experience in Australia.

We hope more occupational therapists will take up this opportunity to enhance their supervisory skills, learn more about how occupational therapy is practised in different countries, learn different cultural activities and gain CPD points for their annual registration. If you want to find out more, visit the assessment section of the OTC website: otcouncil.com.au

Below is feedback from supervisors who have found this process to be a rewarding experience for both parties: All of the occupational therapists I have supervised have all had experience in their own countries prior to making the move to live and work in Australia. We have worked through the supervision process together, and they have all brought enquiring minds and buckets of enthusiasm and stories from their previous occupational therapy skill sets. As in any invested teaching environment, it’s not just about what I have given but also what I have received from each of them along the way. It would definitely have been a lot more stressful if it wasn’t for the support of Julia, who answers my countless emails to the OTC. Julia is so calm and unflappable. The most significant takeaway she gave me was when I understood that the OTC are just as keen for these occupational therapists to be registered in Australia as the occupational therapists themselves. Phew! There is no need to fear a report coming back with a big red cross on it and a “Get on the next plane home”. But instead plenty of gentle guidance, support and clarification. Just as you would expect from occupational therapists! I’ve left the most important question for the end. “Would you do it again?” I’m just about to!

I’ve just submitted the final documents as a supervisor for my sixth overseas-trained occupational therapist. It was definitely not a road I had ever intended to go down, but it has been an engaging journey. When I agreed the first time, I remember thinking: “I’ve been an occupational therapist for over 20 years and have worked overseas. How hard can it be?” And now that I have been asked to reflect back, there are different questions. “Was it confusing at times?” Yes. “Does it take a significant investment of time?” Yes. “Was it stressful?” Occasionally. “Was it worthwhile?” Definitely! “Was it fun?” Yep!

30 otaus.com.au

I had a great experience as a supervisor, as I really enjoyed teaching and mentoring different clinicians and felt a great sense of pride in supporting clinicians to successfully complete their stage two supervised practice. As a supervisor, I always felt supported by the council regarding the supervision period and if, and when, I had any questions or needed to clarify information. I also felt that the whole supervision process was set up clearly and in detail from the beginning, allowing both myself and my supervisee to set up clear goals and expectations. In addition, I further developed my own skills in providing clinical supervision and providing feedback as part of the supervision period. I would encourage anyone to take part in this great opportunity of being a supervisor.

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14 steps to smarter goal-setting Seb Della Maddalena, Occupational Therapist

Developing goals with the people you support is a skill that requires practice. I recently returned to working as an occupational therapist and about the same time landed a teaching opportunity with final-year occupational therapy students at Edith Cowan University. It seemed a good time to sharpen my skills on how I developed goals with clients, and at the same time attempt to teach students the art of forming sound occupational therapy goals. I quickly learnt that students were confused about how to form goals, and it’s fair to say this remains a challenge for many practising therapists. I started to explore how to teach occupational therapy students how to develop goals and consulted with Denise Luscombe (physiotherapist) and Victoria Kennedy (speech pathologist) at Perth-based disability provider Mosaic. Discussions confirmed that SMART (Specific, Measurable, Achievable, Realistic, Timeframe) goals alone do not equate to good therapy goals. We fail our clients if we focus only on goals being SMART. But unfortunately, it’s an epidemic. Speak to any therapist and they will tell you they write SMART goals, and the conversation usually ends there. In my opinion, goals must be SMART and FIRM (Functional, Interest-based, Routinesbased and Meaningful). Occupational therapists may prefer goals to be in SMART FORM, the O representing Occupation-based. From here, 14 steps towards SMART and FIRM (or SMART FORM) goals was created. I’d like to share an example that highlights why including strategy in the goal may be

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The goal has been identified by the person or their support network.

The goal is relevant to the person and their life stage.

There is rationale as to how the goal was chosen (e.g. through interview, assessment etc).

The goal includes context (i.e. routines-based) and includes where and with whom.

The goal is functional (e.g. related to the person’s independence or participation in home or community life). For example, not “John will stand on one leg for three seconds in six months”. Instead, “John will walk up/down the steps from his back door to the garden in six months”.

The goal is an area of interest for the person.

The goal has a meaningful timeframe (e.g. end of NDIS plan, special occasion such as a birthday).

The goal can be graded if required (i.e. if the goal needs to change over

unhelpful to clients. Imagine you formed the goal “Johnny will use a visual schedule to prepare a simple meal within three months”. Including the strategy (i.e. visual schedule) may seem to make the goal more specific, however, it risks missing opportunities to explore alternative strategies. Including strategy limits how you can support your client to achieve the goal (not to mention that the example goal was not to use a visual schedule).

time). For example, “Sally will use a knife and fork to cut a sausage” could be upgraded to “Sally will use a knife and fork to cut steak”. The goal does not include detail on strategy (e.g., how the goal can be achieved: assistive technology, services, intervention).

10. The goal will improve the person or their family’s quality of life.

11. It is clear as to what the goal

being achieved looks like. The goal is clear in stating what achievement of the goal looks like.

12. The goal is documented clearly and easily understood by the person and their support network.

13. There is a direct link with the

goal to the funding available for the client as appropriate. For example, therapy goals link to the NDIS capacity building goals. However not all goals might need funding associated with them.

14. The person has a copy of their goal/s for their records and reference.

Hopefully in reviewing the 14 steps you’ve reflected on your own practice and are now on your journey towards SMART FORM. About the author: Seb Della Maddalena is an occupational therapist and manager at Perth-based disability provider Mosaic. Seb has worked in the Western Australian disability sector for 15 years.

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Hands turn to telehealth Lisa Copland, Occupational Therapist

hange is hard. It is even harder when you need to do it quickly, without the usual planning and evaluation of your practices. This is what we have dealt with during 2020 and now 2021. Shutdowns, physical distancing, and many government restrictions have forced us as occupational therapists to rethink how we provide our care to the most vulnerable. Telehealth feels like it has been thrust upon us providers. You may feel like telehealth has little evidence, that the technology is clunky, the internet drops out, and privacy issues and poor computer literacy of clients make it difficult to provide best clinical outcomes. It is true that some components of our clinical practice are difficult, if not impossible, to provide via telehealth. Splinting, compression bandaging and objective measures such as strength and formal sensory assessment require a faceto-face review. A proportion of patients will continue to desire a traditional clinical model of service (Worboys et al., 2018).

What the research says While the virtual environment has limitations in providing hand therapy care, it improves access for patients in under-serviced areas and can be efficient in terms of reducing costs, travel time, waiting room time, administrative costs, environmental pollution and energy consumption (Szekeres and Valdes, 2020). Studies of burn wounds show that still digital images are a reliable way to assess wounds, to differentiate between different burn depths and to identify oedema, erythema and cellulitis (Wallace, 2004). Literature supports a range of motion assessments

via telemedicine using smartphone technologies, demonstrating excellent agreement with conventional measurements for the shoulder, elbow, wrist and hand (Grandizio, Foster and Klena, 2020). Occupational therapists can guide clients to make observations, palpations, complete muscle tests, and self-apply orthopaedic and neural tension tests. Direct comparison with a physical examination revealed high clinician agreement and correct diagnoses (Worboys et al., 2018). Research suggests greater improvements in grip and pinch strength for patients who completed treatment by a telemonitoring system, compared with those who completed self-directed practice at home (Worboys et al., 2018). Additionally, the impact for clients should be considered. Many clients feel comfortable with telehealth and would prefer to use it if available. Many consider telehealth equal to a traditional model. High levels of consumer satisfaction with telehealth are a consistent finding in the literature (Worboys et al., 2018) It also allows improved access with reduction in travel, costs, child care and time away from school/work (Grandizio, Foster and Klena, 2020). Ultimately, if clients see it as a benefit to them, telehealth may reduce nonattendance and optimise therapy outcomes.

to change your ideas about how you provide your usual therapy. A virtual and face-to-face mix optimises efficiency, improves access to therapy, decreases costs, minimises exposure to virus transmission and optimises hand therapy outcomes (Szekeres and Valdes, 2020). As occupational therapists we began our careers celebrating our creativity and ability to innovate and provide a holistic therapy program for our clients. Allowing clients to achieve their goals and perform their occupational roles is core to occupational therapy. Telehealth has the potential to enhance patient access to intensive management of hand injuries, helping to optimise patient outcomes (Worboys et al., 2018). Telehealth is one of the many ways that we can provide care that is a best fit for our clients. About the author: Lisa Copland is an occupational therapist and certified hand therapist. She has worked across public and private settings and is now working in Queensland Health. Lisa is passionate about clinical outcomes that benefit all consumers, and led the telehealth project during Covid-19.

How to succeed Healthcare costs are growing, with the potential to be unsustainable. Telehealth is an innovative strategy to address this. Implementation will be guided based on ongoing funding for providers and infrastructure at a national and local level. It will also be dependent on your willingness

References can be viewed by scanning the QR code

CONNECTIONS SPRING 2021 33

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A brighter future for refugees Laura Irvine-Brown, Rachelle Coe, Rosemary Signorelli

or decades, occupational therapists have been working with refugees and asylum seekers as they resettle in Australia. This article provides considerations for occupational therapists working with people from refugee-like backgrounds, and highlights the work of occupational therapists in the refugee sector.

What is a refugeelike background? It is pertinent to clarify the difference between refugees and asylum seekers. A refugee is someone who has sought protection, been granted refugee status and has a permanent humanitarian visa allowing them to stay in Australia. A person seeking asylum is someone who is seeking protection but has not yet been granted refugee status and is here on a temporary visa. However, regardless of visa status, refugees and asylum seekers have experiences of fleeing their countries due to fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinion1. This, however, may also be the reality for many immigrants, especially those who have come from countries with political instability, conflict, or where human rights abuses are common. Additionally, we acknowledge that such experiences have intergenerational consequences, impacting children born in the country of settlement. With this in mind, we begin to understand that as occupational therapists working in Australia, a country which is home to many displaced people (Aboriginal and Torres Strait Islander people, immigrants, refugees and asylum seekers), it is highly likely that we will at some stage have the privilege of working with someone from a refugee-like background. 34 otaus.com.au

Experiences of people from refugee-like backgrounds People who have fled their home countries may have had direct or indirect traumatic experiences of physical/sexual abuse, torture, armed conflict, kidnappings, loss of loved ones, or financial and food insecurity. Their journey is often perilous with a focus on survival. While in transit and waiting for refugee status, many experience continued persecution, discrimination and lack of access to essential services and occupations, often living in temporary accommodation or camps with no control of their future. From a bio-psychosocial perspective, we understand that these experiences affect the individual, their family and community. Many people find the transition to Australia challenging with the combination of language and cultural differences and the ongoing impact of trauma2. For example, a student may not be learning well at school due to being triggered by the sound of the bell but may also not understand classroom expectations.

Where do occupational therapists come in? A recent Occupational Therapy Australia Refugee Settlement Interest Group meeting showcased occupational therapists and students working within settlement services, refugee torture and trauma services, refugee health services and multicultural services. Whether a specific occupational therapy role or a generic role, occupational therapists working in the refugee sector use an occupational lens to identify occupational issues, enable occupational engagement and address barriers to participation often caused by occupational injustices.

Occupational therapists may do this by: • Assisting with the process of cultural and occupational transition and the development of life skills; • Enabling access and reducing barriers to participation through advocacy for health, disability or other services; • Supporting bicultural workers as a means to provide flexible and culturally responsive services; • Building capacity in mainstream services (e.g. community sector, education, mental health) through consultation and training to support people with refugee-like backgrounds; • Providing individual and group interventions to counter the effects of trauma and occupational deprivation; • Building capacity of refugee communities through community development strategies and relationships with strategic partners and community leaders.

How might a refugeelike background affect occupational therapy? The significance of a refugee-like background should be considered at all stages of the occupational therapy process. Many people with refugee-like backgrounds have experienced situations where it has been difficult to trust others and their safety has been at risk. Unfortunately, coming to Australia does not mean a person automatically feels safe, particularly those on temporary visas. Therefore, fostering a safe and positive therapeutic relationship is essential. It takes time to build trust and develop the capacity of the client and their family to engage in power sharing. Using

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a qualified interpreter and other language support strategies is vital to this process. During assessment there is the potential to incorrectly label behaviours that may be reactions to trauma. For example, some children may lack eye contact/demonstrate hyperactivity or difficulty paying attention, which could be incorrectly labelled as attention deficit disorder, autism or global developmental delay. Mistrust of many systems or stigma may also mean that people with refugee-like backgrounds may under-report their children’s issues due to concern their children will be taken away. Additionally, symptoms related to mentalhealth presentations need to be considered in relation to cultural understandings and idioms of distress. For example, talk of body-focussed issues may actually be a sign of mental-health distress. This highlights the importance of using interpreters to understand the cultural meanings of words used to describe experiences. In identifying and analysing occupational issues, there may be systemic barriers to occupational engagement that result in changes to people’s roles. For example, the inability to work in a preferred job may be linked to non-recognition of overseas qualifications, limited understanding of job-seeking processes in Australia, or discrimination on behalf of potential employers rather than an absence of skills. The abilities and resilience of people from refugee-like backgrounds in light of such adversity should be championed. During occupational therapy intervention, clients may be compliant with suggestions regardless of whether they meet their needs. Reluctance to disagree with the therapist may be reflective of cultural norms or fear

... fostering a safe and positive therapeutic relationship is essential.

of appearing ungrateful for services, which clients might predict will negatively impact their visa status. Possible trauma responses need to be considered when suggesting the separation of a child from their parent for the purposes of assessment or promotion of occupational engagement. There may be difficulties with money and access to resources, social support and other services. Additionally, ending the therapeutic relationship may be challenging. There may be different views on the role of the health professional, and people may not have had experiences of positive relationships with people in authority or of positive goodbyes.

• Advocate for access to services, particularly for people seeking asylum or on temporary protection visas;

Best practice working with people from a refugee-like background

• Dedicate time to building trust and a positive therapeutic relationship.

Some steps occupational therapists can take when working with people from refugee-like backgrounds: • Become trauma-informed and aware of the biopsychosocial impact of trauma on the person, their family and community;

• Understand the process of cultural transition and its impact on occupational transition; • Always use interpreters, seek training in their use and advocate their use by others; • Consider having translations of resources in other languages and audio recordings to accommodate different levels of literacy; • Be transparent with the information you are gathering and how it will be used;

About the authors: Laura Irvine-Brown, Rachelle Coe, Rosemary Signorelli are convenors of the Occupational Therapy Australia Refugee Settlement Interest Group and have a range of experience working with refugees and asylum seekers.

• Develop cultural humility–start by acknowledging your own culture and worldview, and become curious about different cultures; • Consider the people who access your services and learn more about their home country, community and cultural and religious backgrounds;

References can be viewed by scanning the QR code

CONNECTIONS SPRING 2021 35

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Self-awareness, cognition and function in post-stroke recovery Toni Heinemann, Senior Occupational Therapist

oni Heinemann presented at the 29th National Conference and Exhibition on stroke rehabilitation, and the role of Occupational Therapy in post-stroke recovery.

between two hospitals: Osborne Park Hospital (rehabilitation hospital) and Sir Charles Gardiner Hospital (an acute tertiary hospital in Perth, Western Australia).

Self-awareness is such a crucial part of a stroke survivor’s rehabilitation journey. It is the cornerstone for beginning to understand what has happened to them, and how it impacts their world and occupations. Occupational therapists play a pivotal role in the recovery of many stroke survivors, so this small pilot study was a collaboration

The primary aim was to examine the relationship between self-awareness and functional outcomes for patients in the first three months post stroke. The secondary aim included determining the feasibility of the Patient Competency Rating Scale (PCRS) as a measure of selfawareness in acute and sub-acute care.

36 otaus.com.au

Self-awareness deficits following neurological injury have been well-recognised by clinicians and researchers (1-4). Self-awareness can be defined as a highly integrated brain function, encompassing the ability to perceive oneself in relatively objective terms while maintaining a sense of subjectivity.(1,8) The term “awareness deficits” is utilised to refer to a lack of recognition of changes to an individual’s self and abilities following brain injury.(6) It is believed that awareness of deficits is critical in influencing patient

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Self-awareness deficits following neurological injury have been well-recognised by clinicians and researchers

outcomes related to rehabilitation and long-term functioning post brain injury (2, 5-8). Stroke survivors won’t engage in rehabilitation if they don’t see or believe they have any difficulties, and it doesn’t impact their occupations or safety. There are minimal studies that have explored screening of selfawareness in the acute stages (one week) post stroke as an indicator of functional outcomes. There is also limited data to define the impact of self-awareness on therapy outcomes in acute care and on transition to rehabilitation in patients 65 years of age and older. This prospective observational pilot study recruited 27 stroke survivors and assessed self-awareness, cognition and function at three time points (acute, four weeks and 12 weeks). The assessments undertaken included the PCRS, Montreal Cognitive Assessment (MoCA) and motor component of Functional Independence Measure (mFIM)–the PCRS being a measure of self-awareness, the MoCA a measure of cognition and the mFIM a measure of dependence in daily functioning. Results showed that MoCA and mFIM scores demonstrated statistically significant improvements in function and cognition in the first three months post stroke. The PCRS did not significantly change, however clinical improvements in awareness from one month to three months post stroke were noted. The PCRS also got worse from acute care to one month after stroke. These results recognised that self-awareness can change frequently for stroke survivors in their rehabilitation journey. There was a moderate significant correlation from acute to one month post stroke between the MoCA and PCRS. From this small study we can see impaired cognition is associated with poor self-

awareness which impacted on short-term functional rehabilitation gains. Assessment of self-awareness utilising the PCRS was feasible and provided clinical insights into how patients progressed. Ongoing assessment of self-awareness would be recommended to identify stroke survivors at risk of poor motor and functional gains in hospital rehabilitation, which impacts the time spent in hospital, discharge destination and follow-up support needs. The implications for occupational therapists in stroke rehabilitation and potential directions for further research into the future include recognising: • Impaired self-awareness is a cognitive deficit that requires identification post stroke to support patient rehabilitation outcomes. • The Patient Competency Rating Scale can identify older adults with selfawareness deficits for intervention at multiple intervals throughout the acute to rehabilitation hospital journey. • Poor self-awareness may still be present at three months post stroke but is likely most impaired at one month, a crucial time for engagement in sub-acute rehabilitation. Final thanks to the Charlies Foundation for Research–which supported me as a clinician through a small research grant–and all the stroke survivors and their families for their participation in this research. Dr Kristie Harper, Judith Talbot and Angela Jacques also contributed to the research. About the author Toni Heinemann is a Senior Occupational Therapist who works in stroke rehabilitation at Osborne Park Hospital in Perth. Toni has worked across multiple tertiary and

secondary hospitals as a clinician across Perth and also completed her masters of public health. She is passionate about the crucial role Occupational Therapy plays in many of the hidden symptoms of stroke – (cognition, fatigue, perception) and how to provide evidence based care for stroke survivors returning to their valued important occupations in rehabilitation.

References can be viewed by scanning the QR code

CONNECTIONS SPRING 2021 37

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Are you paying your staff correctly? Anna Pannuzzo, Director WorkPlacePLUS

Compliance for practice owners and healthcare employers

ne of the most common business challenges of running a health practice is keeping up with changes to pay rates and employment legislation. This article highlights recent compliance updates and common human resource pitfalls. Wages have increased Following the Fair Work Commission’s Annual Wage Review, the national minimum wage has increased to $772.60 a week—or $20.33 an hour—effective from the full pay period on or after 1 July, 2021. Minimum award wages have also increased. Allied health services were among the first group of industries to receive a pay increase under modern awards, effective from the first full pay period on or after 1 July, 2021. This includes the Health Professionals and Support Services (HPSS) Award 2020. If your health practice employs an administrator under the Clerks—Private Sector Award 2020 or a cleaner under the Cleaning Services Award 2020, these wages were also increased effective from 1 July, 2021. Please contact WorkPlacePLUS for a copy of the new pay guide. When wages are increased, allowances also need to be increased accordingly. Failing to pay the correct allowances will effectively result in the unlawful underpaying of staff. Contractor or employee? If you are not classifying your staff correctly, you may be underpaying them. An employee works in your business and is part of your business. An independent contractor, on the other hand, effectively runs their own business—which means they operate under their own business name, and are responsible 38 otaus.com.au

As a practice manager or business owner, it is crucial to know your employer obligations. The potential penalties for non-compliance have never been higher. for their own business compliance and commitments such as insurance, PAYG, superannuation, workers compensation, etc. The distinction between contractors and employees is not always clear-cut. Courts look at the relationship, and there is no single indicator to determine if a person is a contractor or an employee, which creates added complexity. If you engage contractors, it is good practice to review the arrangements regularly to ensure compliance. Otherwise you risk a court penalty of up to $12,600 for individuals and $63,000 for corporations per contravention, not to mention other associated costs. Also, the ATO is clamping down on businesses that force workers to be contractors with so-called sham contracts in order to circumvent their legal entitlements. New rights for casual employees On Friday, 26 March, 2021, the Fair Work Act 2009 was amended to change workplace rights and obligations for casual employees. The changes were made by the Fair Work Amendment (Supporting Australia’s Jobs and Economic Recovery) Act 2021 (Amendment Act). Practice owners must now provide new casual employees with a Casual Employment Information Statement when they start work. New casual employees also need to be given the Fair Work Information Statement.

Changes to compulsory super payments The super guarantee refers to the proportion of wages that employers must contribute to their workers' retirement savings. The super guarantee is legislated to increase 0.5 per cent a year before reaching a final 12 per cent by 2025. As part of this plan, the super guarantee rate increased to 10 per cent on 1 July, 2021. Private practice owners should make it a priority to review their obligations regarding compulsory superannuation payments. Changes to unpaid parental leave On 26 November, 2020, the Fair Work Act 2009 was amended to include new unpaid parental leave entitlements for employees who experience traumatic events during or ahead of their unpaid parental leave. This includes stillbirth, premature birth or death of a child. The changes also enable all eligible parents to access up to 30 days of their unpaid parental leave flexibly, complementing similar changes that were made to the Paid Parental Leave scheme in July 2020. Penalties for underpayment As a practice manager or business owner, it is crucial to know your employer obligations. The potential penalties for non-compliance have never been higher. The Fair Work Ombudsman constantly audits businesses and cracks down on employers who breach their employer obligations,

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such as underpaying staff or failing to comply with a compliance notice to back pay staff. Fair Work inspectors not only have a strong audit and education focus—they use their compliance and enforcement powers where required. A reverse onus of proof can also now apply, meaning employers who don’t meet record-keeping or pay-slip obligations without a reasonable excuse will need to disprove allegations of underpayments made in court. On 1 July, 2021, wage theft officially became a crime in Victoria. This applies to employers who intentionally underpay employees or dishonestly withhold or deduct any employment entitlement. Liability also extends to officers (such as directors and management) who engage in such conduct. The crime of wage theft carries significant

penalties for individuals and companies, including up to 10 years’ imprisonment. The information provided in this article is a summary of current workplace compliance considerations, particularly related to paying your staff the correct wages and entitlements. If you have any questions or require more detailed or tailored information, it is advisable to seek professional workplace relations advice, whether this be through the Fair Work Ombudsman or a human resources consultancy that works closely with the allied health sector such as WorkPlacePLUS

About the author Anna Pannuzzo is the Director of WorkPlacePLUS, OTA’s preferred human resources provider. OTA members can receive professional support for addressing complex human resources issues such as restructuring, bullying and harassment claims, industrial audits, employment agreements and more. Learn more at www.workplaceplus. com.au or by calling (03) 9492 0958.

All OTA members receive special OTA member benefits through WorkPlacePLUS for support with human resources and industrial relations issues. Additional resources can be viewed by scanning the QR code

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OTA Connections Spring 2021

Articles inside

Are you paying your staff correctly?

Self-awareness, cognition and function in post-stroke recovery

A brighter future for refugees

Hands turn to telehealth

Mobile work and cyber safety

14 steps to smarter goal-setting

The benefits of supervising overseas-qualified therapists

OTA awards recap

President’s report

Positive change and a growing presence

Vale Colleen Mullavey O’Byrne

Challenges of technology’s brave new world

CEO’s report

Inspired insights from the opening day of the 2021 National Conference

Our journey to understanding is more than our Reconciliation Action Plan