OTA Connections Summer 2021

Supporting all people to engage in activities they find meaningful

SUMMER 2021 | VOL 18 ISSUE 1

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This is OT Print Post Approved PP340742/00147 ISSN 1832-7605

Supporting Participation, Inclusion, and Independence Creativity and transdisciplinary practice in aged care How one man got his life back through OT The history of a growing profession

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CONTENTS

ABOUT CONNECTIONS

OT Week highlights

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

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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

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CONTRIBUTIONS

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

FEATURES

04

President’s Report

18

Where is the profession heading?

05

CEO’s Report

20

The history of a growing profession

06

Policy, Lobbying & Advocacy Update

24

08

Professional Practice & Standards Update

OT and rehabilitation, an obvious match?

26

10

AOTJ Update

How one man got his life back through OT

12

WFOT Update

28

Student Careers Forum

14

OT Week wrap up

30

Occupational therapy in 2050

32

Staff concerns in an evolving Covid-safe workplace

34

Creativity and transdisciplinary practice in aged care

36

Safe vehicle transport for children with disabilities

39

Maximising participation through home automation

40

A gallery of measuring meaning in hand therapy

42

The importance of record-keeping in a digital world

36

CONNECTIONS SUMMER 2021 3

PRESIDENT’S REPORT

President’s Report Associate Professor Carol McKinstry | OTA President

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nother very strange year has passed, and again we have celebrated OT Week, this time with the theme, “Occupational therapy supports participation, inclusion and independence”.

This theme would have resonated with Australian occupational therapists as being the core of what we do, regardless of the workplace setting. This year has seen an increased awareness of the value of participation, with the global pandemic making participation in some occupations challenging for ourselves and for those with whom we work. Inclusion has also been at the fore of our thinking – whether working with those who continually encounter difficulties, looking for ways to increase diversity of inclusion, or just not wanting to leave anyone behind as we enter our new way of living with Covid.

Although it has not been an ordinary year, there are many positives to take out of 2021.

As the number of registered Australian occupational therapists continues to grow – and there are now nearly 25,000 of us – demand and recognition of our services has never been higher. We are now one of the biggest allied health professions in Australia.

While more people than ever are receiving services from an occupational therapist, there is still that frequently asked question: “What exactly is occupational therapy?” I would love a dollar for every time it is asked.

So how do you describe occupational therapy? Do you base your answer on what you do as a practitioner? Do you base it on what you research – demonstrating how effective occupational therapy is – or our

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Reflecting on what attracted you to a career in occupational therapy may be quite different to what has sustained you in the profession. unique approach and contribution? How you respond to the question is possibly closely linked to your identity as an occupational therapist and the setting in which you work.

Understandably, it is not uncommon for students to struggle to explain occupational therapy and how it differs from other health professions.

Then there is the need to set straight those who think occupational therapy is all about OHS. Interestingly, in Europe there are some countries in which occupational therapists are called ergotherapists. Early writing about occupational therapy in the Medical Journal of Australia in the 1920s also gave the impression that the medical profession associated occupational therapy with work therapy.

Reflecting on what attracted you to a career in occupational therapy may be quite different to what has sustained you in the profession. For me, wanting to work in a rehabilitation setting was the major attraction. Yet now, as an academic teaching future occupational therapists, promoting occupational therapy as a great profession to attract rural and regional students is what gets me out of bed each day.

While the number of Australian occupational therapists continues to grow, we are also continuing to see emerging areas of new practice. This may be due to growing confidence or a sign of a mature profession.

There are more occupational therapists promoting well-being in their practice, focusing on working with communities and outside traditional health settings. The Australian occupational therapy profession is becoming a very broad church, valuing and willing to embrace diversity as a strength.

There is growth in private practice as occupational therapists see the value in being more autonomous.

I hope you have had the opportunity to celebrate the work of occupational therapists, including your own contributions to the profession. As an organisation, one of our strengths is the volunteers who are passionate about their profession and continue to work on behalf of practitioners and clients. From the OTA Board, many thanks for your ongoing membership, which helps us deliver high-quality member services and advocate and lobby on your behalf.

CEO’S REPORT

CEO’s Report Samantha Hunter | OTA CEO

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s 2021 draws to a close and 2022 stretches before us, it provides an opportunity to look at where we have come from and what lies ahead.

I have been considering how the 2021 OT Week theme, Participation, Inclusion and Independence, resonates for us as an association and a profession after a challenging two years of pandemic response.

How has our changing landscape changed the way we work and engage, with our members, with each other and with our communities, partners and stakeholders?

Have our lives changed irrevocably?

Undoubtedly there have been challenges associated with the often tight restrictions placed upon us. In the early days we were required to flip the way we conducted business, how we interfaced with clients, friends and families. We had to be rapidly responsive. Our reliance on technology was paramount as we adapted to new systems, new interfaces and to supporting those around us to embrace change that kept them connected, too. As time has unfolded the technical challenges, while still frustrating, seem a lesser burden than the adaptive challenges of constant change and the emotional resilience required to navigate life on new uncertain terms.

The new normal of uncertainty can be unsettling and draining. Supporting others

while juggling an ongoing workload, working from home and the endless hours online has been challenging – each person’s resilience and fortitude tested. It has been important for us as an association to demonstrate the ethos of participation, inclusion and independence so no one was left behind.

We actively work to create a space where every one of our team is heard, valued and respected, with diversity front of mind.

Different voices bring different ideas and generate different thinking – and, we hope, more creative outcomes. We foster the ability to stretch, bend and snap back (and forward) in our thinking so we can learn from each other, play to our strengths and learn to see things with multiple lenses.

Participation and inclusion also come alive for us as an association working with members. From our divisional council members to the work of the Australian Occupational Therapy Journal, the members on reference groups, working groups and individuals responding to calls for case studies or consultation on submissions, the open inclusion of ideas and the participation of our members bring the work of the association to life, maintain our relevance and keep us connected with the profession across the breadth and depth of OT. We are working towards greater participation and inclusion of those closest to us – the

It has been important for us as an association to demonstrate the ethos of participation, inclusion and independence so no one was left behind.

clients and consumers who benefit from the commitment of our members. As our world slowly opens up, we must enable more voices to join ours in amplifying the message of the important work of occupational therapists. Our vision for OT is that “people and communities are engaged in occupations that bring meaning and purpose to their lives, fostering health, wellbeing, participation and inclusion”. To truly live this vision we must open our eyes and our doors to participation outside of our membership and staff, and embrace greater and more diverse participation in our association.

And finally independence. Workplaces have perhaps changed forever. There is still much debate and conjecture about what they will look like in the future. The pandemic has brought about a level of independence never previously experienced. Working from home has presented challenges for some (does anyone ever want to hear the words “home schooling” again!) but there have also been incredible gains for many. Location is less of a barrier to the best staff or a workplace, commute times don’t impinge as greatly on life balance and trust is strengthened when independence is respected.

At OTA with a focus on participation, inclusion and independence we have stood together and built a bigger, stronger team despite not being physically connected for much of the past 24 months.

While technology has allowed that to happen, our culture and commitment has made it happen.

CONNECTIONS SUMMER 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

OTA lobbying produces a win for vulnerable clients Michael Barrett OTA General Manager, Government and Stakeholder Relations

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his edition’s theme “This is OT” is a deceptively simple expression, implying occupational therapy is a vocation easily defined and categorised. In fact, occupational therapists can be found anywhere and everywhere, assisting just about anybody at any point in their lives.

The remarkable diversity of occupational therapy work across this vast and challenging continent is reflected in the great diversity of OTA’s lobbying activities in 2021.

The year has, of course, been dominated by the ongoing Covid-19 pandemic and the sudden need to lock down whole cities with just a few hours’ notice. Even with the capacity to support clients via telehealth, hard lockdowns have seriously impeded the progress of clinical care and challenged the viability of practices. OTA has sought to hold governments to account, demanding there be a credible rationale for suspending allied health services. In October, for example, the Victorian government belatedly saw reason and admitted it was anomalous to allow hairdressers to reopen in regional Victoria while still insisting that only essential allied health care be delivered face-to-face.

OTA knows it has been a very hard two years for many of its members, with few communities being spared lockdowns. We acknowledge and applaud your resilience and flexibility in the face of an historic challenge.

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The year will also be remembered for a concerted and passionate campaign to prevent the federal government and NDIA from introducing a crudely designed and potentially very harmful means of assessing eligibility for the NDIS. As experts in the assessment of functional capacity, occupational therapists immediately recognised the clinical shortcomings of so-called independent assessments and their potential to do real harm. And as university-educated professionals, occupational therapists saw through the NDIA’s selective use of evidence and a profoundly flawed pilot process.

In my five years at OTA, I have never seen occupational therapists come together so smartly, and join forces with other allied health professionals so readily, to achieve a common purpose: the defeat of independent assessments as initially proposed. And this was not a self-interested campaign. It was not about occupational therapists’ pay and conditions, for example.

It was occupational therapists speaking up on behalf of highly vulnerable clients.

The OTA submission to the inquiry into independent assessments conducted by the Australian parliament’s Joint Standing Committee on the NDIS was described as “immensely powerful” by Professor Bruce Bonyhady, one of the architects of the NDIS and now executive chair and director of the Melbourne Disability Institute. The submission, based on feedback from scores of OTA members, exposed the

flawed assumptions on which independent assessments were so precariously based, and called into question the NDIA’s belated and half-hearted consultation process.

The breadth, depth and passion of opposition to the proposal left the federal government with no option but to abandon independent assessments in early July.

But we should be under no illusions. This abandonment is an attempt to kill a difficult issue less than a year out from an election.

Next year, and irrespective of who wins the election, the federal government will be looking for means to rein in the cost of the NDIS. There is some disagreement about the extent of the cost blowout, but the scheme is costing considerably more than initially expected. OTA’s task remains one of ensuring any cost-cutting measures do not come at the expense of quality supports for participants. OTA remains willing and able to work with the NDIA to ensure genuine co-design of a scheme that should be uniquely supportive of participants and economically sustainable. In the spirit of co-design, we have already recommended a process which is effective, evidencebased and, most importantly, involves a comprehensive assessment conducted by a discipline-specific allied health professional the client knows and trusts.

Occupational therapists working with veterans and war widows had an important win during the year. After a sustained advocacy campaign involving the lobbying of successive Veterans Ministers and even

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 stand-alone website, OTA achieved its goal of winning a substantial increase in the fee paid by the Department of Veterans’ Affairs (DVA) to occupational therapists working with veterans. In the 2021-22 Federal Budget, this fee was raised by 27 per cent, which will go some of the way to making this work sustainable. This was a welcome victory for occupational therapists and the clients they support.

Concerns remain, however, around a new treatment cycle for veterans, introduced on 1 October, 2019. The new cycle requires a client to get a fresh referral from their GP after 12 sessions with an allied health professional, or 12 months – whichever comes first. Unfortunately, the new treatment cycle imposes an enormous administrative burden on allied health professionals – work for which they are not remunerated. The problem is compounded by the fact that many GPs remain unfamiliar with the details of, and their key role in, the new arrangements. This leads to repeated and time-consuming interactions between a client’s GP and their allied health providers.

This is frustrating for all concerned, and will remain a focus of our lobbying in 2022.

The unique role occupational therapists play in the delivery of mental health care is the subject of sustained and ongoing policy development and advocacy. Thinking Ahead: The future of occupational therapy and mental health in Australia is a project commissioned by OTA to ensure we have a strong understanding of the diverse nature of occupational therapy practice in the context of mental health. A series of workshops has enabled us to identify where and how occupational therapists are working, and the factors that help or hamper this work.

The project, being conducted by an outside consultancy under the supervision of an expert advisory group, addresses three separate but related areas: Advocacy and research – the development of a comprehensive advocacy strategy; Clinical and community practice – building the

The unique role occupational therapists play in the delivery of mental health care is the subject of sustained and ongoing policy development and advocacy.

infrastructure to support clinical competency and professional development; and Communications – raising consumer and referrer awareness of the occupational therapist’s unique role in mental health care.

to advocate in this space for a much greater role for occupational therapists, enabling them to bring the full range of their expertise to bear and, in so doing, enriching the lives of our seniors.

Australia’s aged care sector is still coming to terms with the findings and sweeping recommendations of the Royal Commission into Aged Care Quality and Safety.

Recommendations 36, 37 and 38 call for enhanced access to allied health care for senior Australians, whether they are in an RACF or ageing in place. The government accepted these recommendations, but only accepted in principle recommendation 38, something the commissioners themselves could not agree upon. Commissioner Pagone recommended improved access to allied health for people in RACFs, suggesting it be provided by outside service providers, while Commissioner Briggs recommended facilities be required to employ a suite of allied health professionals – clearly a much costlier arrangement.

In the primary health space, there has been some recent movement after a 12-month lull owing to the pandemic. In July, we made a submission in response to the Primary Health Reform Steering Group’s draft recommendations discussion paper, which will inform the commonwealth government’s Primary Health Care Ten Year Plan. And in September, we made a submission to the Senate Community Affairs References Committee inquiry into the Provision of general practitioner and related primary health services to outer metropolitan, rural, and regional Australians. Both submissions stressed the importance of occupational therapy in multi-disciplinary teams delivering care in primary health settings.

This year’s federal budget included additional expenditure of $17.7 billion over five years on aged care, with $7.5 billion of that sum funding improved home care arrangements, and $7.8 billion supporting improved and more sustainable residential aged care.

In addition to this work, OTA’s policy and advocacy team has worked alongside members who give generously of their time and expertise to advance the interests of occupational therapists working with groups as diverse as schoolchildren, injured workers, those needing driving assessments, First Nations people, refugees and the terminally ill.

Labor has differentiated itself from the coalition on several aspects of the aged care debate, so this may well prove to be an election issue. OTA continues

It has been a remarkable year for a remarkable profession.

CONNECTIONS SUMMER 2021 7

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

Human-centred healthcare reform Carol Jewell | Acting National Manager, Professional Practice and Development

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have recently been prompted to reflect on the humanistic, consumer-centred foundations of our profession. They are engrained in our stance on people’s fundamental human rights to have agency, autonomy, self-determination, choice and control. They are also characterised in the person-centred way we enable and empower consumers. Humanism in healthcare involves respect, compassion and partnership with clients, families, groups, communities, organisations, and populations (WFOT, n.d.). As such, we should embrace the opportunity to engage and partner with consumers to better understand their lived experiences and collaborate with them to co-design services that will improve their healthcare experiences and outcomes.

Consumer-centred care values consumers’ subjective experiences and appreciates their knowledge, hopes, dreams and autonomy (WFOT, n.d.). The principles of consumercentred care are universally espoused in Australian healthcare policy. However, this does not necessarily mean these principles are effectively operationalised in our complex and multifaceted healthcare system. The strong advocacy that consumer lobby groups have undertaken in recent years suggests client-centred care is not as effectively embedded as it should be. If this is the case, it is a travesty for consumers, and an existential dilemma for our profession. Hamell (2013) clearly articulated this dilemma in her reflections on client-centred practice in Canada. She strongly recommended the profession put a renewed focus on the core values of consumer-centred care: one that champions and respects consumers’ strengths, experiences, knowledge and, most

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importantly, their moral right to make choices concerning their lives (Whalley Hamell, 2015).

We have a precious opportunity in Australia to renew our focus on consumer-centred practice by engaging and partnering with them. Indeed, Whiteford in her 2019 Sylvia Docker lecture implored us to “turn our attention to our blind spots and work together with our consumers and our communities to co-design services that are needed, wanted, valued and valuable in creating more inclusive, occupationally just communities” (Whiteford, 2019).

Consumer engagement and experiencebased co-design (EBCD) activities are a way to bring consumers, carers, families and health workers together to shape decisions about service development, quality improvement, research priorities, policy and practice (NHMRC, n.d.). EBCD is modelled on the principles of respect, dignity, inclusivity, shared ownership, and a commitment to continuous improvement. This ensures clients and communities have an equal voice as active partners, and that decision-making is “with” or “by” them, rather than “to”, “about” or “for” them (NHMRC, n.d.). The principles of these approaches are deeply embedded in the humanistic foundations of our profession.

EBCD makes it possible for us to better understand consumers’ lived experiences and collaborate with them to co-design services that will improve their healthcare experiences and outcomes. A wide range of practical and openly accessible EBCD resources are available. They provide guidance on how to engage and partner with consumers in the development, design, implementation and

evaluation of healthcare improvement and research (AHHA, n.d.; NHMRC, n.d.; NHS I.I.I., n.d.; UoQ, n.d.). They stress the importance of ensuring consumer engagement opportunities are accessible and flexible, and that consumer groups are representative. As EBCD groups are based on the principles of equal participation and shared ownership, they also stress the importance of: valuing each other’s perspectives, knowledge and beliefs; developing relationships based on clear and open communication and shared goals; focusing on solutions; and supporting the participation of consumers and the broader community. They all contribute to the development of an inclusive environment that is engaging, enabling, empowering and enlightening for all involved.

The principles and practice of consumer engagement, partnership and co-design are manifested in the fundamental humanistic client-centred principles of our profession.

We therefore have an ethical responsibility to engage and partner with participants to capture and develop a shared understanding of their lived experiences and collaborate with them to co-design services that enable and empower them to reach their full potential.

We have a lot to learn and a lot to gain by engaging and partnering with consumers.

As Gail Whitehead stated in her 2019 Sylvia Docker lecture, “Together we go further”.

References can be viewed by scanning the QR code

CPD

CPD CALENDAR

CPD updates For the latest courses and dates, please visit otaus.com.au/cpd

2022 CPD opportunities

Save 20% on e-Learning Available on all ticket types in December 2021 and January 2022* *Some CPD exclusions may apply

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Expression of Interest OTA are seeking expressions of interest for presenters delivering Continuing Professional Development content in a variety of formats.

Both experienced and first-time presenters are welcome to lodge an expression of interest.

To learn more visit www.otausevents.com.au/cpd-eoi

To support clinical decision making, continued learning and professional engagement, OTA offers a range of evidence-based CPD webinars, workshops, and online resources.

To browse and register visit otaus.com.au/cpd

A O TJ

How has the NDIS changed participation, inclusion and independence for people with a disability?

Dr Tammy Aplin, Editorial Board Member, Australian Occupational Therapy Journal

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Photo: ©gettyimages /portishead1

he Occupational Therapy week theme of participation, inclusion and independence celebrates our core role of supporting people to engage in activities they find meaningful. Reflecting on this theme, I wanted to explore how the introduction of the National Disability Insurance Scheme (NDIS) has impacted the participation, inclusion and independence of those we support. The Australian Occupational Therapy Journal has published a few articles describing participants’ perceptions and experiences of the NDIS. Many in the profession were hopeful that the NDIS would enable occupational therapists to more easily and flexibly support people towards a meaningful life, with choice and control. Eight years on what has transpired from the marketdriven scheme may not be what we had hoped, but there have been some positive changes, along with hope for the future.

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One significant change in the participation of people with a disability, has been the enhanced or new role of “informed consumer”. For some this change from passive recipient to active consumer was welcome, creating freedom to choose providers who would meet their needs best1. However, research with participants of the NDIS suggests this role can also be onerous, complex, time consuming and at its worst exclusionary. Adult participants and potential participants of the NDIS identified the need to be knowledgeable of the NDIS system and the services and

A O TJ

The expectation that in-depth knowledge of the system is required to gain appropriate support places significant additional burden on participants of the scheme ... supports available, before choosing the best services to meet their needs. A participant described, “If you’re not receiving support and you’ve got to go in for your [NDIS] planning meeting uninformed about how the system is, you’re not going to get the same kind of funding support as the one who goes in informed” (p. 43).

and support to enhance the participation and independence of people with intellectual and developmental disabilities4.

While hopeful, these studies have discussed that the NDIS has somewhat changed for the worse, the participation and independence of people with a disability. However, this is based on two articles with limited scope, and we must continue to explore the experience of a range of participants of the NDIS. This work will help to inform occupational therapy practice in the sector, along with NDIS policy and processes.

References can be viewed by scanning the QR code

The expectation that in-depth knowledge of the system is required to gain appropriate support places significant additional burden on participants of the scheme and disadvantages those who are unable to communicate or advocate1. The NDIS is considered excessively challenging to navigate and manage. Smethurst et al. (2020) spoke with parents of children with cerebral palsy receiving NDIS funding who reported the experience was “horrendous”, “life destroying” and a “nightmare experience”. The depersonalised nature and consistently poor communication and administration processes resulted in frustration, stress and negative participation outcomes for the families2. Participation was restricted for these families through lengthy processes, rejections and poor understanding by NDIS decision makers about assistive technology that could support children with cerebral palsy to participate in family life. Delays in equipment provision, restricted the family’s participation with some becoming socially isolated because they did not have the right equipment to participate in social or leisure occupations2.

While the additional role of “informed consumer” of the NDIS has been a negative participation change for many people with a disability and their families, there have been positive changes. People with a disability highly value being able to choose providers and to discontinue if unhappy with a service1 and some parents were grateful for what the NDIS could provide, hopeful that “maybe this is a system trying to find its feet” (p. 212)2. Additional recent articles in the Australian Occupational Therapy Journal also highlight the opportunities the NDIS provides in supporting the participation and independence of people with a disability, for example the opportunity to fund assistance dogs3 and increased access to functional training

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WFOT REPORT

WFOT update

Belong, be you, and appreciate our global impact Dr Emma George, WFOT 1st Alternative Delegate

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orld Occupational Therapy Day was celebrated on 27 October. I have no doubt that occupational therapists, their teams and students hosted events, discussed the wonderful depth and breadth of our work, and occupied their time in interesting and creative ways. I took some time to reflect on the theme “Belong.

Be You” and what it means to belong to the World Federation of Occupational Therapists.

I asked our WFOT delegate, Adam Lo, to share his thoughts on belonging to WFOT: “As a part of the WFOT family, I feel that as a profession we are making collective global impacts on the well-being of individuals, families, communities and society as a whole. It is also lovely to see how we apply occupational therapy in transcendent ways, intersecting across cultures, geography, languages and religion.

The family ties through WFOT allow the sharing of knowledge, research, wisdom, resources and experiences for occupational therapists across the world from the past, the present and into the future.”

Adam’s reflection reminded me of the many times that WFOT past president Marilyn Pattison has described WFOT as a family and place for all of us to belong. This connection to a WFOT family was echoed by second alternate delegate to WFOT Lynette Mackenzie when she said: “My time with WFOT has been so professionally and personally enriching. It is like a family. I have 12 otaus.com.au

Connecting with occupational therapists, 2021.

WFOT REPORT

made so many friends and colleagues from around the world, and being in the research program have worked on projects with some other great researchers, and extended my network enormously. Contributing to the Asia Pacific Regional Group has also been really important for occupational therapy in the region. I have also become much more aware of the advances in occupational therapy outside the Englishspeaking world that I think we can overlook at times. There is so much need in the world that WFOT makes a real contribution.”

As members of OTA, we are automatically members of WFOT and warmly welcomed into the global community of occupational therapists. The WFOT works tirelessly to advocate for occupational rights, and the essential work of our profession in promoting health and well-being. As members we are represented on a global stage, including collaborations with​the United Nations and World Health Organization.

WFOT has been a source of strength and identity for me in my professional career as I have learnt to belong and be me. I have worked as a community development worker, project officer, case manager, occupational therapist, international volunteer and more. Throughout the past 20 years I have always felt a strong sense of belonging to our profession, even when my adventures took me far

Sewing in Bangladesh, 2012.

from my home in Adelaide. Belonging to WFOT has sustained me when working in remote places and within the academic world of public health. My identity as an occupational therapist has kept me focused on occupation at the heart of my work.

Some of my favourite occupational therapy memories involve simple occupations, such as sewing with women in Kazakhstan and Bangladesh, and enjoying sport in multiple languages throughout Asia.

Drinking all different types of tea and coffee has proven to be a meaningful activity for me, and a way to engage with people and communities in every place I have visited.

Drinking tea with family in Kazakhstan, 2009.

Belonging to WFOT has given me the opportunity to connect with occupational therapists near and far, and there is still much for all of us to learn from each other. I’ll be tuned in online for the Asia Pacific Occupational Therapy Congress, to be hosted by the Philippines from 22-24 November 2021. You can still register for this event at apotc2020. com. I hope to see you there. In the meantime, you can access the WFOT Bulletin, which is published twice a year and is available through the WFOT website at wfot.org/bulletin.

WFOT congress After careful consideration, a decision has been made to reschedule the 18th WFOT Congress in Paris, France, to 28-31 August, 2022. There are still uncertainties associated with the Covid-19 pandemic, including concerns relating to vaccine availability, government restrictions and safe travel. The congress venue has provided flexibility to reschedule the event to the August dates to provide a greater opportunity for the occupational therapy community to meet safely and participate in an outstanding congress in 2022. Registration for the congress will open in early 2022.

CONNECTIONS SUMMER 2021 13

F E AT U R E

OT Week wrap up

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his year, OTs around Australia celebrated the work OTs do to support all people engage in activities they find meaningful. In celebrating, the theme for 2021 was occupational therapy supports participation, inclusion and independence, which encouraged reflection in the way OTs empower individuals within their community.

#THISISOT OCCUPATIONAL THERAPY

INCLUSION

Supporting

PARTICIPATION

25-31 OCTOBER

INDEPENDENCE OTAUS.COM.AU/OTWEEK

Broadmeadows Inpatient Psychiatric Unit

In 2021, there have been numerous challenges to the way OTs are able to work, but the value OTs have been able to provide to their communities has never been higher. This OT Week calls for an opportunity to educate, celebrate and reflect on the year and the accomplishments of OTs, whether that be with friends, family, colleagues or peers.

OTA have asked members to submit their celebrations and events for the week around Australia, from universities to hospitals, OTs have been able to participate in the festivities, virtual or otherwise.

World OT Day from the Royal Brisbane and Women’s Hospital.

University of Adelaide Occupational Therapy Students.

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F E AT U R E

Left: Fremantle Hospital Bake off winner – OT, Andre Shiel and Erin Clinch from OTA.

Fremantle hospital OT Week bakeoff.

Fremantle hospital OT Week bakeoff.

OTs celebrating at Broadmeadows Inpatient Psychiatric Unit.

CONNECTIONS SUMMER 2021 15

F E AT U R E

OT Week wrap up

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OT Students from Flinders University, University of South Australia and University of Adelaide.

F E AT U R E

Rocky Bay Group Photos of OT team Acknowledgment to Mariah Campana and Mia Huntley for arranging the morning tea.

CONNECTIONS SUMMER 2021 17

F E AT U R E

Where is the profession heading?

Perspective from an early career therapist Harley Hayes, Occupational Therapist, Everyday Independence

Workforce

Occupational therapists are in significant demand across Australia, with their talent and skills required across multiple sectors including disability, health, aged care, mental health and welfare.

This demand is providing occupational therapists with more opportunities and choice around career direction and progression than ever before.

This demand does not look like slowing – not with Australia’s ageing population and ongoing funding for therapy services through the NDIS. The disability sector has seen significant growth since the introduction of the NDIS. The NDIS workforce strategy indicates there is going to be continued growth in the sector over many years, and this is going to require a significant increase and development of the therapy workforce (Commonwealth of Australia, 2021) – providing new and exciting opportunities for occupational therapists.

For early career occupational therapists, I feel your pain with the ongoing pressure to meet this high demand for services.

Arriving to the profession from university or a different sector, there is a steep learning curve to feel comfortable and confident working in this space. However, I have seen significant career growth opportunities for therapists who are passionate about working in the disability field.

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I appreciate the hard work of experienced occupational therapists to upskill early career therapists like myself, and their efforts in spreading a finite amount of talent to achieve the greatest impact.

They would have spent many late nights and long days providing these additional supports. Since the sector has moved to individualised funding, many would have faced challenges pivoting to a commercial environment while ensuring evidence-based and high-quality services were provided.

Increased demand has presented significant challenges in the face of ever-increasing wait times. Being unable to access occupational therapy services in a timely manner has a significant impact on outcomes, and people being able to fully utilise their therapy plan budget. This presents a major risk to the profession, as early intervention and capacity building is a critical component of the NDIS success (NDIA, 2020).

As a profession, we have the opportunity to build a workforce that is leading disability practice and achieves high impact outcomes for people living with disabilities. But it will require the profession to be innovative and committed to ensuring that all Australians have access to occupational therapy services.

While we have such significant workforce shortages, it is critical to be working at the top of our scope of practice to achieve the greatest impact with our valuable time. This will ensure therapists are delegating, and building the capacity of others to embed therapy into everyday life. Working at top

of scope involves occupational therapists providing services that align with their skills and professional training. Initially, I found it challenging to utilise my full scope, as it took time to develop confidence in building the capacity of natural and formal supports. However, it has allowed me to continue to practise my craft through working more often at a higher level.

Opportunity

The NDIS is the first scheme in the world in which people living with disabilities are provided with individualised funding that is tailored to the person and their support needs. The NDIS is a unique system in that it utilises an insurance-based model and takes a lifetime approach for participants.

Currently, the NDIS is simply viewed as a funding body for disability-related services.

The original architecture of the scheme was based on social insurance principles, and the main function was to fund long-term high-quality care and support. Currently the scheme is purchasing hours of service and support, not outcomes. Occupational therapists have a responsibility to realign the scheme with its original intent, and deliver evidence-based, high-quality services that will change people’s life trajectories and build a more inclusive community – a better Australia.

In addition, the value of occupational therapy interventions should be linked to positive impacts, a return on investment for the Commonwealth, and a reduction in costs

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High-impact participant outcomes are, and always will be, the top priority.

However, we need to broaden our lens ...

to other government departments like health and education. High-impact participant outcomes are, and always will be, the top priority. However, we need to broaden our lens to consider the impact of intervention on reduction in core supports, a re-direction of core supports to meaningful participation, strengthening of informal supports, building mainstream and community supports, and deferred SIL funding. Let’s stay focused on economic participation for people living in disabling situations and their families.

The OTA independent assessments taskforce has recently shown great leadership and had terrific success, with the NDIA advising it will not continue to pursue independent assessments. Occupational therapists can be part of the solution by ensuring any assessment of support intensity is a collaborative process, driven and codesigned by the participant, and considering the person in their entire ecosystem of typical roles and routines. It is a great time to be a member of the OTA, and I would recommend encouraging our peers to come on board. A risk for occupational therapy includes packaging being based on predetermined personas and a shift away from individualised funding. We know the only way to assess support intensity and funding needs is to consider the dynamic interplay between the person, their environment (social, built, attitudinal) and routines.

Occupational therapists have been singing this tune forever, however we cannot keep singing without detailed music sheets.

This is called evidence. Our evidence will have greater impact as a collective.

Impact and inclusion

The unique skills and knowledge of occupational therapists to assess and provide intervention that removes environmental barriers will allow occupational therapists Occupational therapists have a unique skillset, and are one of the only professions with the relevant skillset to analyse and investigate the supports and environments around a person. This is a critical component in identifying the support needs of people living with disabilities. Knowing someone’s function is not enough to determine ongoing support intensity (e.g. core supports and therapy), as function needs to be viewed in the context of the relevant environment and ecosystem.

Research

The NDIS has encouraged occupational therapists to be innovative, and to build and develop new practices that will result in improved participation and inclusionbased outcomes. This will also place additional responsibility on occupational therapists to implement and champion evidence-based practice. We have the opportunity to support consumers in knowing what impactful therapy looks like.

Therapists will have great exposure to the disability sector through student placement or work opportunities, and those leaving university will have a more commercial mindset and awareness around providing value-for-money services. Personally, having the opportunity to complete a placement in a disability and commercial environment allowed me to translate those skills directly into workplace.

I also expect to see increased training opportunities for existing therapists seeking to obtain formal training to develop their skillset in disability. In ten years, Australia will be home to leading disability-based training for therapists, attracting global talent.

Over the next decade, the occupational therapy profession has the chance to cement itself as a critical piece of the puzzle in helping the NDIS achieve its purpose of supporting people with disabilities to live their best lives.

About the author Harley Hayes is an occupational therapist and behaviour support practitioner at Everyday Independence. Harley is passionate about supporting people living with disabilities to reach their potential through creating enabled and accessible environments. Harley was recently awarded the: • 2019 Early Career Clinician of the Year – Australian Allied Health Awards • 2020 Rising Star – Victorian Rural Health Awards • 2020 City of Greater Bendigo Young Australian of the Year

Training

I envisage we will start to see more training that is tailored to the disability sector.

References can be viewed by scanning the QR code

CONNECTIONS SUMMER 2021 19

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The history of a growing profession Angela Berndt, Acting Dean of Allied Health Programs, Occupational Therapy Program Director, UniSA

I

t was 1971. Australian rock band Daddy Cool’s classic song Eagle Rock was topping the charts when the first cohort of students signed up for an inaugural degree at the South Australian Institute of Technology (SAIT, now the University of South Australia, UniSA). This year marks 50 years since the Occupational Therapy Program began. With the theme of this edition being “This is OT”, we thought it a golden opportunity to share some of our history, values and contributions.

The Occupational Therapy Program’s story reflects common themes in our profession: willpower, advocacy and lobbying. Before it started, a small group of unflagging women – led by Cecilie Bearup (OAM) – created the South Australian Occupational Therapy Association in 1963, and succeeded in having the program approved and created. It secured registration status for the profession in 1974. We owe them such a debt of gratitude.

The program started at the Parkside Mental Hospital (later Glenside Hospital), a large and busy psychiatric hospital where Ms Bearup began work in 1963 upon her arrival from England where she trained at the London School of Occupational Therapy (State Library South Australia, collections. slsa.sa.gov.au). This alliance may explain some of the early values of the program, as occupational therapists were closely connected to the deinstitutionalisation processes of later years. For example, one of the long-standing academic awards, the Marjorie Black Prize, honors students who gain the highest grade point average 20 otaus.com.au

First graduating class of 1973.

in courses with psychosocial components.

Although not an occupational therapist herself, Marjorie Black created Marjorie Black House to offer security and social inclusion to people with long-term mental-health issues who were exiting psychiatric hospitals.

Fast forwarding a little in our timeline, the program re-settled in the Bonython Jubilee Building of SAIT/UniSA. Decades of students have studied in this building, which was formerly the School of Mines

Ann Wilcock

Cecilie Bearup

(and therefore has very few female facilities – an irony lost on no one). In the late 1970s and through to the early 1990s, however, the benefits of being in that building were the industrial-level workshops used for wood or cane work. Many hours of detailed activity analysis, making and adaptation practice occurred in those basement spaces. We also had the joy of being near the Botanic Gardens where, due to Ms Bearup’s foresight, we undertook gardening therapy and horticulture classes on-site.

Susan Gilbert Hunt

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Moving along, the program grew and matured. Due to the small size of the profession in SA, we benefited from the arrival of occupational therapists from across the world, including Canada and the UK, while we also began to grow our own.

An instrumental academic in our program was Professor Ann Wilcock, best known for her contribution and international leadership in occupational science. We were lucky to be the first home of the Journal of Occupational Science, which started in that same basement as a $2 shelf company with a volunteer workforce. But perhaps less known is Prof. Wilcock’s clinical background, which was stroke rehabilitation. Always a scholar, Prof. Wilcock (Ann Ellison, as she was then) co-wrote her first text as a new occupational therapy graduate with Peggy Jay and Elizabeth Walker, entitled Help Yourselves; a handbook for hemiplegics and their families (Butterworth, 1966). I was privileged to have had Prof. Wilcock as my neuro rehabilitation lecturer. I recall vividly one of her key messages, that was less about rehabilitation and more about equity and justice. She told us (and I paraphrase from memory): “One of the worst combinations to experience is to be old, female and a stroke sufferer. Your outcomes will be poor because you won’t be prioritised for treatment – not because of your stroke, but because of your age and your gender.” A powerful call to action for a generation of young occupational therapists.

In 1991, the State Bank of SA went bankrupt.

The debt and social impact was staggering.

A cohort of students faced the prospect of unemployment and the population was enormously impacted. However, only a

Top left – Prof Esther May, Prof Ann Wilcock and Sue Gilbert Hunt cutting our 40th birthday cake. Bottom left – the graduates photo. Right – Miss Cecilie Bearup.

few years earlier, Adelaide had hosted the 2nd International Conference on Health Promotion, which started from the position that health was both a fundamental human right and a sound social investment. The conference urged governments to promote health through linked economic, social and health policies. This combination of

Sue discourages the use of the term “role emerging” and encourages us to reflect – looking back and forward – to ensure our profession is always responding to community need.

social forces, coupled with the innovative mind of Susan Gilbert Hunt, led to the beginnings of the Participatory Community Practice (PCP) courses in the program.

As a result, participation through an occupational therapy lens and bottomup approaches to meeting community need have formed a core pillar of our ethos for 30 years. Sue discourages the use of the term “role emerging” and encourages us to reflect – looking back and forward – to ensure our profession is always responding to community need.

That is, the core values remain true, although the context might change.

Continued next page CONNECTIONS SUMMER 2021 21

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The history of a growing profession continued The photo wall in the Bonython Jubilee Building sadly only captures the graduates from 1999 onward. However, a scan of the faces and recollection of those who came before, shows our profession increasingly reflects the society in which we live, with more diversity. We are proud to report that in one cohort of our graduate entry master program, we achieved a 50/50 ratio of males to female students. But we hope to achieve more deeply as part of our UniSA RAP to grow Aboriginal allied health graduate outcomes.

The UniSA program has produced entrepreneurs, scholars, advocates, innovators and quiet achievers, and has always been a contributor to the wider profession through OTA. The occupational therapy program UniSA has had eight

heads of school/program directors over its 50-year history. Of those eight, four have been honoured with the Occupational Therapy Australia Sylvia Docker Lecture Award: Cecilie Bearup in 1982, Peggy Farrow in 1995, Prof. Ann Wilcock in 1999 and Susan Gilbert Hunt in 2017.

I am an occupational therapist because I believe in our values and the power of occupation for health and well-being, rehabilitation or recovery. We are growing a new generation of research and clinical scholars, whose challenge is to grow our evidence base. I’m a true believer but also a healthy sceptic, knowing some of our truths may need to be left behind as we continue to mature into our second century of existence.

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It is 2021, the profession and our program is embedded with solid roots from which to flourish. I remain passionate about our profession because of the stellar role models I have had the privilege of knowing. I am honoured to be the eighth academic lead of the UniSA program, and to uphold its values and traditions including participation, engagement and occupation-based practice.

About the author Dr Angela Berndt Is a graduate of the UniSA / SAIT program, class of 1987.

She is UniSA Occupational Therapy Program Director, recently Acting Dean of Allied Health, was past President of the Occupational Therapy Australia Board of Directors and was awarded the Honorary Life Membership of OTA in 2021.

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F E AT U R E

OT and rehabilitation, an obvious match?

Jessica Moretti, Occupational Therapist, JK Corporate Resourcing and Changing Ways Consulting

W

hen I hear the words occupational therapist and occupational rehabilitation together, it seems an obvious fit. Others may think not. Many times during the 14 years that I have worked in the occupational rehabilitation sector as an occupational therapist, I have found myself explaining or trying to justify to others – whether friends, family or peers – that I have a legitimate occupational therapy role.

I began my undergraduate studies at the University of Western Sydney in 2003 after being awarded an academic scholarship – not in the field of occupational therapy, but podiatry. It was not the right fit for me.

Fortunately, six months in, I began to learn about occupational therapy from my peers in combined applied science classes. I liked the diversity the profession provided – even though I had never really heard about it before – in supporting people with not only their physical needs, but also their psychological and emotional well-being.

I wanted to make a difference – to improve people’s quality of life, and increase their independence and feelings of self-worth.

This is why the profession appealed to me I changed course, and after four years of study and a variety of clinical placements, my final placement landed me in a private occupational rehabilitation business where I was fortunate enough to be given a full-time position. I thought I would give the role six months and then move from occupational rehabilitation into an occupational therapy 24 otaus.com.au

... it is equally important to explore a person’s goals and provide support in maximising their independence in self-care and leisure.

role in a community or hospital setting.

I never did – and 14 years later, I am still working in occupational rehabilitation, loving it, and never looking back or wondering where I would have been otherwise.

When people talk about occupational rehabilitation, it is often related to worker’s compensation: workplace assessments, return-to-work plans and functional assessments. However, there are many more layers to the role.

I have helped people in a vast array of workplace settings, from teachers to nurses, oyster farmers, florists, butchers and plumbers. The role never gets mundane, with a new challenge and problem to solve every day.

The role never gets mundane, with a new challenge and problem to solve every day.

I have worked my way from a junior to senior therapist, to a team leader, branch manager and injury management

specialist for a large, education-based employer. I have worked within the workers compensation, compulsory third party insurance and NDIS sectors – all complicated systems in which people need support, guidance and help to advocate with doctors, employers and sometimes the Industrial Relations Commission.

This is the core role of an occupational therapist in occupational rehabilitation.

When we go back to the basics of occupational therapy, we look at the three activities of daily living: selfcare, productivity and leisure.

Having an occupation helps people shape how they identify themselves. Employment not only provides financial stability, it allows people to feel they are contributing members of their household and community, and provides meaning to their life. Some injured workers quickly shift from identifying themselves with their profession to identifying themselves as injured. It is therefore imperative for occupational therapists to help them see beyond their

Photo: ©gettyimages /sturti

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injuries, and support them to maintain their identity in the activities of daily living.

Occupational therapists in occupational rehabilitation must have a strong mix of clinical, strategic and negotiation skills. They help employers, too. It is about ensuring that people’s return to their occupation is safe, supported and sustainable, with minimal risk of re-injury.

OTs in occupational rehabilitation must have a strong mix of clinical, strategic and negotiation skills.

They help employers, too.

Supporting clients to a successful return to employment may be the primary goal in this sector, however, it is equally important to explore a person’s goals and provide

support in maximising their independence in self-care and leisure. It is about determining how a person’s incapacity in the workplace will also affect their capacities in their home environment and community. It is about determining how productivity links to self-care and leisure, and how each of these core areas equally rely on the other to maintain or improve a person’s physical capacities, independence, psychological well-being and feelings of self-worth.

The Australian Rehabilitation Providers Association believes early referral to a workplace rehabilitation provider for specialist, return-to-work intervention services is one of the most critical factors in helping injured workers achieve a successful outcome (ARPA, 2021).

About the author Jessica Moretti has been a practising occupational therapist for 14 years. She is working as an occupational therapist for JK Corporate Resourcing and Changing Ways Consulting. An F45 training tragic, South Sydney supporter and lover of true crime podcasts, Jess is kept on her toes by her wonderful children Ava and Alex.

JK Corporate Resourcing is a member of ARPA in Queensland and NSW, providing workplace rehabilitation services to the injured worker community.

References can be viewed by scanning the QR code

CONNECTIONS SUMMER 2021 25

F E AT U R E

How one man got his life back through OT Emma Edwards

R

hys Gray is a T9 complete paraplegic who credits a host of amazing occupational therapists and a vehicle modification specialist with getting him back to 90 per cent of his pre-injury life.

“I had my accident on 5 September 2016: I fell off a truck at work,” he said.

“The impact of that has definitely been pretty catastrophic. Hard on the person and on the whole family.

“I have four daughters and a son, and when I had my accident, my eight-yearold daughter at the time was really upset because we do a lot of camping, fishing and shooting, and all that fun stuff. She thought that was it for us. That was the driver for me to get back out and do the things that I love to do. So I spent a lot of time trying to find occupational therapists who were as committed to my goals as I was.”

Versatility of equipment enables Rhys to get back to his passion.

Life transformed

Through his work with Tom Ely, Angela Rankin, Susan Lett and Ryan Waterman, Rhys says his life has been transformed.

“I’ve got a Zoom wheelchair for the beach and snow, and I’m getting solar actuator gates on my farm to allow access without excessive transfers. I’ve got custom wheelchairs that have made a huge difference to my pain, and a custom bed – as I’m 6’1” and the standard mechanical beds don’t bend in the right position, which also affects pressure on my skin. Then there’s my kitchen which has lifts for the bench tops and the overhead cupboards.

26 otaus.com.au

Rhys’ custom ute includes a crane on the back, lifts in the doors and hand controls.

“That’s just a sample of what they’ve done for me. I’ve been incredibly lucky to work with such great people.”

But, given his lifestyle, Rhys says getting back into a 4WD was “huge”.

“I said to Ryan from Independence Automotive: ‘I need to be able to drive into the middle of the river and throw my chair out – then the dogs can swim, the kids can play, and my wife can drive the car out of the river. And that’s me back to normal.’

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Rhys has had multiple trips through the Victorian High Country and Wonnangatta Cattle Station.

Everyone always looked at me a bit strangely when I said that. But that’s what I like to do.

“I had a brand-new ute dropped off with Ryan and he did all the modifications that I had approved through the Transport Accident Commission: the tray, lifts in the doors and hand controls.

Versatility of equipment

“Then he put a quick lift crane on the back of the ute that lifts 500 kilos. So that’s amazing for me because I work in the building industry. If I want to pick up something, well, I can’t just throw it in my ute anymore, but I can hook the crane up to it and put it on the back. The versatility of this equipment is just huge.

“Since then, I’ve done multiple trips through all the Victorian High Country and Wonnangatta Cattle Station. The car is very capable, whether I need to go down to the

“Now you’ll find me in places that people in wheelchairs probably really shouldn’t go.” creek or up a mountain into the snow or the desert – possibly even going to pick up the groceries. The car will do it all.

“I’ve always worked in the vehicle modification industry, but with imports,” he said.

“It’s life-changing for someone in my situation. It’s massive, actually. It gets me back to 90 per cent of what I used to do, to be honest. Everything I did before my accident I’ve done since my accident.

“Then one day someone asked me to help with an accessibility modification. They were thrilled and told someone else, who told someone else, and here we are.

“Now you’ll find me in places that people in wheelchairs probably really shouldn’t go.”

For Ryan Waterman, from Independence Automotive, being able to help people get back on the road is hugely rewarding.

“As the parent of a child with cerebral palsy, I know what that independence means and the importance of having things as easy to use as possible for each person. Working with occupational therapists and thinking outside the box – it’s life-changing work.”

CONNECTIONS SUMMER 2021 27

VI RTUAL ST U D E N T C A R E E RS FORUM

Supporting your transition to practice Occupational Therapy Australia’s inaugural Student Careers Forum held on Thursday 26 August 2021 provided a unique opportunity for soon to be graduating fourth year and second year masters occupational therapy students to come together virtually from universities across the country to support their transition to practice.

Delegates were exposed to a carefully curated program including: Preparing for and maintaining registration Hearing OT stories and pathways to success OTA as a partner for your career

An exclusive feature of the forum platform enabled delegates to meet and interact with 20 employers in an Employers hub. This was a very popular feature and delegates and employers engaged in these opportunities to connect through chat, direct calls and share contact details.

Thank you to the support from our members in lending their expertise and experiences to this forum and our partners for presentations and engaging with students through the Employer Hub.

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Securing your future responsibility including superannuation, insurance, and contract employment Professional Resilience and preventing burnout Employer Panel Discussion exploring what employers are looking for

VIC

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54

178

WA

Benefits and opportunities of working in regional and remote Australia

ACT/NSW

Students

19 SA

24 QLD

Students from all over Australia participated, including representation from the below Universities: Australian Catholic University Charles Sturt University CQ University Curtin University Deakin University Edith Cowan University Flinders University Griffith University Imagine Me / University of Sydney LaTrobe University Monash University Swinburne University of Technology University of Canberra University of Newcastle University of Queensland University of South Australia University of Sydney University of Sunshine Coast Western Sydney University

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We would also like to acknowledge the support of our major sponsors and their contribution to the program sessions:

“The forum allowed for employer contact that allowed me to ask targeted question to private practice employees I would not have had the opportunity to ask otherwise” C. Smith

“I found the forum to be really beneficial to help me refine what I’m looking for in a new graduate position!”

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Occupational therapy in 2050 Adam Lo, WFOT delegate

On technology

Mind-controlled prosthetic arms, self-driven cars, robots with sophisticated artificial intelligence (AI) providing real-time therapy and counselling: these capabilities are no longer science fiction. They are fast becoming a probable reality, if not already. Our advances in technology, machine-learning, big data, the Internet of Things and quantum computing will soon be increasingly embedded within healthcare innovation and delivery.

Diversity

Aside from technology, the foundation of occupational therapy is beginning to shift with increasing cultural, linguistic and geographic influences. Because occupational therapy was pioneered in the Western World, it was defined and developed by a certain perspective and methodology. As other countries begin to learn about occupational therapy, occupational science and all the intricacies associated with the field, they are also intentionally or unintentionally reshaping the profession in the process. According to the World Federation of Occupational Therapists (WFOT) Human Resources Project 2020 – which examines the global demographics of the occupational therapy profession – Japan ranked second behind the USA in having the most practising occupational therapists in the world (with almost four times the number of occupational therapists in Australia). This shows how Japan, with its distinctive culture and language, will define occupational therapy practices in its unique way. Japanese occupational therapist Tomoko Kondo wrote in 2004 that “the study of culture and the 30 otaus.com.au

production of culture-specific occupational therapy theories will contribute to best practice. I conclude by demonstrating that universal as well as culture-specific theories are needed to nurture occupational therapy”1 .

Holistic disruption

Over the years, and particularly in recent times, more and more alternative views and approaches have emerged as a result of the technological, geopolitical and epistemological changes in occupational therapy. Disruption of the status quo seems inevitable. This can be a positive phenomenon as occupational therapy becomes increasingly holistic in its evolving theoretical and practice frameworks – living up to its own core concepts of holistic care models. This growth in the diversity of collective knowledge, experiences and cultural lenses may be the catalyst to positive disruptions that seem to be appearing in various fields such as medicine, health, science and technology.

Such disruptions will hopefully enhance efficiency in occupational therapy practices (within the diverse fields of practice in which they engage), reduce the resources and costs required to deliver interventions, enhance accessibility, or foster breakthroughs in areas in which it was previously stuck. However, on the flip side, will all these changes and disruptions create division, conflict, tension and uncertainty? What are the risks posed to clients, society and the profession as a whole?

be helpful for our profession to be proactive, and address some of the potential issues and existing issues now before they become real problems. Change is inevitable, but we can steer the rudder in a direction that will benefit occupational therapy – whichever direction that might be. One thing is for sure, it will not be a straight line. Therefore, ongoing adjustments, refinements and reflections are essential. We can all play a part in shaping the future of our profession in a positive way at the local, national or international levels. Personally, I think that while we need to be flexible and adapt to a changing world, there are many traditional values and concepts of occupational therapy that I will continue to preserve and protect.

We must all continuously work together to create a holistic profession with holistic considerations to cater for a holistic world.

About the author Adam Lo has 19 years of experience as an occupational therapist and mental health clinician. He is the WFOT delegate for OTA and a board member. Adam works across the spectrum of mental healthcare from promotion to complex clinical care.

He is a strong advocate for consumers and their families, and works hard to champion for the profession, with a keen interest to work collaboratively with fellow occupational therapists across the world.

Occupational therapy in 30 years

Without a crystal ball, we do not know how occupational therapy will look in 2050. It might

References can be viewed by scanning the QR code

2022 OT EXCHANGE

CENTREPIECE at Melbourne Park

Learn Practise Enrich

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

9-10 JUNE 2022 If you currently work in or have interest in the Aged Care, Disability, Knowledge Translation, Occupational Rehabilitation or Paediatrics space, and are looking for information on the latest innovative solutions and updates to practice, then the OT Exchange is the event you should attend in 2022.

Located at CENTREPIECE, a brand-new and accessible venue located in the Melbourne Park precinct, the OT Exchange 2022 is an inclusive and interactive conference for all working within the broad spectrum that is occupational therapy. It is designed so that all participants — whether they are clinicians, students, managers, educators or academics — will contribute and employ ideas of value, implementing solutions into their own work.

KEY DATES Registration Open January 2022 Program Available February 2022 Exhibitor Presentation Submissions Close 28 February 2022 Early Bird Registration Close 17 March 2022 Occupational Therapy Australia acknowledges the support of our sponsors: OT Exchange Partner

Major Sponsor

Supporter

To find out more about available sponsorship and exhibition opportunities, visit the website or email events@otaus.com.au

FURTHER INFORMATION

P: 1300 682 878 E: otexchange@otaus.com.au www.otausevents.com.au/otexchange2022

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Staff concerns in an evolving Covid-safe workplace Anna Pannuzzo, Director at WorkPlacePLUS

This article provides general, bestpractice advice on three of the top Covid-related concerns of allied health practice owners. Employment arrangements for each workplace must be assessed on an individual basis.

O

rganisational landscapes are always adapting to a range of external influences, such as changes in technology, community attitudes, competition, legislation and climate.

Even before Covid-19, we have seen how weather events such as bushfires and floods have impacted workplace operations in healthcare settings.

The Covid-19 pandemic has amped up the need for organisational agility, with employers and workers continuously adapting to new developments in Australia’s evolving Covid-safe work culture. This can be particularly challenging for private practice owners, who must stay alert to changing rules and restrictions, and address staff concerns while continuing to maintain day-to-day operations.

It is important for private practice owners to refer regularly to bestpractice guidance from the Fair Work Ombudsman and Work Health and Safety (WHS) authority in their jurisdiction.

Following below are three Covid-related staff concerns that allied health practice owners face, with corresponding general, best-practice advice.

32 otaus.com.au

Flexible working arrangements

During the Covid-19 pandemic, many allied health practitioners have enjoyed utilising telehealth as an alternative to face-to-face services. As Covid-19 restrictions ease, private practice owners may want their staff to return to “normal”, while some practitioners and office staff may wish to maintain more flexible or hybrid work arrangements.

WHS jurisdictions around Australia agree that flexible work arrangements can promote a greater sense of work-life balance, which prevents work-related stress and burnout.

The Fair Work Act 2009 outlines employee rights for flexible working arrangements, and how employers can manage these. For example, private practice owners must: • Consider each employee request and try to agree on a new arrangement • Grant or refuse the request in writing within 21 days • Only refuse a request on reasonable business grounds Private practice owners should take a bestpractice approach to managing flexible working arrangements. This includes: • Developing and promoting workplace policies on flexible working arrangements, managing remote employees, and ensuring practice managers are trained in these areas • Considering how technology like telehealth can help • Informing employees on options, providing support to adjust to changes, and mitigating the risk of one employee’s

work arrangements negatively impacting another employee’s workload • Recognising that flexibility requirements may change, and scheduling regular reviews to address any issues or concerns promptly

Covid-safe workplaces

Private practice owners must abide by WHS laws and provide Covid-safe workplaces.

Best-practice protocols include: • Doing a risk assessment of the workplace • Carefully planning and designing work systems and physical environments to avoid risks and hazards • Speaking with team members about WHS risks and any significant changes in the workplace • Ensuring there is a good emergency plan in place • Providing communication, assistance, resources and support to employees who may be impacted by workrelated hazards or incidents, and ensuring resources are provided in different languages as required All states and territories require or encourage workplaces to have some form of Covid-safe plan. Even if a private practice has previously conducted a risk assessment, it should revise and implement updated control measures each time Covid restrictions ease. For example, it should ensure policies, procedures and systems address the following concerns:

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The Covid-19 pandemic has amped up the need for organisational agility, with employers and workers continuously adapting to new developments in Australia’s evolving Covid-safe work culture

Who is responsible for preventing, responding to, and reporting a Covid-19 outbreak in the practice?

• What infection control measures will be implemented?

• How can social distancing be maintained?

• What forms of contact tracing are being implemented?

• What approach to mandating and monitoring Covid-19 staff vaccination will be taken?

• What privacy, record-keeping and anti-discrimination measures will be implemented?

• Are there sufficient leave entitlements and workplace adjustments for staff?

• Is there sufficient communication and training for staff?

• Is there sufficient mental health support for staff, like an Employee Assistance Program (EAP)?

Mandatory Covid-19 vaccinations

State and territory governments have made, and may continue to make, public health orders requiring certain workers to be vaccinated against Covid-19. In many cases, these orders apply to the allied health profession, and private practice owners and their staff must comply with them.

Preparing to bring workers back on site? Please contact WorkPlacePLUS to receive your complimentary Returning to the Workplace checklist

Public health orders aside, an increasing number of Australian workplaces across a range of sectors are now choosing to implement mandatory Covid-19 vaccination as a new condition of employment or on-site attendance. The Fair Work Ombudsman advises it is reasonable for healthcare employers to mandate Covid-19 vaccinations for client-facing or on-site workers, as they will have close contact with people particularly vulnerable to the health impacts of Covid-19. This applies to the allied health sector.

In some instances, you may need to offer extra support services such as an EAP.

While some employees may be concerned about mandatory vaccinations, allied health practitioners who are employees must comply with any applicable public health orders, and any lawful and reasonable directions from employers.

All OTA members receive special OTA member benefits through WorkPlacePLUS for support with human resources or industrialrelated issues. For more information, contact Anna Pannuzzo on (03) 9492 0958 or visit www.WorkPlacePLUS.com.au.

It is always important for private practice owners to understand employer rights and obligations. If you have any questions, or require more detailed or tailored information, it is advisable to seek professional advice, whether through the WHS authority in your jurisdiction, the Fair Work Ombudsman or a human resources consultancy that works closely with the allied health sector, such as WorkPlacePLUS.

Private practice owners should provide staff with reliable, facts-based information and practical support on Covid-19 vaccination. They should also provide ample opportunity for staff to discuss any concerns. If private practice owners take steps to lawfully mandate Covid-19 vaccination in the workplace, or if a public health order requires it, then any employee who refuses to get vaccinated will find their employment options limited.

In general, it is best practice for private practice owners to take a compassionate approach to resolving any employee concerns. Always listen carefully to any staff concerns, and talk things through.

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Creativity and transdisciplinary practice in aged care Renelle Harrison, Occupational Therapist

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ccupational therapy is an innately creative profession. Our vibrant history is firmly steeped in the arts and crafts movement, with origins in the use of basket weaving and leatherwork as a means of rehabilitation and well-being. Of course, as the body of professional knowledge and evidence has continued to grow, so, too, have the frameworks and approaches to practice.

Contemporary practice – where do we fit?

Fast forward to present day, and we can see an evolution of the profession as we emphasised the biomedical approach, expanded horizons in recovery and mental health practice, and employed the principles of occupational therapy more broadly in the context of rehabilitation.

Occupational therapy now encompasses a wide range of models, frameworks and theoretical approaches. Practically, the profession is also further enriched by the breadth of interests and experiences held by this magical breed of practitioners.

Today we see occupational therapists in a vast array of health and community settings – and yet while we appear to be almost everywhere, it sometimes seems as if we don’t really fit anywhere.

Such has been my own professional struggle of late. After the exciting new 34 otaus.com.au

graduate years, I took up a series of roles in community and hospital settings and eventually landed in aged care.

What does OT mean anyway?

While I have always loved my clients and work, I have often felt that institutional environments placed various constraints that prevented me from fully outworking my occupational therapy principles and ideals. In other words, the ideal has been continually sacrificed on the altar of practicality.

In my aged care role, I have focused on pain management, as well as working with an allied health assistant to create and implement programs based on cognitive stimulation therapy for residents with dementia. In the course of my CPD, I was happy to see the overwhelming body of evidence in relation to the benefits of creativity and facilitating the older person to cultivate their own creative practice as a key aspect of healthy ageing. It became apparent to me that the creative process in and of itself held validity as an intervention for improving occupational performance.

The creative process itself, regardless of the end product, brings together elements of self-care and self-attentiveness, cognitive stimulation, biofeedback, motor and sensory components, rest and leisure, a sense of agency with strong interpersonal links and connection to our physical and cultural

environments. The creative process helps us gain a sense of the world and our place in it – even touching on aspects of our spiritual being, an element of our theoretical approach as occupational therapists that often seems all too difficult to articulate in the reality of everyday practice, especially in aged care. With all the evidence and the obvious clinical benefits, why wasn’t I seeing more of this targeted and specific intervention in residential aged care?

I started to long for ways to reconnect with the origins of our profession; rediscovering what we have known all along, but reappropriating our rich heritage for contemporary practice. And I wondered: what does occupational therapy really mean to me in this context?

Exploring transdisciplinary practice

This line of thinking and questioning drove me back to my roots in undergraduate study, where I drew on the concept of transdisciplinary practice. As occupational therapists, we’re very familiar with the idea of multidisciplinary and interdisciplinary practice, but for me, transdisciplinary practice had been something left firmly in the textbooks.

“Transdisciplinarity integrates the natural, social and health sciences in a humanities context, and transcends their traditional

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boundaries” (Choi and Pak, 2006). More than simply exchanging information, transdisciplinary practice promotes role release, transfer of skills and free-flowing communication. Pouring over the stories of artists and aged care residents in the course of my CPD, I knew that bringing professional artists into this space was integral to how this aspect of practice could be more fully explored. Artists bring a professional body of knowledge that supports the creative process in a deeply personal, intuitive manner, adding more dimensions to the occupational therapy perspective.

A project is born

The key to making a way forward was forging the synergistic partnerships that enabled sharing of knowledge and transfer of skills. I decided to reach out to my local regional arts body, Eastern Riverina Arts, with an idea that had been on the back burner of my mind: creating an opportunity for artists to complete a residency in an aged care facility. In a twist of fate, funding became available within a couple of months, and the genesis of a collaborative, transdisciplinary project was in motion.

The power of shared practice

The residency would give the artist time and space to freely explore ways and methods of unearthing and facilitating shared creative practice with individuals in residential care experiencing dementia or ill health. As the focus was on facilitating the creative process, there was less emphasis on the outcome, which relieved pressure on all involved to produce something. Instead, we could focus on the beauty of facilitating the process and how the aspects of each of our disciplinary areas overlapped or complemented each other, with the older person at the centre, leading the practice.

Lasting about six weeks, the program would be bookended by initial training, preparation and debriefing for artists. A former dementia clinical nurse consultant, occupational therapist and two local artists shared stories, space and knowledge

as we embarked on the experience. An allied health assistant was also utilised to assist with selecting and providing initial information to participants for the creative ageing program, and creating another point of contact for artists when on site.

What followed was something I can only describe as an unveiling. Not only did we discover, transfer and draw on the professional skills of one another in cofacilitating creative practice, the participants themselves unveiled skills, perspectives, dreams and discoveries of their own, revealing new facets of identity, shared experience, engagement and roles, and ultimately new meaning in the process of creating as occupation. The flow-on effects also made shared memories with significant others – whether a spouse, friend or staff.

Reflections

The importance of holding space: Some participants were unsure of the process or not confident in their abilities, so the concept of holding space became central to facilitating a shared creative practice.

Artists were key to holding the space as participants found traction to engage with the process and begin their work. The therapeutic use of self was a technique that bridged disciplinary boundaries easily.

The importance of knowledge translation: Occupational therapy has a wide body of evidence, but we also have a wide scope of practice. Becoming skilled in the art of knowledge translation will help us see more of our research hitting the ground in practice. Navigating this territory has opened my eyes to the possibilities of this area of practice for our profession.

Finding language to frame, forge and expand transdiscipline partnerships: Becoming aware of how our professional frameworks intersect, align and complement others is key to creating strategic partnerships. My biggest reflection: it will remain impossible until you do it.

Expanding our horizons: Our various models of practice give us a unique perspective allowing us to frame occupational performance in terms of its various domains and subdomains, while also looking holistically at the person, their environmental contexts, and their goals and roles that feed into the richness of layered meaning through occupational engagement.

I found engaging in transdisciplinary practice was like looking at the two sides of a coin, and then looking at that same coin again with coloured glasses.

It expands the creative possibilities.

Back to the beginning

It’s an exciting time to be an occupational therapist. I look forward to what the future might hold as we continue to break barriers and show the world: “This is OT”.

About the author Renelle Harrison is an occupational therapist from Wagga Wagga, NSW. She uses the principles of her practice in clinical work, health writing and in forging strategic transdisciplinary partnerships to see occupational therapy take shape in new ways. Her interests are in paediatrics and ageing, public health and in implementing evidence into practice through effective knowledge translation.

Acknowledgement This project was funded by the NSW Government through Create NSW Arts Restart Package, with the assistance and support of Eastern Riverina Arts.

References can be viewed by scanning the QR code

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Safe vehicle transport for children with disabilities Helen Lindner, Chief Executive, Mobility and Accessibility for Children in Australia (MACA)

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ACA’s recent national survey by Curtin University showed health professionals report low selfconfidence and knowledge when prescribing safe vehicle transport options for children with disabilities and medical conditions.

MACA’s new, evidence-informed website macahub.org – funded by the NDIA – is the first step towards addressing this. It is the result of almost two years of research, advocacy and policy development. Importantly, the resource has been informed by the lived experience of families and the clinical perspective of allied health professionals.

Macahub.org contains independent and trusted information for parents and carers, and allows confidence when making decisions about children’s vehicle transport needs. MACA believes every family deserves peace of mind that their children are travelling safely and comfortably.

connections to MACA, the paths they took to becoming occupational therapists, and why they value their profession.

clients, empowering them to state their needs about everyday supports. It’s all about supporting participation in everyday life.

Lisa Vale, principal OT at MACA

We have so much to offer, and I hope that in years to come the evidence base continues to solidify, and we become more confident and vocal in our scope of practice.

My role at MACA is to provide the perspective of occupational therapy and an allied health professional – contributing this knowledge to the development of website content, resources and training.

I also advise allied health professionals about best-practice approaches to prescribing assistive technology, and developing strategies to support safe transport for children with disabilities and medical conditions.

Health professionals can also find information about vehicle restraints and their safety, policies, jurisdiction-specific template letters and answers to frequently asked questions.

Why are you an OT? My sister was born with a neurological condition and had frequent hospitalisations during her childhood. As a result, I became aware of occupational therapy from a very young age. When choosing a career, I thought occupational therapy had a great mix of both science and creativity – and I was always focused on paediatrics as I really love working with children.

Occupational therapists play a fundamental role in helping MACA to achieve its vision: that every child has access to safe and accessible transport, regardless of circumstance. In this article, we introduce some of these occupational therapists and outline their

Why do you value OT? I value occupational therapy because of its amazing ability to analyse where an activity or performance is breaking down, and cocreate solutions with clients and families.

We are able to advocate and lobby for our

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Dr Susan Greaves, OT manager, RCH

The occupational therapy department at The Royal Children’s Hospital, Melbourne, has been working with MACA (and its predecessor TOCAN) to promote the safe transportation of children – our primary focus being children associated with a tertiary hospital. This work ranges from evaluating lie-flat car beds for children unable to be upright, to finding suitable car-seating solutions for children in hip spicas or braces. This muchneeded work aims to help determine and standardise best practice in this area.

Why are you an OT? I was attracted to occupational therapy because I felt it provided a broader perspective of healthcare than many other health disciplines, and had a great variety of areas in which to practice. Having said that, I have only worked in paediatrics since graduating.

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Why do you value OT? I value occupational therapy because we focus on what is important to children and families, work with them to solve their problems, and offer practical solutions to promote their participation in everyday activities.

Dr Melissa Black, Curtin University

I worked with MACA to develop and implement a large national survey exploring the transport needs of children with disabilities and medical conditions in Australia. This project provides us with insights into the state of vehicle transport for children with disabilities and medical conditions in Australia, and directions on how we can better support children and their families to travel safely and comfortably.

The follow-up survey will enable Curtin University to evaluate the impact of MACA’s new national information resource.

Why did you become an OT? When I was in high school, I knew I wanted a career in which I could help people, but I wasn’t sure what it would look like. I was lucky to meet an occupational therapist, and once I learnt about their work, I knew it was the career for me. What drew me to occupational therapy was the fact you could work with people to make a real difference in their lives.

Why do you value OT? Occupational therapy has given me a new way of thinking about the world and the people in it. It challenges me every day, and forces me to think outside the box.

Belinda Egan and Kyle Norton, masters of occupational therapy practice, Monash University

We were involved in a project for MACA as part of our masters degrees at Monash University.

We developed behavioural strategy guidelines for supporting children with challenging behaviours during vehicle transport.

The guidelines assist allied health professionals to develop their knowledge, clinical reasoning and decision-making.

Why did you become an OT? Kyle: I worked as a rehabilitation therapist before pursuing an occupational therapy degree. During this time, I had the opportunity to see clients across a variety of different settings, and learn about the roles of different allied health professionals. I was drawn to occupational therapy because I saw how rewarding the profession could be when a client reached their functional goals.

What is incredibly special about occupational therapy is that we have the privilege to work with people from all walks of life to enable them to participate in what is meaningful to them.

Belinda: There have been many times when members of my family have required occupational therapists. One thing I noticed was how much time and effort occupational therapists spent not only caring for and treating members of my family, but also providing support for their carers.

What I really value about occupational therapy is that we see the person first and take a holistic approach to health and well-being.

Why do you value OT? Kyle: Occupational therapy has a unique ability to improve the quality of life of

an individual through facilitating their participation in occupations they find meaningful. This is often accomplished by thinking outside the box and providing solutions that clients may not have considered, such as altering their environment or providing adaptive equipment to help them regain skills they may have lost.

Improving the physical, emotional and mental health outcomes of vulnerable people is an incredible opportunity, and I look forward to helping people for many years to come.

Belinda: Occupational therapy is so valuable as it enables everyone from children to elderly people to participate in activities that are important and meaningful to them. They do this by developing interventions which are specific to each individual, whether that be assistive devices or implementation of services.

MACA looks forward to continuing to collaborate with occupational therapists and other health professionals to improve road safety and participation outcomes for Australian children and their families.

About the author MACA is a registered charity dedicated to advancing the rights of children with disabilities and medical conditions to safe and accessible transport. Chief executive Helen Lindner has an early childhood and policy background, and has worked in road safety and the transport sector for a decade.

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Maximising participation through home automation Karen Maurer, Managing Director, Capable Spaces

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ome automation allows people with limited or progressively deteriorating movement to remain as independent and safe as possible in controlling their environments.

Occupational therapists can use electronic assistive technology to design home automation systems – like switches and alternative access methods – and then train clients in technological literacy. Keeping up-todate with the brands and products available to set up smart homes is critical to this role.

In activities like using a mobile phone, controlling air conditioners and fans, turning lights on and off, talking to visitors at the front door, and opening and shutting windows and blinds. Determining what is reasonable and necessary, compared with what is luxury and mainstream, can be challenging.

As an emerging field of occupational therapy, some strategies are offered to build skills in this role.

Focus on OT process: Human, activity and assistive technology

This is the foundation in designing a system to control appliances that the client will then learn to use.

Maximise use of technology

Practise optimising accessibility features in devices people already own before introducing new products (Deverell, 2020; Erickson, 2015), such as the following: • Access devices hands-free; • Try different access methods i.e. switch controls, gestures, eye and head movements, voice control; and • Be familiar with accessibility across different platforms like Apple, Android, Windows.

Recognise the importance of training clients

Learning to use new technology can be intuitive for some, but for many it takes practice. Occupational therapists may set up training programs to develop skills to use technology efficiently (Jamwal et al., 2020). Setting clear expectations for training as part of the process reduces the risk of abandonment (Cruz et al., 2016).

The Human Activity Assistive Technology (HAAT) model by Cook and Hussey provides a clear assessment framework (Cook et al., 2008; Giesbrecht, 2013). The occupational therapy assessment begins by assessing the human, their diagnosis and prognosis, occupational goals, level of function, ability to learn new technology and willingness to change.

Designing a whole system versus single appliances

As de la Guía et al. (2019, p.179) explains, “this process requires considering the human aspect, since the human is, in fact, the main subject of smart environments”.

Someone with a long-term injury – like a spinal cord injury – may require a more comprehensive and coordinated approach for environmental controls and automation.

Assessing assistive technology includes outlining devices to be controlled, age of appliances, brand preferences, model/serial numbers, and the client’s context including environmental and social supports.

Developing a system that integrates the control of appliances and access methods is imperative to determine an efficient and effective home automation system that will be used for years to come (MacLachlan and Scherer, 2018).

Consider your client’s diagnosis and prognosis when designing home automation systems.

Someone with a rapidly deteriorating condition may need rapid-install solutions that may focus on one appliance or function, like turning lights on and off.

Build your support network

Build your network for home automation so you can recommend, install and set up home automation. Consider the system may need to work with any augmentative and alternative communication.

Develop your team of speech pathologists, home automation installers, specialist electricians, assistive technology suppliers, technology assessors, engineers, builders and so on.

Summary

Home automation is an exciting and everchanging area of occupational therapy.

Occupational therapists use home automation to maximise people’s independence in their homes to manage functional limitations from a disability or health condition. Quality of life often improves when people have greater control over their environment (Desmond et al., 2017). Occupational therapists are wellsuited to this role due to their expertise in assessing function and overcoming these with assistive technology solutions, and working collaboratively with extensive networks to help clients achieve their goals and aspirations.

About the author Karen Maurer is the founder of Capable Spaces, a community occupational therapy service in Newcastle, NSW, supporting people with progressive neurological conditions and spinal cord injuries to access assistive technology and home modifications. Capable Spaces offers practical solutions to maximise independence in everyday life, and online training for community occupational therapists.

References can be viewed by scanning the QR code

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A gallery of measuring meaning in hand therapy Vicki Strelan, Principal Occupational Therapist and Hand Therapist at Arm to Palm Upper Limb Clinic “Occupational therapists don’t ask what’s the matter with you, they ask what matters to you.” These words were inscribed on mugs gifted in thanks from a young woman at the end of her hand rehabilitation.

OT Week 2021 provided an opportunity to reflect on the role of occupational therapy in meaning-making. How do we measure

Shortbread biscuits – baked by a labourer who had 200kg of metal fall from a two-metre height onto both his thumbs – are periodically handmade and hand-delivered to our clinic via a 200km round trip.

At the beginning we saw fear, anger and despair. While he was waiting for a suitable duties program to start, he decided to teach himself something new, and took up baking. At the end of hand therapy, he was fully employed in his original job, engaging in long distance cycling, home renovating, and hobby farming cows. He offers us a calf when they birth, however to date we have only accepted biscuits.

“Handybear” was handmade and gifted by a woman with a tissue erosion form of scleroderma. She was one of the first clients to our private practice 21 years ago, and has cycled back to us after subsequent surgeries. Today we see meaning and function as she is planning new ways to explore handcrafts.

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outcomes in occupational therapy intervention? Technology, albeit inherently useful, is a superficial measurement. One of the founders of the occupational therapy profession was Eleanor Clark Slagle, and if her beliefs stand the test of time, the true measurement of therapy outcome is in the narrative of occupation and meaningful activity (Reed, 2019).

The hand therapy strap storage debacle well known to anyone working in splinting has had two skilled tradesmen volunteer solutions. One female tradie recovering from a circular saw injury to her non-dominant hand installed an inbuilt splint strap holding system inside a cupboard at our former workplace. A second quietly spoken worker with a tendon and wrist injury spent months fabricating a stunning portable splint strap storage system which has hands at each end, with carved fingernails!

To measure outcomes in hand therapy we have technology in the form of goniometers and dynamometers, gauges and tape measures.

Is this a true measure of outcome?

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Leatherwork brings meaning and function to a correctional services officer whose hand required surgery after a violent work event. She created a quote from her heart to match the energy she found in coming to our clinic “FACT: Do not judge me by my material possessions but by the friends I choose to keep”.

The crooked smile of the young cowboy testifies to facial injuries from his bull-riding days.

He acted quickly when he saw his employer was about to be crushed by a vehicle and in averting disaster received a crushed and lacerated hand that required microsurgery. When the black dog of depression was nipping at his heels a few months into rehabilitation, a positive turning point occurred when we replaced putty exercises with leatherwork, and a keyring was the first project.

The young woman who gave us the mugs that were mentioned at the beginning of this article had her fingers guillotined by a posthole digger on a remote property, later replanted after a Royal Flying Doctor flight. When we first met her, hand therapy involved tears, screams, sobbing and trembling. At the end of hand therapy, we saw smiles, a return to horse riding and employment in a new area. We saw meaning and function. We sensed that her end with us was a new beginning. She appreciated that we asked what mattered to her, not what was the matter with her.

Hand therapy crosses the barrier of touch and may require numerous hours of face-to-face contact. It is natural for the stories to emerge. To measure outcomes,

goosebump moments arise considering the teddy bear, the horse riding, the biscuits, the cycling, the leatherwork, the employment. This is how we measure hand therapy. This is how occupational therapy enables meaning-making.

Work occupies a huge slice of our lived time.

The artwork on the clinic wall reminds me how grateful I am to have passion for my work as an occupational therapist in hand therapy, a career that makes meaning for me.

In 2019 a beautiful painting was made for the Australian Hand Therapy Association (AHTA) national conference with the theme “To Extremity and Beyond”. The artist is one of Queensland’s eminent hand therapists running a public occupational therapy department. This artwork is proudly displayed in our clinic as a reminder of the artist’s passion for hand therapy and passion for her art, meaningful activities both.

About the author Vicki Strelan has worked as an occupational therapist, hand therapist and educator for more than 30 years. Based in Townsville, North Queensland, Vicki runs her private practice Arm to Palm Upper Limb Clinic and is actively involved in creating pathways for occupational and physiotherapists to become accredited hand therapists with the Australian Hand Therapy Association.

References can be viewed by scanning the QR code

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The importance of recordkeeping in a digital world Aon

Why keeping appropriate records can help during a claim

In a world in which almost everything is paperless, keeping records and filing documentation might slip your mind as you go about your usual business. While digitalisation has made record-keeping easier in some ways, it has also brought about some complexities. While there was a time when everything needed to be done in writing, nowadays a simple phone call can be enough to prompt action. Recordkeeping also goes beyond simply filing documentation. Think of all the ways you might interact with clients, whether by phone, text, email or in-person. Good record-keeping should encompass keeping details of all conversations and interactions, no matter how seemingly minor.

Consequences of not keeping adequate records

Poor record-keeping can lead to multiple challenges for small business professionals.

Firstly, you may be held accountable for something you otherwise would not have been liable had you maintained records relating to the advice or services you provided. Lack of appropriate records can also lead to going back and forth unnecessarily. Mistakes are also possible as a result of failing to adequately document your client interactions.

These mistakes can lead to allegations of professional negligence from clients, and end with potentially costly litigation.

And while you may hold professional indemnity (PI) insurance to help cover such 42 otaus.com.au

claims, lack of appropriate records often makes it difficult to defend claims. If you do need to make a claim under your PI policy, the outcome may not be in your favour.

As Carter Newell Lawyers partner Michael Gapes says, “In the absence of contemporaneous written records, the courts will often have to make findings of credibility and decide whose recollection of events it prefers. It is unfortunately often the case that the courts will favour the evidence of the consumer or client, who may profess to have a very clear recollection of events in circumstances where he or she has not previously been involved in a similar situation before, over the evidence of the professional with poor record-keeping practices who may have been involved in countless similar transactions over the course of many years.”

He goes on to say: “The courts have an expectation, which is not unreasonable, that professionals will keep adequate records to document their interactions with clients and third parties. We (Carter Newell) have successfully defended multimilliondollar claims on behalf of numerous professionals based upon file notes which they have drafted and retained on file evidencing the advice which they provided to their clients. The courts have regarded these contemporaneous file notes as the best evidence available and certainly far more accurate than relying upon the oral recollections of parties at a trial many years after the relevant events took place.”

Following best practice

Maintaining appropriate evidence and records doesn’t have to be a tedious task. Provided you have appropriate digital infrastructure to store information securely, sometimes it’s enough to simply develop some small habits to help ensure you can keep adequate records. Following are some things you can do to get into the habit of ensuring you’re documenting all your interactions and conversations appropriately:

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The courts have an expectation, which is not unreasonable, that professionals will keep adequate records to document their interactions with clients and third parties • Make it everyone’s shared responsibility, not just the administration staff.

Photo: ©gettyimages /SDI Productions

To show how helpful sound recordkeeping can be in the event of a claim, regardless of your profession, here are a couple of claims from Aon clients in which record-keeping helped the outcome.

• After a phone call, send an email to your client to clarify what was discussed, and what you will do next; • When sending emails, attach delivery and read receipts; • Save emails to shared network drives (where there aren’t privacy concerns). This is likely to be especially helpful if staff members move on; • Ask clients to submit all requests in writing; • Invest in a dictaphone so you can keep records while you’re on the go; and

Sally* was an occupational therapist who received an allegation from a client for whom she had recommended a wheelchair.

The client had suffered an injury when their foot became stuck in the wheelchair, and alleged Sally had been negligent in her recommendation. However, as Sally was able to produce detailed records of each of her appointments with the client, Sally’s claim was successfully defended and she was not required to pay compensation.

Tim* was the property manager for a house tenanted by Jenny*. Jenny suffered an injury falling down the stairs in the home due to the timer light failing to switch on. Jenny took legal action against Tim, claiming she had informed Tim of the light not working, but Tim claimed he had not been told of this required repair. The court ruled in favour of Tim as he was able to produce very comprehensive records of all interactions (among which there were no reports or entries of Jenny advising of the faulty light).

How a broker can help

While keeping adequate records should be a priority for professionals, sometimes it’s not enough to completely eliminate allegations of professional negligence. If you are faced with an allegation of negligence, and need to make a claim under your PI insurance policy, the process can be stressful and confusing,

not to mention the potential impact on your business and reputation. In such situations, arranging your insurance through a broker can be highly valuable. An insurance broker can guide you through the process and help lighten the load significantly, as well as lobby and negotiate with insurers to help ensure you’re getting the best possible outcome.

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 our number of clients continues to grow.

If you’d like to find out more about Aon or get a quote, visit aon.com.au/ota, call 1800 805 191, or email au.ota@aon.com. * This story is based on a real-life claim experienced by a client with insurance arranged by Aon. All names have been anonymised for privacy reasons.

Aon has taken care in the production of this article, and the information contained in it has been obtained from sources that Aon believes to be reliable. Aon makes no representation as to the accuracy of the information received from third parties and is unable to accept liability for any loss incurred by anyone who relies on it.

The recipient of this document is responsible for their use of it. © 2021 Aon Risk Services Australia Limited ABN 17 000 434 720 AFSL no. 241141 (Aon) The information contained in this article is general in nature and should not be relied upon as advice (personal or otherwise) because your personal needs, objectives and financial situation have not been considered. Before deciding whether a particular product is right for you, please consider your personal circumstances, as well as any applicable Product Disclosure Statement, Target Market Determination and full policy terms and conditions, available from Aon on request. All representations on this website in relation to the insurance products we arrange are subject to the full terms and conditions of the relevant policy.

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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.

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