4 Extending the Boundaires of Practice Learning – Theresa Baxter

practice educators
Extending the
Boundaries of Practice
Dr Theresa Baxter
service users
Extended Scope Placements
• The emergence of new roles for Occupational Therapists
is a global phenomenon.
• Within the UK, OTs are increasingly employed in nontraditional settings, often within the third sector. OTs in
these settings work with a greater amount of autonomy
and independence, as they are often the only OT within
a setting.
Opportunities & Benefits for
students, service, service users
• Students will graduate with confidence and
equipped in service development, making
them the ideal new generation of OTs to take
up the emerging employment opportunities,
and further expand the profession enabling
more people to benefit from rehabilitation and
reablement outside traditional statutory
Examples of placement opportunities
Areas of Opportunity
Clare Lodge is a leading national provider
of secure accommodation "welfare" only
placements and the only all female unit in
the UK.
Sooper Troopers a registered charity that
supports young people 16 and over to
develop confidence and self esteem performance arts
Practice Example
• Reach(Southwell Project) - Nottinghamshire
'Our mission is to support Adults with Learning
Disabilities to achieve and sustain the best
possible quality of life within their local community'
• 2 Students placed for 12 weeks - Level 5
• Long arm supervisor - Team leader
Learning Disabilities LPFT
• On Site Supervisor
What the Students bring...
Occupational Focus
Grading/Activity analysis
Assessment tools
Evaluation tools
What the students gain...
New Ways of working
Collaborative working skills
Understanding of voluntary organisations
OT Professional identity
What the students said...
'Being on a non-traditional placement felt scary at times but I can honestly
say that I developed more as a student and a person over the 12 weeks I
was there, than I did over the course of both my previous placements
combined. It wasn't always comfortable but it was an excellent preparation
for being out in the real world of work.'
'Undertaking a placement in a setting where people had no clear
understanding of the role of occupational therapy, made me develop a
stronger sense of my professional identity. I couldn't assume that people
knew why I was doing what I was doing. I not only had to make sure I
understood the rationale behind my actions but I had to articulate it clearly
to others in a way that was easy to understand.' Beth & Clare 2014
'Being on a non-traditional placement helped me to understand the true value
of supervision and reflection. Because I didn't have immediate access to a
supervisor, I prepared well for my supervision sessions and used them to the
max. I was needy to start with but as time went on and my confidence grew, I
was able to let go and trust my own judgement more.'
'The supervisor/supervisee relationship is always important but it is essential in
the context of a non-traditional placement to have a supervisor who is fully
committed to the process. My supervisor supported and challenged me in equal
measures. Between our weekly supervision sessions she stayed in regular
contact via email, sending articles and links to relevant info. She also let it be
known that she was happy for me to call at any time and if unavailable, she
would phone me back at the earliest opportunity. '
Practice Example
• Framework is a registered charity and housing
association that exists to tackle the causes and
consequences of homelessness.
• By preventing homelessness
• By stopping rough sleeping
• By helping people to live independent lives
'too many hospitals simply discharging homeless people back to
the streets. Patching a person up and sending them out without
a plan makes no sense.' DoH 2012
2 Students 13 week p/t placement
Pre visit to meet manager
Audit & risk assessment
Identification of on-site supervisor
Identification of long arm supervisor
Establish placement Learning objectives
Service User needs identified by students
Implications of long term alcohol
Physical Health
Increased risk of
•alcoholic hepatitis
•Liver cirrhosis
•Heart disease
•Inflammation of the
•stomach ulcers
Public Health Agency Know your
limits (2009)
Mental Health
Associated with:
•Depression & Anxiety
•Personality Disorders
•Difficulty sleeping
Alcohol related brain
• coordination,
•behaviour and
Mental Health foundation (2006)
At a greater risk of :
•Becoming a victim of
•Involvement in criminal
or antisocial behaviour
•Having an accident
•Lack of education
•Damaging relationships
Klingemann (2001)
•Enhance quality of life
•Promote independence
Intervention Plan
• a structured timetable of activities
tailored negotiated with residents
• AIM = help the person using alcohol or
drugs to gain satisfaction from new
activities away from these substances.
Health and
• Incorporate health and wellbeing
sessions into the timetable
• AIM = promote health and encourage
more independant self care, self
esteem, empowerment & self worth
• Create a life story with a service user
experiencing memory problems
• AIM = Use this life story to benefit the
service user in their present situation
Practice Example
• Finalise student - secure unit for young women - 9 week full
time placement
• on site -supervisor - Psychiatrist
• long arm supervisor - OT in CAMHS
• Focus Occupational Performance - moving on...
• Interventions negotiated with Service users
• Additional outcome - business plan for development of OT
'Why do we need an OT?'...'What will we do without you?'
preparation for practice
• placement is preparation for practice - depends
on good communication between all parties
• Integrating theory with practice
• we all want highly effective, skilled, flexible,
innovative, caring, compassionate, person-centred
• placement is at centre of our education and as
such is pivotal to success of our courses
The Student Voice
• "So much scope, so much potential, no
hierarchy, back down to earth working with
people, no uniforms, black pens, form filling,
bleeps and titles"
• "Its a whole different way of working. People are
there with passion and fire and belief in the
Conclusion & Outcomes
Understanding of Practice that is Service user focussed
Development of extended skills and knowledge
New ways of working with the 'patient at the centre'
Meeting the needs of those who are often excluded or sit
outside statutory organisations, or are seen as 'difficult
patients' when accessing the NHS
• Leadership skills
Any Questions?
Dr Theresa Baxter
[email protected]