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“Able to enable” College of Occupational Therapists1990

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The underpinning concepts of occupational therapy are centred on meaningful occupation related to a need for enablement, whether in a

health or social context

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Occupations fill and structure time Occupation is centred on self-care,

leisure and productivity (work) Occupation has a socio/cultural context

and incorporates social participation and engagement

Occupation contributes to a sense of identity

Occupation enhances self-esteem and supports mental and physical wellbeing

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Social Work/NHS liaison working (POA and ESD) Orthopaedic rehabilitation Neuro/acquired brain injury rehabilitation Child development/habilitation/Bobarth All areas of mental health/treatment and

rehabilitation Learning disabilities/habilitation and rehabilitation Private practice Work/industry rehabilitation Counselling/CBT Care Home liaison/education Stroke rehabilitation Community outreach The Wheelchair service/orthotics/splinting Consultancy Volunteer/charitable agencies NHS and Social Work general management

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All courses in Scotland are now 4 year Honours courses

All students have to fulfil placements in physical and mental health settings and also in a Community setting

Training encompasses psychology, psychiatry, biometric sciences, sociology, biomechanics, ethics, ergonomics, mental and physical illhealth and condition specific rehabilitation

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In the 18th and 19th centuries there was already philanthropic practice where charity was the sole outcome, with no expectation that the recipients would regard it as a route to achievement or

self-determination. It was later advocated that rewarding productive activity would be more enabling, as

outcomes would raise self-esteem and induce self-reliance

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Occupational Therapy and Social Work share common antecedents and there were significant individuals who were in the same sphere of social

reform and with a common belief in social equality and occupation

For both Occupational Therapy and Social Work the formalisation of theory and practice has origins in

Americaand as they developed their eventual professional

titles reflected their developed focus

Both chose routes to enablement

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Octavia Hill (1838 - 1912) was an early and significant social reformer who was instrumental in formulating the concepts of

Social Work and who inspired others in her belief of the need for social change and enablement

Elizabeth Casson (1881 – 1954), worked for Octavia Hill. She later became a doctor and subsequently an eminent psychiatrist. She set up the first British school of Occupational Therapy in 1930. Each year the College of Occupational Therapists awards the

Elizabeth Casson Prize for exceptional practice

In 1925 the first person in Great Britain appointed to work as an Occupational Therapist was Margaret (Peg) Fulton (1900 – 1989).

She was later awarded an MBE in recognition of years of advocating and practicing meaningful occupation in rehabilitation.

Peg trained in Philadelphia but worked in Aberdeen and contributed to the development of the British and World

Federation of Occupational Therapists

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Occupational Therapy staff make up one percent of Scottish Social Work staff but account for 35 percent of

referrals for adult social work services. They can be individually responsible for assessment and equipment

provision/adaptations that will allow greater independence and/or facilitate or support the carer role.

In 2008 there were 516 occupational therapists working in Scottish social work services. This is lower than in 2006!

This has happened when the fastest rising demographic group is the over 85’s, with a commensurate rise in

dementia and debilitating frailty. Similarly, previously life-limiting conditions are prolonged with more

successful treatments, with a consequent need for extended and additional support services and

interventions in the community

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In response to this initiative, the College of Occupational Therapists has produced a report that analysed the role of

community occupational therapy in the enablement process and set within their historic role of habilitation and

rehabilitation

The COT report encompasses many Scottish Office initiatives

Changing Lives (2006)

Co-ordinated, integrated and fit or purpose: a delivery framework for adult rehabilitation in Scotland (2007)

Framework for adult rehabilitation in Scotland (2006)

The better health, better care, action plan (2007)

These, amongst many others place occupational therapy alongside social work in the development and delivery of

enablement initiatives

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The current “enablement” agenda is an opportunity to reinforce the historic relationship between

Occupational Therapy and Social Work

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Due to demographics, we will be unable to meet future demands for service unless better use is made of our resources

Services must be at the time of need and be more flexible

“Care” models of service provision can lead to disabling rather than enabling Service Users

Enablement will result in better outcomes for Service Users

To comply with initiatives and agendas such as Changing Lives, Shifting the Balance of Care and Angus Council’s Best Value Review of Older People’s Services

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In 2007 a Personal Care Pilot Scheme ran in Angus and focused on Service Users whose requirements included personal care

The scheme sought to determine the potential for enabling the person rather than an a tacit acceptance of a Long Term need

The scheme involved 29 SUs with a total of 137 hours requested

At the end of the scheme only 21 hours of ongoing service required

6 Service Users achieved total independence

The majority of the remainder only needed assistance with bathing

The scheme ran between August 08 and April 09 and investigated requests for Older People in Brechin/Montrose for new meals provision or increases to existing provision

Prior to pilot scheme there was an average 15 referrals monthly

Each referral was more fully assessed by a Home Care Assessor, Care Manager and an Occupational Therapist

There was a focus of the potential for short-term support with enablement/independence as the preferred outcome

In the last 12 months there has been a maximum of 4-5 referrals monthly and 50% of theses has been for short –term meals provision

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Better long and sort term outcomes for Service Users with regard to enablement and independence

For services to be delivered at the right time to the right people with the ability to adjust as needs change and to prevent waiting lists for services

To provide flexible support and service delivery and give greater job satisfaction

To maximise resources in order to meet current and future demands

To comply with government and local initiatives and agendas

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The COT report concludes;

“The full, effective and timely involvement of occupational therapy

in social work services now and in the future will reduce the need for complex and costly packages of

care”