The Royal College of Occupational Therapists have been working with Alzheimer Scotland and a group of specialist occupational therapists to consider how we can share occupational therapy expertise more widely. Too often services are designed to only be accessed when people require specialist help. It makes sense to focus a resource such as occupational therapy around people with the most complex needs but many people living with dementia would benefit from strategies, techniques and technology that could be used at an earlier stage that would either prevent or reduce some of this complexity. Could moving away from a 1:1 model of care delivery to freeing occupational therapists to adopt a public health approach be the answer?
We attempted to drill down into what this might look like when we held a joint event in Dunfermline last September, bringing together occupational therapists working with people with dementia and occupational therapists with a social care and housing background. This is what we envisaged….
Working in new environments:
- One-stop shops and drop in sessions within communities, for example: in fire and rescue centres, leisure centres and GP surgeries.
- Local hub of information on what is available sited on health and social care council websites and in community centres, such as libraries.
- Virtual drop-ins – people can phone or use video call to speak to an occupational therapist in a virtual clinic for advice, signposting or onward referral.
Structuring services to:
- Allocate time and resources for occupational therapists to teach families, formal carers and volunteers how to enable people living with dementia to continue to participate fully in daily life. For example, for home care to support independence rather than “doing to or for”
- Enable occupational therapists to advise on adapting environments in the community, such as library, community centres and shops.
- Have a single point of access for referral, including self-referral and a range of access points, including the third sector.
- Upskill the triage process in order to match the support or professional to the presenting issue.
- Agree clear goals on what the service delivers, linked to local assessment of need.
- Agree outcomes to measure the impact on the wider community, including evidence of working together and minimising fragmentation.
- Increase diversity within teams to include volunteers, link and support workers and health and social care professionals.
- Make telecare more accessible and advice on how to use everyday technology work for people.
- Early occupational therapy intervention to prevent crisis, such as the Home based Memory Programme.
- Provide education in primary care, schools, supermarkets, pharmacy, etc
- Use media to promote advice and practical tips people can employ.
- Simplifying information/leaflets etc and not using jargon or overcomplicated letters or advice
- Increasing access to relevant information – too much information can be overwhelming
We are not all in the position where we can influence how services are structured but we can all consider what is available in our community, talk to people living with dementia, step into their shoes and understand what it is like to be diagnosed. What do people really need, how do they access this, what’s actually available and how would people know? Where are the gaps and who or what service is best placed to fill these? We have to change our thinking to consider the community we serve rather than focus on the service we work within. This way we are more likely to give people the information they need at the right time, make the most of existing communal assets and create partnerships that are able to reach out to everyone.
It is essential that specialist knowledge and skills are focussed on the people with the most complex needs. These are the people that need individual, tailored interventions but freeing up services to explore how that knowledge could be more widely shared has the potential to delay dependency on services and reduce the number of crisis points in people’s lives.
If you leading on new initiatives, creating new partnerships, adopting a public health approach then the group would be keen to hear from you. Contact firstname.lastname@example.org
Karin Orman, Royal College of Occupational Therapists.