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.

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.

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..'

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'

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.

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.

 

Student Occupational Therapy Links Scotland conference

Earlier this month I was honoured to have been invited to run a workshop at the Student Occupational Therapy Links Scotland (SOTLS) conference at Glasgow Caledonian University. The conference is organised by and for Scottish OT students- and beyond. Read more about SOTLS here.

The conference theme- Positive Thinking: Positive Future.

The students on the organising committee were so dedicated and enthusiastic and this shone through in the whole conference- a warm welcome, a fantastic team of helpful volunteers (thanks especially to Angela and Morven!). It was very inspiring to see what students and new graduates are doing. They are beginning their careers in OT in a much more difficult economic and employment environment than I did.

 Providing jelly babies ought to ensure they look at my info sheets...

With Nikki (one of the fantastic SOTLS committee)

The keynote speakers were:

Dr Sheena Blair - an exploration of the notion of occupational resilience

Dr Blair spoke about the link between occupation and health and well being, pointing out that although this is very much an implicit part of occupational therapy, but we need to make it explicit. She compared the concepts of occupational and human resilience. She asked the audience to consider:

• how would you recognise occupational resilience?
• can you recognise it in yourself?
• how would you attempt to convey the value of occupational resilience as a concept to others? 
• how would you facilitate it?

Our chosen occupations are closely linked to our sense of self and identity. Dr Blair gave three powerful examples of people who have developed occupational resilience in order to adapt to, and triumph over illness or adversity in their lives. One short explanation might be 'reinventing self in changed circumstances'.
In view of the importance of occupational resilience, Dr Blair concluded that as occupational therapists, our next big challenge and emerging area of practice is in public health and in the prevention of illness. A lot to think about and there were also some reading suggestions that I know I will want to follow up as Dr Blair's presentation has much relevance to the study visit I will making in a few weeks:

 Hasselkus B, 2002 The Meaning of Everyday Occupation
Wilcock A, 1998 An Occupational Perspective of Health

Dr Edward Duncan- a critical reflection on professionalisation

Dr Duncan spoke about his career, from working in some very challenging areas of practice to moving into research. He gave us much to think about regarding the impact of environment on health and well being, and on occupational opportunities, illustrating this with some startling statistics on life expectancy variations in different areas of Glasgow.
He explained how he moved from a very 'hands on' role into the academic world and spoke convincingly of the need for occupational therapy to build on it's strength as an 'applied profession'.  There is a real need for more quality research papers such as those produced by Professor Florence Clark whose research team I will be visiting on my study visit.
Dr Duncan sees the way forward as

• increasing the use of high quality theory and evidence to support practice
• increased use of conceptual models of practice.
• a focus on applied research

This future vision can be described as 'the art of practice supervised by measurable evidence'. We were signposted to the work on measurement of impact being done by the Nursing, Midwifery & Allied Health Professions council (NMAHP). 

I found this quote on the NMAHP website:

“Measurement is the first step that leads to control and eventually to improvement. If you can't measure something, you can't understand it. If you can't understand it, you can't control it. If you can't control it, you can't improve it."
H. James Harrington

OT Frontiers- supporting the development of occupational therapy in the developing world

OT Frontiers presented information about their work in developing countries, beginning by challenging our thinking about how countries may be defined as 'developing', it is not just about economic prosperity but may also include issues such as gender equality. OT Frontiers hold similar principles to those of the World Federation of Occupational Therapists (WFOT).
We learned about the work the team have carried out in countries such as Uganda, where they aim to support local training of Occupational Therapists who will be able to provide culturally appropriate interventions. The OTs in Uganda do not have access to many of the facilities we take for granted, even in these cash strapped times but the photos that illustrated the presentation demonstrated the high level of creativity and ingenuity used to produce equipment to enable independence.
OT Frontiers gave us a lot to think about regarding the appropriateness of some of the 'support' offered to developing countries, for example, equipment that once broken will have no spare parts available, OT text books that are based on Western cultural ideas and assumptions. In the West there is an emphasis on the individual, whereas in the East and much of the developing world, community is much more important.
A very inspiring presentation that opened our eyes to the global nature of our profession.
I will be visiting the US, one of the world's most 'developed' countries, but I understand there are huge variations in wealth and life opportunities in Los Angeles where I will be based. Despite a common language, the UK and the US are very different cultures so I am sure my assumptions will be challenged.

My workshop:
A travel award to study an Occupational Therapy approach in the USA. Can it improve the hospital to home interface for older people in the UK?

Workshops were presented three times during the day in small informal groups. I presented the information about the study visit I will be making early in 2012 as is also described within this blog.
Given the conference theme, I decided to add one more statement of my own:
'Luck is opportunity seized' (I didn't make it up, but it does fit!). I wanted to present to the delegates who attended my workshop the process by which I came to have such a wonderful opportunity. I felt this was an important message as they are beginning their careers with no certainty of jobs within 'traditional' OT roles and I believe that there are now many ways to work on developing a career in OT, even if you are not in an OT job at all times. There are many opportunities to network as I have been discovering over the internet, there are conferences such as this. So although the jobs market is extremely tough, there are also more ways that individuals can develop knowledge independently and become the designers of their own careers. Even those of us in established jobs can no longer rely on our employers to provide opportunities in the way that some of us used to be able to expect.

I have been a member of the College of Occupational Therapists Specialist Section- Older People (quick plug- any COT member can join, very good value, great information source- check out the link) for some years. Two years ago the Specialist Section offered 2 sponsored places to attend the COT conference in Brighton. I applied and got one of the places. This was where I first heard Prof Florence Clark speak about her work. There being no such thing as a free lunch, this led me to become involved with the COTSS-OP as co-lead of the Acute Care & Emergency Clinical Forum, and as a result, I got to attend conference again in 2010, where I had the opportunity to meet and talk with Prof Clark. It was only when the information about WCMT came to my attention that it occurred to me that this could be the way to find out more about Lifestyle Redesign. I went through the application process (see the link to WCMT at the right of the screen). My application was successful, and this blog is a result!
There is nothing intrinsically special about me- anyone could have applied for the sponsored places at conference, and any British citizen can apply for a WCMT travel award.

This discussion and the information about the study visit led to some interesting thoughts and questions that I will be taking with me, and trying to answer during the study visit. A couple of themes were:

• How can a process like Lifestyle Redesign that is delivered over a period of time be managed within the constraints of fast turnover and emphasis on 'basic ADLs' to get people out of hospital?
• Are OTs deskilled by working in discharge orientated hospital settings? In other words could they actually deliver something like this?

What do you think?

Many thanks to those who attended the workshop. I really valued your views and observations and hope you will continue to follow this blog.