OT? So What?

During the week I attended the College of Occupational Therapists Conference in Glasgow. The College of Occupational Therapists Specialist Section- Older People (COTSS-OP) conference ran simultaneously. It was really inspiring to hear many of the main keynote speakers, such as professor Michael Iwama, talking about preventative work and public health being important future arenas for OTs. The vital role OTs play in acute and emergency care settings was very much acknowledged, but the importance of linking well with community based services was very much at the forefront of the discussions.

I presented a facilitated poster discussion about my study visit to the University of Southern California. I outlined the background to the visit and then went on to the following:
 

'...Current hospital discharge practice can be frustrating for both OTs and older people themselves. It can be reductionist, grounded in a medical model and emphasise ‘safety’ at the expense of occupational engagement and enablement of valued daily activities. A paradigm shift on the part of policy makers, service managers and individual OTs is needed to change this. An understanding of the principles of the LRD model can provide a way forward.

I want to leave you with some points to ponder based on the opening plenary speech given by Professor Iwama and Jacqui Lunday Johnstone’s Keynote address to the COTSS-Older People’s conference. Professor Iwama challenged us to re-examine how and where we work and to look at the preventative and public health arenas as the future of Occupational Therapy. He asked us to consider the relevance of our services to the lives of the people and communities we serve. Jacqui Lunday Johnstone emphasised the need to demonstrate outcomes or the ‘added value’ that occupational therapists provide- what she termed the ‘So What?’. Both affirmed that the unique skills of OTs, if fully utilised can have real impact on the hospital to home interface. Using an approach inspired by Lifestyle Redesign® could help to make this a reality.

Imagine the older people who use your service being asked two questions:

1. Was the OT service you received relevant to your life?
2. If you received a service, So What? What was the added value it brought?

If the answers you think you would get are not what you would wish them to be, then it is time to begin looking at the reasons and to think about whether using aspects of Lifestyle Redesign® could be a way to change the answers in future.'

H is for Health....

 

Health is defined by the World health Organisation (WHO) as “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”. This definition was made in 1948 when the WHO was founded and has not been amended since.

Yesterday, 7^th April, was the WHO’s annual World Health Day. This year the focus was on older people and based on the slogan:

‘Good health adds life to years’

You can visit the website using this link http://www.who.int/world-health-day/en/ to read more, see the inspiring photo gallery and find lots of useful links and articles. The basis of the campaign to improve older people’s health is that ‘healthy behaviours throughout life can help older men and women lead full and productive lives and be a resource for their families and communities’.

Reading this statement re-inforced for me the potential of the Lifestyle Redesign® occupational therapy approach that was the focus of my recent travel award. The approach uses an occupational, or ‘doing’ approach to help people to incorporate health-promoting behaviours in their lives. This can begin as later years approach, a preventative method (see E describing the Well Elderly studies), or could be developed once older age has arrived- I am looking at developing the approach in my own practice for older people at the ‘hopsital/home interface’.

The WHO’s press release for the World Health Day outlines the following 4 actions for governments and societies:

1. Promote good health and healthy behaviours at all ages to prevent or delay the development of chronic diseases.

 2.  Minimize the consequences of chronic disease through early detection and quality care (primary, long-term and palliative care).

 3.  Create physical and social environments that foster the health and participation of older people.

4.    "Reinvent ageing" - changing social attitudes to build a society in which older people are respected and valued.

All of these are reflected in current government policy. Occupational Therapy and OTs can contribute a great deal to this agenda.

Lifestyle Redesign Class- The End of Overeating

This week's class was explicitly about the issue of over eating and obesity.   

Center for Occupation & Lifestyle Redesign

Lifestyle Redesign Class at 'the Center"

 The Lifestyle Redesign methodology has 4 key components originally developed in the Well Elderly study.

• didactic material
• peer support (often group work)
• occupational self analysis
• direct experience

I am fortunate to be  following a Weight Management Lifestyle Redesign group for 8 weeks. The other students are all having the opportunity to sit in with one session. We reported back on our experiences, how we have observed the 4 components above in practice and how the OT's skills were used to ensure that the process occurs.

Some clients begin the process having repeatedly failed to lose weight in the past and are pessimistic about their prospect of doing any better this time. The intervention aims to allow them to develop a sense of self efficacy initially, often in small stages, so that they can continue to set clear, progressive goals. Others attend as a requirement of their insurance company in preparation for having bariatric surgery and may have low motivation as they believe that surgery will provide a 'magic solution', or even fear that if they lose weight they may be refused surgery. Here the OT takes an educational approach, to allow clients to understand that even with the surgery they will need modified eating habits to ensure a successful outcome in the longer term and to cope with the very restricted regime for the first few months post surgery.

Camille referred to a paper we will be looking at in more detail later that investigates the elements of successful weight loss. There are complex issues involved that are linked to behaviours developed over a lifetime and therefore closely entwined in daily occupation. If weight loss interventions are situated in the context of the complexities of daily life routines - OT's area of expertise- this can help to ensure successful and sustained weight loss. In this model the keys to success are:

• habit training
• occupational self analysis, or considering the link between 'doing' and eating
• healthier habits are embedded into the real fabric of everyday life 

 In the group I am observing and form the feedback form other students, it is evident that this approach is motivating the participants.

Feed back from The End of Overeating...

We covered a large amount of readings for this class and divided these up to give a 5 minute synopsis each. I had 6 chapters from a book I would highly recommend:

Kessler, David.  (2009). The end of overeating: Taking control of the insatiable American appetite.  NY: Rodale.

It's fascinating. It talks about what the food industry does to make food highly palatable and constantly available, how this has changed the way we respond to it, and how we can regain control.

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.