Stayin’ oOT!

Thanks to Emma Lewis and Lindsay Kerr, Occupational Therapists, for this week’s blog. A really interesting feature if you had never considerd how occupational therapy could be used in the context of the justice system.

What is occupational therapy….??

Anyone who works as an Occupational Therapist will know that the profession is so diverse, that at times it can be difficult to fully define our unique role and how we use our specialist skills to enable people realise their full potential.

The college of Occupational therapists defines our role…..

‘Occupational Therapy provides practical support to enable people to facilitate recovery and overcome any barriers that prevent them from doing the activities (occupations) that matter to them. This helps to increase people’s independence and satisfaction in all aspects of life.’

 So in principal we use holistic assessment and engage with people in meaningful conversations to find out what matters most to them; looking at ways to enable and make a real difference by considering all of a person’s needs – physical, psychological, social and environmental.

Partnership is key!

Within Ayrshire we have been fortunate that our woman’s justice partners have fully recognised the value that Occupational Therapy brings to this area of work. Allowing for transformational partnership working, that challenges traditional service delivery and provides early and effective intervention. This collaborative working with SACRO, South West Scotland Community Justice Authority (SWSCJA) and the local Health and Social Care Partnerships has been essential in ensuring the provision of a quality, seamless service. Moreover the recent funding support from the CJA has allowed for the further development of this new and emerging area of work for Occupational Therapy, which supports women across Ayrshire.

Need for change ……

The women’s prison population has been rising by 120% and with most presenting with mental health and or substance misuse; more services are required to prevent re-offending behaviours.  It was hoped that by engaging this group of women in Occupational Therapy at the right time there would be a reduction in re-offending behaviours. Early indications have highlighted that this has absolutely been the case.

Traditional health care services often have large waiting lists; this can make it hard to engage in early intervention work. The ability to access the right person at the right time is essential!!. Too often by the time some of our service users reach the top of our waiting lists their motivational levels have dipped and they are no longer as willing to engage with the appropriate supports.

Why Occupational Therapy??

A 3 day a week post was funded in order to provide an opportunity for woman within the criminal justice system early access to Occupational therapy intervention. There were agreed routes of referral from the following service areas; diversion, court screening and Sacro’s bail supervision.

So how do you support a client group using our diverse skills and how do you define an appropriate referral from one which isn’t? Is it the person’s motivation and ability to want to seek changes? Or is it the person’s ability to define how they feel their functioning has become effected?

Essential components of the intervention provided:  person-centeredness and a focus on personal strengths (assets). The underlying reasons behind the offending behaviour are the focus of therapy and not the crime.

Within less than a year the service has received in excess for 50 referrals. Since then women have been supported with:-

  • Anxiety management/graded exposure
  • Challenging negative thinking patterns
  • Self esteem and confidence building
  • Engagement in community resources
  • Stay well mental health plan
  • Identifying alternative coping mechanisms
  • Referral on to other services
  • Voluntary opportunities
  • Functional assessments
  • Provision of small equipment
  • Sleep hygiene

So what impact has Occupational Therapy made to individuals? 

Personally being able to work with this service user group, has been really rewarding and exciting. I have been able to see first-hand a real difference to people’s lives as direct result of my Occupational Therapy interventions.

One example was a young mother who accessed the service following an assault; and had been utilising alcohol as a coping mechanism. She did not have a diagnosed mental health difficulty but had pressured speech, negative thinking patterns and low self esteem. We worked together to identify what mattered most to her; which was “being a good mother and partner, being able to look towards volunteering and to engage in activities of interest”. I utilised a Cognitive Behavioural Therapy (CBT) approach and in addition provided self help materials to look at identifying and challenging negative thinking patterns. In order to address self esteem issues she was encouraged to create positive self affirmations surrounding her abilities as a mother. We also used meaningful goal setting. She was able to identify positive coping mechanisms around crafting, attending local groups and meeting up with friends.

Other clients have stated “My initial experience of going through the judicial system was horrible, but this has allowed me to access the necessary supports to make big changes to my circumstances.”  And “I was apprehensive about what would happen during our sessions, however I feel that I have made large changes to my thinking patterns and I am now engaging in more positive coping strategies.”

A number of women only required short term interventions which enabled them to look more positively towards their future. In some cases however the women were not at the right stage to think about engaging in occupational therapy work; these women often required support from other organisations such as Addictions services or other support agencies, which we linked them in with. Being an NHS employee but being on secondment to third sector and social work has made this ‘linking in’ a much smoother process, as I have wide knowledge of referral pathways within all of these organisations. A very small number of women did not feel ready to start changing their lives; being respectful personal choice, intervention was not pushed, however they were aware that they could be re-referred at any time.

We have demonstrated that Occupational therapy can play a large role in supporting women through the judicial system. We look beyond offences, seeing the ‘bigger picture’, focus on building strengths & personal resilience; all of which are essential components of effective occupational therapy input.  All too often people don’t know how to access the right support at the right time. Let’s hope that by continuing to work innovatively and in partnership with others, we can support many more women with ‘Stayin’ oot!!’ and improving their quality of life.