A little about my past
My name is Gail Boniface. I used to work in Cardiff University running its postgraduate Occupational Therapy programme. When I taught students, I was always telling them about the occupation in Occupational Therapy. They probably got fed up with me banging on about that, but I used to think back to when I left my own course with a lot of knowledge of anatomy, physiology, psychology, psychiatry and crafts, but little idea of what the profession actually was or for that matter how to be an Occupational Therapist. Despite having gone through three years of an Occupational Therapy programme, I found I had to work out for myself what the essence of Occupational Therapy was. I was also a little taken aback when other professionals asked me to explain the profession to them. When I became a lecturer on Occupational Therapy courses, I had to teach students about Occupational Therapy and was given the job of translating a beautifully written, theoretical course into practice. I was actually delighted to find that the new curriculum contained a lot of the theory of the profession. I was equally delighted to find that I now had access to this (admittedly mostly United States) theory. Therefore my “banging on”’ about occupation to students, stems from the fact that during my own Occupational Therapy course, I did not know this theory existed. My “banging on” became my attempt to instil an understanding of their profession in the students, not just knowledge of other professions’ theory or discrete skills. Therefore, I think you can begin to tell from this, that I also feel very strongly that if we really want to be regarded as a profession we need to be clear as to what our own profession specific knowledge actually is. And yes, that does include that anatomy, physiology, psychology, psychiatry and sociology: But those to me are the things that help us to make sense of occupations. So, it is the understanding of occupational theory (and now occupational science) that we need to make sure is at the front of our thinking and acting as Occupational Therapists.
What’s all that got to do with a blog post for Alzheimer’s Scotland I hear you ask?
Well allow me to tell you. I left Occupational Therapy lecturing in order to take up a post in the Community Dementia Team based in the Lorn and Islands Hospital Oban. This post is part time (but not very – as one of my previous colleagues pointed out to me) and started off with me engaging in the team-based assessments, Occupational Therapy daily living assessments and the occasional minor adaptation (I had previously been an Occupational Therapist in Social Services –so I knew the ropes on that one). All this was quite satisfying, but somehow not completely so. Then along came the opportunity to join in on something called at that time the Home-Based Memory Rehabilitation Programme (now called Occupational Therapy Home Based Memory Rehabilitation). This is an intervention process which investigates what occupations are important to a person and introduces and encourages a person to use memory-based strategies to enable them to continue with their valued occupations. The strategies are:
- Writing a “My Memory Book”
- Remember where you have put something
- Remembering something you have to do
- Remembering what people have told you
- Keep your brain active
- Out and about
The Occupational Therapist can choose the most appropriate strategies, tailor them to suit the person and engage in what I would call real Occupational Therapy and can then write an occupationally based intervention plan with the person they’re working with.
The exciting thing for me about this was that it is so very clearly occupation based and highly person centred; with the Occupational Therapist not only able but encouraged to personalise the intervention. My previous experience of working with people with memory issues and dementia had been that there was little hope, little engagement in occupations and an emphasis on what was being lost, rather than what was being retained and engaged with. Occupational Therapy Home Based Memory Rehabilitation, for me, brings the emphasis back onto what the person with the memory problems CAN do, rather than how much their memory had deteriorated. Via Occupational Therapy Home Based Memory Rehabilitation the discussion and action is around the things the person does, how they enjoy those things and working on strategies to enable them to keep doing those things. This then brought to mind that views of the professional body that: “Occupational Therapy enables people to achieve health, well being and life satisfaction through participation in occupation.” (COT 2015:2 also quoted by the WFOT in 2017). Thus by, for example, asking someone to write down the things that they do over a few weeks or so, the person can be reminded of what they enjoy doing, remember what they have done and talk about it with other people – that is how I use the “My Memory Book” strategy.
I often use a medication prompt in the strategy around ‘remembering something you have to do’ part of Occupational Therapy Home Based Memory Rehabilitation and try very hard to encourage the person to take responsibility for their own medication (within reason of course). Therefore, I was delighted working with someone on organising taking their own medication, when they took my checklist from me and rewrote it in a way which made sense to them. Alright, we will need to keep repetitiously working on remembering how to take the medication, but the person now owns that process, not me. This means that instead of emphasising how that person cannot take care of their own medication, we are working out how they CAN be helped to do it for them self. The process has become more positive and person centred along the way.
By engaging myself with Occupational Therapy Home Based Memory Rehabilitation, I have been able to really work with people on their valued occupations as well as their discrete skills and have consequently been able to avoid this pitfall:
“sometimes occupational therapy so heavily emphasizes performance components that it ceases to be occupational in terms of the client’s perceptions”
(McLaughlin Gray 1997:354)
McLaughlin Gray J 1997 Putting Occupation into Practice: Occupation as ends, occupation as means AJOT May 1998 Volume 52, Number 5 354-364
World Federation of Occupational Therapists 2016 Definition “occupation”. Forrestfield, AU: WFOT. Available at: http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx accessed 22.10.2019
World Federation of Occupational Therapists 2017 Definitions of Occupational therapy from Member organisations: https://wfot.org/resources/definitions-of-occupational-therapy-from-member-organisations accessed 1.07.2019
Dr Gail Boniface, Occupational Therapist, Community Dementia Team based in the Lorn & Islands Hospital Oban