BSc (Hons) Occupational Therapy
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Item Planning, designing and evaluating a guide for online therapy sessions, using the values and principles of the Occupational Performance Coaching intervention.(2021)Executive Summary This project has been created in collaboration with bOunceT, a third sector social enterprise service in Scotland. The service has granted permission to use their name (Appendix 1 ). bOunceT works with families and service users, with the purpose of enabling their occupational participation and improving quality of life. As a result of the current COVID-19 pandemic, the team at bOunceT have identified a need for increasing their input with service users and their families via an online platform. Furthermore, the service identified a want for implementing the Occupational Performance Coaching (OPC) (Graham et al. 2009) intervention into practice, in order to allow for the creation of home/community based goals for service users and their families. The creation of the resource guide has a clear occupational focus, as it includes the creation of occupation-based goals with the purpose of improving performance and social participation of meaningful occupations. The development of the resource for bOunceT staff and students on placement has provided them with a guide for increasing their knowledge and skills within the scope of occupational therapy, in order to further their continuing professional development (HCPC 2016).To support the need for a service development of an online OPC resource guide, a literature review of five articles was carried out, all of which involved the implementation of OPC into practice, via an online platform. The themes that emerged from this literature were occupational performance, self-determination theory and telehealth. The reviewed literature identified many benefits to support the implementation of this intervention into practice. To achieve the project aim of developing a resource guide for staff and students at bOunceT, a questionnaire was administered to them, to gather their expectations of he content and structure of the resource. The following points were identified from the questionnaire and incorporated into the development of the resource: Text box 1: Questionnaire Findings • As majority of the participants identified that they had a limited knowledge of the OPC Intervention, the resource included background information on the intervention and links to relevant literature to further develop an understanding of the intervention. • The format chosen for the resource guide was a PDF document, as this was identified in the findings of the questionnaire as the most accessible form. • The content of the resource was identified from the results of the questionnaire and from relevant literature. The content was identified as information on OPC, how it fits with vision of bOunceT, identification of who OPC is suitable for, how it fits with bOunceT service pathway, implementation of OPC, creation of OPC goals, how to record OPC sessions and how to evaluate the intervention.The analysis of the questionnaire and the review of literature contributed to achieving the project's aims and objectives. The resource guide was planned in partnership with the project lead, project partners and project supervisor. A draft of the resource guide was developed by the project lead, which was then evaluated using feedback from the project partners, supervisors and author of OPC. This project can be developed further by carrying out a future evaluation of the OPC on line sessions, once it has been implemented into practice by bOunceT staff and students. An abstract for the Royal College of Occupational Therapists Annual Conference (2021) can be found in Appendix 2.Item The development of a specialist competency framework to support the induction of occupational therapists new to community Children and Young People’s services across Scotland.(2021)Executive Summary Competence can be used to describe an individual’s ability to effectively perform a role or appropriately carry out tasks. Mindtools (2019) describe a competency framework as a compilation of the relevant skills and knowledge required to achieve competence in a certain area. Competency frameworks are used to guide learning, recruitment and practice allowing measurement of an individual’s ability and suitability (Bogo, Mischna and Regahr 2011). This project was carried out by a Queen Margaret University (QMU) 4th Year BSc (Hons) Occupational Therapy student in collaboration with NHS Borders Children and Young People’s (CYP) service. NHS Borders CYP service supports individuals aged 0-18 with a variety of physical, neurological and mental health conditions (Royal College of Occupational Therapists [RCOT] 2020a). The nature of these conditions often means individuals require lifelong input from an early age (NHS Greater Glasgow and Clyde 2021). Occupational therapists aim to support individuals and their families using assessment and interventions concerned with activities of daily living (NHS Borders 2020). A specialist competency framework was developed for use in Children and Young People’s occupational therapy across Scotland to guide the induction and learning of occupational therapists new to the practice setting. Previously CYP practice was guided by the Knowledge and Skills Framework which outlines general practice requirements (RCOT 2020b). Previous research identified the need for the development of a competency framework to outline of specialist knowledge and skills required to work in CYP Services (Hook 2020; Johnstone 2020). It is recognised that the development of the competency framework would help to align induction, learning and continuing development opportunities with the requirements set out by policy including the Children and Young Peoples (Scotland) Act (2014) (Esplen et al. 2020; Henderson et al. 2020; Hinman et al. 2020; Khuabi and Bester 2020). The project was based in service development and used a method informed Mindtools (2019) competency formulation process. A needs analysis was conducted through an exploration of literature and discussion with the project partner. Existing competency frameworks were used to inform the structure and results of previously conducted 2 research were translated into competency statements (Hook 2020; Johnstone 2020). The competency framework was continually evaluated with feedback from the project partner and project supervisor. A final evaluation was conducted by sharing the competency framework with CYP team leaders across Scotland using email to gather qualitative responses (Kamberelis and Dimitriadis 2013). The evaluation highlighted some suggested changes to the content however, feedback established that the resource fits with the expectations of CYP team leaders. Further discussions on the framework will take place at an upcoming meeting. Recommendations for the continuation of the project include actioning the suggested changes, evaluation of the competency framework and its effectiveness following implementation over time. Further exploration of how appropriately continuing professional development opportunities are aligned with the competencies to be met would be beneficial. An abstract of the project was developed for the Word Federation of Occupational Therapists (2021) upcoming conference, Occupational Re-Volution (see Appendix A: Conference Abstract 18001865).Item The Value of Leisure: Exploring how occupational impediment due to Covid-19 impacts theatre group members’ health and wellbeing.(2021)Executive Summary This report describes a research-based project conducted in partnership with Leitheatre, a local community theatre group (see Appendix A for identification permission). The research intended to investigate the value of leisure occupations, and how occupational impediment due to the Coronavirus (Covid-19) could impact group members’ health and wellbeing. The research topic was explored through a literature review. Relevant literature found that leisure occupations, including community groups and theatre, are valuable and have many benefits. Evidence regarding the impact of occupational impediment was found, including a lack of purpose, loneliness and frustration (Laliberte Rudman et al. 2006; Hocking 2012; Douglas et al. 2020). Due to the newness of the Covid-19 phenomenon, limited literature was found regarding the impact of restrictions on health and wellbeing. This evidence base justified this research. A mixed-method questionnaire was chosen to investigate the topic, with survey methodology and relativism underpinning this research. The questionnaire was mixed-mode, and convenience sampling was utilised, resulting in 21 responses. Three key themes were found from the results: Value of Community, Modification of Occupational Components and Additional Identified Impacts. The value of community included key social aspects of Leitheatre, and acknowledged the impact on community from occupational impediment. The modification of occupational components was evidenced in the adaptation from in-person activities to online. The lack of creative outlet and performance aspect were mentioned as debilitating. Furthermore, virtual platforms are not conducive to theatre, with no audience feedback and no opportunity to develop skills such as stage presence. Additional identified impacts of Covid-19 restrictions included emotional, mental and physical effects. Conversely, some participants expressed appreciating ‘the break’ from Leitheatre. 17005495 vii This project was deemed successful in fulfilling the aim of researching the value of leisure and the impact of occupational impediment. Further research could be completed into long term impacts of Covid-19 with a larger sample, and how occupational therapy may facilitate leisure participation. A conference abstract was composed for the World Federation of Occupational Therapists Congress (2022) to present these findings under the themes of ‘mental health and wellbeing’ and ‘health promotion’ (see Appendix B).Item Exploring the complexities of safe postural management for people in Scotland with a diagnosis of Huntington’s disease: A survey of health care professional opinion.(2021)Executive Summary The following project was developed in partnership with Scottish Huntington’s Association (SHA) who have given permission to be named throughout this report (appendix 1). Scottish Huntington’s Association are a charity that offer extensive specialist support to families with a diagnosis of Huntington’s disease in Scotland (SHA 2019). Huntington’s disease (HD) is a hereditary neurodegenerative condition that impacts on a person’s cognitive, physical and psychological functioning (Nance 2017). The need for the project was identified by SHA after the development of new postural management guidelines for neurodegenerative conditions. From their expertise in this field, they acknowledged the guidelines would not meet the needs of this population as they failed to incorporate the unique characteristics of HD. Involuntary movements (known as chorea) is characterised by abnormal, uncontrollable movements affecting the persons trunk, face and limbs (Bates et al. 2014). As the condition progresses, the person will be unable to change their position independently (Pope 2007). Therefore, 24hour postural management is an imperative intervention for people with HD to maintain function, health and support postural stability (Stinson et al. 2020). The preliminary stage of developing guidelines was completed, through a scoping exercise which took place in the form of a research project. A generic qualitative approach was used to develop an online survey and a total of seventeen participants completed the survey. Participants were from a variety of health care disciplines across different localities within Scotland, which was the desired sample representation. The survey required the participants to reflect on experiences of providing postural 3 management to those with HD, offering opinions on the needs, risks, barriers and facilitators to this approach. Six themes were identified from the findings and involuntary movements were discussed extensively throughout. The findings from the survey made it abundantly clear that involuntary movements are a unique characteristic of HD which impacts on safe postural management. The postural management needs for people with HD related to functional ability, comfort, safety and maintaining an appropriate posture over a 24hour period. The expertise of occupational therapists and HD specialists were an important tool utilised by other health care professionals when providing postural management. This was often the preferred method of knowledge generation rather than the use of guidelines, although some guidelines and resources were utilised. There was a disparity in response across localities relating to training and education. Cost, use and availability of equipment impacted on the effectiveness of services and to the health and wellbeing of the person and their family. A report will be provided to SHA with evidence from the research that could have the potential to move guideline development onto the next phase. A conference abstract for the World Federation of Occupational Therapy Congress: Occupational R-Evolution in 2022 is included in appendix 2.Item An evaluation of the impact of an enquiry line phone service for education staff in schools to obtain immediate support from allied healthcare professionals supporting children and young people during COVID-19.(2021)Executive Summary This project has been undertaken with the NHS Fife Health and Social Care Partnership (HSCP) children and young people’s occupational therapy service. The project was pre determined by the project partner as the service wished to explore the impact of a universal service provided during the onset of the Coronavirus Disease 2019 (COVID-19). The allied health professional (AHP) enquiry line phone service was developed by NHS Fife HSCP as a response to service delivery during COVID-19 for children and young people. Children and young people’s services that have been available through the service so far are occupational therapy, speech and language therapy, physiotherapy, and support for learners service. The enquiry line is available for education staff to obtain immediate access to universal advice and information for the children and young people they teach and support. Universal services form part of a tiered model of service delivery of universal, targeted and specialist and are described as services designed to meet the needs of all children and young people (Hutton et al. 2016). Providing universal services to children and young people is a key role of allied health professionals and is integral to achieving legislative aspirations across local and national levels (Scottish Government 2008; Scottish Parliament 2014; Scottish Government 2016; Fife Children’s Services Partnership 2020). An evaluation of the impact of the enquiry line service as a means of occupational therapy service delivery was carried out. The research sought to identify the impact of the universal support received, to understand how this universal support transferred to the classroom setting, to identify if teaching staff continuous professional development (CPD) has been impacted and if staff have been able to use the universal advice received with other children and young people. An online questionnaire was completed by twenty participants, followed by a semi-structured interview with one participant. A thematic analysis approach yielded five main themes relating to the three research objectives. The findings support government and professional body publications around addressing 2 concerns at a universal level by adopting a prevention approach and promoting well-being for all children and young people (Scottish Government 2016; Royal College of Occupational Therapists (RCOT) 2019). The project partner service was recommended to continue to provide the enquiry line service as a clear need has been established from this research. The findings can be used to support the development of the service in extending the availability of the service to health visitors, parents and families.Item A service development proposal for implementation and evaluation of Sue Parkinson’s ‘Recovery through Activity’ intervention for service users in a Forensic Mental Health Unit.(2021)Executive Summary This service development project was carried out in partnership with a forensic mental health service that provides assessment and rehabilitation for adults with complex and enduring mental health conditions, some of whom have been in contact with the criminal justice system. The purpose of this project was to develop a proposal for the implementation and evaluation of Sue Parkinson’s ‘Recovery through Activity’ (RTA) intervention (Parkinson 2014). Please see (appendix 2) for a group profile, and overview of the intervention. The proposed intervention is intended for implementation within a medium secure ward. Service users are often diagnosed with complex mental health needs, and can have multiple diagnoses of a mental health condition, learning disability and/or personality disorder (Royal College of Occupational Therapists 2017). Common diagnoses include schizophrenia, bi-polar affective disorder, and personality disorder (Couldrick and Alred 2003). Enduring mental health conditions can have a significant impact on occupational participation and cause individuals to become less engaged in daily occupations (Law 2002). Additionally, within secure environments service user’s opportunities to spontaneously engage in occupations of one’s own volition can be significantly limited and essentially lead to occupational deprivation (Whiteford et al. 2020). This can be influenced by the individual’s mental health, safety risk, legal status, institutional regulations and policies (Royal College of Occupational Therapist 2017). Long-term effects of occupational deprivation within secure environments can include, difficulty transitioning into the community, social isolation and exclusion, and difficulty structuring time in a meaningful way (Long et al. 2008). Furthermore, a significant absence of occupation can have serious negative effects on mental and physical wellbeing (Wilcock and Hocking 2015). To attempt to address such issues, the implementation of the RTA programme was suggested. RTA is an occupation-focused intervention which aims to improve occupational participation for individuals experiencing barriers to their preferred activities and occupations. It explores the importance of 9 activity to service user’s recovery and acknowledges the important link between occupational balance and wellbeing. It seeks to enable participants to recognise the long-term benefits of occupational participation on mental health and wellbeing through exploring the value of a range of leisure, self-care and vocational activities (Parkinson 2014). A systematic review of the literature was carried out to inform the development of the proposal, and establish the potential benefits and limitations of the RTA programme for this specific population. Planning for implementation and evaluation of the programme was accomplished through collaboration with the project partner, drawing on their expertise in forensic mental health, and ensuring what was being proposed was in line with the services requirements. The outcome of this project was an intervention protocol to help support implementation and evaluation of the intervention within the service.Item An evaluation of outcome measures for use by occupational therapists working in an inpatient Intermediate Care setting(2021)Executive Summary One of the most challenging decisions for an occupational therapist is selecting the most appropriate outcome measurement tool (RCOT 2015a; Law et al. 2017). Outcome measures are used to evaluate a client’s progress, and hence, should be valid, reliable, and able to measure the impact of the rehabilitation interventions on the individual clients. It is a Government recommendation and standard for all occupational therapists to measure the effectiveness of intervention in order to evidence the necessity of the profession and the service. Occupational Therapy outcome measurement tools are of significant importance due to the increased focus within the NHS on efficiency and economic performance, and the additional pressure placed on services and professions to evidence their value (Brindle 2015). Furthermore, these measures remain essential in demonstrating the efficiency of occupational therapy overall whilst ensuring maintenance of quality healthcare for individuals (Wendy 2013; RCOT 2017; NICE 2017). Intermediate care settings are newly established and are, therefore, under additional pressure to evidence their benefits. To date, a specific outcome measure has not been developed for use in an inpatient intermediate care service. Liberton hospital, a service based in Edinburgh, have unsuccessfully trialled a number of outcome measures. The trialled outcome measures failed to suit the service ethos and client group. However, these findings have influenced the design of this project evaluation, the aim of which is to explore outcome measures as a tool for occupational therapists and identify a suitable measure to be implemented in practice. An online questionnaire was created and distributed by email to occupational therapists in the service. Through the collection of qualitative and quantitative data, participants were able to voluntarily contribute their own knowledge and share personal experiences of using outcome measures. Five participants completed the questionnaire, and their responses highlighted the following points in relation to outcome measures: vi 1. Outcome measures were identified as very important for practice. 2. A number of barriers were highlighted to administering outcome measurement tools in practice. The tools were felt too time consuming leading to increased paperwork. In addition, they were not occupation focused or practicable to service setting and required additional training. 3. Key areas, properties and functional skills required by the outcome measure to use within the service were identified. The results of the questionnaire assisted the project lead in completing the following stage of the project which involved an exploration of literature in relation to outcome measures. Findings from the literature highlighted four outcome measures which contained suitable properties, meeting the requirements for use within the service. An outcome measure resource was developed to present the findings to the service.Item Supporting Community Care and Support Workers (CCSWs) to use the Assessment of Quality of Life – Eight Dimensions (AQOL-8D) in a stroke rehabilitation team(2021)Executive summary This project was completed in partnership with a Community Stroke Service (CSS). The CSS is split into a North team and a South team that are made up of occupational therapists, community care and support workers (CCSWs) and physiotherapists. The service’s priority is to provide person-centred community-based stroke rehabilitation interventions. Information gathering is a crucial part of the occupational therapy process, as it supports the identification of a person’s occupational participation and performance needs (Royal College of Occupational Therapists [RCOT] 2017). Within the CSS, information gathering is completed by CCSWs. The occupational therapists communicated that reported findings about service users’ needs were not always detailed enough to begin intervention planning. The CSS decided they wanted to trial the use of the Assessment of Quality of Life – Eight Dimension (AQOL-8D) to support the information gathering process and use this tool as an outcome measure in the future. This service improvement project aimed to enhance CCSWs’ understanding of the AQOL 8D as an information gathering tool. An action research approach was taken, including the use of two methods. The first method was virtual education workshops about information gathering, outcome measures and the AQOL-8D that were delivered separately to the North and South teams. A total of 21 participants attended the education workshops. The second method was an online survey, which was used to collect data about the usefulness of the education workshops and the AQOL-8D in practice. A quantitative dominant mixed methods approach was selected for the online survey to allow exploration of the participants’ views from a quantitative and qualitative perspective. A total of 15 participants completed the survey. Results displayed that most participants ‘agree’ that their understanding of the education workshop topics was enhanced and that the AQOL-8D was easy to use in practice. Most respondents ‘neither agree nor disagree’ or ‘agree’ that the AQOL-8D enhanced communication between occupational therapists and CCSWs about service user 2 problems. Three themes were identified from the qualitative data, including ‘education workshops’, ‘administering the AQOL-8D’ and ‘lack of opportunity to use the AQOL-8D’. Key discussions included that data collection in stroke care can be challenging due to communication difficulties (Stroke Association 2021; Cameron 2000), ‘invasive’ questions and difficult conversations are necessary to engage in holistic practice (Priftanji et al. 2020), and the CSS may require more time to use the AQOL-8D in practice. Recommendations include considering a future project exploring the AQOL-8D as an outcome measure, or its usefulness for enhancing communication between occupational therapists and CCSWs; considering a future project exploring service user perspectives of the AQOL-8D; and that the participants may benefit from further skill development in having difficult conversations.Item An exploration into the effectiveness of an occupational therapy service evaluation tool for a GP practice in Ayrshire(2021)Executive Summary The following project was created in partnership with an NHS service in South Ayrshire, who provide occupational therapy assessment and intervention within a General Practitioner’s (GP) practice. The role is a temporary funded position, endorsed by Action 15 of the Mental Health Strategy (Scottish Government 2017a), alongside additional funding through NES Career Fellowship (NHS Scotland 2020). In order to sustain the role being developed, the service are expected to demonstrate the unique contribution and impact of occupational therapy. This was considered pivotal in influencing commissioning decisions and securing future funding to remain as part of the primary care workforce. The team initially developed their own service evaluation tool; however, concerns were raised regarding its effectiveness. An evaluation into the staff’s perceptions and experiences regarding the tool was therefore carried out, to explore these issues in more depth. Three semi-structured interviews were conducted and through thematic analysis, two themes and six subthemes were developed. Findings support current literature regarding data deemed valuable to obtain when evidencing the impact of a service to stakeholders, such as the patient’s satisfaction and their outcomes. New insights also emerged, such as the importance of documenting referral sources, so education around occupational therapy can be given to members of the multi disciplinary team (MDT) who are referring less frequently. A particular emphasis was placed on the limitations regarding the current tool, resulting in participants concluding that the impact of occupational therapy 2 interventions are not being captured to their fullest extent. Key issues concerned language, timing and participant’s understanding of the Canadian Occupational Performance Measure (COPM) (Law et al. 2014). Unanticipated issues arose, relating to inconsistences in terminology used by participants to describe the service’s aims, specifically frequent use of the word ‘function.’ Literature suggests this may restrict the profession from highlighting its distinct role in enabling occupation (Wilding and Whiteford 2008). Unrecognised professions may struggle to achieve appropriate remuneration; as a result, the service’s long-term viability may be jeopardised due to a lack of adequate representation regarding occupational therapy’s value in primary care. It was recommended that the service clarify their aims and intended outcomes, so that patients, GPs and funders know the exact purpose of occupational therapy practice (Bitel 2007). It was further recommended that the service consider deploying the COPM as a standardised outcome measure, to either complement or replace the existing tool. This may support the service in detecting change in patients as a result of occupational therapy interventions, whilst potentially promoting the use of occupation-focused language (Maclean and Breckenridge 2015). However, the team may benefit from developing their understanding and awareness regarding the COMP’s theoretical underpinnings. The project may be of interest to those developing services within primary care and a conference abstract for the 18th WFOT Conference (2022) is included in appendix 1.Item The impact of the Covid19 pandemic on the ability to maintain community connection for people living with dementia.(2021)Executive Summary The following project was created in partnership with Alzheimer Scotland. Alzheimer Scotland aims to “make sure nobody faces dementia alone. We provide support and information to people with dementia, their carers and families, we campaign for the rights of people with dementia and fund vital dementia research” (Alzheimer Scotland 2021). The research was conducted with members from the Scottish Dementia Working Group (SDWG), who are a “national, member led campaigning and awareness raising group for people living with a diagnosis of dementia in Scotland” (Alzheimer Scotland 2021). Alzheimer Scotland developed a framework called the 8 Pillar Model (Alzheimer Scotland 2012), where one pillar focused on the importance of building and maintaining community connections to allow for continued independence, participation and inclusion in occupation (Alzheimer Scotland 2012). Social connection has been defined as “feeling close to and bonded with other people” (Cacioppo and Patrick 2008). For people living with dementia, social distancing and self-isolation as a result of the Covid19 pandemic have limited social connection (Alzheimer Europe 2020). This connection previously played a vital role in helping those living with dementia to live well and reduce their chances of loneliness and isolation (Dam et al. 2016 and Wedgeworth et al. 2017). Not only this, social interaction allowed them to engage in meaningful activity, facilitating their need for communication, self esteem, and sense of identity (Bennett et al. 2006). Therefore, it is acknowledged that social interaction is linked to improved general wellbeing (Dam et al. 2016 and Willis et al. 2016) and an improved quality of life for people living with dementia (Giebel et al. 2016). For those who received social support prior to the Covid19 outbreak, these services were almost immediately stopped and for those which could continue, there was a shift to online interaction rather than face to face (Giebal et al. 2020). With this, also came challenges. A study carried out by Rosenberg et al. in 2009, stated that technology may be more challenging to use for older adults, especially those living with dementia. They raised the 17003400 2 concern that these individuals may become at risk of exclusion from engagement and participation where technology is used. However, technology has played a huge role in maintaining social connection during this pandemic (Garfin 2020). A conversation was carried out with four participants from SDWG to explore their perspectives of how community connection has or has not been affected as a result of the Covid19 pandemic. Through a general inductive analysis approach, two key themes were developed. These themes were “social interaction- “no longer busy” and “the importance of links.” The findings from the research successfully met the objectives originally set out which were 1. To understand if community connection has been challenged or impacted during the Covid19 pandemic. 2. To identify strategies which may have facilitated continued participation in occupation in the community for those living with dementia during the Covid19 pandemic. 3. To understand to what extent individuals living with dementia have faced occupational disruption during the Covid19 pandemic. The findings of this research project could be used to support Alzheimer Scotland to secure funding in the future as well as to potentially ensure that appropriate support is available to older adults with dementia in using technology. This knowledge could then be used to create tailored strategies aimed at ensuring that people living with dementia receive the best possible care and that the Alzheimer Scotland Dementia 8 Pillar Model of support is fully implemented.