OTA Connections Winter 2021

Print Post Approved PP340742/00147 ISSN 1832-7605

Supporting people to engage in activities they find meaningful

WINTER 2021 | VOL 18 ISSUE 2

From Theory to Practice Animal-Assisted OT: Providing Safe and Ethical Services Putting Co-design into Service Design: The AT Navigation Program Shaping New Graduates’ Experiences: Make Intervention Decisions J O I N US AT T H E N AT I O N A L CO N F E R E N C E 2 3 -2 5 J U N E 2 021

AUSTRALIA’S MAJOR SCIENTIFIC CONFERENCE FOR OCCUPATIONAL THERAPISTS

23-25 JUNE 2021

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VIRTUAL CONFERENCE AND ENGAGEMENT HUBS

#otaus2021 29TH NATIONAL CONFERENCE AND EXHIBITION 2021

REGISTER NOW Join like-minded OT colleagues online or see them face to face at one of our Engagement Hub locations. Watch the live streaming of the program and join in the Welcome Reception drinks on Wednesday 23 June 2021!

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KEYNOTE SPEAKERS

The Hon Michael Kirby AC CMG

Professor Gregory Phillips

Professor Lindy Clemson Sylvia Docker Lecturer

PROGRAM HIGHLIGHTS

Dr Karen Whalley Hammell

Marilyn Pattison

WHY ATTEND?

We are excited to include a range of invited speakers and panel sessions including: • Surviving Covid-19 • International Presidents Panel • Lived Experience Panel • Aboriginal and Torres Strait Islander Peoples Panel

• Gain skills and valuable knowledge from a wealth of experienced OTs sharing their latest research and case studies • Build professional networks with peers, suppliers and industry leaders • Think outside the square and challenge yourself • Review and ignite passion for your career • Earn up to 90 CPD hours • View more sessions than ever before with the ability to watch on-demand after the Conference

FURTHER INFORMATION

P 1300 682 878 | E conference2021@otaus.com.au

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

28 Building Connections

NEWS

CONTRIBUTIONS

Connections welcomes article submissions, email info@otaus.com.au Attention: Connections Editor Themes and guidelines can be found found here: otaus.com.au/blog/connections-2021-themes-shareyour-story DEADLINES FOR SUBMISSIONS

Spring 2021 9 July 2021 Summer 2021 8 October 2021 ADVERTISING

Please contact advertising@otaus.com for advertising enquiries DESIGN

04

President’s Report

05

CEO’s Report

06

A Call to Return to Proven Theory

09

Professor Tammy Hoffmann Receives Medal of the Order of Australia

10

The real-world impact of models and theory

12

WFOT Update

15

How do Communities of Practice in OT Promote Social Learning and Connectivity?

Perry Watson Design 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.

CORRECTION

On page 15 in the Autumn issue, the seventh paragraph should have read: “Wilding et al. (2012) arranged monthly teleconferences to bring together academics and practitioners from across all regions of Australia to discuss occupation-based concepts and theory from one source (Townsend and Polatajko, 2007). The 20 participants had pre-reading to complete before discussion at one of three teleconferences scheduled each month. These teleconferences were moderated by three academics and the transcripts from the last teleconferences were the data presented in the published paper. The contents of the three papers will now be synthesised with a focus on reported social learning and connectivity arising from the practice communities and recommendations about their structure and purpose.”

17

WFOT Update

14

The Role of ADMs in OTA Membership’s Community Development

FEATURES 14

The Role of ADMs in OTA Membership’s Community Development

17 Person-Environment-Occupation: Applying Theory in Practice for a New Grad at Better Rehab 19

Personal Alarms Help Older People Feel Safe and Secure to Remain Living Independently

20

Shaping New Graduates Experience: Learning to Make Intervention Decisions

22

How OTs Can Help Turn a House Into a Home

24

Putting Co-Design into Service Design–the AT Navigation Program

26

Animal-Assisted OT: Providing Safe and Ethical Services

28

Building Connections: Development of a Collaborative Resource Centre

30

Walk for Wellness: A Mental Health OT Initiative to Foster Recovery and Optimise Well-being

32

Theory to Practice in Action: A Research and Program Commitment at Griffith University

35

When to Contact Your Insurance Broker

36

A Model Life: How a Queensland OT Left her Mark on Functional Cognition

38

Modern Care for All

40

Employment Considerations for New OT Graduates

CONNECTIONS WINTER 2021 3

PRESIDENT’S REPORT

President’s Report Associate Professor Carol McKinstry | OTA President

W

ith the year of 2021 rushing by, and now finding ourselves in winter, it is good to stop and reflect on the important theme of ‘From Theory to Practice’. In my day job, I get immense enjoyment from working with students to help them apply what they have learnt in the classroom or lab to the real world of practice. Teaching them the value of using occupational therapy models or frameworks to help make sense of what they are experiencing, observing, or reading often leads to those light-bulb moments when they simply ‘get it’. The same applies for higher-degree research students, who are trying to make sense of their research findings and emerge from the fog of data-analysis to understand the full extent of their research implications.

Theory is often underrated by our profession.

I constantly hear from students returning from placement that occupational therapists working in practice do not use models. Sometimes, even clinicians state this–although, when unpacked, their professional reasoning is informed by at least one model, even for those who may not have been explicitly taught occupational therapy models at university. I believe occupational therapists do use models or frameworks in their practice, but just have trouble naming or articulating them.

When talking with graduates in the early stages of their careers, many will report being relieved when they have landed

upon the model or framework that has assisted them in managing a challenging situation in practice. The transition into practice for students and clinicians is challenging enough, but without models or frameworks to draw upon, it is like being in a rowboat without an oar–lacking direction and feeling out of control.

For those occupational therapists with a few miles on the clock, engaging in CPD activities is another way to keep up to date with useful models or frameworks for practice.

Access to CPD is a major OTA member benefit and enables us to feel confident in the currency of our skills and knowledge, as well as satisfying AHPRA registration requirements. CPD such as our national conference and forums provide formal and informal exchanges with colleagues, students, and experts particularly relating to the latest research evidence. Do not let COVID-19 restrictions prevent your networking at virtual events—be brave and email the presenter your question, or reach out to someone who is doing amazing things in their practice. The national conference also provides researchers with the opportunity to disseminate their research and have the desired impact.

Increasingly, researchers are being assessed not on their research outputs, but on the impact their research has on clinicians, policy makers, and particularly those using occupational therapy services and the health and well-being of our communities.

... without models or frameworks to draw upon, it is like being in a rowboat without an oar–lacking direction and feeling out of control 4 otaus.com.au

As a profession, we have challenges that we can turn into opportunities. We need evidence to support not just our practice, but also our lobbying activities. We need to find creative ways to reach and influence those who are responsible for setting the structures and contexts in which we practise. We celebrate our Research Fellows who have made a substantial contribution to establishing evidence and developing models for our profession. Additional Research Fellows will be inducted at this year’s national conference, and we appreciate what they have contributed to our profession. As an association, we are continuing to look at how we can support and recognise all researchers, both those in professional practice and in academia.

In the February issue of the Australian Occupational Therapy Journal, an editorial

by Professor Reinie Cordier (Cordier, 2021) on the issue of reducing research waste was explored. Reinie raised some very important points about the need for research to be conducted with clients (rather than to, or for), and for the research agenda to be led by those individuals, groups, and communities that will impacted.

More collaboration and involvement by practitioners in the research process could also improve the usefulness and uptake of research evidence, further reducing the gap between theory and practice.

Reference Cordier, R. (2021). The research challenges we face: Identifying and minimising res 1), 1-2.

CEO’S REPORT

CEO’s Report Samantha Hunter | OTA CEO

T

hroughout our lives, our careers constantly develop and change– sometimes in a planned and managed way, other times by opportunity, or often by circumstance beyond our control.

Upon completing our formal education, we embark on putting theory into practice and becoming technical experts in our chosen field. Once the textbooks are closed and we find ourselves in the real world, we quickly realise that Albert Einstein was correct in saying that: “In theory, theory and practice are the same. In practice, they are not.”

“In theory, theory and practice are the same. In practice, they are not.”

Albert Einstein

strategy development and execution, change management, and the never-ending juggle of shifting and competing priorities.

assess the opportunities and challenges facing the profession and membership associations now and into the future.

Like many professions, the health field is guided by the principles of learning through theory, and then experience–and the benefit of knowledge and wisdom transferred through supervision. Supervision ensures theory can be translated into practice–and is necessary to extend your technical expertise, and test your judgement, ideas, and practice in a safe setting.

Technical competency—even excellence— does not necessarily equip you to be a good, or even great, manager or leader. In fact, it can sometimes be a fatal flaw–narrowing the lens too sharply, and not readily translating to the practical and adaptive skills of managing and leading. The most highly functioning, productive, and rewarding teams are those in which there is the correct balance of technical skills and adaptive leadership to effect real change.

While technical expertise and experience are critical to developing your professional reputation and career, theoretical skills learned at university and technical skills honed through years of practice are not all that is required to elevate you to management or leadership. Management and leadership are also underpinned by a range of theories and models that guide best practice, and enable us to grow into roles where technical occupational therapy expertise may not equip us for the management and leadership challenges ahead. This may include managing staff, budgets and the adaptive challenges of

Now in our tenth year as a national association, and after a year of forced technical and adaptive challenges, OTA is on the precipice of our coming of age.

The board and executive have spent considerable time looking ahead, using theoretical models including Dr Ron Heifetz and Marty Linsky’s Adaptive Leadership and the Theory of Change. These and other theories and frameworks will allow us to not only move nimbly and flexibly forward, but also over time assess the impact of our activities and actions on the profession and community at large. By spending time ‘on the balcony’ we have been able to

For the profession to step boldly into the light of the new and emerging opportunities that are presenting themselves, I encourage all members to consider how we can best adapt and thrive in constantly challenging environments— and individually and collectively take on the gradual, meaningful, and sustainable process of change. Change is difficult and often uncomfortable, but ultimately necessary if we are to grow professionally and personally. Releasing the traditions of the past or the comfort of the present can be challenging. At OTA we acknowledge and honour the past, while looking to the future to enhance the importance and influence of the profession. We look forward to continuing to extend and expand our capabilities to meet our highest aspirations for both the profession and association. We will continue to put evidence-based, data-driven decisions into practice, and turn outputs and outcomes into impact as we grow and evolve to meet the changing needs of the profession and communities we serve.

CONNECTIONS WINTER 2021 5

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

A Call to Return to Proven Theory Michael Barrett, OTA National Manager, Government and Stakeholder Relations

T

he transition from theory to practice can at times be rocky for young clinicians, as clients present with particularly complex or—perhaps just as challenging—finely nuanced conditions.

It remains the case, however, that new graduates can always draw on their grasp of theory to help guide them through this transition, allowing them to accumulate experience and grow in confidence.

What is most egregious, however, is when governments throw established theory out the window, and young clinicians to the wolves.

This is precisely what the Federal Government and one of its agencies, the National Disability Insurance Agency (NDIA), propose to do with the introduction of Independent Assessments (IA) for those highly vulnerable Australians seeking access to the National Disability Insurance Scheme (NDIS).

As the IA process is currently envisaged, an allied-health professional will be expected to conduct an assessment using the generalist tools developed, but not drawing on their years of clinical experience or their powers of clinical reasoning—in effect, ticking

boxes. That person will then forward the raw data to an NDIA delegate who may or may not be a clinician (the NDIA does not intend sharing that detail, nor even the percentage of NDIA delegates who are clinicians). The NDIA delegate, who may have no clinical background and has had no particular training, will then decide whether the client is eligible for the scheme, basing their decision on data collected from tools not designed for this use and without knowing or seeing the client.

Is that ideal? Is that in the spirit of a scheme that is supposed to represent world’s best practice in disability support, and which the Productivity Commission estimates will ultimately cost about $22 billion a year?

Many OTA members have questioned the appropriateness of IA of those clients with rare or complex disabilities, and those with psychosocial disability.

Cognitive and psychosocial issues are poorly addressed in the battery of tools being proposed by the NDIA as part of the IA process. This is of considerable concern, given the great difficulty clients with mental-health issues have had accessing the scheme to date.

Significantly, Mental Health Australia, of which OTA is a member association, has expressed concern that the measurement tools proposed are not appropriate for psychosocial assessment.

Consumer groups in the mental-health space have also been advocating on this issue.

They are concerned about the mandatory nature of the proposed assessments, and the fact that highly vulnerable people will be assessed by complete strangers rather than the health professional they have come to know and trust. And, of course, how can the often episodic and fluctuating nature of mental illness be assessed in the context of a one-off engagement, lasting one to four hours, and with as little as 20 minutes of clinical observation?

In summary, the proposed IA model is in fact a screening device, and its suite of tools is unsuited to a functional assessment.

It is of concern that this will be used to determine a person’s eligibility for the NDIS by people unable, or not allowed, to bring their clinical expertise to bear. Now we learn that this incorrectly labelled ‘assessment’ will also inform the participant’s plan and the funding of that plan.

That is clinically unsound. It amounts to a deliberate abandonment of best practice. It makes a mockery of theory.

What is most egregious, however, is when governments throw established theory out the window, and young clinicians to the wolves.

6 otaus.com.au

OTA is further concerned that, contrary to earlier undertakings, existing NDIS participants will be subjected to regular reassessment using the IA. This puts in jeopardy the certainty of funding and the attendant peace of mind that

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 scheme was supposed to offer Australians with permanent disability.

While a number of these issues were elevated to the NDIA during our involvement in a working group developing the training modules for the model, not all of these matters have been addressed, let alone satisfactorily resolved, by the NDIA. Moreover, it appears the NDIA has largely ignored the good work of the working group.

OTA is deeply concerned that the NDIA’s proposed changes to personalised budgets and plan flexibility will disadvantage and disenfranchise participants, particularly as the proposed changes centre on the use of the generic IA toolkit. The toolkit lacks sensitivity, specificity, and, in many cases, relevance to a broad range of people that live with substantial and permanent disabilities.

OTA therefore strongly refutes the claim that the implementation of the IA tool for determining personalised budgets and plans will benefit participants.

Rather, a participant’s plan and budget should be determined by a process that includes a comprehensive functional assessment carried out by an alliedhealth professional working strictly within their scope of practice and bringing their professional expertise and powers of clinical reasoning to bear.

Robust and independent research should be carried out, using consumer codesign methods in line with international standards. OTA believes this is the only way to ensure redesign and policy reform is appropriate, viable, and sustainable. In short, we call for a return to proven theory.

Finally, OTA recommends that no potential participant be excluded from the NDIS on the strength of an IA alone. In all circumstances, an IA should be followed up with a comprehensive and clinically credible functional assessment carried out by an allied-health professional acting strictly within scope of practice. Unsuccessful applicants should have recourse to a genuinely independent appeals process.

As part of our ongoing campaign against NDIS Independent Assessments as currently proposed, OTA members Leanne Healey and Muriel Cummins appeared before the Australian Parliament’s Joint Standing Committee on the NDIS. They are pictured here alongside NDIS architect Professor Bruce Bonyhady, who also gave testimony against IAs.

And there should be financial support for those wishing to appeal an adverse decision arising from an IA, ideally through the Administrative Appeals Tribunal. This will help ensure one’s eligibility for the NDIS is determined by clinical considerations, not one’s socio-economic status.

In numerous forums, OTA has made the point that IAs as currently proposed amount to little more than a one-dimensional checklist, with inexperienced clinicians ticking boxes and being explicitly prevented from bringing their powers of clinical reasoning to bear.

And, with only eight large companies allowed to do the work, the emphasis will likely be on throughput and profit rather than informed observation.

As the Executive Director of the Melbourne Disability Institute and former NDIA Chairman, Professor Bruce Bonyhady AM, recently wrote in a submission to the NDIA: It [the proposed IA Model] is also likely to generate inequity, as those who are better educated or more knowledgeable about the underlying assumptions of the questions will be more successful in detailing their impairments in a particular way ...

… questions which are being piloted, such as “Can you dress yourself independently?”, frequently cannot be answered with a simple “yes” or “no”. Without further information and context, simplistic responses risk misleading or inaccurate scores.

This jeopardises the validity of the entire assessment–and the resource allocation which will follow it. Consequently, the current piloting of IA leads to major questions about whether it will in fact result in improved equity and fairness.

Most tellingly, Professor Bonyhady, who is effectively the architect of the NDIS, likened the use of IAs to determine an NDIS participant’s plan to “robo-planning”.

And I doubt if any OTA members, when studying best-practice occupational therapy at university, encountered the concept of robo-planning.

LEARN MORE

To read an analysis of the NDIA’s proposed approach to Independent Assessments from the Melbourne Disability Institute, visit: https://bit.ly/3lLyO7J

CONNECTIONS WINTER 2021 7

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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

Professor Tammy Hoffmann Receives Medal of the Order of Australia A

s part of the 2021 Australia Day honours, Professor Tammy Hoffmann was awarded the Medal of the Order of Australia for her services to clinical epidemiology and occupational therapy. Tammy is a long-standing OTA member, a Fellow of the Occupational Therapy Australia Research Academy, and a Fellow of the Australian Academy of Health and Medical Sciences. She has a long-standing commitment to facilitating evidence-based health care, initially in occupational therapy and now across all fields of health and medicine.

Working as Professor of Clinical Epidemiology and NHMRC Senior Research Fellow at the Institute of Evidence-Based Healthcare, Bond University, Tammy noted: “I was very surprised to receive notification from the Governor-General’s office. I’m absolutely honoured.”

“A lot of my work is filtering through research to find the best-quality research evidence and then making it understandable and useable for health professionals and patients.

Equipping health professionals, policy makers, patients, and the public with the skills and tools to sort fact from fiction and make evidence-informed health decisions is critical.”

OTA extends its warmest congratulations to Tammy on this recognition of her contributions to our profession.

LEARN MORE

Members can read Tammy’s interview with Bond Buzz here: bond.edu. au/news/67156/oam-professortammy-hoffmann-patient-s-friend

“I was very surprised to receive notification from the Governor-General’s office. I’m absolutely honoured.”

CONNECTIONS WINTER 2021 9

A O TJ

The real-world impact of models and theory Associate Professor Stephen Isbel, Editorial Board Member, Australian Occupational Therapy Journal

“Without theory, practitioners are akin to technicians. Without practice, theory has no grounding in the world. Combining the two is crucial to occupational therapy.”

(Turpin and Garcia, 2021, p.213) In this short piece, two examples are highlighted showing how theory is being successfully used to guide occupational therapy practice. In the first example Dr Robert Pereira is interviewed and describes the CORE approach (Pereira et al., 2020) and how he uses it to guide his everyday practice. Dr Pereira is an occupational therapist who works in a public mental health service part time and his own private practice part time. In the second example Katie Cole is interviewed and explains The Intentional Relationship (Taylor, 2020) in occupational therapy. Katie has successfully embedded key aspects of The Intentional Relationship with occupational therapists in a large public health service.

10 otaus.com.au

1. The CORE approach: Dr Robert Pereira Stephen: “What is the CORE approach?”

Robert: “The CORE approach is basically a way of doing your practice through an inclusive lens. It uses the ideas of Capabilities, Opportunities, Resources and Environment to help people engage in life and ultimately be included in society in meaningful and productive ways. It is a way of practising that is inclusive of including peoples’ goals and aspirations and importantly of their values.”

Stephen: “What are some of the key ideas that underpin the CORE approach?”

Robert: “The capabilities approach underpins some of the key assumptions of the CORE approach. The capabilities approach assumes that allows people the opportunity to engage in life by looking at their capabilities is a powerful way of creating meaningful change.

Combine that with looking at how

environments can influence behaviour gives us a really nice way of organising our occupational therapy practice.”

Stephen: “How do you use the CORE approach in your everyday practice?”

Robert: “The CORE approach is a way of doing practice that is all about authenticity, all about enabling people to achieve authentic occupational outcomes and I use it all the time in the mental health setting I work in.”

Stephen: “Can you give me an example of how you use the CORE approach?”

Robert: “I had a client with a mental health condition and other co-morbidities during the first COVID lockdown. He really wanted to be able to engage socially with his family and friends and continue the pre-vocational work I had been doing with him prior to the lockdown. The CORE approach helped me identify the key capabilities he brought to the table, and to frame some of the opportunities I saw he could engage in based upon those capabilities. Then we used some of the resources we had available in the form of an NDIS plan to purchase some assistive technology that allowed

A O TJ

him to be able to address his goals and aspirations. For him it was ultimately about social inclusion despite COVID and I did see that he was able maintain that important social inclusion aspect of his life and that was framed by the CORE approach.”

2. Katie Cole: The Intentional Relationship

“Without theory, practitioners are akin to technicians. Without practice, theory has no grounding in the world. Combining the two is crucial to occupational therapy.”

(Turpin and Garcia, 2021, p.213)

Stephen: “What is The Intentional Relationship and how is it relevant to your occupational therapy service?”

Katie: “The Intentional Relationship is a way to describe the components that make up a strong therapeutic relationship. It really gives you some discrete areas you can consider around yourself as a therapist, that you need to consider for your client and those activities or events that will happen in therapy and how you could respond to those. It gives you specific areas you intentionally consider and analyse in those three areas with the aim of strengthening that therapeutic relationship.”

Stephen: “How did you go about implementing The Intentional Relationship in practice?”

Katie: “Following a skills audit we identified there was a need in this area [developing therapeutic relationships with clients]. We saw there was no formal training so we developed our own workshops to deliver the training. The training focusses on the three main areas of consideration which is the client, the therapist and the interpersonal events that shape a therapeutic relationship.”

Stephen: “How did you know that the content was relevant and therapists translated that into practice?”

Katie: “We invested in the workshop to make sure it was relevant to the therapists. We made sure staff knew the common language around the model and we specifically asked about the barriers and enablers to implementing the practices described in

The Intentional Relationship and we have modified the workshops as a result. We have also set up a community of practice so that the skills, knowledge and momentum we have created are continued. We have had about half of all of our clinical staff attend the training which I think shows the value that clinicians place on the training.”

Stephen: “Was there anything that surprised you about implementing this in practice?”

Katie: “I think it was interesting that many therapists said they instinctively did a lot of the practices we covered in the workshops but they didn’t have a ‘model’ in their minds as they did this. I think using The Intentional Relationship was a way of improving their practice but also validating what they were doing already.”

These examples give an insight into how two occupational therapists are applying theory in a practical way to improve their

own practice, their colleagues’ practice and ultimately improve the care given to their clients. All occupational therapists are invited to reflect on the role theory can play on their everyday practice.

References Pereira, R., Whiteford, G., Hyett, N., Weekes, G., Di Tommaso, A., & Naismith, J. (2020). Capabilities, Opportunities, Resources and Environments (CORE): Using the CORE approach for inclusive, occupation-centred practice. Australian Occupational Therapy Journal, 67: 162– 171. https://doi.org/10.1111/1440-1630.12642 Taylor, R.R. (2020). The Intentional Relationship: Occupational Therapy and Use of Self. F.A. Davis Company.

Turpin, M., & Garcia, J. (2021). Occupational therapy models of practice. In Brown, T., Bourke-Taylor, H., Isbel, S., & Cordier, R. (Eds), Occupational therapy in Australia: Professional and practice issues (pp. 213-235). Routledge.

CONNECTIONS WINTER 2021 11

WFOT REPORT

WFOT Update Dr Emma George, WFOT 1st Alternative Delegate

Welcoming New WFOT Leadership The WFOT 34th Council Meeting was held online in January. Adam Lo represented OTA and voted on its behalf to elect new officers to executive positions. We congratulate the following members elected:

WFOT Resources A recent WFOT publication on Economic Evaluations reported on the impact of occupational therapy in relation to the cost of providing a service. A Quality Evaluation Strategy Tool (QUEST) is presented as a guide for evaluation and details appropriateness, sustainability, accessibility, efficiency, effectiveness, person-centredness, and safety.

Access the report through the WFOT resources page: https://www.wfot.org/resources/ economic-evaluations-a-resource-for-occupational-therapy

• Samantha Shann (United Kingdom)–President • Tracey Partridge-Tricker (New Zealand)–Vice President Finance • Andrew Freeman (Canada)– Programme Coordinator Practice Development Thank you to Marilyn Pattison who most recently served as president following an incredible era with WFOT beginning in 1992. During this time, WFOT has grown from 43 members to 105, more than 1000 approved occupational therapy programs worldwide, and more than 100,000 students. You can read Marilyn’s farewell message online: https://wfot.org/ news/2021/presidents-farewell-message

WFOT International Congress and Exhibition 2022 The next WFOT Congress is scheduled for Sunday to Wednesday, 27-30 March 2022 in Paris, France. The congress will be a hybrid event, so you can attend in-person or online.

The theme is ‘Occupational R-Evolution’.

Registration will open in August 2021.

12 otaus.com.au

WFOT REPORT

Anti-Racism in Occupational Therapy The WFOT (2020) condemns systemic racism as an abuse of human rights. Occupational therapists globally are calling for action on racism through social media, professional associations, and in education and research.

As I aim to improve my own competency in this area, and to share these experiences with members of OTA, I have sought opportunities to challenge my own thinking about racism and move towards being actively anti-racist. The author of New York Times bestseller How to Be an Antiracist, Ibram X. Kendi, wrote: “Antiracism is a powerful collection of antiracist policies that lead to racial equity and are substantiated by antiracist ideas” (Kendi 2019, p.20).

To learn more from an occupational perspective, I attended a training on ‘AntiRacism in OT: Uprooting White Supremacy and Steps for Combatting Racism in Your Practice’. This online workshop was hosted

by POTAC (Psychiatric Occupational Therapy Action Coalition), an organisation based in the US with a mission to support the practice of psychiatric occupational therapy through education, information, and advocacy for consumers, health-care providers and the community (POTAC, n.d.).

Driven by a motivation to be personally challenged, and burdened with a sense of professional responsibility to bring this content to the Australian conversation, I woke up at 3am and logged on to Zoom for the session. I was joined by 60 occupational therapists from different corners of the world. A team of occupational therapists facilitated discussion and created safe spaces to unpack issues of white privilege, race as a social construct, implicit bias, microaggressions, white fragility, and being an ally. Historically, within countries like Australia, our profession has not been known for diversity, and most occupational

therapists are white. Therefore, those in positions of power and service provision do not always represent the clients and communities they serve. In the workshop, we discussed that while there were many ways to unite people within society, we acknowledged that occupations were diverse, knowledge systems were diverse, and communication styles were diverse. In order to demonstrate and commit to anti-racism, the workshop participants collated intentions for action (word cloud shared with permission).

write for Connections. I bring anti-racism to our magazine with the hope that it will spark conversations and action. We have been called to address systemic racism by the WFOT, and this is one of the reasons I strive to be an occupational therapist who is actively anti-racist. Please join me.

LEARN MORE

OTA offers online courses in Aboriginal and Torres Strait Islander Cultural Competence and Trauma Informed Capability through our CPD Library. Visit: otaus.com.au/cpd

I noted the importance of listening, reflecting, thinking critically, being open to vulnerability, and developing action plans. Kendi (2019) argued that “being anti-racist requires persistent self-awareness, constant self-criticism, and regular self-examination” (p.23).

References Kendi, I. X. (2019). How To Be An Antiracist. The Bodley Head.

As the first alternate delegate to the WFOT for OTA, this is one of many articles I will

World Federation of Occupational Therapists. (2020).

Position Statement on Systemic Racism. https://www. wfot.org/resources/wfot-statement-on-systemic-racism

The Psychiatric Occupational Therapy Action Coalition (POTAC). (n.d.). Mission Statement. https://www.potac. org/about

CONNECTIONS WINTER 2021 13

F E AT U R E

The Role of ADMs in OTA Membership’s Community Development Miriam Hobson, OTA Manager SA/NT

A

key part of the OTA membership community calendar is the hosting of Annual Divisional Meetings (ADMs).

The meetings hold a valuable space for drawing focus on the community development element of the association’s purpose, pursuits, and direction in leading the profession of occupational therapy in Australia. The sustainability of an association such as OTA is founded upon the belief of members that “while there may be many channels and tools that provide information and data about a field, the warrant for this ‘professional expertise’ is not provided by technology (e.g.

Google); rather it stems from the professional community–the professional association (Sanders 2016, McKinley Advisors (2016)”.

Member hosting, presentation, and feedback garnered through ADMs is instrumental in the pursuit of our shared “relatively permanent affiliation, an identity, personal commitment, specific interests and general loyalties (Freidson and Lorber, 1972; Larson, 1977; Abbott, 2014)”. Given their pivotal role, let’s take a minute to look behind the scenes at how ADMs are structured to ensure they offer opportunities for occupational therapists to contribute to our community engagement.

The objectives of hosting ADMs include several short-term targets as well as longer-term implications. Specifically, the localised nature of holding ADMs in each of the states and territories provides: 14 otaus.com.au

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The contribution of members to the running of ADMs goes well beyond presentations by Divisional Council Chairs and selected presentations on topics of current practice.

• The opportunity for members to meet each of the divisional councillors who self-nominate to act as advisors for OTA and facilitate connections with the industry. These members represent the breadth of specialty areas of knowledge, particular pieces of advocacy, or localised areas of practice.

• A platform to individually thank members for their voluntary contribution of time, knowledge, and voice in supporting the aims of the association • An experience of direct engagement with OTA leadership–in 2021 this included time connecting with CEO Samantha Hunter and OTA President Carol McKinstry • An occasion to reflect on individual membership journeys–their value and progression of achievement within the professional community • A showcase of the valuable work of members relevant to their legislative jurisdiction

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• Insights from member feedback on areas of attention and focus for the association moving forward NSW Divisional Chair Jess Francis commented on the value of ADMs: “It brings members together to understand what the association is doing, and gives members a chance to provide feedback and network.”

One of the deliberate parallels between the principle of member empowerment in community development models and the structure of OTA ADMs is a format that allows for each of the Divisional Council Chairs to informally report on the activities and intents of their advisory role. Further it is part of a longstanding tradition of self-help and membership capability support that enables the lean staffing structure of the association to achieve substantive and widespread representation of the profession. This aligns with the role of “professions (to) constitute regulations of actions that are relatively long-lasting and make rules of behaviour binding on the basis of values

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CONNECTIONS WINTER 2021 15

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The Role of ADMs in OTA Membership’s Community Development Continued from previous page

and norms, and sanctions. They are seen as forming the habitus of particular groups and as symbolically expressing a certain order (Rehberg, 2006)”.

Community engagement through ADMs being online mutually benefits the broader membership by: • Giving wide access and equity of opportunity for inclusion in open discussions on a range of topics–including changes in the scope of current practice • Providing an informal chance to give feedback to the association on the progression of the profession and any issues of concern • Providing an opportunity to network with peer members in a constructive and strengths-focused environment distinct from their employment context.

“These sessions are invaluable elements of the association functionality in both reflecting on lessons learnt as well as shaping future planning.”

SA Divisional Chair, Elizabeth McHugh sessions being held online (since mid2020) has further extended our inclusive approach to active membership–with a direct link to the increase in the breadth of practice areas represented on the Divisional Councils since this change. With Zoom discussions on collective action, advocacy preparations, and networking a now familiar OTA engagement opportunity, our support for timely participation is increasing.

Core to the expression of community development for the OTA membership is the application of the governance framework built on the objectives of the association, and including the constitution and by-laws along with strategic and operation plans.

These are designed to work together to ensure the association remains true to its purpose and does not lose sight of its mission to operate as the peak professional body. In order to achieve this, ADMs help to focus members’ attention beyond receipt of individual services to our collective purpose: “The concept of the professional association is fundamentally based on the idea of collaboration, working together collectively to create valuable outcomes (Dawson, 2016).”

The contribution of members to the running of ADMs goes well beyond presentations

by Divisional Council Chairs and selected presentations on topics of current practice.

Members witness the ‘test of value’ of OTA divisions, and can provide trusted, expert, current, influential feedback on their assessment of the relevance of the association, reflective of aggregate perspectives. We understand our influence comes from professional representation of the expertise offered by members’ information, knowledge, skills, and experiences. We are pleased to have received positive and constructive feedback from members who feel the ADMs were worth their involvement, and that members can still rely on informal and formal association alliances to achieve full community participation.

Evolving our operations approach to ADMs so all members can engage with the Divisional Councils at the same time via online portals further aligns our practice with the community development principles of participation, access and equity. Moving forward, Divisional Councils’ quarterly

Recent SA Divisional Chair Elizabeth McHugh reflected on her time leading the advisory group of members from students to seasoned practice leaders: “The OTA 2021 SA ADM provided an opportunity to thank the dedicated time, expertise, and insights of the Divisional Council members.

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Without their generous commitment to the profession and volunteering for the association, the Divisional Council is unable to carry out our function of keeping communications channels across the profession open and speaking up when the membership has been impacted by changes in industry and/or policy. These sessions are invaluable elements of the association functionality in both reflecting on lessons learnt as well as shaping future planning.”

Importantly, we also received acknowledgement from employers of occupational therapists who are aware of, and attracted to, the value base of OTA following the hosting of the 2021 ADMs. We welcome the breadth of input from members and their colleagues moving forward. Continuing to empower and support members to take on representation roles in line with community development principles will certainly aid the sustainability of the association and further build capability to generate community benefits.

References can be viewed by scanning the QR code

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Person-Environment-Occupation: Applying Theory in Practice for a New Grad at Better Rehab

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ccupational therapists undergo several years of formal training to learn theories that they can then apply in practice. Theories rely on assumptions and often imagine an ideal world, but once we begin practicing, we may realise that some of our guiding principles can be challenged by real-life experiences.

Occupational therapists live with this tension, and figuring out which guiding principles would be most helpful to the people we are assisting in their daily lives is a lifelong endeavour. Still, there is incredible insight that we can get from new occupational therapists who navigate the gap between theory and practice at the beginning of their careers.

We speak with an occupational therapist, Romy Labuschewski. Romy completed a Bachelor of Occupational Therapy (Honours) at the University of Queensland, St Lucia in 2020. During her studies at University, she also undertook a TAFE course and completed a Certificate III in Individual Support Disability. She currently works as an Occupational Therapist at Better Rehab.

In this interview, Romy, who is currently focusing on helping participants with meal preparation, talks about the PersonEnvironment-Occupation (PEO) model that she has found helpful in her clinical practice. However, she also acknowledges that each individual is unique and that no single theory or model can be applied to offer support to all participants.

What occupation are you focusing on at the moment with your participants?

An occupation that I am focusing on with

most of my participants is engagement in meal preparation tasks such as chopping, peeling, and grating. Meal preparation is a meaningful and purposeful activity that allows individuals to make choices and control around their lifestyle. Meal preparation is also an important way for people to increase social participation with their family or friends. Ultimately, meal preparation is a holistic occupation that promotes healthy physical and emotional health for everyone.

What were the prevailing theories or guiding principles around occupational therapy and travel training?

One of the most fundamental theories that I have utilised in my intervention planning for increasing participation in meal preparation has included using the PersonEnvironment-Occupation (PEO) model.

Using the PEO model has allowed me to understand how the participant’s occupational performance is either hindered or facilitated through interactions between them, their environment and the occupation – meal preparation, in this instance. The PEO is a great model to utilise when trying to understand how a person completes their meal preparation tasks and what supports they may need help with. The PEO has helped me to be able to understand the person’s spiritual, cognitive and physiological aspects around this meaningful and purposeful occupation.

The Person aspect of the model is important at looking at the intrinsic factors of the occupation and what motivates them; it helps to understand that everyone is unique, with their own unique set of identities and abilities.

Romy Labuschewski

Furthermore, it is important to also consider the physical and social environment of the participant’s home. It is determining whether they have access to appliances or if their goal is to want to be able to contribute to the household and make meals for their family.

Finally, the Occupation aspect of the PEO model helps the clinician to understand the participant’s routine and frequency of the task.

If there is a good fit between these three constructs, meaningful participation increases, whereas a poor fit can threaten their engagement or performance in this occupation. The PEO has helped me as a new graduate clinician to be able to take a more client-centred and holistic approach to support my participants in reaching their occupational performance goals.

How were these theories or principles able to guide you in your real-world practice?

Since I graduated at the end of 2020, the PEO model has supported and guided me CONNECTIONS WINTER 2021 17

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through my real-world practice in my first full time job as an occupational therapist. At University, we applied the PEO model more theoretically using case studies. This was an important skill to learn as this has been able to support me in being able to apply this theory into practice with my participations.

For example, I have been able to understand my participants and their role in meal preparation tasks by being able to pull apart the PEO and identify factors that either facilitate or are a barrier to their occupational performance. Utilising this model has made it easier for me to identify these factors during initial appointments as well as discussing their meal preparation goals and how I can provide appropriate OT interventions.

Did you experience any surprises/ conflict between theory and practice when you started working with our participants?

A surprise that I encountered when trying to apply theory into practice when working with my participants is that it is important to identify that each participant is unique and will respond better to different theories or models. There is an endless amount of OT process models such as the PEO, CMOP-E (Canadian Model of Occupational Performance & Engagement), MOHO (Model of Human Occupation) and the list goes on.

It has been a learning experience in trying to firstly identify which model is appropriate to use in different cases, and whether they will prove beneficial to meet the participants

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needs. I have been consistently building upon my clinical knowledge and reasoning to be able to appropriately choose theories and be able to apply these in my practice.

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One of the most difficult things about ageing is it often leads to challenges completing normal everyday activities. It can be incredibly frustrating to realise we need help with everyday tasks. Older people may avoid asking for such help out of embarrassment or even fear of losing their independence.

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CONNECTIONS WINTER 2021 19

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Shaping New Graduates Experience: Learning to Make Intervention Decisions Elizabeth Moir, PhD candidate, The University of Queensland Jodie Copley, Associate Professor, Occupational Therapy, The University of Queensland Merrill Turpin, Senior Lecturer, Occupational Therapy, The University of Queensland I think this is what I want to do…

I’m not sure if this is what I want to do… I’ll check before I do it… (S1 NG11) … as a new grad, you do get frustrated, because it doesn’t come easy… it takes time to make decisions. (S2 Sen. 3)

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hese phrases were used by a recent new graduate and experienced occupational therapists working in paediatric practice when describing their experiences of learning to make intervention decisions. It has long been identified that the transition from student to occupational therapy practitioner is stressful1-3, with decision-making identified as one aspect of practice that is challenging for new graduates4-6. Numerous decisions are made daily in occupational therapy practice–when planning for assessment and intervention, but also during and after service provision. Decision-making within paediatric occupational therapy practice may be particularly challenging for new graduates due to the need to simultaneously engage children with varying abilities while also meeting the needs of the whole family.

Previous research has focused on support for new graduates during the transition to practice generally, with little addressing new graduate decision-making. It has also focused on workplace support, rather than new graduates’ personal resources and support

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from the professional community. To better understand new graduates’ experiences of learning to make intervention decisions when working with children and families, we undertook a research project using case study methodology7. This enabled us to explore new graduates’ experiences within three diverse paediatric service delivery models– private practice, an acute hospital, and nongovernment organisations (NGOs). We sought the perspectives of current new graduates, as well as experienced occupational therapists who had navigated the new graduate years and supported new graduates, who were able to reflect on their experiences.

Findings: Support and Resources Participants identified a range of common supports and resources that influenced and informed new graduates’ intervention decisions. These included: • Support from others: formal supervision sessions and informal discussions with colleagues and individuals within new graduates’ personal networks (i.e. university staff and peers, own family) enabled new graduates to ask questions, check their plans and clinical reasoning, gather ideas, and receive validation and reassurance. Opportunities for work shadowing and joint sessions provided a baseline for new graduates to follow, and confirmed their current practice.

• Physical resources: these ranged from on-site written materials to university notes and online resources • Knowledge and experience: knowledge and experience gained while at university from coursework and student placements gave new graduates something to fall back on. Knowledge and experience gained within the workplace enabled them to draw on their early workplace clinical experiences and translate intervention ideas between clients.

• Feedback and reflective practice: reflective practice enabled new graduates to reflect on the decisions they made and determine whether they needed to change their approach in the future. Seeking feedback from colleagues, clients, and families was often used to affirm their decisions.

Seeing progress in their clients also helped new graduates to know they were making the right decisions.

Initially new graduates relied more on their colleagues to help them know what to do, but as they gained practice experience they felt more confident to make their own decisions and mostly only sought support for unfamiliar or complex cases. They also began to make faster decisions by drawing on previous experiences within the workplace.

However, despite a range of supports and resources being identified as useful, not

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all new graduates were able to access or use all support mechanisms that were available, describing variable experiences.

Findings: Differences Between Settings

A range of contextual factors impacted new graduates’ ability to access and use available supports and resources, and influenced their overall experiences of learning to make decisions. For example: • Access to support: new graduates working in private practices solely providing paediatric services appeared to have greater access to on-site support and resources compared to those working in practices that serviced both children and adults. Those with less on-site support were sometimes offered external supervision or went without.

Many new graduates in private practices appeared able to draw links between the work they were undertaking and everyday experiences in the wider community, such as ways of managing children’s behaviour. This enabled them to draw on a variety of supports, resources, and experiences external to the workplace, and outside the profession, when making intervention decisions.

• Being seen as capable and competent: some new graduates within private practices described wanting to be seen as capable by families, key stakeholders and their employers, and providing a financially worthwhile service. This sometimes led to seeking information from university peers and their own family members and friends when making decisions, rather than ‘bothering’ or appearing incompetent to those with whom they were working. It also appeared to result in a high level of collaboration with families and teachers, a strong focus on engaging children in therapy sessions, and a reluctance to ‘experiment’ with strategies early on in practice.

• Time and perceived clinical risk: within the acute hospital setting, the immediacy with which new graduates

needed to respond to some referrals made it challenging to access colleagues and resources to support their decisionmaking in the time frame available.

Many new graduates also perceived a level of clinical risk within the work they were undertaking, prompting them to seek support from others when making decisions and a reluctance to learn through ‘trial and error’. The amount of on-site supports and resources reportedly reduced the need for new graduates to seek external support.

• Changes in funding: many NGOs are experiencing an increased focus on billable hours following the introduction of the National Disability Insurance Scheme. As a result, new graduates perceived themselves and their colleagues as ‘time poor’ which impacted their ability to seek support from others and the depth of discussions. The increased demands on occupational therapists associated with the funding changes also impacted new graduates’ ability to engage in reflective practice in the moment.

Findings: Other Influences Participants described a range of personal factors that shaped their experiences of learning to make intervention decisions. For example, supports and learning opportunities that aligned with new graduates’ preferred learning styles, such as learning through observation, were seen as advantageous.

Additionally, new graduates often described having high expectations of themselves when commencing practice, which did not appear to impact their willingness to seek support, but rather impacted how they felt when seeking support or prompted them to speak to individuals with whom they felt a level of comfort. Some new graduates attended professional development events hosted by OTA, but many did not mention drawing upon wider professional bodies to support and inform their decisions.

graduates in learning to make intervention decisions, personal and environmental factors significantly impact new graduates’ experiences. Therefore, it may be helpful for universities, workplaces, graduates, and the wider profession to further consider: • Does occupational therapy education need to focus more on occupational therapy students’ personal resources and resilience to prepare them for practice? Or are workplaces responsible for personal skills training?

• Are current workplace support mechanisms sufficient for supporting new graduate decision-making? Or are additional structures and tools required to support new graduate decisionmaking and clinical reasoning?

• Do workplaces facing time constraints and/or an increased demand for services need to reduce new graduates’ responsibilities (including billable hours) while they are gaining confidence in their decision-making?

• How can new graduates’ awareness of the supports and personal resources they bring with them into practice be further supported?

• Do professional bodies need to target their supports and resources more explicitly to new graduates’ reasoning and decision-making?

About the Authors Elizabeth Moir is approaching the end of her PhD candidature at The University of Queensland. Her research is supported by an Australian Government Research Training Program (RTP) Scholarship, and has been conducted under the supervision of Associate Professor Jodie Copley and Dr Merrill Turpin. Contact: e.moir@uq.net.au

Implications While a range of supports and resources have been identified as useful for new

References can be viewed by scanning the QR code

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How OTs Can Help Turn a House Into a Home Eve Vickerson, Myositis Association Australia Liz Ainsworth, Occupational Therapist and Access Consultant, Home Design for Living

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house is a physical structure, whereas a home is all about living. A home offers comfort, meaning, safety, and a feeling that you belong. It is a springboard for life.

Occupational therapists with specialist environmental modification knowledge and skills can help older people and people with disabilities turn their houses into homes.

As well as maintaining or improving people’s essential physical health, safety, and independence requirements, home modifications can result in a range of outcomes that are often much broader than what may have been expected at the outset.

The following are two case studies on home modifications proposed by an occupational therapist. In each case, the home modifications have aimed to contribute towards greater personal autonomy and control for both people involved.

The case studies include two people living with myositis and are being showcased to coincide with Myositis Awareness Month in May. Myositis is a group of rare muscle diseases involving inflammation within the muscle tissues. Over time, it can cause significant muscle loss with a comparable decline in strength, dexterity, and mobility.

People with this condition may acquire mobility and other equipment and rely on the help of carers and paid support workers over time.

Because most homes are not designed to cater for people’s changing needs, environmental barriers tend to emerge, requiring a home modification and equipment response.

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Case Study One: Changing Needs Over Time Background Jim is a retired veterinary surgeon who lives with Inclusion Body Myositis (IBM), a form of the disease that currently has no effective treatment.

Initially, Jim modified his house by installing a ramp and handrails. At this stage he was walking with the assistance of a walker. As the disease progressed, he encountered a change in his physical and functional status and acquired different types of equipment.

A particular issue of concern was the lack of access provided by the bathroom.

Home Modification Features A significant component of Jim’s home modifications was improvements to the bathroom. The environment created ‘excess disability’ to the extent that he was abandoning tasks and being at risk of having accidents and injuries.

Important design considerations were: • To provide a level access shower • To maintain cost-effectiveness by keeping as many areas in their current location to prevent changing the plumbing • Jim’s handedness for access and use of each item in the room (e.g. grabrail, cupboard with door and drawers, power points, etc.)

• To comply with the waterproofing requirements of the Building Code of Australia that applied at that time.

As a result of the need to have a level access shower and the requirements of Queensland state legislation and the National Construction Code (Building Code 2019), the whole bathroom needed to be altered to include: • Adequate space leading up to, and around, each area for Jim (and his carer) • Asbestos removal • Level access for walking and wheeling using mobility equipment without the need to negotiate a small step at the doorway • ‘Slip resistive when wet’ flooring for wheeling and walking–for Jim, his carer, and for family using the area • A slimline sink, microtrap, and lever handle on single-lever mixer tap for ease of use in standing and then sitting. A shallow sink prevents reaching low into a deep sink, a microtrap ensures the pipework does not scrape on the knees, and a lever handle ensures ease of reach and a sink height that suits all users.

• A wall-hung cupboard beside the sink to prevent any water damage to the base and to provide turning circle space under the cupboard suitable for feet on footplates • Drawers below the bench for easy storage access. The drawers featured easy-glide runners with stops and D-shaped handles to allow good grasp given Jim’s hand size and function.

• Level access shower with a continuous shower track and safety glass to contain the water • A handheld shower and lever tap

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moving from sitting to standing, and setting the toilet out to accommodate a mobile shower chair in the future • Installing grabrails that are towel rails to provide support in standing during selfcare routine and for carers to use to rest

• Towel rails that were designed as grabrails so they can take weight or enable the carer to lean on them when they need to rest during the routine • A fan/light/heater for steam evacuation, lighting the room, and warming the area in the cooler months for comfort.

Jim also had a bidet installed with a custom height raiser that he helped design and made himself at the local Men’s Shed. Working with a specialised artisan, Jim made melamine slices that could be placed under the bidet to raise it to the desired height. The bidet will have to be changed to an alternative toilet at a later date to suit mobile shower commode access.

Case Study Two: Future-Proofing Background Gordon is a musician and keen veggie grower who lives with Inclusion Body Myositis (IBM).

He is walking but also relying more on wheeled equipment in his home. Gordon’s priority is to future-proof his home to ensure maximum liveability as his health needs change over time.

He has made a range of modifications to provide access into the home, such as platforms and ramps, but now needs to change areas within the home to cater for a powerchair, other mobility equipment, and care support. A range of areas within and outside the home are becoming harder for him to access and use.

Home Modification Features Gordon’s occupational therapist has performed an assessment, and recommended the following modifications and equipment to address some of the environmental barriers within and outside the home: BATHROOM • Fitting a low toilet with the Aerolet toilet lifter and bidet seat to assist with toileting,

• Installing grabrails in the shower for standing routine and to lean on when seated • Cutting back the glass in the shower for future mobile shower commode use • Etching on the floor to provide greater grip when wet.

BEDROOM • Removing carpet that has a ‘pull effect’ on equipment and replacing it with tiles that will also be longer-lasting, harder wearing, and easier to wheel on • Reinforcing the ceiling for future ceiling track hoist for bed mobility and transfers.

ENTRIES • Installing threshold ramps and step ramps to address changes in level for walking and wheeling with mobility equipment.

ELECTRICAL • Introducing environmental controls to operate in the bedroom (and other areas of the home) for lights, blinds, air conditioning, and security.

EXTERNAL ACCESS • Raising low garden beds for easier access when standing or seated • Replacing turfed areas with concrete to provide flexible and increased access around the home in all weather conditions.

This helps with socialisation, care of pets, accessing the power box and other electrical items, and gardening.

• Providing a cover over a door entry for safety in all weather conditions.

APPLIANCES The following appliances are recommended to ensure Gordon does not fall when reaching in standing, to accommodate a sitting position, and to use his hands that are deteriorating in grip function: • Remote control for the range hood so he can operate it from different parts of the kitchen

• A drawer-style dishwasher with D-shaped handles • Refrigerator freezer with a water dispenser on the door, fridge at the top, and freezer drawers at the bottom.

There’s No Place Like Home

In each case study, the occupational therapist has recommended home modifications and appliances for Jim and Gordon that help maintain and improve their independence and functional performance, and strengthen their sense of personal autonomy and control in the home.

In Jim’s case, the home modifications helped him to adapt positively as his myositis progressed. “It means that I can get around and be fairly self-sufficient,” he said.

For Gordon, his planned home modifications will help him continue to do some of the things he loves (like caring for a thriving veggie garden) while future-proofing his home to avoid costly and time-consuming alterations in the future.

“When you’re on your good days, what’s there now is fine. But when you’re on your bad days, it’s not real good,” Gordon said. “A lot of the improvements that the occupational therapist is looking to do will certainly make it easier for me to be able to do things myself rather than relying on others all the time.”

LEARN MORE

If you are interested in forming a myositis working group with other occupational therapists, please contact Jane Day at jane@thebullantnest.com About the Authors Eve Vickerson is a freelance health writer working with the Myositis Association Australia–a volunteer-run charity with nationwide membership that provides a support network for people living with myositis. Learn more at www.myositis.org.au.

Liz Ainsworth is an occupational therapist who specialises in working with older people and people with disabilities by providing advice about their minor and major home modifications.

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Putting Co-Design into Service Design–the AT Navigation Program Kathleen Martinez, Occupational Therapist and AT Peer Support Lead AT Chat, Independent Living Assessment (ILA)

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aving worked in caring, education, support coordination, and therapy service roles over the past 10 years, I have seen the wealth of knowledge a person with lived experience can bring to the table when it comes to service design. The role of ‘service design’ and ‘co-design’ can be traced back to 1970, and has gained momentum over the past 10 years, with the variety of service design education programs increasing1. Co-design is often viewed as a ladder of participation of how consumers are involved in the design of a service or product.1 Consumer involvement is transforming from being ‘informed’ and ‘consulted’ to more active roles of ‘co-design’, ‘co-production’ and ‘co-delivery’ of the service.

Of course, it is not as black and white as that, especially with changes to serviceprovider operations, and government policies and funding. In these cases, practitioners can feel like bystanders, with many factors beyond their control.

So what can we do about it? We can implement and advocate for co-design, to improve the experiences of service users and understand the services themselves.

Co-Design with AT Chat

Co-Design and OT Practice

AT Chat, an initiative of ILA, is a peer-led, co-designed online community for assistivetechnology (AT) users. AT Chat’s mission is to share the lived experience and knowledge of AT users with the wider AT community through peer support, so individuals can become confident and capable to make AT decisions to ‘Live, Play and Work!’

The underpinnings of co-design strongly resonate with occupational therapy teachings. Working from a strengthsbased model focused on building capacity, occupational therapists explore the barriers and facilitators that service users encounter in their daily life–and then work with them to create strategies, interventions, and evaluation reviews that help them progress towards achieving their goals.

And then the whole process starts again.

Thanks to an NDIS Information, Linkages and Capacity Building Grant, and a passionate community of AT users, AT Chat wanted to include AT users, experts, practitioners, and the wider AT community in the design, development, and review of its service offerings to ensure it discovered ‘what good looks like’. To achieve this vision, the Living Labs co-design methodology of exploration, experimentation, and evaluation was applied to get the best possible outcome for the user.1

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Living Labs with the AT Community

The early exploration work began with user surveys, focus groups, and think tanks.

It explored the current state of AT service delivery, which focuses on the AT user as the ’end’ user–then proposed a future state, in which peer support would be valued as ‘part’ of the AT servicedelivery process.

This innovation received overwhelming support from all stakeholders.

The next phase in the exploration identified and described the work roles of AT users, practitioners, service providers, and suppliers within traditional AT service delivery steps2. A key part of this process was translating traditional AT service delivery steps into terminology that reflected the voices of AT users and their roles as peer supporters.

It was acknowledged early in the phase that AT was becoming more accessible, with online shopping and big box stores offering mainstream and off-the-shelf AT products. The AT community strongly identified the need to consider the safety and risks that AT may pose to AT users, and the instrumental role of allied health professionals in AT service delivery.

The experimentation stage of the Living Labs began with User Driven Prototyping

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1. Active co-design of AT services meets human rights and good practice benchmarks required by contemporary services 2. Foregrounding AT users within program design and delivery brings a range of positive outcomes and possibilities for the way services are delivered 3. AT users have substantial untapped potential which brings tangible outcomes for other AT users, health professionals, service providers, and for society 4. Development of paid roles and pathways to recognise the skills of AT users and AT communities has potential to improve AT user self-efficacy and contribute to the AT workforce

Figure: AT risk and roles

(UDP) sessions to identify how the AT community would like to connect. The sessions confirmed an online service and portal as the preferred method of service delivery. This online approach allowed the peer support solution to be launched and tested remotely as a pilot program in 2020, during the challenging conditions of COVID-19.

The Connect Create Control Model of Peer Support was co-designed using data from the exploration stage, and contributions and evaluations from pilot participants, the university research partner, and accessibility consultant.

Pre-pilot evaluations were conducted with participants, and weekly supervision sessions conducted with AT Navigators.

The dynamic process of the experimentation stage led to the next iteration of the AT Navigation Program. The word ‘navigate’ means to travel on a desired course after planning a route. The word ‘facilitate’ means to make things less difficult. The AT Navigator works alongside the AT user to facilitate the process of finding an AT solution through planning. The partnership aimed to empower the AT user to take control of the knowledge they gained, build their capability and confidence to act upon the AT information and apply it to their individual circumstances3.

These actions may include seeking further support or assessment from an alliedhealth professional, completing further research before buying their AT, and discussing training options or funding applications with service providers and funders.

From Best Practice to Next Practice Evaluation is the final stage of the Living Labs to measure the potential impact and added value created by the innovation. The pilot provided positive indicative evidence about the value of peer support from the perspective of AT Navigators, AT users, and the knock-on benefits for service systems. It also highlighted the need for an increased emphasis on workready skills for AT Navigators, such as time management, and embedding a community of practice with alliedhealth supervision.

Based on an independent implementation evaluation, four key implications were identified for next practice4.

Although the key implications focus on AT service delivery, each point can be applied to all servicedelivery settings.

The AT Navigation program centres on the AT user, and is built on foundations of co-design, bestpractice approaches, and creating valued roles for people with disabilities to share their experience and knowledge, building increased leadership and influencing opportunities.

About the Author Kate has broad experience working in the disability sector in the community, schools, homes, and workplaces. Kate has a passion for working with people and communities to incorporate their lived experience and expertise into service design through co-design.

References 1. Evans, P., Schuurman. D., Ståhlbröst, A., and Vervoort, K. (2017). Living lab methodology handbook: User engagement for large scale pilots in the internet of things.

2. Walker, L., Astbrink, G., Summers, M., and Layton, N. (2012). Assistive technology and the NDIS: The ARATA ‘making a difference with AT’ papers.

3. Harris, J., Springett, J., Croot, L., Booth, A., Campbell, F., Thompson, J., et al. Can community-based peer support promote health literacy and reduce inequalities?

A realist review. Public Health Res 2015; 3(3).

4. Proctor et al. 2011. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and policy in mental health, 38, 65-76.

AT Navigation Peer Support Journey

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Animal-Assisted OT: Providing Safe and Ethical Services Dr Jessica Hill, Associate Lecturer in Occupational Therapy, The University of Queensland What is Animal-Assisted Therapy?

Animal-assisted therapy (AAT) involves the deliberate incorporation of a trained and assessed therapy animal into pre-existing, evidence-based therapy modalities such as occupational therapy (International Association of Human Animal Interaction Organisations, 2015). Within the field of occupational therapy, AAT is viewed as a purposeful activity in which an animal is incorporated into an intervention with the aim of enhancing an individual’s therapy engagement and performance skills (Andreasen et al., 2017). AAT has been suggested to facilitate engagement in occupational therapy sessions with a range of client populations including children with cerebral palsy, autistic children, ‘at risk’ youth, and older adults diagnosed with dementia (Hill, 2020).

An expanding research base and increasing media exposure of the proposed benefits of AAT has resulted in a rapid rise of animals being included in occupational therapy interventions in Australia. However, with limited education and training pathways available, questions must be asked about whether the profession truly understands how to incorporate AAT into occupational therapy sessions effectively, in a manner that is safe and ethical for the clients and animals.

For the past six years I have incorporated AAT into my practice. When I first decided to embark on my animal-assisted journey, 26 otaus.com.au

I enrolled in what was then the only therapy dog training course in Australia.

Needing to attend this five-day, intensive face-to-face required me to travel with my dog from Brisbane to Melbourne at considerable cost. Ethical concerns about animal welfare–in particular, how many days a week was appropriate for one therapy dog to work–prompted me to buy a second dog and again travel to Melbourne for training. Since then, I have completed a number of additional courses and workshops in AAT and am trained in canine and equine-assisted therapy.

Acknowledging the limited information available to occupational therapists about the ethical delivery of AAT services, I embarked on a PhD with the aim of further expanding the evidence base for this intervention. This six-year journey has allowed me to fully appreciate the complexity involved in delivering AAT, and guided my passion in working with therapists to ensure animal-assisted services are delivered in a way that is effective, safe and ethical for the clients and animals.

My work in the field of AAT has raised significant concerns about the way in which this highly specialised intervention is being implemented. One common perception is that because AAT is ‘unregulated’, additional training or education is not required to incorporate this intervention into occupational therapy practices.

Occupational therapists are required

by Section 2.2 of our Code of Conduct (Occupational Therapy Board, 2014) to work within our scope of practice and maintain appropriate knowledge and skills to ensure safe and competent care. Furthermore, when deciding to include an animal in our practice, we must acknowledge that we hold an ethical responsibility of care to both our clients and animals. Failure to recognise these responsibilities will cloud our understanding of ‘best practice’ and impact our professional integrity (Coghlan, 2020).

Our Ethical and Professional Responsibilities When considering our ethical responsibilities as occupational therapists, Gillon’s (1994) four prima facie principles of nonmaleficence, beneficence, autonomy, and justice are a good guide.

Nonmaleficence (do no harm) and beneficence (promote well-being) Practising AAT without the appropriate training or knowledge carries a high risk of harm to clients. Like any treatment modality, it is imperative that occupational therapists incorporate therapy animals into sessions in a way that is goal-directed, occupationcentred and informed by the best available evidence (Hill et al., 2019). Occupational therapists must have a clear understanding of client goals, the occupational therapy intervention they intend to use, and

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the way in which the inclusion of the therapy animal will assist in facilitating client engagement (Hill et al., 2019).

Occupational therapists must ensure they do not allow the presence of the therapy animal to distract themselves or their client from the overall goals (Hill et al., 2019).

Poor understanding of the underlying theories of AAT, in particular attachment theory, also has the potential to cause harm. When entering into a therapeutic relationship, clients should feel safe to make mistakes knowing they have a secure, non-judgmental base to turn to for support (Hill, 2020). It is crucial that therapists understand what secure attachment looks like, and the ways in which we can support its development (Hill, 2020). Actions that could fracture the relationship include the animal being removed as a consequence of undesired behaviour or verbalising the animal’s dissatisfaction in the client as a result of behaviours (Hill, 2020). It is also important to be aware of the impact of the bond formed between the client and the therapy animal when it is time to end the therapeutic relationship (Hill, 2020).

Failure to take these situations into account has the potential to cause distress.

Inadequate ability to assess an animal’s temperament and to appropriately train the animal may also potentially expose clients to physical harm in the form of bites, scratches, and kicks (Coghlan, 2020).

Respect for autonomy Autonomy relates to an individual’s ability to make a self-determined choice (Coghlan, 2020). AAT must be delivered as an opt-in service in which the client is provided with adequate information to make informed consent (Coghlan, 2020). To do this, the client must fully understand the nature of the service including the potential benefits and risks (Coghlan, 2020). Therapists must therefore fully understand what is involved in AAT and be able to communicate this to the client in a way that does not bias them towards the therapist’s preferred method of treatment (Coghlan, 2020).

In addition to the autonomy of our human clients, we must also respect the autonomy of our animals. Animals should work in environments that allow them to consent to interaction (Hill et al., 2020). This involves working off lead, in a space that is large enough to allow them to move away from unwanted interaction (Hill et al., 2020).

Additionally, the handler must have a thorough understanding of animal body language so they can identify when their animal is uncomfortable and intervene in a way that protects the welfare of the animal whilst not compromising the well-being of the client (Hill et al., 2020).

Ltd, 2020; Driscoll et al., 2020; Hill, 2020; Winkle and Ni, 2019). It is recommended that all occupational therapists considering embarking on their AAT journey familiarise themselves with these standards of practice to ensure they are delivering a service that supports the needs and well-being of their clients and animals.

Justice Within the space of AAT, justice refers to respecting all humans and animals equally (Coghlan, 2020). As health professionals, we are taught to put the needs and the well-being of our clients ahead of all else (Coghlan, 2020). When working with animals, however, our responsibilities extend beyond this, as the welfare of the animals needs equal consideration (Coghlan, 2020). This requires therapists to have an in-depth knowledge of animal selection, behaviour, and welfare concerns to ensure the safety of both the client and the therapy animal (Hill et al., 2019).

What To From Here?

While the field of AAT remains in its infancy, progress has been made. This has included the development of a number of recommended standards of practice for incorporating AAT into health professions (Animal Therapies Ltd, 2020; Driscoll et al., 2020; Winkle and Ni, 2019). While the available standards of practice might have minor differences, there are a number of suggestions that are consistent. These include the need for additional training in order to deliver AAT safely and ethically, continued completion of professional development and supervision, appropriate animal selection and assessment, and ensuring occupational therapists continue to deliver a service that is goal-directed and occupation-focused (Animal Therapies

About the Author Dr Jess Hill is an Associate Lecturer in Occupational Therapy at The University of Queensland and has six years’ experience working as an animal-assisted therapist with children and adolescents. Jess has recently completed her PhD at The University of Queensland, exploring the efficacy of canineassisted occupational therapy with autistic children. During this time Jess has published six journal articles and two book chapters on the topic of animal-assisted therapy.

References can be viewed by scanning the QR code

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Building Connections: Development of a Collaborative Resource Centre Chris Pearce, Managing Director and OT, Occupational Therapy Services Group

A

s Michelle Bihary identified in her recent Connections article, “Leading to Support Communities”, one of the best ways to support our communities— whether it be clients, professional colleagues, or our professional network—is to be more proactive and influential in our leadership. The Solutions Centre is one such initiative driven by a perceived need for an accessible community resource where suppliers, therapists, students, and service users can collaborate.

As one of the leaders in the WA occupational therapy community, and with established and long-standing networks with the various suppliers across WA, the team at OT Services Group (led by Chris Pearce) designed and envisioned a ‘centre’ as part of its strategic planning and to centralise resources for therapists, suppliers, and service users.

After securing sponsorship from four other local suppliers—who are also established, long-standing, family-owned businesses with lived experience in disabilities—our six-month journey of development began in mid-2020 and culminated in January 2021 with the opening of the Solutions Centre.

This innovative community space provides a fresh approach to the WA disability community, with resources for open-minded collaboration, as well as therapy services, information, professional development, social events, community resources, and professional advice to the community at no charge.

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The Solutions Centre was born from a belief that services and resources for people with disabilities had become decentralised and operationally (or financially) driven, rather than consumer-focused (in particular, as funding for disability services has transitioned to individualised funding under the NDIS). It is designed to enhance consumer experience by centralising innovative assistive-technology solutions for trial, providing resources for therapy service provision, combining community resources, professional advice, and information that is available to everyone, and providing access to all key stakeholders in the WA disability community.

The centre aims to ‘inspire solutions’ through collaboration of stakeholders and by providing displays and demonstrations of conventional and extra-ordinary possibilities.

Rather than adopting a showroom model, the Solutions Centre is an inviting, interactive space with innovative assistivetechnology solutions on display–including

those found in mainstream marketplaces such as Bunnings or Ikea, as well as specialist assistive-technology options from disability equipment suppliers. The centre encompasses the full range of activities that we complete every day, with areas dedicated specifically to: driving and vehicles; mobility, cushioning, and seating; sensory; home and daily living (including kitchen, bedroom, and bathroom demonstrations); vision, hearing, and communication; home automation and environmental modifications; and lifestyle (including items to assist with participating in social integration, gardening, pets, and sexuality). To date, all visitors have expressed their amazement at having found at least one solution they had not seen or trialled previously. The coffee nook has also been well received and creates a relaxing non-clinical atmosphere.

Located in Malaga, WA (11km north of the Perth CBD), the Solutions Centre sits alongside other specialist, disability assistivetechnology providers and creates a therapy

“I believe that the more integrated and collaborative that service users, occupational therapists, and the commercial sector can be, the better the experience and outcome for the service users. The Solutions Centre is our next step in that direction.”

– Chris Pearce

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the resources available to therapists and the community. The Solutions Centre currently includes items like the Areolet toilet lift (from the Bidet Shop), which is not available for trial anywhere else in WA! The goal of the centre aligns with the purpose of the OT Services Group: to help people achieve a safe, active, and independent lifestyle. Everyone is welcome to visit and use the Solutions Centre at no cost (competitors and community members alike), with barista-trained students and staff at hand to deliver a coffee of choice while providing professional advice!

space that facilitates access to commonly required resources for all users. The founding sponsors–National Trade Supplier (NTS), Wild West Wheelchairs, Freedom Motors (WA), and Emprise Mobility–all bring inspiring assistive-technology options and expertise to the centre. These sponsors generously support the project financially and align with its values, bringing their energy, drive, and belief to the centre’s functions. In addition, other local and national organisations have contributed to combine innovative assistive-technology solutions for enhancing all activities and tasks of daily living.

The Solutions Centre is participant-led and coordinated by a participant of the NDIS, provides a centralised pool of resources (one-stop centre across multiple domains), provides impartial advice from health professionals and participants with lived experience at no cost, includes social activities and events, has an information station, and provides ACROD assessment to community members at no cost. A participant-led visual arts gallery displays hand-crafted items for sale, with all proceeds going back to the artists. In addition, the centre is being utilised for collaborative, hands-on, free, professional development sessions facilitated between suppliers and therapists and offering a different learning perspective for occupational therapists in WA.

It is envisioned that the Solutions Centre will develop into a one-stop resource for occupational therapists, suppliers, and individuals who work closely, adding value to our community.

“I believe that the more integrated and collaborative that service users, occupational therapists, and the commercial sector can be, the better the experience and outcome for the service users. The Solutions Centre is our next step in that direction.” – Chris Pearce The OT Services Group has learnt that although this endeavour has not been easy to achieve, the feedback from participants and providers indicates it is needed and has already benefited many. In the first week of opening, 98 visitors attended the centre or an event (combination of participants, veterans, therapy, and equipment providers), with three professional development sessions completed collaboratively with a supplier and therapist addressing areas of interest (ramping, wheelchair and seating, and driving adaptations). The interest was overwhelming, with additional education sessions now being run monthly. An increasing number of participant trials are also being scheduled daily at the centre.

The Solutions Centre is still evolving, with displays to be expanded and connections with additional providers made to enhance

The Solutions Centre would not have been possible without the financial support of our sponsors, National Trade Supplier (NTS), Wild West Wheelchairs, Freedom Motors (WA) and Emprise Mobility; the work of occupational therapists at OT Services Group, in particular Chris Pearce, Lois Murray, Marilyn Pearce, Amber Jones, and Ruth Jodrell; other organisations such as Intelligent Homes, For-de Group, Unicare Health, HospEquip, Total Ability, Read at Ease, and the Bidet Shop, who have been enormously supportive and offered invaluable collaboration with therapists and participants; our artists to date, Tony White, Elizabeth Conquest, and Jeff Kealey; Edith Cowan University with inclusion of occupational therapy students; many volunteers (retired occupational therapists, participants, and interested parties); and the WA Division of Occupational Therapy Australia (thank you Erin Clinch!). Lois and Chris will present an abstract on lessons learnt during the development of the Solutions Centre at the upcoming 2021 National OT Conference.

We look forward to sharing this information and hopefully inspiring other therapists to be proactive and influential within the health system, or even to consider setting up a similar resource for their community.

LEARN MORE

To find out more, or stay up to date with events or activities at the Solutions Centre, please join the mailing list via www.otservicesgroup. com/solutions-centre.

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Walk for Wellness: A Mental Health OT Initiative to Foster Recovery and Optimise Well-being Laura Kagan, (OTR) BPsychSc, MOTPrac Mental Health Occupational Therapist, Luna Therapy

One of the key principles of Luna Therapy is ‘Recovery through Connection’. We embody the belief that for people to experience sustainable recovery, they need support to establish a connection with their sense of self, connection with other people, connection with their communities, connection with nature, and connection with their unique values, cultural beliefs, and truths.

Modern Life + Pandemic = Sympathetic Nervous System Overload

The collective mental health has taken a massive hit over the past year. It has been crystal clear that more and more people have been struggling–and disconnection and the stress of modern life play a major part.

Modern life involves an immense level of isolation and loneliness. Many people have lost their villages of support, are overstimulated, and experience sensory overwhelm daily. Most of the time they are operating from the sympathetic state of their nervous system. It’s overwhelming just thinking about it, let alone living it.

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One of the most apparent, worrying, and ongoing casualties of the COVID-19 pandemic has been the collective mental health. The ongoing stress, uncertainty, disempowerment, survival threat, and fear that the pandemic created was unmanageable and catastrophic for many people’s nervous systems and well-being. The pandemic’s impact has significantly contributed to increased global mental-health problems and immense difficulty securing mental-health support. Mental-health practitioners are also experiencing burnout, mental-health problems, and illness themselves. The world can no longer ignore that globally, mentalhealth systems and support processes are not working to effectively support people with mental illness in the way that they need to foster sustainable recovery and engagement in meaningful living. In many ways, mental illness is the pandemic we need to focus our energy and attention on.

Recovery Is Possible

Recovery frameworks in mental health are based on holistic, trauma-informed and person-centred approaches.

Recovery frameworks are based on two clear principles: 1. It is possible to recover from a mental-health illness 2. The most effective recovery is when the client drives it.

Luna Therapy is an integrative outreach mental-health occupational therapy service on the Mornington Peninsula, Victoria. Like many other occupational therapists, we have experienced increased demand for services during this time, and challenges supporting and discharging clients and families as the support they need is intensive and cyclical. I was incredibly alarmed when I, a mental-health occupational therapist with knowledge, experience, and stable mental health to navigate the process, could not find a psychologist or fellow mental-health occupational therapist with availability for new referrals. I contacted many different mental-health services and was told many had closed wait lists or had a wait list of six months or more. Simply put, we do not have available mental-health services to meet the desperate demands of our community. There has been an immense increase in people needing mental-health support over the past year. How can mental-health services support them towards the best chance at recovery when we are all at capacity and unable to refer them elsewhere?

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When people experiencing mental-health problems and emotional distress don’t get the support they need, they are not the only ones adversely impacted. Family structure, employment duties, physical health and well-being, along with the ease and flow of a cohesive, productive, engaged, and healthy community are heavily affected.

Game Changer–The Royal Commission into Victoria’s Mental Health System

The Royal Commission into Victoria’s Mental Health System delivered its final report in March 2021. As stated on the health.gov website, “there are 65 recommendations in the Final Report, in addition to the nine recommendations in the Interim Report”.

The Royal Commission’s recommendations set out a ten-year vision for a rebalanced system in which mental-health and well-being treatment, care, and support are provided in the community, hospital, and other residential settings. It seeks to rebuild the system from the ground up, with communities at the centre.

These reforms aim to rebalance the system so that more services will be delivered in community settings, and extend beyond an acute-health response to a more holistic approach to good mental health and well-being across the community.

Recommendations are grouped around four key features of the future mentalhealth and well-being system: 1. A responsive and integrated system with community at its heart 2. A system attuned to promoting inclusion and addressing inequities 3. Re-established confidence through prioritisation and collaboration 4. Contemporary and adaptable services.

This is fantastic for our mental-health system’s future. However, what do we do now while we wait for these recommendations to be actioned and the paradigm to shift?

We do the best we can, with what we know, and the resources we have.

From Theory to Practice, Introducing Our New Offering–Walk for Wellness

Walk for Wellness is Luna Therapy’s way of offering a genuine commitment to mentalhealth support that encompasses so much of what we know with the resources available at this time. Mental-health services are at capacity, and many people are struggling to find the connection, support, and services they need. It will take time for the Royal Commission’s recommendations to create the vital change that the Victorian mental-health system has been identified to desperately need.

Walk for Wellness is a free, weekly, women’s walking, mindfulness, and social group facilitated by a mental-health occupational therapist (currently me, Laura Kagan). It is designed to be flexible and accessible, driven by recovery frameworks, naturebased therapy frameworks, mindfulness, movement and exercise, yogic philosophies, and trauma-sensitive approaches.

The offering is simple, and there are no expectations. It is an offering we have birthed and are nurturing. If it grows to address the need we have identified, we will continue to facilitate it. However, we are aware it may not be hitting the mark, and are therefore endlessly open and curious to adapt and explore other options to do our small part to create the change we wish to see in the world.

The group aims to create opportunities for well-being routine, connection, new villages of support to be nurtured, and dedicated time for cultivating physical, mental, energetic, and emotional health and well-being. We must provide opportunities that support people to build sustainable well-being from the ground up, fostering a connection with self and others. This includes dedicated time in nature, opportunities to learn about trauma, stress, nervous-system balance and regulation, and engaging with activities that bring joy and meaning.

Part of the Walk for Wellness social group’s beauty is that this time is energetically, emotionally, and physically protected each week. Regardless of whether ten people

attend or none, this time is precious and available to at least our occupational therapist running the group, who will still immerse herself in nature, walk, grab a coffee, and spend time mindfully and intentionally with herself, genuinely embodying the offering’s intentions. We chose a central peninsula location in Mount Martha for the group. It has terrific options for walking and mindfulness (beach on one side, estuary boardwalk on other, cafes, park, flat street walking, etc) and addresses some of the potential barriers to those wanting to attend. However, we are also aware that many people experience barriers to accessing health-care support, and addressing how we advertise this offering and enable its sustainability is a work in progress.

Finding a balance and creating a service that supports women who seek this mental-health support on the peninsula is deeply important to us. We are confident we will continue to evolve this offering, and empower the connection needed to support women to recover and thrive.

About the Author Laura Kagan is a mentalhealth occupational therapist and hatha yoga student/teacher who founded Luna Therapy, an integrative mentalhealth service on the Mornington Peninsula in 2018. Laura believes each person’s physical, psychological, and spiritual path to healing is unique to them, and that life can be transformed through deep connection to self-awareness. Laura has a special interest and passion for women’s mental health and well-being, honouring rites of passage, and empowering women through self-discovery and connection to self and community. If you would like to connect, engage, or ask any questions, please reach out to laura@lunatherapy. com.au or visit www.lunatherapy.com.au References The Royal Commission into Victoria’s Mental Health System. Retrieved 10 April 2021 from https://finalreport. rcvmhs.vic.gov.au/

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Theory to Practice in Action: A Research and Program Commitment at Griffith University Louise Gustafsson, Michelle Bissett and Matthew Molineux, Griffith University

T

he unique contribution of occupational therapy is the profession’s occupationcentred approach to promoting health and well-being. However, change has been slow following the renaissance of occupation and a theory-to-practice gap persists within clinical practice. We believe research holds an important role in supporting changes to occupational therapy practice consistent with the following three core constructs of the contemporary paradigm: occupation is inextricably linked to health and wellbeing, humans can experience dysfunction in their occupations, and occupation-based practice. At Griffith University (GriffithOT) we are committed to supporting the profession to bridge the theory-to-practice gap through research partnerships with all stakeholders. Our research agenda aims to: • Demonstrate the value of occupation and occupational therapy practice to health and well-being • Build evidence-based approaches to support student occupational therapists and practitioners to integrate theory into practice

In this article we summarise some of our key work, findings, and implications for the profession. Through doing so, we aim to

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inspire other occupational therapy researchers and clinicians to consider how they can contribute to the theory-to-practice evidence base and bridge the theory-to-practice gap.

Occupation in Practice

Our research has identified that occupationbased practice is valued by the profession and satisfaction is high for consumers1,2.

We found that clinicians working in an acute paediatric setting recognised the power of occupation and the benefits of an occupation-based approach, and incorporated these in practice, albeit inconsistently3. The clinicians identified barriers external to themselves such as working within the medical model, workplace expectations, and multidisciplinary team understanding.

However, scoping reviews from other practice settings suggest that a common problem is the disconnect between the planned outcomes and the interventions that we implement. For example, occupationbased interventions are often implemented within a residential setting but the key outcomes are often measured at a person level4–or within hand therapy settings, the push of a biomedical culture and pull of an occupational perspective means there is often an expectation that component level

interventions will directly translate into improved occupational engagement 5,6.

While these findings suggest the intent, and attempts, to work within the contemporary paradigm, they also challenge the profession to make the occupational perspective explicit. Supervision and/or professional development to refresh knowledge and skills in occupational therapy conceptual practice models—and to support integration of occupation throughout all of the practice process—can assist. One of our current projects involves working alongside occupational therapists in an acute setting to coach and strengthen occupation-centred practice. Intentionally increasing knowledge, skills, and confidence for implementing occupation-based practice and the changes required for documentation and intervention protocols is not only important for the profession, but also to outwardly demonstrate this perspective to the interprofessional team. Language is a powerful tool that can be used to support occupational therapists who often feel unable or unsure of how to engage in occupation-based practice. As one example, the term ‘function’ is often used interchangeably with ‘occupation’ and used variably by the interprofessional team. A conscious decision to change language and documentation to include terms such as occupation, occupational performance and engagement, and enabling occupation is a simple but powerful step to prioritising occupation in practice.

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Understanding how occupation is conceptualised within the profession and experienced by our clients are two other areas of focus for our research. A concept analysis of the term ‘occupational adaptation’ found it was used variably across multiple contexts, however it lacked maturity and concept refinement was required7. Interviews with stroke survivors found that reconstruction of an occupational identify was central to adjustment and was facilitated through connections to self, reality, and others8. Explorations of the experience of occupation for stroke survivors has found that rehabilitation was most valued when there was an explicit link between the therapy and the persons’ occupations 9,10. Further people with mild stroke identified persistent occupational gaps in outdoor activities, work, sports, and light and heavy home maintenance11. Understanding how occupation is experienced by our clients is essential to building the evidence base and contributing to service development.

Occupation in Supervision

Supporting clinical supervisors to integrate occupational therapy concepts and theory into supervisory processes is another key enabler for change. Our research reveals that common barriers to occupation-based practice for new and recent graduates include the pressure to practise in a manner accepted and expected by senior members of the profession and the multidisciplinary team12. As a new graduate, they have emerged from a period of intense learning and application of occupational therapy theory, models, and frameworks. However, the graduates in this study were most comfortable implementing impairment-based practice and considered their practice would become increasingly occupation-based with growing experience and confidence. The existence of this theory-to-practice gap early in their career highlights a key dilemma for the profession. Supervision is an important enabler but can only be effective if both the clinician and the practice context supports

A conscious decision to change language and documentation to include terms such as occupation, occupational performance and engagement, and enabling occupation is a simple but powerful step to prioritising occupation in practice.

occupation-based practice. As evidenced by a collaboration with a local health service, learning packages can support supervisors to incorporate theory into their supervision sessions with early-career staff 13.

Occupation in Education Leaders within the profession have identified three core characteristics of occupationcentred education: embodied knowledge and understanding of occupation and its link to health and well-being, deliberate educators who value occupation, and rhetoric versus reality of professional practice14. University-based educators are the instruments of occupation-centred education–it is their in-class strategies and use of tools, models, and frameworks that link occupation to practice and support the students to learn and embody occupation15.

Our program includes annual theory-topractice transition workshops that assist students to link theoretical concepts to practice16. These focused workshops enhance student knowledge and confidence in applying theoretical concepts to practice contexts. There are opportunities to extend this concept to practice education supervisors, as students will often experience ‘dilemmas’ when occupation is not explicit within the practice area, with detrimental impacts on professional identity.

Harnessing and developing supervisor knowledge regarding contemporary practice, and supporting them to understand

that this knowledge is powerful and important, is a key precursor to change.

Occupation in Research is Needed to Bridge the Theory-to-Practice Gap

In this article we have summarised some, but not all, of the research undertaken by GriffithOT academics, higher-degree research students, and honours students. Collectively, we remain committed to bringing occupation to the fore to support practice, education, and supervision, and to ensure that occupational therapy retains its unique place within any team. We work in partnership with clinical teams, ensuring that change and implementation are feasible within practice settings. We encourage other occupational therapists to consider how their work can build the evidence and/or advance theoryto-practice translation–perhaps through research partnerships or through deliberate practice decisions which proactively position occupation into their work. We welcome contact from people interested in joining the GriffithOT research agenda.

References can be viewed by scanning the QR code

CONNECTIONS WINTER 2021 33

LIFTING PEOPLE

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F E AT U R E

When to Contact Your Insurance Broker Aon

I

t’s a common assumption that, as a business owner, you only need to contact your insurance broker when you need to renew your policy or make a claim. The reality, however, is there are many things in your operations that can change that your insurance broker needs to know about. Regularly keeping in touch with your broker can help ensure you’re not left with any gaps in cover and are getting the most value from your broker’s service.

Here are some of the instances in which you will need to contact your broker to ensure your insurance is up to date and correctly reflects your business’s current situation.

You Experience a Complaint that May Lead to a Claim

sub-contractor, or employing a permanent employee, you should contact your insurance broker to discuss the changes to your risk profile and the steps you might need to take.

It’s easy to assume sub-contractor actions are automatically covered under your insurances, but this may not be the case.

Without the appropriate cover in place, if a sub-contractor makes a mistake in the work or advice they undertake on your behalf, or are held responsible for bodily injury to someone, your business could be left with the financial burden of a lawsuit. Your broker will advise whether your policy covers the actions of your sub-contractor, and the sub-contractor’s own liability, or whether they need to take out their own insurance.

This is one of the most important scenarios in which you should promptly contact your broker. If your business is involved in providing a service or advice, and a client hints that your advice caused them financial loss or damage, it could be the first sign of a Professional Indemnity Insurance (PI) claim. Even if you feel their dissatisfaction is minor, or that their allegation has no basis, a conversation with your broker can help ensure you’re being honest and transparent and will have minimal issues if you do need to make a claim.

Your Services have Changed

You Expand your Workforce

Your Revenue has Changed Substantially

Expanding your workforce is an exciting time for your business, but it also means there’s some homework on your part.

Whether you’re engaging someone as a

If there has been a change to the products/ services your business offers, you should tell your insurance broker to ensure it is covered under your policy. This also includes hiring a new staff member who is qualified in a different area, and provides a service in line with their qualification. Your broker will determine whether your policy needs to be changed mid-term, or whether it can wait until your next renewal. Remember, if a service is not listed on your schedule, it may not be covered under your PI.

When you take out an insurance policy for the first time, you’re usually asked to nominate your annual revenue, and

possibly asked to report this amount at each renewal. You will need to notify your broker if there is a substantial change to this amount during the year. For example, if you secure a large contract or client.

As you can see, there are many situations in which your broker may need to be notified of changes to your business. The factors listed above aren’t exhaustive, and there may be other instances in which you may need to update your insurance. If anything else does change in your business, and you’re unsure about whether your insurance needs updating, a quick call to your broker can help clear any confusion.

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 client numbers continue to grow. If you’d like to find out more about Aon, or to get a quote, please visit aon.com.au/ota, call 1800 805 191 or email au.ota@aon.com © 2020 Aon Risk Services Australia Limited ABN 17 000 434 720 AFSL no. 241141 (Aon) This information is intended to provide general insurance-related information only. It is not intended to be comprehensive, nor does it, or should it (under any circumstances), be construed as constituting legal advice. You should seek independent legal or other professional advice before acting or relying on any of the contents of this information. Aon will not be responsible for any loss, damage, cost, or expense you, or anyone else, incurs in reliance on, or use of, any information contained in this article.

CONNECTIONS WINTER 2021 35

F E AT U R E

A Model Life: How a Queensland OT Left her Mark on Functional Cognition Felicity Fay, Founder at OT Do and Cathy Hill, Founder at OT Do

I

n care settings around the country, a simple task of lacing a thread has become the preferred method of screening a person’s functional cognitive ability. The Allen’s Cognitive Levels screening tool (ACL) is a standardised, evidence-based assessment approach. It determines what a person can do (rather than what they can’t), or what is meaningful and realistic when considering occupational performance.

Occupational therapist Delaune Pollard has played a key role in the ACL’s uptake, dedicating her adult life to the application of the Cognitive Disabilities Model (CDM), which informs all aspects of the ACL tool.

Who is Delaune Pollard?

As a young graduate from the University of Queensland in 1961, Delaune Pollard had little idea that her career path would take her on such a diverse journey. It was also a path that would indelibly shape the care of people living with disabilities and alter the perception of disability to a model of ability.

Delaune Pollard

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Moving through the spectrum of human care, Delaune’s remarkable story encompasses academia, politics, and community and peak organisations. Her journey took her to Pennsylvania, the epicentre of functional cognition study. She became a lobbyist and advocate for those who did not have a voice, and mentored and taught the many who followed her example.

A Model Takes Shape

A knowledge of the impacts of a cognitive disability on occupational performance needs to be understood and applied to ensure the best outcomes and the selection of the ‘best fit’ strategies for individuals.

The CDM helps us to recognise the cognitive complexity of tasks that people are able to engage in (Can Do) by assessing their functional cognitive capabilities to perform.

This is then considered alongside the activities they want to do (Will Do), and how social and environmental barriers and enablers may impact (May Do).

What we now understand as ‘functional cognition’ is a term that Delaune introduced in a 2005 publication, Allen’s Cognitive Levels: Meeting the Challenges of Client Focused Services (Pollard, D. V. and Olin, D., 2005).

This core construct recognises the link between brain function and task behaviour.

For therapists, the connection between function and cognition removes the stigma of disability or impairment, and shifts the focus towards interventions that build on abilities.

The guided use of the ACL enables caregivers to plot abilities on a series of rubrics, much like a teacher fills in learning outcomes for students. When the level of functional capacity is known, strategies can be implemented to help the client succeed in the activities they can and wish to do.

F E AT U R E

Practice Made Perfect

Delaune applied her expertise in multiple settings. In Brisbane in the 1970s she assisted children with learning problems, sparking her interest in the study of cognition. Later, she became Occupational Therapist-in-Charge at Queensland’s largest psychiatric hospital, where she gained skills in psychogeriatrics and forensics.

In the 1990s she studied under the guidance of Professor Claudia Allen at the Eastern Pennsylvania Psychiatric Institute and formed key relationships with cognitive disability advisors throughout the US. She became an Allen Cognitive Advisor and Master Clinician in cognitive disabilities.

Delaune’s clinical experience extends across multiple areas of practice. From “The Park” Wolston Park Memorial Hospital and John Oxley Forensic Facility, to paediatrics, employment consultancy, policy management, and political advocacy.

A prolific writer, Delaune has authored five clinical texts to support occupational therapy practice. These were informed by the CDM and established research, along with her own research and clinical observations. In her ever-practical support to caregivers, she has written several textbooks on sustainable care for people with a cognitive disability.

She also formed her own company, specialising in the assessment and management of people with cognitive disabilities and providing an advisory service to the aged-care and insurance industries.

Tireless in her advocacy, Delaune used her extensive experience in many different roles, such as consultancy, policy, and education. She was able to make a submission to the House of Representatives Standing Committee on Ageing to support best practice in Aged Care.

“Many people who don’t function at an optimal cognitive developmental level for human behaviour can still be valued and appreciated for functioning to their best ability, which reflects their maximum effort.”

Delaune Pollard As Vice-President of the Local Ambulance Committee on Tamborine Mountain, Delaune keenly supported the inclusion of people with disabilities on the committee in active and meaningful roles. This drive towards inclusiveness and appreciation of people, informed by pragmatic expectations of ability, and support through ‘May Do’ factors, has been an ongoing standard throughout Delaune’s career.

Towards a Sustainable Future

Now more than ever, occupational therapists must be able to assess and then establish effective, timely strategies for clients. We need to have the tools to follow through with best practice.

Within an Australian context, Delaune’s pioneering work has ensured the CDM remains accessible, dynamic, occupationcentric, and evidence-informed in its application. She continues to exemplify her passion to educate occupational therapists and other allied-health professionals, to support caregivers, and to advocate for the CDM and the people it supports.

The founders at OT Do (Occupational Therapists Do) are inspired by Delaune’s example. Cathy Hill worked with Delaune for many years and says Delaune’s motivation for continuing professional engagement is two-fold: “Firstly, it derives from an irresistible urge to discover and describe the physiological basis for developmental and ageing behavioural changes, leading

to increasing or declining individual ability to function. Secondly, there is her need to use this information to support human best ability to function at all ages and in all areas of the human condition.”

OT Do practitioners continue Delaune’s passion—advancing innovative practice for caregivers and contributing to further development of the model.

Above all, we remain firmly focused on occupational outcomes for the people supported by occupational therapists.

Many people who don’t function at an optimal cognitive developmental level for human behaviour can still be valued and appreciated for functioning to their best ability, which reflects their maximum effort—Delaune Pollard.

About the Author OT Do was established two years ago and services areas in south-east Queensland.

The combined clinical experience of the proprietors, Felicity Fay and Cathy Hill, extends to more than forty years.

Together, they have assembled a team of occupational therapists whose practice is firmly informed by the CDM as one of the primary organising models.

OT Do services the areas of Brisbane, the Gold Coast, and Toowoomba. Its practitioners train workers in all aspects of the CDM. More widely, OT Do facilitates workshops in functional cognition around Australia.

CONNECTIONS WINTER 2021 37

ADVERTORIAL

Modern Care for All W

ith the pace of technology as fast as ever, there’s no reason that the care industry shouldn’t keep up with the innovations that have transformed every other aspect of our lives. But it isn’t enough to give someone the latest gadget and wish them well. The product and service have to be personalised and tailored to the individual needs of the person.

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To expand beyond this, into a truly predictive and personalised solution, Cognitive Care™ is our vision for an integrated health and care system that will make a robust and scalable health and social care model possible. Making healthcare more accessible, efficient, and sustainable through digitally-enabled solutions is a key component of Tunstall’s mission.

Cognitive Care™ is an intelligent solution that collects and analyses data from different sources – from sensors to smart watches, through to systems that capture health metrics and integrate with thirdparty databases and electronic health records – and then uses advanced AI to generate alerts if it detects an end user’s condition has signs it may worsen.

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Cognitive Care™ will enable providers to deliver accessible, value-based health and social care. Tunstall’s customers will be able to use data-driven insights to personalise high-quality care programmes and effectively allocate resources, making sure those in need have the right levels of support.

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Empowering a bright future for Connected Care & Health For over 60 years Tunstall have pioneered the development of technology that enables independent living and continual care & health monitoring for over five million people and their families across the world.

We empower people through interconnected, preventative and proactive healthcare solutions to continue to live as independently, happily, healthily and securely as they can.

Discover how our Connected Healthcare can benefit your clients.

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F E AT U R E

Employment Considerations for New OT Graduates Anna Pannuzzo, Director, WorkPlacePLUS

E

ntering the occupational therapy profession can be an exciting yet challenging time for new graduates.

With a smorgasbord of potential workplace settings to consider, from private practice, hospitals, and rehab centres to schools, community organisations, and businesses, it is important to know your role and responsibilities when looking to be employed as an occupational therapist.

Before you Sign

When looking for an occupational therapy position and considering a potential employer, the first few things to look out for are: • The position description–does this reflect the role you are looking for?

• Employment arrangement–is it employee or contractor, permanent or casual, full-time or part-time?

• Pay rate–is the correct pay rate being offered?

• Contract of employment–make sure you read and understand it!

The terms and conditions of your contract may differ depending on the workplace setting you choose (e.g. private practice, hospital, not-for-profit organisation, etc). Some employers will offer the minimum rates under the Health

40 otaus.com.au

Professionals and Support Services Award, whereas others with have an enterprise bargaining agreement (EBA).

• Organisational values or mission statement

Once you’ve read, understood, and signed your contract, it’s time to pop the champagne! But it’s also important to know what to expect in those first few days, weeks and months as you transition into your new workplace.

• Key stakeholders

Onboarding

In the first few days of employment, there will generally be plenty of paperwork.

For example, you will need to fill out your superannuation and tax forms, your bank details so you can get paid, and any professional requirements such as a Working with Children Check or Police Check.

Your employer may have an onboarding or induction program, designed to familiarise you with the workplace culture and the way things operate.

This may include an introduction to:

• Policies and procedures • Access to technology and/or workspaces • Your key contacts and co-workers within the organisation During this time, it is advisable to keep a copy of your position description on hand and ask plenty of questions to gain a better understanding of where you fit in and the expectations of your role.

Tip: When you start with a new employer, ensure your pay rate is as per your contract and you get paid either in the fortnight or month advised. If you have any queries about your entitlement, don’t be afraid to ask!

As an employee, you need to understand your legal rights and take the time to properly review and understand the policies and expectations of the business.

F E AT U R E

Probation Period and Performance Reviews

A probation period or ‘trial period’ is the initial period of employment in which the employer can assess your suitability and you can decide if the job is right for you. Your employer decides on the length of the probation period, which can range from a few weeks to a few months.

While on probation, you should expect to receive your normal entitlements per your employment contract, including accruing and accessing paid annual leave and sick leave. If you don’t pass your probation, or decide that the job isn’t right for you, you are still entitled to have your unused accumulated annual leave hours paid out.

Regular performance reviews are an important part of the professional manager/staff relationship. They include discussions around: • Achievements • Areas for improvement • Future objectives

At the beginning of your probation period, your manager or employer should sit down with you to discuss the key result areas they are looking for, and to schedule some follow-up meetings. Use these as an opportunity to receive feedback, track your own progress, and discuss any concerns.

properly review and understand the policies and expectations of the business.

In particular, make sure you familiarise yourself with the code of conduct, rules around workplace safety, and the processes for performance management, including how to make a complaint.

Employee Obligations

If you are going to be working outside of your usual workplace–such as visiting a client in a residential facility or in their home–it is important to be aware that these places become an extension of your workplace, and all relevant policies and procedures apply. Make sure you discuss the relevant workplace protocols with your employer, including what to do if a safety incident occurs or something goes wrong.

Employees generally have a duty to: • Take reasonable care for their own health and safety • Take reasonable care for the health and safety of others who may be affected by their actions or omissions • Not ‘intentionally’ or ‘recklessly’ interfere with or misuse anything provided in the workplace • Behave and act appropriately in the interests of a positive workplace culture • Cooperate with anything the employer does to comply with legislative requirements (e.g. Fairwork Act, WHS Laws, Privacy Laws).

As an employee, you need to understand your legal rights and take the time to

Before you accept a job offer, do not hesitate to do some research and ask plenty of questions. There is a range of support services available to members of OTA who are new graduates transitioning into practice. For employment-related queries, you can contact OTA’s preferred HR provider, WorkPlacePLUS. Learn more at www.workplaceplus.com.au or by calling Anna Pannuzzo on (03) 9492 0958.

CONNECTIONS WINTER 2021 41

Am I covered if my client misinterprets my advice? not sure?

Talk to Aon, the small business insurance specialist.

Our occupational therapy industry and broking expertise helps you make more confident decisions when using us to arrange your insurance purchase.

Visit aon.com.au/ota or call 1800 805 191.

Don’t just insure, be sure. © 2021 Aon Risk Services Australia Limited ABN 17 000 434 720 AFSL 241141 (Aon). Coverage terms, conditions and exclusions apply to all covers. Please carefully read the policy terms prior to making a purchase decision to ensure it meets your particular objectives, financial circumstances and needs. Contact Aon on 1300 836 028 for a copy of the policy wording and/or Product Disclosure Statement.

AFF20210329-OT