Employment, Dementia & Occupational Therapy – Personal Reflections

About Alison

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.

On reflection

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?

Alison Long

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.

 

 

Dementia Friendly Prestwick – We’re one year old!

Dementia Friendly Prestwick celebrated its first birthday on 4 June 2017 so it’s an ideal opportunity to reflect on the last year and the progress which has been made in such a short time.

Dementia Friendly Prestwick aims to support people with dementia, and their families/carers, in Prestwick to be included and remain part of their community for as long as possible.  Since launching Dementia Friendly Prestwick in June 2016 we’ve already made great progress including:

Dementia Friendly Community Garden: Biggart Hospital: With the support of Biggart Hospital, Dobbies Garden Centre and GE Caledonian, we developed a Dementia Friendly Garden in the grounds of Biggart Hospital.  This is in the main entrance area to the hospital and open to any member of the public to enjoy.  Our raised beds, comfortable seating, wide paths and bright colours means that this space is attractive and safe for everyone to use. The environment is so inviting, that even before we’d finished building it, people were sitting with us and chatting. We’re expanding the garden this summer 2017 with a bespoke summer house with big windows and patio doors beside the garden: giving shelter and beautiful views throughout the year.

Community Cinema with relaxed screenings: Our monthly pop-up community cinema, has so far been attended by over 250 local residents including all care homes in the town. Initially funded by Ayrshire Council and Place Partnership, we secured further funding through a recent participatory budgeting event. Our screenings of classic films are “relaxed”, which means the room we’re in isn’t as dark as traditional cinema, the volume isn’t as loud, we show subtitles on all of our films, people can get up or make a bit of noise without fear of shushing, and cups of tea, coffee, cake and ice cream are provided free of charge. It’s more than a cinema, it’s a social hub!

Cinema attendees commented:

“It’s so relaxing to go somewhere, and know that even if we make a bit of noise, no one is going to stare, judge or not understand us”. “My husband was diagnosed with dementia five years ago, and this is the first time in a couple of years we’ve gone out socially to something. Thank you.”

Intergenerational Activities: In February 2017, we worked with Alzheimer Scotland to organise an engagement event in the style of the Dragon’s Den, for Prestwick Academy pupils and primary 7 pupils from local primary schools.  The pupils were supported to develop design ideas for new innovations to support people living with dementia and then to pitch their ideas to our ‘friendly dragons’. Many drew on their own family experience of dementia in order to inform their thinking.  The winning team won the ‘Dementia Friendly Prestwick Innovation Award’. The winning idea ‘snappy reminder by mail’ will be followed up by Alzheimer Scotland to identify opportunities to test this in practice.

Dementia Friends Training and other activities: We have engaged with some of the local business community to promote dementia friends training.   We will be developing this work further in the year ahead. Other initiatives have included running Lingo Flamingo language classes to include people with dementia  in the local community and running a range of fundraising events including a ‘purple party’, Christmas card and twiddle mitt sales.

On reflection 

What one thing could you do to support your local community to become dementia friendly?

Thank you to all who have supported our work so far. Keep up-to-date with our developments via:@Dementiapwick, Facebook: Dementia Friendly Prestwick, website: http://www.dementiaprestwick.co.uk/

C

 

Allied Health Professionals supporting #DAW2017: Monday 29 May – Sunday 4 June 2017

Today 90,000 people in Scotland are living with dementia, and that figure is set to rise. Receiving a diagnosis of dementia can be a devastating and frightening time both for the person with dementia and for their families and friends.  Sadly, many people with dementia tell us that friends and even family drift away after their diagnosis. People can find it difficult to know how to react when they hear the news that a friend has dementia. This Dementia Awareness Week, let’s help people understand why friendship and kindness are more important than ever when you have dementia.

Allied health professionals will be supporting Dementia Awareness Week to make sure nobody faces dementia alone. We will be blogging all week, sharing messages on how we CAN help, we are getting involved in local events, ready to answer any of your questions and you will also find us the Alzheimer Scotland presenting national conference on 2nd June, sharing our work in both policy and practice. Follow #AHPDementia #OTHBMR or #ConnectingPeople to find out what we are doing and where we are?

Maybe use this blog to ask us a question if you are worried about falls, good foot care, eating well and keeping active? Perhaps you have questions about communication, looking for tips on how to boost your memory or develop a musical profile? We have Allied Health Professionals who could answer your questions on these topics or direct you to resources.

You can also find out how to contact some of the allied health professional by downloading our allied health professional leaflet http://www.alzscot.org/assets/0002/1191/AHP_Leaflet.pdf.  Join us in sharing information on what we CAN all do to support friends, family and people in our communities who are living with dementia.

Other useful information

For local events you can click here http://daw.dementiascotland.org/events where you can discover all the events taking places across the country during Dementia Awareness Week 2017 and beyond! Simply zoom in to a location near you to find out what’s on!

Dementia can bring many challenges, both for the person with the diagnosis and for those close to them.  If you have any questions about dementia or need to talk to someone, the Alzheimer Scotland Dementia Helpline provides information and emotional support to people with dementia, their families, friends and professionals. It’s a Freephone number and our team is available 24 hours a day, 7 days a week. Call on 0808 808 3000 or email helpline@alzscot.org

Allied health professional Enhancing Daily Living: Home base memory rehabilitation #OTHBMR – An update

On Wednesday there was a workshop with over 40 occupational therapy staff from across Scotland to talking about home based memory rehabilitation. Home based memory rehabilitation was originally developed by Mary McGrath (2013) and is an evidence-based, occupational therapist-led, six week intervention. It takes place in the person’s own home with a family member, where possible and is based on principles of cognitive rehabilitation. It aims to teach the person to compensate for their memory deficits and includes minor adaptations to the home environment to support these strategies. There are also four key principles that Mary shared in Dementia in Scotland (2016:23) that can help all of us cope a bit better with dementia:

  1. Don’t multi-task. Focus on one thing at a time. Whether that’s what you’d planned to make for dinner or trying to recall the name of a school friend from a photograph, putting all of your attention on the task at hand puts less strain on your memory.
  2. Don’t guess. If you don’t know, you don’t know and that’s fine. For a person with dementia, the process of making a guess can store that information in their mind, whether that information is right or wrong. For example, if somebody asks what day it is, don’t urge them to work it out for themselves, tell them and then reinforce the answer by encouraging them to repeat it and write it down.
  3. Dementia doesn’t define you. It’s very easy to start defining someone (or yourself) by their dementia. However, you must remember that there is more to someone than their dementia. Loss of self-confidence can have a big impact on a person with dementia’s trust in their own ability to remember things or carry out tasks. 
  1. Don’t over care. For many family members and carers it is a natural instinct to want to support the person with dementia as much as they can. This over caring can mean that even tasks and responsibilities that the person in still capable of achieving are taken away and that can contribute to further decline. Where it is safe to do so, people should be encouraged to continue being involved in familiar activities.

Home based memory rehabilitation has been successfully implemented in Scotland by the occupational therapy team in NHS Dumfries and Galloway. You can hear from four people who have been involved on the positive impact of the approach to their daily lives in the video below.

We are now collaborating in Scotland to test home based rehabilitation in 12 areas of Scotland and you can see from our photo album below who is involved.

National team supporting the work

NHS Dumfries and Galloway, Queen Margaret University & Alzheimer Scotland.

Keep in touch:

We will continue to share with you our progress on home based memory rehabilitation through this blog and on our community of practice http://www.knowledge.scot.nhs.uk/ahpcommunity/ailip-priority-workstreams/dementia.aspx

You can also follow #OTHBMR to find our more or post us a question on this blog

Thank you

McGrath M P 2013 Promoting safety in the home: The home-based Memory Rehabilitation Programme for persons with mild Alzheimer’s disease and other dementias.

Techniques and strategies for improving memory 2016 Dementia in Scotland issue 90 page 23

Occupational Therapy Lead Memory Management Group: a practice example

For over ten years occupational therapists in Lanarkshire have been running memory management groups. These groups are for people who have a problem with their memory and wish to do something themselves to improve this. It aims to enable people to be as independent as possible in their daily lives.

The groups are suitable for those with mild memory difficulties who feel it is impacting on their daily life. It is essential that the person is aware of their memory problem and actively wants to manage this effectively. People are referred to our groups via their consultant psychiatrist or GP. Everyone is visited at home by the occupational therapists prior to the group starting to talk through how the group could help and if they would like to take part.

The informal structure of the group allows people to gain support from others in a similar situation as themselves. Occupational therapist staff facilitate discussion, whilst working through a programme and offer practical advice related to their concerns regarding their memory.

Through discussion we assist people to work out solutions to the difficulties they are experiencing with memory problems. This is done by suggesting techniques and strategies to assist their memory in order to manage their day to day lives more effectively. The groups are generally small for approximately 4-6 people, taking place over four to five with each session lasting 90 minutes.

Some of the topics included in the group are:

  • Remembering names
  • Staying safe at home
  • Getting out and about
  • Tips and strategies
  • Enhancing well-being
  • Keeping the brain active
  • Leisure

We have practical materials we demonstrate in the group and provide what we can after each session as from experience individuals are more likely to use the strategies suggested if they have the required material rather than having to go and get the item themselves.

 

To evaluate the group we use “Emotional Touchpoints” which has been an effective way for those attending to share how they have found their group experience. For those unfamiliar with this method, ‘Emotional Touchpoints is a powerful means of helping people to share the aspects of experiences that are important to them – rather than the things service providers think are important.’ (Scottish Health Council, 2016). Below are a few examples of what people have said about this group.

“I now feel hopeful but I didn’t before I came here. I used to isolate myself and do things alone as I was embarrassed if I got things wrong. I now willingly go out with others and say yes to invites. I feel I’ve changed. I feel more positive and see a difference in myself since coming to this group. I’m relieved as I used to think about my memory all the time but I’m now at the stage I go with the flow and I’m enjoying myself.”

“I’m happy I’ve been involved with others with the same problem and feel I can now handle stuff I couldn’t have before. I’ve valued the hints and tips shared in the group and hopeful that what I’ve learned will stay with me and allow me to enjoy myself.”

“I’ve felt welcome here right from the start and quickly felt involved. I’m relieved to know I’m not the only one going through this. I’m hopeful; by using what I’ve got from here that I will be able to manage what is ahead of me.”

“I was really anxious about my memory at the start but now feel inspired and more hopeful and confident in myself and about my memory. I’m using techniques eg in the pub yesterday I was listening for someone’s name being said as I knew him from years ago and was talking to him but couldn’t remember his name. Being supported here has made this a great group and I will miss coming.”

Thank you for reading our blog post. we would love to hear what you think and if you have experience of working with occupational therapy

 

Gill Gowran, Specialist Occupational Therapist, NHSL

@MHOTGill (Twitter)

#valueofOT

 

 

 

Maximising Psychological Wellbeing – Music Therapy Reflections: On a positive note…

 

In my last Blog post, I asked our Art Psychotherapy Student, Shirelle Young about the best of her Alzheimer Scotland placement experience. Here, the conversation is with Ed Muirhead who has just finished his Music Therapy placement, asking him about what worked well during his time spent in one of our Dementia Resource Centres.

Environment

Question: Reflecting on the therapeutic environment, what really mattered?

Answer: “The room was very important as part of the secure space, and maintaining this space was a key building block of the therapeutic process.

Music

Question: Concentrating on the process of music making, what worked well?

Answer: “Singing was the most frequent form of music-making, people seemed most familiar and comfortable with this. We would sing known songs according to peoples’ preference – everyone has their own particular songs they like to sing. These would be accompanied with piano or guitar, and we would occasionally improvise words in the moment to known tunes. Other instruments such as glockenspiel, shakers, drums and tambourines were also used, though not so often as singing.”

 

Relationships

Question: Focussing on the therapeutic relationships that developed, what made a difference?

Answer: “There was evidence of developing relationships with people throughout the 22 weeks of the music therapy practice placement. Particularly after the Christmas break, I noticed a deepening of relationship, a closer proximity, both physically and emotionally, and heightened eye-contact and engagement. At this point, so close to the work, it’s hard to pinpoint exactly what made a difference, perhaps the continuity of the work, being there every week at the same time in the same place and holding on to memory on behalf of people.”

Reflection

Question: Thinking about your own reflective processes, what was helpful?

Answer: “Reflection has been important along the way, and will continue in the coming weeks as I write up my professional project. I’ve chosen a clinical project that focuses on personal reflection while carrying out the placement – including a service evaluation element. Process notes along the way were helpful, as were video recordings of sessions (with informed consent by people coming to Alzheimer Scotland).”

Approach

Question: Looking at how you have adapted your approach to meet the needs of people with dementia and their families within Alzheimer Scotland what has been important?

Answer: “Learning repertoire to suit each person has been important, as has learning chord sequences that suit music from their era. General knowledge of the music of the 1940s, 1950s and 1960s in particular has been useful. My own approach relies on listening, which has been vital in hearing what people have to say or sing, though sometimes musical prompting has been required.”

Dementia

Question: In working towards becoming a dementia skilled practitioner, what has been useful?

Answer: “My practice educator provided valuable documentation about working with dementia (NHS/NES manual, articles), also I’ve read Kitwood and other person-centred literature. Working alongside colleagues in Alzheimer Scotland has had the most practical benefit, seeing them with people living with dementia, watching how they are and learning from them.”

Celebration

Question: Looking back at your placement at Alzheimer Scotland, what are you really proud of?

Answer: “It has been a wonderful experience to use music therapy with people who seem to have benefited so much from the experience. Questionnaire feedback from people living with dementia, families and staff has been very positive, and I’ve learned a lot about the unique power of music for each person involved.”

Over to you

Having shared some of Ed’s thoughts, we would be interested to hear about your experiences of being creative and the impact on your health and wellbeing… What has made a difference for you?

 

A Skilled AHP workforce :

When many people think of physiotherapy they think of that person who runs onto the pitch when a player is injured gets their magic sponge out and within a few rubs all is well again. So what role CAN physiotherapy play in dementia and why does it matter?

This was the question that struck me when I learned that I was going to be the first physiotherapy student from Glasgow Caledonian University to go on placement at Alzheimer Scotland. I had met people with dementia before on other placements and my experience was of frail old ladies and gents in their 90’s and it didn’t take long before I was scouring the web looking to discover more information to get to grips with this daunting new placement and role. Soon I had ideas whizzing around my head about what I would be doing on placement and the types of people I would be seeing.  These ideas all started to change on my first day on placement, receiving dementia friends training made me think twice about my misconceptions.

 

Then a trip to a Dementia café where I met the real people with dementia that Alzheimer Scotland help completely turned my ideas on their head. The people there weren’t wee old ladies nor were they by any means frail. There were people here younger than my own parents who looked and were, fit and healthy. So my whole idea of what I was here for was out the window.

Luckily I wasn’t alone I had great support in the form of Lorna a dementia advisor who knew every one of the people at the café personally. She was able to introduce me to the individuals who she felt would most benefit from my knowledge and ability. It was after this I knew that going back to basics was the best thing I could do. For physiotherapists basics mean providing exercise for therapeutic purposes. In other words I would set up and run exercise classes to improve the general fitness of the participants. The overall aim would be to introduce them to activity and eventually get them to independently engage with the resources in their area to continue being active individuals living well with their diagnosis. This would be my remit for the placement getting people to engage with their own health and take action to make a lifestyle change to increase their activity levels.

The thread that runs through all physiotherapy services from musculoskeletal services to pulmonary rehabilitation or even care of the elderly is that we aim to maximise a person’s ability to be active and independent. We try to promote healthy lifestyles, especially the minimum activity amount of 150 minutes a week that all adults should be achieving. It sounds easy enough when you break it down to 30 minutes a day but getting into the routine can be difficult and for some the mere mention of exercise brings on cold sweats. Though there is no need to fear activity, a brisk stroll through the park, washing the car, doing the housework all of these things count towards our 30 minutes of daily activity. Building a routine that encompasses our household chores is a great way to keep ourselves fit, active and maybe even save some money!

I discovered during my placement that there are plenty of options to keep active out there in Lanarkshire. Paths for All is a great organisation that provides you the opportunity to go out on organised walks all over Lanarkshire and meet new people. Both North and South Lanarkshire leisure offer specialist classes for all including age specific exercise classes called Active Health, swimming as well as other sporting opportunities. If you are lucky enough to qualify you can get access to South Lanarkshire leisure facilities for as little as £1.10 per week!!!

For those who experience dementia it can be a terrifying condition where you feel you are stripped of your independence and perhaps even your dignity. Alzheimer Scotland offer support and guidance to everyone involved and are able to put you in contact with local activities. As I have experienced over my short period with Alzheimer Scotland, they are a supportive well informed group of caring individuals who I owe a very big thank you for all their help and making a positive impact to my future career as a physiotherapist.

Questions…..

What physical activities would you like to take part in within your local area??