New Ways of Working for Occupational Therapists Documents

New Ways of Working for occupational therapists is being promoted by the College of Occupational Therapists through a series of road shows around the country which link it to the college’s mental health strategy “Recovering Ordinary Lives. The strategy for occupational therapy in mental health services 2007-2017. A vision for the next ten years.”

In 2007, the College of Occupational Therapists carried out ten road shows in Glasgow, Llandrindod, London, Warrington, Exeter, Canterbury, Doncaster, Suffolk and Chelmsford to a total of approximately 600 people. The events provide information about "Recovering Ordinary Lives" in the context of New Ways of Working and allow delegates to take part in workshops to discuss the implications for mental health practice. Although most of the delegates have been occupational therapists, some nurses, social workers, physiotherapists, psychologists and service users have also attended.

In 2008 future road shows are planned including Cornwall, Stoke-on-Trent, Harrogate , York and Northern Ireland. The College of Occupational Therapists will also be taking the presenation to the Council of Occupational Therapists in the European Countries 2008 conference in Hamburg.

A presentation explaining the implications of New Ways of Working for Occupational Therapists is available to download at: http://www.cot.co.uk/public/introduction/intro.php

The Department of Health’s New Ways of Working (NWW) initiative started in 2003 as psychiatrists brought current work difficulties to the government’s attention. These challenges were characterised by high caseloads leading to staff burn out, difficulty with recruitment and a falling number of people entering the mental health workforce. New Ways of Working was introduced to change the practice and culture of mental health teams and evolved from New Ways of Working for Psychiatrists ( CSIP/NIMHE 2005) into New Ways of Working for Everyone (CSIP/NIMHE 2007). It essentially involves developing extended roles beyond traditional professional boundaries and bringing new people into the workforce, so skills can be used in a cost effective way.

The College of Occupational Therapists (COT) have had representation on the NWW working parties and have contributed to both the Allied Health Professions and Occupational Therapy work streams. The COT mental health strategy Recovering Ordinary Lives (COT 2006b) grew out of New Ways of Working for Psychiatrists (CSIP/NIMHE 2005 p.7) which set goals of: * the development of a strategy for occupational therapists in mental health services; * exploring the new roles for occupational therapists under Patient Group Directives; * exploring the 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 generic and specialist functions of occupational therapists.

New Ways of Working for Everyone (CSIP/NIMHE 2007b p.69) gives an update on the progress towards these goals. Both the above documents provide many examples of what NWW looks like in practice and contain occupational therapy examples. The New Ways of Working Best Practice Implementation Guide was also launched in 2007.

Implications for Occupational Therapists

NWW for occupational therapists can best be summarised as being able to “work across boundaries while ensuring that the occupational needs of service users are addressed” (New Ways of Working for Psychiatrists - Appendices CSIP/NIMHE 2005 p.65). It entails holding occupation at the heart of practice (COT 2006b) while moving across boundaries into new areas of practice. This shift in practice involves all members of the multidisciplinary team and encourages true culture change within teams.

The three main implications for the multi-disciplinary team and service users can be summarised as follows:

1 – Redistribution of responsibility

Changing concepts of who holds the responsibility in teams has allowed members of the multidisciplinary team to renegotiate who works with service users and when. Psychiatrists have been challenged to let go of some of their responsibilities and allow other team members to take this work on. Competency based practice encourages judging staff by their competencies rather than their professional qualification. Mental health teams in England have sought to rearrange team structures to allow redistribution of responsibility.

The Mental Health Act 2007 ( Carr 2007, Mason 2008) takes this further with the expansion of roles that have traditionally been the remit of single groups. Approved Social Workers will become Approved Mental Health Professionals who can also be occupational therapists, nurses, psychologists and social workers. The Responsible Medical Officer will become the Responsible Clinician who can be an occupational therapist, nurse, psychologist, social worker or psychiatrist.

Extended scope practice which has allowed occupational therapists to supply and administer medication under patient group directives for medication and the care co-ordinator role under the Care Program approach have been precursors for the gradual expansion of responsibility for occupational therapists in mental health. (COT 2005, COT 2006a)

With new responsibilities and new roles, occupational therapists are required to ensure that their job descriptions clearly include any new duties. They also need to ensure that they are not working outside of their competencies and undertake appropriate training if this is required. Supervision will be required from an appropriately skilled relevant person for new areas of practice (COT 2007).

2- Changes to team work

There is increasing emphasis on what team members have in common rather than professional differences. Values based practice encourages team members to ensure that they are focusing on common values in practice and are able to evidence these. Ten shared values for mental health team members have been identified in The Ten Essential Capabilities (Hope 2004) as:

Working in partnership
Respecting diversity
Practising ethically
Challenging inequality
Promoting recovery
Identifying people’s needs and strengths
Providing service user centred care
Making a difference
Promoting safety and positive risk taking
Personal development and learning

Capabilities for Inclusive Practice (NSIP/CSIP 2007) offers a framework for organisations and individuals to demonstrate their use of the common values.

New team members include pharmacists, mental health graduates, black and minority community development workers and support time recovery workers.

The Department of Health has issued a training package called the Creating Capable Teams Approach (CSIP/NIMHE 2007), which is a substantial process of redesign that teams can use utilising NWW principles. A skilled facilitator is required to guide the team through a series of workshops. Teams that have used this approach have introduced changes to improve the staff and service user experience.

3- Leadership

As role boundaries have shifted, assumptions about who should lead mental health teams have been questioned. There is increasing emphasis that staff at all levels should develop leadership skills. Occupational therapists need to be able to lead on occupation using their occupational expertise and in order to develop leadership, it will sometimes be necessary to relinquish parts of roles to be able to develop new skills (COT 2006b).

NWW can fundamentally alter mental health services and the role of occupational therapists, offering new opportunities and enhanced career development options.

References

Carr J (2007) The introduction of new roles under the Mental Health Act 2007. Mental health occupational therapy. 12 (3) 99-100

College of Occupational Therapists (2005) Prescribing, supply and administration of medicines and OTs. (BAOT/COT Briefing 15). London: COT.

College of Occupational Therapists (2006a) Extended scope practice. ( BAOT/COT Briefing 14) London: COT.

College of Occupational Therapists (2006b) Recovering ordinary lives: The strategy for occupational therapy in mental health services, a vision for the next ten years. London: COT.

College of Occupational Therapist (2007) Professional Standards for Occupational therapy Practice. London: COT.

CSIP/NIMHE (2005) New ways of working for psychiatrists: Enhancing effective, person-centred services through new ways of working in multidisciplinary and multi-agency contexts. London: DH.

CSIP/NIMHE (2007a) Mental health: New ways of working for everyone, a best practice implementation guide. London: DH.

CSIP/NIMHE (2007b) Mental health: New ways of working for everyone, developing and sustaining a capable and flexible workforce. London: DH.

Hope, R (2004) The 10 essential shared capabilities: A framework for the whole of the mental health workforce. London: DH.

Mason K (2008) A legitimate role for OTs? Occupational Therapy News, 16 (7), 13.

NSIP/CSIP (2007) Capabilities for inclusive practice. London: DH.

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