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A process for developing a student led programme in an acute mental health setting.

Abstract

This paper will describe the process used to develop a student led programme, within a mental health setting. The goal was to provide an effective occupational therapy student placement while increasing the capacity of the service to take students. The student led role enhanced the clinical team's capacity to supervise students. Access to evidence based interventions was increased for service users while student interest in the field of mental health was increased. Student placements in mental health should be structured to include a specific clinical role that enables students to assume responsibility while contributing to ongoing service development.

Key words

Fieldwork, occupational therapy, psychiatry, sensory modulation

Reference

Lloyd, C., Williams, P. L., & Machingura, T. (2015). A process for developing a student led programme in an acute mental health setting. New Zealand Journal of Occupational Therapy, 62(2), 67-70.

Due to an increase in the number of occupational therapy students there has been a corresponding increase in the need for student placements. Consequently, there is a greater onus on both educators and clinical settings to provide learning opportunities to meet the demand. The need for innovation to enhance clinical placement opportunities has been identified by programme directors (Rosenwax, Gribble, & Margaria, 2010) yet research into sustainable student led programmes is relatively new. Still, it has been reported that an acute menta health care setting provides a unique learning opportunity for students (Chojecki, Lamarre, Buck, St Saveur, Eldaoud, & Purden, 2010). This paper will relate the steps taken by a psychiatric occupational therapy service within an Australian general hospital to build capacity for peer learning approaches to student led roles to meet the demand for clinical placement hours.

Fieldwork

Fieldwork is recognised as an integral and critical component of training for occupational therapy students (Overton, Clark, & Thomas, 2009). Yet, a decline in the number of occupational therapists working in mental health settings means there are fewer opportunities for students to undertake a mental health fieldwork placement (Thompson, Eakman, & Owens, 2012) since there are fewer experienced clinicians available to supervise them. If students lose exposure to mental health fieldwork sites, then it can be assumed that fewer graduates will pursue work in mental health settings (Thompson et al., 2012).

Fieldwork facilitates the integration of knowledge, professional reasoning and professional behaviours in practice. It is an opportunity for students to develop the level of competence required of a qualifying occupational therapist (World Federation of Occupational Therapists, 2002). Importantly, it allows students to apply academic knowledge in the clinical setting and to gain practical experience while developing clinical skills that will broaden their abilities (Overton, Clark, & Thomas, 2009). Fieldwork also gives students the opportunity to explore future practice areas. This is endorsed by a study that used qualitative methods to better understand the transformative experience of students who had successfully completed a mental health fieldwork placement. Four main themes emerged:

1. understanding people with a mental illness;

2. understanding the role of occupational therapy in a menta health setting;

3. feeling like a professional and;

4. changing as a person (Bagatell, Lawrence, Schwartz, & Vuenick, 2013).

The study revealed that students began fieldwork with an array of assumptions and beliefs. In the course of a fieldwork placement they learn and experience things they did not previously know or understand (Bagatell et al., 2013). The findings also highlighted the importance of mental health fieldwork for student learning as this type of learning will not occur in a classroom.

Likewise, a study undertaken in New Zealand found that students welcomed opportunities for active learning and hands on experience (Flood, Haslam & Hocking, 2010). According to Keller and Wilson (2011) students seek employment in their placement setting if the teamwork is sound, occupational therapy is respected and valued, and they receive good supervision. Understanding the effect of learning styles on fieldwork learning has also been reported to assist students to modify their approach to fieldwork (Robertson, Smellie, Wilson, & Cox, 2011).

With a growing number of students, concerns have been raised about the provision of quality fieldwork programmes in occupational therapy. In fact, it has been suggested that fieldwork education has reached a crisis point with a critica shortage of placements (Kirke, Layton & Sim, 2007). To gain an understanding of what constitutes quality fieldwork education, Kirke et al. (2007) conducted a qualitative study using focus group discussions. The major findings revealed that there is a need for ongoing professional development for fieldwork educators to encourage tangible strategies for fieldwork education. When more than one university is involved there is also a need for close collaboration between the universities and fieldwork educators. Thus, the authors argue that research is essential to support the future directions of the profession of occupational therapy by informing quality fieldwork education.

Developing an occupational therapy student led programme

Mental health services have traditionally had a limited number of fieldwork opportunities however, the nature of service delivery is changing (Queensland Health, 2012) and there is a call for increased service efficiency. In taking a proactive approach to establish sustainable placements, occupational therapists working in the hospital's acute mental health setting set up a series of meetings to discuss ways of offering a placement that would be of interest and appeal to students. This involved both local meetings between the occupational therapy team and joint meetings with the clinical educators. The educators were experienced occupational therapists whose primary goal was to bridge the education-clinical practice gap. As a result of these meetings a decision was made to trial a student led placement model that had been successfully implemented in another treatment setting within the same hospital network. Two senior practising therapists agreed to lead the project. In order to identify the most suitable role for student led placements several key criteria were considered including:

* Was the placement desirable for students?

* Could adequate supervision be guaranteed?

* Was the purpose of the role able to be defined?

* Was it appropriate for the skills of the students?

* Would there be an adequate range of resources available to the students?

* Did the programme add value to the occupational therapy service?

After applying these criteria the practising clinicians considered sensory modulation the most suitable clinical approach for a student led role. As an emerging area of interest for occupational therapists in mental health, it was anticipated that a sensory modulation approach would provide a desirable learning experience for the students.

The practising clinicians leading this project, as well as the broader inpatient therapy team, were involved in the previous introduction to the sensory modulation programme within the hospital, and therefore they had experience in this area. Accordingly, appropriate skills were available within the team to provide a high level of supervision and support to the students undertaking the placement.

In order to ensure the student placement was both sustainable and a valued addition to the service, it was important to ensure that the student led services were available throughout the academic year. Therefore one of the first tasks was to negotiate with the universities involved, and the occupational therapy clinical educators, to find the best way to structure the student placements so that a cohesive service could be run throughout the year. This was essential as the duration of placements may differ between universities, varying in length between seven and ten weeks. A proposal providing basic information about the programme was developed and submitted to Queensland's occupational therapy practice education network. The application was successful and the proposal approved.

Sensory modulation in an acute mental health setting

Sensory modulation is the neurological regulation of the response to sensory stimuli (Kinnealey, Koenig, & Smith, 2011), it relies on people's ability to regulate and organise sensory input in order to function at an optimal range of occupational performance. The use of sensory modulation has been shown to be a valuable intervention in reducing the use of seclusion and restraint in acute psychiatric settings (Champagne & Stromberg, 2004; Chalmers, Harrison, Mollison, Molloy, & Gray, 2012; Lloyd, King & Machingura, 2014; Novak, Scanlan, McCaul, MacDonald & Clark, 2012; Sivak, 2012). To evaluate staff's understanding of the use of sensory rooms within a large mental health facility, Martin and Suane (2012) tested staff knowledge of sensory modulation pre and post-training. The researchers found statistically significant increases in staff awareness after training. Moreover, education increased the use of sensory rooms by the study participants.

In light of this evidence, and in an attempt to take positive action towards the high rates of seclusion within the hospital's acute mental health setting, a sensory modulation programme was introduced two years ago. A consequent evaluation of the service found that most service users reported a marked reduction in disturbance after taking part in sensory modulation. Furthermore, the frequency of seclusion dropped dramatically (Lloyd et al., 2014). In 2004, Champagne and Stromberg argued that by developing sensory strategies to manage their emotional state, service users can sustain an optimal range of occupational performance. That may be why Champagne and Frederick (2011) challenged occupational therapists working with people with a mental illness to research, develop, and administer occupation specific assessments and interventions designed to target service user's sensory-processing needs.

Organisation of the placement

Prior to undertaking the fieldwork placement, students were encouraged to do pre-reading on mental health conditions, sensory modulation and, to visit their host clinic so that they would know what to expect. Orientation to the setting was deemed important to give the student an opportunity to learn about the environment in which he/she would be involved for the duration of the fieldwork experience. During the first week the student was introduced to the occupational therapy role in the student led practice area. In week two, the student was given opportunities to further learn from supervisor and when the student felt confident, they would lead a session or part of the session. From week three onward the student was expected to lead the programme with supervision.

The sensory modulation programme was made up of an individually structured interview questionnaire on sensory preferences and, a group programme. Known as the Sensory lounge, the group programme encouraged service user's who had an interest in exploring sensory modulation concepts, to develop strategies that would help to optimise their functional performance through soothing, self-coping tactics. Both approaches were clearly defined, and adapted as required, to meet individual student needs for supervision and support. This was important for the safety of the student programme as it allowed the student role to be matched to the skills of the individual. There was also an expectation that the programme would become more accessible to service users and allow occupational therapists to provide a more comprehensive service.

Discussion

The placement sparked enough interest amongst occupational therapy students to make the student led programme a success. Similarly, the practising clinicians who were involved, reported that the student led fieldwork placement was an interesting experience and easier to manage than the previous 1:1 style. Having placements organised back to back, meant students were always involved in the mental health setting. A secondary benefit has seen the sensory modulation programme continue to develop as new students contribute to the structure and running of the programme. Of significance, a greater number of service users have had access to sensory modulation interventions. To date there has been no review of the service user's view of the programme.

Conclusion

An increase in the demand for occupational therapists has resulted in an increase in university programmes and the number of students studying occupational therapy. This has placed a greater demand on educators to find fieldwork placements within hospitals and health service providers. This paper has reported the processes used to develop a student led fieldwork placement, focusing on sensory modulation, in an acute mental health setting.

The authors advise that student led programmes such as this need to be well structured and supported by both the host service and the universities involved. Further research focusing on student and service user's experiences of student led programmes would assist in clarifying the benefits and sustainability of such placements.

Key messages:

1. Student led programmes increase the capacity of a health service to supervise students.

2. Careful planning and appropriate support are essential to ensure student led programmes are delivered safely and are of benefit to service users.

References

Bagatell, N., Lawrence, J., Schwartz, M., & Vuernick, W. (2013). Occupational therapy student experiences and transformation during fieldwork in mental health settings. Occupational Therapy in Mental Health, 29(2), 181-196.

Chalmers, A., Harrison, S., Mollison, K., Molloy, N., & Gray, K. (2012). Establishing sensory-based approaches in mental health inpatient care: A multidisciplinary approach. Australasian Psychiatry, 20(1), 35-39.

Champagne, T., & Frederick, D. (2011). Sensory processing research advances in mental health - implications for occupational therapy. OT Practice, June, 7-12.

Champagne, T., & Stromberg, N. (2004). Sensory approaches in inpatient psychiatric care. Journal of Psychosocial Nursing, 42(9), 35-44.

Chojecki, P. Lamarre, J, Buck, M., St. Saveur, I., Eldaoud, N., & Purden, M. (2010) Perceptions of a peer learning approach to pediatric clinical education. International Journal of Nursing Education Scholarship, 7(1), 1-14.

Flood, B., Haslam, L., & hocking. C. (2010). Implementing a collaborative model of student supervision in New Zealand. Enhancing therapist and student experiences. New Zealand Journal of Occupational Therapy, 57(1), 22-26.

Keller, S., & Wilson, L. (2011). New graduate employment in New Zealand: The influence of fieldwork experiences. New Zealand Journal of Occupational Therapy, 58(2), 30-36.

Kinnealey, M., Koenig, K. P., & Smith, S. (2011). Relationship between sensory modulation and social supports and health-related quality of life. American Journal of Occupational Therapy, 65(3), 320-327.

Kirke, P., Layton, N., & Sirn, J. (2007). Informing fieldwork design: Key elements to quality in fieldwork education for undergraduate occupational therapy students. Australian Occupational Therapy Journal, 54 Supplements 1, S13-S22.

Lloyd, C, King, R., & Machingura, T. (2014). An investigation into the effectiveness of sensory modulation in reducing seclusion with an acute mental health unit. Advances in Mental Health, 72(2), 93-100.

Martin, B. A. & Suane, S. N. (2012). Effect of training on sensory room and cart usage. Occupational Therapy in Mental Health, 28(2), 118-128.

Novak, T., Scanlan, J., McCaul, D., MacDonald, N., & Clarke, T. (2012). Pilot study of a sensory room in an acute inpatient psychiatric unit. Australasian Psychiatry, 20(5), 401-406.

Overton. A., Clark, M., & Thomas, Y. (2009). A review of non-traditional occupational therapy practice placement education: A focus on role-emerging and project placements. British Journal of Occupational Therapy, 72(7), 294-301.

Queensland Health (2012) Activity based funding. Retrieved 30 September, 2014 from: http://qheps.health.qld.gov.au/abf/home.htm.

Robertson. L., Smellie, T., Wilson, P., & Cox, L. (2011). Learning styles and fieldwork education: Students' perspectives. New Zealand Journal of Occupational Therapy, 58(1), 36-40.

Rosenwax, L, Gribble, N., & Margaria, H. (2010). GRACE: An innovative program of clinical education in allied health. Journal of Allied Health, 39(1), e11-6.

Sivak, K. (2012). Implementation of comfort rooms to reduce seclusion, restraint use, and acting out behaviors. Journal of Psychosocial Nursing, 50(2), 24-34.

World Federation of Occupational Therapists. (2002). Revised minimum standards for the education of occupational therapists. In: C. Hocking & N. E. Ness (Eds). The Council of the World Federation of Occupational Therapists 1958. WFOT.

Corresponding author:

Chris Lloyd

Senior Research Fellow Recovery Services Schizophrenia Fellowship of New South Wales Locked Bag 5014 Gladesville NSW 1675

Email: c.lloyd@grifflth.edu.au

Philip Lee Williams Manager Headspace Youth Early Psychosis Programme Southport 4215

Tawanda Machingura Assistant Director of Occupational Therapy Gold Coast University Hospital Southport 4215
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Title Annotation:Practive reality
Author:Lloyd, Chris; Williams, Philip Lee; Machingura, Tawanda
Publication:New Zealand Journal of Occupational Therapy
Date:Sep 1, 2015
Words:2565
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