Occupational Therapy Strategy. Mental health and wellbeing

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1 Occupational Therapy Strategy Mental health and wellbeing

2 Background Occupational Therapy (OT) is an integral part of the services Derbyshire Healthcare NHS Foundation Trust (DHCFT) provides for people in Derbyshire experiencing mental health problems. Occupational therapy provides practical support to enable people to facilitate recovery and overcome any barriers that prevent them from doing the activities (occupations) that matter to them. This helps to increase people's independence and satisfaction in all aspects of life. "Occupation" refers to practical and purposeful activities that allow people to live independently and have a sense of identity. This could be essential day-to-day tasks such as self-care, work or leisure. Occupational therapists work collaboratively with service receivers and carers to help them live life their way. This strategy takes into account the changes occurring at a local and national level. In doing so, it provides a framework for the development of occupational therapy services in mental health, supporting the Trust s strategic aims and vision: To improve the health and wellbeing of all the communities that we serve On a professional level, the College of Occupational Therapists (COT) 10 year mental health strategy, Recovering Ordinary Lives ( ), continues to have a significant bearing on the direction of travel for occupational therapy services within the Trust. COT position statement (2015): 2

3 Our Vision Occupational therapists are valued members of the organisation and recognised as key people making a significant contribution to the recovery journeys of those using DHCFT services, their families and carers. To achieve this, there will be a skilled, competent occupational therapy workforce with the personal attributes to champion occupationally focused, evidence based, interventions that are routinely evaluated. Occupational Therapy will develop and enhance a Trust culture of resilience in mental wellbeing and recovery from mental ill-health. Focussing on people s strengths, practical skills and how they manage their lives, occupational therapy will offer an enabling approach across care pathways and across the domains of: Self-care (How I look after myself) Productivity (How I contribute in work, home, education) Leisure (How I enjoy myself). Getting Well : OT offers people assessments and interventions to help overcome their acute mental health episode to help them identify how they may need to adapt their lifestyle or change their occupations in everyday life to manage their mental health. Keeping Well : Working with people to help them gain self-management skills and coping skills to keep well. This may include individual or group work and working in partnership with other agencies to enable people to look after themselves and their family, get back into work and return to their interests. Staying Well : This involves embedding coping skills and establishing pathways within the community that support people outside of mental health services. These activities are often led by external partners - we support the development of these pathways. 3

4 Defining the occupational therapy contribution All Occupational Therapists employed by DHCFT are integrated within multidisciplinary teams. It is essential that the OT contribution to care is part of the integrated care package for the service receiver, that all involved agree the plan of care and that all occupational therapy offered is in line with NICE guidance. Specific OT interventions have been grouped as follows: 1. Occupation as Therapy The belief that activity can be used to work towards an improved quality of life, despite disability (Yerxa 1983) is at the core of our occupational therapy philosophy. Interventions include: I. Building self-efficacy to engage in activity (self-care, work and leisure). II. Use of activity to enable re-motivation process (behavioural activation). III. Facilitate engagement in meaningful activity. IV. Explore future activity options. V. Engaging in meaningful activities that maximise sensory opportunities to allow more engagement in a broader range of environments. Equine therapy: Bolsover Recovery tea Gardening: Hartington unit Creative expression: Chesterfield 4

5 2. Self-management through Occupational Therapy Empowering and enabling people to self-care and lead independent lives despite disability. Person centred approaches to enable wellbeing. Interventions include: I. Increasing understanding of mental health problems and their impact on daily activities: developing positive coping skills, condition management and managing emotions. II. (Re) establishing productive and valued daily routines. III. Lifestyle adjustment. IV. Lifestyle management. V. Developing and maintaining independent living skill. VI. Developing/maintaining capacity to assure adequate stability, movement and energy to participate in daily activities. VII. Developing/maintaining organisation and problem solving within activity. VIII. Environmental modification to support engagement in activity (including social and physical environment). IX. Assistive technology. Healthy Lifestyles: Hartington Unit Gardening for Wellbeing: Derby City 5

6 3. Occupational Therapy to enable social and community inclusion Working in partnership with individuals and local communities to improve mental health awareness and social inclusion. Enabling people to have meaningful lives within their own community. Interventions include: I. Developing/maintaining communication and interaction skills within activity. Individual or group work activities to enhance and develop interpersonal and social skills. Specific attention to communication and interaction skills. II. Developing supportive social relationships and networks. Increase engagement in social roles. Maintenance and development of roles and social functioning following age related changes. Decrease social isolation and develop positive social links. III. Vocational enablement: back to education, employment and meaningful occupation. IV. Vocational guidance, signposting and advice. Referral to and collaborative work with other resources/providers e.g. Jobcentre Plus, expert patient programmes, local education providers, occupational health, human resources and voluntary organisations. Providing consultation/liaison/advice to employer, other support providers or service receiver in relation to disclosure, reasonable adjustment; mental health awareness. Including adjustments required under DDA: adaptive equipment, accessibility, colleague support and graded return to work. V. Supporting transitions in new physical and social environments. VI. Supporting engagement in leisure and exercise. Nature connections: Derby City CONNECT 5: Chesterfield 6

7 4. Occupational Therapy consultancy, education, liaison Education, advice and empowering others to understand impact of occupational functioning on quality of life. Partners may include: carers, students, care homes, social care, education, health partners and the voluntary sector. Interventions include: I. Carer education and support (in relation to maximising the service users activity and functioning). II. Advice to MDT by providing occupational therapy perspective on return or stay at home functional abilities, risk and management, engagement in activities. III. Supervision of interventions of care delivered by other providers and agencies e.g. home care Working with housing services and care providers Liaison with acute and primary care practitioners. Establishing Recovery pathways working collaboratively with community based resources. IV. Liaison to enable independent living. V. Working with Care Homes. College of OT recommended toolkit on engaging people in meaningful activities and therapeutic environments in care settings. VI. Helping to address challenging behaviour through. VII. Education to students, work experience placements, schools, colleges and universities. Dementia question & answer: Amber Valley Older adults COTMH conference: Liverpool 2015 Further information on OT intervention in line with NICE and PBR is available to view on our Trust website at: 7

8 Our ambition for people who receive our services This OT strategy is based on the four strategic Trust outcomes that are all about the nature of care that people who use our services should experience. The supporting work plans will guide the work of our clinicians and leaders to deliver a high quality occupational therapy service. Outcome 1 People receive the best quality care Professional standards are in place and all OTs are aware of their scope of practice. This is evidenced through OT CPD events and communications Professional accountability by OTs is in place. Any professional conduct investigations are accounted professionally and do not increase Evidence based practice is evident by OT practice and our OT events champion evidence based practice Payment by Results (PbR) pathways are in place and OT interventions are evident in offers of care linked to NICE guidance Audit/research is embedded within OT practice; this is evidenced through annual clinical records and individual CPD, research and presentations. In the life course of this strategy clear evidence of audit and research by OTs is in place Standardised OT assessments are in place in all clinical areas with a set of core assessments and outcome tools for OT use. Clinically agreed shared model of OT practice. One audit of clinical practice has occurred to evidence this OTs will develop policies that support standardising clinical practice and reduce clinical variation in OT practice. This is what we will do to deliver this outcome: Goals 1 Audit of OT practice using Recovering Ordinary Lives tools 2 Develop OT pathways based on PbR and NICE guidance occupational focussed interventions 3 Develop OT research and have an OT research strategy which will include working jointly with research department to apply for research grants and support Improving quality of care Baseline 2015/16 Baseline survey of clinicians and managers Agree on OT pathways in line with PBR Engage with Research department to develop strategy 2016/ / / /20 50% Working to standards Define & develop the pathways in line with transformation Apply for research grants 60% Working to standards Audit pathways Aim for minimum of one research project 80% Working to standards Review & amend Continue with ongoing projects, present. Apply for further 90% Working to standards Review & amend Aim for at least three research projects 8

9 Outcome 2 People receive care that is joined up and easy to access Internal and external OT care pathways are developed to ensure parity of service whilst meeting the needs of the different populations Occupational therapy will lead to strengthened community partnerships/community asset building. Developing a culture of positive risk taking through graded occupations, working with community providers so that recovery pathways are socially inclusive Occupational therapy for mental health is available in all neighbourhoods and campus pathways. Access to occupational therapy is communicated clearly to our colleagues, commissioners, service receivers and carers Self-management approach is offered to service receivers through occupational therapy. This will involve OTs being part of the development of recovery education and peer support Vocational and employment pathways for service receivers will be developed; this will be evident through multi-agency forum and vocational strategy OTs will continue to actively contribute to multi-disciplinary teams within their professional role and capacity. This is what we will do to deliver this outcome: Goals 1 Develop OT therapeutic programme for neighbourhood and campuses, recovery education courses and peer support network 2 OT care pathways within services clearly defined with standardised clinical practices 3 Coaching network to support clinical practice: standardised assessments, case formulation intervention planning 5 Mapping exercise of current community partnership practice. Gap analysis. 6 Develop vocational strategy Joined up care easy to access Baseline 2015/16 Establish neighbourhoods Develop peer support network aim for I group course per area Establish neighbourhoods and campus. Define pathways and OT process within Establish coaching network Neighbourhood mapping in conjunction with campus and VSPA 2016/ / / /20 Expand group programme Review & measure outcome Measure outcomes & Survey to all OTs on practice impacts Vocational Strategy completed Expand group programme Review & measure outcome Measure outcomes & Expand group programme Review & measure outcome Measure outcomes & Repeat OT survey Repeat mapping exercise Expand group programme Review & measure outcome Measure outcomes & 9

10 Outcome 3: Public have confidence in our healthcare and developments There will be a clearer understanding and promotion of occupational therapy in mental health to internal and external partners. This will include examples of good practice, measured outcomes of therapeutic value and clear messages what OT in mental health can offer our public A robust database of OTs in mental health working within the Trust: HCPC registration, Apple accreditation and post graduate qualifications An assured governance framework is in place for all OTs working within the Trust that is clearly communicated both internally and externally. Work in close partnership with our senior managers and Trust Board members Innovative practice will be encouraged in line with NHS England s five year forward plan. This will include looking at new ways of working and exploring new business opportunities Service receiver and carer involvement will be at the core of occupational therapy service developments, informing decision making, co-developing, and shaping best practice. This will be evidenced through engagement meetings and Special Interest Group (SIG) reports Develop local OT practice in line with national and international OT developments. OTs will pro-actively contribute to national policy; this will be evidenced at an annual Trust OT conference. This is what we will do to deliver this outcome: Goals 1 OT/ AHP conference 2 Develop use of social media: Trust OT website, Twitter 3 OT skills database 4 Governance framework and develop accountability of Special interest groups 5 External conference: poster presentations/ paper presentations 6 Communication plan internally and externally Baseline 2015/16 Annual OT/AHP conference Establish media group and work plan Work with ESR to develop Work with quality team to develop Aim for one poster presentation Develop OT coms plan Public confidence 2016/ / / /20 Annual OT/AHP conference Implement plan Measure hits/tweets Monitor effectiveness One poster One workshop lead Develop & plan Annual OT/AHP conference 20% Increase of activity Monitor Two posters Two workshops lead Develop & plan Annual OT/AHP conference 20% Increase of activity Monitor Publication plus presentatio ns Develop & plan Annual OT/AHP conference 20% Increase of activity Monitor Three presents One publication Develop & plan 10

11 Outcome 4: Care delivered by empowered and compassionate teams Develop and strengthen compassionate professional leaders to support the development of occupational focussed interventions as part of the governance assurance. This will be part of the transformational change and clinical skills audit Strengthen the leadership skills of our OT workforce. This will be evidenced by increasing number of OTs taking part in the East Midlands Leadership Academy and development of leadership skills across all bandings of OT workforce Preceptorship OTs will be supported to gain compassionate skills that are embedded into practice and will evidence this as part of the preceptorship Occupational therapy will contribute to future workforce planning as part of AHPs. Working together with workforce and education teams to look at OT career framework within the Trust Professional CPD and development is supported through robust clinical supervision. A supervision audit will be conducted as part of this strategy and findings submitted to inform the Trust supervision policy guided by the COT supervision policy We will work closely with Health Education East Midlands (HEEM) and local universities to increase the numbers of OT student placements within the Trust. We will also monitor and develop the quality of the practice placement in partnership with our educators. This will involve reporting on student activity and supporting the case for an AHP practice development position. This is what we will do to deliver this outcome: Goals Empowered compassionate teams Baseline 2016/ / / / /16 1 Robust OT leadership structure Review leadership structure 2 OT career framework Work with workforce and HEEM to 3 Leadership workshops for each banding of OTs and OTAs address Develop workshops Deliver workshops Review 4 Improved links with universities and develop AHP student facilitator post Establish AHP student facilitator post Review and develop links and pathways 5 Audit of supervision Audit Audit Review 11

12 Occupational therapy assurances supporting CQC Standards of practice SAFE HCPC registration all OTs HCPC required CPD and audits OT standardised models of practice supported into practice through standardised OT assessments and outcome measures Policies supporting practice COT (College of OT) guidance and protocols Links to national OT networks CARING Person centred OT practice, holistic approach Personal goals intrinsic to all OT interventions based on occupational needs Occupational therapy enabling improved quality of life Self-management approach to care EFFECTIVE Use of standardised OT outcome measures to evaluate effectiveness Research OT interventions OT audits Development of personal outcome tool Collaborative working with Medequip RESPONSIVE Training in community and respite facilities Developing Therapeutic group programmes Educating care home staff on engagement in meaningful activity to address challenging behaviour Public question & answer sessions on dementia WELL LED Professional supervision structure OT preceptorships COT directives embedded into practise Students capacity increasing and quality improved by introducing student co-ordinator roles Leadership meeting: enabling collaborative working across Trust for OT Further information For information and to view a video on OT practice, please visit: You can also follow us on This strategy has been developed to indicate the direction of travel for the OT profession in mental health. It is a template for delivery of quality services enabling people to make choices as part of personalised care and care planning. This will be adjusted to align with the forthcoming new Trust strategy when developed. Derbyshire Healthcare NHS Foundation Trust Trust HQ, Ashbourne Centre Kingsway Site Derby, DE22 3LZ Tel:

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