Research Day: from the safe side of the podium

 

 

The word 'research' has begun to have a strange effect on my class: a slight groan, followed by a half eye-roll, culminating in a long, tired sigh. We've just begun working on our group research proposals, selecting a suitable topic, drawing up our first concept papers and scanning library bookshelves and the world wide web for any relevant literature. It seems a mammoth task to us at this stage, with so many big words and foreign concepts, but within the space of a year, our very first research dissertation (we hope and pray) will be complete.

 

A stressful day for the OT 4th years, Monday marked Research Day: a day to present a year's work of research to an audience of parents, students supervisors and adjudicators in the dignified space of the Senate Chamber. As third year students, we were present to assist with the smooth running of the day- which for many of us involved a lot of smiling and being generally helpful- as well as to get a glimpse of what we would be in for this time next year...

  

Glancing at the programme in the morning, I was surprised at the diversity of the research, from assistive devices and prosthesis use, right up to the lived experiences of teenage mothers. Within the single field of OT, the research focus varied from children to the elderly, from the higher socio-economic bracket of society to the lower and from institution-based to community based. The range of ideas and perspectives was a stark indication of the wide scope of Occupational Therapy, incorporating nearly every aspect of society. 

The Occupational Therapy Practice Framework  defines occupational therapy as

"the therapeutic use of everyday life activities (occupations) with individuals or groups for the purpose of enhancing or enabling participation in roles, habits, and routines in home, school, workplace, community, and other settings."  

 (AOTA, 2014b)

Townsend and Polatajko describe occupational therapy as,

" the art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life"

(Townsend& Polatajko, 2013, p. 380).

Given that each person has unique roles, occupations, interests and contexts, it is not surprising that OTs are often referred to as the 'jack of all trades', having to master our understanding of each role or occupation that a person values, so that we can accurately rehabilitate our clients and return them to the occupations that have meaning to them.

According to the Canadian Association of Occupational therapy,

"The essential elements of occupational therapy practice are:

1. Presence of an occupational challenge
2. Possibility of solutions that enable occupation
3. Client–specific goals/challenges/solutions and client-centred enablement
4. Multidisciplinary knowledge base
5. A reasoning process that can deal with complexity"

In the South African context, occupational challenges are everywhere: the low socio-economic conditions faced by the majority of the population, high HIV rates, issues within the healthcare system and other contextual problems such as crime. Hence, occupational therapy has a huge role to play in our society, which we began to really appreciate after seeing the many diverse foci on Research Day.

The guest speaker made an interesting point in his opening presentation, highlighting the importance of OT in the healthcare system. He pointed out that OT is one of the few professions where the training extends beyond the course requirements and leads to personal growth as well as professional growth. I've seen this first-hand, watching my class, and myself, develop over the years.
People I've known since first year have matured in an amazing way, revealing deeper talents and complex worldviews that were hidden just a few years ago.
Three years into the course, I find it difficult to meet people without automatically starting to analyse their life. I see a beggar on the roadside, and wonder what events have led up to him being there, and what other roles he holds in life. I go into someone's office and can't help looking for clues about their personality and interests beyond the work sphere. It fascinates me to ponder how complex we all are, shaped by our context and experiences.
I once met a student from Wits who asked 'What do they teach you guys in OT? You all have such a different way of looking at the world'. It's true: OT teaches us to see beyond face-value, converting our 2D, black and white perceptions of people into glorious 3D colour wheels.


Watching the fourth year students on Research Day, I could see the years of training emerge, as each group considered the various factors contributing to their participants' experiences, tying it all together succinctly. The use of narratives and personal quotes from participants highlighted the person-centred approach of our profession.
It was a bit intimidating to hear how they wielded heavy OT and statistical jargon and watch their creative presentation styles, considering that we would be in their shoes- and what beautiful heels some of them managed to manoeuvre in...- in just a year.

Research Day was a great opportunity to gain some inspiration for our own research. We noted down some wonderful ideas from the 4th's, such as the use of creative diagrams and flow charts to present our information in a more visually appealing manner , as well as the use of auditory input, in the form of voice recordings or quotations, to add to the richness of the presentation. Watching how the Person-Environment-Occupation model and the Model of Human Occupation were used to explain and interpret research findings was helpful, as it made us start thinking along better lines when planning our research design.

Research Day was a wonderful event. Not only did we get to see our colleagues at their most professional (there is hope for us!), we were reminded of the many opportunities for advancement within our field. In the unique dynamic that is South Africa, we have access to an amazingly diverse population, with a plethora of issues that come into play. This presents us with an unparalleled opportunity to add valuable input to the global body of Occupational Therapy knowledge, which is currently distinctly Western-centred.

Research Day presented us with a new challenge: to learn from our predecessors and return in a year to add our small bit to the volume of knowledge built up by those who came before us.

Canadian Association of Occupational Therapists. (2012). Profile of occupational  therapy practice in Canada. Ottawa, ON: CAOT.

Townsend, E.A. & Polatajko, H. J. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation, 2^nd Ed.. Ottawa, ON: CAOT.

Casual Day 2015

 I made the long walk from my car to the campus bus stop on Friday morning (a walk that always seems much longer on the way back in the afternoon...) laden with bulging activity bags, a chalkboard and a small mint-coloured sticker affixed to my jacket.

Casual Day had arrived, a day to celebrate people with disability, and we were pulling out all the stops to make sure our clients had an unforgettable experience.

Unlike the usual sea of blue, black and white, made up of the uniformed OT and Physiotherapy students, the bus stop on Friday was dotted with the colours of our various spring-themed outfits, garlands and flowers, in accordance with the 2015 Casual Day Theme: Spring into Action.

According to the Casual Day website,

"Casual Day is South Africa’s foremost fundraising campaign for persons with disabilities and is the flagship project of the National Council for Persons with Physical Disabilities in SA (NCPPDSA).(It is) a campaign that invites all fun-loving South Africans to dress differently for a day to raise funds and raise awareness of persons with disabilities."

 

(Casual Day, 2015)

To celebrate Casual Day at our fieldwork venue- a protected workshop setting catering for individuals with intellectual disability and various mental illnesses- we decided to hold an adapted Sports Day, incorporating fun activities, music and team spirit.

Our aim for Casual Day was threefold: to reduce institutionalisation of the clients by breaking their usual routine and encouraging spontaneity, to encourage teamwork and a sense of team spirit, as well as to simply make the day a true celebration of the people we were working with.



As our taxi pulled up to the venue that Friday, we experienced a moment of collective affection for our clients as we noticed the splashes of red, blue and yellow amongst the green, marking the three teams for casual day: the Red Ferraris (my amazing team!), the Blue Violets and the Yellow Lions. The clients had taken a great deal of care with their appearance, sporting flowered hats, multi-coloured temporary tattoos and a variety of floral accessories.
We were impressed.


Excitement was in the air as we disembarked from the taxi with all our luggage and began to set up.
The first activity, musical chairs, was a firm favourite of the workshop clients. The combination of movement, music and competition got everyone energised, starting the day off on the right foot. What I loved most about this classic game was that it was an equaliser for all the clients- whether high- or low-functioning- as it was simple enough that everyone could grasp the rules and have an equal chance to do well.



The competitive element became more evident in our second game of 'duster hockey', a hockey-like game played with brooms and a rag or paper ball. Initially, we had teams of two playing against each other, but after a mild altercation and one broken broom, the game was downgraded to a series of one-on-one matches, with people of equal abilities paired together. The best part of the game was watching how team members cheered for their participants, reinforcing a sense of inclusion and team spirit.

After tea, the merriment continued, with a tennis-ball and spoon relay, a hula-hoop competition, and finally a beanbag toss. The excitement mounted as the scores on the scoreboard rose steadily, and students, staff and clients all joined the fun.

It was wonderful to watch the way quieter individuals gained confidence as the day progressed, and the way those who were initially reluctant to participate were drawn in by the fun atmosphere.


On Friday, I developed a deeper understanding of what it means to develop an 'enabling environment', a space that encourages and allows clients to perform to the best of their capabilities (WFOT, 2012).
By setting the games at a level suited to every client, and creating an atmosphere that encouraged participation, people who would ordinarily have been unable or unwilling to engage in activity were able to join in, increasing their sense of self-efficacy and self-esteem.

Although it had been stressful to plan a day that we hoped everyone would enjoy, we hadn't anticipated the level of fun and learning we would get out of Casual Day. It will definitely remain one of the more positive memories of Psychosocial Fieldwork, the sort that overrides all the stress we associate with this module and makes it all worthwhile.

 

 

 

 

 

Casual Day (2015). What is Casual Day? Retrieved from http://www.casualday.co.za/what-is-casual-day/ on 4 September 2015

 

World Federation of Occupational Therapists (2012). Definition of Occupational Therapy. Retrieved from http://www.wfot.org/AboutUs/AboutOccupationalTherapy/DefinitionofOccupationalTherapy.aspx on 4 September 2015

 

Invited speakers left me thinking...

With our brains buzzing from the imminent threat of midterms, we were given a brief break from pure academia today. We welcomed four speakers from the community to give us some insight into Down's Syndrome, Autism, Eating Disorders and Depression, all of whom had something invaluable in common: personal experience, and a lot of it...

Down's Syndrome is a condition I was only vaguely familiar with from high school Biology and university Physiology lectures, so it was unsurprising that I was introduced to many concepts I had never come across before.
Through her 31 years of experience, following the birth of her daughter with Down's Syndrome, our speaker had a great deal of practical information that clarified my understanding of the syndrome tremendously.

She explained the prevalence of Down's Syndrome, pointing out that it is present across all races and socio-economic boundaries. It was surprising that Down's Syndrome has a prevalence of 1 in 660 in South Africa, much higher than I had imagined.

Having been given a brief overview of the history of the syndrome, I found it interesting how perceptions of the condition have changed over time, from people with Down's Syndrome being referred to as 'Little Mongolians' and having a life expectancy of just 9 years, to their current participation in all aspects of society, most experiencing a normal lifespan. It was also fascinating to find out that there are different manifestations of Down's Syndrome, such as Trisomy 21 (the most common occurrence), Mosaic and Translocation types.

I found it inspiring to hear the story of a young man with Down's Syndrome, who not only holds down a normal job, but also has his driver's license and is married. I hadn't realised that I had been constructing a ceiling for people with Down's Syndrome in my head, and it was eye-opening to have it shattered by the story of this individual.

From the perspective of a mother, the speaker had a unique insight into the difficulties faced by the caregivers of children with Down's Syndrome, not only physical and mental challenges, but societal as well. She expressed her annoyance at being told she was 'special' for having received a child with Down's Syndrome, or being treated to a range of irrelevant generalisations when someone found out her child had Down's Syndrome. It was refreshing to hear her perspective from the other side of the therapeutic 'table'.
She also stressed that children with Down's Syndrome be integrated into society as much as possible, so that they learn to comply with social norms, and can therefore be better functioning members of society.






The next speaker focused on Autism, another condition I had never had much opportunity to experience first-hand (but one I should definitely look into for my next Electives block...). She gave a good picture of a typical Autistic child: solitary play, routine or stereotyped behaviours, often a lack of verbal communication and delay or absence of social norms. She also explained that sensory difficulties are another common presentation, which OTs have a large role in, particularly with regard to sensory integration.
An interesting aspect was the historical progression in thought around Autism, from viewing it as a result of an unattached 'cold ice-berg' mother in the 1960s, to viewing it as a behavioural problem that could be remedied through reinforcement schedules in the 1970s and 80s, and finally, to the current socio-developmental or humanistic approach, which uses a more child-centred approach.

An interesting concept that the speaker introduced us to was the 'Theory of Mind', the idea that Autistic children lack the ability to perceive the thoughts or intentions of others, leading to a fear of the others' unpredictability. This in turn affects social interaction.

The speaker offered some good advice to us for working with autistic children:

• As patterns develop quickly, have a regular, positive routine for the session, so that the child starts to build rapport and learns to trust the therapist
• Do not set unrealistic expectations for the child, as this will cause anxiety and be overwhelming
• Focus on enjoyment and building rapport first
• Correct sensory, social and communication deficits first, through simple activities (e.g. starting off with blowing bubbles) before upgrading to include more interaction and functional skills

These tips make sense in a slightly vague way to me currently, but will no doubt come in more useful next year, when I have some practical experience to relate to it. In the meantime, the speaker left us with a list of interesting titles of books around Autism, which we can start perusing over the holidays (well, that's the plan... I hope some of them have pictures :D)

The next speaker, discussing Eating Disorders, was an interesting one, as she had gone through and recovered from an eating disorder herself. She explained how her problem had started, when she was High School and had been placed in the 'Fat' line due to her muscular build, setting off a spiral of negative body-image problems that, combined with a sense of perfectionism and obsession, turned into a full-scale eating disorder. She explained how she would constantly weigh herself, do excessive exercise and barely eat in an effort to lose weight.

From a first hand perspective, I got a real sense of the complexity of an Eating Disorder, and the all the underlying issues that have to be resolved before the disorder can be healed. It goes far beyond a simple desire to 'look thin' and into an obsession with control over the body, often to compensate for a lack of control in other areas of life.

The speaker gave some interesting tips on dealing with an eating disorder of a loved one: never comment on their weight or appearance, as it is likely to cause more harm than good. Rather focus on feelings and relationships, expressing your worry and desire to help them seek assistance. She stressed that eating disorders are not a demand for attention, but rather a maladaptive way of dealing with various underlying issues.

The final speaker spoke on Depression, a disorder affecting 1 in 4 people in South Africa, and accounting for 95% of suicides. She used an interesting way of presenting, using videos and music to convey the seriousness of the condition, and give us a sense of how people with depression really feel.
The important points stressed were that depression is treatable on medication, but is never an illness that just disappears. It often reappears throughout the lifespan, triggered by traumatic events or illness. She also reiterated the importance of picking up warning signs of depression and suicidal ideation, such as withdrawal, isolation, loss of interest in activities and irritability, and confronting them as soon as possible.

The speakers today were each inspirational in their own way. They provided valuable  perspectives on conditions we will be working closely with as we progress in our profession, from a very personal viewpoint not usually experienced in our academic lectures. They also introduced us to a variety of resources, such as the Down's Syndrome Association, Action in Autism and SADAG (South African Depression and Anxiety Group), that we can draw on in  years to come.

Reflecting on Reflection: my thoughts on blogging

When my mother found out that we would be required to submit an OT blog every week, she was ecstatic. Ever since discovering 'Diary of a Guji Girl', she had been hounding me to start my own blog, to keep whatever traces of writing skills I still had from dying a slow death.

Truthfully, I was not as impressed with the idea. The combination of enforced creative, critical writing, coupled with self-disclosure- being forced to dig out my opinion every week and smear it across the internet- was not appealing in the least. It was as though campus work was trying to insinuate itself into my personal life, and I wasn't quite ready to invite it in. It has taken me a while to realise that my personal growth is intertwined with my growth as a therapist, and that I don't need to exclude the two from each other to allow both to flourish.


7 months later, as much as I dread getting home exhausted at 4pm (or 3pm if the Clinical Sciences lecturer has an ounce of pity for us...) on a Friday afternoon and tapping listlessly at my laptop to complete a blog- with my siblings openly flaunting their Friday afternoon freedom- I have (more-or-less) made my peace with blogging.
There are days when I have to squeeze the words out like juice from a 5-year old lemon, and rare days when I have the odd epiphany that gets the blog flowing. Whether it's the former or latter, though, I always learn something new.

According to Katie Charner-Laird, co-author of 'Cultivating Student Reflection', reflection is "the mind's strongest glue", allowing us to connect ideas together, which helps us understand concepts better (Boss, 2009).

 This is something I've found to be true throughout the past few months. As a visual thinker, consolidating images into words allows me to compartmentalise information better, so that I can access it more easily when the time comes to integrate it into a new idea. It allows me to consolidate my learning at the end of the week, to reflect and regroup before heading back into the cycle of studies or fieldwork.

According to a study done by Rachel Ong on The Role of Reflection in Student Learning,

 

"Reflection journals can help to increase the value of the learning experience

by facilitating learners to make meaning out of the process they are engaged

in. It enables the learners to relate the new material of learning to prior

knowledge and hence a better understanding of the discipline. It also

enhances the learner’s meta-cognitive awareness." (Ong, 2012)

 
Reflecting on my experiences, knowing that it has to make sense to others reading my blog, is a good way for me to evaluate the strength of my viewpoint, and unpack it more comprehensively. It stimulates me to read more, to see what others have said on the topic, or whether there are alternative opinions that challenge mine.

I have begun to discover more about myself, my profession and my learning process. What was a deep aversion to self-disclosure has become more refined: I have begun to distinguish the depth to which I am comfortable with divulging and, in the process, begun to understand my own 'layers' of being.
I sometimes wonder whether it was just the fear of outside criticism that made it difficult for me to express my opinions through blogging, as putting my views out into the world left them open to judgement by others. This fear would make sense, considering that I had rarely received negative feedback before starting University. Three years into OT, I'm glad to see that fear dissipating, as (having received a lot...) I am more open to criticism. In fact, I have discovered that I definitely learn more, and faster, from negative feedback than positive.

 Blogging has been at times frustrating and stressful, and at times satisfying. It's difficult to pin thoughts onto paper, but once they're there,it's worth the effort. With so much information channelling through our brains every day, blogging allows us to consolidate, organise and move into the week ahead just a little bit wiser (hopefully) than before.

Boss, S (2009). High Tech Reflection Strategies Make Learning Stick. Retrieved on 27 August 2015 from http://www.edutopia.org/student-reflection-blogs-journals-technology

Ong, R (2012) The Role of Reflection in Student Learning. Reflections on Problem-based Learning. June 2012 (12) , pgs 1-14. Retrieved from http://www.myrp.sg/ced/research/papers/role_of_reflection_in_student_learning.pdf

 

 

Movies under the Microscope: The Portrayal of Mental Illness in Film

In a world where mental illness is commonly hushed up, for many people, movies are the sole arena through which we can catch a glimpse into the lives of those with mental illness  Unfortunately, many myths and stereotypes are perpetuated through this medium, including the notion that people with mental illness are dangerous, unpredictable, 'different' or incurable.

 

 (Tartakovsky, 2013)

According to a YouTube video entitled How the Media Controls Society (very 'conspiracy-theory', but a lot of good points), movies elicit 'emotive sequences', which allow the reasoning centres of the brain to be bypassed. In this way, new ideas can be 'downloaded' into your mind without their merits and faults being analysed, as they would be in any other form of information gathering. This leaves us susceptible to believing the many false ideas regarding mental illness which pervade our film media.

Not all mental illness portrayals in movies are negative. Some, which have gained popular acclaim, depict a very positive picture of mental illness, which seeks to lessen the stigma associated with mental illness. However, many of these are unrealistic, and tend to either have a very light-hearted approach to mental illness, or are entirely unrealistic (Fawcett, 2015)

The movie I chose to review, Forrest Gump, is one of the more widely acclaimed movies on mental illness, representing a more positive slant on intellectual disability.

Forrest Gump tells the life story of a young man with mild intellectual impairment, at the higher end of the functional spectrum, who has a strange knack of landing himself in fortuitous situations.
The story is told retrospectively, from Forrest's point of view, and, through flashbacks, the strange and wonderful series of events and coincidences that led up to the present is portrayed.

I thoroughly enjoyed Forrest Gump, and it will always remain one of my favourite movies. It ticked all the boxes I look for in a movie: compelling storyline, strong characters, historical basis and happy ending
(unless of course the "virus" Jenny has was HIV, and through transmission of the virus, Forrest and his son were to die soon after the events at the end of the movie... but I'm hoping otherwise...
On the topic of Jenny, I have many opinions on her character and life choices, not all of which are flattering, and which could constitute an entire topic by itself...)


At face value, I felt this movie had made great strides in overcoming the stigma of mental illness, through providing a view into the life of someone with intellectual impairment, from his perspective. It portrayed the unique way in which Forrest viewed the world, through a concrete lens, often missing deeper connotations.
It appeared that through the use of Forrest as the narrator, the movie sought to express how people with intellectual disability are viewed by others, how they view themselves and how they understand the world around them. In the movie, Forrest finds himself in a variety of important historic moments, yet does not seem to understand the significance of these events, tending to focus on his own, simpler, agenda.

 

 In a world where being different from everyone else is becoming increasingly attractive, it's almost as if the movie is presenting intellectual impairment as a new kind of 'different' that is not necessarily negative.
Through making an intellectually impaired individual more 'human' and highlighting his positive personality traits, such as honesty, loyalty, hard work and kindness, a more positive picture of intellectual disability is painted.

However, I feel that this is where one of the major flaws of the movie lies. In highlighting the positive aspects and glossing over, or ignoring entirely, negative aspects that many intellectually impaired people face, such as low self-esteem, discrimination and impaired social skills, the movie portrayed a wonderful, but inaccurate portrayal of intellectual impairment (Menchetti, Plattos and Carroll, 2011)
Although some of these issues were hinted at in the beginning of the film, when Forrest was refused admission to school, was bullied, and when Jenny felt he could not understand the concept of love,  by the end of the movie, they had been resolved or had inexplicably disappeared.


 In terms of its portrayal of intellectual disability, it demonstrated one of the two errors described by Hannah Lawrence in her YouTube video, "Representations of Mental Illness in the Media":

'Decent mainstream portrayals of mental illness are extremely rare and tend to glamourise the condition of the sufferer" or "underemphasise the suffering".

In Forrest Gump, Forrest's life was unrealistically positive. Through the support of his mother and Lt. Dan, not only did he attend a mainstream school and graduate from college, but through a series of coincidences and miraculous events, established a successful shrimp brand, became a millionaire, married the woman of his dreams and fulfilled the popular American dream of fame and fortune.

Throughout the movie, there were glimpses of the types of difficulties people with intellectual impairment face, such as ridicule, misreading social situations and missing the deeper meanings of events, but they were not explored beyond a superficial level, possibly because this would have undermined the 'happy' or 'feel-good' theme of the movie (no one wants to watch a depressing movie that makes you think about things we like to pretend don't exist... right?) In so doing, the movie presents a skewed depiction of intellectual impairment, which undermines the very real difficulties faced by these individuals and their caregivers.
While it rightly points out that people with mild intellectual impairment are capable of integrating into society and achieving success in many life roles with the right support and opportunities, I feel it presents unrealistic expectations for the majority of those living with intellectual impairment, most of whom are unlikely to reach the levels of (socially-perceived) success as Forrest.

That said, although I would not necessarily recommend this movie for purposes of education on intellectual impairment, unless accompanied by various other resources, I feel the movie was cinematically well-made, had a great storyline, and has secured a spot on my list of movies I'd gladly watch again.

Watching this movie, and being pushed to analyse it, has made me realise the ease by which we accept what we see in film without questioning the effect it has on society. It has taught me to be more aware of subtle stereotypes that are present in our media that influence the way we think, so that I can critically evaluate my own response to these stereotypes.

With film and televised media being one of the most popular and accessible means of information, I feel it is of critical importance that we continue to evaluate the effects of media portrayals of mental illness, and work towards advocating more accurate representations of mental illness. Through this, the stigma of mental illness, largely perpetuated through ignorance and negative media portrayals, can be gradually eliminated.

 

 

References:
 

Tartakovsky, M. (2013). Media’s Damaging Depictions of Mental Illness. Psych Central. Retrieved on August 20, 2015, from

http://psychcentral.com/lib/medias-damaging-depictions-of-mental-illness/

 



Fawcett, K. (2015). How Mental Illness is Misrepresented in the Media. US News Health. Retrieved on 20 August 2015 from http://health.usnews.com/health-news/health-wellness/articles/2015/04/16/how-mental-illness-is-misrepresented-in-the-media

 

Carrol, S., Menchetti, B., Plattos, G. (2011). The Impact of Fiction on Perceptions of Disability. The Alan Review. Volume 39 (1). Retrieved on 20 August 2015 from  https://scholar.lib.vt.edu/ejournals/ALAN/v39n1/menchetti.html

 

Turn Off Your Television! (2011, March 29). How the Media Controls Society [Video File] Retrieved from https://www.youtube.com/watch?v=zOQ1jZOj_ho

 

Hannah Lawrence (2014, July 14). Representations of Mental Illness in the Media [Video File]. Retrieved from https://www.youtube.com/watch?v=yEJPOSoEeqk

 

 

 

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.

Mock Prac Musings...

Laptop fully charged and small Tupperware containers of snacks at the ready, I sat amongst my classmates in the OT seminar room on Tuesday, all of us breathing the same air of trepidation as it dawned upon us that we had just a week left until the Psychosocial block commenced.



Mock prac, or Prac prep, is a good jolt in the ribs for those of us who tend to be slackers because it turns up the pressure, never failing to induce an 'I have no clue what I'm doing and just want to go home and SLEEP so I don't have to think about all the work ahead!' panic response, which is soon replaced with a good sense of fear that if I don't get buried in the books ASAP, I'll soon be buried neck-deep in other, more unpleasant things...


That said, I find mock prac to be an excellent compass, orientating me to the direction I should be moving in to achieve my fieldwork aims and highlighting common mistakes to avoid. Just having a joint meeting in which everything is discussed is reassuring, because it gives a sense that we're all on the same page in terms of what is expected of us during fieldwork.

It was a bit of a  lightbulb moment for me when we discussed the idea of empowering facility staff and residents to perpetuate meaningful change instead of waltzing in with our OT baskets and doing amazing things that would die the moment we left. It was a reminder that while this may be just a three-month block for us, it would be unethical, and a failure, if we made no lasting positive impact on the people we worked with.



Unlike the Physical Prac Prep, Psychosocial seems to focus more on the development of our therapeutic selves than on the development of our knowledge base, although the two are inextricably linked. I like the underpinning idea that there is no set formula to achieve successful intervention, but that if we could learn how to think critically and creatively, we would be able to apply our knowledge to any patient and achieve an infinite range of client-centred intervention programmes.

Sitting among my classmates, I was struck again by how brilliantly and differently each of our minds worked. It was a reminder of how much we have to learn from each other, a lesson I am reminded of every day. Through the differently coloured lenses of our cultural backgrounds, we each perceive things from a unique vantage point, offering a rich opportunity for peer learning. Allowing us to each present an academic and community resource that could potentially benefit the rest of the class was a great idea, because there were some amazing gems- websites, books and articles- that could assist us with selecting and adapting our activities, as well as obtaining cheap resources from within our communities.


During mock prac, we had the opportunity to discuss our fieldwork venues in more detail, in terms of the type of clients we would be likely to receive, as well as the resources available and potential barriers that may be present. Knowing that I am likely to receive clients with intellectual impairment, and possible institutionalisation, I can focus a bit more on choosing activities that are more concrete and meaningful to the clients. Of course, until I meet my clients, I'm still navigating blind, but at least I have a sense of direction to focus my research on.



Heading into the weekend, Vona du Toit is going to become my new best friend as I brush up on my Model of Creative Ability notes and dig out my rainbow colour-coded MoCA assessment form. Not only will it be a definite assessment tool, but will also give me a good idea of the type of principles I will need to apply during intervention sessions, and what sort of grading I could use, given that my clients are thus far unknown. It will be a tool I will have to become proficient in to determine a client's correct level of Creative Ability, so that activities are meaningful, achievable and therapeutic.



According to Crouch and Alers in "Occupational Therapy in Psychiatry and Mental Health", in order for an individual to behave creatively and extend their level of creative ability, an individual must

• "  Have a positive attitude towards an occupational opportunity offered to him by a therapeutic activity despite some anxiety (creative response)
• Be actively engaged in 'doing' the activity, which offers the appropriate challenge (creative participation)
• Work towards producing an occupational product or outcome that denotes some activity participation change, be it tangible or intangible"

(Crouch, Alers, 2014: pg.5)

According to the International Creative Ability Network,

"For occupational therapists, the model brings together all the core aspects of occupational therapy practice (activity analysis, grading, purposeful activity, activity groups, therapeutic use of self and the non-human environment) to provide therapists with a tool that is practical and user friendly, enabling occupational therapists to be occupational therapists: the application of activity as a powerful therapeutic tool."

http://www.ican-uk.com/about.php 

 

This means that it is imperative that I select an activity of the correct complexity to meet the creative level of the client,  and apply the correct handling, presentation and structuring principles as per the level of creative ability of my client. It is also important that the activity be meaningful and enjoyable for the client, as this will ensure that motivation, and therefore volition, to participate in the activity is present. There needs to be a balance between offering an activity that the client will be able to achieve success in, and providing an appropriate challenge to allow the client to move to the next level of creative ability.

In the real prac situation, I know it will be a challenge to place the client at the correct level and correctly grade my activities to achieve progress. Hopefully, through practice and continuous learning from mistakes, it will become easier.

With just three days left to prepare, it's time to unpack my craft cupboard, start photocopying assessment forms and officially bid farewell to the holiday: Let Psychosocial Fieldwork begin...

Crouch, R., Alers, V (2014). Occupational Therapy in Psychiatry and Mental Health. 5th ed. John Wiley and Sons: West Sussex


ICan(2010). About the VdT Model of Creative Ability. Retrived from: http://www.ican-uk.com/about.php (6 August 2015)