Tweeting from #UDMH2011 a CPD opportunity for me and #OT ?
Today I attended the new University Department of Mental Health’s first conference: ‘Engagement in Life: Promoting Wellbeing in Mental Health’ and I was inspired and frustrated in equal measure. The buzzword used throughout was recovery and it was highlighted that this word often means different things to clinicians and service users. For example with anorexia nervosa, recovery is often measured by clinicians in terms of weight gain, restarting menstruation etc when for a number of service users weight gain has been and is still is associated with failure (see tweets from Ciaran Newell’s session). The service user turned peer support worker who opened discussed a plateau in recovery when without having something to do symptom relief alone is all but meaningless (my analysis). This also links to the ideas of the perils of recovery, something that is often under acknowledged which may lead to lower recovery rates. Now I’m not going to rehash everything that I heard here because I live tweeted during the conference sessions. A lone tweeter on this occasion. I used the hashtag #UDMH2011 so please search out this on twitter or a collation sire such as whatthetrend.
So, what did I find inspiring. Terry Bowyer’s eloquently presented story of his path to recovery and the fact that all of the presenters after him showed that health professionals are finally getting and acting on this message about the importance of working towards what the client sees as important and giving them hope that things will change.
But what was frustrating is that as Occupational Therapists this has been our guiding philosophy for years so why is it not us leading this debate? It was a nursing researcher colleague of mine who has worked with OTs in the past that asked in one of the concurrent sessions can the suggestions from CHIME and REFOCUS (see hashtag timeline for more detail and speaker info) not be mapped to occupational science models. Of course they can. Three elements of the REFOCUS model for example were ‘Understand Value, Assess Strengths and Support Goal Striving’. Immediately I can see that CMOP-E, MOHO, KAWA and the new to me Model of Creative Ability (http://www.otstudent.info/home/models/model-of-creative-ability) would all address this.
Take the CMOP-E (Canadian Model of Occupational Performance and Engagement) for example, which was developed alongside CPPF (Canadian Practice Process Framework) and the CMCE (Canadian Model of Client-Centred Enablement) (Turpin and Iwama, 2011). A client’s spirituality (which includes their values, beliefs, desires etc) is as the centre , the person is assessed in terms of both their deficits and strengths in relation to Affective, Cognitive and Physical Skills (along with their environment and their occupational performance in self-care, productivity and leisure activities. Goal setting is something to be agreed between client and therapist and if using the COPM tool (Canadian Occupational Performance Measure) they re framed under occupational performance headings rather than symptom related ones (Turpin and Iwama, 2011).
So the question remains, why when our theory and philosophy matches current thinking in Mental Health care are we not leading this revolution and how now can we ensure that our role is recognised and valued during the ongoing process of proposed NHS reform. Of course recovery depends on health professionals working together so we need to highlight our profession’s unique role in this process. There are no clear cut answers and I’d be interested to hear your views but here are some of my personal suggestions.
Encourage explicit implementation of occupational therapy models in practice (whichever works best for your setting or indeed each individual client). Share this with your MDT colleagues.
Research, publish and disseminate not only at OT conferences but setting related or medical or at any conferences where we can raise the profile of our profession (I need to take note of this to).
Promote, promote, promote OT, talk about it whenever you have an opportunity to anyone and everyone you meet.
As a lone tweeter did I feel I wasted my time? It’s true I got a little hand cramp and I’m not going to lie it is hard to multitask and I inevitably lost the track of the talks at times. But I have followers who aren’t OTs and hopefully something will have made its way into their consciousness whilst scanning my tweets. After all societal stigma and misunderstanding of mental health conditions is one of the challenges to recovery. But what tweeting did was make me think about what were some of the key messages and summarise these into concise 140 character tweets (minus the characters needed fir #UDMH2011). I can now go back and collect these tweets as a lasting record which is far more legible than my handwriting.
Now as the HPC audit of CPD fast approaches I would like to ask my Twitter/Blog/Facebook followers or friends a favour. If you’re not an OT I hope you didn’t find the influx of messages too annoying, can you tell me if you learnt anything or if anything struck you on reading/scanning the tweets?
If you are an OT, for a CPD activity for your own audit, either having already read the timeline for #UDMH2011 or taking the time to review it now, reflect on what you learnt or picked up that you might be able to implement in your practice, what insight it gave you to making sense of past experiences etc. Please share them with me in the comments in the blog being sure to maintain confidentiality (I moderate comments and will not approve comments that break this so no patient identifiable information). I look forward to seeing some of your responses to the key messages from the sessions I attended.
I will be live and delayed tweeting/blogging from both the College Of Occupational Therapists conference 29th/30th June/1st July and the Occupational Science Conference in Plymouth on 8th/9th September. Before these events I will put up a timetable of the sessions I am attending so you can follow my tweets on those you are interested in.
Sadly the COT session on tweeting was cancelled but if you were planning to attend session 115 and you are interested in meeting up informally please let me know.
Thanks for reading and hopefully reflecting, even if it’s only on one or two points.
Turpin, M. and Iwama, M. K. 2011. Using Occupational Therapy Models in Practice: a field guide. Edinburgh: Churchill Livingstone/ Elsevier.
100 ways to support recovery http://www.mentalhealthshop.org/document.rm?id=8914
REFOCUS project http://www.researchintorecovery.com/refocus/refocusprogramme.html
- R is for…Reflection (and Referencing)
Following on from my C is for… Continuing Professional Development post today I will be discussing a method of CPD that is free – reflection.
If someone asked you to describe your face you might mention eye colour, hair colour/length etc. This is basic description and if you gave that information to someone you were due to meet they might find you difficult to pick out of a crowd.
If you did this whilst looking in a mirror, you might be able to give more specific, distinguishing features, a mole you had forgotten or a scratch that until then you didn’t know you had. You might also then start thinking about how you could have received the scratch, evaluating what you had been doing.
Reflection that enables learning comes from really putting something under the microscope, examining and re-examining it. Reflection should lead to understanding, insight, and goals for development. You might decide, based on ‘research/evidence’ (e.g. that acrylic nails don’t appear to scratch), that you need a manicure!
Reflection or looking at a situation in detail is used widely by health and social care professionals to inform personal and professional development, to learn from events and situations and to make links between theory and practice. When people first start reflecting there may be a tendency to purely describe an event but there is a need to move beyond this to ‘unpick’ what has happened and make conclusions and future action points.
Critical Reflection – some quotes
Critical reflection is: – “using the reflective process to look systematically and rigorously at our own practice.”
And using reflection “to learn from our actions, to challenge established theory and, most importantly, to make a real difference to our practice.” (Rolfe et al 2001, p. xi).
“Emphasis is placed on WHY something happened and an investigation of the issues involved, not on a purely descriptive account of what or how it happened.” (Brown and Rutter 2005, p. 8).
“Reflection aids and enhances deeper learning as it makes us aware of what happened during an experience and helps us make connections with what we already know.” (Brown and Rutter 2005, p. 13).
“We need to reflect not just on the content of the situation but also on our thoughts – those which underpinned judgements and decisions – and also the way we arrived at those thoughts – the processes underpinned by our abilities and values.” (Brown and Rutter 2005, p.13).
“Reflection on some experiences may go even further and change deep or personally held beliefs, assumptions or inner values. If this happens you may need the extra support of someone you trust to help you deal with it.” (Brown and Rutter 2005, p. 22).
Ways to Reflect
Critical reflection and writing are linked. According to Moon (1999 cited Brown and Rutter 2005, p.14), writing:
• Forces us to spend the time
• Helps us focus and sift material by slowing us down
• Forces us to organise and clarify our thoughts so we can sequence them
• Gives us a structure
• Gives control – we choose which points to make – enables identification and prioritising of material
• Helps us to know if we do understand something by attempting to explain it
• Can help a deeper understanding of something as we work through it and explain it
• Can record a train of thought and relate it to the past, present and future
• Can initiate new ideas, connections, questions etc.
Use of structured models of reflection
These take you through events step-by-step aiming to draw information out of you that leads to critical reflection. Often reflective models are used ‘after the fact’ especially when a situation has not gone to plan. It is however, also important to review events when things go smoothly too, to evaluate why and allow successful repetition.
Click on the links or locate the references below to find out more about each approach.
Kolb’s Reflective Cycle (1984) – Concrete experience, reflective observation, abstract conceptualisation, active experimentation.
Gibbs’ Model (1988) – Description, Feeling, Evaluation, Analysis, Conclusion, Action Plan.
Johns’ Model (1996) – A series of questions to answer
Rolfe et al (2001) What? So What? Now What? – questions to consider under each of the three heading
Schön – Reflection in action/Reflection on action (1984) – Schön distinguished between reflection in action and on action with the first being ‘spontaneous, skilful execution’ within a situation and the latter being stepping back and explaining the execution.
More recently I have discovered Boud and Walker’s three stage model of reflection (1990) cited in Jackie Andrews (2000) BJOT article where she demonstrates use of this model. In contrast to many of the other models situations are selected for reflection prior to them occurring. The practitioner then completes preparatory reflection and follows this with reflection in action and reflection on action (as Schön previously suggested). This example shows how supporting references and links to literature can be made to enhance the depth of reflection and make links between theory, research and practice. I strongly suggest reading this article to see how she applies the model.
Additionally you could use more creative strategies for evaluating a scenario (Rolfe et al 2001):
- Writing the unsent letter
- Writing to another person
- Writing as the other
- Story telling
- Poetry as reflective writing
- Audio recording reflection
- Video recording reflection
- Reflecting with others, e.g. Peers in a workplace or even through the use of social media
- (It is important to maintain confidentiality at all times when documenting and sharing reflections and that no client identifiable information should remain. It is also advisable to only mention the clinical area you were working in and not name specific workplaces and colleagues to protect them also).
- Andrews, J. 2000. The Value of Reflective Practice: a Student Case Study. British Journal of Occupational Therapy, 63(8), 396-398.
- Brown, K. and Rutter, L. 2005. Critical Thinking and Analysis: A guide to enhancing Reflection, Learning and Writing for Post Qualifying Social Work Programmes. Bournemouth: Institute of Health and Community Studies, Bournemouth University.
- Gibbs, G., 1988. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit.
- Johns, C. 1996. Using a Reflective Model of Nursing and Guided Reflection. Nursing Standard. 11( 2), 34-38.
- Kolb, D. 1984. Experiential Learning experience as a source of learning and development. New Jersey: Prentice Hall.
- Rolfe, G., Freshwater, D. and Jasper, M. 2001. Critical Reflection for Nursing and the helping professions: a user’s guide. Hampshire: Palgrave.
- Schön, D. 1983. The Reflective Practitioner: How Professionals Think in Action. London: Basic Books.
Reflective statements on your CPD evidence
Not all evidence in a CPD portfolio needs to be a written reflection, you may include evidence on you from other people, examples of leaflets you have developed, assessments you have completed, etc. For each piece of evidence in your CPD portfolio ensure you know WHY you have included it and HOW it affects your DEVELOPMENT. Try to make this clear to the anyone who might read your portfolio. You can use brief reflective statements on the evidence itself, e.g.
• I chose to include this because it demonstrates that I have…
• I was really happy with this because…
• I think this shows my development in (type of skill) because…
It is important to recognise that reflection is a personal thing and you will not want to (and indeed it may not be appropriate to) share all reflective writing you complete. You may just highlight a few key points to share.
Please share your comments/questions; I hope this has been a helpful post.