Category: AHP

AHP, Blog Post, Occupational Therapy, RCOT, Recovery

What is #rehabilitation, why is it so hard to define and do we need to define it? 

@OT_rach

Acknowledgment – This blog post is a personal opinion piece, based on thoughts and ideas about my own lived experience, writing is an occupation that helps me make sense of my thoughts and ideas. I acknowledge these may not be shared others, and respect peoples rights to have, different even conflicting ideas.  This website has an accessible feature, that allows different accessible formats by simply clicking on a button labelled ‘Accessibility Menu’ that appears in green on all pages. It will provide you with a number of options to change the appearance to meet your accessibility needs.  This communication has been written by a dyslexic person. If you have any trouble with the meaning of any of the sentences or words, please do not be afraid to ask for clarification. I’m #MadeByDyslexia – expect creative thinking & creative spelling.

This week at work, I attended a two day event to look at the provision of mental health rehabilitation services that the trust I work for provides and how we might redesign it as part of the national driver of community transformation expected within all NHS mental health service providers.  

In a nut shell community transformation is about dramatically changing how services are run by braking down barriers to care, by removing criteria and long referral processes.  A service that meets the needs of the individual rather than the individual having to fit in to the narrow criteria of a service. 

Brilliant, just the sort of service I have talked about when reflecting on my own journey of recovery.  

Changing cultures are hard, and perhaps although a lot of difficulties with poor practice that dehumanises people still remain within institutional services.   Mental health and learning disabilities organisations and national drivers are ahead of the curve when it comes to progressing towards services that meet the needs of people.   

Why might this be?  

For me it’s a move towards, co-creation, recovery focused and inclusive practices that don’t just listen to stories of lived experiences,  but actively invites it in to work for the organisations and develop alongside traditional health and care professionals changes in culture, and service delivery.  

Something NHS services, delivering physical health services and local authorities that provide social care need to embrace.  

So at this event there was a mixture of health professionals working within the current rehabilitation service, like nurses, health care assistants, psychologists, occupational therapists, peer support workers,  experts by experience, managers, service leaders, etc..

Our first task was to define rehabilitation. What it is, how it is different from other services offered by the trust. In essence the unique selling point.  

This blog will focus on this question as perhaps you might be surprised how difficult a group of people who have worked in or received care from rehabilitation services found it so hard to define.  

Where to start? 

Perhaps with the general population understanding of rehabilitation or rehab as it is often referred to.  Like me your first thought might be of the Amy Winehouse song Rehab and the lines ‘They tried to make me go to Rehab, but I said no, no, no’

We often hear of celebrities attending ‘Rehab’ for addiction issues,  so it’s easy to understand when you might start talking to a person about getting some rehab,  they might be confusion if an addiction to substances is not a priority concern or not apparent at all.  

But when you add another word for context it becomes more understandable.  

  • Nero rehabilitation (which was the rehab I have personally experienced) 
  • Mental health rehabilitation 
  • Physical Rehabilitation
  • Vocational Rehabilitation 
  • Cognitive Rehabilitation
  • Rehabilitation Therapy.  

So what are the origins of the word?  

The noun rehabilitation comes from the Latin prefix

 “re” meaning “again” and “habitare” meaning “make fit.” 

Dictionary definitions 

plural rehabilitations

  • the action, process, or result of rehabilitating or of being rehabilitated: such as a restoration especially by therapeutic means to an improved condition of physical function 
  • the process of restoring a person to a drug- or alcohol-free state
  • the process of restoring someone (such as a criminal) to a useful and constructive place in society
  • the rehabilitation of prisoners
  • the restoration of something damaged or deteriorated to a prior good condition the rehabilitation of the neighbourhood the rehabilitation of a person’s reputation

How do other organisations define rehabilitation? 

The World health organisation says Rehabilitation is defined as “a set of interventions designed to optimise functioning and reduce disability in individuals with health conditions in interaction with their environment”.

From NHS England’s guide on commissioning rehabilitation. A modern healthcare system must do more than just stop people dying. It needs to equip them to live their lives, fulfil their maximum potential and optimise their contribution to family life, their community and society as a whole. Rehabilitation achieves this by focusing on the impact that the health condition, developmental difficulty or disability has on the person’s life, rather than focusing just on their diagnosis. It involves working in partnership with the person and those important to them so that they can maximise their potential and independence, and have choice and control over their own lives. It is a philosophy of care that helps to ensure people are included in their communities, employment and education rather than being isolated from  the mainstream and pushed through a system with ever-dwindling hopes of leading a fulfilling life.

What about occupational therapy and rehabilitation?  

In 2020 the royal college of occupational therapists (RCOT) ran events called the Big Rehab Conversations to help them develop best practice for rehabilitation, identify the challenges and ensure the advice they offer reflects what’s actually happening on the ground.

Within the RCOT Informed View – mental health rehabilitation it is argued that 

The term ‘rehabilitation’ can be problematic within the mental health sector, as it is typically associated with complex rehabilitation for people with psychosis, delivered in tertiary services. This means occupational therapy delivered in wider mental health services, such as community teams, is not commonly framed as rehabilitation.

As a broad term, the aim of rehabilitation is to maximise people’s ability to live, work and learn. Occupational therapy interventions focus on helping people to achieve these goals to the best of their potential. This aligns with a recovery approach in adult mental health services and a reablement approach within older people’s mental health services.

Occupational therapists are underrepresented within multidisciplinary mental health teams. Where roles do exist, capacity to offer rehabilitation may be diluted by generic responsibilities.

Across the UK there is a renewed focus on the best way to deliver rehabilitation. This requires innovative new approaches and service redesign, co-produced and co-delivered with people who access services. This offers a unique opportunity for occupational therapists to influence development and implementation.

They go on to state occupational therapist need to lead mental health rehabilitation reform with a focus on meaningful occupations, ensuring people keep links with local employment and education, manage daily living and social skills, and take part in leisure and community activities. It is fundamental that rehabilitation is person and occupation focused and that services address environmental, social and economic need.

https://www.rcot.co.uk/files/rcot-informed-view-mental-health-rehabilitation-april-2022pdf

Of course this is a statement i’m going to agree with because occupational therapy is my bread and butter and anything that helps occupational therapy being seen as a treatment tool rather than the name of a profession is always going to be helpful,  but there is a need to look at what resources are available and what other skills other professions can bring,  for me its more about having an approach to rehab that is important one that has a common way of working with people, rather than doing things for people.  

If rehabilitation is about the person do we need to define it?  

Is it the complexity of a persons needs, and the goals they want to accomplish that is the essence of rehabilitation?  

When I reflect on my own lived experience of rehab it wasn’t focused on my goals but a set of expectations, expectations I would walk again, when that expectation took longer than expected, services were at a loss of what to do!  

At times it felt like they had given up.   

My goals and wants were thought about to an extent but not explored, not set out as a goal to work towards.  Walking again, was never my priority.  I got there, but only when I was allow to hold the rains myself and seek support privately that my goals were really addressed.  

  • Finding passion again
  • Sharing my thoughts 
  • Writing 
  • Doing art,
  • Being a wife and not a person who needed constant caring for 
  • Enjoying life 
  • Getting back to work  

Washing myself, dressing my self, feeding myself were needs but not priorities for me.  They were met in a way that was satisfying to me.  

That’s rehabilitation to me, finding away through what is difficult to be the person I wanted and do the things I wanted, that make my life fulfilling.  

By the end of the two day event, we have created an outline of a new model of delivering rehabilitation,  but i’m not sure we were able to define it in a way that was agreeable, and maybe that’s the point?  

References

A professional’s guide to functional rehabilitation – The OT Practice

Rehabilitation

https://www.etymonline.com/word/rehabilitation

rehab | Etymology, origin and meaning of rehab by etymonline 

Rehabilitation Definition & Meaning – Merriam-Webster

Defining rehabilitation: An exploration of why it is attempted, and why it will always fail – PMC

(PDF) What is rehabilitation? An empirical investigation leading to an evidence-based description

https://www.physio-pedia.com/An_Overview_of_Rehabilitation_for_Nurses

Ableism, AHP, Blog Post, Occupational Therapy, RCOT

Let’s encourage an inclusive culture of understanding by using words. – Why we should stop using acronyms, and why occupational therapist should be leading the way.  #EncourageInclusiveCultures  #UseTheWords

@OT_rach

Acknowledgment – This blog post is a personal opinion piece, based on thoughts and ideas about my own lived experience. I acknowledge these will not be shared others, and respect peoples rights to have, different even conflicting ideas.  This website has an accessible feature, that allows different accessible formats by simply clicking on a button labelled ‘Accessibility Menu’ that appears in green on all pages. It will provide you with a number of options to change the appearance to meet your accessibility needs.  This communication has been written by a dyslexic person. If you have any trouble with the meaning of any of the sentences or words, please do not be afraid to ask for clarification. I’m #MadeByDyslexia – expect creative thinking & creative spelling.

Acronyms – an abbreviation formed from the initial letters of other words and usually pronounced as a word.  

Acronyms are common place in most lines of work, particularly in health and social care, but in the interest of fostering inclusive cultures,  should we remove the use of acronyms altogether?  

Acronyms are useful, they save us time.  Good practice when using them in a document is to write out the full meaning first followed by the acronym. However this often does not happen, or they are so commonly used in some settings that the words they stand for are hardly used, sometimes becoming only known as the acronym.  

This can create problems with clear communication and levels of understanding for a number of reasons, 

  • Acronyms can often be a barrier to those not ‘in the know’. 
  • Levels of embarrassment about asking or a concern you may be considered ignorant leads to avoidance in asking.
  • Communicating effectively to others that don’t work in the same field can become difficult
  • Sometimes acronyms can mean different things to different groups or can stand for more than one thing. 
  • Those who are neuro-divergent, often find following the flow difficult when acronyms are used.
  • Sometimes making acronyms can create odd or funny words. 
  • We can become complacent, forgetting to explain terms to people accessing the services we provide. 

Detailed below are some examples from personal experiences;

A great example of an acronym that means more than one thing is OT.  This stands for both occupational therapy and occupational therapist,  often the context of the rest of the sentence might give a clue as to which term is being referred to, but it can also mean people aren’t sure.  

Recently I was involved in a project updating a resource in the national health service (NHS) trust I work for, and a senior occupational therapist asked if RCOT stood for royal college of occupational therapy or therapist.  They were so used to just hearing RCOT that despite being a member for many years, found themselves asking the question.  

My job title is lead occupational therapist –  When I was once talking to a police officer as part of my role he said to me so you’re a LOT? and giggled to himself.  

Often titles of meetings as referred to as their acronyms,  My diary is now full of them, PIPA, OTLGN, DDTV, LTHC to name but a few, often these meetings are just referred to as their acronyms,

Within an occupational therapy meeting I attend last month, I kept hearing the term ATR, later after asking for clarity,  it meant activity through recovery –  a book I know well, but never heard it referred to as an acronym,  perhaps evidences that we can create a quick and easy language for ourselves, that excludes new people. 

There are lots of other acronyms the occupational therapy profession, they become second nature, but aren’t easily understood by other professions, or our clients.    

for example: AHP, MOHO, MOHOST, VDTMoCA, AMPs, LCALS, SAP, OTA. 

Often it is said that occupational therapy is poorly understood,  surely we are not helping this when not fully explaining what we mean?  

For example, saying I have completed a MOHOST in a multidisciplinary team meeting, could be meaningless to other professions,  but saying I have completed a model of human occupation screening tool,  gives some context that could be understood at some level.  There is another common tool used within mental health settings MHOST (Mental Health Optimal Staffing Tool) using both has often course confusion. 

I’m a public governor for a local acute national health services trust, despite working for a mental health national health service trust for 20 years.  I’m coming across acronyms I am unfamiliar with as they are not commonly used in my area of work.  I’m having to ask constantly what something stands for, sometimes I can work it out, but I now always ask to make sure I understand, often other governors  thank me for asking.  

Today I held some interviews for some newly qualified occupational therapists, in the part where candidates can ask us questions, one person asked what the acronyms on the front of the job description meant.  The job description is a generic one for band 5 occupational therapists within the trust so on the front is has acronyms related to the different specialities AMH, MHSOP, CYPMHS, LD.  We are so used to using these acronyms within the trust,  we don’t even explain them on a job description for newly qualified staff that might be totally new to the field.  

I’m dyslexic and have long covid, both create difficulty with processing skills, often when I say acronyms out loud I get the letters muddled. For example CPD and CBT. I know the meaning of both, but because they are so similar my brain muddles them up.  I find saying the words stops this from happening.  

Continuing Professional Development,  

Cognitive Behavioural Therapy.   

When I hear another person saying acronyms out loud, my brain takes a little longer to process that information and recall the meaning, at times I lose the flow of the topic because my brain focuses on remembering what the acronym stands for, or wonders what it means and I get lost. 

I have lots of experiences of asking for clarity from colleagues, and having a response of annoyance that I asked, being told ‘I’m not going to explain that to you,’ or eyes rolled at me.  This used to make me not speak up, not contribute to meetings, in fear of being thought of as foolish or not worthy of my role.  However what I have learnt is that this sort of behaviour is not an inclusive way of working, it shows ignorance of others diverse needs and can be interpreted as ableist.   It’s that persons problem not mine and at least I am clear in what was meant and feel better informed.   

There has been times when people have kindly offered to make a crib sheet for me that includes common acronyms,  this although meant well, is ableist it could be interrupted as I hear you have a difficultly  but I’m not willing to change my pattern of behaviour, you need to conform to neurotypical ways of working.  










The health and care professions council (HCPC) have revised their standards of proficiency for registrants, they have significantly expanded the role of equality, diversity and inclusion (EDI), placing specific importance on making sure that practice is inclusive for all service users.   Registrants must:





    

  • 5: recognise the impact of culture, equality and diversity on practice and practise in a non-discriminatory and inclusive manner
    • 






    

  • 5.1: respond appropriately to the needs of all different groups and individuals in practice, recognising this can be affected by difference of any kind including, but not limited to, protected characteristics, intersectional experiences and cultural differences
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  • 5.2: understand equality legislation and apply it to their practice
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  • 5.3: recognise the potential impact of their own values, beliefs and personal biases (which may be unconscious) on practice and take personal action to ensure all service users and carers are treated appropriately with respect and dignity
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  • 5.4: understand the duty to make reasonable adjustments in practice and be able to make and support reasonable adjustments in theirs and others’ practice
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  • 5.5: recognise the characteristics and consequences of barriers to inclusion, including for socially isolated groups
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  • 5.6: actively challenge these barriers, supporting the implementation of change wherever possible
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  • 5.7: recognise that regard to equality, diversity and inclusion needs to be embedded in the application of all HCPC standards, across all areas of practice
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Expectations of registrants:





    

  • Registrants are always expected to provide care to all their service users and ensure their specific needs are responded to
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  • Registrants should be able to identify when a service user’s care needs to be adjusted because they have a protected characteristic
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  • Instead of waiting for a service user to raise the need for accommodations, a registrant should be proactively thinking about how to make the care they offer as accessible as possible
    • 

















Occupational therapy has roots in social justice, which is key to inclusive ways of working. The royal college of occupational therapists statement on diversity says, 







“The principles of diversity and equality are core to the practice of occupational therapy and are enshrined within the RCOT Code of Ethics. We believe that all people should be treated with dignity and respect, above all as equal members of society with the same choices, rights and privileges. Discrimination and prejudice have no place in our practice and no place in society.”

Royal College of Occupational Therapists














By dismissing the ideas of at least making an effort to reduce your usage of acronyms it could be argued you’re not living up to the standards expected of you.





In conclusion there are many reasons to stop the use of acronyms,  it might feel hard, feel unnecessary,  but we have a responsibility to be clear and inclusive in clinical practise,  by embracing behaviours that foster clear communication ensuring we are understood, can only be a good thing.    





I hope reading this has given you time to reflect,  review your own use of acronyms,  discuss the idea within your teams.  





Join the campaign to change a culture of using terms that only includes those in the know, by saying what you mean, being clear and ensure others understand.  





Share your own thoughts and experiences, feel free to use the graphics below to spread the word, or create your own and share.  





I pledge to stop using acronyms and always use the words; so everyone can be included and have a clearer understanding.





































Image gallery image







		


			
		
	






	
	

		AHP, Blog Post, Covid
#AHPsDay 14th Oct 2022 – A video to say thank you
	


	

							

			 @OT_rach		
		
		

			

 Friday 14th October 2022 was Allied Health Professional day.  I made a little video and post parts of it on my social media accounts.  It’s about my lived experiences of collective treatment from AHP staff during a long hospital admission.  










Having received some lovely feedback and some people asking if they can use it in teaching sessions, I have decided to post it here on my blog site in full, with an open permission for it to be used by health and care professionals and universities for teaching purposes.   I ask that you do not edit it without permission from myself.  Please contact me via email if you want to use it outside of the context I have given permission.  OT_rach@outlook.com   

















NHS England Give this definition of Allied health professionals 





The Allied Health Professions (AHPs) are the third largest workforce in the NHS.  In the main they are degree level professions, and are professionally autonomous practitioners.  13 of the 14 AHPs are regulated by the Health and Care Professions Council (HCPC) with Osteopaths regulated by the General Osteopathic Council (GOC).





AHPs provide system-wide care to assess, treat, diagnose and discharge patients across social care, housing, education, and independent and voluntary sectors.  Through adopting an holistic approach to healthcare, AHPs are able to help manage patients’ care throughout the life course from birth to palliative care.  Their focus is on prevention and improvement of health and wellbeing to maximise the potential for individuals to live full and active lives within their family circles, social networks, education/training and the workplace.







In total there are 14 AHP’s 





You can find out more about what each one does on the NHS England website: https://www.england.nhs.uk/ahp/about/





    

  • Art Therapists
    • 




  • Dramatherapists
    • 




  • Music therapists
    • 




  • Chiropodists/podiatrists
    • 




  • Dietitians
    • 




  • Occupational therapists
    • 




  • Operating Department Practitioners
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  • Orthoptists
    • 




  • Osteopaths
    • 




  • Paramedics
    • 




  • Physiotherapists
    • 




  • Prosthetists and Orthotists
    • 




  • Radiographers
    • 




  • Speech and language therapists
    •