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

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Monday, 13 February 2012

Pressure Ulcer Prevention Study- celebrations, challenges and homeboys

The Pressure Ulcer Prevention Study (PUPS) is an ongoing study where the therapists are blinded to the methodology so I am being careful what I say about it! I continue to sit in on the meetings of the researchers- celebrating a target being reached last week:

In the interveners' meeting caseloads are starting to wind down as the current phase nears completion and the discussions are often about making sure everything is completed and that the process of clients exiting from therapy is well handled. The interveners are able to identify some clients who they feel have achieved a great deal and there was discussion about how to capture and celebrate these successes- as well as learning form the cases where there were greater challenges. Often the difficulties are due to the 'marginalised' lives that many of the participants lead- see also previous post. Not all have been involved in gangs, but violence associated with gang involvement is a common scenario for acquiring a spinal cord injury in Los Angeles.

Living on the margins of society often leads to occupational and financial deprivation. A client who has a high level spinal cord injury following a gunshot wound sustained in a gang shooting was issued with an electric wheelchair suitable for his needs, but because it would not fit through his front door it was kept outside- and soon stolen. He does not have health insurance so does not qualify to be provided with another chair for possibly some years and is therefore confined to bed or an unsuitable manual chair that makes him dependent on others and at higher risk of pressure ulcers. Someone in different social and financial circumstances might have been able to get rehoused or have their housing adapted, might have lived in a lower crime area where the electric wheelchair would not have been stolen, could have used their insurance for a replacement, might have been better able to advocate for themselves to get a replacement sooner under the circumstances.

Lack of money can be a immediate and serious challenge. Last week one of the OTs had been working to get a client in contact with agencies or charities who might be able to help him. He was on the brink i.e, within a few days, of being made homeless. He and others sometimes take part in clinical trails that they are paid for. This is seen as a legitimate and fairly common way to make some money- and has the advantage of being legal. There are websites giving advice on how to go about registering for clinical trials, follow this link to for a flavour.

Several times the OTs have talked about the issue of 'arrested development' , not uncommon in the clients they are working with. Many of the clients sustained their injuries in their teens or early twenties, the age when gang activity is probably most common. Some of them are now much older but becoming spinal cord injured at a young and crucial stage of development into adulthood, has had a significant impact. They have often not experienced some of the usual stage of development such as having romantic or sexual relationships, completed education or had a job. Many are dependent on a care giver, often their mother, at an age when they would usually have long since been leading independent lives.

Homeboy Industries

 I have heard the OT interveners mention Homeboy Industries a number of times as some of their clients are involved with this initiative.

Homeboy Industries Mission: 'Jobs not Jails: Homeboy Industries assists at-risk and formerly gang involved youth to become positive and contributing members of society through job placement, training and education.' You can check out the website  by following this link.

One of the founders Father Greg Boyle has written a moving and inspiring book about his work with gang members in LA and how Homeboy Industries came into being.

Boyle, G (2010) Tattoos on the Heart- the power of boundless compassion. Free Press USA

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