Alzheimer Scotland AHP PhD Studentship

The Tailored Activity Programme

Can you tell us about who Niamh is?

I am Niamh Kinsella and I recently completed a postgraduate MSc in Occupational Therapy at Queen Margaret University. I am now studying full time for a PhD which has been offered as part of the strategic alliance between Queen Margaret University and Alzheimer Scotland.

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I studied sociology and social policy as my undergraduate degree in Dublin and moved to Scotland in 2013. I have an interest in dementia which comes from both personal and practice experience. I have a particular interest in self-management and a strong belief that everybody deserves to live a full, balanced and healthy life with as much help as is necessary. I feel that occupational therapy has much to offer and development of its evidence base is another step towards supporting people living with disabilities to live a full, happy and healthy life.

What inspired you to study occupational therapy?

During my time studying in Dublin I became very aware of and interested in the social issues that are frequently present across society. I began to question the impact that they have on health and the impact that poor health has on an individual socially. This interest was also inspired by classes in global health and social justice.

I have always been a practical person and knowledge of health and social issues was not enough. I explored my options and spent time volunteering at a respite centre for people living with a variety of disabilities. I decided that occupational therapy was a practical path to take which would allow me to develop my knowledge of health and social issues while also providing the opportunity to work with people in many areas of health and social care.

I understood occupational therapy to be a profession which aligned with my own values which was important to me. I also had some personal experience of the difficulties that a person with a physical or mental health problem may face and began to understand the value of occupational therapy and the very clear link between occupation and good health.

What is your current role?

My current role is primarily in completing a PhD which will involve research into the Tailored Activity Programme (TAP) – a prescription based activity programme for people living with dementia and their care partners implemented by HCPC occupational therapists. I am in the early stages of the research process and am hoping to complete the PhD by September 2018.

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As the research progresses I will be involved in presenting and disseminating results to a wide audience on behalf of Alzheimer Scotland. It is expected that the research findings will help to enhance the evidence base for occupational therapists who work with people living with dementia and their carers. I hope that contributing to the evidence base will promote both occupational therapists and allied health professionals as valuable assets in health and social care for people living with dementia.

What impact do you hope your PhD will have on people living with dementia and their families?

I am hoping that the results of my research will demonstrate the value of using an evidence-based intervention for occupational therapists and result in an increase in its use. Increased use of such an intervention may then provide people living with dementia and their families with the necessary tools to live well with dementia at home for longer.

In addition, I hope that dissemination of the results of my PhD will result in increased awareness and understanding of the possibilities available to people living with dementia and their families as well as of the difficulties facing them. Awareness of a possibility of living well with dementia may reduce stigma and misconceptions associated with the disease and, hopefully, encourage the wider community to offer appropriate support when necessary.

What has been the best part about being a PhD student?

Although my PhD journey has only just begun, I have found the prospect of finding positive, encouraging results through studying the tailored activity programme (TAP) in partnership with the occupational therapists currently implementing TAP, and the impact that this may have, extremely exciting and motivating. This has been a great start and is a feeling which I hope will maintain my energy and enthusiasm for the research throughout the PhD process. Being a full time PhD student has also offered me time to learn about and understand something which interests me greatly and to develop research skills which I hope will stand to me in the future.

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You can find out more of the current work in Scotland here:

http://www.knowledge.scot.nhs.uk/dementia/communities-of-practice/national-ahps-best-practice-in-dementia-network/tailored-activity-programme.aspx

I would welcome any comments on my blog or on the work we are developing to research a prescription based activity programme for people living with dementia and their care partners implemented by HCPC occupational therapists.

 

pic 6Niamh Kinsella, PhD student, Alzheimer Scotland and Queen Margaret University

@NiamhKinsella

My current role is as a PhD student, completing research into the Tailored Activity Programme for Alzheimer Scotland. My position is a result of the partnership agreement between Alzheimer Scotland and Queen Margaret University which aims to educate allied health professionals to understand the needs of people living with dementia and to work more effectively. My role in PhD research will contribute to the development of an evidence base to support these aims, as well as development of an evidence base for experienced and practicing allied health professionals.

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Sharing our success

Occupational therapy assessment clinic in Fife

Development of the occupational therapy clinic

Increasing rates of referrals, people waiting for treatment, travel time, staff vacancies were just a few of the triggers to lead staff in the older adult mental health occupational therapy service in Fife to say:

We are not having people waiting 4-5 months for an occupational therapy assessment

We were also acutely aware that waiting months for an assessment was resulting in people with a cognitive impairment/dementia having deteriorated over this time, increase in stress and anxiety on carers and families as well as not having accessed other services and supports that they could have been receiving. This was not a positive outcome for people living with dementia, their families or the occupational therapy staff.

We considered a number of solutions to this issue, but all of them had an adverse effect on other parts of the service. So in a room covered in “post it’s” with various ideas and suggestions plastered across the walls – the Cognitive and Functional assessment clinic was born.

The solution, simple really, we invited people to the occupational therapy service to undertake functional occupation focussed assessments which were:

Claudia Allen Screening tool: This cognitive assessment tool measures global cognitive processing capacities, learning potential, and performance abilities.

Occupational Self-Assessment (OSA): The OSA is a tool that facilitates client-centred therapy and reflects the uniqueness of each person’s values and needs. The OSA self-report and planning forms assist the client in establishing priorities for change and identifying goals for occupational therapy.

Kitchen assessment:

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We had 3 members of staff for each clinic, 2 occupational therapists and 1 member of clinical support staff. The occupational therapists carried out the standardised assessments and the clinical support member of staff carried out the OSA.

We carried out a pilot of the clinic with the grateful assistance of some volunteer service users and identified that each assessment took 30 minutes to complete. Therefore, the full assessment process took 1.5 hours. We received positive feedback from the people who we worked with during the pilot stage who were comfortable attending an occupational therapy clinic within the hospital or seeing more than one therapist which had been an initial concern for us.

“An Occupational Therapy Clinic” 7 things you need to know

  1. We treated more people in a day, offering 3 appointments at one time over 4 sessions from 9:30am-11am, 11:30am-1pm, 1:30pm-3:00pm and 3:30pm-5:00pm.
  2. We reduced the length of time people were waiting to be seen by an occupational therapist to a month.
  3. We utilised the skills of our occupational therapy staff more effectively.
  4. We had the opportunity to assess people quicker allowing us the chance to signpost to services that people thought would be helpful, make referrals to other agencies more timely or engage the person in occupational therapy sooner if required.
  5. We linked people to the post diagnostic support service in Fife if they were not already receiving support from them.
  6. We worked with carers. We invited carers to attend the occupational therapy clinic if they wished and a member of staff was available to speak with them, to offer support, advice or information which all carers who attended found very useful.
  7. It is an award winning service which we highlight in the section on “what’s next”

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What’s next?

This service was a “win win” for all concerned. The Occupational Therapy assessment clinics are now running across Fife in the Mental Health Occupational Therapy service as standard clinical practice.

We are currently planning to pilot an extended AHP assessment clinic that will include physiotherapy, mobility and falls assessments, with the hope that this prevents unnecessary falls and identifies people who will benefit from targeted intervention earlier.

NHS Fife Occupational Therapy Cognitive and Functional Assessment clinic was recognised at the Advancing Healthcare Awards in London in 2015. Winning the category for maximising resources for success, sponsored by the Department of Health, Social Services and Public Safety, Northern Ireland Award and we are going to be sharing the experience of developing the clinic at the AHP national conference in November this year as we have been invited to do a presentation and workshop session for delegates.

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There was excellent evidence of service user involvement and leadership skills were very evident in bringing the team along the change process.”

As a service, we feel very strongly that it is important that as AHP’s we constantly challenge how we work and strive to make our services more efficient, relevant and accessible to the benefit of carers and service users: the challenge for us all continues and we are always developing the occupational therapy services in Fife to be innovative, more patient centred, effective and delivered to a high quality. The assessment clinic is just one example of innovation and creative thinking which has been successful for all.

On reflection

Thank you for reading my blog post and I would welcome any comments

  • I would also invite to share, if you are an allied health professional, what have you done do enable people living with dementia to directly access your service.
  • If you are living with dementia or a family member, what service from an allied health professional would you like access to?

Useful resources

You can read more about this work on pages 27-28 in the Alzheimer Scotland publication http://www.knowledge.scot.nhs.uk/media/CLT/ResourceUploads/4052050/02295%20AHP%20report%20on%20post-diagnostic%20support.pdf

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For more information on the Chamberlain Dunn awards 2015, follow this link http://www.chamberlaindunn.com/AHA/documents/AHAAwards2015Compendium.pdf

I am proud to also share a picture of my family supporting everyone ‘Talking About Dementia’ – Lynn

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Pic 6Lynn Dorman

Occupational Therapy Professional Manager

@dorman_lynn

I work in NHS Fife Mental Health Occupational Therapy Service where I manage the adult and older adult service across 3 clinical hubs. I have been an Occupational Therapist for 20 years and spent most of that time working older adult mental health services so am passionate about improving services for people with dementia and their families, hence the development of the assessment clinic.

Dr Norma Clark

AHP Clinical Services Manager and Lead OT

@normaAHPMH

I work in NHS Fife Mental Health Occupational Therapy service as the Lead OT. I am also an AHP Clinical Services manager within Fife Mental Health Service. I am always thinking of creative an innovative ways to improve the quality and efficiency of services for people with mental health problems in Fife and together with Lynn, came up with the idea of the cognitive and functional assessment clinic.

How Can We Create Dementia Friendly Occupational Therapy Graduates?

This was the question we explored in our You, Me and Dementia resource project.

Raising awareness of dementia and its impact on the lives of those we love, live with and work with is an increasingly important issue in the education sphere. University graduates need to enter society feeling equipped to support the growing numbers of people who experience dementia.

In January 2014, Julia-Helen and I had the privilege of working with our fantastic Occupational Therapy Lecturer Dr Claire Craig to create a co-produced dementia resource by students for students.

Claire wanted to explore ways to meet the new HFEE dementia curriculum for higher education and gave us the opportunity to co-create a resource delivered to occupational therapy students to share information about what dementia is, and how to work alongside people living with dementia in a sensitive and empowering way.

The ultimate aim was to create a resource that could be used not only with occupational therapy students, but tailored to meet the needs of different types of students across the university and developed into an online accessible App.

 

What do occupational therapy students need to know about dementia?

We met over 4 weeks, initially brainstorming what type of information to include in the resource – what do occupational therapy students need to know about dementia and how should we deliver it?

We felt that it was important to ask the students themselves what they wanted to know, so we sent out a poll to find out what they were most concerned about and what topics were important to them.

Based on their answers, we created a presentation using Prezi software and delivered this as a 1 hour lecture, covering information about the types of dementia and how to work with people with dementia with respect.

We drew on work by Kitwood and Jackie Pool, which promotes a person-centred equitable relationship and recognises that it is people living with dementia themselves who can teach us most about the condition and how to support them. We included short videos by the wonderful Scottish Dementia Working Group to illustrate this. (@S_D_W_G).

 

Click here to view the presentation we developed & then delivered.

We paired the lecture with an interactive 2 hour workshop, to give students the chance to explore what it might feel like to experience dementia through games, discussions and practical experiments. We also discussed creative ways to deliver occupational therapy interventions with an emphasis on self-expression through tools such as poetry and singing.

So what did the project achieve?

Well we had fantastic feedback from our student peers about their experience of the resource! And we ourselves underwent a transformation through the trust and responsibly bestowed on us co-production experience. It helped us step into our professional selves and envisage our future as autonomous occupational therapy practitioners.

Here is the link to the YouTube video of us talking about our dementia resource and our contribution to creating dementia-friendly occupational therapy graduates?

We would love to hear your comments on this work and other ideas you have to enable our practitioners of the future, of all disciplines to be “dementia-friendly”.

 


Gill Smith: 
@gillyflower78

Sheffield Hallam University occupational therapy graduate 

&

Julia-Helen Collins: @JuliaHelenOT

Sheffield Hallam University occupational therapy graduate