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OT role in primary health care

Primary health care is mainly based in community settings, where it targets people who are the make initial approach in seeking medical attention. Primary health care is normally based in clinics were the main approach should be focused more on prevention and promotive rather than curative, this approach is slightly different from hospital setting and should be taking into consideration by occupational therapist working in these communities (Naidoo, Van Wyk, & Joubert, 2016). In these low socio-economic communities, you will find that the only access to health care that people have is primary health care. Thus our aim in these communities like the two communities I aim placed in, is to provide health promotion and prevention in paediatric clients, screen children for developmental delays, working in schools with teachers to identify and assist learners with difficulties, working with caregiver and community health care worker to facilitate carry over of intervention.

The large gap between the quality of health care received by governmental institutes those mainly being your primary, secondary, regional and tertiary level health care facilities, compared to non-government is large which resulted in the government implementing the national health insurance which aims to bridge the gap between health care in government and private sectors. This policy put in place will make sure that the quality of healthcare received across the board is equal. In primary health care, the most important aspect to address when you are seeing someone who is coming to the clinic is to treat them holistically this includes their environment. This is what I took into consideration during intervention, I always looked at the person holistically and took their environment into consideration as they return home and need to engage in occupations within that environment and not just the clinic, school or were ever intervention was provided. 

‘Occupational therapy focuses on helping people with everyday activities. Wherever physical or mental illness, ageing or accident has disrupted the ability to function, we help the individual to adapt. Where there are difficulties, we seek solutions. Our aim is to help each person achieve maximum independence and quality of life.’ (McGuinness, 1996). This quote sums up the role I amongst other student therapists played during community fieldwork block, we used a community driven approach to address and intervene in different cases, educating the community about lifestyle modification, health promotion, chronic disease management and providing adaptive equipment/ assistive devices to benefit the client’s accessing primary health care.

The other role I had was to work in a multidisciplinary/interdisciplinary team with the health professionals that are present at the clinic to ensure that the client receives optimal treatment, and work closely with the community health care workers. Community health workers are appointed at the PHC level to address outreach, conduct home visits and improve access to health care thus our role as student therapists also evolved around teaching them how to facilitate carry over of intervention because we as student therapists are not constantly there thus teaching them how to do a wheelchair transfer, pressure care and facilitate bed mobility are some of the skills they need to have when doing home visits. In these institutions I have been placed in there are poor resources and there is limited staff, as a result there weren’t any therapists there, and no community service therapists which is common at PHC level due to a lack of posts resulting in poor continuity of occupational therapy services (Jejelaye, Maseko, & Franzsen, 2019). Thus having student therapists placed there was very beneficial to the community as it provided them with access to rehabilitation of which majority of them cannot afford to even take a taxi and go to tertiary institution for intervention or further management.

The mass media is also suitable for health promotion and prevention because it enables health promoters and the public to shape a message using media that fits the message they wish to deliver rather than have to force content to fit existing media forms which may be sub-optimal for learning or literacy (Norman, 2012). Hence we reached out to local radio stations and any local print media such as the community newspaper that the community gives off for free, the aim was to get articles and useful information about health prevention, health promotion and disease management posted to the people of the community. We reached out on radio stations in order to deliver interesting information on health promotion as well as promote projects done in the communities so that they can be aware of occupational therapy services as well as be informed about what we have been doing in the communities. Living in the twenty first century where everyone is connected using social media, going forward with this block different content can be posted on different social media platforms such as Facebook where people can get daily knowledge on how to modify their lifestyle to live a healthy lifestyle as well as disease management. Occupational therapy is needed in primary healthcare as this is where initial intervention can begin starting with prevention and promotion of many conditions. A stronger primary health care system will lead to better prevention of many disease were people of the community live a promotive lifestyle.

References

Jejelaye, A., Maseko, L., & Franzsen, D. (2019). Occupational therapy services and perception of integration of these at Primary Healthcare Level in South Africa. South African Journal of Occupational Therapy, 49(3), 46-53.

McGuinness, O. (1996). The role of the occupational therapist in primary health care. British Journal of Therapy and Rehabilitation, 3(9), 483-486.

Naidoo, D., Van Wyk, J., & Joubert, R. W. (2016). Exploring the occupational therapist's role in primary health care: Listening to voices of stakeholders. African journal of primary health care & family medicine, 8(1), 1-9.

Norman, C. D. (2012). Social media and health promotion.

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Sustainable developmental goals

Shifting from the Millennium Development Goals to the Sustainable Development Goals  (SDG) resulted in the number of goals increasing followed by a new target date being 2030. Through working in different communities I am granted the opportunity to be part of the change and through intervention help meet these sustainable development goals, although it is worth acknowledging that not all goals can be met through the 5 weeks of placement however I have been able to meet some and will continue working towards meeting the few that I haven’t met. The 5 SDG’s I can and have been working towards within the two communities I have been placed in are goal 2, 3, 4, 5 and 8.

The 2nd goal is aimed towards eradicating extreme poverty in communities, and mobilising resources to abolish poverty, this goal can be achieved through working with other stake holders as I have seen in both communities I have been placed in were there are people who come once a week to provide food outside the clinics, through engagement with these individuals I am able to inform my clients who are in need of food to come on these days for food or even talk to social workers about getting a social distress food voucher. As mentioned in communities I have been working in the people there are subject to poverty due to unemployment, others are dependent on government social grants which is not enough to feed an entire family as a result we come across many patients especially children who are severely or moderately malnutritioned. Thus during fieldwork we have continued implementing projects such as the women empowerment project which will empower clients to make their own money so that they can be able to provide for their families.

The 3rd goal is aimed at good health and well being, this can be achieved through fighting infectious diseases, preventing substance and alcohol abuse, strengthening capacity for early warning of health risks through health promotion. During fieldwork I have been doing and will continue doing a lot of health promotion talks and screening with the intent of preventing and reducing the incidence of illness, injuries and disabilities in the population I have been placed in. Health promotion has proven to reduce health disparities in populations and is said to enhance mental health, and improve quality of life of people as well as prevent secondary conditions and improve the overall health and well-being of people with chronic conditions or disabilities(Scaffa, & Reitz, 2001, p. 27)

The 4th goal is aimed at improving the quality of education of people, it ensures that people get universal access to early childhood development and ensures that all learners acquire knowledge and skill. I have come across many children who have a lot of learning difficulties and experience delays at school due to not having had access to early childhood education and did not receive enough stimulation to facilitate meeting their developmental milestone as a result are more susceptible to not performing well at school and not being ready for school. Hence as part of health promotion when i come across mothers i always educate mothers about ways in which they can stimulate their children from an early age and at schools we have also been going to help children who are experiencing difficulties to be able to improve their knowledge and skill and ensure they also obtain quality of education. 

Gender equality is the 5th goal, this goal ensures that women participate in decision making and have equal rights to economic resources. While goal 8 is targeting decent work and economic growth. The communities i have been working are examples of patriarchal societies in the country, most men are afforded better opportunities and women are disempowered thus as previously mentioned our community based programs have also targeted women to equip them with skills that will give them a fair chance at participating in the economy and making their own money.

I will use a community-based approach to ensure that development reaches the poor and marginalized, and facilitates more inclusive, realistic and sustainable initiatives. 

In order to implement the SDGs i will use a common framework for CBR programmes (Fig. 1) as it will guide the programs run in the communities using the 5 key components to relate to the key development factors reflecting the multisectoral focus of CBR.. The matrix consists of five key components – the health, education, livelihood, social and empowerment components. The final component relates to the empowerment of people with disabilities, their families and communities, which is fundamental for ensuring access to each development sector and improving the quality of life and enjoyment of human rights for people with disabilities (Khasnabis et al., 2015) There for through following the CBR approach we will ensure that the SDGs are are met within the communities

If the SDGs are to drive further gains in population health, a much stronger focus is needed on addressing social determinants, and on basic and applied research in pregnancy and infancy. Advancing such research capacity should be a major global objective; for many low-income and middle-income countries, this will depend substantially on external support (Taylor et al., 2015)

References:

Khasnabis, C., Motsch, K. H., Achu, K., Al Jubah, K., Brodtkorb, S., Chervin, P., & Goerdt, A. (2010). CBR and mental health. In Community-Based Rehabilitation: CBR Guidelines. World Health Organization.

Scaffa, M. E., & Reitz, S. M. (2001). Occupational therapy in community-based practice settings. Philadelphia: Pennsylvania: FA Davis Company.

Taylor, S., Williams, B., Magnus, D., Goenka, A., & Modi, N. (2015). From MDG to SDG: good news for global child health?. Lancet (London, England), 386(10000), 1213.

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Discovering my positionality

Growing up I have lived in different environments, I have moved from living in a township, playing in the dusty streets in a small peri urban area to relocating to an urban area. The experiences learned from living in both these areas have shaped who I am today, I have interacted with different kinds of people from different socioeconomic backgrounds, different cultural backgrounds, different race/ethnic groups as a result my positionality has largely been influenced by culture, and socioeconomic background.

Growing up as the first child and being able to see my families socioeconomic circumstances change throughout the years has largely shaped my drive and motivation to ensure that I break “generational curses” and be part of the people who create generational wealth hence i have always had to put in twice the work. In both the communities I work in I have come across people who come from low socioeconomic backgrounds and their frustrations are primarily centred around finances and how that illness/diagnosis has interrupted their ability to sustain themselves and their families. Although both communities have people from different ethnic backgrounds, however their socioeconomic status is something they all have in common, they all come from low socioeconomic backgrounds . Thus in therapy I always make it my goal to ensure that the client returns to work especially if they are still willing to go back to work because I understand the pain and frustration that is associated with not being able to provide for your family.

It’s important to consider one’s positionality when assessing conditions, so as to not impose your own thoughts or cultural beliefs about what is the main cause of the diagnosis but to get scientific knowledge and use your clinical reasoning to back you up. Competence in language and culture in a field like occupational therapy is very important especially when working in communities (Govender et al, 2017) I can remember when working with many clients of colour who believe that witch craft or black magic exists and works, they would use it as explanation for their medical diagnosis or would associate their medical diagnosis with ancestors not being pleased and thus a traditional ceremony that needed to be done in order to appease them. In such a situation it was very important that I put my views aside, acknowledge their belief and still treat using occupational science adapt my intervention based on my clients cultural beliefs to suit the clients needs and still meet my aims for intervention.

I had mentioned my positionality is shaped by my cultural beliefs, i believe in ancestors and always take them into consideration although I always use scientific knowledge first especially when it comes to medical explanations of illnesses or disabilities.  Thus this shared belief with the clients allows me to be a culturally sensitive therapist as I understand that I am working with diverse individuals from different racial backgrounds and different cultural beliefs and behaviours as I work between two communities. Both these communities one community has majority of individuals who use witchcraft/black magic as way of explaining their illness in contrast the other community I work in with coloured people as the majority they trust scientific and medical explanation to explain their medical diagnosis. Therefore cultural sensitivity enables me to be able to adapt in both communities and provide intervention suitable for individuals.  

References:

Govender, P., Mpanza, D. M., Carey, T., Jiyane, K., Andrews, B., & Mashele, S. (2017). Exploring cultural competence amongst OT students. Occupational Therapy International, 2017.

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Maternal and child health

The field of Occupational Therapy (OT) allows for diverse and creative ways to assess and address client difficulties, needs and objectives. We utilize various models and frames of references, to guide our assessments and interventions.  Through these, we get the issues affecting an individual's participation in occupations and limitations in client factors and performance skills and we use these to come up with suitable client centred interventions. This reminds me of how basket-weaving was used as occupational intervention in order to improve client factors and performance skills for war veterans, no other profession would have thought of using that occupation to facilitate functional wellbeing. As a field we are different as we look at the person holistically to help them perform at their optimum level. OT intervention in maternal and child health is no different, the journey starts from the perinatal stage, the transition from woman to mother is a very huge shift and requires OT services to facilitate smooth transitioning between roles.

During the first week of community fieldwork I have come across different mothers and soon to be mothers, they all had different experiences to share with me about what they feel women need to successfully transition between womanhood to motherhood. Some had successfully transitioned without the help of an OT but some were still struggling with mental health related issues such as depression, stress, anxiety etc some were physical changes in their bodies such as back pain, swelling on the feet, insomnia, and would benefit from occupational therapy services.

“The comfort zone is a psychological state in which one feels familiar, safe, at ease, and secure. If you always do what is easy and choose the path of least resistance, you never step outside your comfort zone. Great things don’t come from comfort zones.” (Bennett, 2016). Reflecting on this week I realized that I had personally never provided OT services at a perinatal phase which was widely due to not having done research in order to find recent articles/ literature that provides in depth evidence about how to provide intervention from that phase. Thus felt a little bit out of my depth during the first few days when intervention was needed as I experienced discomfort when I offered intervention as I was not certain that it was in line with findings and recommendations in recent literature hence I had a little bit of extra work to do as I constantly come across mothers and children within the communities I work in.

So I asked myself how can we as OT’s better support mothers, mothers to be and children through our services? What evidence is available that we can draw and feel more confident that the advice, interventions and recommendations are evidence based practice as it helps when there is literature backing up our intervention (Leung, 2002). Although it is not always possible but what matters is the client achieving at the end of the day is able to meet their goals in the way that is more meaningful to them.

Woman face many changes which could be physical, affective, cognitive and spiritual, They may have altered self-identity and self-image along with other mental health related issues affecting their emotional wellbeing. We as occupational therapy can help facilitate transitions for women to reduce “maternal role strain, and thus incidences and severity of paediatric and maternal stress and depression” (Slootjes, McKinstry, & Kenny, 2016). Thus using different techniques such as mindfulness, relaxation techniques, we can help improve the emotional and cognitive changes experienced by women during the perinatal period. Interventions used can also be used to improve hormonal imbalances, improve mood, improve parental bonding, and reduce stress and anxiety. Ots can also help with muscle strengthening, improving postural alignment, improving body image and self-image and identity, client education, engaging in meaningful occupational participation, ensuring rest and sleep routine is established.

Woman engage in various occupations associated with parenthood, various routines e.g planning appointments to clinics, shopping for healthy meals, breaking old habits such as drinking alcohol, drinking more water those are some of the role associated with prenatal care before the baby arrives. Therefore OTs could provide educational talks, post delivery they can bring their babies, facilitate bonding, identify different milestones, lifestyle redesign, holistic approach, mental health changes associated, physical changes (make it difficult to walk, work, swelling )due to biomechanical changes happening in the body. OTs might work with women from an ergonomic perspective how to deal with pain, energy conservation techniques, prevent further damage.

There are findings that show that woman who have received early intervention from occupational therapists had more knowledge, improved attitude towards their role as a mother and had better awareness and understanding about their child’s needs for optimal growth and development (Parush et al., 1987). There are many interruptions to a women’s routine as well as occupational performance during this phase thus they really do need to be addressed especially by OT’S and I wonder I ask myself if we are doing enough especially as South African OT’s.  Do we have enough South African OT’s addressing needs related to driving and car modifications when need be?, Do all OT’s even at public hospitals work with women during perinatal stages, Do we understand our role during when it comes to maternal and child health, are there OT’s who work with ergonomics to maximise the safety of women and children are we proactive enough and have we come up with these solutions that will work in the African context? I hope that the future will be full of OT’s who understand their role in fully supporting women and not just focusing on the child as the mothers health is just as important as the babies health.

Woman engage in various occupations associated with parenthood, various routines e.g planning appointments to clinics, shopping for healthy meals, breaking old habits such as drinking alcohol, drinking more water those are some of the role associated with prenatal care before the baby arrives. Therefore OTs could provide educational talks, post delivery they can bring their babies, facilitate bonding, identify different milestones, lifestyle redesign, holistic approach, mental health changes associated, physical changes (make it difficult to walk, work, swelling )due to biomechanical changes happening in the body. OTs might work with women from an ergonomic perspective how to deal with pain, energy conservation techniques, prevent further damage.

There are findings that show that woman who have received early intervention from occupational therapists had more knowledge, improved attitude towards their role as a mother and had better awareness and understanding about their child’s needs for optimal growth and development (Parush et al., 1987). There are many interruptions to a women’s routine as well as occupational performance during this phase thus they really do need to be addressed especially by OT’S and I wonder I ask myself if we are doing enough especially as South African OT’s.  Do we have enough South African OT’s addressing needs related to driving and car modifications when need be?, Do all OT’s even at public hospitals work with women during perinatal stages, Do we understand our role during when it comes to maternal and child health, are there OT’s who work with ergonomics to maximise the safety of women and children are we proactive enough and have we come up with these solutions that will work in the African context? I hope that the future will be full of OT’s who understand their role in fully supporting women and not just focusing on the child as the mothers health is just as important as the babies health.

References :

Bennett, R. T. (2016). The light in the heart. Inspirational Thoughts for living your best life, Roy Bennett Publishing.

Leung, E. K. H. (2002). Evidence-based practice in occupational therapy. Hong Kong Journal of Occupational Therapy, 12(1), 21-32.

Parush, S., Lapidot, G., Edelstein, P. V., & Tamir, D. (1987). Occupational therapy in mother and child health care centers. American Journal of Occupational Therapy, 41(9), 601-605.

Slootjes, H., McKinstry, C., & Kenny, A. (2016). Maternal role transition: Why new mothers need occupational therapists. Australian Occupational therapy journal, 63(2), 130-133.

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Lessons learnt and the way forward for me

“Learning is experience. Everything else is just information.” Albert Einstein

These words by Albert Einstein reflect on my overall experience of fieldwork block it has been such a rollercoaster, there were highs and lows, challenges were experienced through that a lot was learned and I have grown a lot and realised a lot of my strengths and weakness that I still need to work on going forth into the next year. It was such an insightful practical block I was afforded me the opportunity to really work on learning how to integrate theory into practice when planning intervention. I had the chance to work & engage with individuals from different backgrounds & different contexts with different needs which has taught me how to put my views & beliefs aside thus putting the client first and also adjusting the intervention plan making it relevant to their context.  

Treatment in psychiatry was a lot more challenging than I had anticipated, because we are taught to prioritise certain areas of occupation such as basic adls but due to the type of facility I was placed in I had to be creative with my intervention taking into consideration that it is their work place and therefore they had to be appropriate to the context we were in and be realistic & client centred (Finlay, 2004). Thus the difficulty I first encountered was understanding the context they are in which would have made it easier to guide my focus of treatment with other clients. I later realised that it was crucial to first get the clients input in deciphering which areas of occupation is currently important for them and work more in realistic areas that they will be able to perform independently to some extent without their diagnosis hindering their autonomy in these. Also being aware of the fact that intervention in psychiatry is different from physical block in the sense that it sometimes takes longer to see change in your client and that the client might need you conduct the same session as many times as necessary in order for them to be independent in doing that thing.

We had the privilege of being able to go with our clients to outings and it was such a great experience to assess and treat during these outings, these outings were indeed helpful because we were able to identify which areas still needed to be addressed especially in terms of social skills. We were able to see things that we weren’t going to see within a sheltered environment because it limits them into performing based on how everything is structured in the environment. The first outing to the movies allowed us to assess how our clients behave in the outside/ real environment without much structure and treat whatever still needed to be addressed. The second outing to the shopping centre allowed us to see how far our clients have come and how much improvement they have made through our intervention sessions. The shopping centre outing was exciting to see because it also enable us to reinforce what we had been treating all along and see how they cope with it in an environment that is not structured. These outings where really necessary as we never really know whether our interventions will work when the clients leave the facility we usually just hope they will cope but through these outings we get to see and experience the challenges they are faced with in the real world and take them into consideration when doing intervention and recommendations. It would be so amazing if we could do that in every fieldwork facility although I know that it is impossible but there is no harm with wishful thinking right?.

In conclusion this block has allowed me to grow as a student therapist and as an individual allowing myself to learn from my colleagues and through feedback sessions from my supervisor which were very helpful, this block helped enlighten me on where my shortfalls are, on how to approach treatment in psychiatry. Therefore going into my next fieldwork blocks next year I am no longer as blind sighted as I was prior to feedback because one never really learns until they make mistakes.

References:

 Albert Einstein. (n.d). Retrieved from https://www.goodreads.com/quotes/133135-learning-is-experience-everything-else-is-just-information

Finlay, L. (2004). The practice of psychosocial occupational therapy (pp.159-160). UK: Nelson Thornes Ltd

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Research day

“Research is tremendously important, but it is a horse to be ridden and not a deity to be worshipped. At its best it can propel us into a more effective and assured future but, at its worst, it erodes the courage to say what we think without feeling obliged to prove that three other people have already said it“(Creek, 2011). On research day we had the privileged to see what the fourth years had been researching on, one thing that came out for me is that the research groups used research as evidence to support their studies and through research they were able to come up with findings and make recommendations that will develop our knowledge on how we as a profession can make a difference. Thus the quote makes a lot of sense in the sense that research should not be worshipped but it should be used to guide practice and should empower us to make our own conclusions and have our own voice, it shouldn’t cripple our ability to think critically.

Another thing that I noted is that some of the research topics were inspired by some clinical problems that they had come across during their fieldwork block in different venues, which was so beautiful to witness because you could see where the passion for the research was practical and it tackled real and current issues. This made me realize that the purpose of research is to make us become more aware of our surroundings and see what gaps are missing and how we as emerging therapists can help make a difference in our own surroundings.  It also made me realize that it is our duty as professionals to not only to partake in the development of research and practice on a personal level, but also to involve our patients about the need for and the utilization of research because they know and understand better what they are going through and how we can help them in order to make it more effective once we conduct research and they become a part of the process and it is not just about the researchers.

I think research day was an inspired me and a lot of us as it showed us how we can use research to develop our knowledge base, also how we can be actively involved in scientific inquiry that is relevant to occupational therapy.  As well as to prevent scientific dependency on other health professions by being involved in the systematic questioning and improving existing intervention methods designed to advance the science of occupational therapy (Ottenbacher, 1987).

In conclusion I will just like to add that besides being inspired by the way in which they had put effort into their research studies and the passion in which they presented their topics with, I really loved the part where they spoke to us about the behind the scenes of research how one gets to grow as an individual. Some knew nothing about research but stated that they learned a lot from their group members and discovered that they actually enjoyed research which goes to show that there is power in group work which made me think of an African proverb that says “If you want to go fast, go alone. If you want to go far, go together” this made me value working with other people even more.  

References:

Creek, J., & Lougher, L. (2011). Occupational therapy and mental health. (p173) Elsevier Health Sciences.

Ottenbacher, K. J. (1987). Its importance to clinical practice in occupational therapy. American Journal of Occupational Therapy, 41(4), 213-215.

African proverb. (n.d). Retrieved from https://www.passiton.com/inspirational-quotes/7293-if-you-want-to-go-fast-go-alone-if-you-want

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Psychosocial professional experience

Throughout this fieldwork block I have had to treat clients that are diagnosed with Intellectual Disability thus it was important for me to obtain more information that will enlighten me on how to go about treating the service users from an OT’S perspective therefore I’ll talk about 2 articles that I read at the beginning of the block and kept referring to broaden my perspective on intellectual disability.

The first one I will be referring to is titled “Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities” which was a research article conducted by Hällgren in 2005. This article emphasises the importance of OT’s ensuring that they prioritize ADLs when planning interventions for persons with ID while taking the persons needs and wants in to consideration, because these tasks are usually performed at home therefore they help to place the home in a more meaningful context and promotes participation and well-being. I fully agree with this article because based on what I have observed on fieldwork once the client is independent in basic ADLs they feel more empowered, even though I was at a challenge workshop I did assess some basic ADLs in a simulated setting and you could see the confidence the client had when doing these as they have developed self-efficacy in performing these activities and did them to the best of their abilities and needed little intervention in these areas.  One would assume that a person with Intellectual disability is not teachable however this is possible through repetition and reinforcement and the clients I had that are moderately impaired are able to perform these basic ADLs although not as per norm but they are aware of how to perform them because of practice which validates the findings of the research study were they found that clients with mild to moderate intellectual disability can learn how to perform ADLs.

However with other clients they did not deem independence in ADLS/ IADLS to be a need/ priority in their lives especially some of my male clients, an good example would be teaching them how to perform meal preparation tasks, cleaning up, child rearing or other tasks because they believe that those tasks should be done by women and I had to respect that as the treating therapist while still using a by the way approach to teach them these tasks because they need these skills even though they might not use them at home. The second article I read written by Francisco in 2002 touched on gender issues, family issues and lifestyle differences for people from different backgrounds and also how communication with someone of a different cultural background might affect treatment therefore they provided some strategies included taking time to develop rapport and trust, this was suggested to encourage communication and willingness to ask questions; and  work collaboratively and not prescriptively, checking that the family agreed with the approach being taken. Some of these strategies were very effective for me because with my male clients they were hesitant to do anything they believe their wives/sisters would do for them and I had to communicate with them as to why I wanted us to do it. Also some of my clients would go on fasting on certain days so I had to be mindful of the treatment sessions I would do on those days to show that I am still taking the clients culture into consideration.

In conclusion I would like to say that through reading literature about psychiatric conditions I have learnt a lot about it however I also believe in learning from real life experiences because sometimes it doesn’t feel like one is making a difference until they are told or start seeing the change which is tricky when you are treating a client with Intellectual disability. ��However this week we had the privilege of having external speakers from various organizations come speak to us and share their experiences with Occupational therapy. Some of the speakers were service users who were diagnosed with different conditions but their reflections about OT were so similar, they all narrated how OT’s are the only ones who managed to get through to them and made a bigger impact in their lives than other health care professionals. “We only want to be treated like human beings” this was said by one of the external speakers who was expressing his frustrations with other health care professionals and said all the OT’s who have treated him are the only ones that understood this and were able to establish rapport with him. This just validated what I had already known about OT’s that we go beyond just treating the client but we seek to understand the client more and I think the fact that we use a client centred approach to guide our practice is one of the reasons why it becomes so easy for OT’s and clients to work efficiently together because we look at the client holistically and not just treat what we see or what they have been diagnosed with. This just made me more enthusiastic about treating clients because it reminded me that it is not just about me but the impact I make in their lives.

References:

Francisco, I., & Carlson, G. (2002). Occupational therapy and people with intellectual disability from culturally diverse backgrounds. Australian Occupational Therapy Journal, 49(4), 200-211.

Hällgren, M., & Kottorp, A. (2005). Effects of occupational therapy intervention on activities of daily living and awareness of disability in persons with intellectual disabilities. Australian Occupational Therapy Journal, 52(4), 350-359.

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What i have learnt on fieldwork block and about myself

Fieldwork block has thus far granted me the opportunity to learn how to really integrate theory into practice when planning intervention as well as see it all coming together. At first it was difficult to adjust to treatment in psychiatry because it is more abstract in comparison to the intervention we give in physical as it is not as straight forward. However what I came to realize is that it is not that different as we still focus on making our treatment interventions client centered in order for us to set more realistic goals, increase the clients volition, thus making it more meaningful for the client and also therapeutic (Finlay, 2004).

Another thing that treating in psychiatric practice has taught me is that the signs of progress of the client are smaller and usually take longer see however when they start to manifest no matter how small they are they contribute largely to clinical practice. This is where I saw the importance of our clinical reasoning (answering the what?, how? And why? questions) and critical thinking ( which involves identifying the purpose, the question at issue, assumptions, implications, inferences, point of views, concepts/theories and principles) when selecting activities because these will help justify for the use of those particular activities for that specific individual. (Crouch, 2005, p90). However these are complex processes which fully develop with experience but I have become more aware of the fact that it is important for me to give special attention by reading journals/books that will help develop both my clinical reasoning & critical thinking skills in order for me to grow as a student therapist.

“The more radical the person is, the more fully he or she enters into reality so that knowing it better, he or she can better transform it , this individual is not afraid to confront, to listen to see the world unveiled. This individual is not afraid to meet the people or to enter into dialogue” (Freire, 2018). This quote summarizes my entire experience of this field block because I have become more and more mindful of my thoughts & my actions. I’ve learnt how to become more and more comfortable with criticism as I know it will contribute to my personal development as an individual and as a student therapist. 

Engaging in any conversations pertaining to my practical experience used to give me so much anxiety because I was afraid of criticism, but the more and more feedback sessions I got from my supervisor on an individual basis and as a group it has made me more confident to engage with other students about my practical experience be it the challenges I’ve faced to sharing information about activities and different resources for activities. I’ve become more open and I’m no longer afraid to share my knowledge and methods with my fellow class mates because we do it so much at our practical site that treatment in psych is now starting to make sense and I can confidently talk about it. The feedback sessions have also helped to enlighten me on where my shortfalls are, on how to approach finals and that was of paramount importance for me because i wanted to know what I still needed to work on. Therefore I am no longer as blind sighted as I was during midterms as I was still trying to understand treatment in psych however I acknowledge that there is still so much room for improvement. 

References: 

Crouch, R. B., & Alers, V. (Eds.). (2005). Occupational therapy in psychiatry and mental health (p90), UK: Whurr Publishers Ltd. 

Finlay, L. (2004). The practice of psychosocial occupational therapy (pp.158-160). UK: Nelson Thornes Ltd 

Freire, P. (2018). Pedagogy of the oppressed. Bloomsbury publishing USA

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Casual day 2019

“Time to shine” was the theme for this years’ casual day, well thought out if I may say so myself given the purpose of casual day which is not just to raise funds for people with disabilities through the ten rand stickers, but to also raise awareness of people with disabilities and to ensure that they are also included in the main stream society (“Casual day theme”, 2019). This theme spoke volumes to me as it meant that through casual day people with disabilities get to shine on this day as everyone celebrates and embraces them because of their disability.

Casual day for me is a great initiative because to a great extent eradicates the stigma people have in our communities about people with disabilities. They are seen a in different light because on this day we get to say there is nothing wrong with a person having a disability instead we come together as a country and celebrate them. People with disabilities get to realize that their disability doesn’t make them unimportant in our societies and that their presence matters hence a day is dedicated towards recognizing them.

In the facility I am at we got the opportunity to plan an event in celebration of casual day and it was one of the best events I have ever had to plan as a student therapist not just because it meant we get to feast on good food, listen to music, play games etc, but because the service users were looking forward to it. They had suggestions from the get go on what they would like to do and I saw the true benefits of taking clients’ interests and values into consideration and using a client centered approach meant.

“ The bottom line is that to be client-centered you have to care about the person, you have to care about their life as it were your own, and you have to hold their spirit in great respect” (Crouch, 2005, p124). This quote emphasizes the importance of being client centered which is one of the most valuable experiences I take with me from casual day reason being that had we not engaged with the clients and involved them in the planning process for casual day we would have missed the plot. They most probably weren’t going to enjoy the activities we were going to plan and we wouldn’t have known what they would have wanted to do thus it wasn’t going to be as therapeutic for them it most probably were going to refuse to participate.  

It was such an exciting moment for me to also realize that once you know the creative level of your clients you are able to select appropriate activities, I saw the importance of using the model of creative ability and placing clients on it because had we not known this our activities weren’t going to be therapeutic due to them being at a level too high or too low for their abilities (Sherwood, 2011). Also the benefits of using activities in a group setting as it offered the clients the opportunity to belong in a group especially those that are socially withdrawn and also be accepted by the group which also had a positive impact of their self-esteem because they realized that they also make a useful contribution in a group setting (Finlay, 2004, p51).

All in all I think there is a lot of work that still needs to be done in terms of raising awareness of people with disabilities in our country because in certain communities’ especially rural places there is still a stigma associated with disabilities due to lack of knowledge. It is also up to us as health care professionals to help raise awareness through more campaigns and not just waiting for casual day to do this in order to ensure that they always are part of our societies & are not isolated.

References: 

CASUAL DAY THEME 2019: TIME TO SHINE WITH PERSONS WITH DISABILITIES (2019) http://www.casualday.co.za/casual-day-theme-2019/ accessed 2019/09/06

Crouch, R. B., & Alers, V. (Eds.). (2005). Occupational therapy in psychiatry and mental health (p124), UK: Whurr Publishers Ltd.

Finlay, L. (2004). The practice of psychosocial occupational therapy (p51). UK: Nelson Thornes Ltd

Sherwood, W. (2011). An introduction to the Vona du Toit model of creative ability. Revista electrónica de terapia ocupacional Galicia, TOG, (14), 12.

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Portrayal of mental illness in film: Welcome to Me

“Media representations of mental illness can have a significant effect on public images of people who experience mental health problems” (McKeown & Clancy, 1995). This is a very powerful statement because it expresses how the media influences the community at large. Thus if the media were to display a health related illness especially mental illness most people will deem whatever is potrayed to be true because they assume that thorough research has been done and rely mostly on it. However this is not always the case sometimes the media over exaggerates mental illnesses and portrays them as being dangerous and violent (Anderson, 2003).

Welcome to me directed by Shira Piven she uses comedy and drama to depict border line personality disorder and the film stars Kristen Wiig who plays the role of Alice Klieg, a multi-millionaire with borderline personality disorder who uses her newfound wealth after winning 83$ million dollars from the lottery to write and star in an autobiographical talk show named Welcome to me. The protagonist (Alice Klieg) is seen in the film throwing tantrums when things don’t go her way like when they cut her interview short during the live lottery show when she started talking about her sexual habits, and doesn’t see the inappropriateness of what she said, she goes one to show us her impulsive side when she invests 5th of her winnings in the tv show about herself as she always watched Oprah and had many video tapes of her and wanted to be like her.

In the midst of it all she stops taking her medication and decides that this is a chance for her to start over again, makes a reservation at a casino to live there, and engages in more impulsive spending decisions. Her poor decision making skills and lack of social judgement leads her to losing her close friends, although she later relapses and is back on her medication and apologizes to all those she had wronged and we see a happy ending.

According to the Dsm V borderline personality disorder falls under cluster B and is characterised by erratic, dramatic behaviour, emotionally labile, self centered/self-focused & unstable, these signs are seen in the protagonist although the only intervention for her is coming from her psychiatrist and we are given the impression that, that’s the only form of intervention for borderline personality, of which she showed behavioural problems, decreased awareness of social skills, poor coping mechanisms when stressed which intervention could come from OT. They portrayed a form of role play however the protagonist is the one who was directing it without a therapist which is not how it is done. Therefore again we see the media turn a blind eye to the use of a Multidisciplinary team. However it was a brilliant movie, enlightening especially if one didn’t know what a borderline personality disorder it then it will definitely help open their eyes just the only disappointment is that they didn’t educate the viewer on how to handle or deal with a person with a personality disorder and scenes with the family were very short and we didn’t get to see much in terms of how they handle them and support her.

In conclusion i think it a good idea for film makers to continue filming movies which depict mental illness however in doing so they must do thorough research and also ensure that they are contributing towards removing the stigma behind mental illness not adding to the stigma because they hold the power to influence many communities.

 References:

Anderson, M. (2003). ‘One flew over the psychiatric unit’: mental illness and the media. Journal of Psychiatric and Mental Health Nursing, 10(3), 297-306.

Diagnostic and Statistical Manual (DSM-V), American Psychiatric Association (internet)- accessed 30/08/19

McKeown M. & Clancy B. (1995) Media influence on societal perceptions of mental illness. Mental Health Nursing 15 (2), 10–12.

Wloszczyna S. (2015) Rev of Welcome to Me by Pive S (2015)  https://www.rogerebert.com/reviews/welcome-to-me-2014 - accessed 30/08/19

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Assessing & Treating in Psych

“It is time to open our eyes and see what it there, without making too many value judgements about it all. It is time to lend our ears to our clients’ preoccupations from a position of recognition and resonance instead of with the purpose of analysis and reducing them to a state of despair and degradation. ” (Van Deurzen, 2009, p.344).  When I think about what occupational therapists aim to do that’s the quote that comes to mind, because we are one of the few members of the mdt that actually make the time to listen & understand what our clients are going through before we can even formulate an intervention plan especially in psychiatry because it is an abstract field not everything is easy to see until to sit and engage with the client.

This is the notion I had in mind when I started assessing my clients so as to establish what it is that my client wants to achieve from therapy in order to set realistic & client centred goals (Finlay, 2004, p.158). What I have realised though so far is that one is never done assessing, assessments are more of an ongoing process I found myself several times going back & forth trying to deduce my assessment findings after every session and trying to see whether the intervention I had started was in line with them and what the client wants to achieve. Assessments are crucial because they serve as the first step to establishing a rapport with the client because that will make the client easily share crucial information with you; it will build trust which is good for your working relationship (Maitra, K.K and F. Erway, 2006, pp298-310) which at this point I think I have managed to do so with my clients.  

What was important for me was to make sure that I treat every client differently, by acknowledging that they will have different needs & that just simply understanding their diagnosis is not enough! The treatment plan I formulate in collaboration with the client should fit their context & environment within & outside of the hospital environment because when the client leaves their sheltered work place they should be able to carry out occupational activities there as well with minimal or no assistance of a caregiver. However I have noticed that there is still room for improvement in my intervention planning especially when it comes to formulating a subprogram and ensuring that there is a balance between the activities I select.

In conclusion I personally think what I’ve learnt is that the way I approach psychiatric interventions is not too different from the way I approached physical interventions in the sense that a client centred approach/ treatment intervention is that which requires flexibility from the therapist in the sense that you need not to use structured methods for all your clients if it doesn’t work for that client you can adapt it so that it works for them (Pendleton H.M, Schultz-Krohn W, 2006, p37) which I still make use of in this psych block. You need to also take cultural diversity into consideration as it will affect your treatment plan; you shouldn’t impose your cultural values onto your clients but take theirs into consideration & incorporate it in treatment.

References:

Finlay, L. (2004). The practice of psychosocial occupational therapy (pp.159-160). UK: Nelson Thornes Ltd

Maitra, K. K., & Erway, F. (2006).  Perception of client-centered practice in occupational therapists and their clients. The American Journal of Occupational Therapy, 60(30), 298-310

Pendleton H.M., & Schultz-Krohn W. (2006) Pedretti’s occupational therapy practice skills for physical dysfunction (p37). Elsevier Health Sciences 

Van Deurzen, E. (2009). Everyday mysteries: A handbook of existential psychotherapy. Routledge.

#OT #Student blog 

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An OT is born

It’s been 2 & ½ years now and looking back I have no regrets with my choice, I always had the dream to work as a health professional but I didn’t want something that would force me to perform the same duties every day or that wouldn’t allow me more interaction time with service users. Thus when I found out about Occupational therapy I feel in love with it because of its diversity, and its non pharmacological approach which enables one to use other methods of intervention and be able to see the progress of your therapeutic intervention.  

An article that has inspired me to carry on with my journey to becoming an OT the one titled Occupational therapy interventions in the treatment of people with severe mental illness (Höhl, W. et al, 2017)  this article talks about how occupational therapy also plays a role in mental health through the use of activities that are necessary for the individual to function independently or with minimal assistance in society so that they can also feel hopeful and have some level of autonomy which is good for their medical & functional prognosis.

Most people with mental illnesses face personal and social barriers when it comes to engaging in healthy activity patterns and meaningful participation in the community especially in South Africa because of the lack of resources and support from their families and society due to the stigma around mental health thus occupational therapy tries to break that by making them as competent as they possibly can be. This validates that occupational therapy isn’t just a passive type of intervention but it puts the service users first, it is a proactive type of field that ensures that when clients/ service users leave the institution they have the survival skills required for them to live a healthy life. Which was always one of my wishes that I become a part of the clients healing process and I see the impact I’ve made in their lives hence I still believe I am on the right path and chose a suitable degree.

References:

Höhl, W., Moll, S., & Pfeiffer, A. (2017). Occupational therapy interventions in the treatment of people with severe mental illness. Current opinion in psychiatry, 30(4), 300-305.

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First day of fieldwork

On my first day of psych block my anxiety levels were high as anticipated because i was about to officially begin yet another fieldwork block. Although I have been to a challenge workshop before I still felt anxious and didn’t know what to expect since it was a different venue and our last psych block was last year so my psych knowledge still needs to be polished up.

We walk into the facility and I immediately fall in love with it, it’s a calm atmosphere, the clients/service users were all excited to see us they all greeted us with smiles and welcomed us warmly, the manager was also lovely as well as their supervisor. They explained to us how they work within the sheltered employment environment of which most of them knew how to do their work and the staff including management seemed to be supportive and treated all of them as employees with equal rights and respect which is what is expected even in sheltered employment (Crouch, 2005). We even managed to come up with an idea on what to do for casual day which was awesome because it meant we could immediately get the ball rolling and plan our group therapy sessions around the mean idea and theme.

Initially I imagined my first week to be less busy but little did I know that assessments & treatment are demanding, reality hit me hard and I realized that it is crucial to constantly go through assessments as they are the foundation of treatment & long term goals for your client because they give us information about how the individual copes with their daily life occupations in leisure, adls, iadl, work  and other areas of occupation thus we will be able to see the functional skills and problems they have (Finlay, 2004) . As I was initiating treatment it suddenly hit me that I enjoy being at a challenge workshop more because we get to actually see the client progress & see the difference the treatment is making as opposed to an acute venue were your client stays for a week or two and also its more exciting because we get to do a work analysis and see how they really cope with the demands of work. I was more determined to understand the model of creative ability because it will help me choose my activities, as well as understand their level of functioning thus apply the correct treatment principles.

I have come to realize that i need to be more creative & innovative with my treatment sessions, not just focusing on an activity for the day but to look at how it will be beneficial to my client, whether it is solving problems listed in my problem list & whether they will attain fulfillment from engaging in it. Going forth i need to look at my patient holistically & not just focus on the mental diagnosis but also look at how it’s impacting the client mentally, emotionally & spiritually. Thus constant communication with members of the multidisciplinary team is inevitable & is something i need to get into the habit off and advocate for my clients. 

References:

Crouch, R. B., & Alers, V. (Eds.). (2005). Occupational therapy in psychiatry and mental health (pp 222-223), UK: Whurr Publishers Ltd.

Finlay, L. (2004). The practice of psychosocial occupational therapy (pp.159-160). UK: Nelson Thornes Ltd.

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MDT in health care

A multidisciplinary team in the health care system refers to a group of health professionals ( working together in order to provide the health care service users/ patients with services that will address not just one but all the health challenges the client might be encountering. Therefore with this sort of system in place the client is looked at holistically thus reducing the chances of readmissions, because all health care professionals would have assisted the client prior to them being discharged.  (Jefferies, H., & Chan, K. K. 2004)It is ideal because it takes away power from one member of the mdt and makes sure that they all have a say on the treatment the patient receives.

Although there are many advantages of working in a multidisciplinary team most hospitals don’t make use of it and usually doctors have more power over other team members, for it to be effective it requires trust and respect between all members of the team, there needs to be a system for referrals and constant communication and meetings that bring all staff members together to discuss and review the effectiveness of the treatment their patients are receiving.

I have come to realize that even though some institutions try to enforce a multidisciplinary system some team members do not adhere to it and prefer working alone. However I have also seen the effectiveness of it when it is employed by team members not only does it make it easy for the team members it is also beneficial to the clients.

 References

Jefferies, H., & Chan, K. K. (2004). Multidisciplinary team working: is it both holistic and effective?. International Journal of Gynecologic Cancer, 14(2), 210-211.

https://www.health.nsw.gov.au/healthone/Pages/multidisciplinary-team-care.aspx

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Clinical reasoning in OT

Clinical reasoning in OT refers to the process of thinking about information pertaining your client which helps you as the therapist make a decision about the relevant and appropriate intervention for that client. It continuously develops as you progress and become more experienced in the field. There are complex factors that make up clinical reasoning and the professional advancement of occupational therapists. these factors can either positively or negatively influence decision making in the OT treatment setting.

In general clinical reasoning focuses on the assessment of the needs of a client, intervention planning based on those needs, and decisions that influence the progression of the client towards independence and functioning.  Reflection on interactions is part of the process of decision-making. There are various factors that possibly influence decision-making cover; these include social and cultural influences were by the values beliefs of me as the therapist indirectly influence my ability to understand the clients beliefs because they may not be inline with the clients own beliefs (Sonn, I., & Vermeulen, N, 2018, pp34-39). The clients values and beliefs influence their ability to reach their individual goals in therapy for example if they don’t believe in that a man should do domestic tasks therefore even if the I as the therapist believe that the client needs to learn these tasks.

The clients context and environmental influences how the therapist will think and plan intervention as it needs to be relevant and realistic to the client (Radomski, M. V., & Latham, C. A. T, 2008, pp311-312).  In conclusion clinical reasoning is crucial as it guides intervention, it makes intervention client centred and ensures that the therapist takes the client into consideration in the process.

References;

Radomski, M. V. & Latham, C. A. T (Eds). (2008). Occupational therapy for physical dysfunction (pp. 311-312). Lippincott Williams & Wilkins

Sonn, I., & Vermeulen, N. (2018). Occupational therapy students’ experiences and perceptions of culture during fieldwork education. South African Journal of Occupational Therapy, 48(1), 34-39.

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Experience of midterms

Fieldwork block has afforded me the opportunity to really work on learning how to integrate theory into practice when planning intervention. Midterms have been helpful in giving me the chance to identify my strengths and weaknesses in planning and implementing intervention, that way going into finals I know what to work on & what to carry on doing in as much as it is different clients. Through midterms I have had the chance to work & engage with individuals from different backgrounds & different contexts with different needs which has taught me how to put my views & beliefs aside thus putting the client first and also adjusting the intervention plan making it relevant to their context.  

Treatment is a lot more challenging than I had anticipated, because we are taught to prioritise certain areas of occupation such as adls but due to institutionalisation it becomes hard for the client to practice carrying these out independently especially in long term facilities. Thus the difficulty I first encountered was understanding the context they are in which would have made it easier to guide my focus of treatment with other clients. I later realised that it was crucial to first get the clients input in deciphering which areas of occupation is currently important for them and work more in realistic areas that they will be able to perform independently without institutionalisation hindering their autonomy in these.

Another challenge I had was with motivating my treatment with principles in terms of explaining what principles of treatment I was using in my sessions thus showing that I understood how the aim was being met meaning that my clinical reasoning still needs improvement. Another thing was managing my anxiety levels throughout the block because I was constantly worried about my marks and clinical performance forgetting that I could use my supervisor as a resource when encountering a problem.

Feedback sessions from supervisors is very helpful, it helped enlighten me on where my shortfalls are, on how to approach finals and that it is absolutely important to change your focus of intervention if you can tell that the current one won’t work with your client due to the institution you are in and the diagnosis they have. Therefore going into finals I am no longer as blind sighted as I was prior to feedback because one never really learns until they make mistakes.

References:

African Journal of Health Professions Education 2016;8(1):37-40. DOI:10.7196/AJHPE.2016.v8i1.536

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Reflecting on my OT journey thus far

So at this point we are getting closer to our finals and ideally one should be getting the hang of things by now but I’m feeling like there is still so much work to do! When looking back into the past month’s experience I have deduced what my strengths are and what difficulties I have been encountering.

When looking in to my strengths its clear evident that I have mastered the art of working under pressure, with so many submissions & assessments & treatment sessions to be done within one day of practical one could easily feel overwhelmed with work. Another thing that would be my strength is establishing good rapport with my clients, having a good working relationship & getting them to always participate even when they don’t feel like it.

So far I’ve encountered so many difficulties; I’ve realised that I actually need to re-read my assessments because the accuracy of my treatment plans is dependent on the assessments I do. Recording of assessment findings especially sensation is also something I’m still yet to master in terms of mentioning the exact dermatome levels with or without sensation or motor function. Creating relevant subprograms &making sure that they link to the main sessions that I have with my clients is also proving to be challenging, I need to make sure that every time I plan a session with my client I keep in mind the focus of my treatment, the subprogram as well as the applied frame of reference & approaches I said I would use. I’ve also been having difficulty planning sessions that are cost effective, I need start utilizing the resources available at the OT department.

Overall it has been a challenging block but I’m taking it one day at a time & making sure that I appreciate & embrace the difficulties I’m having and making sure that I start ironing out those problems as soon as possible.