Monday, 12 December 2011

All in Gods perfect timing, seeing the beauty in everything.

 I’ve been struggling with having to wait for things recently.
Waiting is one of the most difficult things to do, whether we're waiting for a phone call, the right job or an answered prayer. We become impatient and wonder why things are not happening when we want them to. It seems like the more we want something, the harder it is to wait - and we get impatient with God.
But we have to remember that God's timing is different than our own. He sees things from a different perspective and sees the whole picture, not just what we want, but what is best for us in the grand plan for our lives. All is part of a divine order and will be done in its own right and proper time. Of course, when we are hoping, praying and waiting for something, it's easy to forget this. After all, waiting is "remaining inactive in one place while expecting something." And being inactive means feeling powerless and at the mercy of the world - nobody likes that feeling. But we must keep in mind God's greater plan and His perfect timing:
“..And we know that in all things God works for the good of those who love him, who have been called according to his purpose." Romans 8:28

Yesterday God taught me two very important lessons.
  1. God has perfect timing.
  2. See the beauty in everything.
Most of you will know that I like to be creative. It is a rare moment when I’m not thinking of things I could either make or bake.
A few months ago for some bizarre reason I decided I was going to keep all my old toilet rolls, figuring that one day I would know what to make from them. Over the course of a few months on the back of my bathroom door hung a bag which gradually became full of toilet rolls. When it was full it just stayed there. I didn’t know what to do with 25 brown tubes, but I knew that one day I would. Yesterday that day came.
I looked at those tubes and saw something of myself. How I was feeling about myself. Dull, plain and useless. But God sees us differently, He does not see us as being “dull” or “plain” or “useless” He sees us as the beautiful creations which He Created and the beautiful and fruitful men and women of God whom we can be.
After lots of cutting, positioning and sticking together I ended up with this:

Finished and looking lovely in my room. :)

Everything has beauty but not everyone can see it.
Throughout this process God spoke to me. He told me about how before now making this wall art would have meant little to me, doing it now has taught me lessons and helped me grow that little bit closer to Him.
We can be just like the toilet rolls and God the “creator”, we may need to wait until the right time, be shaped, rearranged, stuck back together and held until we are fixed, but at the end of the day, when God has finished with the processes we will be able to shine in the beauty of what He created us to be.
God has perfect timing. He is never late. He is never early. He is never in a hurry. He is always on time. On His time. The hardest part to remember is that our time isn’t necessarily His time.
..and I make a vow as a child of God to try and stop looking in the mirror and seeing:
  • ugly
  • fat
  • plain
  • weak
BECAUSE I am now certain. Certain that when God looks at me and at you, at His creation, He only sees wonderful. He only sees beauty. He only sees precious.

It’s time for us to start seeing the beauty in everything, in Gods creations, and most of all; find the beauty in ourselves. For you are..Fearfully and wonderfully made!” Psalm 139:14

You've got a place in this world.

Hey you!
The one hiding in the corner,
wondering if you're seen,
hoping you're heard.

You are.

You matter.
You have something to give.
Something good and right and beautiful and true.
And God sees it.

Sees you.

Right where you are.
He invites you to the centre of the floor,
to His waiting arms, to His unfolding plans.
We need you. Just as you are.
And we can't wait to see even more of the ways,
He's going to use you to light up the room and the hearts of all who are in it.

"For I know the plans I have for you," declares the LORD, "plans to prosper you and not to harm you, plans to give you hope and a future." Jeremiah 29:11

I read a poem earlier today entitled "Just think". I have no idea who wrote it but as i was reading it, taking in each of its statements, each of its promises, I was reminded and captivated by the knowledge that this IS truth. God designed, created, loves and has perfect plans for each and every one of us.
The poem reads:

"Just think,
you’re here not by chance,
but by God’s choosing.
His hand formed you and made you the person you are.
He compares you to no one else—you are one of a kind.
You lack nothing that His grace can’t give you.
He has allowed you to be here at this time in history,
 to fulfill His special purpose for this generation."

The world only gets one YOU!...

You with your gifts.
You with your smile.
You with those things you do.
So take your place,
take your chances,
take this moment to know...
You've got something to offer.
Something good and right and true.
Something God-given,
Heart-of-Heaven created.
And the rest of us need it, need you.
You may think it's no big deal.
Anyone could be that way.
Anyone could do it.
Not true.
There's just one irreplaceable you.

"For we are chosen by God and precious to Him." 1 Peter 2:4

Tuesday, 29 November 2011

Mental Health Awareness.

Recently I have been really encouraged by the increase of adverts and campaigns in the public eye which openly talk about and promote the awareness of Mental Health/Mental Illness in society.
Rethinks' new campaign poster (2011).
Growing up I can't think of myself having any real knowledge or understanding of Mental Health problems or illnesses, other than opinions that were formed from watching TV programs, films or reading and hearing about incidents in the news/media.
So often the media portrays people with Mental Health illnesses and problems in a purely negative light which I believe caused the topic to not only become a taboo subject but one which evoked feelings of fear and allowed stigmas to develop.

At the weekend I was out shopping with my father when we both noticed how many disabled people we had seen whilst out, mainly those with Learning Disabilities -not only shopping themselves but also working in the shopping center. We began discussing how it wasn't that long ago that you would not really see those with disabilities, especially those with learning difficulties and also types of mental health problems out and about in the community. Although this is slightly steering away from mental health in particular, an increase in acceptance and integration of disabled individuals into society can only be applauded and encouraged. Along with physical and learning disabilities I believe Mental Health issues are also become more understood and less taboo.

Recently on the TV, in newspapers and in the media as a whole I have been encouraged by the increase of awareness campaigns and also positive stories which do not portray those living with mental illness as being 'monsters' as previous depictions have.
Also the increase of celebrities and well-known individuals speaking up about mental health issues is increasing and making it more of an understood and accepted part of society. After all statistics show that one in four will experience some kind of mental health problem in the course of a year (

Notably people such as Demi Lovato who has bipolar disorder and has suffered from an eating disorder as well as self harm, and Ruby Wax who has experienced depression are now using their status in the public eye to raise awareness of Mental Health issues and to encourage people to discuss mental health issues openly. Ruby Wax is also setting up a website/social network for everyone who suffers or knows someone who suffers from Mental Illness. Its a brilliant way of providing much needed information and support for those who truly need it. (Link to the site can be found below)

Hopefully these positive changes will continue to become more and more apparent in society and Mental Health issues will no longer be associated with stigma and discrimination.

Some brilliant organisations and campaigns surrounding Mental Health which are well worth looking at:


Monday, 28 November 2011

I had a break from blogging...

As you will have seen if you often have a quick look on this blog (BIG THANK YOU if you do!), I have not posted anything for a while. Over the past month a lot has happened. I have been offered a job as a Forensic OT - very exciting! And will be moving away from my home, friends and family in the New Year. So the past month has been spent looking for houses, sorting out CRB checks and Occupational Health forms etc whilst working at my current job.

But I have more time now so I'll be jumping back on the blogging bang wagon! Keep your eyes peeled folks! :)


Friday, 21 October 2011

Defining Forensic Occupational Therapy.

Earlier this week I mentioned that I had been asked to write an article for the website: Here is the link to the article: .... and here is the article:

When people think about Occupational Therapy the most common ideas which emerge revolve around physical rehabilitation and/or work within learning disabilities. Less commonly thought of are the areas within mental health and socially excluded groups. Placed within this latter category is Forensic Occupational Therapy.
Forensic Occupational Therapists (FOTs) work with service users who present as a risk of offending or who have a history of offending, and are concerned with promoting their occupational well-being.
In a keynote lecture at the National Forensic Occupational Therapy Conference (2004), Duncan (2004) stated that:
“Forensic occupational therapy engages people and facilitates their participation in meaningful life activities whilst assisting in the development of their increasing personal capacity and pro-social values, identity and skills.” Duncan (2004)
FOTs primarily work with those who have mental health problems, cognitive and/or social difficulties within secure environments which include but are not exclusive to; High secure units, Prisons and Community outreach services. Following the OT process FOTs aim to re-establish, maintain and develop the service users occupational functioning through encouraging independence, self-efficacy, a positive identity and whilst addressing their offending behaviours (COT 2011).

There is a wealth of different interventions which FOTs can utilise within this area, here are a few examples:

At present most FOTs work with those who are experiencing mental health difficulties which is a crucial role, however the links between occupational performance, offending behaviour and alienation are increasingly being recognised. The Social Exclusion Unit 2002 report , claims that custodial sentences are not succeeding in reducing reoffending levels and can also have a detrimental effect on an individual’s mental health and wellbeing including the erosion of effective life skills. This is therefore a prime opportunity for Occupational Therapists to be further integrated into forensic settings – helping service users to engage in meaningful and fulfilling occupations whilst reintegrating them into their society in a positive and pro-social way, excluding alienation and anti-social behaviour (Couldrick 2004).

It is important when thinking about Forensic Occupational Therapy to acknowledge the complex nature of both the service users and the environments, and how these provide frequent challenges for FOTs (Watkins 2001). For example creating and providing a therapeutic environment and program within a secure setting can prove to be very restricting.                                                                 
Other areas of consideration include conflicting philosophies of therapy vs. punishment, the culture of the environment - in particular Prison regimes and regulations, and in accessing appropriate and ‘safe’ resources to facilitate assessment and interventions. FOTs may also come up against personal and professional issues where client-centred values of unconditional positive regard may be challenged, for example when faced with service users who have committed serious/sexual offences. It is when issues such as these arise that the importance and benefits of clinical supervision and reflection are openly recognized (Duncan 2003).

I find that the below quote by Martin Luther King can provide an encouragement for those embarking on this area of Occupational Therapy.
‘When we look beneath the surface, beneath the impulsive evil deed, we see within our enemy – a measure of goodness and know that the viciousness and evilness in his acts are not quite representative of all that he is. We see him in a new light.” Martin Luther King.

Kate Neilson

Tuesday, 18 October 2011

A brief update.

Hello all,

Firstly I must apologise for the absence of posts recently. For various reasons (including lots of work shifts!!) I have not been able to blog properly this past month. BUT things will change - promise! :)

Today I have been working on producing a piece about Forensic Occupational Therapy for the OTexpert website. I will share that piece with you on here as well once it is all finalised.
I fully recommend you check out the website at: Its a new site which will be the perfect place for all things OT!

Hope everyone is having a wonderful OTuesday.


Wednesday, 5 October 2011

Citation du jour.

I've been reading one of my OT textbooks today before I head off to work. The book - "Occupational Therapy and Mental Health. Fourth Edition." (Creek, J and Lougher, L 2008) and I just find that the end of the Forensic chapter is simply wonderful.

When we look beneath the surface, beneath the impulsive evil deed, we see within our enemy - neighbour a measure of goodness and know that the viciousness and evilness in his acts are not quite representative of all that he is. We see him in a new light. ~ Martin Luther King.

Tuesday, 20 September 2011

Go play in the sand, John

For the past two weeks I have been reading the book; “Go play in the sand, John: A life disabled by dyslexia, reclaimed through love.” By John Tipping (with Frances Kavanagh). I chose to read this book after spotting it in the library and thinking to myself –“how much do I actually know about the effects of dyslexia?”. I studied dyslexia whilst at university and so I would say that I have a pretty good base of knowledge but we only focussed on the effects on children and their development. It never occurred to me to wonder how it would continue to effect individuals as they grew up.

I always find that either talking to individuals who have conditions/disabilities/difficulties etc. or reading first hand their story helps me to understand the realities a lot easier.  I also think that this is an important part of OT as well, actually listening to individuals and discovering their story and how dyslexia or whatever is effecting them actually impacts on their everyday lives – its all part of holistic and client centred care.

The book (which I recommend everybody reads) depicts the journey which John has taken; from a child struggling at school, to a young man swamped with difficulties and low self-esteem to now, when John is a happy, inspirational, entrepreneur. The book really awakened me to the realities of dyslexia.
So often when people think of dyslexia they just think of people struggling to read and write. But it is so much more than this.
According to Dyslexia Internationals dyslexia defined as:
“..a neurological condition, which is often hereditary. Dyslexia means a difficulty with language - words and letters - so that the most obvious and persistent difficulties you will see will be with reading and writing, and very intractable difficulties with spelling, also with memory, especially sequences such as days of the week and months of the year: memory will be poor; personal organisation will be poor in almost every circumstance."
John describes how it affects him as follows:
“My brain does not work in the normal way. I have to select information coming in at me more consciously than the average person, and I’ve had to train my brain everyday over the years just to cope with everyday life. (...) It’s like someone being picked up from this country (the UK) and put down in the middle of China; they have never spoken Chinese in their life, but they’re expected to talk Chinese straight away, go out and work, make a living, have a family and so on.”
I had never really considered how dyslexia would affect adults beyond reading and writing and this book has really opened my eyes to the difficulties and also the prejudice which people with dyslexia have to face.
The most important aspect of this book is that it is about a champion, a fighter. John is described as being “the most dyslexic man imaginable” yet with love, self confidence and constant support he has learnt to grow and develop as a person and is now a successful business man. 

Being dyslexic does not make you stupid. You are still as wonderful and as worth it as everyone else in the world. If you are dyslexic I would 110% recommend you read this book and become inspired by Johns’ story.
As well as this book I have been learning a bit more about two other individuals, this time both in the public eye, and how dyslexia effects them and how they are overcoming their own difficulties whilst inspiring others to overcome their battles with dyslexia also.
First off - Henry Winkler. Most people will know him as the Fonz in Happy Days. The actor who has dyslexia has just been awarded an honorary OBE for this work on dyslexia in the UK. Winkler has toured schools in the UK over the last two years to talk about the learning difficulty.
He has also written books for children about Hank Zipzer, a boy with dyslexia, whose experiences are based on the actor's own childhood.
Secondly – Kara Tointon. Most people will either know her from playing Dawn in Eastenders and/or from participating on Strictly Come Dancing. The BBC recently aired a show about Kara, her struggle with dyslexia and how she has worked hard and become the successful actress (and I guess dancer) who she is now.
Linking this to OT:
I can only see a perfect match between dyslexia and OT. Firstly OT is all for empowerment and this, I feel, is a massive benefit for those with dyslexia. Having the belief and the knowledge and support that they can achieve is going to be nothing but beneficial. Also practical skills and occupations can be addressed and developed through OT with a particular focus on meaningful and fulfilling occupations to the individuals.
OTs also focus on each individual and in a holistic manner – this, I feel, is particularly important when considering individuals with dyslexia as everyone is different and has varying levels of the condition. Interventions should not be viewed as being “one size fits all” and should be graded and adapted to suit each individuals varying needs.  
If anything can be learnt from these individuals’ stories and indeed from this blog then I hope it is that having dyslexia is hard BUT it is not the end of your dreams or your hopes. With hard work and the rights support you can achieve great things.
For more information on dyslexia and one both Henry Winkler and Kara Tointon please see the links below:
Information links:
Media stories:

Happy OTuesday everybody,


Monday, 19 September 2011

Citation du jour.

Tonight I have just finished reading a book about the challenges one man faces with Dyslexia: 'Go play in the sand John' by John Tipping (with Frances Kavanagh). Its such a good book and has been a really interesting and inspiring read. A more detailed blog will be appearing shortly.
BUT..for now here is a snippet of the book which I particularly liked:

You have to take everything you can out of life because the better you feel about yourself, the more you give back. It becomes infectious in the end, which I think would be quite nice for the world. The majority of people just exist; a small minority live. Shouldn't that be the other way round?

Tuesday, 6 September 2011

Bake the blues away..

If any of you know me personally then you will know that I am a BIG lover of cooking, in particular Baking. My mind is full of memories of spending time in the kitchen helping my mum bake all kinds of lovely treats and over the years my love for it has grown. Baking for me now is my own kind of therapy. I bake not only when I want to take something to a friend’s gathering or as a special present but also as a way to de-stress and detach myself from the world and its problems.

Since finishing uni, job hunting and having to face the reality that due to the current economic climate finding an OT job isn’t going to be as easy as originally thought when I started my training has led to a lot of anxiety and uncertainty. I decided to channel this into something positive – and so the baking marathon began.
Flour was sifted, pastry was rolled, cream was whipped and cupcakes were frosted...some of the results were as follows:

 All this baking got me thinking, the process of baking for me is really therapeutic, the way that it has this ability to transport me to a place far away from my worries and problems, the feelings of pride and joy that I get when giving people something I have made and them enjoying it and complimenting. This got me thinking, if baking can affect me in these ways then surely it must affect other people as well.

This led me to think about the benefits of utilising baking within OT.
Food preparation and baking is used within OT for a number of reasons, mainly in my experience as a way of increasing skill development and promoting independent living skills. But it can also be used for building social interaction skills when performed in a group environment, as a means of increasing self confidence, self belief and also to provide a productive leisure activity.

I found a really interesting article in the British Journal of Occupational Therapy which relates to this post:
“‘Baking Gives You Confidence’: Users’ Views of Engaging in the Occupation of Baking.” By Lesley Haley and Elizabeth Anne McKay – BJOT March 2004 67(3).
This study shows the responses gained after 12 Mental Health service users engaged in Baking.
The report showed that the benefits received by the service users included:
·         Provided a meaningful occupation, a purposeful use of their time.
·         Engaging in baking also improved concentration, increased coordination and built confidence, leading to an increased feeling of self-esteem.
·         Baking offers a therapeutic encounter that can provide experiences of success and promote improved functioning.
·         The experience of achievement had personal meaning for the participants. They talked about what they had made, expressed pride in their workmanship and described feelings of personal satisfaction. The discovery of previously unknown skills through engagement in baking was also a source of great satisfaction for some.

On my Learning Disabilities placement I worked with a lot of service users who had problems with sensory integration. One service user in particular who had both complex learning disabilities and sensory integration dysfunction. It was decided at the time by myself and my supervising OT that we would try some simple sensory baking utilising The Social Integration model (Fisher et al. 1991) to try and gradually increase positive responses to sensory interaction. The task which we graded and adapted was making Angel Delight (not necessarily baking but was a start and an activity which was suitable and achievable for the service user at the time.) Over a number of weeks the benefits of engaging this service user in ‘baking’ were evident. Not only did we see an increase in their skills and tolerance to different sensory inputs but there was also a definite improvement in their attitude and behaviour. The intervention was working and they were growing closer to achieving their goals.

It is obvious that there are many benefits to baking and when used with the right client, one who would find this occupation both meaningful and purposeful, I feel it could be a really positive and effective addition to their therapy.

I was surprised to find that when I was looking into writing this post there was little evidence or articles which I could find concerning the utilisation of Baking within Occupational Therapy – perhaps this is an area of growth which Occupational Therapist should begin developing. 

Tuesday, 9 August 2011

Woke up to find..

...that my blog post "Babies behind Bars" from yesterday has since been added to two separate publications.

The #Forensic Daily - 
and The Therapy Fun Zone Daily -!education

Until today I had not heard of these two publications of even but what a good idea for collecting and spreading the word on important matters and latest developments. Surely the growth of works like these and others can only help increase knowledge and expertise in a wealth of different areas.

A little Tuesday Morning Inspiration...

"The potential of the average person is like a huge ocean unsailed, a new continent unexplored, a world of possibilities waiting to be released and channeled toward some great good." 
Brian Tracy

Monday, 8 August 2011

Babies behind Bars.

The other week I watched the two ITV documentaries from within an American Prison currently running a nursery scheme. These are my reflections of the scheme.

Babies Behind Bars. ITV documentary first aired on the 27th June 2011. May still be available to watch in the UK on the ITVplayer.

According to the documentary there is a soaring number of women entering US prisons (the number is up by 400%) and there are now more women offenders in the US than in any other country.

Within US prisons women offenders who give birth whilst behind bars are required to have their baby/babies removed from the establishment after 24hours of birth. HOWEVER the Indiana Womens Prison has introduced a new scheme which lets 10 babies and their mothers stay in a special nursery wing -but with around 60 women giving birth each year in the establishment this makes competition strong.

The Nursery is named the "Wee Ones Nursery" and was opened in 2007 and is separated and protected from other offenders and is a more relaxed area. Its aims are to allow mothers to bond with their newborns, teach effective mothering skills, build skills in being effective members of society and to reduce the rates of re-offending and re-incarceration. The nursery also offers the opportunity for 4 inmates not resident on the wing to gain training in and work as 'nannies' to the resident babies.

Some quotes which I took from the documentary show the positive effects which the scheme is having on the women involved:
"I'm glad I'm here because I don't want to miss any time with my child. They're too precious and I understand this now."
"It's taught me how to live up to my responsibilities."
"I want to be a good mom and a good example. Its time I'm able to teach her good habits, right from wrong you know. I don't want her to think the things I did were right."

Evidence from the scheme shows that the women on the nursery wing have a 20% lower re-offending rate compared to other women offenders. Also the scheme has helped the women involved improve their motivation for creating positive futures.

Whilst on my prison placement it became apparent to me that the men who had maintained strong links and relationships with their children showed more motivation to become more effective member of society and to begin building a more positive lifestyle. In an article published in the Prison Service Journal (May 2008) it talks about how fatherhood is regarded as a key motivation for change and fathers who maintain contact with their families are up to six times less likely to re-offend. I feel that this would be the same for, if not more so, with mothers.

As OTs we look at the importance of individuals having roles, responsibilities and meaningful and purposeful occupations - I feel that this is an important issue to consider and look into, in particular if either currently working in forensic environments or wanting to follow this clinical area of practice as It is such a crucial part of a parents life and an area which would affect both the future of the parent and also their child/children in forming effective and positive futures.

On the brink of a new chapter....

Just under three years ago I started the biggest learning curve of my life so far. University.

The chosen uni – Canterbury Christ Church, and the chosen course – Occupational Therapy.

Over the past three years I have learned an incredible amount – about OT, about myself and about other people. I have changed, developed and matured.

Last week I received my degree classification. I GOT A 2:1!! Very pleased that all the effort that went into my degree paid off and that I overcame all the challenges which I faced.

There have been far too many experiences and treasures which uni provided for me to write down in one post. BUT here are the top four (in no particular order) things to treasure:
·         I met and made friends with some truly amazing people. Whether on my course or at the CU/Churches in Canterbury.
xXx Moi, Katie F and Emma W. xXx

·         I completed all of my placements in fascinating clinical settings and each with fabulous and supportive teams.
·         I went to Kerala, India for two weeks work experience – the trip proved to be the most amazing and humbling experience I have ever had.
·         I grew as a person, as a Christian and can finally say I am ready to be an OT.
So what will the next chapter of my life be??
·         Conventional OT job  in the UK?(when this silly recession ends!!)
·         Moving abroad to practice?
·         Or something more unconventional?

Who knows! What I do know however is that it is all in Gods hands.

“For I know the plans I have for you,” declares the LORD, “plans to prosper you and not to harm you, plans to give you hope and a future.” Jeremiah 29:11 (NIV)

...and from now on I’m dreaming God sized dreams.
BE the change you wish to see in the world.

Friday, 5 August 2011

Busy, busy busy....

Hello everyone! 
Thank you all so much for checking out my blog so far, I have been very encouraged by all of the positive feedback which I have received. Especially from the British Association of Occupational Therapy who tweeted that the blog is "full of great OT reading." HOW EXCITING!!! to keep up with blog posts!

As you have probably noticed I have not posted anything for a while! This is because I have been super busy for the past three weeks, working and going on mini breaks, seeing friends etc. BUT I will return to posting more blogs soon so please keep your eyes peeled.
If you would like then subscribe to my blog which will notify you every time I post something new :).

All the best,
Kate x

Tuesday, 5 July 2011

Neurological Practice - Seminar.

"Practical strategies for managing challenging behaviour following brain injury."
Blacker DD, McLaren S, Royal Hospital for Neuro-disability.

Challenging behaviour can be defined as: behaviours that seriously compromise a persons ability to engage and appropriately, productively and socially interact with their environment. 

Active challenging behaviours: 

  • Overt and observational behaviours that can potentially cause harm to self or others (both pysical and verbal)
Passive challenging behaviours:
  • An absence or lack of a particular type of behaviour. This could involve failing to express our wants, needs or feelings or communicating them in an indirect or apologetic way.
Inappropriate social behaviours:
  • Sexualised behaviours.
  • Disinhibition. 
  •  Impulsive actions.
  • Socially disruptive.
There is a need for OTs and those dealing with service users displaying challenging behaviour to have a good understanding of behaviours and need to react with a mix of proactive (long term) and reactive (short term) strategies.

Common strategies to manage challenging behaviours:

  • Control and restraint (last resort). (Can cause social withdrawal and/or escalate the behaviour.)
  • Sedation and medical intervention.
  • Time out.
  • Punishments.
  • Breakaway techniques.
  • Verbal de-escalation = negotiation, calming methods.
  • Hierarchy  of techniques from less restrictive to control and restraint.
  • Need to teach consequences of behaviour.
  • Slow down movements.
  • Think about how you sounds and what they are thinking.
  • Options - what can be done?
  • Plan for the situation.
  • Change the environment - minimise negative stimulation, provide positives (meaningful and productive activities), provide structure and predictability.
  • Change oursleves - Get to know your service users, build a rapport with them, use simple and clear language, provide personal space, alter your approach if necessary, don't offer things you can not give, get to know their behaviours and triggers.
De-escalation through communication:

More top tips:
  • See the person not the problem.
  • Look at the individual and their strengths.
  • Be creative and flexible.
  • Meaningful activities are a must!
  • Provide explicit rewards.
  • Help the individual to increase self esteem and control.
  • Positive attitudes towards the patients.
  • Task demands to consider: Activity as distraction, grade and adapt, re-direct individuals to positive/socially acceptable activities.
  • Skills training to consider: Rebuild skills, teach more socially appropriate behaviour, coping strategies (anger and stress management etc.), alternative means of communication, use of props.
Behaviour has a meaning!! Find it..

p.s. Sorry about the different colours in this post - I can't seem to get rid of them!! 

Forensic Forum - Paper Session.

“Horticulture and pet care in a medium secure unit: a growing success.” 
Bowen C, Kent and Medway NHS and Social Care Partnership Trust.

This paper described a gardening and pet care programme which has been developed and implemented within a Medium Secure Unit. Service users at the unit are given the opportunity to engage in horticulture activities and in the active care of animals such as rabbits, chickens and goats.

The OT described that the development of skills which these programmes enable provides a sense of wellbeing for service users. Boosts confidence, social interaction and engagement. As well as decreasing depression and anxiety – providing an outlet for frustration and tension and also building on a sense of relaxation.
Further benefits of the programmes which have been recognised include:
  • Sense of achievement.
  • Service users become better at planning and sequencing.
  • Helps relieve boredom.
  • Service users can work at their own place - idea for grading and adapting.
  • Service users are able to get off the ward and get some fresh air.
  • Increasing routines, structure and responsibility.
  • Problem solving skills increased.
  • Increased feelings of empathy.
There are also many ways in which these programmes can be developed in the future:
  • Ward based groups and individual horticulture activities.
  • Pet residents on the ward.
  • Photography opportunities.
  • Wildlife and conservation.
  • Art groups.
  • Picnics.
  • Weather station - meteorology. 
  • Involvement of more service users and also families, partners, friends etc.
This paper session got me thinking as to the benefits of Pets in forensic settings. My final university placement was a role emerging placement in a male foreign nationals Prison. I had thought about the introduction of pets - in particular fish, after reading an interesting article on the benefits of introducing fish onto the wings. Unfortunately I cant not find the article! Will keep looking. However after doing a quick "google" search on pets in Prison I found a couple of interesting articles.
  1.  "Washington State Correctional Center For Women -Prison Pet Partnership Program" ( Women in this American Prison have the opportunity to care for and train dogs that will assist disabled people. The women learn how to train, groom and board dogs within the prison walls. One really interesting paragraph from the link given is this:
"The Prison Pet Partnership Program gives inmate trainers the opportunity to learn valuable pet industry-related vocational skills to use in finding employment when they resume their lives outside of prison. They are able to work toward Pet Care Technician certification, levels one and two, through the American Boarding Kennels Association. They are also able to obtain Companion Animal Hygienist certification under the auspices of the World Wide Pet Supply Association. At this time, 100 percent of the inmates who have been released have found employment. Additionally, over the past three years the recidivism rate has been zero."
2.  "Jail house flock- Allowing inmates to keep pets in prison is more than just a reward for good behaviour - it can also teach old dogs new tricks." (
 I would definitely recommend reading the above article is you have a few minutes. Observations made from allowing service users to care for pets, in this case birds, include a reduction in violence and service users being on "report", an increased engagement and willingness to learn skills such as reading in order to learn how to care your their pets more effectively and also increasing social skills and co-operation. Further more the article states that in an American study, service users who had opportunities to care for pets:
"...needed only half the medication of their petless peers, and there were no suicide attempts, compared with eight on the other ward (without pets)."

I find it really interesting and encouraging that programmes such as these can have such a beneficial effect on the rehabilitation of forensic service users. This is definitely an area which I feel OTs can get involved with and develop!!

Saturday, 2 July 2011

Forensic Forum - Paper Session.

Vocational Rehabilitation within Forensic services.
“The development of a vocational pathway in forensic services.” Pollard K Northumberland, Tyne and Wear NHS Foundation Trust.
“Real work matters on a high dependency ward within a high secure environment.” Robertson CJ, Russell S, West London Mental Health NHS Trust, First Step Trust UK.
“Are you bored? Looking at boredom in a forensic in-patient setting.” Ayles K. Kent and Medway NHS and Social Care Partnership Trust.

Key points from these papers:

  • There are many barriers for forensic patients wanting to maintain or find employments, these could include: Self image, Societal preconceptions, lack of appropriate/transferable skills, inappropriate behaviours, mental health problems, anxieties.
  • Pre-vocational skills are needed in order to build on achieving an occupation/paid employment. Steps in order to achieve this could include group work, individual goal plans to achieve existing therapeutic programmes, developing social skills, employ-ability and personal development programs.
  • Promote work as part of recovery and eventual inclusion into society.
  • Create paths which make patients seem and feel as if they have left the ward.
  • Importance of social skills/social inclusion when leading groups. Eventually as OTs to facilitate the group rather than to lead.
  • Boredom in forensic units is extremely high and can stem from occupational deprivation (as defined in a previous blog entry). Within the study on boredom participants revealed that they perceived and described being bored as a negative emotion. - "frustrating", "worthless", "numb" etc.
  • Few patients within the unit engaged in solitary time in their rooms as they feared it would be viewed negatively by staff.
  • Patients revealed that previous coping strategies to boredom where illegal and/or antisocial - as a forensic OT one challenge lies in replacing these coping strategies which positive ones.
  • Recommendations for tackling boredom:
  1. Ensure activities are interesting and meaningful.
  2. Introduce new/taster sessions to help patients.
  3. Make clear links between groups and the skills acquired.
  4. Provide adequate activities for those without leave from the ward.
  5. Increase resources, including people, evenings and weekends.
  6. Enhance work experience opportunities.
  7. Explores additional opportunities for education.
  8. Increase access to books and DVDs.

Forensic Forum - Paper Session.

“Establishing a work-based learning programme: vocational rehabilitation and forensic learning disabilities.”
Smith A, Petty M, Outhgton I, Alexander RT. Partnerships in Care, Learning Disabilities Services.

Some top tips which I gathered from this paper session!

  • Develop as life like a work environment as possible.
  • Enable social and life skills.
  • Work opportunities need to be meaningful and relevant to them in order to be of relevance.
  • Increase self esteem and confidence by promoting independence and autonomy.
  • Accompany work skills with educational skills for example reading, writing and numeracy.
  • Patient reflection is important in order to help them to identify how they have improved and what skills they have.
  • Always need to consider risk management. (Individual and environmental risk assessment.)
The authors of this paper session have also published a journal article in the British Journal of Occupational Therapy. The reference for it is here if you are interested in reading it:
Smith A, Petty M, Oughton I and Alexander R (2010) "Establishing a work-based learning programme: vocational rehabilitation in a forensic learning disability setting." British Journal of Occupational Therapy. 73(9) pp. 431-436. 

Neurological Practice - Paper Session.

"Exploring the concerns and unmet needs of stroke survivors at six months."
Crow JN, Kilbride C. Imperial College Healthcare NHS Trust.
From this study it was revealed that there are six main areas of concern for stroke patients at six months post-stroke. The six areas are as followed:
1.     Loss = pre-stroke lives, independence, identity etc.
2.     Future uncertainty.
3.     Lack of information provision.
4.     Fear - another stroke, recovery, being a burden etc.
5.     Lack of therapy input - in particular vocational rehabilitation and psycho-social elements.
6.     Abandonment and isolation.
I was pretty shocked when I heard of these six areas. Most of them, for example numbers 1,2,4 and 6 I feel that you are almost always going to get to some degree due to the nature of a stroke and the outcomes of them. However for numbers 3 and 5 I feel that these are areas which can and should be stopped from occurring. I am aware that service provision and the NHS in general is rather stretched at the moment but these are two areas which I think OTS could really make an impact in. OTs are well suited to be both advocates and actively signpost patients to other professionals and services who can provide them with the right information and services which can help aid their recover and increase their general well-being.

Occupational Therapists help individuals live a life which is not dominated by disability.

Forensic Forum - Paper Session.

“The use of reflection for OTS in a forensic personality disorder unit.”
Rawdon CP, Stiles S, Northumberland Tyne and Wear NHS Trust.

There are many different uses and positives to reflecting, one being that effective reflection can inform clinical reasoning and deepen understanding of the behaviours of the above defined clinical group.
Within this paper Gibbs model of reflection was used by both staff and patients.
Staff reflection – Why?
·         Transfererance of emotions
·         Boundaries
·         Entitlement
·         Behaviours
·         Stops taking work/emotions home.
·         Supervision
·         Reflective practice
·         Informal reflection
·         Humour
·         Peer reflection.
Patient reflection – why?
·         Enables ‘enlightenment’
·         Helps them clarify and make sense of things.
·         Helps them to visually and cognitively see problems and the solutions.

When using reflective methods with patients it is important to be careful of patient discomfort when flaws are laid out in front of them – no one likes to come face to face with their flaws! Also try and minimise as much as possible the feeling of always being watched/scrutinized and judged.

I really liked the idea of this paper, which was to encourage both MDT and patient uptake in reflective practice however I think the chosen model could be altered. From my personal opinion although I think that the Gibbs model has some definite positive points there are so many other, newer, models out there which could be utilised. For example I like Driscolls cycle (2000) as it is a more simplified model and would suit a wider range of patients perhaps, especially if they have any cognitive or processing difficulties. Also Johns model of reflection (1994) has been helpful over my three years of studying.