CHARITIES: Introduction to OT – common difficulties and finding solutions.
by Nikki Thompson, Founder & Executive Director
“If you know, you know”, occupational therapy can have life changing impacts for the people we support, often leading to them becoming our biggest advocates in spreading the word to others on the varied ways an occupational therapist can help people lead meaningful and independent lives. However, unlike our physiotherapy or speech and language therapy colleagues for example, we are not a profession where our title has instant meaning, and occupational therapists have a long-standing challenge of helping those who have not yet experienced the impact of our involvement, to understand how and when to refer to us.
Throughout our 2023 Educational Series specially created for the charity community, we are aiming to provide a rounded knowledge base of why and how occupational therapy (OT) can help your beneficiaries.
Starting with the basics of explaining some of the common difficulties we see, and the approach we take to the solutions we may recommend; this important article will provide the foundations in understanding for the wider series.
Why charities use occupational therapy to support grant applications
Charities are often tasked with improving or enhancing the lives of their communities. Over the past decade we have seen the remit of our charity customers increase significantly due to the challenges that our public sector are experiencing. With an increase in waiting lists to access statutory (NHS and Social Care) services and a reduction in the services that are available to access, charities are finding the requirements that their beneficiaries approach them with have increased and have reacted positively and creatively with a diversification in service scope.
This wider scope has meant that charities are now providing services that in the past would have been delivered through statutory services and they are therefore needing to draw upon the skills and expertise of an occupational therapist to ensure that the items or services provided are the most appropriate for the beneficiary's immediate and long-term needs. By making clinically sound recommendations, we both mitigate risk to the beneficiary and charity ensuring the best use of the charity’s funds.
Mitigating risk
This is about ensuring both the beneficiary’s safety and also protecting the charity from claims or negative incidents. Beneficiaries will often approach charities with a specific request such as for a scooter or a riser recliner chair. It is the role of the OT to ascertain if the item is the most clinically appropriate solution for the beneficiary based on their medical history, diagnoses and prognosis, environment and level of current and likely future levels of physical and cognitive function. A good example of this would be a request for a scooter where on assessment the OT identifies that the beneficiary has a rapidly deteriorating eye condition affecting vision and perception. The provision of the scooter would place the beneficiary (and others) at risk when using it out in the community and could also expose the charity to risk in terms of potentially being the ones who provided an item of equipment that was wholly unsuitable. It is the role of the OT to advise the charity on the most appropriate solution for the beneficiary to allow their independence to be maximised safely.
Protecting funds
We need to ensure that the solution we provide is going to meet not only the current, but also the likely future needs of the beneficiary. By doing so we are ensuring that the charity does not then need to fund a further grant in the near future to replace the item originally provided. An example of this could be where a stairlift was originally provided for a beneficiary with a deteriorating neurological condition such as multiple sclerosis and within a few months of provision the beneficiary can no longer safely transfer on and off it and a secondary application is put in for a through floor lift or downstairs bathroom works. The relatively low cost of an occupational therapy assessment in comparison to the equipment cost, at the point the original grant application was made, would have protected the charity’s funds from a potentially unnecessary double grant expenditure or expensive equipment simply not getting used.
Equally, once the OT has ascertained that an item is clinically appropriate for the beneficiary they will then write a specification. This document is very important as it sets out the specifics of what is clinically required from the item of equipment for that beneficiary, nothing more and nothing less. At a basic level this could be the height or fabric of a chair (pressure management can be an expensive addition if not required) through to dimensions of shower cubicles or types of ramp coatings.
Whilst many OTs working with charities work alongside an equipment provider and will often visit together to ensure a seamless service, there are also occasions where the OT will visit alone and provide a specification to the charity for them to source the item directly (we see this arrangement more in the smaller charities who do not have a preferred provider arrangement in place with an equipment company). An equipment or adaptation specification written by an HCPC registered occupational therapist, ensures that the item or works provided have clinical integrity and the charity can trust that it is exactly what is needed by the beneficiary.
Hopefully this section helps clarify why charities choose to have an occupational therapist involved in their grant provisions. We ascertain if the item is needed, if not what alternatives are there and if so what specification will best meet the beneficiates needs.
How occupational therapists determine their recommendations
OT’s are specialists in supporting people to lead meaningful lives that are as independent as possible.
To achieve this our skills lie in the following areas:
1. Identifying the activities in a beneficiary's life that they need and what to do.
During an OT assessment we complete a holistic review of a beneficiary's ‘activities of daily living’. These are the activities that we all do from when we wake up to when we go to bed and tend to be the things we take for granted until, for whatever reason, we are no longer able to do them as we once did. We also look at how the beneficiary currently, and wishes to, interact with their environment which is most likely their home and garden but will also take into consideration the community around them. Often, we can adapt the environment or provide compensations which can open up previously lost activities.
From this assessment we have a clear picture of the areas of a beneficiary’s everyday life that are being impacted.
Examples include being able to: have a shower or bath, safely climb the stairs, sit or stand (or ‘transfer’ in OT speak) from a chair/bed/toilet, get their shopping, access their garden, return to work, care for their children or attend education.
2. Assessing what barriers are preventing or restricting the beneficiary from achieving these activities and where these barriers are coming from.
Once we know what areas of a beneficiary’s life are impacted, we then analyse these to establish why. Two people who are having the same challenge maybe doing so for very different reasons and it is not until we establish the reason for the difficultly that we can accurately identify the most appropriate solution.
A good example of this would be two children who are both struggling at school with their handwriting. On the surface both look like the issues are the same, messy handwriting. However, when we analyse each child performing the activity, we identify that one has poor awareness of letter formation and the other has weak muscles in their fingers leading them to tire easily. Both are presenting with the same challenge, but the approach to helping both children achieve the goal of improving the legibility of their handwriting will be significantly different. For one we will work on building up the small muscles in their hands, upper limb and trunk so they have greater core stability and fine motor strength, meaning they can control their pencil better and write legibly for longer. The other we will revisit basic letter formation to ensure they develop the muscle memory of how to form them. We were presented with one issue but for two different reasons. The same approach of activity analysis applies to all activities of daily living, and it is the skill of the OT that will ensure the most appropriate solution is found.
3. Analysing the risks and benefits of various possible solutions to recommend the most appropriate, bespoke solution to meet the beneficiary's needs.
We have identified the areas of a beneficiary’s daily life that are challenging and/or pose risk, we also know why these challenges are happening. Next, we need to find solutions to address them.
The OT will have an extensive knowledge of possible solutions ranging from those that adapt the environment to those that compensate for the challenges. These are called adaptive and compensatory strategies. Each one will have strengths but also reasons why it may not be the most suitable solution or ‘contraindicated’ in OT speak. For example the beneficiary may well request a shower over the bath if they are struggling to access the bath. For some this may well be the most appropriate solution, but for others this provision could present an increased risk of falling when getting in and out of the bath, so rather than mitigate risk, could in fact introduce it. Equally, if a beneficiary requests a scooter and is planning on storing this inside their property, the OT may look for alternative storage solutions, often an outdoor scooter storage facility with charging point can address this need but we have also seen several occasions where there is no outside space or options (we are good at coming up with creative solutions) and storing/charging the scooter inside will present a fire escape risk to the beneficiary. In these circumstances, the OT will complete a risk versus benefit analysis and, as disappointing for the beneficiary as it maybe, may well not recommend the provision of a scooter as the risk of not providing it, on balance is less than the potential risk of serious harm if it was provided and stored in the only way available.
Like a jigsaw puzzle, the OT will use their expertise to fit together the pieces. They will consider the beneficiary’s needs and goals, the reasons they are experiencing challenges, the environmental considerations and the options available to them within the charity’s scope... from this they will recommend the most appropriate solution.
Ultimately whether recommendations are approved or implemented should be the decision of the charity and the OT should always be clear with the beneficiary that their recommendation is only that, a recommendation, certainly these are the expectations we ensure our OTs set when completing assessments. There is a process to go through prior to any final decision being made on the grant or item being approved and provided.
Hopefully this article has provided some foundation knowledge and clear explanation as to what occupational therapy is. I have used real life practical examples of some of the common difficulties our charity customers ask us to assess for and explained the process we will go through to provide the possible recommended solutions. Throughout the article I hope to have illustrated the valuable contribution the role of the OT can make to the charity's decision making for grant provision.
We are proud to support charities both large and small and would be delighted to discuss in more detail if you provide grants for health and well-being to your beneficiaries. Call Aaron on 0330 024 9910 or email enquiries@theotpractice.com.
