Week 1: Psyched for Psych

Week 1: 11-14 August

Tuesday morning- the first day of Psych prac- was a workout session for my arms. I lugged three bags to the bus-stop: one bulging bag half my size for my activity items, one for my assessment forms and notebooks, and one for my personal items (mainly lunch, because one never knew just how much energy would be required...). My mother always complains that I over-pack, which is true, but I felt I'd rather be over-prepared than under-prepared, especially going into the uncharted waters of Psych Fieldwork...

Once we had managed to stack all our bags and baskets into a perilously tottering pile in the back of the small Toyota Avanza, we set off to the familiar pre-prac soundtrack of East Coast Radio (a station I've begun to associate exclusively with the to- and from-fieldwork journey, to the extent that just hearing The East Coast Breakfast starts getting my mind into prac mode...).
One wrong venue and two distress calls later, we arrived, disembarking to the curious stares of the workshop workers.

Originally, we were meant to work with members of the facility's social club, looking at areas like skills development, socialisation and functionality. However, upon our arrival, we learnt that the social club had been shut down and that we would be working with the workers of the protected-employment workshop. This meant that the focus of our intervention moved towards a more vocational approach, ensuring that our clients are working optimally, in a role best suited to their capability.

It was daunting to be faced with a completely new picture within the first few minutes of fieldwork, and having to adapt our mindsets and plans. However, we had all experienced first-hand over the past two years that nothing ever goes quite as planned in the real world, so we got used to the idea faster that we would've thought.

This new development prompted a lot of research into vocational intervention in the protected employment setting, which is still a very abstract idea in my mind. Reading over my Fundamentals Voc. Rehab notes, I started to get an idea of the concept of protected employment, and the many considerations that need to be taken into account.

To get further information, I decided to take the easy way out this time and go to YouTube instead of the library (I had a good feeling that mountains of text would go straight over my head in my current state of exhaustion, considering that I had returned from prac on Tuesday and collapsed straight into 15 hours of sleep... only to be greeted the next morning by lists of articles to read through for our Research concept paper...)


Looking at the videos, I began to get a pictorial idea of how a protected workshop was set up, and the type of work the individuals would be likely to receive.

https://www.youtube.com/watch?v=xsWvNvV_So0

https://www.youtube.com/watch?v=4HaLgqGBCx0

Unfortunately, I was disappointed to find very little South African perspective on the sheltered or protected workshop scenario, and the OT role within it. I'll have to begin looking through other sources, such as journals and other internet sites to see whether I can glean more information through a more relevant South African lens.

 

The challenge we know we're going to face during this fieldwork block is gaining access to our clients for sufficient amounts of time to conduct initial assessments and intervention, as well as groups, because any time the client spends with us is income lost from the work we would be pulling them out from.
We experienced this today, when we arrived at the Challenge to find the workshop humming with the sound of busy people and clicking of plastic pieces. The bottle cap pieces had arrived, and all clients were deep into the rhythm of 'grab a cap, grab a lid, snap them together and line them up'. We heard from the workshop supervisor that the consignment of bottle cap parts had arrived on Wednesday, and that the company would be returning to pick up the completed caps this afternoon.
With the deadline looming overhead, it would have been unfeasible to remove individuals or groups from the workshop without hindering productivity.
With that, our day plan changed completely. We spent the entire day working with our workshop groups, observing the ergonomics of the work space, the layout of the work materials, the speed at which each of our clients worked and their interpersonal contact.

I thoroughly enjoyed the session, as it provided a different view of my clients, in the work sphere, within a role that has significant meaning for them. They take great pride in being able to earn their own income through meaningful labour.
Doing the task myself was a great opportunity to experience exactly what degree of physical and psychological components were required for the task. It also allowed me to identify ergonomic red flags, such as repetitive wrist and shoulder flexion that caused pain over time, and hard chairs that inhibited good posture and comfort over long-term periods. Working with my clients in a setting where they had the home-ground advantage was also a wonderful opportunity to build a stronger rapport with them, from a more equal footing.

I found that my first client, who had had difficulty grasping the concept of the envelope-making task and appeared distractible, thrived in the concrete basic work scenario. Seated at his own desk due to space constraints, he had devised a system whereby he would lay out his  pieces in front of him before starting, allowing him to complete an average of 21 caps per minute. Unlike during the activity session, when he worked, he maintained an excellent focus on his work, continuing even when spoken to. It's possible that being paid according to weight served as a good extrinsic motivator for him to complete as much work as possible, and that the demands of the work task were more suited to his level of creative ability.

However, my second client, having displayed good focus and interest during the creative name-plate activity session, showed signs of fatigue and perhaps boredom after approximately two hours of working, evidenced by yawns, decreased speed and distractibility. It could be that the task was too simple for her, or that she has not yet built up the endurance to continue for as long as the others, as she has only recently joined the workshop.

This weekend, my goal is to integrate all my findings into a logical whole, and begin drawing up an intervention plan that addresses the problem areas identified.
I'm anxious that, having not been able to complete many of the formal assessments, I may be missing crucial aspects of my clients' problem list, which may topple my entire treatment programme. However, I have a sprout of an idea of where I want to go with both clients, based on my observations and initial interviews, with which I'll begin working this weekend. I know that I'll have to monitor my programmes carefully  as I get to know my clients better and pick up new areas of concern to ensure that they're relevant.

Having got through my first week of Psychosocial prac alive and sane (a relative term), I understand why many OTs choose to remain in Psych: like moss on a damp rock, psych clients grow on you... They have a unique way of looking at the world and engaging with reality that reminds me that as much as I teach them, they teach me. I already know that the lessons learnt here will be priceless.