DISPLAY POSTERS AGEING/GERONTOLOGY P-001 ECOLOGICAL VALIDITY OF STANDARDISED FUNCTIONAL ASSESSMENTS OF COGNITION AFTER BRAIN INJURY IN AN ACUTE SETTING Emma Hays1, Katelyn Moloney1, Michelle Farquhar1, Eloise Thompson1, Jacqui Morarty1, Natasha Lannin1,2, Lisa O’Brien1,3 1 Alfred Health, Melbourne, Victoria, Australia 2La Trobe University, Melbourne, Victoria, Australia 3Monash University, Melbourne, Victoria, Australia
Introduction: Cognitive dysfunction is common in older adults after traumatic brain injury. Appropriate assessment of the many complex interrelated cognitive functions is critical, yet age-related cognitive changes in elderly trauma patients present a challenge to traditional pen-and-paper assessments. Ecological validity has become an increasingly important focus in cognitive assessment, in which it is important to assess the person’s cognitive and behavioural capacities with real-world demands and environments. Objectives: To describe the adaptation of two functional assessments of cognition, which were originally developed for administration in the community, into an acute setting. Method: The clinical utility and ecological validity of two standardised functional assessments, The Kettle Test and the Functional Cognitive Assessment Scale (FUCAS), were assessed using specific criteria. The adaptation process, including barriers to administration in an acute hospital setting, was documented and key challenges addressed. Results: With assumptions regarding the familiarity of an environment being central to functional assessments of cognition, ensuring ecological validity in an acute hospital environment is challenging. Both The Kettle Test and FUCAS could be adapted, although hospital protocols and environmental limitations have impacted on the ability to carry out specific subtests of both assessments. Conclusion: Whilst there is evidence to support the use of standardised functional assessments of cognition, it must be acknowledged that the ecological validity of tests may be reduced as a result of adaptation to the acute hospital setting.
Conclusion: A limitation in standardized assessment tools and variations in service delivery compromises rehabilitation for people with CRF. Further research into feasibility and validity of management guidelines for CRF is warranted.
CONTEMPORARY PRACTICE ISSUES P-003 SUPERVISION, PEER SUPPORT AND MENTORING AND THEIR IMPORTANCE IN PROFESSIONAL IDENTITY AND THE SENSE OF BELONGING Amanda Bladen Occupational Therapy Australia, Victoria, Australia Introduction: Supervision, mentoring and peer support can provide challenges and rewards, be confronting and frustrating: at times because of this OTs give them a low priority-but well directed efforts bring protection and benefits to individual clients and client groups as a whole, and also have a positive impact on professional identity and resilience. Aim: This presentation explores practice based evidence and evidence based practice around the benefits -to clients and to occupational therapists-of structured conversations around practice. Along with evidence supporting the need for an individually tailored career long approach- with themes around the need and right to access flexible, occupation focussed support -concepts of the importance of belonging to and identifying with the profession through supervision, mentoring and peer support will be explored. Methods: The author has used literature review, focus groups, personal peer support and professional practice reflection. Conclusion: Supervision, peer support and mentoring are vital in professional identity, good practice and the sense of belonging to the occupational therapy profession.
P-004 EAST MEETS WEST NETWORK – A MODEL FOR SUPPORT AND PROFESSIONAL DEVELOPMENT Ralda Bourne, Anita Major-Brown
CANCER/PALLIATIVE CARE P-002 CLINICAL ASSESSMENT OF CANCER-RELATED FATIGUE: CURRENT PRACTICE IN AUSTRALIA Elizabeth Pearson1, Carol McKinstry1, Marilyn Di Stefano1,2, Meg E. Morris1 1
La Trobe University, Victoria, Australia 2Vic Roads, Victoria, Australia
Introduction: Cancer-related fatigue (CRF) is a common and distressing problem during and after treatment for cancer. Fatigue can restrict participation in self-care, social, work and leisure occupations. Guidelines published regarding screening, assessment and management of CRF are available; however limited research investigating clinical application of these guidelines has been undertaken. Objectives: This research aims to describe how Australian health practitioners assess CRF and to compare this to current international guidelines. Methods: A cross-sectional on-line survey of Australian health professionals working with people with a cancer diagnosis collected data on CRF assessment in clinical practice. Six cancer and health professional associations emailed the survey link to health professionals. Quantitative data was statistically analysed and qualitative data analysed using axial coding. Results: The 129 respondents included 92 allied health practitioners across five Australian states. Location of practice was predominantly metropolitan areas (73%) and 40% worked in acute hospital settings. There was a wide variation between services in screening for CRF, prioritisation, response and assessment of people referred with CRF. In 79% of services guidelines for assessment were not used. Participants reported a lack of clear guidelines, awareness, resources and access to services as barriers to treating CRF.
Private Practice, Melbourne, Victoria, Australia Staying in contact with OT networks and maintaining PD has always been a challenge whilst working part time or in non – OT or non-paid work. A group of 10 O.T.’s who live east or west of the Yarra river and whose ages span 3 decades and who work in such diverse areas as private practice, aged care, management, non-traditional OT role, ABI and ‘career breaks’ were spurred on to form this group just prior to National registration commencing. Their challenge was to find a way to meet some of the PD requirements of registration and expand on their OT skills and development. The group meets one evening every second month at locations on both side3s of the Yarra and group members volunteer to lead with a learning opportunity. Examples of topics already addressed: A podcast on ageing Presentation on dementia, prepared for a work-place in-service training Presentation of a relevant Master’s thesis Case study and peer review Members attribute group effectiveness to: Diversity of the group’s professional and clinical experience Willingness to share knowledge and teach others Capacity to provide relevant and constructive feedback/peer review Occurs at a pace, time and place that suits families Provides valuable face-to-face time with colleagues We envisage that this model is easy to replicate and are happy to support and resource colleagues in setting up such a group.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-005
P-007
THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) AND OCCUPATIONAL THERAPY: IS IT A GOOD FIT?
THREE TYPES OF DECISION-MAKERS: RESOURCING SEATING SERVICES FOR OPTIMAL CONSUMER INCLUSION
Judy Ranka
Deakin University, Geelong, Victoria, Australia
Occupational Performance Network, Sydney, New South Wales, Australia Introduction: The International Classification of Functioning, Disability and Health (ICF) is a generic classification system developed by the World Health Organization (WHO) to standardise data collection about the consequences of health conditions around the world. Information gathered includes dimensions of body structure and function, activity capacity and performance, participation capacity and performance and the impact of environmental factors on health outcomes. Occupational therapists and others are increasingly encouraged to align their practice with the ICF domains. This raises questions. Does the ICF reflect the profession’s core values of client-centred practice? Will adopting the ICF as a framework for occupational therapy over-simplify the complexity of our practice? Does the ICF enable the unique contribution of occupational therapy to be identified? Objectives: The purpose of this paper is raise discussion about the strengths and limitations of aligning occupational therapy practice with the ICF. Approach: The structure, purpose and assumptions of the ICF were examined and compared to those of selected occupational therapy practice models. Findings obtained were presented to a panel of five occupational therapy theory experts for analysis of the degree to which each reflected the unique core values of the profession, the focus of practice and methods used, as well as the strengths and limitations of each. Practice implications: The assumptions and structure of the ICF are consistent with perspectives of occupational therapy, however, there are significant differences in purpose, processes reflected and capacity to explain the unique contribution of occupational therapy. Conclusions: Care should be taken when aligning practice too closely with the ICF.
Rachael Schmidt Introduction: Within a new consumer-driven NDIS environment, the Australian seating service sector needs to make smart decisions, to allocate service cost effectively to be service efficient while also involving the consumer. This case-study has exposed three types of decision-makers that inform how to optimise the consumer inclusivity and service resources. Method: Sixty participants were purposively recruited from 2011–2012 via the ARATA network. Sixty participants’ service experiences were explored in an in-depth interview process: within four stakeholder groups that included 11 consumers, five care providers, 28 prescribing clinicians and 16 vendors with recent specialised wheelchair-seating procurement experience (≥3 years). All participant interviews were recorded, transcribed, and member-checked. The first analytical phase was a peer reviewed thematic analysis. A second analysis explored the data from a decision-making perspective and a third, from a social justice perspective to enhance data trustworthiness. Results: The study exposes three types of decision makers: the independent, supported and advocate decision makers. Each type of decision maker describes the consumer’s capacity to make decisions and identifies the degree of support required. Identifying the degree of consumer support required by the type of their decision making capacity helps to allocate the service resources and expertise appropriately. Conclusion: This poster describes the Three Types of Decision-makers, its discrete the factors and their influence on the seating service pathway. This is new, evidence based data that provides service clarity to provide specialised wheelchair and seating technology for complex mobility and postural needs.
EXTENDING SCOPE OF PRACTICE P-008
EVIDENCE-BASED PRACTICE P-006 SYMPTOM MANAGEMENT TO PREVENT ONSET OF DISABILITY Margarita Makoutonina, Svetlana Makoutonina ParkiLife Australia Pty Ltd, Melbourne, Victoria, Australia Introduction: Despite the benefits of medical and surgical interventions for people with Parkinson0 s disease (PwP), patients still develop progressive disability in both the motor and non-motor domains. Aims/objectives: To increase awareness of the importance implementation of Parkinson’s disease specific assessments by the Occupational Therapist (OT), the design of targeted rehabilitation program to provide the most effective and comprehensive care for PwP, consequently delaying the onset of disability. Method: The OT conducts the comprehensive assessments of the patient with PD at different times to reflect the changes in functional ability during ON and OFF phenomenon. During assessment key problem areas are indentified and specific follow-up interventions are planned to manage motor and non-motor symptoms, to support the patient and to help them maintain their usual level of self-care, work and leisure activities and therefore to prevent disability. Results: The OT shares the theoretical knowledge with the other team members, as the foundation of the comprehensive care model (CCM). This model proves to be the cost effective and efficient as it provides specialist knowledge in one facility. Conclusion: The implementation of CCM has the capacity to delay the disability, improve quality of life and maintain independence. It provides the comprehensive approach and continuity of the care/therapy provision. It centres on education for the person with PD and their care-giver, intensive assessment, evidence based interventions, movement rehabilitation and drug manipulation. The CCM is proactive, preventative and education program that complies with the Parkinson’s Charter.
BENCHMARKING AUSTRALIAN SEATING SERVICES: UNCOVERING THE HIDDEN SERVICE COSTS Rachael Schmidt Deakin University, Geelong, Victoria, Australia Introduction: In a competitive, NDIS environment where consumers have the power to drive their own specialised wheelchair and seating procurement, knowing the costs involved is crucial. The finding from this in-depth case study provides the missing evidence based data to make informed choices. Method: Sixty participants were purposively recruited from 2011–2012 via the ARATA network. The service experiences were explored in an in-depth interview process with four stakeholder groups: eleven consumers, five care providers, 28 prescribing clinicians and 16 vendors with recent specialised wheelchair-seating procurement experience (≥3 years). All participant interviews were recorded, transcribed, and member-checked. The first analytical phase was a peer reviewed thematic analysis. A second analysis explored the data from a decision-making perspective and a third, from a social justice perspective to enhance data trustworthiness. Results: The case study findings show there are the six non-linear, dynamic seating service steps. In addition, the Six Seating Service Steps are described by time estimates of the stakeholders according to their service role, by the level of service (i.e. primary or secondary seating service) and by the type of seating approach. This poster presents an Australian Seating Service Benchmark that describes each of the six seating service process by the estimated stakeholder service contribution in time. Conclusion: This new and valuable evidence based data. Employing the Australian Seating Service Benchmark allows for occupational therapists to compare costs, by one process or in full and to alert and inform the service team to allocate adequate resources based on evidence based data.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-009 EXPANDING THE THERAPUTIC RELATIONSHIP: RELATIONSHIP BASED INTERVENTION PROFESSIONAL TRAINING FOR OCCUPATIONAL THERAPISTS TO EXPAND THEIR KNOWLEDGE BASE AND BROADEN SKILLS TO IMPROVE EFFECTIVENESS AS PRACTITIONERS
HEALTH PROMOTION P-011 MSWA SLEEP SERVICE; PART OF A HOLISTIC APPROACH IN SYMPTOM MANAGEMENT AND LIFESTYLE CHOICES TO ASSIST MEMBERS WITH FUNCTION AND PARTICIPATION
Prudence Watson1,2
Belinda Cobcroft
1
Curtin University & UWA, Western Australia, Australia
Connect and Relate for Autism Inc, Queensland, Victoria, Tasmania, Australian Capital Territory, Australia 2Prue Watson OT, Rockhampton, Queensland, Australia Introduction: The poster will describe the Relationship Development Intervention Professional Consultant Training process as a unique educational programme available to those with credentials in a broad range of professional backgrounds and speciality areas. Objectives: The Relationship Developmental Intervention Professional Training trains the consultant to guide parents and carers to be the agents of change in the remediation process for their child, and restore the guiding relationship within families. Approach: The training process equips the consultant with the perspective and framework to understand the mission, goals and strategies needed to create opportunity for mental growth and neural integration, and involves parent coaching to increase mindful decision making. This flexible innovative training programme comprises elements such as online live webinar learning, face to face workshops with practical engagement and reflective learning, and a supervised clinical practice with families. Practical implications: The Relationship Development Intervention approach guides and empowers the parents and embeds the remediation processes within the childs natural environments, promoting partner competence, framing meaningful learning engagements and using a continuous improvement process based on reflective practice. The guiding relationship is dependent on two equally significant roles, the guide – parents and family, and the apprentice – the child partner. The guide is responsible for providing challenging moments for mental and neural growth on an ongoing process, while the apprentice is challenged to join in this shared emotional attachment. Conclusion: The Relationship Development Intervention Professional Consultant Training provides an opportunity to enhance and expand the Therapeutic relationship with families.
Introduction: In the past sleep quality has not been considered when looking at other MS symptom management. However, sleep deprivation leads to a wide range of poorer physical and psychological outcomes in any population group. Aim: Research has begun to demonstrate a significant relationship between MS, sleep disorders and symptoms such as fatigue, pain, poor cognition and the prevalence of anxiety and depression. Method: MS Members of MSWA were asked ‘do you sleep well?’ A high number of respondents answered no, and indicated sleep quality or duration as a problem and the need for intervention. A sleep service was developed to address this need. The Pittsburgh sleep questionnaire is used to gather data related to variables of poor sleep such as sleep hygiene, pain, temperature regulation and respiration. A detailed sleep assessment is undertaken to identify specific sleep difficulties or the presence of a sleep disorder. The assessment is made up of a home visit, various questionnaires, collection of sleep data via the Actiwatch, possible overnight video and may lead to a referral for an overnight Polysomnography. Results: Assessment results direct intervention which may include addressing sleep hygiene, temperature regulation, positioning, supportive equipment, relaxation techniques, and lifestyle education or referral for counselling, nursing and physiotherapy. Conclusion: The Sleep Advisory Service is part of a holistic approach in symptom management and lifestyle choices to assist Members in optimising their function and life participation. Data continues to be collected for future research.
KNOWLEDGE TRANSLATION P-012 THE ROLE OF OCCUPATIONAL THERAPY (OT) IN MULTIDISCIPLINARY TEAM (MDT) MANAGEMENT IN PARKINSON’S DISEASE (PD)
HEALTH CARE REFORM/ POLICY DEVELOPMENT
Margarita Makoutonina, Svetlana Makoutonina
P-010
Introduction: Parkinson’s disease is complex illness, requiring continuous comprehensive care which is best delivered by a MDT, including medication optimisation and strategy training (ST). However no guidelines exist to define the scope of practice for each discipline. Objectives: We now report on specific guidelines for OT intervention based on well-known standardised assessments to define the role of OT in MDT management in PD. Method: Following assessments, targeted interventions were developed by the OT for patients admitted for comprehensive care to a private rehab hospital (average stay 14 days). The UPDRS I, II (OFF medication), PDQ 39 and PDFS 16 were administered on admission and at discharge from hospital. Comparisons utilised paired T tests and correlation analysis. Specific OT interventions included ST for ADL, education about energy conservation, fatigue and stress management; environmental implications; functional medication management and care giver support. Results: The records of 177 patients (males = 100) were reviewed. The mean age was 71.6 (9.9 SD) years, with mean disease duration of 7.2 (5.9 SD) years. Significant changes (P < 0.0001) occurred for all parameters following intervention. It was also found that the improvements in the PDFS 16 were not reflected in the changes for the UPDRS and PDQ 39. Conclusion: This proof of concept study suggests that the OT interventions, defined in the study, have the capacity to improve outcomes for PD patients when applied to inpatient management. However, randomised controlled trials with long-term follow up are necessary to confirm these interventions.
WHAT VALUE DOES OCCUPATIONAL THERAPY ADD? THE DEVELOPMENT OF A SCOPE OF PRACTICE DOCUMENT Jude Boyd, Sharon Downie, Annette Leong, Nichola Terrington, Allison Farley Eastern Health, Melbourne, Victoria, Australia Introduction: Due to the resource limited health care environment, occupational therapy is required to clearly define and justify what value add occupational therapy as a profession can provide to the individual patient and to the community. An occupational therapy service in a large health network over a period of 2 years, has developed a scope of practice document, which has assisted in clearly defining their services and also assisted in identifying gaps and future projects. Objectives: The aim of this paper is to present the process and final document and to discuss the identified gaps and the impact this has on the occupational therapy profession. Method: A quality cycle process was utilised. The initial need for a scope of practice document was identified during a planning day. Each clinical leadership group developed their own document and then a combined scope of practice document was developed. Results: A thorough written document was developed which included service type, target population & exclusions, referrals and triage categories, assessment tools, documentation requirements, discharge procedures, allied health assistant use and relationships with stakeholders. Clinical practice guidelines are now being developed from the identified gaps in practice. Conclusion: It is important for the occupational therapy profession to be evidence based, clear on its scope of practice and effectively governed and monitored for occupational therapy to continue to be an ever-growing, relevant and necessary health profession.
ParkiLife Australia Pty Ltd, Melbourne, Victoria, Australia
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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MENTAL HEALTH
P-015
P-013
CHANGING FEATURES: CHALLENGES OF COURTYARD AND GARDEN DESIGN TO PROMOTE WELL-BEING IN A PSYCHIATRIC INPATIENT UNIT
IMPLEMENTING SENSORY ASSESSMENT AND INTERVENTION PRACTICE TO ASSIST IN MANAGING BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD) IN AN ACUTE AGED MENTAL HEALTH UNIT Angela Ferris, Tania Meltzer Aged Persons Mental Health Service, Eastern Health, Burwood East, Victoria, Australia Introduction: Sensory rooms have been introduced to mental health inpatient settings to assist consumers to monitor and manage their levels of arousal, and encourage self-soothing behaviours. Sensory approaches contribute to a recovery focussed care environment. Consumers with advanced dementia are often unable to engage in self monitoring and soothing, resulting in the expression of behavioural and psychological symptoms such as agitation, aggression, vocalisation and intrusiveness. Objectives: The aim of this presentation is to describe a quality project implementing the use of sensory modulation assessment and intervention to inform management of behavioural and psychological symptoms in an acute aged mental health unit. Approach: On admission, consumers exhibiting behavioural and psychological symptoms of dementia are referred to occupational therapy for sensory assessment. Sensory preferences are used to inform inpatient care plans and communicated to their carers on discharge. Practice implications: A brief description of the implementation of sensory modulation practice within the unit will be provided. Case studies will be presented to demonstrate the value of including sensory approaches in inpatient and discharge care planning for consumers exhibiting behavioural and psychological symptoms of dementia. Conclusion: Sensory modulation assessment and intervention contribute to and encourage a recovery focused framework for care planning and addressing behavioural and psychological symptoms of dementia in an acute aged psychiatry unit.
Jonathan Smith Alfred Hospital, Prahran, Victoria, Australia Introduction/Rationale: Horticulture therapy is thought to influence healing, alleviate stress, increase well-being and promote participation in social life and re-employment for people with mental illness. However, numerous parameters and criteria unique to the psychiatric inpatient setting often limits applying horticulture therapy within the hospital environment. Objectives: To identify features of psychiatric inpatient courtyard design that promotes independence, privacy, relaxation and family interaction. Approach: Mixed method research. Consultation with users (staff, patients and clients) was conducted in addition to an audit of usage patterns. Audit results reveal trends in the effect of weather and time of day on courtyard usage, as well as diagnostic variation. Early indications are that the needs and capacity to engage with a therapeutic space is disrupted by acute mental illness. A follow-up audit is planned to see if changes to the courtyard design effect usage patterns. Practice implications: This poster will outline the design process undertaken to revise the outdoor space, along with pitfalls to avoid, and low-cost interventions. The framework for reviewing and developing a recreational garden space to maximise occupational use will provide other occupational therapists working in mental health with practical solutions for changing the environment to increase occupational engagement in clients. Conclusion: Strategies to maximise opportunities for exercise, privacy and contemplation, fellowship, and skill acquisition are presented and creative approaches to utilising restricted spaces are available. Outdoor spaces in psychiatric units could potentially be modified using occupational therapy theory to maximise opportunities for autonomy, social connection and healthy activity.
MUSCULOSKELETAL/HAND THERAPY
P-014 RAISING AWARENESS OF THE IMPORTANCE OF EMPLOYMENT FOR CLIENTS WHO HAVE A SERIOUS MENTAL ILLNESS Joanne Robertson, Natasha Tudor Melbourne Health, Melbourne, Victoria, Australia Employment is an important step in the recovery journey for consumers with the lived experience of a serious mental illness. Involvement in meaningful employment has been linked to positive mental health outcomes for this population. However for those with a series mental illness, this can remain a distant goal with the unemployment rate exceeding 75% in many economically developing countries. Surveys conducted by a Melbourne metropolitan area mental health service (2009–2011) identified that up to 84.5% of clients were unemployed. This evidence raises the question around what is being done to meet the needs of those who want to work and have the lived experience of a serious mental illness. Mental health clinicians are well placed to hold the initial discussions with consumers about their thoughts on returning to or seeking employment. This presentation will showcase the efforts of a group of mental health clinicians from an area mental health service passionate about empowering their consumers who want to obtain and sustain employment. This was achieved through the organisation of several training days for mental health clinicians across metro and regional Victoria. Evidence based materials and guest speakers, including consumer representatives were utilised to educate clinicians about various essential topics. This presentation seeks to demonstrate a pathway which can be taken to raise awareness of the importance of employment for people with a mental illness, while displaying what we did, how we did it and what we learnt.
P-016 EFFECTIVENESS OF A WRIST REHABILITATION GROUP INCLUDING PROPRIOCEPTIVE EXERCISES: A PILOT STUDY Sarah Grzegorczyn1, Lisa O’Brien1, Jane Aarons2, Claire Stockdale2 1 Monash University, Melbourne, Victoria, Australia 2Peninsula Hand Therapy, Mornington, Victoria, Australia
Introduction: There is emerging evidence regarding the important role of wrist ligaments in proprioceptive function of the upper limb. It is, however, unknown whether rehabilitation programs that include proprioceptive activities result in improved pain and function for people with injuries to wrist ligaments. Objective: The aim of this study was to evaluate the effectiveness of proprioceptive exercises in rehabilitating wrist injuries. Method: A pilot, pre-post, repeated measures study was completed at a private hand therapy practice. Participants were excluded if they had a peripheral nerve laceration, complex regional pain syndrome or coexisting rheumatological conditions. Participants attended the rehabilitation group one or two times a week for 6 weeks. Exercises completed during and outside group time were recorded and categorised into types of exercises. The primary outcome was pain and function, measured by the Patient Rated Wrist/Hand Evaluation (PRWHE). The secondary outcome was grip strength using a Jamar Dynamometer. Measures were taken at baseline, 4 and 6 weeks. Locus of control scores were also recorded. Results: Four participants completed the intervention, limiting the power and generalisability of the results. A statistically significant relationship was found between grip strength and a Multidimesional Health Locus of Control ‘other’ rating. Most participants’ grip strength and reported pain and function improved but did not reach significance. Conclusion: While overall results were not significant, general improvements were seen in all participants. This suggests the need for future research involving larger samples, proprioceptive-specific exercises over an extended period of time with a longer follow up period.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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NEUROLOGY
P-019
P-017
DOES UPPER LIMB THERAPY IN THE COMMUNITY THROUGH AN EARLY SUPPORTED DISCHARGE PROGRAM, COMPARED TO INPATIENT REHABILITATION IMPROVE FUNCTIONAL UPPER LIMB OUTCOMES FOR STROKE CLIENTS?
OCCUPATIONAL THERAPY AND MOTOR NEURONE DISEASE – ADJUSTING AND ADAPTING TO AN EVER MOVING TARGET Sarah Solomon Calvary Health Care Bethlehem, Melbourne, Victoria, Australia Introduction: Neuropalliative care is a confronting and demanding area of practice. OTs in the community often report they lack confidence and/or skills to manage the complex needs of individuals with progressive neurological conditions especially Motor Neuron Disease (MND). Objective: We aim to assist our OT peers in understanding the specific care needs of this unusual population by sharing our experience and knowledge in the area of neuropalliative rehabilitation. Approach: Our poster will focus on assisting clinicians manage the challenges of providing care and intervention for people with Motor Neurone Disease. It will include points to consider when making decisions, clinical reasoning based on phenotype and disease progression and the cognitive/psychological impact of this devastating disease. Practice implications: This is an incurable but not untreatable condition. The subsequent resulting disability has a massive impact on all aspects of a person’s being and ability to participate in previously held life roles. Rate of disease progression can be rapid requiring a flexible and responsive approach. Working in this area of care provides many challenges including: • Constant change in functional abilities.
• • •
Accessing funding, carer demands and specialised equipment needs. Grief, loss and emotional adjustment to devastating diagnosis.
The understanding of MND phenotypes to guide clinical reasoning Conclusion: Occupational Therapy has an important role in helping individuals and their families ‘adjust and adapt’ to the impact of a progressive neurological disease. MND is a rare and rapidly moving disease which requires a flexible and responsive approach to intervention.
Sara Whittaker1,2, Juile Smith1, Chris Barr2, Katherine Harding1 1
Eastern Health, Victoria, Australia 2Flinders University, South Australia, Australia Introduction: Early Supported Discharge (ESD) Programs for stroke aims to fast track clients home from hospital earlier than usual to receive intensive rehabilitation in the community environment. Traditionally, stroke clients needing ongoing intensive rehabilitation would be referred to inpatient rehabilitation (IPR). It has been found clients who are discharged directly from acute settings and receive rehabilitation through an ESD program are more likely to remain at home in the longer term and were more able to regain independence in their daily activities, however, research to date has not explored the benefits of this model of care on motor recovery of the upper limb. Objectives: The aim of this research project is to compare and contrast the experiences of patients referred to IPR and ESD in the initial phase of stroke recovery, with particular focus on upper limb therapy and the recovery of upper limb function. Approach: The study is an observational research design comparing traditional IPR with the ESD Program with a samples size of 26 in each cohort. Results/Practice implications: This presentation will discuss: • Background literature
• • • •
Study design Data analysis and results Implications for practice
Future research directions Conclusions: It is anticipated that results will further help shape rehabilitation program development and examine the preferred mode of delivery of upper limb rehabilitation in the stroke population.
P-018 THE EFFECTIVENESS OF SENSORY TRAINING TO IMPROVE SOMATOSENSORY DISCRIMINATION SKILLS AND UPPER LIMB FUNCTIONING OF ADULT STROKE SURVIVORS: SYSTEMATIC REVIEW Megan Turville1,2, Liana Cahill1,3, Tom Matyas1,2, Jannette Blennerhassett2,4, Leeanne Carey1,2 1 La Trobe University, Bundoora, Victoria, Australia 2The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia 3Australian Catholic University, Melbourne, Victoria, Australia 4Austin Health, Kew, Victoria, Australia
Introduction: One in two stroke survivors experience a loss of somatosensation. Treatment approaches for sensory loss have been diverse with emerging evidence for effective retraining. Aims: To systematically investigate the evidence and theory of sensory retraining in treating somatosensory impairment and upper limb functioning of stroke survivors. Methods: A literature search of electronic databases was conducted to identify studies that involved: (i) adult participants with a history of stroke who had clinically significant somatosensory loss in the upper limb; (ii) treatment approaches aimed at improving somatosensory discrimination skills; (iii) primary outcome results related to somatosensory discrimination skills and possible outcomes of upper limb functioning; and (iv) control trial or single case experimental study designs. Data was extracted from included studies according to established criteria. Quality analysis of data was completed using Cochrane risk of bias tool or Single-Case Experimental Design scale. Results: Findings to be presented will include treatment effects calculated as standardized mean differences with 95% confidence intervals and level of statistical significance. Results will be pooled for meta-analysis if possible. Findings will indicate the level of evidence for sensory retraining approaches within the field of stroke rehabilitation. Theoretical discussion of models used to guide sensory retraining, including task-specific and generalisation approaches, will be presented. Conclusion: In order to support clinicians in stroke rehabilitation and clarify a gap in the sensory intervention literature, this systematic review will determine the effects sensory retraining programs have in achieving desired outcomes for those living with stroke.
OCCUPATIONAL THERAPY EDUCATION P-020 FACILITATING INTERPROFESSIONAL PRACTICE IN OCCUPATIONAL THERAPY CURRICULA: A SCOPING REVIEW OF EDUCATIONAL INTERVENTIONS Lisa Broom Monash University, Frankston, Victoria, Australia Working in interprofessional teams more closely represents work environments as students prepare to enter a workforce which promotes client-centred health delivery from interdisciplinary teams across a range of practice settings. However, what is unknown, is how well our education programs enable students to be better participants in those teams, and what evidence still needs to be generated to support the inclusion of interprofessional education (IPE) in ‘busy’ occupational therapy curriculum. This paper identifies the current scope of interprofessional education interventions in occupational therapy curricula by locating, analysing and summarising the evidence. Methods: A scoping review was conducted to identify interprofessional education interventions involving pre-qualification occupational therapy students. Arksey and O’Malley’s (2005) framework was used to structure the review. Analytical methods: The Interprofessional Framework proposed by Reeves et al. (2011) was used to interpret the results, in addition to the modified version of the four-level Kirkpatrick typology to reflect upon and categorise documented learning outcomes from IPE interventions. Results: 450 documents were found to fit the inclusion criteria for this review. The results (being finalised at the time of submission) will be presented according to the Interprofessional Framework (Reeves et al., 2011). Conclusions: New graduates must be prepared to engage in collaborative practice in order to meet the occupational needs of society. Key findings identify methods used to implement effective IPE in addition to identifying further areas for research. Reference: Reeves, S., et al. (2011). A scoping review to improve conceptual clarity of interprofessional interventions. Journal of Interprofessional Care, 25, 167–174.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-021
P-023
CAN ANYTHING PREPARE YOU FOR A CHILD DYING? USING PALLIATIVE CARE RESOURCES TO PREPARE UNDERGRADUATE ALLIED HEALTH STUDENTS FOR SUPPORTING CHILDREN WITH LIFE LIMITING CONDITIONS
PREGNANCY AND PARENTING WITH A SPINAL CORD INJURY: SHOWCASING USER-FRIENDLY RESOURCES FOR PEOPLE WITH A SPINAL CORD INJURY AND HEALTH PROFESSIONALS
Natalie Hamam, Patrick O’Sullivan
Spinal Outreach Team, Brisbane, Queensland, Australia
Charles Sturt University, Albury, New South Wales, Australia Introduction: Many therapists report not feeling ready to handle the challenge of working with children and families in a palliative care situation. The Palliative Care Curriculum for Undergraduates (PCC4U) learning resources were designed by the Department of Health to enable graduates to become competent in implementing palliative care principles. Objectives: To prepare occupational therapy, physiotherapy and speech pathology students at Charles Sturt University for working with children who are dying using a collaborative, family-centred approach. Approach: The PCC4U learning resources are freely available and include indepth case studies, videos and learning plans. The three disciplines learnt together for 2 weeks during their final session at university using ProblemBased Learning tutorials, workshops and the story of Emily and her family. Learning outcomes: This interdisciplinary approach to working with a child with a life-limiting condition provided a supportive learning environment for students to explore responses to grief and loss, assessment and interventions, communication styles and therapist self care strategies. Feedback from the occupational therapy students showed that they valued the opportunity to learn with and from their peers in an interprofessional setting. The module also increased their knowledge of palliative care and strategies for talking about dying with children and families. Conclusions: Palliative care involves a team of professionals all who bring their own unique skills and qualities to provide a child with the best possible life before they die. The PCC4U resources can be used for interprofessional education of allied health students and enhance undergraduate learning of palliative care.
P-022 ENHANCING ASSESSMENT AND CARE PLANNING IN RURAL, REMOTE AND INDIGENOUS COMMUNITIES Heather Jensen1, Maree Daly2, Melissa Lindeman1, Kylie Stothers1, Annie Farthing1, Fiona Bremner2 1
Centre for Remote Health, Alice Springs, Northern Territory, Australia National Aging Research Institute, Melbourne, Victoria, Australia
2
Introduction: Research has identified the need for increased skills and knowledge about assessment, care planning and case management in rural and remote regions to enhance service delivery in aged care, mental health and disability. Education is also required on recent aged care reforms and the National Disability Insurance Scheme (NDIS). Objectives: This paper describes the development, delivery and evaluation of a 2 day course, which was conducted in both rural Victoria and remote Northern Territory. A further course will be taught in Alice Springs prior to the presentation of this paper. Approach: A literature review informed the development of the course materials and workbook. The knowledge and skills required for assessment, care planning and case management are shared and are known to benefit from an interactive interprofessional learning approach. Course content includes models and principles underlying good assessment and care planning practice, policy context and history, frameworks including person centred care and cultural safety, goal setting, prioritising care, evaluation, communication and report writing. Evaluation of the pilot courses was conducted including use of immediate written post-course evaluation with course participants and collated project team members’ observations. Practice implications: While the course received positive evaluations in both centres, there were differences between the two groups in the nature of their work, their skill levels and the social context. Conclusion: The importance of the context of delivery cannot be overemphasised in the rural and remote setting. Learning materials needed to be adapted and modularised to meet the needs of the participants.
Christine Leech Introduction: Occupational therapists at the 2012 Australia New Zealand Spinal Cord Society annual scientific meeting explored issues surrounding parenting with a spinal cord injury, and highlighted the lack of comprehensive, user-friendly resources currently available for such parents. Objectives: Occupational therapists in this service determined that resources for clients, nurses and allied health professionals were required to cover the different challenges that someone with a spinal cord injury would encounter when pregnant or parenting, and should include strategies to help overcome these challenges. Method: A literature search confirmed the lack of pregnancy and parenting information suitable for our purpose. It was determined that two resources were needed:
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A parenting resource focusing on parenting babies and of toddlers Information gathering included contact with interstate spinal occupational therapy departments for their advice/info/resources, focus group sessions with experienced clinicians of various disciplines, a comprehensive literature search, visiting relevant parenting websites, and conducting ten qualitative interviews with mothers and fathers with spinal cord injuries in the state’s capital city.
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A pregnancy resource A literature review and expert consensus on pre-pregnancy, pregnancy, labour, birth and post- partum from a spinal cord injury perspective was completed. The resource was reviewed by the spinal rehabilitation consultants and clients for accuracy. Results and conclusion: Both resources are now available as on-line booklets. They can be downloaded in chapters or in full. They add to the freely available web resources for people with spinal cord injuries, their families and health professionals.
P-024 OUTCOMES AND PARTICIPANT EXPERIENCE OF ONLINE TRAINING FOR BANGLADESHI HEALTH PROFESSIONALS Lisa O’Brien1,2, Lisa Broom1, Mohammad Mosayed Ullah3 1 Monash University, Melbourne, Victoria, Australia 2The Alfred, Melbourne, Victoria, Australia 3La Trobe University, Melbourne, Victoria, Australia
Introduction: An evaluation of a 6-year therapy capacity-building program in Bangladesh identified that future professional development must be sustainable and driven by local clinicians. It was, however, acknowledged that Bangladeshi clinicians needed training to become effective clinical educators. Objectives: To determine whether an online training program was effective in establishing locally driven, sustainable, evidence-based training for local therapists. Methodology: Five Bangladeshi therapists from a rehabilitation centre participated in the course, which was facilitated on-line by an Australian university. They completed eight pre-recorded modules and were assessed in-situ on their ability to deliver a tutorial to their peers. A qualitative explanatory case study design was used to evaluate outcomes, drawing on data gathered from pre-, post-course and 1-year follow up surveys, observations, and a post-course focus group. Results: All participants demonstrated satisfactory planning and delivery of an evidence-based interactive tutorial to their peers. Participants noted improved competence and confidence in searching for evidence, and developing and executing a teaching plan. This was sustained at one-year review. The key theme was a shift in participants’ concept of learning from being an expert-driven to a self-driven exercise. Enablers were multi-modal teaching techniques, the presence of a local leader, and the establishment of informal peer support. Barriers were logistical issues such as access to reliable internet services, and late delivery of course materials. Conclusions: On-line distance education can be effective in producing sustainable change in clinician skills in developing countries. Future programs would benefit from a blended learning approach incorporating ‘face-to-face’ instructor contact.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-025 EXPERT PANEL: AN INNOVATIVE MODEL WHICH AIMS TO ADD VALUE TO FIELDWORK AND INCREASE THE ENGAGEMENT OF OCCUPATIONAL THERAPISTS IN GENERIC ROLES Sue Rowan, Nikki Lyons, Nicole Shaw Barwon Health, Geelong, Victoria, Australia Introduction: Increasingly Occupational Therapists are working in generic positions in traditional clinical settings. Occupational Therapists skills are valuable in these roles and it is important to impart this knowledge to undergraduates. But it can be difficult for Occupational Therapists in generic roles to remain engaged with student education. Objectives: A large regional health network introduced ‘Expert Panels’ to engage ‘Occupational Therapists’ in generic roles in student education and to inform students about the variety of jobs available to Occupational Therapists. Approach: Four, 1 hour sessions with a total of 14 speakers were conducted to different student groups. The ‘Occupational Therapists’ presented their career narrative and described how they apply their Occupational Therapy knowledge and skills to their current role. Surveys were distributed to gain qualitative data. Practice implications: Forty two students students attended the ‘Expert Panels’. Each of the ‘Occupational Therapists’ speakers had different position titles. The Survey data was analysed for themes. Results indicated students were inspired and reassured by the information presented. The staff felt they provided a valuable contribution to the student program. Consequently, some ‘Occupational Therapists’ have agreed to host fieldwork in 2015. Therefore changing the perception they have nothing to offer students. Conclusion: The program expanded students’ ideas about future career pathways and provided an opportunity for the ‘Occupational Therapists’ in generic roles to become engaged and contribute to the student program.
P-027
CLINICAL PLACEMENTS – MORE THAN JUST LEANINGS Nikki Lyons1,2, Kate Ingwerson1, Nicole Shaw1,2 1
Barwon Health, Geelong, Victoria, Australia 2Deakin University, Geelong, Victoria, Australia Introduction: As a result of a review of the OT student education program at a large regional public health network, group sessions were introduced to standardise education material presented and increase time efficiency for student supervisors. A number of additional positive unforeseen consequences were reported and noticed as a result of these group sessions. Aim: To provide opportunity for peer support for students engaged in practice education that in turn provided a positive experience Methods: Group education sessions for students on placement included orientation, clinical skills development and reflective practice. There were six student groups between 6 and 12 members from first to fourth year. There were 10 sessions per group per placement block. All groups contained students from the same year level and also included students from more than one university. Results: The unexpected positive consequence of the group sessions was the bonding and peer support that the students provided to each other while on placement, that in turn resulted in improved learning outcomes. Students organised social activities while on placement, reported the forging of friendships that would continue throughout the course and into their careers and spoke of the increased awareness of the OT profession in the context of hearing about others undergraduate university courses. Students report this peer support contributed to positive placement experiences. Conclusion: Group sessions for OT students while on fieldwork were found to assist in developing peer support and improving learning outcomes for OT students. Further research into this observation is part of an ongoing research project
P-028 P-026 THE BUDDY MODEL – AN INNOVATIVE PRACTICE EDUCATION MODEL THAT INCREASES CAPACITY WHILST ACHIEVING QUALITY OUTCOMES Nikki Lyons1,2, Nicole Shaw1,2, Kate Ingwerson1 1
Barwon Health, Geelong, Victoria, Australia 2Deakin University, Geelong, Victoria, Australia Introduction: As a result of recent changes in the organisation and increasing student numbers, a need was identified to research, develop and pilot an innovative model for practice education. The Buddy clinical placement Model is a innovative approach to practice education piloted with a large regional health network in 2014. Aim: To increase capacity while maintaining quality and sustainability for the OT student program with minimal impact on clinicians. Methods: Six 1st year OT students were paired and spent 2 weeks progressing across Acute, Inpatient Rehabilitation, Community Rehabilitation and Community Health; mirroring the care pathway of clients. This model also involved five 3rd year OT students from a different university who were also on placement and who provided the site orientation for their area and shared their experiences and learnings. The students then spent 2 days at each site observing OTs and third year students. Results: The aims of the Model were achieved and the feedback was overwhelmingly positive from all stakeholders. Comments included: 1ST years After watching a third year complete an assessment a first year student stated “I hope I am like that when I am a third year!” At the beginning of placement I wasn’t sure I wanted to continue with my OT studies, now I can’t wait to finish the course and work as an OT!
THE SUCCESSFUL IMPLEMENTATION OF A SAEBOFLEX PROGRAM TO OPTIMISE UPPER LIMB MOTOR RECOVERY FOLLOWING STROKE Kylie Smith, Sara Whittaker Eastern Health, Victoria, Australia Introduction: The Saeboflex allows clients with neurological upper limb deficits to integrate their hand into a functional arm training program. It promotes functional use, reduces spasticity and improves range of movement, strength and motor control. Due to the intensity requirements of this upper limb treatment modality, a group program was implemented to meet service demands. A Saeboflex inter-disciplinary working party has been established. Objectives: To successfully implement emerging technology within an established OT service without increasing the need of additional resources to optimise functional upper limb recovery of clients following stroke To increase consistency of therapy approaches and access to the Saeboflex program across all Community Rehabilitation Program sites Approach: Quality improvement principles were at the heart of this initiative with the Plan-Do-Study-Act cycle supporting the development, implementation and evolution of this new therapy approach. Results/Practice implications: This presentation will discuss: • Overview of emerging evidence using the Saeboflex as a therapy modality for upper limb function • Background rationale for implementation of the Saeboflex Group into the Community Rehabilitation Program • Establishment of a multi-site and interdisciplinary working party
• • •
Implementation of a multi-site Saeboflex program Benefits and barriers to implementation of Saeboflex
Future directions using the Saeboflex in practice Conclusions: Implementation of a Saeboflex Group is a favourable means of providing intensive upper limb therapy in a community environment with promising results emerging for clients with upper limb deficits following stroke.
3RD years The presentation gave me a chance to reflect on my placement and all the things I have done- it made me realise I have learnt a lot Conclusion: Program to be implemented again in 2015.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
Introduction: Cognitive dysfunction is common in older adults after traumatic brain injury. Appropriate assessment of the many complex interrelated cognitive functions is critical, yet age-related cognitive changes in elderly trauma patients present a challenge to traditional pen-and-paper assessments. Ecological validity has become an increasingly important focus in cognitive assessment, in which it is important to assess the person’s cognitive and behavioural capacities with real-world demands and environments. Objectives: To describe the adaptation of two functional assessments of cognition, which were originally developed for administration in the community, into an acute setting. Method: The clinical utility and ecological validity of two standardised functional assessments, The Kettle Test and the Functional Cognitive Assessment Scale (FUCAS), were assessed using specific criteria. The adaptation process, including barriers to administration in an acute hospital setting, was documented and key challenges addressed. Results: With assumptions regarding the familiarity of an environment being central to functional assessments of cognition, ensuring ecological validity in an acute hospital environment is challenging. Both The Kettle Test and FUCAS could be adapted, although hospital protocols and environmental limitations have impacted on the ability to carry out specific subtests of both assessments. Conclusion: Whilst there is evidence to support the use of standardised functional assessments of cognition, it must be acknowledged that the ecological validity of tests may be reduced as a result of adaptation to the acute hospital setting.
Conclusion: A limitation in standardized assessment tools and variations in service delivery compromises rehabilitation for people with CRF. Further research into feasibility and validity of management guidelines for CRF is warranted.
CONTEMPORARY PRACTICE ISSUES P-003 SUPERVISION, PEER SUPPORT AND MENTORING AND THEIR IMPORTANCE IN PROFESSIONAL IDENTITY AND THE SENSE OF BELONGING Amanda Bladen Occupational Therapy Australia, Victoria, Australia Introduction: Supervision, mentoring and peer support can provide challenges and rewards, be confronting and frustrating: at times because of this OTs give them a low priority-but well directed efforts bring protection and benefits to individual clients and client groups as a whole, and also have a positive impact on professional identity and resilience. Aim: This presentation explores practice based evidence and evidence based practice around the benefits -to clients and to occupational therapists-of structured conversations around practice. Along with evidence supporting the need for an individually tailored career long approach- with themes around the need and right to access flexible, occupation focussed support -concepts of the importance of belonging to and identifying with the profession through supervision, mentoring and peer support will be explored. Methods: The author has used literature review, focus groups, personal peer support and professional practice reflection. Conclusion: Supervision, peer support and mentoring are vital in professional identity, good practice and the sense of belonging to the occupational therapy profession.
P-004 EAST MEETS WEST NETWORK – A MODEL FOR SUPPORT AND PROFESSIONAL DEVELOPMENT Ralda Bourne, Anita Major-Brown
CANCER/PALLIATIVE CARE P-002 CLINICAL ASSESSMENT OF CANCER-RELATED FATIGUE: CURRENT PRACTICE IN AUSTRALIA Elizabeth Pearson1, Carol McKinstry1, Marilyn Di Stefano1,2, Meg E. Morris1 1
La Trobe University, Victoria, Australia 2Vic Roads, Victoria, Australia
Introduction: Cancer-related fatigue (CRF) is a common and distressing problem during and after treatment for cancer. Fatigue can restrict participation in self-care, social, work and leisure occupations. Guidelines published regarding screening, assessment and management of CRF are available; however limited research investigating clinical application of these guidelines has been undertaken. Objectives: This research aims to describe how Australian health practitioners assess CRF and to compare this to current international guidelines. Methods: A cross-sectional on-line survey of Australian health professionals working with people with a cancer diagnosis collected data on CRF assessment in clinical practice. Six cancer and health professional associations emailed the survey link to health professionals. Quantitative data was statistically analysed and qualitative data analysed using axial coding. Results: The 129 respondents included 92 allied health practitioners across five Australian states. Location of practice was predominantly metropolitan areas (73%) and 40% worked in acute hospital settings. There was a wide variation between services in screening for CRF, prioritisation, response and assessment of people referred with CRF. In 79% of services guidelines for assessment were not used. Participants reported a lack of clear guidelines, awareness, resources and access to services as barriers to treating CRF.
Private Practice, Melbourne, Victoria, Australia Staying in contact with OT networks and maintaining PD has always been a challenge whilst working part time or in non – OT or non-paid work. A group of 10 O.T.’s who live east or west of the Yarra river and whose ages span 3 decades and who work in such diverse areas as private practice, aged care, management, non-traditional OT role, ABI and ‘career breaks’ were spurred on to form this group just prior to National registration commencing. Their challenge was to find a way to meet some of the PD requirements of registration and expand on their OT skills and development. The group meets one evening every second month at locations on both side3s of the Yarra and group members volunteer to lead with a learning opportunity. Examples of topics already addressed: A podcast on ageing Presentation on dementia, prepared for a work-place in-service training Presentation of a relevant Master’s thesis Case study and peer review Members attribute group effectiveness to: Diversity of the group’s professional and clinical experience Willingness to share knowledge and teach others Capacity to provide relevant and constructive feedback/peer review Occurs at a pace, time and place that suits families Provides valuable face-to-face time with colleagues We envisage that this model is easy to replicate and are happy to support and resource colleagues in setting up such a group.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-005
P-007
THE INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH (ICF) AND OCCUPATIONAL THERAPY: IS IT A GOOD FIT?
THREE TYPES OF DECISION-MAKERS: RESOURCING SEATING SERVICES FOR OPTIMAL CONSUMER INCLUSION
Judy Ranka
Deakin University, Geelong, Victoria, Australia
Occupational Performance Network, Sydney, New South Wales, Australia Introduction: The International Classification of Functioning, Disability and Health (ICF) is a generic classification system developed by the World Health Organization (WHO) to standardise data collection about the consequences of health conditions around the world. Information gathered includes dimensions of body structure and function, activity capacity and performance, participation capacity and performance and the impact of environmental factors on health outcomes. Occupational therapists and others are increasingly encouraged to align their practice with the ICF domains. This raises questions. Does the ICF reflect the profession’s core values of client-centred practice? Will adopting the ICF as a framework for occupational therapy over-simplify the complexity of our practice? Does the ICF enable the unique contribution of occupational therapy to be identified? Objectives: The purpose of this paper is raise discussion about the strengths and limitations of aligning occupational therapy practice with the ICF. Approach: The structure, purpose and assumptions of the ICF were examined and compared to those of selected occupational therapy practice models. Findings obtained were presented to a panel of five occupational therapy theory experts for analysis of the degree to which each reflected the unique core values of the profession, the focus of practice and methods used, as well as the strengths and limitations of each. Practice implications: The assumptions and structure of the ICF are consistent with perspectives of occupational therapy, however, there are significant differences in purpose, processes reflected and capacity to explain the unique contribution of occupational therapy. Conclusions: Care should be taken when aligning practice too closely with the ICF.
Rachael Schmidt Introduction: Within a new consumer-driven NDIS environment, the Australian seating service sector needs to make smart decisions, to allocate service cost effectively to be service efficient while also involving the consumer. This case-study has exposed three types of decision-makers that inform how to optimise the consumer inclusivity and service resources. Method: Sixty participants were purposively recruited from 2011–2012 via the ARATA network. Sixty participants’ service experiences were explored in an in-depth interview process: within four stakeholder groups that included 11 consumers, five care providers, 28 prescribing clinicians and 16 vendors with recent specialised wheelchair-seating procurement experience (≥3 years). All participant interviews were recorded, transcribed, and member-checked. The first analytical phase was a peer reviewed thematic analysis. A second analysis explored the data from a decision-making perspective and a third, from a social justice perspective to enhance data trustworthiness. Results: The study exposes three types of decision makers: the independent, supported and advocate decision makers. Each type of decision maker describes the consumer’s capacity to make decisions and identifies the degree of support required. Identifying the degree of consumer support required by the type of their decision making capacity helps to allocate the service resources and expertise appropriately. Conclusion: This poster describes the Three Types of Decision-makers, its discrete the factors and their influence on the seating service pathway. This is new, evidence based data that provides service clarity to provide specialised wheelchair and seating technology for complex mobility and postural needs.
EXTENDING SCOPE OF PRACTICE P-008
EVIDENCE-BASED PRACTICE P-006 SYMPTOM MANAGEMENT TO PREVENT ONSET OF DISABILITY Margarita Makoutonina, Svetlana Makoutonina ParkiLife Australia Pty Ltd, Melbourne, Victoria, Australia Introduction: Despite the benefits of medical and surgical interventions for people with Parkinson0 s disease (PwP), patients still develop progressive disability in both the motor and non-motor domains. Aims/objectives: To increase awareness of the importance implementation of Parkinson’s disease specific assessments by the Occupational Therapist (OT), the design of targeted rehabilitation program to provide the most effective and comprehensive care for PwP, consequently delaying the onset of disability. Method: The OT conducts the comprehensive assessments of the patient with PD at different times to reflect the changes in functional ability during ON and OFF phenomenon. During assessment key problem areas are indentified and specific follow-up interventions are planned to manage motor and non-motor symptoms, to support the patient and to help them maintain their usual level of self-care, work and leisure activities and therefore to prevent disability. Results: The OT shares the theoretical knowledge with the other team members, as the foundation of the comprehensive care model (CCM). This model proves to be the cost effective and efficient as it provides specialist knowledge in one facility. Conclusion: The implementation of CCM has the capacity to delay the disability, improve quality of life and maintain independence. It provides the comprehensive approach and continuity of the care/therapy provision. It centres on education for the person with PD and their care-giver, intensive assessment, evidence based interventions, movement rehabilitation and drug manipulation. The CCM is proactive, preventative and education program that complies with the Parkinson’s Charter.
BENCHMARKING AUSTRALIAN SEATING SERVICES: UNCOVERING THE HIDDEN SERVICE COSTS Rachael Schmidt Deakin University, Geelong, Victoria, Australia Introduction: In a competitive, NDIS environment where consumers have the power to drive their own specialised wheelchair and seating procurement, knowing the costs involved is crucial. The finding from this in-depth case study provides the missing evidence based data to make informed choices. Method: Sixty participants were purposively recruited from 2011–2012 via the ARATA network. The service experiences were explored in an in-depth interview process with four stakeholder groups: eleven consumers, five care providers, 28 prescribing clinicians and 16 vendors with recent specialised wheelchair-seating procurement experience (≥3 years). All participant interviews were recorded, transcribed, and member-checked. The first analytical phase was a peer reviewed thematic analysis. A second analysis explored the data from a decision-making perspective and a third, from a social justice perspective to enhance data trustworthiness. Results: The case study findings show there are the six non-linear, dynamic seating service steps. In addition, the Six Seating Service Steps are described by time estimates of the stakeholders according to their service role, by the level of service (i.e. primary or secondary seating service) and by the type of seating approach. This poster presents an Australian Seating Service Benchmark that describes each of the six seating service process by the estimated stakeholder service contribution in time. Conclusion: This new and valuable evidence based data. Employing the Australian Seating Service Benchmark allows for occupational therapists to compare costs, by one process or in full and to alert and inform the service team to allocate adequate resources based on evidence based data.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-009 EXPANDING THE THERAPUTIC RELATIONSHIP: RELATIONSHIP BASED INTERVENTION PROFESSIONAL TRAINING FOR OCCUPATIONAL THERAPISTS TO EXPAND THEIR KNOWLEDGE BASE AND BROADEN SKILLS TO IMPROVE EFFECTIVENESS AS PRACTITIONERS
HEALTH PROMOTION P-011 MSWA SLEEP SERVICE; PART OF A HOLISTIC APPROACH IN SYMPTOM MANAGEMENT AND LIFESTYLE CHOICES TO ASSIST MEMBERS WITH FUNCTION AND PARTICIPATION
Prudence Watson1,2
Belinda Cobcroft
1
Curtin University & UWA, Western Australia, Australia
Connect and Relate for Autism Inc, Queensland, Victoria, Tasmania, Australian Capital Territory, Australia 2Prue Watson OT, Rockhampton, Queensland, Australia Introduction: The poster will describe the Relationship Development Intervention Professional Consultant Training process as a unique educational programme available to those with credentials in a broad range of professional backgrounds and speciality areas. Objectives: The Relationship Developmental Intervention Professional Training trains the consultant to guide parents and carers to be the agents of change in the remediation process for their child, and restore the guiding relationship within families. Approach: The training process equips the consultant with the perspective and framework to understand the mission, goals and strategies needed to create opportunity for mental growth and neural integration, and involves parent coaching to increase mindful decision making. This flexible innovative training programme comprises elements such as online live webinar learning, face to face workshops with practical engagement and reflective learning, and a supervised clinical practice with families. Practical implications: The Relationship Development Intervention approach guides and empowers the parents and embeds the remediation processes within the childs natural environments, promoting partner competence, framing meaningful learning engagements and using a continuous improvement process based on reflective practice. The guiding relationship is dependent on two equally significant roles, the guide – parents and family, and the apprentice – the child partner. The guide is responsible for providing challenging moments for mental and neural growth on an ongoing process, while the apprentice is challenged to join in this shared emotional attachment. Conclusion: The Relationship Development Intervention Professional Consultant Training provides an opportunity to enhance and expand the Therapeutic relationship with families.
Introduction: In the past sleep quality has not been considered when looking at other MS symptom management. However, sleep deprivation leads to a wide range of poorer physical and psychological outcomes in any population group. Aim: Research has begun to demonstrate a significant relationship between MS, sleep disorders and symptoms such as fatigue, pain, poor cognition and the prevalence of anxiety and depression. Method: MS Members of MSWA were asked ‘do you sleep well?’ A high number of respondents answered no, and indicated sleep quality or duration as a problem and the need for intervention. A sleep service was developed to address this need. The Pittsburgh sleep questionnaire is used to gather data related to variables of poor sleep such as sleep hygiene, pain, temperature regulation and respiration. A detailed sleep assessment is undertaken to identify specific sleep difficulties or the presence of a sleep disorder. The assessment is made up of a home visit, various questionnaires, collection of sleep data via the Actiwatch, possible overnight video and may lead to a referral for an overnight Polysomnography. Results: Assessment results direct intervention which may include addressing sleep hygiene, temperature regulation, positioning, supportive equipment, relaxation techniques, and lifestyle education or referral for counselling, nursing and physiotherapy. Conclusion: The Sleep Advisory Service is part of a holistic approach in symptom management and lifestyle choices to assist Members in optimising their function and life participation. Data continues to be collected for future research.
KNOWLEDGE TRANSLATION P-012 THE ROLE OF OCCUPATIONAL THERAPY (OT) IN MULTIDISCIPLINARY TEAM (MDT) MANAGEMENT IN PARKINSON’S DISEASE (PD)
HEALTH CARE REFORM/ POLICY DEVELOPMENT
Margarita Makoutonina, Svetlana Makoutonina
P-010
Introduction: Parkinson’s disease is complex illness, requiring continuous comprehensive care which is best delivered by a MDT, including medication optimisation and strategy training (ST). However no guidelines exist to define the scope of practice for each discipline. Objectives: We now report on specific guidelines for OT intervention based on well-known standardised assessments to define the role of OT in MDT management in PD. Method: Following assessments, targeted interventions were developed by the OT for patients admitted for comprehensive care to a private rehab hospital (average stay 14 days). The UPDRS I, II (OFF medication), PDQ 39 and PDFS 16 were administered on admission and at discharge from hospital. Comparisons utilised paired T tests and correlation analysis. Specific OT interventions included ST for ADL, education about energy conservation, fatigue and stress management; environmental implications; functional medication management and care giver support. Results: The records of 177 patients (males = 100) were reviewed. The mean age was 71.6 (9.9 SD) years, with mean disease duration of 7.2 (5.9 SD) years. Significant changes (P < 0.0001) occurred for all parameters following intervention. It was also found that the improvements in the PDFS 16 were not reflected in the changes for the UPDRS and PDQ 39. Conclusion: This proof of concept study suggests that the OT interventions, defined in the study, have the capacity to improve outcomes for PD patients when applied to inpatient management. However, randomised controlled trials with long-term follow up are necessary to confirm these interventions.
WHAT VALUE DOES OCCUPATIONAL THERAPY ADD? THE DEVELOPMENT OF A SCOPE OF PRACTICE DOCUMENT Jude Boyd, Sharon Downie, Annette Leong, Nichola Terrington, Allison Farley Eastern Health, Melbourne, Victoria, Australia Introduction: Due to the resource limited health care environment, occupational therapy is required to clearly define and justify what value add occupational therapy as a profession can provide to the individual patient and to the community. An occupational therapy service in a large health network over a period of 2 years, has developed a scope of practice document, which has assisted in clearly defining their services and also assisted in identifying gaps and future projects. Objectives: The aim of this paper is to present the process and final document and to discuss the identified gaps and the impact this has on the occupational therapy profession. Method: A quality cycle process was utilised. The initial need for a scope of practice document was identified during a planning day. Each clinical leadership group developed their own document and then a combined scope of practice document was developed. Results: A thorough written document was developed which included service type, target population & exclusions, referrals and triage categories, assessment tools, documentation requirements, discharge procedures, allied health assistant use and relationships with stakeholders. Clinical practice guidelines are now being developed from the identified gaps in practice. Conclusion: It is important for the occupational therapy profession to be evidence based, clear on its scope of practice and effectively governed and monitored for occupational therapy to continue to be an ever-growing, relevant and necessary health profession.
ParkiLife Australia Pty Ltd, Melbourne, Victoria, Australia
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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MENTAL HEALTH
P-015
P-013
CHANGING FEATURES: CHALLENGES OF COURTYARD AND GARDEN DESIGN TO PROMOTE WELL-BEING IN A PSYCHIATRIC INPATIENT UNIT
IMPLEMENTING SENSORY ASSESSMENT AND INTERVENTION PRACTICE TO ASSIST IN MANAGING BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA (BPSD) IN AN ACUTE AGED MENTAL HEALTH UNIT Angela Ferris, Tania Meltzer Aged Persons Mental Health Service, Eastern Health, Burwood East, Victoria, Australia Introduction: Sensory rooms have been introduced to mental health inpatient settings to assist consumers to monitor and manage their levels of arousal, and encourage self-soothing behaviours. Sensory approaches contribute to a recovery focussed care environment. Consumers with advanced dementia are often unable to engage in self monitoring and soothing, resulting in the expression of behavioural and psychological symptoms such as agitation, aggression, vocalisation and intrusiveness. Objectives: The aim of this presentation is to describe a quality project implementing the use of sensory modulation assessment and intervention to inform management of behavioural and psychological symptoms in an acute aged mental health unit. Approach: On admission, consumers exhibiting behavioural and psychological symptoms of dementia are referred to occupational therapy for sensory assessment. Sensory preferences are used to inform inpatient care plans and communicated to their carers on discharge. Practice implications: A brief description of the implementation of sensory modulation practice within the unit will be provided. Case studies will be presented to demonstrate the value of including sensory approaches in inpatient and discharge care planning for consumers exhibiting behavioural and psychological symptoms of dementia. Conclusion: Sensory modulation assessment and intervention contribute to and encourage a recovery focused framework for care planning and addressing behavioural and psychological symptoms of dementia in an acute aged psychiatry unit.
Jonathan Smith Alfred Hospital, Prahran, Victoria, Australia Introduction/Rationale: Horticulture therapy is thought to influence healing, alleviate stress, increase well-being and promote participation in social life and re-employment for people with mental illness. However, numerous parameters and criteria unique to the psychiatric inpatient setting often limits applying horticulture therapy within the hospital environment. Objectives: To identify features of psychiatric inpatient courtyard design that promotes independence, privacy, relaxation and family interaction. Approach: Mixed method research. Consultation with users (staff, patients and clients) was conducted in addition to an audit of usage patterns. Audit results reveal trends in the effect of weather and time of day on courtyard usage, as well as diagnostic variation. Early indications are that the needs and capacity to engage with a therapeutic space is disrupted by acute mental illness. A follow-up audit is planned to see if changes to the courtyard design effect usage patterns. Practice implications: This poster will outline the design process undertaken to revise the outdoor space, along with pitfalls to avoid, and low-cost interventions. The framework for reviewing and developing a recreational garden space to maximise occupational use will provide other occupational therapists working in mental health with practical solutions for changing the environment to increase occupational engagement in clients. Conclusion: Strategies to maximise opportunities for exercise, privacy and contemplation, fellowship, and skill acquisition are presented and creative approaches to utilising restricted spaces are available. Outdoor spaces in psychiatric units could potentially be modified using occupational therapy theory to maximise opportunities for autonomy, social connection and healthy activity.
MUSCULOSKELETAL/HAND THERAPY
P-014 RAISING AWARENESS OF THE IMPORTANCE OF EMPLOYMENT FOR CLIENTS WHO HAVE A SERIOUS MENTAL ILLNESS Joanne Robertson, Natasha Tudor Melbourne Health, Melbourne, Victoria, Australia Employment is an important step in the recovery journey for consumers with the lived experience of a serious mental illness. Involvement in meaningful employment has been linked to positive mental health outcomes for this population. However for those with a series mental illness, this can remain a distant goal with the unemployment rate exceeding 75% in many economically developing countries. Surveys conducted by a Melbourne metropolitan area mental health service (2009–2011) identified that up to 84.5% of clients were unemployed. This evidence raises the question around what is being done to meet the needs of those who want to work and have the lived experience of a serious mental illness. Mental health clinicians are well placed to hold the initial discussions with consumers about their thoughts on returning to or seeking employment. This presentation will showcase the efforts of a group of mental health clinicians from an area mental health service passionate about empowering their consumers who want to obtain and sustain employment. This was achieved through the organisation of several training days for mental health clinicians across metro and regional Victoria. Evidence based materials and guest speakers, including consumer representatives were utilised to educate clinicians about various essential topics. This presentation seeks to demonstrate a pathway which can be taken to raise awareness of the importance of employment for people with a mental illness, while displaying what we did, how we did it and what we learnt.
P-016 EFFECTIVENESS OF A WRIST REHABILITATION GROUP INCLUDING PROPRIOCEPTIVE EXERCISES: A PILOT STUDY Sarah Grzegorczyn1, Lisa O’Brien1, Jane Aarons2, Claire Stockdale2 1 Monash University, Melbourne, Victoria, Australia 2Peninsula Hand Therapy, Mornington, Victoria, Australia
Introduction: There is emerging evidence regarding the important role of wrist ligaments in proprioceptive function of the upper limb. It is, however, unknown whether rehabilitation programs that include proprioceptive activities result in improved pain and function for people with injuries to wrist ligaments. Objective: The aim of this study was to evaluate the effectiveness of proprioceptive exercises in rehabilitating wrist injuries. Method: A pilot, pre-post, repeated measures study was completed at a private hand therapy practice. Participants were excluded if they had a peripheral nerve laceration, complex regional pain syndrome or coexisting rheumatological conditions. Participants attended the rehabilitation group one or two times a week for 6 weeks. Exercises completed during and outside group time were recorded and categorised into types of exercises. The primary outcome was pain and function, measured by the Patient Rated Wrist/Hand Evaluation (PRWHE). The secondary outcome was grip strength using a Jamar Dynamometer. Measures were taken at baseline, 4 and 6 weeks. Locus of control scores were also recorded. Results: Four participants completed the intervention, limiting the power and generalisability of the results. A statistically significant relationship was found between grip strength and a Multidimesional Health Locus of Control ‘other’ rating. Most participants’ grip strength and reported pain and function improved but did not reach significance. Conclusion: While overall results were not significant, general improvements were seen in all participants. This suggests the need for future research involving larger samples, proprioceptive-specific exercises over an extended period of time with a longer follow up period.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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NEUROLOGY
P-019
P-017
DOES UPPER LIMB THERAPY IN THE COMMUNITY THROUGH AN EARLY SUPPORTED DISCHARGE PROGRAM, COMPARED TO INPATIENT REHABILITATION IMPROVE FUNCTIONAL UPPER LIMB OUTCOMES FOR STROKE CLIENTS?
OCCUPATIONAL THERAPY AND MOTOR NEURONE DISEASE – ADJUSTING AND ADAPTING TO AN EVER MOVING TARGET Sarah Solomon Calvary Health Care Bethlehem, Melbourne, Victoria, Australia Introduction: Neuropalliative care is a confronting and demanding area of practice. OTs in the community often report they lack confidence and/or skills to manage the complex needs of individuals with progressive neurological conditions especially Motor Neuron Disease (MND). Objective: We aim to assist our OT peers in understanding the specific care needs of this unusual population by sharing our experience and knowledge in the area of neuropalliative rehabilitation. Approach: Our poster will focus on assisting clinicians manage the challenges of providing care and intervention for people with Motor Neurone Disease. It will include points to consider when making decisions, clinical reasoning based on phenotype and disease progression and the cognitive/psychological impact of this devastating disease. Practice implications: This is an incurable but not untreatable condition. The subsequent resulting disability has a massive impact on all aspects of a person’s being and ability to participate in previously held life roles. Rate of disease progression can be rapid requiring a flexible and responsive approach. Working in this area of care provides many challenges including: • Constant change in functional abilities.
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Accessing funding, carer demands and specialised equipment needs. Grief, loss and emotional adjustment to devastating diagnosis.
The understanding of MND phenotypes to guide clinical reasoning Conclusion: Occupational Therapy has an important role in helping individuals and their families ‘adjust and adapt’ to the impact of a progressive neurological disease. MND is a rare and rapidly moving disease which requires a flexible and responsive approach to intervention.
Sara Whittaker1,2, Juile Smith1, Chris Barr2, Katherine Harding1 1
Eastern Health, Victoria, Australia 2Flinders University, South Australia, Australia Introduction: Early Supported Discharge (ESD) Programs for stroke aims to fast track clients home from hospital earlier than usual to receive intensive rehabilitation in the community environment. Traditionally, stroke clients needing ongoing intensive rehabilitation would be referred to inpatient rehabilitation (IPR). It has been found clients who are discharged directly from acute settings and receive rehabilitation through an ESD program are more likely to remain at home in the longer term and were more able to regain independence in their daily activities, however, research to date has not explored the benefits of this model of care on motor recovery of the upper limb. Objectives: The aim of this research project is to compare and contrast the experiences of patients referred to IPR and ESD in the initial phase of stroke recovery, with particular focus on upper limb therapy and the recovery of upper limb function. Approach: The study is an observational research design comparing traditional IPR with the ESD Program with a samples size of 26 in each cohort. Results/Practice implications: This presentation will discuss: • Background literature
• • • •
Study design Data analysis and results Implications for practice
Future research directions Conclusions: It is anticipated that results will further help shape rehabilitation program development and examine the preferred mode of delivery of upper limb rehabilitation in the stroke population.
P-018 THE EFFECTIVENESS OF SENSORY TRAINING TO IMPROVE SOMATOSENSORY DISCRIMINATION SKILLS AND UPPER LIMB FUNCTIONING OF ADULT STROKE SURVIVORS: SYSTEMATIC REVIEW Megan Turville1,2, Liana Cahill1,3, Tom Matyas1,2, Jannette Blennerhassett2,4, Leeanne Carey1,2 1 La Trobe University, Bundoora, Victoria, Australia 2The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia 3Australian Catholic University, Melbourne, Victoria, Australia 4Austin Health, Kew, Victoria, Australia
Introduction: One in two stroke survivors experience a loss of somatosensation. Treatment approaches for sensory loss have been diverse with emerging evidence for effective retraining. Aims: To systematically investigate the evidence and theory of sensory retraining in treating somatosensory impairment and upper limb functioning of stroke survivors. Methods: A literature search of electronic databases was conducted to identify studies that involved: (i) adult participants with a history of stroke who had clinically significant somatosensory loss in the upper limb; (ii) treatment approaches aimed at improving somatosensory discrimination skills; (iii) primary outcome results related to somatosensory discrimination skills and possible outcomes of upper limb functioning; and (iv) control trial or single case experimental study designs. Data was extracted from included studies according to established criteria. Quality analysis of data was completed using Cochrane risk of bias tool or Single-Case Experimental Design scale. Results: Findings to be presented will include treatment effects calculated as standardized mean differences with 95% confidence intervals and level of statistical significance. Results will be pooled for meta-analysis if possible. Findings will indicate the level of evidence for sensory retraining approaches within the field of stroke rehabilitation. Theoretical discussion of models used to guide sensory retraining, including task-specific and generalisation approaches, will be presented. Conclusion: In order to support clinicians in stroke rehabilitation and clarify a gap in the sensory intervention literature, this systematic review will determine the effects sensory retraining programs have in achieving desired outcomes for those living with stroke.
OCCUPATIONAL THERAPY EDUCATION P-020 FACILITATING INTERPROFESSIONAL PRACTICE IN OCCUPATIONAL THERAPY CURRICULA: A SCOPING REVIEW OF EDUCATIONAL INTERVENTIONS Lisa Broom Monash University, Frankston, Victoria, Australia Working in interprofessional teams more closely represents work environments as students prepare to enter a workforce which promotes client-centred health delivery from interdisciplinary teams across a range of practice settings. However, what is unknown, is how well our education programs enable students to be better participants in those teams, and what evidence still needs to be generated to support the inclusion of interprofessional education (IPE) in ‘busy’ occupational therapy curriculum. This paper identifies the current scope of interprofessional education interventions in occupational therapy curricula by locating, analysing and summarising the evidence. Methods: A scoping review was conducted to identify interprofessional education interventions involving pre-qualification occupational therapy students. Arksey and O’Malley’s (2005) framework was used to structure the review. Analytical methods: The Interprofessional Framework proposed by Reeves et al. (2011) was used to interpret the results, in addition to the modified version of the four-level Kirkpatrick typology to reflect upon and categorise documented learning outcomes from IPE interventions. Results: 450 documents were found to fit the inclusion criteria for this review. The results (being finalised at the time of submission) will be presented according to the Interprofessional Framework (Reeves et al., 2011). Conclusions: New graduates must be prepared to engage in collaborative practice in order to meet the occupational needs of society. Key findings identify methods used to implement effective IPE in addition to identifying further areas for research. Reference: Reeves, S., et al. (2011). A scoping review to improve conceptual clarity of interprofessional interventions. Journal of Interprofessional Care, 25, 167–174.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-021
P-023
CAN ANYTHING PREPARE YOU FOR A CHILD DYING? USING PALLIATIVE CARE RESOURCES TO PREPARE UNDERGRADUATE ALLIED HEALTH STUDENTS FOR SUPPORTING CHILDREN WITH LIFE LIMITING CONDITIONS
PREGNANCY AND PARENTING WITH A SPINAL CORD INJURY: SHOWCASING USER-FRIENDLY RESOURCES FOR PEOPLE WITH A SPINAL CORD INJURY AND HEALTH PROFESSIONALS
Natalie Hamam, Patrick O’Sullivan
Spinal Outreach Team, Brisbane, Queensland, Australia
Charles Sturt University, Albury, New South Wales, Australia Introduction: Many therapists report not feeling ready to handle the challenge of working with children and families in a palliative care situation. The Palliative Care Curriculum for Undergraduates (PCC4U) learning resources were designed by the Department of Health to enable graduates to become competent in implementing palliative care principles. Objectives: To prepare occupational therapy, physiotherapy and speech pathology students at Charles Sturt University for working with children who are dying using a collaborative, family-centred approach. Approach: The PCC4U learning resources are freely available and include indepth case studies, videos and learning plans. The three disciplines learnt together for 2 weeks during their final session at university using ProblemBased Learning tutorials, workshops and the story of Emily and her family. Learning outcomes: This interdisciplinary approach to working with a child with a life-limiting condition provided a supportive learning environment for students to explore responses to grief and loss, assessment and interventions, communication styles and therapist self care strategies. Feedback from the occupational therapy students showed that they valued the opportunity to learn with and from their peers in an interprofessional setting. The module also increased their knowledge of palliative care and strategies for talking about dying with children and families. Conclusions: Palliative care involves a team of professionals all who bring their own unique skills and qualities to provide a child with the best possible life before they die. The PCC4U resources can be used for interprofessional education of allied health students and enhance undergraduate learning of palliative care.
P-022 ENHANCING ASSESSMENT AND CARE PLANNING IN RURAL, REMOTE AND INDIGENOUS COMMUNITIES Heather Jensen1, Maree Daly2, Melissa Lindeman1, Kylie Stothers1, Annie Farthing1, Fiona Bremner2 1
Centre for Remote Health, Alice Springs, Northern Territory, Australia National Aging Research Institute, Melbourne, Victoria, Australia
2
Introduction: Research has identified the need for increased skills and knowledge about assessment, care planning and case management in rural and remote regions to enhance service delivery in aged care, mental health and disability. Education is also required on recent aged care reforms and the National Disability Insurance Scheme (NDIS). Objectives: This paper describes the development, delivery and evaluation of a 2 day course, which was conducted in both rural Victoria and remote Northern Territory. A further course will be taught in Alice Springs prior to the presentation of this paper. Approach: A literature review informed the development of the course materials and workbook. The knowledge and skills required for assessment, care planning and case management are shared and are known to benefit from an interactive interprofessional learning approach. Course content includes models and principles underlying good assessment and care planning practice, policy context and history, frameworks including person centred care and cultural safety, goal setting, prioritising care, evaluation, communication and report writing. Evaluation of the pilot courses was conducted including use of immediate written post-course evaluation with course participants and collated project team members’ observations. Practice implications: While the course received positive evaluations in both centres, there were differences between the two groups in the nature of their work, their skill levels and the social context. Conclusion: The importance of the context of delivery cannot be overemphasised in the rural and remote setting. Learning materials needed to be adapted and modularised to meet the needs of the participants.
Christine Leech Introduction: Occupational therapists at the 2012 Australia New Zealand Spinal Cord Society annual scientific meeting explored issues surrounding parenting with a spinal cord injury, and highlighted the lack of comprehensive, user-friendly resources currently available for such parents. Objectives: Occupational therapists in this service determined that resources for clients, nurses and allied health professionals were required to cover the different challenges that someone with a spinal cord injury would encounter when pregnant or parenting, and should include strategies to help overcome these challenges. Method: A literature search confirmed the lack of pregnancy and parenting information suitable for our purpose. It was determined that two resources were needed:
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A parenting resource focusing on parenting babies and of toddlers Information gathering included contact with interstate spinal occupational therapy departments for their advice/info/resources, focus group sessions with experienced clinicians of various disciplines, a comprehensive literature search, visiting relevant parenting websites, and conducting ten qualitative interviews with mothers and fathers with spinal cord injuries in the state’s capital city.
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A pregnancy resource A literature review and expert consensus on pre-pregnancy, pregnancy, labour, birth and post- partum from a spinal cord injury perspective was completed. The resource was reviewed by the spinal rehabilitation consultants and clients for accuracy. Results and conclusion: Both resources are now available as on-line booklets. They can be downloaded in chapters or in full. They add to the freely available web resources for people with spinal cord injuries, their families and health professionals.
P-024 OUTCOMES AND PARTICIPANT EXPERIENCE OF ONLINE TRAINING FOR BANGLADESHI HEALTH PROFESSIONALS Lisa O’Brien1,2, Lisa Broom1, Mohammad Mosayed Ullah3 1 Monash University, Melbourne, Victoria, Australia 2The Alfred, Melbourne, Victoria, Australia 3La Trobe University, Melbourne, Victoria, Australia
Introduction: An evaluation of a 6-year therapy capacity-building program in Bangladesh identified that future professional development must be sustainable and driven by local clinicians. It was, however, acknowledged that Bangladeshi clinicians needed training to become effective clinical educators. Objectives: To determine whether an online training program was effective in establishing locally driven, sustainable, evidence-based training for local therapists. Methodology: Five Bangladeshi therapists from a rehabilitation centre participated in the course, which was facilitated on-line by an Australian university. They completed eight pre-recorded modules and were assessed in-situ on their ability to deliver a tutorial to their peers. A qualitative explanatory case study design was used to evaluate outcomes, drawing on data gathered from pre-, post-course and 1-year follow up surveys, observations, and a post-course focus group. Results: All participants demonstrated satisfactory planning and delivery of an evidence-based interactive tutorial to their peers. Participants noted improved competence and confidence in searching for evidence, and developing and executing a teaching plan. This was sustained at one-year review. The key theme was a shift in participants’ concept of learning from being an expert-driven to a self-driven exercise. Enablers were multi-modal teaching techniques, the presence of a local leader, and the establishment of informal peer support. Barriers were logistical issues such as access to reliable internet services, and late delivery of course materials. Conclusions: On-line distance education can be effective in producing sustainable change in clinician skills in developing countries. Future programs would benefit from a blended learning approach incorporating ‘face-to-face’ instructor contact.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
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P-025 EXPERT PANEL: AN INNOVATIVE MODEL WHICH AIMS TO ADD VALUE TO FIELDWORK AND INCREASE THE ENGAGEMENT OF OCCUPATIONAL THERAPISTS IN GENERIC ROLES Sue Rowan, Nikki Lyons, Nicole Shaw Barwon Health, Geelong, Victoria, Australia Introduction: Increasingly Occupational Therapists are working in generic positions in traditional clinical settings. Occupational Therapists skills are valuable in these roles and it is important to impart this knowledge to undergraduates. But it can be difficult for Occupational Therapists in generic roles to remain engaged with student education. Objectives: A large regional health network introduced ‘Expert Panels’ to engage ‘Occupational Therapists’ in generic roles in student education and to inform students about the variety of jobs available to Occupational Therapists. Approach: Four, 1 hour sessions with a total of 14 speakers were conducted to different student groups. The ‘Occupational Therapists’ presented their career narrative and described how they apply their Occupational Therapy knowledge and skills to their current role. Surveys were distributed to gain qualitative data. Practice implications: Forty two students students attended the ‘Expert Panels’. Each of the ‘Occupational Therapists’ speakers had different position titles. The Survey data was analysed for themes. Results indicated students were inspired and reassured by the information presented. The staff felt they provided a valuable contribution to the student program. Consequently, some ‘Occupational Therapists’ have agreed to host fieldwork in 2015. Therefore changing the perception they have nothing to offer students. Conclusion: The program expanded students’ ideas about future career pathways and provided an opportunity for the ‘Occupational Therapists’ in generic roles to become engaged and contribute to the student program.
P-027
CLINICAL PLACEMENTS – MORE THAN JUST LEANINGS Nikki Lyons1,2, Kate Ingwerson1, Nicole Shaw1,2 1
Barwon Health, Geelong, Victoria, Australia 2Deakin University, Geelong, Victoria, Australia Introduction: As a result of a review of the OT student education program at a large regional public health network, group sessions were introduced to standardise education material presented and increase time efficiency for student supervisors. A number of additional positive unforeseen consequences were reported and noticed as a result of these group sessions. Aim: To provide opportunity for peer support for students engaged in practice education that in turn provided a positive experience Methods: Group education sessions for students on placement included orientation, clinical skills development and reflective practice. There were six student groups between 6 and 12 members from first to fourth year. There were 10 sessions per group per placement block. All groups contained students from the same year level and also included students from more than one university. Results: The unexpected positive consequence of the group sessions was the bonding and peer support that the students provided to each other while on placement, that in turn resulted in improved learning outcomes. Students organised social activities while on placement, reported the forging of friendships that would continue throughout the course and into their careers and spoke of the increased awareness of the OT profession in the context of hearing about others undergraduate university courses. Students report this peer support contributed to positive placement experiences. Conclusion: Group sessions for OT students while on fieldwork were found to assist in developing peer support and improving learning outcomes for OT students. Further research into this observation is part of an ongoing research project
P-028 P-026 THE BUDDY MODEL – AN INNOVATIVE PRACTICE EDUCATION MODEL THAT INCREASES CAPACITY WHILST ACHIEVING QUALITY OUTCOMES Nikki Lyons1,2, Nicole Shaw1,2, Kate Ingwerson1 1
Barwon Health, Geelong, Victoria, Australia 2Deakin University, Geelong, Victoria, Australia Introduction: As a result of recent changes in the organisation and increasing student numbers, a need was identified to research, develop and pilot an innovative model for practice education. The Buddy clinical placement Model is a innovative approach to practice education piloted with a large regional health network in 2014. Aim: To increase capacity while maintaining quality and sustainability for the OT student program with minimal impact on clinicians. Methods: Six 1st year OT students were paired and spent 2 weeks progressing across Acute, Inpatient Rehabilitation, Community Rehabilitation and Community Health; mirroring the care pathway of clients. This model also involved five 3rd year OT students from a different university who were also on placement and who provided the site orientation for their area and shared their experiences and learnings. The students then spent 2 days at each site observing OTs and third year students. Results: The aims of the Model were achieved and the feedback was overwhelmingly positive from all stakeholders. Comments included: 1ST years After watching a third year complete an assessment a first year student stated “I hope I am like that when I am a third year!” At the beginning of placement I wasn’t sure I wanted to continue with my OT studies, now I can’t wait to finish the course and work as an OT!
THE SUCCESSFUL IMPLEMENTATION OF A SAEBOFLEX PROGRAM TO OPTIMISE UPPER LIMB MOTOR RECOVERY FOLLOWING STROKE Kylie Smith, Sara Whittaker Eastern Health, Victoria, Australia Introduction: The Saeboflex allows clients with neurological upper limb deficits to integrate their hand into a functional arm training program. It promotes functional use, reduces spasticity and improves range of movement, strength and motor control. Due to the intensity requirements of this upper limb treatment modality, a group program was implemented to meet service demands. A Saeboflex inter-disciplinary working party has been established. Objectives: To successfully implement emerging technology within an established OT service without increasing the need of additional resources to optimise functional upper limb recovery of clients following stroke To increase consistency of therapy approaches and access to the Saeboflex program across all Community Rehabilitation Program sites Approach: Quality improvement principles were at the heart of this initiative with the Plan-Do-Study-Act cycle supporting the development, implementation and evolution of this new therapy approach. Results/Practice implications: This presentation will discuss: • Overview of emerging evidence using the Saeboflex as a therapy modality for upper limb function • Background rationale for implementation of the Saeboflex Group into the Community Rehabilitation Program • Establishment of a multi-site and interdisciplinary working party
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Implementation of a multi-site Saeboflex program Benefits and barriers to implementation of Saeboflex
Future directions using the Saeboflex in practice Conclusions: Implementation of a Saeboflex Group is a favourable means of providing intensive upper limb therapy in a community environment with promising results emerging for clients with upper limb deficits following stroke.
3RD years The presentation gave me a chance to reflect on my placement and all the things I have done- it made me realise I have learnt a lot Conclusion: Program to be implemented again in 2015.
© 2015 The Authors Australian Occupational Therapy Journal © 2015 Occupational Therapy Australia, 62 (Suppl. 1) 1–33
