I am a Band 6 Occupational Therapist working in the Older Adults Mental Health Service in North East Fife, covering both the inpatient and community services as part of a small team. Typically, the service sees adults of 65 years and above, but within the last year, we have begun to receive a small number of referrals for younger adults experiencing cognitive difficulties.
Younger vs. Older Adults – what is the difference?
From an Occupational Therapy perspective, some of the most obvious differences between the younger and older adult, particularly at the early stages of their memory difficulties, is that they are less likely to experience the same mobility issues as the older service users we meet; I have not needed to address the issues of equipment assessment and provision that are most often associated with Occupational Therapy and consequently clients have not experienced the same physical barriers to community venues, activities and social opportunities as our older client group often do. In addition and most significantly from the perspective of my own personal development, some of our younger adults remain in employment.
Employment and Occupational Therapy – my experience
The prospect of working with people with employment issues was not new for me as I had had experience working on the Condition Management Programme pilot in conjunction with NHS Fife and Job Centre for two years from 2006, however Norma Clark, Lead Occupational Therapist in Mental Health took a partnering role in Occupational Therapy assessment and employability intervention.
Occupational Therapy assessment
Our service routinely uses a standardised assessment toolkit including:
- Claudia Allen Assessment – functional cognitive assessment
- Evaluation of Social Interaction (ESI)
- Assessment of Motor and Process Skills (AMPS)
In addition, other non OT specific assessments:
- ARCS – audio recorded cognitive screen
These same assessments were utilised with our clients remaining in work and completion of the AMPS assessment with this client group allows us to specifically pinpoint areas of strength within their motor and processing skills that have the potential to support that patient in the work environment, and then those areas that present a challenge. We then use our Occupational Therapy knowledge of assessment and activity analysis to understand the impact of our findings upon peoples work demands and routines, potentially identifying adaptive and compensatory strategies and how these can be translated into the work place.
Examples of assessment findings have included challenges with:
- Heeds – ability to carry out and fulfil specific tasks set
- Searches – locating items in a logical manner
- Inquires – asking for information a person should know
- Turn taking in conversation
- Noticing and responding to task related issues
Job Retention issues
The typical skill challenges listed above can then be understood by the Occupational Therapist in the work context. Examples might include:
- A person may not be reasonably expected to complete a range of work-related tasks repeatedly based upon initial explanation only.
- A person may require additional cues and support to consistently locate required items within the work place.
- May require additional compensatory strategies and arrangements to support completion of a task e.g. planner, tick-off list, verbal discussion.
- Other staff may need to clarify that task related direction has been understood if the individual does not immediately demonstrate understanding
- Individual may benefit from working alongside others to provide additional support and assistance should additional or unexpected demands arise.
Where do we go with this information?
We, as Occupational Therapists, are able to use our assessments to support completion of the Allied Health Professional Advisory Fitness for Work Report, which allows us to provide the individual, employer and GP with advice regarding strategies to support them to remain in employment. I have also had the opportunity to meet and liaise with employers to identify whether these ‘reasonable adjustments’ can be put in place to support the individual. In addition, this work has allowed me to work jointly alongside other agencies including the Individual Placement Service (IPS) in Fife, who offer vocational rehabilitation support to people with long term mental health needs.
What have I learned from this experience?
On reflection, I do not feel that I have specifically learned any new or additional skills. What this work has demonstrated and validated however, is how prepared Occupational Therapists are, with their assessment skills and understanding of occupation and activity analysis to work in this area. Assessment of our employed service users utilises the same Occupational Therapy skills as we use with any other people we see and our partner agencies with greater experience in work placement are able to work jointly alongside us to create the best outcome for our service users. It also highlights the important role that work-focused Occupational Therapy plays in Alzheimer’s Scotland 5 Pillars and 8 Pillars of Community Support for dementia; we are contributing to the person centred support that promotes participation and independence.
Do my other Occupational Therapy colleagues agree with me? What has been your experience?
What should and could our role be as occupational therapist to help people living with dementia be to stay at work?
I am a Band 6 Occupational Therapist in the Older Adults Mental Health Service, based at Stratheden Hospital in Cupar, Fife. I work as part of a small team with two other Occupational Therapists and two Support Workers. Together we provide Occupational Therapy assessment and intervention to three inpatient wards at Stratheden Hospital and also provide community input to North East Fife, from Falkland to Newport-on-Tay.