PP3 weeks 1 and 2

Community Mental Health.

My first couple of weeks with the community mental health team has been spent mostly by me getting to grips with the complex range of conditions, environments and even the many different roles within the team. Although the format of the team is similar to the community teams I've spent previous placements with, there are a lot more professionals and roles for example; OT's, support workers, CBT therapists, DBT therapists, social workers, nurses, clinical psychologist and pharmacist. It is an excellent opportunity for me to see the many different professions and how they work together to provide the service. I have seen this through attending various MDT meetings and clinical discussion meetings, which have given me a really good insight and enabled me to voice my views and opinions on service users that I have met on community visits.

So far I have spent time on visits with the OT's and a couple of the support workers in the team. This has enabled me to see a variety of service users with varying mental health conditions. Within the team here the OT's practice by using the framework of the CMOP-E and by using this I have been able to go out with support workers and reflect afterwards, using this model to assist me in having a holistic occupation focus. Although the OT's use the COPM - I am yet so see this or assist in administering this assessment tool as a lot of the service users have had OT involvement for a long period of time and are currently not in need of this assessment. Although I have seen very little standardised assessment tools, I have seen the importance of observation skills within community visits.

Community mental health OT differs quite a lot from my experience in physical community settings. This is because recovery in mental health is a very different process. It is discussed by Lloyd, Wong & Petchkovsky (2007) as a subjective and individualised process:

"Unlike the biomedical definition of recovery, it is not a predictable and medically mediated process, but the emergence of a new identity as a product of self-discovery." (p. 207).

Due to this, I have observed that the OT process involving individuals with mental health conditions can be a very long process and often very cyclical, remaining on the goal setting, intervention/assessment and evaluation stages, changing as a person progresses or adapting for varying needs relating to their condition. OT in mental health appears to be a lengthy process with service users facing many set-backs and barriers to their OT interventions. Some of which include, drug addictions, low motivation, low mood and impaired sense of safety-health and well being etc.

It is very interesting to have seen both sides of community OT within my placement experiences and to be able to contrast and compare the two. Due to the nature of this setting, I feel it is going to be more difficult to perform at the higher level expected for this placement and I have found this difficult during the past two weeks as I have needed this time to 'find my feet' and get to grips with the new conditions I am experiencing and how the team works. 

In-patient Unit

During placement I will be spending one day a week on the in-patient unit and my first day on the inpatient ward was a totally new experience for me. At first I did feel a little apprehensive on the ward as I observed the impact of severe mental health conditions upon the occupational identity, roles, habits, motivation and routines of individuals. I observed the OT using MOHO based screening tools to interview individuals to assess their occupational profile, using narrative clinical reasoning skills to build up an occupational picture of how that person has been in the past, what they are functioning like currently and what they want to do in their future. A shock for me was the impact of their current mental state as the individual being interviewed currently felt that they had no role or purpose in their life, no routine and no hobbies/interests. The part of the OT screening that I really liked was a questionnaire about a persons hobbies and interests which asked a person what hobbies/activities they have engaged in, in the past or had an interest in, and if there are any activities they would like to get back into in their future to assist their recovery process – or even try out some new activities. This for me felt very occupation focused and was assisted with the structure and occupation focus from the MOHO framework.

I also observed arts & craft groups, baking groups and pamper groups taking place for individuals from the ward to take part in. Although this was occupation focused and person centred I did observe that the support workers within the team had more involvement in engaging in these groups reflecting possible generic roles.

I spent some time on the intensive care unit too and engaged in a mindful arts and crafts session. The ward was a very relaxed, friendly atmosphere and the service users appeared to be enjoying the activities offered.

As part of my placement objectives I am currently researching and planning into an art therapy group that I can implement myself on the inpatient unit. This is a personal passion of mine and a huge interest within OT practice so I am very excited by this opportunity.

Acute Therapy Services

The ATS team was another new experience for me. ATS supports individuals for 5 days a week providing holistic, structured activities to aid recovery and to prevent hospital admission. It’s service is unique and the only service of its kind in the country. Within the team is an OT, mental health nurse and support workers.

On arrival I introduced myself to the service users and the atmosphere automatically felt very laid back and relaxed. The service is focused on letting the SU be responsible for their own care and they are not treated as secure patients, they have access to everything and it is their choice should they choose to engage in the structured activities provided.

For the first time on a placement I did not feel like a 'professional' and didn’t feel that client – professional divide within any of the sessions or the environment. Everyone was treated as equal and I felt this made a huge difference to the service users and indeed to the professionals.

The daily activities began with breakfast club, a mindfulness breathing exercise, followed by an art session and then helping to prepare a buffet lunch. The afternoon offered holistic therapies including, massage and the group engaged in more laid back leisure activities including playing card games, board games and engaging in conversation – some laughter therapy! Others chose to sit in quieter areas to relax and un-wind. All of the activities offered provided individuals to socially interact and talk/share about their own experiences and interests in a non-judgemental environment.

I really enjoyed my experience with the ATS team and I will be spending more of my time there during placement.

Placement Objectives

To help me achieve the objectives for my placement, I have set out the following objectives in my learning contract:

• Case study
• Use some assessment tools and models in practice
• Take an OT referral during MDT meeting
• Plan and implement an art group on the inpatient unit
• Take the lead on an intervention with 1 service user
• Develop an understanding of a range of MH conditions

To begin meeting some of my objectives I have created a visual mind map to illustrate the role of the OT within the community mental health team. This includes:

• Conditions
• Symptoms
• Affect on occupational performance
• MDT & Interagency working
• Models
• Legislation
• OT Process
• Interventions
• Assessment tools

This has helped me look at the service as a whole and look at the OT role within the team to gain a wider understanding as I am observing on my placement.

I will blog over the next few weeks about my progress on placement :)

References:

Lloyd, C. Wong, S.R. Petchovsky, L. (2007) 'Art and recovery in mental health: a qualitative investigation. British Journal of Occupational Therapy, 70(5), pp.207-214.

Losing my pets... an occupational therapy perspective.

As an occupational therapy student I now have this constant awareness of occupation all around me and around each person that I encounter. I have an in-built understanding and awareness of environment-person-occupation and of which occupations constitute as self-care, leisure or productivity or even what activities are meaningful enough to a person to be considered as an occupation in the first place.

One of my most meaningful occupations in my life was being an owner to my two cats Suki and Amber. Unfortunately I have lost both of my cats this year. Suki passed away in May and Amber more recently in November. Occupational therapy has given me an awareness and understanding of why my cats meant so much to me, and why it has caused me much distress to have lost them.

Duncan (2011) discusses that occupational therapy is concerned with the key elements of both occupational performance and occupational identity. This can be explored as how a person identifies themselves, their roles and their relationships within their physical and social environment. From this I have realised that a big part of my occupational role was being a pet owner and this was also a huge part of my occupational identity. This dawned on me recently when Amber had passed away and the thoughts of meeting new people on placement...

"Hi my name is Vicky, I have a little cat called Amber, and she only has one eye as she was ran over... look how cute she is!" Oh...

Being a pet owner can be conceptualised as an occupation as it refers to groups of activities and tasks of daily life (Allen 2000). Allen (2000) & McNicholas et al (2005) explore that pet ownership can provide structure to daily routines and can contribute to the areas of self-care, leisure and productivity. Here is my illustrated version:

Routine, self-care, leisure and productivity.

My day would generally start promptly at 6:00am by being 'dive bombed' off the window ledge by this one, closely followed by a lot of purring down the ears, a lick to the face and if I was being really lazy, then a bite to my toes. I would then get up to feed her and get ready for work or uni. This is Amber by the way.

Amber would make sure I did my hair and make-up just right... and would make it as difficult as possible to undertake my self-care activities, especially by stealing my towel...and even my shoes!

Suki loved to get involved with my occupations of leisure and productivity, here she is 'helping' me to knit and wrapping presents.

They both loved to get involved in my uni work and made excellent study companions. I think Suki however, became quite jealous of the laptop taking up space on my lap. 

From this illustration it could be questioned if my occupation was a pet owner who looked after my cats or was I the pet and my cats were the ones looking after me... I think the latter somehow! 

You can see that within my daily routine as a 'pet' my cats were a huge part of my everyday life, and were involved in the majority of my daily occupations at home. I have referred to them above as companions and I do think of them as family members and this is also reflected by McNicholas et al (2005) that over 90% of pet owners within the study regarded their pet as a valued family member. It is also discussed further that 'companionship' may have an importance in fostering positive mental health on a daily basis. 

I can personally relate to this notion that my cats definitely had a positive impact upon my mental health and their little characters genuinely made me happy, laugh, smile and gave me a purpose. I would look forward to coming home after a long day to sit balancing both purring cats on my lap with a cup of tea to un-wind. To look after my cats by feeding them good food, spoiling them with treats, toys, grooming you name it was such a rewarding occupation for me to engage in as they gave so much back in terms of companionship and love. Nicholas et al (2005) discuss that people value the relationship and the contribution their pet makes to their quality of life, reflecting my opinion completely. Looking after their health was a huge part of this too as Amber had a terrible accident in 2013 resulting in losing her eye and fracturing her jaw. It took months of surgeries and tube feeding to nurse her back to health. This therefore did cause me some stress, lack of appetite & sleep and did have a negative impact upon my occupational performance at that time.

But of course I wouldn't have had it any other way! This is an important point though that as well as enhancing quality of life, pet ownership can be stressful at times and the death of a pet can cause extreme distress for owners (Allen 2000, McNicholas et al 2005). Although discussed by Nicholas et al (2005) that pets may be of particular value to older people and patients recovering from major illnesses, there is therefore a risk of a person becoming so attached and reliant on their pet for their quality of life, routines and social interaction that the loss of a pet could cause a reversed affect and the person could become stressed, anxious or socially isolated, having a negative impact upon their occupational performance and general health. From this it is evident just how powerful pet ownership is as an occupation and an experience that I have encountered twice in one year.

To conclude my discussion, it is important as occupational therapists to recognise pet ownership on the impact of occupational roles, routines and occupational identity as it could have a significant meaning within the life of an individual. Pet related occupational therapy interventions could therefore be effective in promoting independence and enabling occupation (McNicholas 2005). 

I hope that this blog post has given you an insight into my occupational identity and role as a cat owner, I really wanted to celebrate their little lives and how they made each part of every day special and unique for me and in turn definitely enhancing my occupational purr-formance. 

References:

Allen, J. M. (2000) 'The Experience of Pet Ownership as a Meaningful Occupation', Canadian Journal of Occupational Therapy, 67(4), pp. 271-278.

Duncan, A. S. (2011) Foundations for Practice in Occupational Therapy. 5^th edn. Edinburgh: Churchill livingstone Elsevier.    

McNicholas, J. Gilbey, A. Rennie, A. Ahmedzal, S. Dono, J. Ormerod, E. (2005) 'Pet Ownership and Human Health: A Brief Review of Evidence and Issues', British Medical Journal, 331(7527), pp. 1252-1254.

In at the deep end...

The first term of second year has proven to be very fast paced and very intense and I have appeared to have neglected my blog over the past few weeks and not really given myself time to reflect! Note to self... in reflection I need to give myself more time to reflect! However it can be a challenge with a very busy timetable.

So... what have I been up to!?

During the 5 weeks of term I have been attending classes for my Applied OT (2) module and learning about many different specialist areas of OT. Along side this I was learning and researching another specialist area of OT in preparation for an assessed 30 minute viva examination. Alongside this I have been working on my dissertation ethics documentation (which have now been approved!), and I have also been preparing for placement. I have just finished my first week of placement but I will be writing separate posts about this.

So the past few weeks I have spent time mostly stressing out about the Viva... I think this is because I had never done a viva before and was unsure of what it looked like, and the expectations of masters level within a speaking examination. Here are strategies I used to prepare:

To begin with I chose a topic area that I was interested in but didn't know a lot about. I chose paediatric OT using a sensory integration approach. Sensory integration is something that I have an interest in and I chose paediatrics as there was more literature available and to make the most of learning about a new area that I have no experience of.

I started by slowly reading... and I did a lot of reading! Just to gain a broad understanding and a foundation to build further understanding on the topic area. On reflection I probably did read too broadly as I ended up with 40 pages of notes scattered everywhere in no particular order which made the situation a lot more stressful (I wouldn't advise doing it this way!). I also ended up with lots of tabs open on my laptop and was not very organised in keeping on top of my referencing as I went along. At that stage I did feel very stressed out...

I decided then that the best way for me to collate my information and condense it altogether would be to create a visual mind map basing it around the structure of example questions that had been provided to us.

This did end up being quite a giant mind map even though I did condense a lot of the information I had gathered! Our formative assessment for this module was to present an overview of our specialist area to a group of 1st & 2nd years and a tutor. This actually proved to be quite helpful for me as it made me aware that I had gathered a lot of un-neccesary information that was quite descriptive. It also helped me to gain ideas of areas I could critique and go further into depth with.

After the formative assessment I made a plan and did yet more reading and added more critique to my information. I then condensed this further and typed it into a script. Now I know we were not to learn our information in a script but in order for me to learn and retain information, I have to put the information into a structure or an order (I spent a lot of time being baffled by this!) 

A good tip which I would personally advise is to try and practice your viva with someone, however I know for some people this is not possible. I practiced my viva with my partner and told him to deliberately switch the order of the questions as he was asking them so I would not be reading from a script of information and so that it would flow more freely. This was really difficult at first as it did highlight weaknesses (like responding in scripted answers) but it gave me really good practice of what to expect in the viva and it helped be be more conversational with my answers.

How did the viva go??

Unfortunately my little pussy cat passed away the night before the viva (if you know me, you'll know just how much I loved my cats). I traveled to uni on my 3 hour long commute on just 2 hours sleep and feeling very distressed.

But, I did manage to get through the viva and even though I was not feeling my best, the experience wasn't as bad as I thought it may be! The environment was actually very relaxed & friendly and after a few minutes I forgot I was being filmed or that I was in an exam at all at times! I felt relaxed into the conversation (This may also be a bad thing) but I won't know how i have done until we get our results in another couple of weeks so I have my fingers crossed!

So all in all it has been quite an intense few weeks to say the least. I think because of the volume of work required in such a short space of time. On reflection I needed to be far more organised with my preparation methods! This is a good outcome though as it will assist me in better preparation for my 45 minute viva next year!

I will post soon about my placement and dissertation I promise! :) 

Wow I'm a 2nd year student!

This photo can mean only one thing! My first train commute back to uni for my 2nd and final year!

I feel excited and nervous about the year ahead and the reality of how close I am to applying for jobs and preparing for life as a newly qualified OT is beginning to hit me! I have a feeling that this year is going to go even faster than the last!

We have started the week by beginning our new module in which we will be studying specialist areas of practice for OT's and there is a 30 minute assessed Viva in 6 weeks time! I have never done a viva assessment before but I feel this will allow me to develop my verbal communication skills/knowledge and prepare for interview environments! The topics we will cover during the module sound really interesting and I am looking forward to learning new things and also synthesising knowledge I have experienced of specialist areas from placement.

I have received my practice placement 3 allocation and this time I am with a community mental health team! I'm very excited about this as it is an area of practice that I am interested in yet have no experience of. This does make me slightly nervous however, because this placement is a step up to level 6 and a lot more is expected of me within an area I do not know a lot about! I will now contact my placement area and begin my much needed preparation!

I have also been assigned some 'buddies' through the new buddy system at uni where we as 2nd years have the opportunity to help and support 1st year students. I am looking forward to this opportunity. I think back to how I was feeling this time last year when everything felt so new and I didn't know what to expect. I would've quite liked to have a buddy. I remember feeling lost and anxious at the critical language of masters level study and the overwhelming un-certanty of what was expected of us at this level. I look back now a year on and I smile, I can't believe I'm here and that I made it through without failing a single thing. I really feel that OT is where I am meant to be and I'm proud of the journey I have been on that has got me here so far. Here's to another roller coaster ride of a year, but this time with a years experience under my belt.

I will post soon about my progress on beginning 2nd year, my new modules and dare I say dissertation? ....

Summer

Summer Holidays 

A break over the past few weeks has been much needed after the intense first year of the MSc! It has been important for me to switch off from uni and to engage in occupations that I do not have chance to whilst studying during term time.

On reflection from my first year I have thought of some tips to share with those who may be beginning the MSc in September:

• Keep a diary! Managing your time is hugely important on an intense course like this one. Plan for classes and lectures in good time, begin your assignments early and most importantly, make some time for yourself!
• Do plenty of reading! It took me a while to gain an understanding of academic literature from coming from a different degree background. But as I have read more and understood the language in which critical research articles are written, I feel my critical reading and writing skills have really improved!
• Be prepared to work in groups and teams and allow room for flexibility in your routine for this.
• Try not to panic, we have all been there it's perfectly normal to feel panicked and anxious (because you will at some stage) take a deep breath. The course intensity is a shock to your system but it will be ok!
• If you are completely new to research (like I was) make a glossary and familiarise yourself with research terminology before your research lectures... trust me, I wish I had done this! 
• Seek help and support from tutors and your universities learning support services.
• Be prepared to move location for your placements, be flexible with this and enjoy all the opportunities offered to you!
• Reflect on all of your experiences! I use my blog for this and creative activities.
• Become a student member of BAOT for access to the British Journal of Occupational Therapy (really good for writing your assignments).
• If you are a Twitter person, join in with #Otalk on a Tuesday evening to get involved and connected with OT's and other students.
• Keep updated with CPD opportunities and attend some conferences if you can.

• Most importantly....  HAVE FUN! Enjoy yourselves, make new friends & contacts. Feed off each others experiences, work together. 

So here's some of the occupations I have engaged in over the summer:

                                                             Painting

Cooking

Spending time with family

Socialising with friends

Time with my partner.

Pampering!

Walking

Exploring & visiting new places

Splash dashing for charity!

Spending time with my cat.

And of course working to earn some much needed cash!

So as you can see I have been engaging in a variety of occupations that span through the areas of self care, leisure and productivity and these occupations are all very important and make me who I am! 

I'm feeling very well rested and relaxed and somewhat ready to tackle second year... feeling slightly nervous about the intense road that lies ahead! But most of all I'm excited! This time next year I'll be an OT! Yippee!

For those new students that may read this I will leave you with this thought:

What is an occupation?

My research head is on!

Wow! It's been over a month since my last post! This reflects just how busy the past few weeks have been. Here's what I have been up to:

My presentation was completed and I survived! I was delighted to discover recently that I gained my highest grade yet for this assignment and this has given me such a big confidence boost and just the motivation I needed to help me get through writing my research proposal.

Yep... one assignment left and 1st year shall be complete! I really cannot believe how far I have come over this past year!

For my research proposal i'm currently within the depths of  occupational therapy theory with creativity entwined through its historical core and i'm on a road of discovery, unveiling it's power to enhance the 'hidden' lives of individual's with Autism in so many ways!

Image available at: http://www.buzzquotes.com/unconnected-quotes

As much as I'm finding it a challenge to write, I am really enjoying it as it is a subject I feel very passionate about. I am looking forward to carrying out my investigations, however apprehensive about writing 10,000 about next year!

'Occupational' Growth?

I always said I wanted this blog to be a true, personal reflection of my experience as a student; and that's just what this post will be.

To be honest I am once again feeling the pressures of masters level study as the upcoming assessed presentation grows ever near and with my research proposal also on the back burner. I'm finding it hard juggling the two with preparing for and attending classes, commuting and working. It also makes it harder when the rest of the uni campus is deserted as most of the other courses have finished for the summer... nope not us! Our research is not due in until the 14th August when we will finally get a small break before returning in September.

But, no one ever said it was going to be easy! So today I took a deep breath and I realised just how much I have developed over the past 9 months. 

In our final class for our Applied OT module the lecturer set us a creative task (which I loved of course!) where we had to create an image/metaphor to represent our journey during the module, and in fact, I feel it represents the whole course really!

My group created an image of a tree (I've decided I must have 'a thing' about trees!) and it represents our journey through theory and growth in knowledge and also the journey of a patient through the OT process. The little nest represents placement - an integral part of our journey where we reinforce our knowledge and fledge the nest at the end filled with new knowledge. The branches represent the different journey's of OT intervention, with liasing with different professionals, setting goals and revising each step throughout the process, taking different angles and making changes.

The course for me has been positive in more ways than one! If you have read any of my past posts from my last placement you will re-call me discussing realising some of my limitations in situations during placement. By this, I meant difficulties in my ability to learn and difficulties highlighted to me through administering cognitive assessments. This week I was assessed and diagnosed as having a specific learning disability, I have Dyscalculia. 

This is no surprise to me as I have struggled specifically with numbers and my ability to retain certain information my whole life! However, it has always been overlooked as I worked to a good level in all of my other classes in school. No one has ever really taken it seriously and I feel so re-assured now that I know the reasons why I have difficulties with certain things, and that there are other people out there like me and people that understand and can help/support me!

So over-all i'm currently feeling anxious and stressed however, this is such a positive adventure for me in which I have learned and gained so much so far!

To help alleviate some of our concerns - our lovely lecturer gave us another creative activity (which I loved!) To create origami boxes and fill it with positive words of support and thoughts to help us get through our presentations.

My little box of thoughts... yes, that is some chocolate too!

...And of course we will all be absolutely fine!