P1:PAB/UKS P2:PAB BLBK399-FM BLBK399-Boniface December16,2011 9:31 Trim:234mm×156mm Using Occupational Therapy Theory in Practice Edited by Gail Boniface PhD, MSc, DipCOT CardiffUniversity Alison Seymour MSc, BSc, DipCOT CardiffUniversity Foreword by M. Clare Taylor A John Wiley & Sons, Ltd., Publication i P1:PAB/UKS P2:PAB BLBK399-FM BLBK399-Boniface December16,2011 9:31 Trim:234mm×156mm Thiseditionfirstpublished2012,©2012byBlackwellPublishingLtd BlackwellPublishingwasacquiredbyJohnWiley&SonsinFebruary2007.Blackwell’spublishing programhasbeenmergedwithWiley’sglobalScientific,TechnicalandMedicalbusinesstoform Wiley-Blackwell. 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Designationsusedbycompaniestodistinguishtheirproductsareoftenclaimedastrademarks.Allbrand namesandproductnamesusedinthisbookaretradenames,servicemarks,trademarksorregistered trademarksoftheirrespectiveowners.Thepublisherisnotassociatedwithanyproductorvendor mentionedinthisbook.Thispublicationisdesignedtoprovideaccurateandauthoritativeinformationin regardtothesubjectmattercovered.Itissoldontheunderstandingthatthepublisherisnotengagedin renderingprofessionalservices.Ifprofessionaladviceorotherexpertassistanceisrequired,theservicesof acompetentprofessionalshouldbesought. LibraryofCongressCataloging-in-PublicationData Usingoccupationaltherapytheoryinpractice/editedbyGailBoniface,AlisonSeymour. p. ; cm. Includesbibliographicalreferencesandindex. ISBN978-1-4443-3317-6(pbk.:alk.paper) I. Boniface,Gail. II. Seymour,Alison. [DNLM: 1. OccupationalTherapy. 2. Models,Theoretical.WB555] LCclassificationnotassigned 615.8(cid:2)515–dc23 2011034240 AcataloguerecordforthisbookisavailablefromtheBritishLibrary. Wileyalsopublishesitsbooksinavarietyofelectronicformats.Somecontentthatappearsinprintmaynot beavailableinelectronicbooks. (cid:3) Setin10/12.5ptTimesbyAptaraR Inc.,NewDelhi,India 1 2012 ii P1:PAB/UKS P2:PAB BLBK399-FM BLBK399-Boniface December16,2011 9:31 Trim:234mm×156mm Contents Contributorbiographies v Foreword xi 1 Introduction 1 GailBonifaceandAlisonSeymour Section1: Theory 2 Reconfiguringprofessionalthinkingandconduct:achallengefor occupationaltherapistsinpractice 9 DellaFishandGailBoniface 3 Definingoccupationaltherapytheory 21 GailBoniface 4 FromStrandstoTheInvisibles:fromatechnicaltoamoralmodeof reflectivepractice 38 DellaFish 5 Theuseofselfinoccupationaltherapy 49 AlisonSeymour Section2: TheUseofTheoryinPractice:SomePractitionerNarratives 6 DevelopingtheuseoftheModelofHumanOccupationina mentalhealthservice 63 LindaKeelanandLisaJohn 7 UsingReedandSanderson’sModelofAdaptationthrough Occupation:ajourney 76 KarenLewisandSharonJames P1:PAB/UKS P2:PAB BLBK399-FM BLBK399-Boniface December16,2011 9:31 Trim:234mm×156mm iv Contents 8 UsingtheCanadianModelofOccupationalPerformanceto reconfigureanintegratedoccupationaltherapyservice 91 SiaˆnWaygood,MargotMason,HeatherHurst,TamsinFeddenand CarolinePhelps 9 Dealingwiththebarrierstochangewhilstimplementingthe CanadianModelofOccupationalPerformance 106 JaneWalkerandGillianThistlewood 10 DevelopingoccupationaltherapytheoryinPoland 120 AniaPietrzakandMagdalenaLoska 11 UsingoccupationaltherapytheoryinCroatia 128 AndrejaBartolac 12 PersonalreflectionsonunderstandingandusingtheModelof HumanOccupationinpractice 141 SarahCook Section3: ContemporaryDiscussionsontheUseofTheoryin OccupationalTherapyPractice 13 Usingoccupationaltherapytheorywithinevidence-basedpractice 155 CarlyReagon 14 Occupationalscienceandoccupationaltherapy:acontemporary relationship 165 JillRiley 15 Mythsaroundusingtheoryinoccupationaltherapypractice 180 AlisonSeymour,GailBonifaceandLouiseIngham Index 189 P1:OTA/XYZ P2:ABC BLBK399-FMBM BLBK399-Boniface December16,2011 8:49 Trim:234mm×156mm Contributor biographies Editors GailBoniface PhD,MScinMedicalEducation,DipCOT,CertEd,CertificateinSupervisory Management Gailhasworkedinoccupationaltherapyeducationfor23yearsandiscurrently workingintheSchoolofHealthCareStudiesCardiffUniversityasanoccupational therapyprogrammelead.Shehasalong-standinginterestintheuseofoccupational therapytheoryinpracticeandhasbeenverymuchinvolvedinprovidingcourseson theuseofmodelsofoccupationaltherapyandsupportingpractitionersintheiruse. AlisonSeymour MSc,PostgraduateCertificateinUniversityTeachingandLearning,FHEA,BSc, DipCOT Alisonhasworkedinoccupationaltherapyeducationfor7yearsandiscurrently workingintheSchoolofHealthCareStudiesatCardiffUniversity.Previoustothis, sheworkedfor19yearsinavarietyofmentalhealthservicesincludingforensic,child andadolescentmentalhealth,communitymentalhealthandeatingdisorderservices. Shehasusedarangeofoccupationaltherapymodelsofpracticewithinthesesettings. Contributors AndrejaBartolacqualifiedinphysiotherapy,occupationaltherapyandpsychology. AndrejahasbeenworkingasateacherattheOccupationalTherapyDepartmentof UniversityofAppliedHealthStudiesinZagreb,Croatia,since2001.Herprofessional interestsareinthefieldofoccupationaltherapyassessment,ergonomicsand occupationalscience.Formorethan10years,shehasactivelyparticipatedinall majoreventsassociatedwithdevelopmentoftheoccupationaltherapyprofessionin Croatia,throughtheworkinthemainboardofnationalassociationofoccupational therapists,establishmentofCroatianChamberofHealthProfessionalsandcurriculum development. P1:OTA/XYZ P2:ABC BLBK399-FMBM BLBK399-Boniface December16,2011 8:49 Trim:234mm×156mm vi Contributorbiographies SarahCook(BScinoccupationaltherapy)isaClinicalSpecialistHeadof OccupationaltherapyintheAcuteandCrisisServicesatSouthLondonandMaudsley NHSTrust.ShehasworkedinavarietyofNHStrustsacrossSouthWalesandLondon aftercompletingherqualificationin1999.MostofherexperiencehasbeeninAcute in-patientandCrisisServices,ForensicsettingsandAssertiveOutreachTeams.Sheis passionateabouttheuseofMOHOinpracticeandregularlyprovidesworkshopson variousaspectsofthemodel.SheisavisitinglectureratSouthBankUniversity. TamsinFedden(DipCOT,PGCertHE,MSc)hasworkedasanoccupationaltherapist for28years.ShehasworkedinMentalHealth,LearningDisability,PhysicalHealth andSocialCaresettingswithadultsandchildrenandhasbeenemployedasasenior lecturerattheUniversityoftheWestofEngland.Tamsinisparticularlyinterestedin thelinksbetweentheoryandpracticeandinpractitioners’continuingdevelopment. SheisamemberoftheGloucestershireCMOP(CanadianModelofOccupational Performance)steeringgroup. DellaFish(MA,MEd,PhD,DipEd,FAcadMed)taughtinschoolsandthenin universityteachereducationfor24yearsbeforebecominganeducationalconsultant inhealthcareeducation.Herinterestsareincurriculumdesignanddevelopmentand inteachingandlearningintheclinicalsetting.ShehasworkedforTheCollegeof OccupationalTherapyasanadviserandastheirrepresentativeinvariousvalidation processes,fortheAcupunctureAccreditationBoard,transitioningprivatecolleges intouniversitiesandforTheRoyalCollegeofSurgeons,helpingthemtodesigntheir firstformalcurriculumforsurgery.SheholdschairsinSwanseaUniversity,Chester UniversityandCharlesSturtUniversityinSydney. HeatherHurst(DipCOT,MScinoccupationaltherapy)hasworkedinavarietyof healthandsocialcaresettingsoverthepast20years.Currently,sheisHead OccupationalTherapisttoateamwhoprovideoccupationaltherapyservicesfortwo communityhospitalsandisstudyingforaProfessionalDoctorate.Sheisverymuch interestedindevelopinglinksbetweentheuseofoccupationaltherapytheoryand clinicalpractice.Shecontinuestoplayanactiveroleinimplementingatheoretical modelwithinherorganisationandchairstheGloucestershireCMOP(Canadian ModelofOccupationalPerformance)steeringgroup. LouiseInghamqualifiedasanoccupationaltherapistin1985.Shespecialisedin adultmentalhealthandwasoneofthefirstgroupofoccupationaltherapiststo becomeestablishedincommunitymentalhealthteams.Inhercurrentclinicalroleas anadvancedpractitioner,shesupportsoccupationaltherapistsinNorthWestWalesto retainanddeveloptheirprofessionaloccupationalfocuswhilstbeingcoreMDT members.ShealsoworksasalecturerpractitionerinBangorUniversity. P1:OTA/XYZ P2:ABC BLBK399-FMBM BLBK399-Boniface December16,2011 8:49 Trim:234mm×156mm Contributorbiographies vii SharonJames(MPhil,DipCOT,CertificateinSupervisoryManagement)iscurrently thedeputyheadofoccupationaltherapyservicesforAbertaweBroMorgannwg UniversityHealthBoardatMorristonHospitalSwansea.Shecompletedaprojecton outcomemeasures,whichledtothecreationofanoccupationaltherapyprofessional model-ledoutcomemeasure:theMOTOM. LisaJohn(MSc,BSc(Hons))iscurrentlyHeadOccupationalTherapistforAdult MentalHealthServiceinSwansea(ABMU).Shepreviouslyworkedin,andmanaged avarietyof,mentalhealthsettingsinEnglandandWalesincluding,forensic, substancemisuseandgeneralmentalhealth.Sheiscurrentlyinvolvedindeveloping anoccupationaltherapyservicetotheProlificandPersistentOffendersProgramme withSouthWalesProbationService. LindaKeelan(DipCOT)isanoccupationaltherapistwhohasworkedwithpeople accessingmentalhealthservicesfor27years.Herclinicalrolehasbeenmainlywithin communitymentalhealthsettings,andalsoincludesin-patientworkwithadults,older people’smentalhealthandmentalhealthrehabilitation.Hercurrentroleisasleadfor occupationaltherapyandothertherapiesformentalhealthservicesinAbertaweBro MorgannwgUniversityHealthBoard,whichoffersextensivelocalandregional mentalhealthservices.Lindahasmaintainedoccupationatthecoreofherpractice andincorporatestheoccupationaltherapyphilosophywithinpeopleandservice development. KarenLewis(MSc,DipCOT)iscurrentlytheOccupationalTherapyManagerfor MorristonHospital,Swansea,whichispartofAbertaweBroMorgannwgUniversity HealthBoard.Shehasworkedinadiverserangeofsettingsthroughouthercareer includinglocalauthority,mentalhealthandlatterlyspecialisinginphysicalsettings. Herareasofpracticehavemorerecentlyincludedpalliativecareandneurosciences, duringwhichshewasinstrumentalinsettingupaParkinson’sdiseaseAssessmentand TreatmentCentreinSwansea. MagdalenaLoska(PhD,MA,BA)currentlyworksasaseniorlectureratTheMaria GrzegorzewskaAcademyofSpecialEducationandistheheadoftheOccupational TherapyDepartmentthere.Sheisalsoaspecialeducationteacher,specialisingin workingwithpeoplewithphysicaldisabilitiesandhasanumberofadditional neuro-developmentalandsensoryintegrationqualifications.Shehascontributedtoa numberofbooksandwrittenarticlesonthesubjectofenablingchildrenwith disabilitiestobecomemoreautonomous.Sheisalsoengagedineducatingteacherson thistopic.Hercurrentinterestsareinassessinglevelsofautonomyforchildrenwith cerebralpalsyandidentifyingbarrierstothatautonomy. MargotMason(BSc,PostgraduateDiplomainOccupationalTherapy)hasworkedin AdultSocialCareoccupationaltherapyfor16yearsandiscurrentlyworkingasa CommunityOccupationalTherapyManagerforNHSGloucestershireCareServices. P1:OTA/XYZ P2:ABC BLBK399-FMBM BLBK399-Boniface December16,2011 8:49 Trim:234mm×156mm viii Contributorbiographies Shetakesanactiveinterestinservicedevelopmentandtheuseofevidence-based practiceandisamemberoftheGloucestershireCMOPsteeringgroup. CarolinePhelpsqualifiedin2002withaBSc(Hons)inoccupationaltherapyfromthe schoolofhealthprofessionsandrehabilitationsciencesinSouthampton.Carolinehas workedatGloucestershireRoyalHospitalsince2004.Carolinebecameinvolvedat theverybeginningofGloucestershire’sjourneyinimplementingtheCanadianModel ofOccupationalTherapyandwasoneofthemembersoftheoriginalsteeringgroup. AniaPietrzak(MAinPedagogicalEducation,DipSocialWork,CertEd,DipOT)is currentlystudyingforherPhD.Aniahasworkedinareformatoryschoolasan occupationaltherapist.Currently,sheworksintheAcademyofSpecialEducationin Warsaw(Poland)asalecturerandoccupationaltherapycurriculumco-author.Her fieldofinterestistodevelopandadaptPolishoccupationaltherapytomeetthe requiredworldstandards.Sheisinthecourseofcreatinganewassessmenttoolfor measuringadaptiveskillsforpeoplewithlearningdisabilities. CarlyReagon(PhD,BScinoccupationaltherapy)isalecturerandresearcherinthe SchoolofHealthCareStudies,CardiffUniversity,Wales.In2006,shecompleteda PhDexploringperceptionsofevidence-basedpracticeamongstagroupof occupationaltherapistsinEngland. JillRiley(PhD,MScinoccupationaltherapy,PGDip(socialscienceresearch methods),DipCOT)hasbeenalecturerinoccupationaltherapysince1998andis currentlyaresearchcoordinatorandprogrammeleadfortheMScinoccupational therapyintheSchoolofHealthCareStudies,CardiffUniversity.Jillhasaspecial interestinOccupationalScienceandespeciallycreativeoccupationsandtheir relationshiptohealthandwell-being. GillianThistlewood(MSc,DipCOT)currentlyleadsandmanagesanoccupational therapyserviceovertwoacutehospitals.Afterqualifyingin1987asanoccupational therapist,GillianwentontogainaMaster’sinHealthSciences(Universityof London)in1994.Shebringsexperience,over23years,inoccupationaltherapy practice,inarangeofclinicalandmanagerialsettings.Shehasworkedacrossteams andinter-professionalboundariesandchallengeswitharangeofhealthcareworkers. Gillianhasaninterestinclinicalethicsandperformancemanagementandisa memberoftheGloucestershireCMOPsteeringgroup. JaneWalker(MSc,DipCOT)leadsandmanagesanoccupationaltherapyservice overarangeofhealthandsocialcaresettings,includingcommunityhospitals, intermediatecare,socialcareandwheelchairservices.Shequalifiedasan occupationaltherapistin1984andgainedaMaster’sinAdvancedOccupational Therapy(PlymouthUniversity)in2008.Herparticularinterestliesinsocialcareand developingtheroleofoccupationaltherapistswithinthispracticesetting.Sheisa memberoftheGloucestershireCMOPsteeringgroup. P1:OTA/XYZ P2:ABC BLBK399-FMBM BLBK399-Boniface December16,2011 8:49 Trim:234mm×156mm Contributorbiographies ix SiaˆnWaygood(MAinManagementandLeadershipinHealthandSocialCare, DipCOT)iscurrentlytheProfessionalHeadofOccupationalTherapyServicesin Gloucestershire.DuringhertimeinGloucestershire,Siaˆnhasworkedwithcolleagues andkeystakeholdersfromarangeofstatutoryandvoluntaryorganisationsin GloucestershireonanumberofprojectstoenhanceservicesforGloucestershire residentsincludingIntegrationoftheOccupationalTherapyandCommunity EquipmentServices,introducingTelecareServicesandDevelopmentof Client-CentredPracticemodels.SiaˆniscurrentlyakeymemberoftheGloucestershire CMOPsteeringgroup. P1:PAB/UKS P2:PAB BLBK399-Foreword BLBK399-Boniface December16,2011 9:35 Trim:234mm×156mm Foreword The notion of the theory/practice divide and the challenge of applying theory into practice is not new and is something that academics, practitioners and students all strugglewith.Therearetextsabouttheorybutwhathavebeenmissingarethestories ofhowtoputtheoryintopractice.Whilstthereflectorsandtheoreticiansamongstus mightbeabletousethestrengthsoftheirlearningstylestoworkouthowtoputtheory intotheirpractice,thoseofuswhoarepragmatistsneedtoseeexamplestohelpusput ideas into practice. Gail Boniface and Alison Seymour and their team of practitioner colleagues have given us the tools and the stories to help cross the theory/practice divideandhavecombinedthe‘ivorytower’oftheacademicworldwiththe‘reallife’ ofpractice. Asoccupationaltherapistsweseeourselvesaspractical,pragmatic,hands-onpeople whogetthejobdone.Howmanyofuswhenwebuyflat-packfurnitureskimthrough theinstructionsbutthenjustgetstuckintryingtobuildthething?Practicecanseemto belikethat,butwithoutthetheoryandtheevidencewecannotarticulateourclinical reasoning, as Sarah Cook says in Chapter 12; we might get ‘found out’, but more importantlywemightnotbeabletogiveaclearrationaleforourroleandsowewill ceasetoexist.Weneedthetheoriesandweneedtobeabletodoasthepractitioners inthisbookhavedone–weneedtobeabletotellthestoryofhowtheoryandmodels underpinourpracticeandouractions. In Chapter 3, Gail Boniface reminds us of the theory of occupational therapy and definestherelevantterms(e.g.model,approach,paradigm)andusesthemetaphorofan umbrellatoillustratehowtheory,modelsandtheprofessionalselfmustbeintegrated withinpractice.Occupationaltherapistsareoftenaccusedofbeing‘jackofalltrades’ (Drummond 2010) and eclectic. However, the metaphor of the umbrella might help practitioners who feel drawn to an eclectic approach to articulate and justify why eclecticismisappropriateandusefulwithintheirpracticeconcept. One of the key tools for linking theory and practice is evidence-based practice. However,thenotionof‘evidence’iscontested,asCarlyReagondiscussesinChapter 13. Whilst the use and application of quantitative research evidence, such as RCT and systematic review evidence, is well documented (e.g. Taylor 2007), the inte- gration of the practitioner’s experiential knowledge is much more complex and less wellarticulated.DellaFish,inChapter4,exploresreflectivewritingandpresentsthe idea of ‘Clinical Reflective Writing’ and particularly the idea of the ‘rainbow draft’