New Ways of Working for Occupational Therapists

Introduction

NWW for Occupational Therapists will ensure that, as a profession, we continue to strive to be at the heart of modern mental health service provision in the 21st century, recovering ordinary lives and delivering what service users want, need and deserve.

Contribution of Occupational Therapy

New Ways of Working for Occupational Therapists Documents

The NWW for Occupational Therapists sub-group was established in July 2006 and is jointly chaired by Tina Hurley (COT Professional Affairs Officer – Mental Health) and Chris Merchant (National Lead for Workforce Mental Health Bill CSIP). The group includes representatives of the COT, the COT Specialist Section for Mental Health, NWW for AHPs sub-group and a service user representative.

Aims and objectives

The aims, as outlined in New ways of working for psychiatrists, were to work towards fulfilling key objectives necessary to raise the profile of the occupational therapists’ contribution to mental health services.

The five key objectives in New ways of working for psychiatrists (DH, 2005), some of which have already been met, are:

• the development of a strategy for occupational therapists in mental health services;
• exploring the new roles for occupational therapists under Patient Group Directives;
• exploring new roles for occupational therapists under the Mental Health Bill;
• establishing occupational therapy secondment with the Social Inclusion Unit; and
• considering a Career Framework for Occupational Therapists reflecting both the generic and specialist functions of occupational therapists.

Progress update

The COT strategy Recovering Ordinary Lives (2006) was launched in December 2006, the programme of secondment to the Social Inclusion Unit is now in its second year, and a Post-Qualifying Development Framework is available to all occupational therapists. NWW is a continuous and ongoing work stream, and the COT will continue to support and promote the implementation of NWW. The NWW for Occupational Therapists sub-group, in its future programme of work, will focus on five priority areas that have emerged from Recovering Ordinary Lives. New objectives have been agreed, and five sub-group leads have been identified to focus and deliver each of these.

Programme of work

Recovering Ordinary Lives closely relates to and complements NWW, and will be implemented from 2007 through a programme of national and regional events. As the profession embraces both programmes, occupational therapists will be enabled to work towards achieving the vision for occupational therapy: ‘By 2017, mental health service provision in the United Kingdom will be better for the active role and inspirational leadership provided by the cultural heritage and identity of occupational therapy, which at its core is social in nature and belief and, therefore, will deliver the kind of care that service users want, need and demand’ (COT, 2006).

A national network has been established to seek and explore the concepts, values and beliefs that are currently held within the profession. Stakeholder events will provide an opportunity for areas of innovative practice to be identified. Pilot sites will be established to demonstrate NWW in action. A summary of the current programme of work, highlighting the five priority areas is included below.

Valuing occupation and the underlying value base for occupational therapy practice

The relationship between occupation, mental health and well-being is evidenced in both the literature review and in the vision Recovering Ordinary Lives. Valuing occupation is one of the key themes in this strategy, with associated key messages for practitioners, managers, educators, researchers, COT and commissioners to ultimately improve services. These key messages will form the basis of discussion at stakeholder events and will also be consulted upon through the national network. Recovering

Ordinary Lives is available at http://www.cot.co.uk/public/publications/new/intro.php

Leadership

Leadership is being considered in four domains: professional, clinical, managerial and political. A need for occupational therapy champions has been identified to promote leadership opportunities and provide development and support for staff in leadership roles.

Consultant occupational therapists are, where they exist, having a significant impact on service delivery, but the paucity of posts makes it difficult to see systemic change or a raised profile.

Occupational therapists are currently employed in key leadership roles at Board level and as directors of therapy services within some NHS Trusts. However, this is often determined by the individual structure of the organisation and not by any workforce directive. Where these positions are in place, staff within the organisation feel that occupational therapy is visible and valued.

COT will continue to secure representation on government working parties, committees and other groups that develop and influence policy, to promote effective and appropriate leadership in the mental health service for occupational therapists.

Education and training

There are a number of different educational routes to occupational therapy registration, with all pre-registration programmes being subject to approval by the Health Professions Council (HPC, 2005).

Most programmes currently undergo voluntary accreditation by the College of Occupational Therapists to ensure their conformity with the Curriculum Framework for Pre-Registration Education (COT, 2004a) and the Standards for Education: Pre-Registration Education Standards (COT, 2004b). Both of these key COT documents belong ideologically to the occupational therapy profession, and are revised on a five-yearly basis, with interim updates as necessary. Programmes that opt for COT accreditation evidence their responsiveness to local and global issues and agendas that influence the learning requirements of students. In conforming to the Curriculum Framework, they demonstrate that they embrace the philosophical and value base of the profession. Both of these aspects of the pre-registration programmes are vital to ensuring that students and new graduates are aware of the contemporary context of mental health practice while on placement and once in the workforce.

There is concern regarding the recent reduction in the number of places being commissioned for occupational therapy training. This will impact upon the existing workforce, its sustainability and capacity to embrace change and new roles in the endeavour to bring quality services to clients.

To make the effective transition into new roles, additional training will be required, e.g. Approved Mental Health Professional (AMHP) and Responsible Clinician. COT, with other professional bodies, will contribute to the development of this training, in order to prepare practitioners for new responsibilities as identified in the Mental Health Bill 2006.

Workforce development

Occupational therapists recognise that they can use their knowledge, skills and expertise in new roles in a changing and diversifying workplace. Opportunities will arise within new and reconfigured services, and occupational therapists need to recognise the career potential associated with these. Through the implementation of the strategy and the accompanying work on NWW, COT will continue to guide its members and identify opportunities for occupational therapists to work in new practice areas where their skills can be most effectively deployed for the benefit of service users.

Occupational therapists within the field of mental health frequently work within multidisciplinary teams and actively promote integrated and generic working. However, the unique purpose of our profession, and its specific contribution to the mental health workforce, needs to be clearly stated and owned by occupational therapists, in order to ensure that commissioners of services also recognise the value and contribution of occupational therapy. The debate over specialist versus generic working will continue within the profession, and will be consulted on further via the NWW email network and events.

Roles

Occupational therapists have core skills in assessment, planning, intervention, evaluation and occupational performance. These skills, combined with the ability to be flexible, creative and responsive, have enabled practitioners within mental health services to take up the challenge of new roles within a modernising and changing workforce. Occupational therapists are the professionals within the mental health workforce who have the knowledge and experience of issues around occupation and employment to deliver creative solutions to complex problems. As one of the five core professions named within the mental health workforce, they will deliver the new roles and ensure a smooth implementation of policies in accordance with the Mental Health Bill 2006. We will jointly review the new roles for existing and new support staff, e.g. Associate Practitioners and their specific contribution to team working.

NWW in action: examples of innovation At an NWW sharing event held at the College of Occupational Therapists in September 2006, occupational therapists put forward the following examples of innovative practice:

• a programme for employment and vocational opportunities, with the appointment of vocational specialists and the introduction of specific assessment tools and models;
• in a community mental health team setting, identifying the specific and generic skills of the occupational therapist, to enable more effective and efficient delivery of services to people with complex needs;
• the establishment of joint lecturer/practitioner and researcher/practitioner posts attached to institutes of higher education;
• the identification of occupational therapists as trainers for clinical and managerial roles;
• flexible and out-of-hours working in crisis resolution and home treatment, assertive outreach and early intervention in psychosis teams;
• care co-ordinating and case management;
• partnership working with the voluntary sector, including secondments;
• introduction of new roles, e.g. Support, Time and Recovery workers and Associate Practitioners;
• occupational therapist appointment to Trust-wide service development roles;
• identified service/organisation lead posts for the arts, social inclusion, education and employment;
• joint posts and protocols in outreach services for older people;
• specialist interventions in forensic services – psychiatric intensive care units (PICUs), low and medium secure units, prisons and special hospitals;
• establishment of integrated care pathways approaches across community, day and primary care services;
• involvement and empowerment of service users and carers, including promotion of WRAPs (Wellness Recovery Action Plans); and
• in a primary care setting, demonstrating the unique intervention and contribution to the team that the occupational therapist makes, through interventions that draw upon the knowledge and skills in both physical and mental health that are gained and are core to occupational therapy training.

Next steps

The College of Occupational Therapists will implement its new strategy for occupational therapy in mental health services from 2007, and NWW will be fundamental to the process. In order for the vision to be achieved in 2017 and beyond, NWW will have been embraced by the profession and will be embedded in practice. To support this:

• We will review the Recovering Ordinary Lives strategy (COT, 2006) regularly to ensure key milestones have been met and that it reflects such things as current and new policy and legislation, NICE guidance, research and the developing evidence base for practice.
• We will promote the implementation of NWW and continue to work in partnerships to facilitate service integration and the introduction of new roles and innovative practice.
• Within the context and overarching NWW programme, we will continue to promote, support and evaluate NWW for occupational therapy staff.
• We will identify what it is that we will need to do, and where and how we will need to do it, in new and innovative ways, to ensure that occupational therapy is recognised and valued for its unique and essential contribution to mental health provision.
• We will continue to contribute to the work being undertaken by other professional NWW sub-groups, and, in partnership, develop the cross-cutting themes that have been identified, with specific reference to leadership, accountability, new roles and team working.
• We will disseminate information regarding NWW for Occupational Therapists within the profession and with other stakeholders through professional briefings, features, articles and updates in a range of professional publications, including the British Journal of Occupational Therapy, Occupational Therapy News, the COT Specialist Section in the Mental Health Journal, and on the COT website, for other stakeholders.
• We will present NWW at national conferences and events.
• We will contribute to research and audit and build the evidence base.

Summary

Occupational therapists currently work, and will continue to work, within all areas of mental health service provision and with people of all ages, across service sectors and agencies. NWW will ensure that occupational therapists continue to contribute a unique professional perspective that focuses on the whole person, embracing the individual’s unique lifestyle and preferences. Enabling someone to participate in everyday activities is a central part of occupational therapy; helping them to carry out the activities they need or want to do will enable them to lead healthy and fulfilling lives.

The more skilful the intervention the occupational therapist makes, the smaller the ‘footprint’ they leave. Success in this is demonstrated when service users feel that they have made the intervention themselves. It is therefore vital that occupational therapists are able to articulate and provide evidence of the basis of their therapeutic interventions and treatment at all levels.

A service user described one of the many roles of the occupational therapist as: ‘Kick starting your mind into recovery and occupation. This involved helping us find our own pathway in life and helping us learn the skills that would allow us to look after ourselves.’

Enabling the continued development of occupational therapists to meet the expectations of service users and their carers and the changing needs of organisations is essential to the delivery of effective, high-quality, sustainable care in our changing communities.

Contact details for the NWW for Occupational Therapists: Tina Hurley and Genevieve Smyth at This email address is being protected from spam bots, you need Javascript enabled to view it

References

COT (2002): ‘Mental health and occupation in participation’. A consensus statement by the College of Occupational Therapists and the Royal College of Psychiatrists.

COT (2004a): Curriculum Framework for Pre-Registration Education. London: College of Occupational Therapists.

COT (2004b): Standards for Education: Pre-Registration Education Standards. London: College of Occupational Therapists.

COT (2006): Recovering Ordinary Lives: The strategy for occupational therapy in mental health services 2007–2017. A vision for the next ten years. London: College of Occupational Therapists.

DH (2004): Ten Essential Shared Capabilities. London: Department of Health.

DH (2005): New ways of working for Psychiatrists: Enhancing effective, person-centred services through new ways of working in multidisciplinary and multi-agency contexts. Final report ‘but not the end of the story’. London: DH Publication Ref 270394A/B/C.

HPC (2005): Standards of Education and Training. London: Health Professions Council.