Discovery Through Activity

Ideas and Resources for Applying Recovery Through Activity in Practice

Sue Parkinson

• Publisher: Routledge
• Year: 2022
• Print ISBN:
  9781032127576
• eBook ISBN:
  9781000510751
• Topic: Medicine
• Subtopic: Education General

Discovery Through Activity provides a compendium of ideas, resources and practice evaluations that will inspire practitioners to be even more imaginative and to customise their own Recovery Through Activity programmes to meet the specifi c needs of participants.

The original Recovery Through Activity handbook offers a flexible programme that is widely used in adult mental health settings. This accompanying and complementary resource shows how the intervention has been extended, adapted and applied service-wide. The resource showcases the work of a growing community of practitioners who have successfully facilitated Recovery Through Activity programmes to provide a forum for people to refl ect on their occupational lives and discuss and practise lifestyle choices that will enable them to improve their health and wellbeing.

It includes:

• an extended range of flexible ideas and resources to meet the needs of participants in Recovery Through Activity sessions

• examples of how to apply Recovery Through Activity in one- to- one sessions and virtual groups

• encouragement to adopt Recovery Through Activity across your services with confidence.

With contributions illustrating the effective application of Recovery Through Activity in a range of settings and situations, this is a valuable resource for occupational therapists and other practitioners in mental health settings.

Part 1
Adopting Recovery Through Activity across services

1. Adopting Recovery Through Activity across adult community and inpatient mental health services
Amy Mitchell

2. Embedding Recovery Through Activity service-wide
Amy Mitchell and Sarah Morecroft

1Adopting Recovery Through Activity across adult community and inpatient mental health services

Amy Mitchell

DOI: 10.4324/9781003226109-3

Aneurin Bevan University Health Board (ABUHB) covers five boroughs in Gwent, South Wales. Within the mental health and learning disability division, occupational therapists work in most settings across both inpatient and community services. The division has three directorates supporting adults and older adults with mental health difficulties and people with a learning disability.

Services are staffed by mental health nurses, psychology staff, social workers, occupational therapists and support staff. More recently, we have employed a number of peer mentors and Support Time and Recovery (STAR) workers across adult mental health.

Client diagnoses can range from anxiety and depression to obsessive compulsive disorder, bipolar disorder and experiences of psychosis. For various reasons, the people with whom we work often have complex occupational lives and can struggle to maintain occupational balance while trying to manage their mental health issues.

The decision to adopt the Model of Human Occupation (MOHO) (Taylor 2017) as a model of practice across all our Occupational Therapy services had been made before I came into the post. This followed several service evaluations, which indicated that practice across Gwent could be more clearly centred on occupation. Varying degrees of generic work outweighed our core Occupational Therapy practice at times, and we were on the verge of planning various introductory MOHO workshops to reinforce our occupational focus. It was recognised that the Recovery Through Activity programme would align well with these practice development initiatives, as its application is underpinned by MOHO theory and it promotes occupation-focused and occupation-based practice. Accordingly, it was decided to investigate Recovery Through Activity as an option to unify our work, particularly in community mental health teams (CMHTs).

I clearly remember the day I attended a practice forum during which my predecessor introduced the programme to a room of around 30 occupational therapists working across a range of adult mental health services (inpatient acute and rehabilitation services, CMHTs, assertive outreach and crisis home treatment teams). We looked at the handbook and explored the 12 topics in small groups. To me, it felt like a ‘light-bulb moment’ and we were all excited to get back to occupation and the use of meaningful activity. The room was a hive of activity as we discussed potential community resources, how we could go about setting up programmes and the potential contribution from partnership organisations and the wider multidisciplinary teams (MDTs). A lot of the occupational therapists felt the manual was a representation of what we are good at as mental health practitioners – finally someone had packaged what we do to enable us all to do it in a similar way. Although the programme is not standardised, it would provide greater parity across all areas of the Occupational Therapy service by ensuring that what we offered was similar in format and delivery.

Working in mental health, occupational therapists can be pulled into so many aspects of support and are often the minority in a MDT. It was recognized that having MOHO and Recovery Through Activity underpinning what we offered would enable us to be more articulate about our common purpose in terms of our core skills, and that by concentrating our efforts on a discrete group programme, this would not disrupt our ability to carry out the generic aspects of our work. Importantly, adopting a shared approach meant that we could start to measure the impact and effectiveness of our interventions.

Example invitation to refer to Recovery Through Activity

The occupational therapists in Newport are currently working on a pilot Recovery Through Activity group to be held in the community.

The aims of the group are to investigate a range of lifestyle choices that enhance health and well-being, to examine the impact of changing lifestyles on roles and routines, and to support the experience of a range of socially inclusive activities.

The group will be facilitated primarily by CMHT occupational therapists with support for individual sessions from occupational therapists in other service areas.

Individuals who may benefit from being referred should be interested in practising healthy lifestyles and wanting to make some positive changes, but may have:

• poor confidence in their ability to make changes
• difficulties making changes due to ingrained habits or multiple role demands
• restricted experience of a range of occupational roles
• reduced social support for making changes.

The programme will run as a closed, structured group, and anyone interested in attending would be expected to come to each of the 12 sessions. Referrals are welcome for anyone currently supported by secondary mental health services with a care coordinator, who needs support with making positive changes in relation to occupation (self-care, productivity or leisure).

When making a referral, please consider whether additional preliminary work may be needed in terms of getting to the group. Care coordinators would be more than welcome to support service users to attend as needed.

Initially, the Recovery Through Activity programme was started in the community, with structured, 12-week programmes carried out locally, based on the handbook and guidance given by the lead occupational therapists. We created leaflets, referral forms and posters, and gave presentations to the MDTs. Programmes were based on the 12 topics and ran approximately twice a year (prior to the COVID-19 pandemic we were aiming for three times a year where groups and staff were more established). The community groups were open to service users accessing the perinatal service, assertive outreach, early intervention and forensic rehabilitation (for service users close to discharge or stepping down to the community setting), and referrals were drawn from existing Occupational Therapy caseloads and from the MDT.

In our inpatient services, facilitation of the programme was carried out more informally as group members tend to need more exploratory interventions. In the acute settings, we used the programme as a framework for intervention, ‘dipping’ in and out of the 12 topics according to preference and individual/group interests. The 12 topics were covered across a weekly timetable, which incorporated support from partnership organisations, volunteers and other therapists such as psychologists and art therapists to ensure that a balance of activity would be achieved. This was also the case in our longer stay rehabilitation settings, although our occupational therapists also piloted a more structured programme for those who might benefit from greater support, particularly if moving towards discharge.

Attendee feedback was gathered using a simple evaluation form and service users were invited to share their experiences of the programme as each new programme commenced.

Attendee feedback

‘The group activities were very helpful and also knowing they are feeling the same as me or going through similar things.’

‘The routine of attending was helpful.’

‘Mixing with new people was helpful.’

‘I feel a lot more confident in dealing with different groups.’

‘I loved the activities, quizzes, and interesting discussions.’

‘I’ve gained confidence and seen more of the old me.’

‘I’ve spent less time in bed and tried to be productive.’

‘I’m taking better care of myself.’

‘Can the course be longer?’

Perceived benefits

• Engages service users in activities and interests that are meaningful to them, promoting resilience and connection with others.
• Creates a potential pathway for safe and supported transfer to primary care from secondary services.
• Provides structure, routine and opportunities to participate in meaningful activity.
• Promotes independence and empowerment of service users.
• Creates supported opportunity for peer mentors to go on to support the programme.
• Promotes social inclusion and access to the community that service users consider home.
• Promotes partnership working with local leisure facilities, businesses and third sector/charitable organisations.

Prior to the programme, one person was heavily reliant on secondary services, requiring multiple contacts every week to maintain a sense of stability.

Following the programme, the individual’s confidence had improved, enabling them to commence an apprenticeship and engage with educational opportunities to gain a maths qualification. They had identified goals to engage with local health walks and cooking groups, and onward referrals were made to promote engagement with these goals. After engaging with the programme, the individual was discharged from the Occupational Therapy caseload.

Prior to the programme, a second person presented as very anxious. This was heightened in social and group environments, resulting in them becoming socially isolated.

Following the programme, their anxiety management had improved to a level where they were able to access the community independently and seek out emotional support from family and friends. They had improved motivation to begin to consider voluntary work and involvement in local health walks and craft groups. The individual was discharged from the nursing caseload to medical review only.

Reference

• Taylor RR ed. (2017) Kielhofner’s Model of Human Occupation. 5th ed. Philadelphia: Wolters Kluwer.

2Embedding Recovery Through Activity service-wide

Amy Mitchell and Sarah Morecroft

DOI: 10.4324/9781003226109-4

After three years of running the Recovery Through Activity programme, and as a result of the positive outcomes described in the preceding chapter, we thought it was important to see how our service could build on what we had already established. This involved raising the profile of our core Occupational Therapy skills by engaging with directorate managers and presenting the perceived benefits and outcomes for those who took part in the programme. These conversations were received favourably and paved the way to bid for further funding to support the expansion of the programme through the creation of more support worker roles to assist with facilitation.

Through service improvement funds, three Occupational Therapy support workers were employed on a fixed term basis to work in dedicated roles supporting the expansion of the programme. In addition, the centralisation of the budget for Occupational Therapy in mental health allowed us to instigate a permanent position for an occupational therapist to develop practice standards and education opportunities across the service. This practice development role has been integral to the development of Recovery Through Activity and has been key to taking the work forward.

Alongside the new posts that were created, senior occupational therapists were sought to take on ‘driver’ roles to help t...

Table of contents

• Cover
• Epigraph Page
• Endorsement page
• Half-Title Page
• Title Page
• Copyright Page
• Table of Contents
• Contributors
• Foreword
• Preface
• Acknowledgements
• Introduction
• Part 1 Adopting Recovery Through Activity across services
• Part 2 Applying Recovery Through Activity in a variety of settings
• Part 3 Adapting Recovery Through Activity for virtual delivery
• Part 4 Extending the content of Recovery Through Activity
• Appendix