Connections - April 2019

The magazine of Occupational Therapy Australia, the peak body representing occupational therapy in Australia APRIL 2019 | VOL 16 ISSUE 2

Print Post Approved PP100018285 ISSN 1832-7605

Connecting with Peers in the Allied Health Sector

Five Things to Consider Before Starting your Own Practice Teamwork Makes the Dreamwork Animal Assisted Therapy in Occupational Therapy D I S CO V E R T H E B E N E F I TS O F P E E R R E L AT I O N S H I P S

CONTENTS

NEWS

FEATURES

President’s Report

4

CEO’s Report

5

Connecting with Peers in the Allied Health Sector

6

Supporting OTs: A New Framework for Supervision

9

Connecting with Peers through Professional Development

10

CPD Report

11

Elaine B Wilson Memorial Award

27

AOTJ Report: Connecting with Peers

28

WFOT Update

30

Animal Assisted Therapy in Occupational Therapy

16

OTA National OT Aged Care Symposium

20

CareSearch and palliAGED

22

14

Animal Assisted Therapy in Occupational Therapy

A Review of Occupational Therapists Working in Residential Aged Care Facilities

24

16

Reaching Out Across Disciplines

27

New Cognitive Impairment Identifier Empowers Collaboration

19

Meet your Conference Committee

31

OTA National OT Aged Care Symposium 2019

20

Five Things to Consider Before Starting your Own Practice

13

Teamwork Makes the Dreamwork

About Connections

Contributions and Advertising

Disclaimer

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

Would you like to contribute to Connections, or do you have a product that is attractive to occupational therapists and would like to advertise your product?

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.

Contact us Occupational Therapy Australia ARBN 007510 287 ABN 65 470 069 906 6/340 Gore Street, Fitzroy, Victoria 3065 Ph: +61 3 9415 2900 1300 682 878 Email: info@otaus.com.au Web: www.otaus.com.au Design: Perry Watson Design

Editorial material including letters to the editor, upcoming events, research material, and important information for inclusion in Connections should be sent by email to marketing@otaus.com.au. The editor reserves the right to edit material for space and clarity and to withhold material from publication.

Deadlines for submissions Edition June edition August edition October edition

Deadline 26 Apr 28 Jun 30 Aug

Cover image: ©gettyimages/Ani_Ka

CONNECTIONS APRIL 2019 3

PRESIDENT’S REPORT

PRESIDENT’S REPORT “The importance of translating knowledge across occupational boundaries is frequently identified as a means of generating innovation and improving performance” (Orbon & Dawson, 2010, p 1835).

T

his quote is drawn from a study that explored the processes of multi-disciplinary team work within an organisation. As occupational therapists, that’s where we typically experience the phenomena ourselves.

We may be in a team of OTs who participate in inter-disciplinary or transdisciplinary ways. Often, we find we are the only occupational therapist in the team. We communicate constantly about the contribution of occupational therapy to the therapy process and outcomes for each client, family, group or community.

This communication is a core competency and part of our daily work lives. It is not always easy, depending on the dynamic of the team, but the central glue that holds the process together is the focus on the target group of the services we provide.

There is evidence that interacting with peers fosters learning and information sharing (Li, Grimshaw, Neilsen et al, 2009). However, how does that opportunity for knowledge translation, learning with and from each other and sharing information occur outside of our employment-based roles While informal groups and networks present good opportunities for information exchange (Li, Grimshaw, Neilsen et al, 2009), do they offer enough structure for deeper or other outcomes, such as innovation? Communities of practice (CoPs) are a type of informal learning organisation. Ten years ago, when they completed their meta-narrative systematic review, Li et al concluded that CoPs were evolving; from interactions between

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Angela Berndt, OTA President

novices and experts where newcomers create a professional identity; to personal growth and individual participation within a group; to application as a managerial tool for improving an organisation’s competitiveness (Li et al, 2009). The meta-narrative concluded that CoPs work well if they are well facilitated, use technologies to increase inclusiveness and have clearly defined roles and structures.

OTA has offered many different forms of CoP and they also continue to evolve.

Through our membership surveys and other quality feedback processes, we have been asking members about their experiences and seeking ways to innovate and respond to an ever-growing professional need.

Special Interest Groups (SIGs) are an interesting case study. In my experience as a member, a convenor and a participant, I reflect that my experiences match the descriptors above, with the addition of lobbying and an outward facing advocacy focus. I highly value my SIG membership, even if more recently I have struggled to be a regular attendee. I value it because it keeps me connected with a practice area.

I have seen many examples of innovation stemming from within that SIG, and I’m sure you can identify similar stories.

However, what about CoPs across interest areas? And what about multidisciplinary CoPs outside of paid employment? Currently, we have many staff and members active in taskforces and working groups that cross disciplinary boundaries (roles that are often time bound and issue specific).

The process enhances our standing in the community and grows our stakeholder network. Thank you to all those members!

However, it seems that in the ongoing evolution of our professional association, as we become more technically proficient and able, and as awareness of the importance of occupational therapy continues to grow, that a new and varied version of CoPs is on our horizon. CoPs of occupational therapists who are all deeply committed to occupation-based practice but who work in diverse sectors or places.

CoPs of peers that are multi-disciplinary in nature, outside of work places.

Can we partner with our other professional associations? What might be the benefits and outcomes of a new look at an old idea? OTA’s strategic plan sets a vision for our profession to be valued for our influence and innovation. Regardless of the means by which we achieve it, connection and communication with our peers, across sectors and of course with our communities, seems to be a positive mechanism to achieve that vision.

Angela Berndt References: 1. Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC & Graham ID (2009). Evolution of Wenger’s concept of community of practice, Implementation Science, 4 (11). Open Access, doi:10.1186/1748-5908-4-11.

2. Orbon E & Dawson S, 2010. Knowledge and practice in multidisciplinary teams: Struggle, accommodation and privilege, Human Relations 63(12) 1835–1857. DOI: 10.1177/0018726710371237

CEO’S REPORT

CEO’S REPORT

A

t the start of each year many of us make a plan for the twelve months ahead. We set goals and milestones both personally and professionally. As the first quarter draws to a close, I thought it timely to review how I was tracking against what I had hoped I would achieve.

Some of the critical objectives of my annual plan were to book in time for self-care and self-reflection, and to make sure I have the necessary professional and personal support and development to live my life to its full potential. It wasn’t a moment of enlightenment or a selfhelp book that taught me the value of taking the time to spend less time with busy-ness and more time with me.

In 2017 I was fortunate to participate in Leadership Victoria’s Folio Program. The program offers a deep dive into social, economic and environmental issues and asked the 21 of us to consider our leadership in a wider context than our professional role or title. The course provided interactive, engaging and experiential leadership development.

All of us came away with a broadened self-awareness where we were challenged to see the world differently.

This program brought both a different perspective to my thinking and 21 new leaders into my life for an intense seven months, and beyond. The Folio Program (and my fellow participants) not only taught me the value of professional peer support, planning and reflection, it instilled in me the value of peer consultation.

There is enormous benefit in bringing your leadership under the lens of others, and in paying back and listening, learning and assisting others in their challenges.

Since we graduated from the program, we have continued to stay in touch, and

apart from catching up socially for drinks and dinner, we also are available to each other to continue with peer consultations should any of us require the perspective, insight and support of our peers. This is a powerful process for those involved and is based on a deep level of trust and honesty. The process also holds us accountable for continuing to unravel and address complex problems so that we are outcomes focussed. We all learn and develop from the process—we all benefit.

Mentoring, supervision and peer consultation groups are all incredibly powerful tools that help with problem solving, goal setting and professional growth, allowing for personal development and insights. At OTA, we are looking to continue to develop resources that empower, enable and connect you—resources that allow you to be supported and encouraged as your career progresses and evolves.

As we become more senior and experienced in our roles, it is a great privilege to be able to give back by supporting younger and less experienced peers. I encourage all members to consider how they can support others either in their workplace or through OTA’s MentorLink program.

So, how am I tracking against my goals for the first quarter of this year?

I have booked family holidays to make sure I am taking the time to laugh, love and eat cheese! I am a mentor in the Joan Kirner Young & Emerging Women Leaders Program. I continue to sit on other notfor-profit boards, each of which gives me a different set of challenges and insights to consider. I also continue to benefit from the diverse and trusted advisers I met in 2017 through Leadership Victoria.

Samantha Hunter, CEO

One of the greatest learning opportunities that I continue to enjoy is meeting with and hearing from members. Hearing of our history, hearing of your challenges and listening to your vision for the future.

All of these elements provide me with the grounding and support to lead your OTA team—a team committed to supporting members and to promoting our profession.

Samantha Hunter

Vale Jennifer Mackay I would like to send my condolences to the Mackay family on the recent passing of Jennifer Mackay. Jen was a well-respected occupational therapist based out of Longreach for many years. Jen was also a founding member of Occupational Therapy Australia, and was granted Honorary Life Membership—awarded to therapists who have performed meritorious services in the field of occupational therapy while displaying exemplary contributions in support of the Association.

Vale Jen.

CONNECTIONS APRIL 2019 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

CONNECTING WITH PEERS IN THE ALLIED HEALTH SECTOR Michael Barrett, OTA National Manager: Government and Stakeholder Relations Gayle Kissonergis, OTA Senior Policy Officer In the field of advocacy and stakeholder relations, OTA considers its peers to be the other allied health professional associations. We have a proven commitment to developing and strengthening our ties with these bodies.

W

hile members would know that OTA is an active member of Allied Health Professions Australia (AHPA), you may not realise just how active we are. There are numerous AHPA working groups, undertaking specific projects or targeting specific objectives to the benefit of allied health professionals. OTA is represented on these groups by the staff member or clinician deemed most likely to ensure occupational therapy is well represented.

In recent times AHPA and its member organisations have undertaken specific projects around the various reviews of Medicare Benefits Schedule (MBS) items, the feasibility of an Allied Health Practice Owners Network, and the forthcoming federal election. At the present moment, AHPA has a subcommittee focussing on the NDIS and is establishing working groups to address the challenges and opportunities around Aged Care, Models of Care and Digital Health. OTA also has a very prominent presence in the Members’ Collaborative Forum.

While at first glance this might appear bureaucratic, the committees do enable the various allied health professions to come together to share ideas and

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experiences in the pursuit of a common goal. Sometimes this goal might be quite specific—the introduction of case conferencing as an MBS item, for example—or quite comprehensive, such as sweeping improvements to the NDIS. In either case, by connecting with our peers, OTA ensures the voice of an entire sector is heard by government.

Panel discussion on NDIS transitional arrangements

In late February OTA was once again invited to appear before the Australian Parliament’s Joint Standing Committee on the NDIS at a public hearing. This time things were slightly different however, with OTA representatives taking part in a panel discussion on transitional arrangements.

This was one of three panel discussions held on the day in addition to a Town Hall style discussion where participants, their carers and family members, as well as service providers and registered plan management providers, shared their views on the implementation and performance of the NDIS. Since inception, the Committee has tabled eight reports to Parliament, four of which have received a Government Response.

The purpose of these discussions was to hear from the key stakeholders of these four inquiries to understand current experiences of the scheme and find out if any progress has been made since the recommendations were provided.

Issues raised included, among others, the scheme’s interface with the health system and other mainstream services, delays in plan activation and access to services, and emerging service gaps and the effectiveness of the ILC program.

The hearing provided another opportunity to connect with our peers in the allied health sector, and the health and disability sectors more broadly, with representatives from the following organisations appearing alongside OTA: • National Disability Services • Australian Federation of Disability Organisations • Victorian Council of Social Services • Victorian Healthcare Association • Speech Pathology Australia Appearances before Parliamentary Committees are becoming more frequent for OTA, with our written submissions being well received and additional information

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

“THE EVIDENCE IS OVERWHELMING THAT EVERY DOLLAR INVESTED IN FALLS PREVENTION RETURNS MULTIPLE DOLLARS IN SAVINGS.”

requested. While such appearances do not necessarily guarantee the adoption of recommendations put forward by submitters, they are an integral part of the lobbying process and a positive reflection of our advocacy work and growing profile.

Institute of Health and Welfare (AIHW) demonstrating the growth in private health insurance funded public hospital admissions, and the fact that a substantial proportion of these hospitalisations involve people aged over 75 years.

OTA makes its case to the private health insurance industry

At least some of these hospitalisations are eminently avoidable, particularly those that result from falls. The evidence is overwhelming that every dollar invested in falls prevention returns multiple dollars in savings. This is a point we make constantly to government, and we are now making to the private health insurance industry.

By investing more in preventative care and, in particular, falls prevention among older policyholders, the funds will in the medium to long term save money.

This is good news for the funds, good news for the policyholders they keep out of hospital, and good news for our nation’s over-stretched health system.

In February, OTA opened up a whole new frontier of lobbying when our National Manager of Government and Stakeholder Relations, Michael Barrett, and Dr Carolynne White, a lecturer in OT at Swinburne University of Technology, made a presentation to the private health insurance funds’ General Treatment Community of Interest. This forum comprises senior executives from all the private health insurance funds with responsibility for the product design of non-hospital related benefits.

We told the forum that occupational therapy is uniquely valuable in both the prevention of injury and illness, and in the recovery process once someone has been injured or fallen ill.

We stated: At a time when government is focusing on the public health and economic benefits that flow from preventative medicine, OTA believes private health insurers should also be encouraged to devote more energy and resources to preventative care when undertaking product design ... In the case of elderly customers, for example, the health system and the private health funds would generate substantial savings by making even a modest investment in assistive technology (AT) and home modifications.

We cited evidence from the Australian

If funds are unable to include “preemptive” home modifications as part of a package, we suggested they could offer a deduction in premiums to those policyholders aged over 65 who undertake a home safety screening, and basic home modifications such as a grab rail or non-slip, visibility strips on steps, at their own expense.

The other issue we raised with the funds is the role of occupational therapists in the care, and more importantly the recovery, of policyholders once they have been injured or fallen ill.

Readers may not be aware that General Treatment fund benefits are dominated by payments for dental care. Once ambulance costs are also removed from

the equation, almost 80 per cent of the remaining pay outs are for optical, physiotherapy, chiropractic and natural therapies. We told the forum that this last one really raises our eyebrows; in the 2017-18 financial year, therapies that have at best a highly questionable basis in science, received $16.50 from the private health funds for every one dollar they invested in occupational therapy.

In all, in 2017-18, occupational therapy accounted for $12.5 million, out of General Treatment benefits totalling $5.15 billion.

That is less than a quarter of one per cent of General Treatment benefits.

This is because many of the more expensive packages offered by the funds relegate occupational therapy to the status of an optional extra. Some cheaper packages exclude occupational therapy altogether, while including most other AHPRA-registered allied health services.

So, in February we asked the funds why. Because we believe, and the scientific evidence supports this belief, that occupational therapists, with their accredited training in both physical and mental health conditions, have a valuable role to play in the care and recovery of their policyholders.

Multimorbidity is one of the conundrums currently facing health services, as it is an established driver of higher healthcare costs. A report by the Commonwealth Fund (Issue Brief August 2016, Hayes et al) found that the healthcare expenditure of people with three or more chronic diseases and functional limitations was three times Continued next page CONNECTIONS APRIL 2019 7

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

Continued from previous page

higher than that of people with three or more chronic diseases and no functional limitations.

As you know, occupational therapists work with people, in the context of their home, work or other relevant environments, to not only manage their symptoms but to address functional limitations and support participation. Occupational therapy is therefore central to the recovery process, enabling people to resume their productive role in the community more quickly than would otherwise be possible.

We also reminded the funds that occupational therapists have an important

role to play in mental health care. We noted that OTs work across the spectrum of mental illness, providing services to people with mild, moderate and severe mental health conditions. They help improve mental health and wellbeing by facilitating access to personally relevant and valued roles in life.

twenty-first is shaping up to be about the preservation of wellness. This is not just rhetoric on the part of governments. In Australia it has become a macroeconomic imperative, as our population ages and the cost of treating their illnesses becomes increasingly prohibitive.

Interestingly, this came as a complete surprise to the funds’ executives, several of whom asked questions around this at the end of our presentation.

We hope that the presentation went some of the way to persuading the private health insurance industry that occupational therapy is uniquely suited to these times. This was a modest but important next step in OTA’s campaign to raise awareness of what it is you do.

We closed by saying that if the twentieth century was all about identifying, addressing and defeating illness, the

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

SUPPORTING OTS: A NEW FRAMEWORK FOR SUPERVISION Anita Volkert OTA National Manager: Professional Practice and Development

T

he way we work as occupational therapists is changing. With a plentiful supply of new graduates, new emerging areas of practice are opening up in tandem with changes to health and social funding, and innovation. It’s incredibly exciting to see occupational therapy impacting the broader community in this way.

However, Occupational Therapy Australia has been aware for some time that with these new developments comes a risk of occupational therapists working with less support than might have once been the case. As a result, we have developed a new framework for supervision for the profession in Australia. The framework aims to provide best practice evidence, models and a range of templates and tools for every occupational therapist.

The framework is relevant whether OTs are working in a large urban hospital centre, as a sole practitioner in an isolated rural location, or in emerging practice areas, and everything in between.

As a best practice framework, the guide does not aim to set regulations around what supervision should and should not be, as it is not the role of the association.

Instead I draw your attention here to the Occupational Therapy Board of Australia’s Supervision Guidelines

“SUPERVISION ENABLES YOU TO REFLECT ON YOUR PRACTICE AND IMPROVE IT. IT OPENS UP NEW APPROACHES AND DEVELOPMENTS IN THE EVIDENCE BASE, AND HELPS YOU DEAL WITH COMPLEX SITUATIONS, EMOTIONS AND ISSUES OF BURN OUT.”

(www.occupationaltherapyboard. gov.au/codes-guidelines), which are for specific use when registration is conditional or provisional and an associated supervision plan is in place.

Instead, Occupational Therapy Australia’s Supervision Framework guides each and every occupational therapist as to best practice in giving and receiving supervision.

The OTBA Code of Conduct (2014) states that it is every OT’s responsibility to ensure they have adequate supervision for the work that they do. This may mean making external arrangements if adequate arrangements are not possible within your organisation, and/or arranging for private supervision. The key issue is that it is your responsibility as a registered occupational therapist (not your employer’s), to ensure that you receive adequate supervision.

Having said that, I would always encourage an employer to work with their

occupational therapy staff to support them to access appropriate supervision, as the benefits to them are so great in doing so.

Does this also apply to those in sole private practice? This is a common query that I receive. Yes, it does, even if you feel that the practice area you are in is very well known to you, and you have been doing it for many years. Supervision enables you to reflect on your practice and improve it. It opens up new approaches and developments in the evidence base, and helps you deal with complex situations, emotions and issues of burn out.

Occupational Therapy Australia’s Supervision Framework is now available on our website to download in full, with templates and tools here: www.otaus. com.au/advocacy/position-statements

CONNECTIONS APRIL 2019 9

N AT I O N A L C P D U P D AT E

CONNECTING WITH PEERS THROUGH PROFESSIONAL DEVELOPMENT Lindsay Vernon OTA Professional Adviser: Learning and Development

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e run a number of CPD sessions — all of which are specifically chosen to support member learning needs and effective evidence-based clinical care. In this edition I wanted to concentrate on two CPD sessions that explicitly connect us with our peers through multidisciplinary working.

acknowledge the numerous words attributed to a person participating in care with clinicians in choosing to use client on this occasion), the family/carer, physiotherapists, speech therapists, doctors, builders, helpers in the home, social workers, dietitians, exercise physiologists etc…

We run a home modifications course that is co-facilitated by an OT and an architect, and we also run a foundations of mental health course that is co-facilitated by an OT and a consumer consultant.

It is no wonder there is value in delivering training in partnership. Why is it we work in collaboration with so many others?

Usually, it is because we recognise that each member of the multidisciplinary team has a set of unique skills to offer and that as humans, we are complex beings in a complex environment. By connecting with our peers and their skill set, we are providing a service to the client that acknowledges those complexities.

The home modifications course is designed to support occupational therapists to undertake clinical reasoning relevant to environmental modification and design for people who are ageing or living with disabilities. The expected outcomes of this program focus on increasing understanding of concepts relating to human measurement (relevant to environmental design); recognising the functional implications of features present in the built environment; application of Australian Standards and other relevant legislation; and becoming familiar with commonly utilised building terminology allowing effective communication with a range of building professionals and other key stakeholders.

When we think of many of our clinical interactions, they are in consultation with numerous others – the client (I 10 www.otaus.com.au

By having the architect in the room providing information based in their practice domain, OTs are being provided with a language skill set they can use in their work with other professionals. How many times have you been on the phone to IT trying to find the right word to explain an issue? Wouldn’t it be amazing to have the right words to quickly describe the difficulty at hand—in this course we offer that opportunity for home modifications!

The mental health foundations course provides training in line with contemporary mental health practice in the Australian context. The day

“WE RECOGNISE THAT EACH MEMBER OF THE MULTIDISCIPLINARY TEAM HAS A SET OF UNIQUE SKILLS TO OFFER AND THAT AS HUMANS, WE ARE COMPLEX BEINGS IN A COMPLEX ENVIRONMENT. ” considers topic areas as they relate to the Australian National Practice Standards for the mental health workforce (2013), particularly those that address: • Rights, responsibilities, safety and privacy (Standard 1) • Working with people, families and carers in recovery focused ways (Standard 2) • Individual planning (Standard 6) • Treatment and support (Standard 7) • Integration and partnership (Standard 9) When we look at those standards, we couldn’t consider achieving them without seeking direction and insight from the people who use the services.

How can we work in a recovery focused way with people, families and carers without asking them what recovery means to them or how recovery can be supported in their environment?

N AT I O N A L C P D U P D AT E

“PEER RELATIONSHIPS HAVE THE CAPACITY TO SUPPORT US IN BROADENING OUR CONNECTIONS THROUGH INTRODUCING NEW IDEAS OR NETWORKS.”

Both these courses have proved successful, and feedback we receive supports the value in having different perspectives.

This connects us with our peers through the provision of alternative perspectives, experiences and theoretical models, and adds value to clinical reasoning in our daily work.

Peer relationships have the capacity to support us in broadening our connections through introducing new ideas or networks. In developing alternative ideas, we are able to consider other people’s experiences of the world which support us with our communication—which, as already noted, is an invaluable tool in our daily interactions.

I have talked about connecting with interdisciplinary peers in this article but I also want to acknowledge that CPD workshops provide the opportunity for you to connect with your OT peers. I know that new, old and current peer relationships are enjoyed through attending CPD workshops. Morning breaks drag out due to animated conversation, phone numbers and emails are exchanged and often people stay on after the end of the course to enjoy the venue and each other’s company.

Connecting with peers whether through a CPD course, a coffee at morning break or a walk back to the car has the capacity to help us refresh our wellbeing and reflect on our interactions. Connecting with peers through PD takes many forms and I hope you continue to enjoy these through OTA.

Independence Australians deserve

CPD REPORT We have started the year in flying form running 22 CPD sessions in the first quarter of the year.

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nnie O’Connell kicked of the program with a sold-out course on addressing sleep in children and adolescents. This course will run again in Brisbane later in the year.

We ran our first Mental Health foundations course in Melbourne with great success. Carla van Heerden and her colleague Michael Burbank co-facilitated a day focused around the Australian National Practice Standards for the mental health workforce. This course is scheduled to run in Queensland, NSW and WA before the end of the year.

We’ve run our first AMPS course for the year—another sold out event in Victoria. AMPS has its own webpage on the OTA site (www.otaus.com.au/pdeducationcontentpages/amps), so check out the available courses around the country.

We have run a number of home modifications courses that continue to be well received along with paediatrics. We’ve also supported CPD in leadership, neuroplasticity, business basics, soft tissue, manual handling, complex regional pain syndrome and how to record all this CPD creatively!

Thank you for all your feedback on our CPD program, both with regard to courses we have run and courses you would like to see available. We do add to the program regularly with SIGs, webinars, online series and workshops. Please check our PD pages online for the latest information.

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CONNECTIONS APRIL 2019 11

CPD CALENDAR

UPCOMING OTA CPD & EVENTS 2019 May – June 2019 Occupational Therapy Australia is excited about the vast selection of CPD & Events available to occupational therapists. Here is a quick overview of what’s coming up.

DATE

COURSE

TYPE

LOCATION

2-4

The Art of Paediatric Therapy – Developing Competence Through Confidence

WORKSHOP

Perth, WA

2

Cultural Responsiveness Training

WORKSHOP

Redfern, NSW

8

HOT TOPIC SERIES: Soft Tissue Conditions: Considerations from a Vocational Rehabilitation Perspective

WORKSHOP

Perth, WA

9-10

Environmental Home Modifications – The Basics

WORKSHOP

Parramatta, NSW

9-10

Understanding Neuroplasticity: From Knowing to Doing

WORKSHOP

Brisbane, QLD

13-17

Assessment of Motor & Process Skills – AMPS

WORKSHOP

Adelaide, SA

17

Navigating Best Practice in OT Driving Assessment & Vehicle Modifications

WORKSHOP

Eight Mile Plains, QLD

20

Evidence-Based Cognitive Rehabilitation for Occupational Therapists

WORKSHOP

Canberra, ACT

20

Foundations of Mental Health Practice

WORKSHOP

Brisbane, QLD

31 May – 1 June

Complex Home Modifications

WORKSHOP

Warwick Farm, NSW

MAY

X

xx

JUNE

xxx

3-7

Assessment of Motor and Process Skills – SCHOOL AMPS

WORKSHOP

Melbourne, VIC

7

Sensory Approaches in OT Clinical Practice

WORKSHOP

QLD

18

Cultural Responsiveness Training

ONLINE SERIES

Perth, WA

20-21

Understanding Stroke: From Knowing to Doing

WORKSHOP

Adelaide, SA

21-22

Foundation Skills Workshop – Introduction to Adult Physical Assessment & Management

ONLINE SERIES

Sydney, NSW

24-25

Home Modifications – The Basics

WORKSHOP

Merewether, NSW

27

Self-Leadership Development (Women’s Edition)

WORKSHOP

Melbourne, VIC

FOR FURTHER INFORMATION To register and for further information please visit: www.otaus.com.au/professionaldevelopment

F E AT U R E

FIVE THINGS TO CONSIDER BEFORE STARTING YOUR OWN PRACTICE

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here is no question that life as an occupational therapist can be deeply rewarding. Seeing your clients progress over time, improving the quality of their life and doing meaningful work is almost as good as it gets. But would it be even better if you could establish your own practice? If you have been working for a larger business – or indeed just someone else – for some time, the thought of creating a business of your own may have crossed your mind. Flexibility with hours, a space you can design and a business you can call your own – running your own business is a highly appealing prospect!

However, as all business owners know, there are also a breadth of challenges that come along with running your own business. But with appropriate resources, advice and preparation, you could be on your way to running a successful practice.

Here are our five top things to consider before you open your own business.

FINANCES Perhaps the biggest consideration when starting a business is how you will finance your venture. This could involve the lease on the perfect premises, fit-out and equipment, marketing and advertising costs, and so on. Start by listing out all the possible requirements that you may need to budget for, and then add a sizeable buffer for anything that doesn’t go to plan.

Then you’ll be well on your way to ensuring you have a financially viable venture.

LOCAL GOVERNMENT REQUIREMENTS

A BUSINESS PLAN If owning your own business is what keeps you up at night with dreams and visions, chances are you’ve already mapped out a rough business plan. Now it’s time to put pen to paper. When you create a solid business plan, you ensure your i’s are dotted and t’s are crossed.

How will your business work? How will you ensure you have the right location?

How will you attract customers? Leave as little as possible to chance for your greatest opportunity for success.

If only starting a business were as simple as opening your doors to the sound of popping champagne. Depending on where your business is located, you’ll also need to run through some registration procedures with your local government.

This may be as simple as getting an ABN and registering for GST – just make sure you work with a good accountant to minimise any hassles or roadblocks.

STAFF INSURANCE As an occupational therapist, you likely already have professional indemnity insurance. Now you’ll need to consider business insurance to help protect your property and contents, and to help cover any business interruption losses if an unforeseen circumstance should arise.

Unfortunately, your requirements don’t stop there. You should also look into cyber liability insurance, public liability insurance (which is often included as part of your professional indemnity – just ensure you have this confirmed), and key person insurance if you plan to hire staff.

Working with an expert in this regard will help to reduce the risk of financial loss.

We don’t need to tell you the importance of finding the right staff to care for those clients you’ve worked so hard to attract. But remember that your staff extend beyond those having day-today interactions with your clients. So when it comes to finding providers to help with your technical, purchasing or business needs – do your due diligence to find the right people for the job.

If you are ready to make the leap and have any questions regarding insurance, Aon would be pleased to assist you.

Simply call our friendly team on 1800 805 191 or email au.ot@aon.com

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 does not make any 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 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. So before deciding whether a particular product is right for you, please consider the relevant Product Disclosure Statement or contact the Aon team on 1800 805 191 to speak to an adviser.

Aon Risk Services Australia Limited | ABN 17 000 434 720 | AFSL 241141

CONNECTIONS APRIL 2019 13

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TEAMWORK MAKES THE DREAMWORK

The Value In Fostering Peer Relationships Mitch Green, OTA Digital Marketing Coordinator

O

ur work is rarely (if ever) completed in isolation. Researchers collaborate across continents.

New graduates work closely with their supervisors. And clinicians often form part of multi-disciplinary teams.

Occupational therapy is a collaborative profession by nature. The bonds we form with our peers hold great sway over what we can achieve—personally, professionally and for consumers. Yet peer relationships don’t flourish of their own accord. They need to be nurtured and fostered over the course of our careers.

The Importance of Connecting with Peers The healthiest forms of peer relationships are reciprocal in nature. That is, both parties gain something from the relationship, with benefits flowing both ways. Connecting with peers shouldn’t be seen as a zero-sum game.

Each peer connection is an opportunity to better consumer outcomes, the directory of our careers and the wider OT industry— sometimes all at once! The benefits of strong peer connections include: • Providing support. Whether we’re just starting out in our careers or faced with an unfamiliar situation after decades of experience, it’s reassuring to know we have access to colleagues who may have already navigated 14 www.otaus.com.au

similar situations. They can provide the support and guidance (and also guide use towards helpful resources) to help us reach our potential.

• Promoting and sharing knowledge.

As an evidence-based profession, an informed approach to practice is paramount. Peer networks act as information highways through which clinical practices are internalised, promoted and refined to better the profession for all involved.

• Enabling networking. As detailed in the February 2019 edition of Connections, strong networks provide the support structures which enable us to grow and develop professionally. These networks need to be nurtured—through offering value to our peers—should we wish to make the most of them.

• Achieving common goals. Often, our expertise extends either deep or wide. That is, we can either have a good understanding of most domains or deep knowledge of a certain few—rarely do we have the capacity/resources for both. Healthy relationships among researchers or multi-disciplinary teams allow us to draw from a larger pool of collective expertise to achieve shared goals.

The Types of Peer Relationships Peer relationships are much more than the day-to-day dealings with colleagues

(although these form a large and important segment). They take many shapes and forms, with unique dynamics existing between all parties involved.

The most common variety exists between colleagues. Two colleagues working in similar areas/roles can utilise shared experiences to support each other to achieve shared outcomes.

Similarly, productive junior/senior relationships provide less experienced staff with access to the expertise and resources to do their job effectively.

For OTs that might not have access to these junior/senior relationships within their organisation, OTA’s MentorLink program connects experienced OTs with more junior colleagues across Australia. OTA’s National Coordinator for Mentorlink, Lissa Selga, notes that the mentor/mentee dynamic benefits not just junior OTs, but senior OTs too.

“Through MentorLink, I’ve heard stories of more experienced mentors feeling re-energised and refreshed when ‘giving back’ to the next generation of OTs, and even discovering new pieces of research and approaches to practice from their more junior colleagues,” Ms Selga said.

Relationships across organisations, while less common, have the power to be highly transformative for both parties. Interstate researchers have the opportunity to collaborate on shared

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“BE PROACTIVE BY SHARING HELPFUL RESOURCES OR MAKING THE TIME TO CONNECT AND DISCUSS IMPORTANT ISSUES.

BY OFFERING VALUE TO OTHERS, PEOPLE WILL NATURALLY GIVE VALUE BACK.”

projects (expanding their resources and scope). While OT clinicians with strong networks can draw on the expertise of other allied health professionals to not only promote referrals, but to also achieve better outcomes for the consumer.

The reach of the internet and social media has opened up an opportunity for the current generation of OTs to develop international connections with domain experts and thought leaders.

With the barrier to entry so low, we would benefit from considering how we might foster peer relationships with the brightest minds across the globe.

Furthermore, OTA’s National Manager for Professional Practice, Anita Volkert, highlights the benefits that online connections offer OTs working in regional/ rural settings, and as sole providers in private practice. “Modern technology

presents a number of opportunities for OTs working in isolated situations to stay connected to—and contribute to—their peers. Webinars, online discussions, industry newsletters, calls for feedback and video conferencing open up a world of opportunities which may not have existed even a decade ago,” Ms Volkert said.

Connecting Effectively Effectively engaging with our peers is a lot like connecting with our friends and family. It’s vital to stay attuned to their professional needs and wants—how can our experience, knowledge or views help them to reach their potential? Likewise, we should feel comfortable in sharing our own particular needs and areas which may require additional support. Healthy, open dialogue is key to strong connections.

If the relationship is one you value and wish to further, then show it. Be proactive

by sharing helpful resources or making the time to connect and discuss important issues. By offering value to others, people will naturally give value back.

At its core, a key philosophy of OT is to enable people to participate in the meaningful activities of their lives.

Likewise, as OT professionals, participating and engaging with our peers allows us to achieve the best outcomes for ourselves, our clients and our profession.

“As an OT who has always worked within multi-disciplinary teams, I have valued the support and thinking of my colleagues from other backgrounds— particularly across unfamiliar issues when I have been wondering how to proceed. It is so enriching to collaborate with allied health peers who offer fresh perspectives!” Ms Volkert said.

CONNECTIONS APRIL 2019 15

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ANIMAL ASSISTED THERAPY IN OCCUPATIONAL THERAPY Melissa Y. Winkle, OTR/L, FAOTA (Dogwood Therapy Services, New Mexico, USA) Karen Ni, OTD, OTR/L (SunDog Therapy Services, California, USA) Claire Dickson, MOT, BA (Assistance Dogs Australia, Sydney, Australia)

A

nimal assisted Therapy (AAT) is gaining popularity and momentum in Australia and around the world. AAT fits under the umbrella of animal assisted intervention (AAI). AAIs intentionally incorporate animals in health, education, and human service to facilitate improved health and wellness (Animal Assisted Intervention International, AAII, n.d.; International Association of Human Animal Interaction Organisations, IAHAIO, 2014; Pet Partners, n.d.). While many animals are involved in AAI, this article will focus on dogs.

AAI encompasses four areas (Winkle, 2011) (Fig A).

While interest in AAT is quickly growing in Australia and around the world, it has been widely misrepresented and misunderstood.

Practitioners have a responsibility to learn and utilise accurate terminology when discussing and providing AAT. AAT, within the context of OT, can be a powerful way to connect with individuals, encourage participation in meaningful activities, and improve quality of life.

The involvement of dogs in practice teaches clients about responsible care of others through occupation-based activities such as grooming, feeding, and carefully planned interventions, while concurrently working towards individual physical, cognitive, and psychosocial goals. There are countless possibilities for the involvement of dogs in practice and there are guidelines to ensure the welfare of both humans and dogs, including the AAII Standards of Practice (2018).

Animal Assisted Interventions Animal Assisted Activity AAA Hospital Visits Library Visits Senior Centers

Animal Assisted Therapy AAT Occupational Therapy Nursing Counseling Social Work Animal Support AS

Figure A: Schematic of AAIs 16  www.otaus.com.au

Animal Assisted Education AAE Special Education Formal Literacy Programs

(Winkle, 2011)

Key AAT Concepts Animal Assisted Therapy (AAT) is a goal directed intervention provided by a registered health professional with specific expertise, to promote improvement in participants’ physical, cognitive, and psychosocial functioning (AAII, n.d.).

Animal Assisted Education (AAE) is similar to AAT but focuses on educational goals and is delivered by a teacher or other licensed education professional.

Animal Assisted Activity (AAA) is a brief and informal interaction, which provides motivational, educational, or recreational benefits to individuals in various facilities, such as hospitals or nursing homes (AAII, n.d.; IAHAIO, 2014; Pet Partners, n.d.). Volunteer visiting teams may work under the direction of a healthcare (AAT) or education (AAE) provider.

Animal Support (AS) is not an intervention and is provided by skilled professionals and organisations.

AS personnel use humane training techniques, understand relationship development, and can objectively evaluate handler-dog teams to ensure the health and welfare of the dog. OTs also carry the responsibility of AS after becoming educated in animal behavior, handling, training, welfare, and advocacy so they may appropriately work with animals in practice.

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It is imperative to apply the core values of the OT Code of Conduct, especially safety and ethical practice, to AAT to prioritise participants’ and dogs’ health and welfare (OT Board of Australia, OTBA, 2014). The OT Code of Conduct, and the Australian Occupational Therapy Competency Standards (2018), require OTs to recognise and work within the limits of their competence and scope of practice.

Practitioners must undertake sufficient training to achieve competence when moving into a new practice area, and also maintain adequate knowledge and skills to provide safe and effective care (OTBA, 2014; OTA, 2018). These are of core importance in the provision of AAT that ensures the safety and wellbeing of participants and dogs.

AAT would be defined as an advanced scope of practice under the OT Scope of Practice Framework and is not typically performed by entry-level graduates as it requires additional training and enhanced competency (OTA, 2017).

There is currently no certification for practicing AAT in the same manner as the Australian Health Practitioner Regulation Agency certifies OTs. Consequently, it

Occupational Therapist, Claire, with AAT team members, Bronte and Lillie, at Assistance Dogs Australia

is even more essential for individuals to pursue education in dog handling, training and behavior, animal welfare, and AAT theory and application from qualified professionals with humane and positive reinforcement based training rather than punitive training methods.

Occupational therapists who would like to incorporate AAT into their practice can be guided by the trajectory laid out in Winkle (2011), which shows a four-step process to gain education, resources and skills (Fig. B).

Figure B: Tiered process for practicing AAT. Continued next page CONNECTIONS APRIL 2019 17

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ANIMAL ASSISTED THERAPY IN OCCUPATIONAL THERAPY Continued from previous page

There are three different ways to implement AAT in treatment sessions.

First, an OT may contact a reputable organisation that trains dogs specifically for this work (reputable organisations prioritise the wellbeing of dogs and employ positive reinforcement based training).

Second, OTs may complete appropriate preparation (relationship development, socialisation, enrichment, experiential situations, etc.) and humane, positive reinforcement based training, and then be evaluated by a skilled objective third party, with knowledge of both AAT and dog behavior/communication. Finally,

for therapists who may not be able to have a dog of their own participate, this is a great opportunity to connect with peers. A colleague within the department may handle the dog while the attending OT treats the client, or the attending OT might call in a volunteer visiting team.

There are plenty of opportunities available to become educated, to identify mentors, and to develop AAT programs.

The journey to practice animal assisted therapy is not fast or easy to achieve, but it will be well worth your time.

Gertie helping build gross motor play skills at Dogwood Therapy Services References Animal Assisted Intervention International (AAII). (n.d.).

Animal Assisted Intervention. Retrieved from http:// www.aai-int.org/aai/animal-assisted-intervention/ Animal Assisted Intervention International.

(2018). Standards of Practice for Animal Assisted Intervention. Retrieved from: https:// aai-int.org/aai/standards-of-practice/ International Association of Human-Animal Interaction Organisations (IAHAIO). (2014). The IAHAIO Definitions for Animal Assisted Intervention and Guidelines for Wellness of Animals Involved. Retrieved from http:// iahaio.org/new/index.php?display=declarations Occupational Therapy Board of Australia.

(2018). Australian Occupational Therapy Competency Standards. Retrieved from: https://www.occupationaltherapyboard.gov. au/codes-guidelines/competencies.aspx Occupational Therapy Board of Australia.

(2014). Code of Conduct for Registered Health Practitioners. Retrieved from: https:// www.occupationaltherapyboard.gov.au/ codes-guidelines/code-of-conduct.aspx Pet Partners. (n.d.). Terminology. Retrieved from https://petpartners.org/learn/terminology/ Winkle, M. (2011). Tiered Approach for Education and Skill Development for Healthcare and Human Service Providers. Symposium conducted at the development meeting for Animal Assisted Intervention International. Groesbeek, Netherlands.

Gertie helping build fine motor and coordination skills via functional pretend play at Dogwood Therapy Services 18  www.otaus.com.au

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NEW COGNITIVE IMPAIRMENT IDENTIFIER EMPOWERS COLLABORATION South Metropolitan Health Service

A

new bedside tool will empower clinical and non-clinical staff working across Fiona Stanley Fremantle Hospitals Group (FSFHG) in Western Australia to better respond to patients with memory and thinking difficulties.

The Cognitive Impairment Identifier (CII) is a visual cue placed at the patient’s bedside once they have undergone screening for memory or thinking difficulties.

Senior Project Officer and Occupational therapist Jane Hopkins said the identifier allowed staff to modify their communication approach to ensure the patient and their carer were engaged as much as possible in the care being provided. Jane is an OTA member and provides valuable support and advice through the Western Australian Divisional Council.

“The identifiers will ensure patients are given the best chance to understand what is being said and help reduce any anxiety about being in an unfamiliar environment,” Ms Hopkins said.

The use of the CII is part of the new cognitive impairment policy developed in consultation with specialties across Fiona Stanley and Fremantle hospitals, and a Cognitive Impairment Reference Group. The policy was developed to improve the screening, identification, care and discharge planning for older adults with dementia or who are at risk of developing delirium while in hospital.

Working across disciplines and connecting with peers is resulting in a cohesive and consistent outcome for patients. FSFHG

Occupational Therapist Jane Hopkins and Dr Bhaskar Mandal with the patient’s bedside Cognitive Impairment Identifier

Head of Geriatric Medicine Dr Bhaskar Mandal said the CII was a significant step forward in Fiona Stanley and Fremantle becoming dementia friendly hospitals.

“In some cases, patients with delirium can be misdiagnosed or not identified as having a cognitive impairment,” Dr Mandal said.

“The identifier and the supporting policy ensures suitable procedures are in place to care for patients with dementia and delirium, aligned to the national standards.”

Dr Mandal said that staff education on how to best care for and communicate with patients with a cognitive impairment was a crucial part of the project.

“THE IDENTIFIERS WILL ENSURE PATIENTS ARE GIVEN THE BEST CHANCE TO UNDERSTAND WHAT IS BEING SAID AND HELP REDUCE ANY ANXIETY ABOUT BEING IN AN UNFAMILIAR ENVIRONMENT,” MS HOPKINS SAID. The FSFHG CII project was developed through a partnership with Ballarat Health Services where the CII was originally developed as part of the Dementia Care in Hospitals Program.

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EVENT RECAP

OTA NATIONAL OT AGED CARE SYMPOSIUM 2019 OTA’s inaugural National OT Aged Care Symposium 2019 was held at the Brisbane Convention and Exhibition Centre on Friday 22 and Saturday 23 February 2019.

T

he Symposium opened with a Welcome To Country from Aunty Maroochy Barambah followed by the opening keynote address from Professor John Pollaers.

Over 200 delegates from around the country participated in plenary and concurrent sessions, workshops and a Careers Forum over the two days.

Topics included Supporting people with dementia, Ageing well, Staying connected to community, Moving beyond boundaries, Consumer choice and control and Innovation and technology.

20  www.otaus.com.au

Delegates engaged with a number of exhibitors, particularly Silver Sponsor Brazier Mobility and Bronze Sponsors Invacare and Walk on Wheels, whilst having fun completing their exhibition passport (we hope the winner enjoys their $200 Myer voucher!).

Thank you to our sponsors and exhibitors for their support, our presenters who offered their time and learning, and our delegates whose enthusiasm for OT continues to inspire us all.

Above: Aunty Maroochy Barambah opened Aged Care 2019 with a Welcome to Country Below: 200+ delegates networked amongst the exhibition area

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OTA CEO Samantha Hunter presenting the OTA Update

Samantha Hunter, Evita Cooper, John Trent and Kim Walder at the OTA booth

KEY EVENT STATS

27

Abstract Presentations

2

Workshops

39 Abstract Submissions

2 Keynote Speakers

1

Keynote speaker John Pollaers presented A Matter of Care – Making Change Happen

State/Territory

Invited Presentation

#AgedCare2019

47 253 People Tweets

tweeting

213,859 People reached

New South Wales Victoria Queensland South Australia Australian Capital Territory Tasmania Western Australia Northern Territory TOTAL

Registrations Percentage

59 33 91 20 4

26.5 15.0 41.0 9.5 1.5

3 9 3 222

1.0 4.5 1.0 100%

CONNECTIONS APRIL 2019 21

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CareSearch and palliAGED Helping occupational therapists work with people at the end of life Susan Gravier, Research Associate, CareSearch, Flinders University Dr Deidre Morgan, Lecturer, Palliative and Supportive Services, Flinders University

E

merging evidence highlights the important role that occupational therapists have in palliative care.(1) A growing population with palliative care needs requires that all health professionals develop palliative care competencies—it is no longer the remit of specialised clinicians. Occupational therapists routinely provide support to older people approaching their natural end of life (with or without chronic conditions) and increasingly work in a range of settings with people who have specific end-of-life care needs.(2,3)

Palliative care is active and supportive care that seeks to enable people to live as actively as possible and to prepare the person and their family and carers for death.(8) Occupational therapists who work with people at the end of life have several key roles.(9) By helping clients identify goals and priorities,(11) occupational therapists promote engagement in meaningful activities that enable maintenance of social relationships and foster a sense of ability, dignity and control.(4, 7, 10, 12) Supporting engagement in everyday occupations also promotes adjustment to functional decline and losses that accompanies life limiting illnesses.(5) Helping people prepare for imminent death may include supporting occupations, including legacy making, teaching a partner how to 22 www.otaus.com.au

manage finances post-death or planning what clothes to wear in the coffin.(4) At the end of life there are many important individual, personal, professional decisions and choices to be made. Access to reliable and relevant information supports people to make these sometimesdifficult choices and decisions.

CareSearch(14) and palliAGED(15) are online resources that collate and consolidate evidence-based information and resources into accessible language and formats for clinicians, patients, carers and families. Funded by the Commonwealth Government, CareSearch provides evidence-based palliative care information across the lifespan and across the health system. PalliAGED provides this information for the aged care sector. In each, the perspectives of health and care professionals, and of patients, carers, and their families are considered, and the materials are tailored to meet their needs.

To support occupational therapists(16) working in any setting caring for a

person with palliative care needs, the Allied Health section(17) of CareSearch offers information, tools and resources.

The Allied Health home page features a tab that links to introductory pages of information and resources for allied health professionals to inform care or to offer to people in their care. For those who are new to CareSearch, starting with these pages can help build confidence in using evidence to inform and improve practice.

Continuing professional development (CPD) helps occupational therapists maintain and improve their knowledge and professional skills.(18) Allied health eLearning resources(19) in CareSearch’s Education section are for independent learning rather than prescribed or formal learning.

CareSearch also hosts a Research Studies Register(20)—a database of Australian research projects and studies in palliative care. Anyone can search this database for current palliative care research activities, and those involved

PALLIATIVE CARE IS ACTIVE AND SUPPORTIVE CARE THAT SEEKS TO ENABLE PEOPLE TO LIVE AS ACTIVELY AS POSSIBLE AND TO PREPARE THE PERSON AND THEIR FAMILY AND CARERS FOR DEATH.(8)

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in research can add their study details to the register. Project completion or publication of the research findings are not requirements for inclusion in this database. palliAGED has also identified and published current gaps in the evidence(21) which may stimulate ideas for research in an area of need.

12. Sviden, G. A., Tham, K., & Borell, L. (2010). Involvement in everyday life for people with a life threatening illness. Palliat Support Care, 8(3), 345-352. doi:10.1017/ s1478951510000143

Palliative Perspectives presents blogs on various topics written by allied health contributors in order to showcase allied health clinical stories and viewpoints. You may wish to start by reading the article When the small things become extraordinarily important.(23)

15. https://www.palliaged.com.au/

(22)

CareSearch welcomes written pieces from occupational therapists about interesting case studies, presentations or opinion pieces that highlight occupational therapy approaches to care at the end of life. CareSearch is also interested in hearing of research conducted by occupational therapists in palliative care. For contributions of stories from the field or research projects or presentations, please contact CareSearch.

References: 1. Eva, G., & Morgan, D. (2018). Mapping the scope of occupational therapy practice in palliative care: A European Association for Palliative Care crosssectional survey. Palliat Med, 32(5), 960-968. doi:10.1177/0269216318758928

13. White, K. M. (2013). Occupational therapy interventions for people living with advanced lung cancer. Lung Cancer Management, 2(2), 121-127. doi:10.2217/lmt.13.3 14. https://www.caresearch.com.au/

16. https://www.caresearch.com.au/caresearch/tabid/2733/Default.aspx 17. https://www.caresearch.com.au/caresearch/tabid/2556/Default.aspx 18. Occupational Board of Australia. (2017). Registration standard: Continuing professional development. Retrieved from https://www. occupationaltherapyboard.gov.au/registration-standards/continuingprofessional-development.aspx 19. https://www.caresearch.com.au/caresearch/tabid/3882/Default.aspx 20. https://www.caresearch.com.au/caresearch/tabid/126/Default.aspx 21. https://www.palliaged.com.au/tabid/4345/Default.aspx 22. https://www.caresearch.com.au/caresearch/TabId/3781/PID/6000/ev/1/ CategoryID/18/CategoryName/Allied-Health/Default.aspx 23. https://www.caresearch.com.au/caresearch/TabId/3781/ArtMID/6000/ ArticleID/62/When-the-small-things-become-extraordinarilyimportant%E2%80%A6.aspx

2. Hammill, K., Bye, R., & Cook, C. (2014). Occupational Therapy for People Living with a Life-Limiting Illness: A Thematic Review. British Journal of Occupational Therapy, 77(11), 582-589. doi:10.4276/030802214x14151078348594 3. Hammill, K., Bye, R., & Cook, C. (2019). Occupational engagement of people living with a life-limiting illness: Occupational therapists’ perceptions. Aust Occup Ther J. doi:doi:10.1111/1440-1630.12557 4. la Cour, K., Johannessen, H., & Josephsson, S. (2009). Activity and meaning making in the everyday lives of people with advanced cancer. Palliat Support Care, 7(4), 469-479. doi:10.1017/s1478951509990472 5. la Cour, K., Josephsson, S., Tishelman, C., & Nygard, L. (2007). Experiences of engagement in creative activity at a palliative care facility. Palliat Support Care, 5(3), 241-250.

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6. Le, B. H., Marston, C., Kerley, C., & Eastman, P. Facilitating the choice of dying at home or in residential care with the implementation of a palliative care rapid response team in a cancer centre and general hospital. Palliat Med. doi:10.1177/0269216318824273 7. Lyons, M., Orozovic, N., Davis, J., & Newman, J. (2002). Doing-being-becoming: occupational experiences of persons with life-threatening illnesses. Am J Occup Ther, 56(3), 285-295.

9. OTAL Occupational Therapy Australia Ltd. (2015). Position Statement: Occupational therapy in palliative care. Aust Occup Ther J, 62(6), 459-461. doi:doi:10.1111/1440-1630.12264 10. Peoples, H., Brandt, A., Waehrens, E. E., & la Cour, K. (2017). Managing occupations in everyday life for people with advanced cancer living at home.

Scand J Occup Ther, 24(1), 57-64. doi:10.1080/11038128.2016.1225815 11. Schleinich, M. A., Warren, S., Nekolaichuk, C., Kaasa, T., & Watanabe, S. (2008).

Palliative care rehabilitation survey: a pilot study of patients’ priorities for rehabilitation goals. Palliat Med, 22(7), 822-830. doi:10.1177/0269216308096526

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8. Morgan, D. D., Currow, D. C., Denehy, L., & Aranda, S. A. (2017). Living actively in the face of impending death: constantly adjusting to bodily decline at the end-of-life. BMJ Supportive & Palliative Care, 7(2), 179. doi:10.1136/ bmjspcare-2014-000744

CONNECTIONS APRIL 2019 23

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A REVIEW OF OCCUPATIONAL THERAPISTS WORKING IN RESIDENTIAL AGED CARE FACILITIES A Sector Constrained by Pain

Dr Isobel J Hubbard, Kelly Mitchelson and Belinda Renzi

W

ith many older Australians calling Residential Aged Care Facilities (RACF) “home�, the overarching aim of service providers must be to maintain positive health and well-being.

The Australian Government’s Aged Care Funding Instrument (ACFI) should support the activities of those employed in RACF and provide standardised, yet flexible funding; however, there are concerns about its focus on specific interventions and calls for a broader approach.

Commercial interests benefit from the

ACFI with subsidies accounting for 7080% of aged care providers’ funding.

Anecdotal evidence indicates occupational therapists working in RACF have little control over their professional activities, with many reporting an almost exclusive focus on pain management and massage. The authors established this “fact-finding� initiative to refute or ratify the anecdotal evidence.

In 2018, occupational therapists working in RACF were invited to participate

• Employer: 71% (n=45) private sector; 17% not-for-profit; 6% public sector and 5% self-employed – Mean hours worked per week=31 • Nominated age range of clients: 81-85y=51% (n=32); 86-90y=40% • Nominated “top 3â€? diseases: >90% dementia; 48% arthritis and 35% stroke (Figure 1)

Nominated “Top 3� Diseases

• Professional mismatch: Three quarters indicated a mismatch between their role and expertise as an occupational therapist and their workplace responsibilities

 Â

The major themes found across the three ACFI domains (Activity of Daily Living (ADL), Behaviour (BH) and Complex Health Care (CHC)) were:

Figure 1: Frequency of nominated “top 3� diseases. Other (n=1 each) included urinary tract infection, brain injury, lymphedema, cancer and oedema.

24  www.otaus.com.au

in an anonymous survey. Data from the 63 quantitative data responses were descriptively analysed, and data from the first 31 (49%) qualitative responses were thematically analysed.

The findings are as follows:

Restricted Practice: Between 40% and 60% of therapists wrote about restricted practice. They rarely assessed or managed ADL but, when permitted, applied interventions targeting transfers and prescribing of equipment. Practice

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Occupational Therapy Constrained by Pain

focused almost entirely on pain, and on massage to manage pain.

Nil officially unfortunately - I have offered showering, dressing and feeding assessments and interventions however I am encouraged to remain focused on pain management entailing massage therapy (ADL: ID4) There is a lot more to offer particularly in the dementia ward, particularly with difficult behaviours, however it is not seen as my role, and there are few resources (BH: ID26) As a therapist under ACFI, you cannot make your own professional decision and recommendation. I have to follow ACFI coordinator’s instructions when deciding therapeutic treatments for residents. It is all about money and they just focus on how much funding they can get from the government through ACFI rather than the exact needs of residents. (CHC ID23) A selection of qualitative responses Therapists also spent time educating, supporting and advising staff and family members, but this was rarely adequately acknowledged or documented.

Ethical Dilemma: Therapists wrote about what else they could offer, and how, at times, they were trying to manipulate domains’ parameters to afford this opportunity.

I have a tick box of ways in which these… may impact on ADL. (ADL: ID26) We are asked to provide massage to soothe residents with dementia diagnoses to assist with calming (BH: ID4) Pain management and “therapeutic massage” Massage can be literal massage, stretching, exercises or walking (CHC ID1) In the CHC domain, responders detailed pain management strategies, with many

4%

Manage pain

12%

13%

Manage oedema 71%

obility, equipment M and position Advice others

Figure 2: Percentage of occupational therapy related to managing differing needs in RACF residents

writing about a requirement to “treat” pain for 20 minutes/day, 4 days a week, and to apply strategies that increased funding sourced through the CHC domain.

Pain management. 20 minutes a day 4 days per week. Or once a week for 20 minutes. Massage. We sign a form to say we have completed 20 minutes a day of massage. It’s a constant ethical dilemma. As they must be marked off 4 times a week and cannot be missed or funding is cut to the facility. (ID26) When asked what evidence-based interventions Occupational Therapy could offer, many listed those that maximised independence and participation in everyday activities and promoted mental health, cognitive health and quality of life. When asked to add comments, therapists wrote about ACFI incentivising higher needs and dependence, at the expense of improving, supporting and maintaining independence in RACF residents; about feeling pressured to prescribe interventions that attracted higher ACFI funding; and about valuing the opportunity to provide professional services to those living in RACF.

Implications and Recommendations This is a profession and sector constrained by pain management and pre-determined interventions. Ethical dilemmas are faced almost daily, with many arising from a

focus on dependence and disability, rather than independence and well-being.

The ACFI appears to be at odds with the Australian Government’s own key objective of “Using wellness and reablement approaches to deliver support to older people”. Although occupational therapists are skilled in assessing and managing ADL, behaviour and complex health care needs, at present, these skills are underutilised or not utilised at all.

Recommendation 1: To support “best practice” in RACF, Aged Care funding models should be client centred and relation-orientated with a focus on wellness and reablement, as opposed to prescriptive and category-orientated with a focus on disability and dependence.

Despite the fact that most residents experience dementia, little ACFI funds target health and well-being in this cohort. Despite the fact that one third of older Australians living in RACF experience chronic pain, most ACFI funds are channelled almost exclusively into pain management. Despite the fact that nationally-agreed, pain management recommendations require a multi-professional team approach that applies validated assessments, vigilant attention to diagnosing the cause, and active involvement of the client, almost all RACF interventions Continued next page CONNECTIONS APRIL 2019 25

F E AT U R E

A SECTOR CONSTRAINED BY PAIN Continued from previous page

apply “one-size-fits” protocols. Whilst AFCI funds are funnelled into predetermined interventions (Figure 2), those living in RACF receive sub-optimal care.

Recommendation 2: To support “best practice” in RACF, Aged Care funding models should provide scope to fund practitioner-prescribed, clinically-reasoned, evidence-based interventions that promote well-being in those experiencing cognitive decline or dysfunction, changes in mood, behaviour difficulties, physical dysfunction and/or pain.

The current findings indicate the ACFI is vulnerable to exploitation by commercial interests looking to “game” funding algorithms and may provide challenging environments for therapists working in RACF. Recommendation 3: Professional associations, such as Occupational Therapy Australia, should support, inform and advocate on behalf of, health professionals working in systems that have challenging ethical considerations.

When relevant, they should also be consulted as primary stakeholders in reviews of funding models such as the ACFI. The ACFI is no longer fit for purpose. Future funding models should support enablement-driven, person-centred, and relation-orientated care that targets health and well-being outcomes. Occupational therapists must be supported and enabled to apply profession-specific skills, expertise and knowledge. In those who call RACF “home”, funding models must support best practice that values independence, health and well-being.

Acknowledgements: The authors would like to acknowledge the contributions of Philomena van Rijswijk and all the

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The full RACF report and finding were presented at the recent Occupational Therapy Australia Aged Care Symposium in Brisbane, and can be found on our website here: otaus.com. au/practice-support/ots-working-with-older-people

ELAINE B WILSON MEMORIAL AWARD

I

n recognition of the life’s work of Elaine Wilson in occupational therapy with children and their families, Elaine’s family and Occupational Therapy Australia established the Elaine B Wilson Memorial Award. This award acknowledges a recent occupational therapy graduate’s contribution to working with children.

Members who are a recent occupational therapy graduate with up to three consecutive years’ experience working with children, are currently working with children, or the majority

26 www.otaus.com.au

whose occupational therapy experience has been working with children, are encouraged to apply for this award.

Application is via a letter of nomination from a member of Occupational Therapy Australia and two refereed reports addressing the criteria. The eligibility criteria are available at: www.otaus.com.au/about-us/awards/elaine-b-wilson with applications (including two refereed reports addressing the criteria) due to exec@otaus.com.au by 8am AEST Monday 19 May 2019.

WFOT REPORT

WFOT UPDATE Adam Lo WFOT 1st Alternative Delegate New Look Website

The WFOT website recently underwent a complete renovation, with the aims to make it more user-friendly and easier to navigate. The website is the one-stop-shop for everything WFOT. It includes information about the organisation’s history, management team, programs and news updates, as well as a variety of resources such as position statements, forms, reports and publications. Take some time to review the changes for yourself at: www.wfot.org.

Don’t forget to connect with WFOT’s Facebook Page www.facebook. com/thewfot, which has over 25,000 people supporting our work and our Twitter account https://twitter.com/ thewfot, with 11,000 followers and continuing to grow on daily basis.

self-care, coping, healing and recovery approaches before, during and after responding, as well as strengthening the field performance of occupational therapists in the first responder role.

This 25-page document is available to download for free in the WFOT Resources section of the WFOT website. https:// wfot.org/resources/wfot-guide-foroccupational-therapy-first-responders

WFOT Classifieds

The Classifieds section of the WFOT website offers and promotes opportunities for employment, training and informationsharing such as research studies from our colleagues across the globe. For example, a full time job was recently on offer in Iraq for an Inclusive Health Technical Advisor for Handicap International Iraq.

This job involves overseeing the technical quality of work to promote inclusion of people from all gender and age backgrounds, in health programming and services provided by the organisation.

Available courses are advertised regularly on the WFOT Classifieds. They included online courses such as Dysgraphia: Helping Children Overcome Handwriting Difficulties and One Handed Strategies for Home Management Tasks.

Conferences and Events Reminder WFOT Guide for Occupational Therapy First Responders

Launched in February, 2019, the WFOT Guide for Occupational Therapy First Responders aims to enhance the preparedness of occupational therapists who perform in the capacity of first responders. It provides strategies for

The following is a reminder of some upcoming occupational therapy conferences and events around the world which may be of interest to our members:

RCOT 2019 (17-18 June)

in Birmingham, United Kingdom.

This year’s themes is Inspiring, Informing and Involving.

For more information, go to https://www.rcot.co.uk/annualconference-2019-rcot2019

11th OTARG Congress 2019 (26-29 August)

The WFOT’s regional group for the African region (OTARG – Occupational Therapy Africa Regional Group) will be hosting its 11th congress at the Serena Hotel, at Kigali, Rwanda, in August 2019.

The theme for 2019 is ‘Giving back meaning to life: occupational therapy at the centre’. Visit www.otarg.org. za/rwanda for more information.

Occupational Science Europe Conference 2019 (30-31 August)

The Occupational Science Europe Conference will be held from 30-31 August 2019, in Amsterdam, Netherlands. A preconference program will start on the 29 August. The theme is ‘Europe in Transition: Impact on Occupation and Health’. Find out more at http://www.amsterdamuas. com/achieve/events/ose-conference-2019/ ose-conference-2019.html

WFOT Congress 2022 (28-31 March, 2022)

The 18th WFOT Congress will be held in Paris, France, 28 -31 March 2022. The official Congress 2022 Facebook page is at www.facebook.com/wfot2022. More updated information will be provided at www.wfot.org/Congress soon.

2022 may sound like a long time away now, but time does fly. Why not start your planning today!

The Royal College of Occupational Therapists’ annual conference and exhibition will be held on 17 and 18 June CONNECTIONS APRIL 2019 27

A O TJ R E P O R T

CONNECTING WITH PEERS The 28th Occupational Therapy Australia National Conference Associate Professor Genevieve Pepin, PhD Discipline Lead, Course Director and Honours Coordinator Occupational Science and Therapy, Faculty of Health, School of Health and Social Development, Deakin University The 28th Occupational Therapy Australia (OTA) National Conference will be held in Sydney from 10 to 12 July 2019. The theme for this year’s conference is Together towards tomorrow.

As members of the organising committee explained on the conference website, the theme aspires “to reflect the dynamic nature of contemporary occupational therapy practice”.

T

he context in which occupational therapists work in Australia faces significant change as the Royal Commission into Aged Care Quality and Safety gets underway and a Royal Commission into Mental Health is established in Victoria. Other significant change includes the implementation of the NDIS – and its role in the support of mental health recovery – and the current reviews of Medicare Benefits Schedule items pertaining to allied health, mental health and eating disorders. And, as we go to print, the Federal Government has announced a Royal Commission into the abuse of people with disability.

The prominent role of OTA in these various reform processes is a sign of our increased recognition as an essential member of the health care system.

Underlying this recognition of course is our demonstrable commitment to clinical excellence, and our determination to demonstrate rigour in all our approaches and interventions. The use of robust and contextualised evidence is also fundamental to the relevance of our role.

The Australian Occupational Therapy Journal (AOTJ) facilitates the dissemination

28 www.otaus.com.au

of this evidence, enabling members of our profession to work together towards a future which is at once challenging and promising. Through a variety of activities planned across the OTA National Conference, members of the editorial board of the AOTJ hope to engage with as many peers and colleagues as possible, and further explore how we envisage evidence, conceptualise it, produce it, and translate it into meaningful outcomes for our clients, our profession, and ourselves.

The conference is also an excellent opportunity for occupational therapists to meet, share, discuss and challenge the current state of occupational therapy practice, education and research.

The AOTJ will again conduct a Writing and Reviewing Workshop. The workshop is an opportunity for peers to enhance their understanding and build their skills. Previous participants reported that the workshop contributed to ‘Making writing and publishing more accessible for clinicians and early and mid-career occupational therapy researchers.’ For some participants, the AOTJ Writing and Reviewing Workshop helped them ‘understand the work done behind the scene to get a manuscript published’, while others felt they could now attempt to write for publication or put their hand up to review manuscripts. One attendee said being

At this year’s conference, members of the AOTJ editorial board will host the AOTJ Reviewers Breakfast to acknowledge reviewers’ contribution to the journal. Reviewers undertake their work voluntarily and we believe it is important to recognise them formally.

Reviewers who attended the breakfast in the past have said ‘It was lovely to have a formal event identified in the conference program’, and ‘meeting other reviewers and discussing our experiences of reviewing manuscripts was extraordinarily valuable’.

“THE CONFERENCE IS ALSO AN EXCELLENT OPPORTUNITY FOR OCCUPATIONAL THERAPISTS TO MEET, SHARE, DISCUSS AND CHALLENGE THE CURRENT STATE OF OCCUPATIONAL THERAPY PRACTICE, EDUCATION AND RESEARCH.”

A O TJ R E P O R T

“MOVING WITH THE TIMES, THE AOTJ WILL ALSO PRODUCE A PODCAST FOCUSSING ON THE NATIONAL CONFERENCE.” able to ‘Catch up with the members of the editorial board was really good. It’s nice to get to know who they are.’

Conference delegates will be able to meet members of the editorial board at the OTA booth throughout the conference. We encourage conference delegates to visit the members of the editorial board and discuss the ins and outs of publications, and to learn about the AOTJ resources available and our plans for the future of the journal.

The journal will also publish an online Conference supplement in which we will aim to share highlights, discoveries, and the implementation and translation of evidence and knowledge presented during the conference. Moving with the times, the AOTJ will also produce a podcast focussing on the National Conference and the journal’s twitter account will be active. Join the AOTJ online community and follow us at @AusOTJournal OTA’s 2017-2020 Strategic Plan(1) envisages the AOTJ fostering research capability and capacity in the profession, supporting provision of robust evidence that will inform practice, education and research, and engaging with members of OTA from various sectors. By engaging with the content of the National Conference and conference delegates, the journal is doing precisely this.

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Members of the editorial board of the AOTJ consider the National Conference a unique opportunity to connect with members, create networks, and strengthen our professional identity. We invite you to connect with us by participating in the AOTJ activities at the 28th Occupational Therapy Australia National Conference in Sydney this July.

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1. Occupational Therapy Australia (2018). 2017-2020 Strategic Plan. Retrieved from https://www.otaus.com.au/sitebuilder/ about/knowledge/asset/files/151/strategicplanv4sept17.pdf

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CONNECTIONS APRIL 2019 29

CONFERENCE

MEET YOUR CONFERENCE COMMITTEE Justin Scanlan, Scientific Program Chair Can you tell us a little bit about yourself and what attracted you to occupational therapy?

I was born in a country town in western Queensland called Cloncurry.

Cloncurry claims to hold the record for “highest temperature ever recorded in Australia”. I grew up in various regional towns in Queensland and then went to university at the University of Queensland.

Coming into the occupational therapy course, I had very little concept of what it was. I had initially thought I would go on to do medicine, but fell in love with OT very early on and knew it was going to be my career. During university, I developed a passion for mental health and my whole career: in clinical practice, management and research, has been focused on this area.

My current role is as Course Director for Bachelor of Applied Science (Occupational Therapy) at The University of Sydney. I love the opportunity to guide and support students to develop their passion for occupational therapy and the attitudes and values that will enable them to work most effectively with service users.

Why did you decide to volunteer for the Conference Committee?

I have been a member of each scientific program committee since 2011. Initially, I was interested to be involved to support the conference and support more mental health presentations to be included in 30 www.otaus.com.au

the program. What keeps me coming back to the committee is the fact that I get a “sneak peek” at many of the abstracts before the program is released as part of the abstract review process.

This is exciting as it keeps me abreast of so many of the exciting new things that occupational therapists are doing.

What are you most looking forward to at the National Conference 2019?

Everything! The keynote speakers are going to be fantastic, the program is chock-ablock full of amazing presentations and we have introduced a number of new features for this conference (such as the ePoster spotlight sessions and Occupation Stations). All of these will be exciting.

Of course the opportunity to catch up with old friends and make new ones is also wonderful. The conference dinner will also be great—an iconic venue on the spectacular Sydney Harbour.

What would you say is your 2019 program highlight?

It is so hard to choose. But the keynote speakers and the Sylvia Docker lecturer are going to provide a stimulating mix of ideas and challenges to help propel us towards tomorrow, together.

What are your tips for first time delegates?

Before the conference: Plan ahead! Look through the program, read the abstracts

and make your schedule of the sessions you would like to attend. Each abstract will be published with the author’s contact details. If you want to make contact with the author reach out to them by email or social media before the conference.

Rather than just setting up a time to meet at the conference,– I’d suggest you start discussions with these authors before the conference. This will make the most of the time you have when you meet with authors during the conference itself.

At the conference: Get lots of sleep the night before the conference starts. There is an overwhelming amount of information you will hear about—the more “brain space” you have, then the more you will get out of it. Don’t be shy to approach other delegates. Use this opportunity to network and meet the people who have inspired and influenced you. At the end of each day, make a list of the things you want to apply to your practice or explore in more depth. Set plans around these so that you have a structure that will support you to implement this new knowledge into your practice.

After the conference: Follow up and implement. Make follow up contact with the people you connected with at the conference. Continue the conversations.

Spend the time to further explore the new knowledge you gained and implement this into your practice. This takes time, so plan ahead so that you have the time to reflect and enhance your practice.

Conference registration is now open. For more information on the program, registration fees and inclusions please visit www.otaus2019.com.au

AUSTRALIA’S MAJOR SCIENTIFIC CONFERENCE FOR OCCUPATIONAL THERAPISTS

28th NATIONAL CONFERENCE AND EXHIBITION 2019

TOGETHER TOWARDS TOMORROW

10-12 JULY 2019 International Convention Centre

SYDNEY

www.otaus2019.com.au #otaus2019

O P T NTS U N OI EAR PD P C 25

KEYNOTE SPEAKERS LEIGH SALES Author and Journalist Opening Speaker

Leigh Sales is an award-winning author and journalist at the Australian Broadcasting Corporation and currently anchors the prime time flagship program 7.30.

From 2001 to 2005, she was the ABC’s Washington Correspondent, covering stories including the aftermath of September 11, the wars in Afghanistan and Iraq, the 2004 Presidential election and Hurricane Katrina.

From 2006 to 2008, Leigh was the ABC’s National Security Correspondent, before becoming the anchor of Lateline.

In 2005, Leigh won a Walkley Award, Australia’s highest journalism honour, for her coverage of Guantanamo Bay and the case of David Hicks. In 2012 Leigh was again presented the prestigious Walkley Award for best interviews for her work on 7.30. She’s the author of 3 books; Any Ordinary Day, Detainee 002 and On Doubt and her writing appears in Australia’s top newspapers and magazines.

She co-hosts a popular independent podcast with her colleague Annabel Crabb called Chat 10, Looks 3 about culture and politics.

DR ALISON GERLACH

A/PROF NATASHA LANNIN

PROF GAIL WHITEFORD

Occupational Therapist

Occupational Therapist

Occupational Therapist Sylvia Docker Lecturer

INVITED SPEAKERS

Leanne Healey

Nick Maisey

Jordan O’Reilly

Joel Pilgrim

Stay connected for more invited speakers to be announced on topics such as: Upper Limb Rehabilitation, Paediatrics, Mental Health, Lived Experience, Working with Aboriginal and Torres Strait Islander People, Positive Psychology and Critical Perspectives.

REGISTER TODAY! www.otaus2019.com.au

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