OTA Connections Winter 2022

Supporting all people to engage in activities they find meaningful

Print Post Approved PP340742/00147 ISSN 1832-7605

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WINTER 2022 | VOL 18 ISSUE 3

Spotlight on OTs in Mental Health

The Future of OT and Mental Health in Australia ​From the Bottom Up: Learning with and from Covid-19 Bringing an Occupational Perspective to Forensic Mental Health DISCOVER STORIES FROM YOUR PEERS

OT MENTAL HEALTH FORUM

VISION FOR THE FUTURE FRIDAY 25 NOVEMBER 2022

SMC, Sydney

Australias Premier Mental Health Forum for Occupational Therapists ’

INVITATION TO ATTEND Occupational Therapy Australia is pleased to invite you to participate in the OT Mental Health Forum 2022 on Friday 25 November at the SMC Conference and Events Centre in Sydney.

After starting as a small initiative in the 1990s the Forum has developed into a national biennial event attended by over 300 occupational

The Forum is a wonderful way to connect with other OT’s and find out what other services/OT’s are doing

therapists working across every area of mental health practice in Australia.

The forum will feature oral presentations, poster displays and occupation stations and provides an opportunity to come together, exchange ideas, share practices and challenges and to celebrate all that is great about occupational therapy in mental health.

KEYNOTE SPEAKER

Professor Gail Whiteford

WHY ATTEND?

> Hear from motivating and inspirational speakers > Engage with fellow OTs in-person > Make new connections with like-minded OT’s working in Mental Health > Earn up to 8 CPD hours REGISTRATION OPENING SOON EARLYBIRD FEES AVAILABLE! FURTHER INFORMATION 1300 682 878 mentalhealthforum@otaus.com.au

otausevents.com.au/mentalhealthforum2022

CONTENTS

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ABOUT CONNECTIONS

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

CONTACT US

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

Connections welcomes article submissions, email communications@otaus.com.au Attention: Connections Editor DEADLINES FOR SUBMISSIONS

Spring 2022 10 July 2022 Summer 2022 10 October 2022

NEWS

ADVERTISING

Please contact advertising@otaus.com for advertising enquiries DESIGN

Perry Watson Design CORRECTION

On page 17 of the Autumn 2022 edition of Connections Libby Callaway was not correctly given her title of Associate Professor.

COVER

04

President’s Report

05

CEO’s Report

6

Eating Disorders Clinician Credential

8

Spotlight on occupational therapy in mental health

10

WFOT update

Photo: ©gettyimages /Rudzhan Nagiev DISCLAIMER

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

Occupational Therapy Australia respectfully acknowledge the Traditional Custodians of the country on which we live, learn and work.

FEATURES

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12

Bringing an occupational perspective to forensic mental health

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How OT can help young people experiencing psychosis with their employment

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Best practice functional capacity assessment for people living with psychosocial disability

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The future of ot and mental health in Australia

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OTs in schools supporting the wellbeing of young people

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Sharing Power: developing a mental health curriculum

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Five things to remember before taking out a business insurance pack

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Spot the difference: poor performance, bad behaviour or mental illness?

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‘DIY’ breakfast program to improve rehab after brain injury

CONNECTIONS WINTER 2022 3

PRESIDENT’S REPORT

President’s Report

Associate Professor Carol McKinstry | OTA President

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s I write this article for Connections, much is happening within Australia: a federal government election in May, domestic and international travel opening up, and a new phase of the global pandemic as we learn to live with Covid-19. More people have returned to the workplace, however, a rise in Covid-19 cases has put increased pressure on health services. This continuing change and increased demand for services – including occupational therapy – can be unsettling and impact everyone’s mental health. This edition’s focus on mental health is therefore timely both professionally and personally.

psychologists and mental health nurses are often seen as the only professionals in the field, I now go to great lengths to promote the historic foundation of occupational therapy in Australia and its role in mental health. I once contacted ABC Radio to enlighten journalists about the role of occupational therapists during the Victorian bushfires, and drew an over-the-top response from some in the psychology profession intent on protecting their turf. Surely, given the demand for mental health services and the excellent work that occupational therapists do, this is not contemporary thinking.

On a mental health note, it is interesting to remember historically that occupational therapy began in Australia – although not initially provided by occupational therapists – at the Broughton Hall Psychiatric Hospital in Sydney and Mont Park Hospital in Melbourne in the early 1930s. Pioneers of occupational therapy in Australia such as Ethel Francis and Joyce Keam also practised in mental health (Cusick and Bye, 2021), and occupational therapists played key roles in the physical and mental rehabilitation of returned World War II servicemen and women.

Occupational therapists have a unique approach and role that enhances mental health teams. In 2020, I represented OTA at the Royal Commission into the Victorian Mental Health Services, particularly focusing on the workforce. Fortunately, those on the panel fully understood and valued the role of occupational therapists, and were very interested in learning how to build and support the occupational therapy workforce. PhD candidate and highly experienced occupational therapist Siann Bowman also presented her research findings, recommending the need for occupational therapists to be situated in schools to support secondary school students and teachers and provide early intervention. Her work is frequently cited in the royal commission’s report.

Talking with prospective and first-year occupational therapy students, I am still amazed there is limited awareness that occupational therapists practise in the mental health field. As psychiatrists,

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In recognition of the pandemic’s major impact on everyone’s mental health, OTA has developed a paper, Thinking Ahead: The Future of Occupational Therapy and Mental Health. This paper seeks to promote the role of occupational therapists and provide solutions to many current challenges. I thank the dedicated reference group that supported those developing the paper, and commend the work of all involved. I would encourage everyone, whether you practise in mental health or not, to read the paper to gain an understanding of what OTA is promoting.

OTA has also been active in promoting the important work of occupational therapists in mental health through its Federal Election Playbook launched in April. Politicians from various parties were pressed for commitments, such as increasing access to mental health services in rural areas and developing an allied health workforce strategy that included occupational therapists.

With the increased incidence of mental illness in Australia, occupational therapists in any area of practice help improve the mental health of all those they work with.

References can be viewed by scanning the QR code

CEO’S REPORT

CEO’s Report

Samantha Hunter | OTA CEO

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xciting developments continue at OTA, with many new initiatives over the past year now coming to fruition.

As always, OTA channels its efforts in areas that will better promote and protect the profession, and enhance or ease the ways in which members practise occupational therapy.

I am exceptionally proud of a number of new projects that will come to life in coming months, and hugely grateful for the energy, time and care that OTA staff, members and collaborators have dedicated to their tasks.

By the time this issue of Connections is printed, OTA will have released a preview of its publication Doing Our Best – a beautiful collection of stories about occupation and how it can help people navigate periods of uncertainty and hardship, like the

pandemic, bushfires, floods and droughts.

As natural disasters often create mental stress, these stories are a lovely reminder of the benefits of occupation during difficult and traumatic times. The authors have been incredibly generous to share their stories with us and our wider audience.

OTA is sharing its Federal Election Playbook through social media and direct representation, educating sitting and aspiring politicians about the profession’s value to the health landscape across the entire population. While election time always provides a great opportunity to make specific requests to the Government and Opposition, the work of advocacy is constant and ongoing, and OTA is continually educating, informing and occasionally agitating. It specifically represents the interests of the profession at state and federal levels,

I am exceptionally proud of a number of new projects that will come to life in coming months

and through the myriad of bureaucratic schemes that enmesh health care.

OTA president and chair Associate Professor Carol McKinstry has reported about the forthcoming Thinking Ahead: The Future of Mental Health and Occupational Therapy paper. The paper has more than 30 recommendations for OTA to consider as it plans a road map for supporting, advocating and positioning this important area of practice into the future. We enthusiastically look forward to sharing the paper with the profession, and important stakeholders and supporters who will help create a better understanding of mental health occupational therapy – especially at a time of significant community need, and fortunately with an increase in funding across many jurisdictions.

I hope you all find a quiet moment to enjoy reading Connections – to learn something new, recognise a name or face, catch up on news from the association, and reflect on the profession’s many great opportunities and achievements over the recent past, and the bright future that lies ahead.

CONNECTIONS WINTER 2022 5

PRACTICE

Eating disorders clinician credential Carol Jewell, Acting National Manager, Professional Practice and Development Dr Gabriella Heruc, Credentialing Director, Australia and New Zealand Academy for Eating Disorders

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ccupational therapists have a long-standing and pivotal role in supporting the recovery of people affected by eating disorders (Clark and Navar, 2012). About 16 per cent of Australian adults live with a diagnosed eating disorder (Hay et. al., 2015), and about a third (31.6 per cent) of Australian adolescents engage in disordered eating behaviours within any given year (Deloitte Access Economics, 2012; NEDC, 2019). With psychosocial stressors stemming from the Covid-19 pandemic, these statistics are set to rise (Touyz and Hay, 2020).

It is fitting that the recently developed Australia and New Zealand Academy of Eating Disorders (ANZAED) Clinical Practice and Training Standards and ANZAED Eating Disorder Credential have come at an opportune time to build workforce capacity to meet increased demand. Occupational therapists are invited to take part in the credentialing

program to get formal recognition of the expertise they bring to this area of practice.

Applications for the ANZAED Eating Disorder Credential are free until 30 June 2022.

The ANZAED eating disorder treatment principles and general clinical practice standards were developed through widespread consultation and engagement of key professional bodies (Heruc et. al., 2020). OTA is proud of its contribution to these standards, which are recommended for mental health clinicians and dietitians providing treatment for people experiencing eating disorders. Separate mental health practice and training standards have also been devised as a foundation for strengthening the workforce, and providing guidance to professional training programs and service providers on the minimal standards required for practice in the eating disorder field (Hurst et. al., 2020).

The credential’s purpose is two-fold: to help people with eating disorders locate the right treatment at the right time, increasing the chances of timely intervention and positive treatment outcomes; and enhance the effectiveness and consistency of treatment for eating disorders in Australia.

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The ANZAED Eating Disorder Credential provides formal recognition of qualifications, training and professional development activities needed to meet minimum standards for delivery of safe and effective eating disorders treatment. The criteria for the credential are built on the NEDC Workforce Core Competencies and the ANZAED Clinical Practice and Training Standards, which prescribe the minimum knowledge, practical skills and experience required of mental health and dietetic professionals to successfully respond to, treat and manage eating disorders, and constitute a basis for content of professional development and training (NEDC, 2018; Heruc et. al., 2020; Hurst et. al., 2020).

The credential’s purpose is two-fold: to help people experiencing eating disorders locate the right treatment at the right time, increasing the chances of timely intervention and positive treatment outcomes; and enhance the effectiveness and consistency of treatment for eating disorders in Australia.

The credential is designed to support the treatment of individuals with eating disorders across all diagnostic presentations, from early intervention to complex and acute care in public and private settings.

The credential is available to mental health professionals including counsellors, general practitioners, mental health nurses, nurse practitioners, occupational therapists, psychiatrists, psychologists,

PRACTICE

psychotherapists and social workers, as well as dietitians, who meet its criteria.

Considerations of safety and risk for the consumer have been central in the development of the credential criteria.

The NEDC Core Competencies and ANZAED Clinical Practice and Training Standards have been applied to an analysis of the curricula of the professional qualification of each of the eligible professions.

Professional training and clinical experience, eating disorders introductory training, evidence-based treatment model training or evidence-informed dietetic practice training, and ongoing supervision and professional development relevant to eating disorders will provide assurance that credentialed eating disorder clinicians meet minimum safe standards for treatment.

Once credentialed, clinicians will be given a digital badge, the post-nominal, CEDC, and access to a new online platform, connect.ed, to build a clinician profile – enabling people experiencing eating disorders, their families and supports, as well as referrers, to find and connect with them as a treatment provider.

submitted until 30 June 2022 for practising clinicians who may not have undertaken training in the mode prescribed, or may not have a record of having done so Applications for the credential are free until 30 June 2022. All information can be found on the ANZAED website connected.anzaed.org.au Please note: limited places available.

Summary Occupational therapists have a unique and essential role in supporting people affected by eating disorders. OTA is therefore proud to have contributed to the development of the ANZAED Clinical Practice and Training Standards and the ANZAED Eating Disorder Credential.

For more information about the limited number of free professional development packages available, or the limited evidence sunset clause, contact ANZAED directly at connected.anzaed.org.au. Applications for the credential are free until 30 June 2022.

The credential aims to support and develop the eating disorder workforce so people experiencing eating disorders can access the right care at the right time. To help build the eating disorder treatment workforce, the credentialing system offers the following:

• Limited Evidence Sunset Clause enabling written evidence to be

Photo: ©gettyimages /Maya23K

• Professional Development Packages with limited free training and supervision opportunities for clinicians starting an eating disorders practice; and References can be viewed by scanning the QR code

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A O TJ

Spotlight on occupational therapy in mental health Genevieve Pepin, Australian Occupational Therapy Journal

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n March 2007, the Australian Occupational Therapy Journal published a Special Issue on mental health. The editorial of this Special Issue was written by Professor Terry Krupa (Krupa, 2007). In her editorial, Krupa recalled a conversation she had over dinner with John Strauss, a renowned psychiatrist and mental health researcher. Strauss is described as a supporter of occupational therapy while being provocative in his desire to push the mental health field to be more inclusive of diverse perspectives to better support recovery. On this particular occasion, Strauss asked the following question ‘So Terry, when is occupational therapy going to stop being a handmaiden to psychiatry?’ (Krupa, 2007, p.2).

Strauss’s argument was that our profession failed to demonstrate the link between occupation and improved mental health while having made this link a central part of our philosophical, theoretical, and ideological underpinnings. Do we, as Strauss argued, position our interventions as ‘secondary to biomedical treatments that are directed to the ‘real work’ of ameliorating illness’ (Krupa, 2007, p.2)?

Fifteen years on from that editorial, let’s put the spotlight on occupational therapy in mental health and explore some of the strategies and interventions that are available to mental health occupational therapists to promote and embed the link between occupation and improved mental health in their practice.

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Action over inertia Action over inertia is a manualised intervention designed for people with a severe and enduring mental illness and who are experiencing significant occupational imbalance and occupational disengagement (Krupa et al., 2007). The focus of Action over Inertia is on occupational time use to support people re-engage in occupations that bring meaning and purpose and facilitate occupational engagement.

Occupational formulation Formulation has been used in mental health by psychologists for several years (Brooks & Parkinson, 2018). Formulation has been described as ‘an iterative and collaborative process, taking the form of a working hypothesis based on a shared psychological understanding between the psychologist and person in need of support’ (Mayers & Agnew, 2019, para. 6). Occupational therapists further developed the process of formulation into an occupational formulation that integrates occupational therapy frameworks and concepts to make sense of a person’s specific circumstances (Brooks & Parkinson,

2018, Parkinson & Brooks, 2021, Parkinson et al., 2011). Interpreting results from assessment procedures with an occupational therapy lens will ensure that goal setting, completed collaboratively with each client, will remain occupation focussed.

The Victorian Mental Illness Awareness Council Declaration The Victorian Mental Illness Awareness Council (VMIAC) is run by consumers and for consumers of mental health services. It is the peak Victorian body for people with a lived experience of mental ill-health. In 2019, VMIAC co-created their collective vision for mental health services to answer their needs and support their recovery and dreams. The Declaration includes eight topics: the lived experiences of participants, social change, concepts to shape the mental health system, people and values, places and services, actions and supports, access, and participants life outcomes (VMIAC, 2019). Occupational therapists have clearly been identified as an important group of people those with lived experience of mental ill-health want to work with. In the words

Provocative questions, like the one posed to Terry Krupa, challenge how we think about our discipline, what we do and why we do it

A O TJ

of those who developed the Declaration, occupational therapist can contribute to creating ‘the kind of society, systems, services, places and supports that matter’ to consumers of services (VMIAC, 2019, p.2).

These are only a few examples of changes in occupational therapy in mental health that occurred since John Strauss had that conversation with Terry Krupa.

There are other initiatives in which that promote the link between occupation and improved mental health. Organisations like the Centre for Mental Health Learning

that employ a Statewide Mental Health Occupational Therapy Educator support the development of the occupational therapy mental health workforce and can contribute to ensuring an ongoing focus on occupation-based interventions in mental health. The Thinking Ahead Mental Health project led by Occupational Therapy Australia is another initiative centred around developing knowledge and strategies that will support a dynamic and occupation-focused workforce driving a contemporary mental health system.

Provocative questions, like the one posed to Terry Krupa, challenge how we think about our discipline, what we do and why we do it. They promote further reflection and advancement of our profession and ultimately, enhance the occupational therapy experiences and health outcomes of our clients and their supports.

References can be viewed by scanning the QR code

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Visit australianvolunteers.com

CONNECTIONS WINTER 2022 9

WFOT REPORT

WFOT update Dr Emma George, WFOT 1st Alternative Delegate

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he World Federation of Occupational Therapists comprises national and regional organisations that work together to improve health and wellbeing, and champion occupational rights and occupational justice. It deplores action that denies access to human rights and occupational engagement.

Conditions that threaten the right to occupation include war, disasters, poverty, discrimination and displacement.

At the time of writing this update, the war in Ukraine rages on. WFOT has been closely following the traumatic events, as millions of people flee their homes and many are caught in the crossfire. WFOT is in regular contact with the Ukrainian Society of Ergotherapists, and collaborating with the WHO Rehabilitation Programme/ Emergency Medical Teams initiatives as part of the humanitarian response. It is distressed that two member countries, Ukraine and Russia, are at war, and the WFOT (2022) statement on the crisis clearly “reaffirms its condemnation of all actions or circumstances that infringe on the rights of people and community to live purposeful and engaged lives in safety and peace”.

In responding to all types of disasters, occupational therapists can draw strength from one another, their association and WFOT.

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In Australia, the devastation of recent floods in NSW and QLD is difficult to comprehend, particularly on the back of bushfires and the unrelenting stress of the Covid-19 pandemic.

WFOT president Samantha Shann wrote to OTA expressing support and condolences to all members, families and friends touched by the flooding. Occupational therapists and the communities with whom they work are resilient and optimistic, which is a great strength of the profession. In responding to all types of disasters, occupational therapists can draw strength from one another, their association and WFOT.

Occupational therapy: working with displaced people WFOT empathy and advocacy for displaced people extends beyond the immediate crisis in Ukraine and floodimpacted communities in Australia. WFOT launched a new online course to introduce occupational therapists to helping displaced people living in transition and crisis.

Displacement refers to the forced movement of people from their localities, environments and occupations due to natural disaster, famine, development, climate change and poverty.

Global displacement continues to grow even in the face of the Covid-19 pandemic.

UNHCR (2020) data shows more than 1 per cent of the world’s population (one in 95) is now forcibly displaced. It is thought that up to one million children were born in displacement between 2018 and 2020, with many at risk of remaining displaced for years or the rest of their lives.

Occupational therapists work with displaced people to address occupational injustices, and utilise the following two basic principles in this scope of practice: 1. Understand the policy and legislation relevant to migrant rights and government/ NGO actions; and 2. Incorporate occupational rights as human rights.

The course is available on the WFOT Learning Platform, and therefore available anywhere with access to the internet.

It teaches about the complexity of displacement, the humanitarian sector and new approaches to sociopolitical occupational therapy. Free to WFOT members, it is designed to be completed through a self-directed model over 35 hours.

WFOT REPORT

Preparing for Paris In August, the three OTA delegates head to Paris for the WFOT council meeting and 18th WFOT Congress. The work of WFOT aligns under the following four program areas: education, research, practice development and executive/leadership and advocacy. As it will be my first council meeting, I anticipate stimulating discussion, plans for action, development of stronger international relationships, and lots of learning from other delegates.

Registration for the WFOT Congress is open at wfotcongress2022.org/registration

References can be viewed by scanning the QR code

Emma George and Adam Lo in Adelaide, March 2022

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F E AT U R E

Bringing an occupational perspective to forensic mental health Lorrae Mynard, Lead OT at Forensicare

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orensic mental health (FMH) services provide care to people experiencing mental illness who become involved with the criminal justice system (CroninDavis, 2017; Muñoz, 2019). Australian forensic occupational therapists work mostly in discipline-specific roles within low to high security and brief to extended stay settings, including prisons, secure hospitals, courts, and community services. Collaborations between justice and multidisciplinary health services are expanding in recognition that many people within this system experience mental ill health and/or disability and need specialised input, leading to recent significant growth in forensic occupational therapy services in several states. Occupational therapists provide interventions that

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consider the interactions between the person, occupation, and environment.

People receiving FMH services often have a diagnosis of mental illness, and may also experience substance misuse, personality disorder, intellectual or developmental disability and history of trauma. Level of educational attainment is often low and indigenous and minority populations are over-represented. The physical environment, often comprising hard surfaces and stark spaces with limited privacy and access to resources, is designed to contain and restrict.

This impacts occupational participation: reducing opportunities for and personal choice of occupations. The social environment of correctional and health staff and other prisoners or forensic patients may

be experienced as supportive or challenging.

The institutional environment may include rigid routines which limit opportunities for person-therapist interactions; or uncertainty around release dates that affects continuity and completion of therapy.

Supporting people in FMH services Occupational therapists work at individual, group, and service levels to promote opportunities for participation in meaningful occupation during incarceration/

F E AT U R E

Supporting people to transition toward lower security and community settings is crucial and occupational therapists often take a lead role admission and in preparation for release/ discharge. Input begins with building rapport, identifying interests and enabling social or activity-based interaction, and advocating for access to objects or opportunities such as magazines or puzzles for use during lockdown periods.

Occupational therapists assess participation and identify occupational needs, which often relate to identifying meaningful goals, building routine, strengthening roles, developing daily life and vocational skills. Supporting physical health is important as the restrictive environment and use of antipsychotic medications can lead to significant weight gain and development of metabolic syndrome.

Occupational therapists may modify the physical environment: installing clocks to support orientation to time or murals for visual interest, developing garden spaces or using blackboard paint on walls to allow chalk drawing. They work with people to identify sensory preferences and develop sensory plans and educate other staff about responding to sensory needs.

Supporting people to transition toward lower security and community settings is crucial and occupational therapists often take a lead role in developing plans for graded community access. Opportunities and challenges have arisen in navigating

NDIS processes to build partnerships with providers to improve service access and support continuity of care. In some services occupational therapists have an ongoing role with people living in the community under forensic legal orders.

Continued next page

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F E AT U R E

Bringing an occupational perspective to forensic mental health Continued from previous page

References can be viewed by scanning the QR code

Building the evidence for occupational therapy in FMH Aware of the risk of being drawn towards generic working or care coordination and losing their unique occupational focus, forensic occupational therapy teams across Australia are actively strengthening the occupational basis of their practice: articulating evidence-based pathways and practice processes, building clinical reasoning skills, implementing use of standardised occupational therapy assessments and/or structured occupational formulation approaches, and using evidence-based intervention resources.

Demonstrating impact is critical, and many teams are conducting formal service evaluation, while some services have partnered with universities to conduct and publish research (e.g. Harris et al., 2020; Perkes et al., 2015; Taylor et al., 2021; Whiteford et al., 2020).

Leveraging the strength of collaboration, an Australasian Forensic Occupational Therapy Network (AFOTN) has been established to create opportunities for FMH occupational therapists across Australia, New Zealand, and Asia to “connect, support each other in conducting evidence-based practice, to promote the forensic specialty and advocate for the occupational needs of clients in forensic settings” (AFOTN, 2022). With legislative reviews leading to increased state-based funding for FMH services, occupational therapists have exciting opportunities to demonstrate and expand the impact of meaningful occupation in the lives of people experiencing mental health within the criminal justice system.

Learn more about occupational therapy in FMH The AFOTN are partnering with OTA to deliver a forensic stream at the November 25 Mental Health Forum in Sydney.

Please contact the author (Lorrae.Mynard@forensicare.vic.gov. au) if you are interested in finding out more about the AFOTN. About the author Lorrae Mynard is passionate about keeping occupation at the heart of occupational therapy. Having worked in varied adult mental health settings in Australia, Canada and the UK, she is presently a lead occupational therapist at Forensicare in Melbourne, chairperson of the Australasian Forensic Occupational Therapy Network, and a doctoral candidate with Monash University. Her doctoral research is focused on occupational formulation; her other research focuses on occupational therapists’ experiences of working in solitary confinement, and experiences of forensic mental health consumers related to disclosure, time use, digital literacy and transitioning to community living.

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F E AT U R E

How OT can help young people experiencing psychosis with their employment Melissa Aguey-Zinsou, University of Sydney, Centre for Disability Research and Policy, Faculty of Medicine and Health and Australian Catholic University, North Sydney

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ccupational therapists are experts in helping people engage in productive occupations, with paid work being one of the main productive roles in adult life.

As teenagers and young adults, people start laying the foundations for employment opportunities and career paths. This is also the period of life when the onset of psychosis is most common. For a young person who develops psychosis, education and early employment experiences can be disrupted.

Disruption of early productive roles can lead to long-term unemployment, even though paid work is a common goal for young people with psychosis. In fact, a nationwide survey found only 22.4 per cent of people with psychotic disorders were engaged in paid work (Waghorn et. al., 2012). This raises the question about what occupational therapists can do to support young people experiencing psychosis with employment.

Current research evidence shows that the most common interventions are Early Intervention and Individual Placement and Support. Most current employment interventions used with people experiencing psychosis focus on finding a paid job. But finding a paid job is only one part of being ’“employed”. Occupational therapists know that in addition to finding and getting a paid job, keeping the job is just as important and can be a real challenge for young people with psychosis.

Despite occupational therapists doing great work in this area, their contributions are not prominent in published research evidence. There is a need to share the great work that is being done and to use meaningful, replicable measures of employment outcome to demonstrate the value of occupational therapy in supporting young people with their employment.

In addition, almost absent in intervention research are the perspectives of young people themselves. There are currently no published employment interventions codesigned with young people with psychosis.

Occupational therapists, with their personcentred approach, start with the needs and aspirations of young people and tailor interventions to help them achieve their goals. They can collaborate with young people to co-produce services and research.

Current research gives useful background information about the prevalence, conditions and interdisciplinary approaches, but there is a need for specialised occupational therapy practice research evidence. The way forward is for occupational therapists to start with what they do know. The world of work is changing with casual, insecure work and the gig economy, where most young people will start their first jobs (MacDonald and Giazitzoglu, 2019). Being able to move between jobs is essential, and keeping the same job may not be possible or desirable.

Occupational therapists need to be ready to support young people with switching jobs.

Also, young people’s own networks are increasingly important. A national survey found that most people obtained work on their own or through personal networks, rather than with employment services (Waghorn et. al., 2012). Occupational therapists with their expertise in identifying enablers in the social environment can support young people to consider and strengthen social networks that may boost employment/career prospects.

Occupational therapists are uniquely placed to support young people experiencing psychosis with their employment. With their training in lifespan development, they understand that many young people want to pursue education to improve their future employment prospects. Occupational therapists appreciate the importance of career planning, job skills coaching and workplace accommodations to develop a satisfying working life. Their training in vocational rehabilitation gives them wide-ranging skills, from encouraging people to consider pursuing their goals for work through to helping people return to work after time out of the workforce.

Occupational therapists working together can advance practice and research in this area. Get in touch!

Contact details and references can be viewed by scanning the QR code

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F E AT U R E

Best practice functional capacity assessment for people living with psychosocial disability Muriel Cummins and Malitha Perera

The vision for Australia’s social model of disability The vision for Australia’s social model of disability – the National Disability Insurance Scheme (NDIS) – promised equitable opportunities for people with psychosocial disabilities to live “ordinary” and meaningful lives through the provision of tailored, individualised support.

Psychosocial disability is an internationally recognised term under the UNCRPD, used to describe the experience of people with impairments and participation restrictions related to mental health conditions1 .

The dawn of the NDIS represented a welcome paradigm shift for cohorts whose care was previously dominated by medical models. Mental health occupational therapists aim every day to honour the original vision of the NDIS by working with participants towards their goals, drawing on a substantive toolbox of evidence-based approaches. Occupational therapists engage in policy advocacy and are committed to building an equitable NDIS.

Functional capacity – a core NDIS construct As defined within the NDIS Act (2013), to be eligible for the NDIS a person must demonstrate “substantially reduced functional capacity” in at least one functional area or domain2. The assessment of functional capacity is therefore a critical aspect of both testing eligibility for the NDIS and ensuring support packages correlate with functional needs identified.

Evidence suggests that people with psychosocial disabilities are more than twice as likely to have their initial NDIS applications rejected relative to other disability types3. A recent change to the NDIS Act (2013), titled the National Disability Insurance Scheme Amendment (Participant Service Guarantee and Other Measures) Bill 2021, means there will be clearer eligibility for cohorts who experience episodic conditions where functional capacity fluctuates4.

Occupational therapy enables everyday life participation5, and assessment approaches

… people with psychosocial disabilities are more than twice as likely to have their initial NDIS applications rejected relative to other disability types 16 otaus.com.au

identify barriers to full participation and supports needed. The assessment of functional capacity is a core focus of the work of occupational therapists.

2021 parliamentary inquiry into independent assessments The Joint Standing Committee (JSC) on the NDIS is a multi-partisan parliamentary committee appointed to oversee and conduct inquiries into specific aspects of the NDIS. During 2021, the JSC undertook a detailed inquiry into independent assessments – of a person’s functional capacity – used to inform decisions about NDIS eligibility and funding in a participant’s plan.

The JSC inquiry sparked a national debate on functional assessment, receiving almost 400 written submissions from people with disabilities and their carer representatives, peak bodies, legal professionals and many more6. It culminated in a report7 which, together with the OTA Submission to the Inquiry8, are essential reading for anyone aiming to understand the current public policy debate on functional assessment and the NDIS. The JSC inquiry report issued a clear set of recommendations for functional capacity assessment within the NDIS, including recommending that functional assessment be completed by allied health professionals with appropriate credentials, and that functional assessment be co-designed in collaboration with

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people with disabilities and their representatives, and the disability sector.

The JSC cautioned against assessment processes that may disadvantage cohorts within the NDIS, and the need to tailor assessment processes. This recommendation is particularly relevant for people with psychosocial disabilities.

Essential elements of functional capacity assessment Drawing on the evidence base, occupational therapy practice wisdom and the JSC inquiry report described above, this article identifies the following seven essential elements of functional capacity assessment for people with psychosocial disabilities.

1. Evidence-based assessment approaches Functional capacity assessment for people living with episodic conditions, where capacity fluctuates over time, require an assessment approach that can capture and contextualise fluctuation.

The legislative framework underpinning the NDIS states that assessment tools must “… have reference to areas of activity and social and economic participation identified in the World Health Organisation International Classification of Functions, Disability and Health” 12. In addition, assessment tools must hold validity and reliability; and be standardized for use with particular impairment-types. Best -practice approaches incorporate the perspective of the person and those of their family, carers and clinical and other care-providers. Generic measurement tools are limited in their capacity to detect and/or predict individual functional capacity and support needs

Photo: ©gettyimages /Chinnapong

The JSC further recommended a bulkbilled Medicare Benefits Schedule model of assessment to ensure greater equity, suitably accredited assessors to provide holistic and multidisciplinary assessment, and assessment processes that consider medical reports and other contextual information as appropriate.

because the characteristics and impact of disability are uniquely variable9.

2. Assessment identifies individualised support needs A comprehensive approach to functional capacity assessment informs tailored recommendations outlining reasonable and necessary support needs – thereby ensuring support plans are appropriately funded. The Productivity Commission (2011) recommended the NDIS be “needs based assessment” for this reason.

3. Skilled assessors Assessments need to be delivered by skilled and experienced assessors with disability-specific expertise. It is essential that assessors are skilled health professionals with a clear understanding of functional capacity as outlined in the NDIS Act (2013), and are able to fully assess the impacts on all six functional domains: self-care, communication, social interaction, learning, mobility and self-management.

4. Recovery-oriented assessment practice Valuing a participant’s lived experience is critical to understanding their strengths, challenges and impact of their disability.

Assessment processes must recognise the person as experts on their own functional

capacity. The NDIS psychosocial recovery framework identifies the need for practice to be responsive to fluctuating and episodic conditions (Principle 5)10.

5. Trauma-informed assessment Mental health occupational therapists recognise the impact of trauma on the individual, group and community, and its impact on mental health.

A trauma-informed approach recognises trauma within vulnerable populations11. Assessment processes that focus on impairments can be inherently distressing for people living with psychosocial disabilities.

6. Co-design Co-design principles have been further embedded in the NDIS through recent legislative changes4. The JSC report recommended the co-design of assessment processes with people with lived experience of disability.

Honouring co-design principles in designing functional assessment means including people with disabilities in decision-making, thereby ensuring Australia continues to meet its obligations under the UNCRPD. 7. Impartiality In addition, assessment approaches Continued next page CONNECTIONS WINTER 2022 17

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need to be conducted with integrity and impartiality. The assessment approach, model and process must uphold the highest principles of best practice.

Contractual models constrained by performance management or quotabased frameworks, or incentives or mandates to depersonalise or reduce funded supports, clearly compromise these principles. The bulk-billed Medicare Benefits Schedule model of assessment has potential to uphold them.

Conclusion During 2022, the NDIS psychosocial recovery framework is due for roll-out, aiming to ensure greater recognition of the unique needs of people with psychosocial disabilities10. Australians living with

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psychosocial disabilities have a right to best-practice functional capacity assessment informing tailored, individualised support packages that can be delivered within a recovery framework. This is in tune with the recommendations set out by the JSC Parliamentary Inquiry into Independent Assessment. Occupational therapists, who play a key role in advocating for this, are uniquely placed to contribute to the co-design of a fit-for-purpose NDIS functional capacity assessment process.

About the authors Muriel Cummins is an occupational therapist and holds a Master of Public Health. She graduated in Dublin 2001 and has worked in mental health and disability in Australia since 2005. She is passionate about working

in close partnership with those with lived experience, and promoting co-design in service development. Muriel’s previous roles span the clinical, not-for-profit, peak body and private practice sectors.

Malitha Perera is an occupational therapist who has worked in various operational, clinical and strategic leadership roles in mental health. He is passionate about addressing inequities that impact on our collective health and wellbeing.

He holds a Bachelor of Occupational Therapy, Bachelor of Psychological Science and Master of Public Health.

References can be viewed by scanning the QR code

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The future of OT and mental health in Australia Philipp Herrmann, SquareCircle Consulting

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ccupational therapists play a critical role in Australia’s mental health system, with mental health interventions at the core of occupational therapy practice. Occupational therapists can be found working in all mental health settings, whether individually or as part of multidisciplinary teams. They provide a unique lens and toolkit of highly effective, profession-specific skills that help people with mental illness achieve outcomes and engage in meaningful occupations.

The role of occupational therapists in the mental health system is not always recognised or understood, however, with many consumers and referrers lacking awareness of mental health occupational therapy. In the public system, mental health occupational therapists may find themselves in non-disciplinespecific roles or the only occupational therapist in a larger mental health team, making it more difficult to provide occupational therapy-focused supports.

Governments and other funders have at different times excluded the profession or discipline-focused interventions when designing funding programs.

To address these issues, OTA began the Thinking Ahead: Mental Health project in late 2021 with the aim of positioning the profession as a key part of the contemporary mental health system, and expanding its capacity to support and advocate for occupational therapists working in mental health. The work has focused on the key areas of advocacy and policy, professional development and awareness. All three

areas are closely connected, but each will have a range of focused activities aimed at addressing issues and taking advantage of opportunities identified.

OTA advocacy and policy work has focused on understanding the issues and barriers that may impact the ability of occupational therapists to provide timely and appropriate supports to consumers. It has examined a broad range of funding schemes and settings, and begun a range of advocacy activities aimed at addressing the issues that occupational therapists have raised.

Findings from the project are contributing to work on the Medicare Better Access evaluation, and work with WorkSafe Victoria has resulted in the launch of new mental health occupational therapy items on 1 January this year. OTA is continuing to work with WorkSafe Victoria to consider models of care, funding and referrer education, and will look to build on that work in other states and territories.

The work on professional development for mental health occupational therapists has focused on identifying the skills and capabilities needed to develop a wellrounded, occupational therapy mental health professional. OTA is looking to provide more guidance to the profession, employers and other stakeholders about how to best support a mental health occupational therapy workforce operating at the top of its scope through a professionspecific lens. Importantly, it is also working on building a more focused, continuing professional development program for mental health occupational therapists.

The other key focus of the project is improving awareness of mental health occupational therapy across the mental health system. OTA aims to provide more information through its website and own channels, as well as developing resources for occupational therapists and improving the accuracy of other sources of mental health information for consumers and referrers. It welcomes any suggestions about where consumers are most likely to search for information about mental health services. Suggestions can be sent to haveyoursay@otaus.com.au A project of this size cannot be undertaken without the support of the profession. OTA acknowledges the incredibly generous contributions of the many mental health occupational therapists that have taken the time to participate in workshops, respond to the OTA workforce survey, or take part in one-on-one conversations. OTA is incredibly grateful for this support as it ensures the outcomes of the project are built on the expert knowledge and input of occupational therapists working in mental health.

If you are interested in reviewing the outcomes of consultation activities, please visit the Thinking Ahead: Mental Health Project page on the OTA website. You can find this in the references below.

References can be viewed by scanning the QR code

CONNECTIONS WINTER 2022 19

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OTs in schools supporting the wellbeing of young people Nicole Keller, Executive Director Mental Health and Wellbeing at Wellbeing SA

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or the first time in more than two years since the Covid-19 pandemic restrictions began, more than 50 occupational therapists gathered in South Australia for an OTA Hot Topic event, OTs in Schools: Supporting Social and Emotional Wellbeing.

It was a privilege to have the OTA board president, Associate Professor Carol McKinstry, in Adelaide to attend the event, together with two iconic SA occupational therapists and OTA honorary life members Dr Angela Berndt and Marilyn Pattison.

With the mental health and wellbeing of young people never as prominent as it is now, the event explored the challenges and opportunities for occupational therapists to help create vibrant futures through evidence-based practice in classrooms.

Occupational therapists were considered to have a central role as agents of change, showing that an integrated, holistic approach was possible to support positive, inclusive and resilient learning environments in which every child/young person, educator and family/carer could achieve optimal mental health and wellbeing.

Guest speakers included South Australian Mental Health Commissioner and Breakthrough Mental Health Research Foundation founder John Mannion, and Department for Education Student Support Services director Sarah Anstey.

They reminded the audience that just over 16 per cent of the Australian population was under 12 years of age, and 21 per cent under 18 – with evidence that the first 2000 days of life were critical to a

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child’s development, and interventions during this time could result in significant improvements to health and outcomes.

Occupational therapists had an opportunity to lead the way in early intervention, prevention and health-promoting action that gave children and young people the best start in life, and the audience was challenged to be ambitious and innovative, and to remember the value of person-centred practice and partnering.

The panel was joined by a number of leading occupational therapists in SA educational settings – Lisa Varona, Sarah Enthoven and Anna Forgan from the Department of Education’s Self-Regulation Service, and Judith Merritt and Michael Sharp from the University of South Australia’s Orion Allied Health Student Service.

The panel shone a spotlight on the opportunities for occupational therapists to work holistically in classrooms using trauma-informed practices to support the participation, engagement, growth and development of children at the earliest possible age and life stage. At the same time, they could also build the capacity, capability and confidence of teachers, schools, families and caregivers to help young people achieve their educational and well-being goals.

Key questions and comments from the floor highlighted the passion and potential to explore further opportunities to combine sectors and systems to influence policy, practice and investment in the programs known to make a measurable difference.

The vision to empower and embolden occupational therapists to improve

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learning, social and emotional wellbeing outcomes for all children and young people – and to create the right environments in homes, schools and communities for children and young people to flourish – is indeed a powerful one.

About the Author Occupational therapist Nicole Keller has extensive experience in health and human services policy, planning and service delivery across NSW, Victoria and SA in government,

non-government and private sectors. She is a highly regarded leader, known for influencing system and service change and innovation, including mental health and wellbeing and suicide prevention. She is a passionate advocate for the power of participatory processes, partnering and ensuring people with lived experience remain central.

Nicole is Executive Director Mental Health and Wellbeing at Wellbeing SA, and is responsible for leading the

collaboration of work to build resilient and connected communities, and to support the mental health and well-being of South Australians, and the SA Mental Health Commissioners to implement the SA Mental Health Strategic Plan.

OTA was honoured to have Nicole facilitate a recent event in SA and provide a summary for this issue of Connections.

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CONNECTIONS WINTER 2022 21

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Sharing Power: developing a mental health curriculum Elisa Yule, Alexandra Logan & Julie Hughes, School of Allied Health, Faculty of Health Sciences, Australian Catholic University

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his is the 10th year of the Bachelor of Occupational Therapy course at the Australian Catholic University.

With this new degree came the opportunity to develop a mental health curriculum centred on recovery principles and recoveryoriented practice. The curriculum was co-produced and delivered with mental health consumers, and the purpose was to produce occupational therapy graduates who would espouse these values and have strong commitment to genuine partnerships with mental health consumers.

In our experience at ACU, students often find it difficult to grasp the concept of recovery and to apply it to their practices as occupational therapists. Students come with an understanding of medical recovery as the absence of symptoms, yet in mental health, recovery is understood as “being able to create and live a meaningful and contributing life in a community of choice with or without the presence of mental health issues” (Australian Health Ministers Advisory Council, 2012, p.11).

Students often have preconceived and stigmatised ideas about consumers as incapable of making decisions about their own treatment. However, recovery-oriented practice focuses on working with consumers to take back control of their lives, promoting independence from relationships with mental health professionals and services (Slade, 2009). It also recognises consumers as experts based on their lived experience and knowledge of themselves, and prioritises partnering with consumers to achieve their goals. Often this contradicts the students’

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conception of the health professional as expert within the therapeutic relationship.

We have employed a co-production approach to the design, delivery and evaluation of the ACU mental health curriculum as a key strategy to foster students’ understanding of recovery and capabilities for recovery-oriented practice (Arblaster, et al., 2018). The involvement of consumers in student education can take many forms. These sit within a spectrum of participation, ranging from non-participation and “tokenistic” telling of the story of lived experience through to meaningful participation at the level of co-production (Arnstein, 2019; Martin & Mahboub, nd).

Co-production sees consumers and academics working in authentic partnership where there is “equal sharing of expertise and experience, workload, design and implementation, [with] shared decision making” (Martin & Mahboub, nd, p.3). This sharing of the power to create the curriculum ensures that students directly hear and engage with the expertise and experience of consumers at every point in the curriculum.

This interaction offers the crucial catalyst for transforming students’ understandings and beliefs about mental illness, their hopes for the recovery of consumers, and their future practice in mental health settings.

Roper, Gray and Cadogan (2018) identified three core principles underpinning coproduction partnerships with consumers: consumers are partners from the outset; power differentials are acknowledged, explored and addressed; and consumer leadership and capacity is developed.

We would like to share some of the strategies we have used in applying these principles and some lessons learned from implementing a co-production approach in the two consecutive dedicated mental health units that span the second and third years of the course.

Preparing for co-production • Becoming familiar with recognised spectrums of consumer participation (see for example Arnstein, 2019; Martin & Mahboub, nd; Tew, Foster, Gell, 2004) allowed us to assess the level of consumer participation in our mental health curriculum and develop a strategy for increasing consumer participation that went beyond storytelling; • A crucial step was ensuring discipline leadership and organisational decision makers understood and supported co-production and were committed to consumer participation. Without this support it would not have been possible to secure the workload and funding necessary for implementing this approach or the necessary approvals for changes to the curriculum.

Consumers are partners from the outset • Fostering connections with local consumer groups and organisations enabled us to identify consumer advocates interested in educational roles. This led to long-term collaborative partnerships built on trust between academic staff and leading mental health consumer advocates, which has been essential to successful co-production

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• All partners had a shared purpose of embedding recovery principles in the design, delivery and evaluation of the curriculum. We were not, however, able to do everything at once. We started small by co-producing teaching materials on recovery oriented practice, traumainformed care, peer and family work and recovery oriented communication.

Following this we co-produced an assessment task that focused on the articulation of collaborative recovery planning. As these initiatives were new to the curriculum, we implemented research to evaluate the efficacy of the initiatives. This assisted us in providing the evidence needed for sustainable consumer participation in the course, and a successful funding grant enabled us to embark on a project to co-produce the entire mental health curriculum.

Power differentials are acknowledged, explored, and addressed • An equal number of consumers and academic staff were involved in all curriculum stages. Power differentials were discussed in the initial meetings of the project to co-produce the entire curriculum. These meetings were also used to ensure all partners had a shared understanding about the purpose and scope of the project, and of co-production, and had collectively decided on processes that would support the team to work collaboratively; • Key areas where academic staff have traditionally exercised power in the design of the curriculum were a

recovery-oriented practice focuses on working with consumers to take back control of their lives, promoting independence from relationships with mental health professionals and services focus to shift decision-making in the direction of consumers. For example, consumer interests and ideas in developing content, and teaching and learning activities, to be included in the curriculum were prioritised; • Wherever possible we looked for opportunities to model collaboration and genuine partnership with consumers in a way that is visible to students, for example, through co-delivering lectures and tutorials and co-marking of an oral presentation assessment. We have seen firsthand how this can be a transformational experience for students in understanding how traditional power imbalances between consumers and practitioners can be challenged.

supported. Several consumers involved in the process reported how it helped them in their professional and personal growth and have gone on to become more involved in consumer projects and roles at ACU and externally; • Co-production has also created a space for building the capacity of academic staff. The benefits have extended far beyond the intended purpose, shaping not only the curriculum but also who we are as educators.

Consumer leadership and capacity is developed • Building consumer capacity has been a goal of the co-production process. A key avenue for doing so is through briefing and debriefing around encounters with students to ensure consumers feel appropriately trained, resourced and

References can be viewed by scanning the QR code

CONNECTIONS WINTER 2022 23

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Five things to remember before taking out a business insurance pack Aon The term “business insurance” may be familiar. It can either refer to any policy that covers a business, or, more commonly, it refers to a package that covers businesses and their assets against events like fires, storms and theft.

This second policy is called a Business Insurance Pack, and has the following five important elements to ensure there are no gaps in cover.

1

A Packaged Insurance Policy

A Business Insurance Pack is a packaged policy that generally has various sections to cover different business needs. It is important to understand these sections to ensure a business has the right cover. For example, a policy may cover contents, but unless there is also cover for theft, the contents will not be covered if they are stolen from business premises. It is therefore important not to assume what the policy includes. More information can be found by scanning the QR code at the end of this article.

2

New Replacement Value

A Business Insurance Pack requires a nominated sum insured, which is the amount for which assets will be covered.

This can also be called a limit of liability, and may need to reflect new replacement value. This means the sum insured must equal the cost to replace all business contents with brand new items that have a similar function, output and construction to those damaged or lost, or to rebuild a building from scratch. Failure to nominate the correct sum may mean the business is underinsured in the event of a claim.

It is a misconception that underinsurance only occurs during a total loss claim, like when a building burns down 24 otaus.com.au

3

Underinsurance

Underinsurance occurs when assets are covered for less than the amount required to replace them. If something happens to equipment or buildings, and the business insurance policy does not cover the full cost to repair or replace them, there may be out-of-pocket expenses.

It is a misconception that underinsurance only occurs during a total loss claim, like when a building burns down. For example, if some equipment is destroyed in a storm, but the business is underinsured, the replacement cover may be reduced. To prevent underinsurance, Aon recommends an insurance valuation of assets. Unlike a bank valuation, an insurance valuation considers matters like property access, escalating costs in the event of a natural disaster, and the products from which a building is constructed (like asbestos, which may cost extra to remove).

4

Business Interruption

A key feature of a Business Insurance Pack is covering lost revenue in the time it takes to repair or replace assets after

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an insured event. For example, if a severe storm damages crucial equipment and the business is unable to operate, the policy will cover lost revenue for the prescribed indemnity period (the maximum amount of time for which lost revenue will be covered until the equipment is repaired or replaced).

For business interruption cover to apply, the assets and event that caused the damage must also be included in the policy.

5

Public and Products Liability

A Business Insurance Pack can also cover public liability against claims that a business caused personal injury or property damage. Most brokers and insurers offer stand-alone Public and Products Liability Insurance, however it is important to determine whether it is also needed as part of a Business Insurance Pack.

An Efficient Way to Buy a Business Insurance Pack Given the nature of Business Insurance Packs, the process of taking out a policy can be time-consuming and confusing.

Most standard applications involve various questions on all kinds of risk – even if they are not relevant to a particular business. That is why Aon is developing an efficient way to buy cover for health professionals, with three pre-selected online options designed to suit the most common business needs in the industry.​ The information contained in this article is general in nature and should not be relied on 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 in this article in relation to the insurance products we arrange are subject to the full terms and conditions of the relevant policy.

Health Professionals Business Insurance is arranged

by Aon Risk Services Australia Limited ABN 17 000 434 720 AFSL 241141 (Aon) under a binder agreement on behalf of the underwriter, Zurich Australian Insurance Limited (ZAIL) ABN 13 000 296 640 AFSL 232507. When acting under a binder, we will be acting as agent of the insurer and not as your agent. Our binder arrangements with the insurer are such that we remain your agent in the handling of any claim. If you purchase this insurance, Aon will receive a commission that is a percentage of the premium. Further information can be found in our FSG or provided upon request.

References can be viewed by scanning the QR code

CONNECTIONS WINTER 2022 25

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Spot the difference: poor performance, bad behaviour or mental illness?

Anna Pannuzzo, Director, WorkPlacePLUS

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anaging staff in a private practice comes with its challenges. It is important for practice owners and managers to recognise the common red flags of staff performance and be able to ascertain whether they are dealing with poor performance, poor behavioral conduct or a mental health issue such as work-related stress or burnout.

Each of these possibilities – performance, behavior or mental health – relates to a different set of rules, expectations, management processes and consequences.

However, making the distinction can be tricky. On the surface, the red flags of poor performance, poor behavioral conduct or poor mental health can present as very similar or the same.

For example, if you had to label the list of red flags below as a staff issue based on performance, behavior or mental health, could you do it?

How confident would you be?

• Employee is always late; • Client complains that receptionist is irritable; • Employee has missed two team meetings; • Employee criticises another employee’s work via a team email; • Employee consistently fails to complete the required forms; • Employee doesn’t fit in with the team; • Employee provides client information to the client’s relative; 26 otaus.com.au

• Employee posts photos of the work Christmas party on social media;

to staff and others, and sometimes leads to suspension or termination of employment.

• Employee is coming to work looking tired and disheveled;

Poor mental health relates to employee health and safety. Practice owners have a duty to ensure the workplace does not cause psychological or physical injury or worsen an existing condition. Practice managers must exercise due diligence to ensure the employer complies with their duties under Work, Health and Safety (WHS) laws. These obligations include looking out for behavioural changes and responding appropriately when an employee appears to be struggling.

• Employee complains that co-worker is creepy; • Employee submits a report with spelling mistakes; • Employee says “that’s not my job” and refuses to lend a hand; • Employee says they need to take a “mental health” day off; and • Employee borrows petty cash.

For several of the above examples, more information is needed to determine what is really going on.

Poor performance relates to an employee’s skill set and not meeting skill-based expectations. Performance management (including performance reviews, giving effective feedback, setting goals, measuring, coaching and training) is an important aspect of the employee life cycle. If performance management is well executed, poor performance is relatively easy to overcome as skills and expectations can be taught and developed.

Poor behaviour relates to an employee’s attitude and values, so this is much more difficult to change. Also, the rules, circumstances and consequences around poor behavior and inappropriate conduct are usually much more serious. Inappropriate conduct can pose a health and safety risk

From the time that the Covid-19 pandemic began to impact our lives, awareness around the occupational syndrome of ‘burnout’ began to skyrocket – and for good reason.

Burnout is caused by chronic workplace stress that has not been successfully managed. The pandemic has placed unprecedented stress on workplaces, particularly those considered to be ‘high risk’, ‘tier 1’ or ‘essential workers’, such as health care. Common psychosocial workplace hazards such as heavy workloads and long working hours have been compounded by extra Covid-19-related psychosocial workplace hazards such as low level of control, remote and isolated work, restrictions on family support, high-risk environmental conditions, the demands of PPE and infection control, fear and concern for physical safety, and often poorly managed organisational change.

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Signs of work-related stress or burnout in your practice Increased absenteeism and lateness Increased staff turnover

Photo: ©gettyimages /SDI Productions

Reduced productivity and engagement A decline in worker job satisfaction Increased accidents and injuries Increased workers’ compensation claims Increased complaints Decreased quality of relationships Reduced client satisfaction Red flags of poor behavioral conduct or a toxic workplace culture in your practice Increased absenteeism and lateness Increased staff turnover

Signs of work-related stress or burnout in an individual include: • Headaches, tiredness, sleeplessness, slow reactions, shortness of breath; • Difficulty in decision-making, forgetfulness, lack of concentration; • Irritability, excessive worrying, feelings of worthlessness, anxiety, defensiveness, anger, mood swings; • Reduced performance, social withdrawal, impulsive behavior, increased alcohol and nicotine consumption and • Compassion fatigue.

Work-related stress or burnout can also manifest as red flags in a practice. Again, this is where things can get tricky for practice owners and managers who need to respond appropriately to workplace issues. For example, the table on the right shows the strong similarities between signs of burnout and the red flags of a toxic workplace culture.

A toxic workplace culture often signifies that leadership has failed to follow best-practice protocols in preventing and responding to serious workplace incidents, such as bullying, harassment/discrimination, which are forms of poor behavioral conduct.

The solution for practice owners or managers is to use their interpersonal communication skills. When they notice any of the abovementioned red flags in their practice, it is important to check individually with each concerned staff member to ascertain what is going on. These conversations require calm energy, a safe, private setting and good listening skills. Open questions like “What’s happening for you?” and “What can we do to support you?” give the employee an opportunity to paint a clearer picture of what they are dealing with.

Managers and employers need to know the correct course of action when poor performance or inappropriate conduct occurs. Getting this process wrong has a strong negative impact on the culture and productivity of the workplace.

Getting it right has a positive ripple effect by reaffirming organisational values, standards and expectations.

When an employee is showing signs of work-related stress or burnout, or if they indicate that they are struggling mentally or physically, it is appropriate to ask, “Do you need to take some time off with leave?” and then help the employee explore their

Reduced productivity and engagement Poor work ethics and attitudes Increased staff conflict and complaints Increased workers’ compensation claims Poor leadership support, communication Decreased trust and quality of relationships Reduced client satisfaction

options of what this could look like. In most cases, a doctor’s certificate will be required to confirm whether or not the employee is fit for work, and able to access personal leave.

Interpreting red flags in a private practice and handling staff issues appropriately is not always clear-cut. To understand the correct course of action, it is a good idea to seek professional advice from an HR consultancy that works closely with the allied health sector such as WorkPlacePLUS All OTA members receive special OTA member benefits through WorkPlacePLUS for support with HR and IR issues. For more information, contact Anna on (03) 9492 0958 or visit WorkPlacePLUS.com.au CONNECTIONS WINTER 2022 27

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‘DIY’ breakfast program to improve rehab after brain injury Michelle Quick, Jacqui Wheatcroft, Danielle Sansonetti, Natasha Lannin and Laura Jolliffe

Increasing participation in acquired brain Injury rehabilitation Clinical practice guidelines recommend that people with an acquired brain injury (ABI) should engage in at least three hours of scheduled therapy a day, and opportunities for increased practice outside these times should be encouraged (Stroke Foundation, 2017).

However, it is often challenging to meet this target within inpatient rehabilitation, with only a fraction of the day spent actively completing rehabilitation in a structured therapy program (Janssen et. al., 2014). As occupational therapists, it is important to consider how to help patients increase intensity and duration of participation in functional activities within the ward environment to meet guideline recommendations and prepare for discharge.

Within the ABI rehabilitation unit, it was identified that opportunities for patients to initiate routine daily activities were limited.

Additional opportunities for brain injury rehabilitation can be provided in groups, like upper limb, community mobility, fatigue management and meal preparation groups.

Activities may include applying cognitive strategies during functional tasks, using aids and equipment, grading tasks, and practising social skills such as taking turns and 28 otaus.com.au

working with others. While breakfast groups have been extensively used, particularly in the general rehabilitation settings (Scaffa, 2013), there is limited evidence of meal groups to improve participation or function in the ABI population.

Do-It-yourself breakfast program evaluation This project aimed to explore and evaluate an independent ‘do-it-yourself breakfast group program. Observational audits were completed before and after the unsupervised group was implemented to evaluate the program. In addition to patient participation, Functional Independence Measure (FIM™) and Functional Autonomy Measurement System (SMAF) scores, activity participation, frequency and time of use before and after the program was implemented were also recorded.

Patients in the 42-bed ABI rehabilitation ward were invited to attend the DIY breakfast program if they: Had a rehabilitation goal of independent meal preparation; or Their treating occupational therapist considered they were nearing independence with this goal.

Patients did not attend the DIY breakfast program if they: Had behaviours of concern that affected the safety of others;

Were on modified diets that could not be managed themselves Required assistance with walking; or Had significant cognitive issues that could pose a risk to self or others.

Environment and resources A review of the ward was completed, and a suitable room in an accessible, highly visible area – which could be locked if required for the safety of others (for example, if patients were exhibiting behaviors of concern) – was identified. Internal windows between the nurses’ station and the identified room further increased visibility.

This room contained equipment and furniture including: • Fridge/freezer (ingredients milk, yoghurt, bread etc); • shelving unit (with plates, cups, cutlery, cereals and spreads); • Kettle; • Table and chairs; • Tea towels; • Whiteboard; • Trolley to put dirty dishes; and • Hand hygiene station.

Due to fire alarm regulations a toaster could not be used in this setting.

Photo: ©gettyimages /KucherAV

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As occupational therapists, it is important to consider how to help patients increase intensity and duration of participation in functional activities within the ward environment...

Development of the program

Results of the program

A DIY program working party was established to develop work instructions and hygiene and food safety protocols, and troubleshoot any issues that arose.

Patients were trained in “house rules” and how to use the area, and had a supervised breakfast preparation session with their occupational therapist. Once patients agreed to take part in the program, they were timetabled up to seven days a week and their ward breakfast delivery was cancelled for specified days. Patients were then responsible for initiating and making their own breakfast on these days.

Use of ward spaces: The pre-intervention observational audit determined that no patients had used the small dining room on the rehabilitation ward. Over the 315-minute post-intervention audit (between 5.45am and 11am), the DIY breakfast was used 16 times by patients. This equalled 135 minutes of activity engagement (mostly meal preparation), with a mean of 19 (SD 13) minutes per patient. Of the 315 minutes of post-intervention auditing, patients were seen using the space alone (totalling 127 minutes), with only eight minutes spent in shared company (two patients at once).

The audit indicated that the DIY breakfast space served different purposes, with some patients choosing to prepare and eat their meal in the dining room, whilst others opted to eat in their own room and return their dishes to the kitchen afterwards.

Patient characteristics of those who used the DIY space: Of the 42 inpatients on the ward at the time of this study, 11 were involved in the DIY breakfast program. The average age of participants was 49 years (SD 10), 86 per cent were male, and the mean time since onset of injury was 175 days (SD 88.98). On the day of post-intervention auditing, four of the 11 patients did not use the DIY breakfast space due to appointment attendance (n=1), sleeping (n=2) or not wanting to socialise (n=1). In total, seven participants used the DIY space during post-intervention auditing. All patients with TBI had a PTA length greater than 25 days (thus, all were considered to have sustained a severe traumatic brain injury).

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F E AT U R E

‘DIY’ breakfast program to improve rehab after brain injury Continued from previous page

Medical file audits of DIY breakfast program participants: Of the seven patients that used the DIY space in the post-intervention audit, medical file audits of their function indicated that the mean FIM total score was 109.1 (SD 8.6), mean FIM cognition/communication score was 26.6 (SD 4.7), and the mean FIM motor score was 82.6 (SD 9.9). The mean SMAF total (disability) score was -23.4 (SD 5.8) and mean SMAF total (handicap) score was -21.7 (SD 6.9). Therefore, the SMAF scores indicated that patients who had sustained moderate-severe brain injuries and required cognitive support (i.e. supervision, prompts, or aids) with daily tasks were more likely to benefit from this program.

managed their daily routines. The DIY breakfast program facilitated the following:

Medical file audits for the number of breakfast sessions in which participants engaged (i.e. breakfast group, therapist facilitated sessions/self-initiated) increased from a mean of 2.4 to 9.7 (SD 5.4) sessions (over 15 days) before and after involvement in the DIY program.

This equates to a mean difference of 7.3 (SD 3.9, CI 95% 3.7 to 10.9, p<.003).

• Increased participation in routine activities without the need for significant additional costs or staff resources.

Benefits of a DIY breakfast program Patients who took part in the DIY breakfast program reported that they enjoyed the independence and increased confidence of preparing their breakfast before they were due to return home. Restructuring the ward environment increased ward space use, increased delivery of meaningful semisupervised therapy, and was appropriate for patients who were not yet independent in higher risk kitchens (for example, those with a stove top, oven and microwave).

Providing increased opportunity for practice provided patients and staff with additional information about how they

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• The environment to be used to creatively promote patient activity and socialisation; • Patients more closely mirroring usual routines and preferences on how and where to spend their time; • Opportunities to gain independence in basic meal preparation and other domestic tasks e.g. washing dishes, cleaning bench tops; • Patients engaging in roles such as “hosting” their visitors or making their own hot drink in the space to simulate a home environment and encourage socialisation;

Tips for implementation • Make small changes to the physical environment to increase opportunities for therapeutic intervention; • Evaluate kitchen equipment that is able to be used in designated area i.e. a toaster may not be able to be used due to fire restrictions;

kitchen due to stove tops and risks involved may be able to safely engage in a DIY breakfast program; • Evaluate risks for each patient i.e. those with allergies or swallowing requirements; and • Ward requirements for the DIY breakfast space may fluctuate over time due to the profile of patients. Be prepared to pause and recommence the group as appropriate.

About the authors Michelle Quick is the senior occupational therapist for the Neuro Trauma stream at The Alfred hospital.

Jacqui Wheatcroft and Danielle Sansonetti are PhD candidates and grade four occupational therapists at Alfred Health.

Professor Natasha Lannin is Professor, Allied Health (Occupational Therapy), Alfred Health, Melbourne, Australia, and Professor, Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.

Dr Laura Joliffe is a lecturer and academic in occupational therapy at Monash University.

• Gather resources such as simple breakfast items, fridge, kettle, cutlery, etc; • Engage the whole team to support greater participation; • Encourage students, volunteers and family members to support patients to take part; • Develop tailored cognitive strategies such as alarms or visual cues to support a patient’s recall and initiation of breakfast preparation; • Consider all patients i.e. those who may not be able to use a full

References can be viewed by scanning the QR code

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