Occupational Therapy and enablement

1. “Able to enable” College of Occupational Therapists 1990 Occupational Therapyand enablement

2. Occupational Therapy and enablement The underpinning concepts of occupational therapy are centred on meaningful occupation related to a need for enablement, whether in a health or social context

3. Underpinning concepts of Occupation Occupations fill and structure time Occupation is centred on self-care, leisure and productivity (work) Occupation has a socio/cultural context and incorporates social participation and engagement Occupation contributes to a sense of identity Occupation enhances self-esteem and supports mental and physical wellbeing 3

4. Where do we work? • Social Work/NHS liaison working (POA and ESD) • Orthopaedic rehabilitation • Neuro/acquired brain injury rehabilitation • Child development/habilitation/Bobarth • All areas of mental health/treatment and rehabilitation • Learning disabilities/habilitation and rehabilitation • Private practice • Work/industry rehabilitation • Counselling/CBT • Care Home liaison/education • Stroke rehabilitation • Community outreach • The Wheelchair service/orthotics/splinting • Consultancy • Volunteer/charitable agencies • NHS and Social Work general management 4

5. Occupational Therapy Training • All courses in Scotland are now 4 year Honours courses • All students have to fulfil placements in physical and mental health settings and also in a Community setting • Training encompasses psychology, psychiatry, biometric sciences, sociology, biomechanics, ethics, ergonomics, mental and physical illhealth and condition specific rehabilitation 5

6. Charity versus enablement In the 18th and 19th centuries there was already philanthropic practice where charity was the sole outcome, with no expectation that the recipients would regard it as a route to achievement or self-determination. It was later advocated that rewarding productive activity would be more enabling, as outcomes would raise self-esteem and induce self-reliance

7. A common origin Occupational Therapy and Social Work share common antecedents and there were significant individuals who were in the same sphere of social reform and with a common belief in social equality and occupation For both Occupational Therapy and Social Work the formalisation of theory and practice has origins in America and as they developed their eventual professional titles reflected their developed focus Both chose routes to enablement 7

8. A link to Social Work Octavia Hill (1838 - 1912) was an early and significant social reformer who was instrumental in formulating the concepts of Social Work and who inspired others in her belief of the need for social change and enablement Elizabeth Casson (1881 – 1954), worked for Octavia Hill. She later became a doctor and subsequently an eminent psychiatrist. She set up the first British school of Occupational Therapy in 1930. Each year the College of Occupational Therapists awards the Elizabeth Casson Prize for exceptional practice In 1925 the first person in Great Britain appointed to work as an Occupational Therapist was Margaret (Peg) Fulton (1900 – 1989). She was later awarded an MBE in recognition of years of advocating and practicing meaningful occupation in rehabilitation. Peg trained in Philadelphia but worked in Aberdeen and contributed to the development of the British and World Federation of Occupational Therapists

9. Facts and Figures Occupational Therapy staff make up one percent of Scottish Social Work staff but account for 35 percent of referrals for adult social work services. They can be individually responsible for assessment and equipment provision/adaptations that will allow greater independence and/or facilitate or support the carer role. In 2008 there were 516 occupational therapists working in Scottish social work services. This is lower than in 2006! This has happened when the fastest rising demographic group is the over 85’s, with a commensurate rise in dementia and debilitating frailty. Similarly, previously life-limiting conditions are prolonged with more successful treatments, with a consequent need for extended and additional support services and interventions in the community

10. Changing Lives, Changing Practice In response to this initiative, the College of Occupational Therapists has produced a report that analysed the role of community occupational therapy in the enablement process and set within their historic role of habilitation and rehabilitation The COT report encompasses many Scottish Office initiatives Changing Lives (2006) Co-ordinated, integrated and fit or purpose: a delivery framework for adult rehabilitation in Scotland (2007) Framework for adult rehabilitation in Scotland (2006) The better health, better care, action plan (2007) These, amongst many others place occupational therapy alongside social work in the development and delivery of enablement initiatives

11. Current and future practice The current “enablement” agenda is an opportunity to reinforce the historic relationship between Occupational Therapy and Social Work

12. Enablement in Angus – Why change? • Due to demographics, we will be unable to meet future demands for service unless better use is made of our resources • Services must be at the time of need and be more flexible • “Care” models of service provision can lead to disabling rather than enabling Service Users • Enablement will result in better outcomes for Service Users • To comply with initiatives and agendas such as Changing Lives, Shifting the Balance of Care and Angus Council’s Best Value Review of Older People’s Services

13. Enablement in Angus A Personal Care pilot scheme • In 2007 a Personal Care Pilot Scheme ran in Angus and focused on Service Users whose requirements included personal care • The scheme sought to determine the potential for enabling the person rather than an a tacit acceptance of a Long Term need • The scheme involved 29 SUs with a total of 137 hours requested • At the end of the scheme only 21 hours of ongoing service required • 6 Service Users achieved total independence • The majority of the remainder only needed assistance with bathing

14. Enablement in AngusA Community Meals pilot scheme • The scheme ran between August 08 and April 09 and investigated requests for Older People in Brechin/Montrose for new meals provision or increases to existing provision • Prior to pilot scheme there was an average 15 referrals monthly • Each referral was more fully assessed by a Home Care Assessor, Care Manager and an Occupational Therapist • There was a focus of the potential for short-term support with enablement/independence as the preferred outcome • In the last 12 months there has been a maximum of 4-5 referrals monthly and 50% of theses has been for short –term meals provision

15. Enablement in AngusWhat the schemes sought to achieve • Better long and sort term outcomes for Service Users with regard to enablement and independence • For services to be delivered at the right time to the right people with the ability to adjust as needs change and to prevent waiting lists for services • To provide flexible support and service delivery and give greater job satisfaction • To maximise resources in order to meet current and future demands • To comply with government and local initiatives and agendas

16. CLCP and Occupational Therapy The COT report concludes; “The full, effective and timely involvement of occupational therapy in social work services now and in the future will reduce the need for complex and costly packages of care”