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.

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Wednesday, 29 February 2012

Funerals not Futures

' A sixteen year old homegirl named Terry, a natural beauty and the object of every homie's longing, was dressed in this magnificent, short, bright red dress...She is radiant, and the toughness often on display in the streets has been left at home. I tell her how gorgeous she looks.
"Promise me something G" she says, giddy and enlivened by all the compliments she is getting. "Promise me, that I get buried in this dress".
I'm instantly imagining the ridiculous snapshot of an old woman, at repose in her coffin, in a dress like this. But Terry envisions no such old woman.
An equally young homegirl bounds into my office one day to tell me she's pregnant. I suppose my face telegraphed, a little too clearly, a decided downsizing of my heart. Before I can say whatever I was going to say, she holds out her hand, as if to impede the words.
"I just want to have a kid before I die."'

From Tattoos on the Heart, Father Gregory Boyle (see Books tab at top of page) 

I have borrowed Father Boyle's words as they illustrate so well an issue that was being discussed at my last meeting with the Pressure Ulcer Prevention Study (PUPS) OT interveners. One of the important concepts in Lifestyle Redesign is goal setting. The discussion turned to the difficulty that the OTs often have in getting clients to engage with this concept. People are very often living 'in the moment'. This may be because they are dealing with an immediate and urgent crisis such as the threat of eviction by the end of the week unless the rent money can be found. Others may never have had a lifestyle that had any structure. Is this due to lack of external factors that provide structure such as a job? Is it more of a cultural issue e.g. a common way of thinking in the Hispanic community? Or is it due to having never had experience of planning ahead in order to achieve a goal, something that many of us learn as children or young adults e.g. planning what homework needs to be done to get an assignment finished on time? Crucially teachers and parents help with this for most people. Many of the clients in PUPS have not had this stability, support or role models earlier in life. Previous experience may well have led to an expectation of failure. Clients typically talk about 'taking it as it comes' or having 'no expectations' when the subject of setting goals comes up. Even when goals are set, they may well be derailed by some other life event. Many of the clients have past or current gang involvement- hence sustaining spinal cord injury through shootings. The passage above illustrates the mindset that Father Boyle calls planning for 'funerals not futures'. This life view and expectation completely alters the way a person engages in a programme like PUPS. Even if a client is now motivated to manage their health and want to achieve things in future, they may require support to build the skills to make it possible.

 Despite this recurring issue, clients are generally reported to be doing well. There is a low drop-out rate from the programme, possibly because the OTs go to the client rather than the client coming to them. But what are the implications for OT? There was quite a discussion about this, one that will continue. There may need to be changes to the programme outline or it may be more of a matter of skillful OT allowing realistic goals to be set and achieved- from what I have heard of from the OT interveners, this certainly seems to be happening.

For more information about Father Boyle, his work with LA gangs and Homeboy Industries, follow this link to my earlier post Pressure Ulcer Prevention Study- celebrations, challenges and homeboys.

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