This blog began as a journal of a Winston Churchill Memorial Trust Travel Award visit to the USA to study how Lifestyle Redesign could be used in Occupational Therapy to improve the hospital/home interface for older people. It has continued to record developments and inspiration gained from that experience since returning from Los Angeles early in 2012.

3 Reasons to follow this blog...

Be Inspired-
WCMT travel awards are open to all British citizens

Be Involved- learn about Lifestyle Redesign programs and contribute to the discussion about the potential of this approach.

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Tuesday, 31 January 2012

Lovely weather in California

Not to be too annoying to everyone back home in the UK, but the weather here in California has been beautiful...

From top of multi storey car park at Health Sciences campus- Downtown LA in the distance, the big building on the left is the old LA County Hospital I'm sure it's been in a film or two.

Venice Beach at the weekend.

Runyon Canyon, Hollywood

Saturday, 28 January 2012

Weight Management Week 3- Reflections

Once again everyone turned up for the group. After an initial delay due to a double booking of the room (some things are the same both sides of the Atlantic!) we got started.
After the weigh in (very low key, for participants own information), the session began with a reflection on how the week had gone, this was relaxed, humourous and supportive but kept to the point and to a schedule by skillful guidance from Chantelle. Most people had achieved to some degree the goals they set for themselves last week, some had even exceeded them. Virtually everyone was continuing to keep a food diary and finding it a helpful mechanism to increase awareness of eating patterns and for planning meals and snacks. The discussion was supportive and focused on successes or what could be learned when things hadn't gone so well. The group were facilitated to consider the occupational issues that made for success (or were more difficult) and to use a problem solving approach to come up with strategies for the future. Most people agreed that the structure of the working week made it easier to keep to a routine and stick to what they had planned. The weekends with social and family gatherings were more difficult and some people identified that they were going to need to think about strategies to help them with this.
Information about food choices and some sample menus helped to get the group thinking in more depth now that they have a couple of weeks experience behind them. Generally people seemed to be enjoying the process and several reported having changed their activity and exercise habits because they felt they had more energy.
As usual the group finished by setting themselves goals for the week ahead, some choosing to maintain what they were already doing, a few decided to exercise more. Chantelle helped with prompts to ensure the goals were realistic and specific- such as how many times will the exercise be done?
Finally one of the researchers arrived to invite group members to participate in a study about the thoughts & attitudes that make for success in a weight loss programme. Participants are asked to attend 2 sessions and are paid for their time.

Friday, 27 January 2012

World Congress on Active Ageing

The WCAA 2012 is due to be held in Glasgow in August. I spent this afternoon submitting an abstract to present or do a poster about this study visit. I don't know how likely it is to be successful, but 'nothing ventured, nothing gained'. I'll find out mid March- watch this space.
Follow this link for more information about the conference.

Classes this week

I attended my regular classes this week.

Communication Skills for Effective Practice
This week we covered Interpersonal Skills, Listening, Verbal & Non Verbal Messages. Some of the course texts were reviewed and the Steven Covey literature was referred to (7 Habits etc).
The core text we are using throughout this module is:
Adler R & Elmhorst M (2009) Communicating at work: Principles & Practice for Business & the Professions.

The skill of active listening was discussed as not being listened to remains the number one complaint of patients in healthcare. The work of Peter Senge was introduced, see the quote below.  I also found one by Winston Churchill and thought it should be included as it is thanks to the Winston Churchill Memorial Trust that I have the opportunity to be here:

"To listen fully means to pay close attention to what is being said beneath the words. You listen not only to the 'music,' but to the essence of the person speaking. You listen not only for what someone knows, but for what he or she is. Ears operate at the speed of sound, which is far slower than the speed of light the eyes take in. Generative listening is the art of developing deeper silences in yourself, so you can slow our mind’s hearing to your ears’ natural speed, and hear beneath the words to their meaning."                                                                                                                                                                                                 - Peter Senge 


"Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen."
— Winston Churchill

Lifestyle Redesign Class
We began looking seriously at the literature and evidence for Lifestyle Redesign and to discuss and critique it in class. The readings are below and for anyone interested in learning more I would certainly recommend all of them and especially the first 4 'readings due' in the order given as they set out the research and development in the order it occurred. It is important to be aware that the 1997 paper at the top of the list described the first large scale randomised controlled trial of occupational therapy to be carried out.
Once again the importance of occupational storytelling or narrative as a means of not only forming a therapeutic connection with an individual, but as a tool to allow them to build an image of themselves that 'bridges' their pre and post self was an important part of the discussion. This theme is explored further in the first optional reading by Dr Clark on the list below.

Readings due:
Clark, F., Azen, S.P., Zemke, R., Jackson, J., Carlson, M., Mandel, D., et al. (1997). Occupational therapy for independent-living older adults: A randomized controlled trial. Journal of the American Medical Association, 278, 1321-1326.

Jackson, J., Carlson, M., Mandel, D., Zemke, R., & Clark, F. (1998). Occupation in lifestyle redesign®: The Well Elderly Study occupational therapy program. American Journal of Occupational Therapy, 52, 326-336.

Hay, J., LaBree, L, Luo, R., Clark, F., Carlson, M., Mandel, D., et al. (2002). Cost effectiveness of preventive occupational therapy for independent-living older adults. Journal of the American Geriatrics Society, 50, 1381-1388.

Clark, F., Jackson, J., Carlson, M.,chou, C., Cherry, B., Jordan-Marssh, M., Knight, B., Mandel,
D., Blanchard, J., Granger, D., Wilcox, R., Lai, M., White, B., Hay, j., Lam, C., Marterella, A., Azen, S. (2011).  Effectiveness of a lifestyle intervention in promoting the well-being of independently living older people: results of the Well Elderly 2 Randomized Controlled Trial.    Journal of Epidemiology in Community Health:   doi:10.1136/jech.2009.099754

Optional readings:
Clark, F. (1993). Occupation embedded in a real life: Interweaving occupational science and occupational therapy. American Journal of Occupational Therapy, 47(12), 1068-1077.

Clark, F., Azen, S.P., Carlson, M., Mandel, D., LaBree, L., Hay, J., et al. (2001). Embedding health-promoting changes into the daily lives of independent-living older adults: Long-term follow-up of occupational therapy intervention. Journal of Gerontology: Psychological Sciences, 56, 60-63.

Clark, F., et al. (1996). Life domains and adaptive strategies of the low income well elderly. American Journal of Occupational Therapy, 50, 99-108.

Jackson, J. (1996). Living a meaningful existence in old age. In R. Zemke & F. Clark (Eds.), Occupational science: The evolving discipline (pp. 339-361). Philadelphia, PA: F.A. Davis Company.

Thursday, 26 January 2012

Reviewing the aims of the study visit

I am now almost at the end of week 3 of my 8 week visit so wanted to check that I am on track with the aims.

  • To learn about the Lifestyle Redesign model first hand and in depth. 
I am certainly having every opportunity to learn through attending the first 8 weeks of the 2nd Year Masters Level Lifestyle Redesign class and completing the coursework and reading for it. Also through my attendance at the research and intervener meetings for the Pressure Ulcer Prevention Study (PUPS), participating in the first 8 weeks of the weight  management group and all the other meetings and discussions I am able to have with research and clinical staff, students in both the Lifestyle Redesign and  Communication Skills classes and clients themselves.
  • To study and develop my understanding of how the model can be applied in the context of the interface between hospital and home.
I have now visited the Keck Hospital to meet the OTs and have also spent a day with one of the OTs in clinical practice there (blog post to follow!). I intend to expand on this by spending some time if possible with OTs in some other areas of clinical practice in the main hospital and in a Primary Care setting. I will also be able to make links based on the principles that I am learning more about in all the experiences I am engaged in.
  • To explore the relevance of this model to my own area of work. Key issues are the translation from an urban, culturally diverse setting to a rural and less diverse region.
The issue of  translating from urban to rural in my mind had been largely to do with transport difficulties, not wanting therapists to be spending long periods driving, lack of public transport etc. In fact wider LA covers a huge area, is one of the most difficult and time consuming cities to get around by car and public transport is not well developed, so there is less difference than I expected. 
The cultural issues are different, but Lifestyle Redesign is showing itself to be very adaptable and applicable to a wide range of client groups, so again I think this will not be too much of an issue.
  • To make links with current policy documents such as Shifting the Balance of Care and Reshaping Services for Older People (Scottish Government) that make clear the need for a new approach to services for older people.
I hope to more clearly reflect this in the latter part of my time here, but the link is becoming clearer the more I learn. I would be very interested to hear people's views on this based on what they are reading on this blog.
  • To identify how occupational therapy services in my own area of work could deliver the most beneficial and cost effective interventions.
As for the previous aim, I am beginning to speculate on various possibilities for using this approach and hoping to have a meeting soon with an OT working in the Gerontoolgy Dept at the University.
  • To prepare a discussion document for the development of occupational therapy services for older people in my region based on the learning from my visit.
To be completed soon after my return to the UK.
  • To develop my own practice with individual patients based on my learning.
I have no doubt that all that I am learning will have a positive impact on my practice.

Sunday, 22 January 2012

Acute Hospital Visit

On Tuesday I had a tour round the acute hospital, the Keck Medical Center of USC, see this link for more information- as you can see the system run quite differently to the NHS.


Katie Jordan, Director for Occupational Therapy & Speech Therapy showed me round. Katie explained that she came into post about 3 years ago when the University of Southern California (USC) bought the hospital and the two amalgamated their services. Her role was to integrate the Occupational Therapy service with the Occupational Therapy teaching & research programmes at the University. As you will see form the website, the hospital services include very complex areas such as organ transplantation.
The Occupational Therapy service in the hospital covers in and out patients and operates a 7 day service. The familiar issue of prioritisation for in patients requiring OT was apparent, a prioritisation board is used in the OT office to plan the work and make best use of resources. Although the US medical insurance system is very different to the NHS, there is still the same concern about length of stay because a patient's medical insurance covers a set number of days for any particular situation or procedure, if a patient requires to stay in the hospital beyond this, the hospital begins to lose money....enter the OTs. The role in assessment and ensuring patients are at a level of function to allow them to return home safely is very similar to the UK.

We discussed the use of Lifestyle Redesign in the acute hospital context. A small scale trial (unpublished but presented at the AOTA conference) using Lifestyle Redesign with patients who have a Ventricular Assist Device has been carried out. There were optimistic results. The biggest challenge was incorporating this approach within the culture and 'regime' of an acute hospital setting. Using Lifestyle Redesign involves participants in making choices that fit with their lifestyle, this can be difficult in a hospital setting where, for example, there is no choice about meal times.
A new project has commenced with an OT working downtown in a Primary Care Centre (it sounds very similar to a GP practice in the UK). It is hoped that this will allow that OT to follow patients throughout their journey, including into the hospital, and this will allow further exploration and of Lifestyle Redesign across the continuum of care.

The principles of Lifestyle Redesign can begin to be applied, even in shorter, acute, episodes of care. One way is to expand on the Initial Interview/Evaluation process by being open to the person's occupational narrative and aware of the importance of 'storytelling' in framing occupation. There has certainly been a lot of interest in this area in the UK literature recently, although perhaps perceived as being more relevant from a mental health perspective that may mean those of us working in acute physical settings don't fully realise it's importance. I'd be interested to hear people's views on this...
Following this initial visit, I hope to be able to spend time with some of the OTs in clinical practice there- so spent the afternoon completing the online Health Insurance Portability & Accountability Act (HIPAA) training so I am covered re confidentiality- no escape from mandatory training! I will be able to report in more detail as my time here continues.

From this visit, a further conversation arose about the issue of electronic records. The hospital is in the process of moving to electronic records, these will include all disciplines, including the medical notes. We compared experiences and debated how the complexity of OT interventions can be captured in electronic notes, and also how to capture and document goals and outcomes. I think we both hoped the other would have the answer but of course we didn't, at least we share the same concerns.

Saturday, 21 January 2012

Weight Management Group- week 2

Almost everyone attended again this week, the group had a more serious feel to it and it was clear that people had given a lot of thought to the issues that were introduced last week. Everyone had kept their food diary (myself included) and some have put it onto a web based site such as .
Chantelle, the OT leading the group, gave positive feedback about the efforts people had made and helped them to see what they could learn from any difficulties. She emphasised the importance of every individual finding the solution that works for them and their lifestyle. For example, one person reports eating take-away virtually every night, so the group talked about solutions that might be a healthier option but not too big a change initially such as looking for 'healthier' take away food, getting a rotisserie chicken one night and more gradually introducing the idea of preparing some meals at home. Another group member explained the difficulty they have eating breakfast to avoid being so hungry later in the day. They leave the house before 6am so quick, easy options that could even be eaten a bit later in the morning were discussed.
There was a weigh-in at the start of the session to allow everyone to keep track of their progress, but the focus of the session was  not explicitly on weight but on giving information on healthier choices that will result in weight loss, and giving people the tools to start making these choices in a way that is relevant to their life. The session ended with everyone setting a goal for the following week, these included increasing exercising by one day a week, making sure to drink a set quantity of water each day, eating breakfast etc.
There is a sense of motivation being high at this stage and it will be interesting to see how the group continues to develop over the next few weeks. As Chantelle explained, change is not easy. I am sure there would be easier ways for the group members to lose weight in the short term, there are lots of prescriptive methods available, but the Lifestyle Design approach aims to enable sustainable changes to people's occupational functioning and choices that are long term solutions.

Pressure Ulcer Prevention Study- lifestyle issues

The regular meeting focused today on some of the problems the therapists face in carrying out interventions, and also the problems that many clients have in their lives that can make it difficult to adhere to long term self management of presssure risks.
A recent LA Times article about law suits currently in progress about alleged abuse and poor facilities for prisoners with disabilities was discussed, you can read it by following this link.

Some of the issues discussed this morning were:
  • what the OT interveners should do if they turn up for a session with a client who is under the influence of alcohol or drugs. There was general agreement that this need to be established as a 'ground rule' for therapy at the outset, but it can be difficult to apply as many clients routinely use alcohol and in addition to street drugs, many use 'medical marijuana'- legal in the state of California if prescribed by a doctor and readily available from numerous outlets in the form of joints, cup cakes, cookies etc. The picture of 'Mr Green's' below is the outlet at the bottom of the street where I am staying. One OT described how his client remains a gang member and drinking with other gang members is very much part of that lifestyle and is an aspect of it he can still participate in.
  •  safety for a client who is unable to get out of bed or mobilise alone but spends a large part of every day locked in the house while other family members are at work. The neighbourhood is too unsafe to leave a door open and assistive technology that would allow control of door opening is beyond the equipment budget of $400 per client.
  • conflicting priorities in use of the budget. Some clients want equipment that is seen as less of a priority by the OT and this can cause difficulties in the therapeutic relationship.
  • unstable or frequently changing life situations, frequent moves and periods when not in contact with OT, some clients may go into jail, others may be admitted to hospital without the OT being aware of it.
One of the OT interveners who works with clients who may be gang members or homeless described his approach to some of these issues as 'this is your lifestyle, let's go with what we can realistically do [for you to manage your pressure ulcers] with you living this way'.

Friday, 20 January 2012

Communication and Lifestyle Redesign Classes

I attended week 2 of the two classes I am joining the 1st & 2nd year Masters program students for.

In Communication Skills for Effective Practice we looked at communication across the diverse population common to most developed countries today. Discussion focused on issues such as what defines culture, the importance of cultural sensitivity in clinical practice and the workplace. We also looked at gender differences in communication and the impact of common experience on the different generations alive today.

In Lifestyle Redesign class we focused on Confronting Public Health concerns of the 21st Century through Lifestyle Redesign , healthy aging and activity (in other words OT?!). We reviewed the reading we had been assigned the previous week. You might enjoy this article The Talent for Aging Well (follow the link) for a flavour of some of it.

We discussed the factors that have been shown to be important to healthy or successful aging. We looked at the prevalance of chronic conditions and the human and financial costs of these- very similar to the UK. We also looked at the evidence for why individuals do or don't adhere to a healthy lifestyle.
Chronic conditions affect a large number of the population and have a high cost. Many factors are modifiable- and many of these by lifestyle changes. One example is cholesterol levels; high cholesterol results in atherosclerosis ('hardening' of the arteries) and increased risk of disease e.g. stroke. Better awareness of dietary issues and the ability to make informed and healthier choices e.g. by understanding of hydrogenated or 'trans' fats can help to modify this risk factor.
The development of healthy habits was seen as a key factor in the evidence if benefits are to be sustained. Intervention therefore needs to happen at several levels, social, cognitive etc.This is where the Lifestyle Redesign approach can be very effective as it addresses occupational concerns in an individual's life to enable them to make changes that promote health in their lives and/or promote successful aging. An individual approach recognises that everyone's journey to change is different and helps to develop a sense of self efficacy that allows changes to be sustained once the support of a programme is over.
This class very much resonates with the experiences of the Lifestyle Redesign Weight Management group I am following throughout my visit here see posts about this.

In the second part of the class we went on to work on some basic 'coaching' techniques that might be used in practice- we practiced in pairs for very short spells and fed back to the class about how it felt to be therapist or client in each exercise.

Monday, 16 January 2012

Martin Luther King Day

Today is a public holiday to commemorate the life of civil rights leader Martin Luther King. Follow this link for more about Martin Luther King, his work and what happens today.

'If it's valuable to you then it's valuable to me" Pressure Ulcer Prevention Study

The OT clinicians who work with the patients/clients in the Pressure Ulcer Prevention Study (PUPS) meet every Friday morning with the researchers and project support staff to discuss updates on cases, any problems and any admin issues. The interveners are blind to the study methods and hypothesis. I joined them for the meeting.

My understanding of the programme so far is that clients are recruited to the programme for a year, they receive a payment and they are allocated $400 for spending (with the OT's agreement) on equipment that will help them with pressure ulcer prevention. The programme consists of a number of units divided into 4 modules, they were designed to run in order but can be used flexibly as the OT and client agree. I am not yet familiar with the modules so will return to this another time.

Almost all the clients have a spinal cord injury, varying from C4 to L6 levels. Many are young or acquired their injury at a young age, very often through gang related violence or due to violence in the environment around them. There are a smaller number whose injuries were accident or other cause related. There are challenges for the OTs delivering interventions as some clients' homes or neighbourhoods are not safe for them to visit.

The OT interveners who were present talked about selected patients from their caseloads, reporting on their progress, any difficulties making contact (maybe because of coming in and out of jail, family problems or other unexplained reasons). They used the meeting to get ideas and support with any difficult issues.

The issues discussed were very varied, from how to make contact with a non-engaged client, to what equipment would be most suitable, to how to open the topic of sexual activity and intimacy in the context of pressure ulcer prevention and avoidance or adaptation of activities that put pressure areas at risk. One of the OTs summed it up in her words to one of her clients:
"if it's valuable to you then it's valuable to me"

Later on in the day I attended the once per semester Faculty meeting, about 40 of the Faculty were present and Dr Clark chaired the meeting. I introduced myself and explained the purpose of my visit to USC. Various sections reported on progress and it became clear that OT is very much a growing entity, and much of this is due to the success of the various Lifestyle Redesign programmes that are being run from the Faculty. Follow this link for more detail of the way the Faculty is organised and the work being done.

I also attended an early afternoon lecture from a visiting academic about Sensory Integration and Autism, another area of work that is developing here at USC.

Friday, 13 January 2012

Lifestyle Redesign Weight Management Group

My first achievement today was managing to get from the Health Sciences Campus (HSC) to the University Park Campus (UPC) on the shuttle bus!
I joined Occupational Therapist Chantelle Rice for the first meeting of a weight management group. To a UK OT this seems an unusual area of work for an OT, but in the context of Lifestyle Redesign with the emphasis on occupation and acquiring habits that promote health & well being, it makes sense. There are 12 people in the group, mostly, but not all women and ages from 20s to 60s. Most people are employees at USC so their health insurance covers them to attend, although they still have to make a payment. The group will run for 16 weeks.
Chantelle introduced the programme and the philosophy of Occupational Therapy, emphasising the use of occupation to enable change. Everyone introduced themselves and explained their reasons for coming along, many wanted to be more active, especially with their kids. Several have been directed to come as part of the preparation for gastric banding. The course hand out was explained and everyone got weighed (privately) and received a slip with their body composition analysis (BMI, Fat % etc) and the meanings of the figures was explained. Everyone though about and most shared their long term goals for attending the group. The OT set the short term goals for this week, to complete a food diary and to read over the course material.
The group had a good rapport from the start and the session was relaxed with lots of laughter. I will be able to stay with the group until they reach the half way stage and look forward to seeing the Lifestyle Redesign process in action. I am also curious to know what my dietician colleagues at home will think of it.

The day ended with the Faculty Practice Open House. A social cum marketing event that they hold annually. There was food, poster displays, lots of people who either refer clients, work in the faculty, students or clients themselves. A chance to meet and chat to more people and to feel that I already know quite a lot of people after almost a week.

Thursday, 12 January 2012

Lifestyle Redesign and Well Elderly- learning more

This morning I joined the first class of a 16 week block on Lifestyle Redesign taught by Camille Dieterle at 'the Center' on the main UPC campus. There are about 20 students in the class, all 2nd Year Masters level who will graduate in the Spring.

We went through introductions:
Who are you?  Current practice interests?  Why did you attend?  What new occupation do you want to try in 2012? (Everything from learning to cook or sew, to kite flying, hot yoga and driving).
My new occupation was to learn to get around in LA on my own, either by public transport (which seems to be a bit of a challenge) or by car (which looks quite scary). Watch this space...

Some definitions of Lifestyle Redesign:
  • 'process of acquiring health promoting habits & routines in daily life' (Clark et al 1997)
  • 'process of implementing self directed, personally meaningful changes to one's lifestyle and daily routines that promote health and enhance quality of life'

We looked at:
  • Lifestyle Components e.g  time management, eating routines, physical activity etc.
  • Client Factors e.g. chronic conditions
  • Risk factors for chronic conditions, these may include poverty and violence
  • Occupational role overload
  • Occupational deprivation
The current emphasis on 'wellness' and preventative work, make Lifestyle Redesign very relevant to current healthcare concerns.
We looked briefly at some of the key research papers, we will be revisiting these in more detail as the course progresses. We also discussed some of the areas Lifestyle Redesign is being used in e.g. weight management, diabetes, pain management, chronic headache. Apparently there is a programme working on prevention of further strokes in women who have had one previous stroke- I will try to find out more about this.
We looked in more detail at the syllabus for this course, which covers experiential learning as well as theory. As well as textbooks, reading and assignments, we were put into pairs (I will be working with three other faculty members who are attending the class) to begin a didactic process using the Lifestyle Redesign methodology that will continue throughout the class and be recorded through journals.
This class will give me the opportunity to experience and learn along with others and to have some experience of the process myself.

One of the key articles about Lifestyle Redesign describes the first Well Elderly study.
Clark F et al (1997) Occupational Therapy for Independent-Living Older Adults. A Randomized Controlled Trial. Jnl of American Medical Association Oct 22/29 Vol 278

I re-read it this afternoon and wanted to share a few of the points made in the final comments section accounting for the succes of the OT interventions (in comparison with non-professionally led activity groups):
  • 'activities chosen based on principles from the OT field that pertain to the relationship of occupation to health', particularly in developing daily routines that are relevant to an individual's own context, meaningful & health promoting.
  • highly individualised, despite the group context.
  • specific instruction is included on how to overcome barriers in everyday life within often limited resources
Individuals learned to 'confront obstacles, take risks & experience self efficacy and personal control while participating in daily activity'.

This afternoon I also met with Jeanine Blanchard who is currently part of the Pressure Ulcer Prevention Study team, but has a lot of experience within the Well Elderly studies. She shared information and her experiences with me, which helped to give me a clearer understanding of how the studies worked at more of a 'nuts & bolts' level and to begin to clarify some of the differences between how systems work here in comparison with the UK.

Wednesday, 11 January 2012

Day 2

Today was spent at HSC, the morning doing some reading up on USC info, making calls and emailing to organise my schedule over the next few days.

After lunch I joined entry level Masters OT Professional Programme students for a Communication Skills for Effective Practice class taught by Linda Fazio. There are 120 students in the year group, divided into 3 groups of 40. They spend this semester rotating between 3 'immersion' subjects:- Pediatrics, Mental Health and Adult Physical Rehabilitation & Geriatrics. The students also attend general skills classes such as this. This is a new course design 'in response to to today's expectation that all practitioners integrate external evidence into their interventions, we explicitly synthesize didactic coursework and on-site intervention ...' The class will run for 16 weeks and I hope to join them during the time I am here as there are close links with the Motivational Interviewing techniques used in Lifestyle Redesign and to gain an understanding of the student experience here at USC. (Thanks to Linda and all the students for welcoming me into the class).

At the end of the day I sat in on the Pressure Ulcer Prevention Study researchers meeting, I will also attend the intervener meeting later this week. The researchers meeting discusses progress & issues with the research process and design. As a result of programmes like this being more widely delivered in various settings, OT is now being seen as being at the centre of 'wellness' work.

I'm beginning to get a feel for what the whole Lifestyle Redesign concept is about. Here are a couple of definitions I came across today:

' .., transformative, evidence based process of enhancing health & wellness by preventing or managing chronic conditions within everyday contexts.'

'...the process of acquiring health promoting habits & routines in your daily life..'

Tuesday, 10 January 2012

First Day

Center for the Health Professions
Today was spent getting orientated to the Health Science and University Park Campuses.
 This is where I will be based.

The day began with an initial meeting with Dr Clark who gave an overview of the work of the Division of Occupational Science & Occupational Therapy- follow this link for more details. I was interested to learn how closely the 3 'arms' of research, education and clinical/care are linked.

My schedule will include taking classes with students at different stages in their training, spending time with members of the research teams and with Dr Clark and time in the Faculty Practice where some of the programmes are delivered. 

In the OT corridor
  The morning continued with a tour led by Floyd Tang, one of the student ambassadors, along with prospective Masters & PhD students. Then a visit to the Faculty Practice, here OTs are using Lifestyle Redesign in areas often not associated with OT such as Pain Management, Smoking Cessation, Weight Management. I will be spending some time with a weight management group that begins this week.
'The Center'

 After lunch we drove over to the main UPC. What a beautiful campus (apparently some of Legally Blonde was filmed there!). The Lifestyle Redesign Centre was a surprise, it's a beautiful Victorian building.

 The day has helped me to begin to get a feel for where I will be spending my time. I have been impressed by the level of commitment, enthusiasm and professionalism evident in everyone I met.
More new experiences in store tomorrow...
University Park Campus

'International Building'

Saturday, 7 January 2012

Arrived in Los Angeles

Arrived safely and have the weekend to do things like get a cell phone, learn to cross the road safely, get over jet lag etc. Been out and about exploring the area where I'm staying in Silverlake. The photo shows Sunset Boulevard with the HOLLYWOOD sign in the distance.

Wednesday, 4 January 2012

Leaving tomorrow!

Feeling nervous. Flying out to LA in the morning and it is blowing a gale. Have I remembered everything? Have I got everything? Lists everywhere....
Reminding myself of the aims of the visit:

Aims of the Project

  • To learn about the Lifestyle Redesign model first hand and in depth.
  • To study and develop my understanding of how the model can be applied in the context of the interface between hospital and home.
  • To explore the relevance of this model to my own area of work. Key issues are the translation from an urban, culturally diverse setting to a rural and less diverse region.
  • To make links with current policy documents such as Shifting the Balance of Care and Reshaping Services for Older People (Scottish Government) that make clear the need for a new approach to services for older people.
  • To identify how occupational therapy services in my own area of work could deliver the most beneficial and cost effective interventions.
  • To prepare a discussion document for the development of occupational therapy services for older people in my region based on the learning from my visit.
  • To develop my own practice with individual patients based on my learning.