The Koestler Trust Art Exhibition 2012

For those of you who haven't heard about the Koestler Trust before, I;m glad that I get to be the first person to introduce such a brilliant charity to you.
The Koestler Trust is the UK's best-known prison arts charity. They have been awarding, exhibiting and selling artwork by offenders, secure patients and detainees for over fifty years now. Each year the trust put together a large art exhibition which is hosted by the Southbank Centre in London. Prior to the exhibition offenders, secure patients and detainees are invited to send in their art work - whether painting, sculptures or music and film etc. This year the trust received over 8000 entries, awards were given and the winning 120 pieces were displayed.

I am a massive lover of arts and crafts and am really interested in the way it can be used in Forensic settings. I am keen to use creative arts at work with my residents and have seen people really develop and grow through using the medium of arts and craft.
One of the best parts of using the creative arts as an OT is that it is easy to grade and adapt almost every creative medium to suit a whole range of individuals. Some brief examples of how I use creative arts where are work are as follows:

• Simple collaging techniques to improving fine motor skills.
• Utilizing creativity as a way of managing anger and aggression through residents channeling their emotions positively.
• Teaching new skills to increase confidence and self esteem.
• Creative arts as a way of assessment.
• Developing group skills.
• Using art to help residents discover their own personal identities, and talents.

There are so many benefits to utilising arts in OT and rehabilitation, and the aims of the Koestler trust in my opinion, definitely help support and encourage these benefits. The aims of the charity including helping offenders, secure patients and detainees lead more positive lives by motivating them to participate and achieve in the arts. Along side this the charity helps to increase public awareness and understanding of this group of society. 

I had the privilege of taking a small group of residents up to see the exhibition this month and it was fabulous to see the art which was on display. Myself and the residents left the exhibition feeling inspired and full of ideas for our art groups and sessions back at work. What was truly priceless however was seeing how the art exhibition was helping to reduce the stigma and prejudices of offenders, detainees and in particular secure patients with mental health problems, through providing a safe yet emotive forum for the worlds offenders and the general public to mix. 

Here are a selection of photographs of the art work which the residents and myself liked in particular:

                                                               (Powerful words.)

 (This sculpture is made purely from Soap - an every day object used to make something incredible!)

 (This is a painting of an offenders dream house. What's interesting is that this is so similar to the dream  houses which I have seen drawn and painted by different offenders since working in Forensics.)

 (This intricate rose is made out of coloured pencil sharpenings. This individual has a talent from making the ordinary beautiful.)

I hope you have enjoyed looking at some of the photographs from this years exhibition. Sadly it is finished in London this year however there is always next year!

For more information on the Koestler Trust please take a look at their website below:
http://www.koestlertrust.org.uk/pages/uk2012/exhib2012.html

Happy OTuesday,
Kate :)

The Breakfast Club

One of the biggest areas of need which I have found working in a secure unit is promoting healthy lifestyles, in particular healthy eating.
It has been proven that people with severe mental illness consume unhealthier diets in comparison to the general population. Also research has shown that individuals with schizophrenia consume more saturated fat and salt compared to individuals without the condition. Individuals with mental health problems are more likely to have poor eating habits, are less likely to source nutritious meals and do not tend to eat as socially as the general population (Davidson et al., 2001). Negative symptoms of mental illnesses such as self-neglect, apathy, amotivation and an increased appetite also create barriers for maintaining a healthy weight. In addition anti-psychotic medication are known to cause weight gain.

I found that at work the residents struggle with maintaining a healthy balanced diet, because of the above factors but also because of their daily routines, most of the residents on my ward for various reasons do not get out of bed until midday and so do not eat a regular three meals a day but skip breakfast and opt for larger lunches and unhealthy snacks.

I decided to try and tackle this problem by introducing a breakfast group once a week on the ward. The group started at 8.30am for residents to help prepare the food in the OT kitchen and then was served in the main dining room for all residents and staff to enjoy.
The four main aims of the group are as follows:

• To encourage a healthy diet by providing residents with the opportunity to prepare and eat a healthy breakfast.
• To encourage residents to wake up in the morning in order to have a more structured day and participate in meaningful occupations.
• To utilise the group as a way of assessing residents functional and cognitive abilities.
• To encourage social skills to develop and to build upon the existing rapport between residents and staff. 

I devised a table of different breakfast food options which the residents could choose a certain number from each week depending on what they would like to prepare and eat. Foods include: fruit salad and yoghurts, porridge, scrambled egg, muesli, bagels etc. The rationale for choosing these foods and the others was that they kick start your metabolism, provide a slow release of energy to keep you full until lunchtime whilst also being food which tastes good and holds nutritional value.

As most of the residents do not wake up in the morning or go back to bed straight after receiving their medication at 8am it took a couple of weeks and prompting to get the residents to get up and try the group whilst encouraging others to attend as well. After a few weeks more residents wanted to either help with the preparation or would just get up to join in with the eating and socialising once it was served. I was pleasantly surprised to find that those who helped and participated in the group would then stay up for the rest of the morning rather than going back to bed.
I also noticed that the residents were choosing to eat the fruit salad every week and this was one of the most popular foods on the day. It has also been evident that the residents have been choosing to eat healthier food during their meals and in particular on a Thursday when we cook a big unit meal together they have been asking for salads and healthier options.
The group has also provided a useful means for me to assess some of the residents functional and cognitive abilities in a non obtrusive  way and also in an environment which is congruent with everyday activities.

Some written feedback which I have gathered from the residents has shown the benefits which are showing after only a few weeks:

'Having this breakfast make me feel like I have a lot more energy. It keeps me full or day and I am much more alert.'

'It makes myself feel fresh and alert for the day. Its lso helping me have a balanced diet.'

'I have felt quite down the last few days but breakfast group has perked me up. It gets you going for the day.'

The breakfast group has already shown many advantages and benefits to my ward and I am looking forward to seeing how this continues and develops as the weeks go by.

Happy OTuesday,
Kate 

References:

Davidson, S., Judd, F., Jolley, D., Hocking, B., Thompson, S. & Hyland, B. (2001). Cardiovascular risk factors for people with mental illness. Australian and New Zealand Journal of Psychiatry, 35 (2), 196–202. doi:10.1046/j.1440-1614.2001.00877.x

The Outcomes Star

Recently at work I have been starting to plan a Recovery Star group to be delivered across the three wards in the Medium Secure Unit where I work. The group aim is to proactively help the residents take a hold on their recovery with the support of the MDT.

I thought that I could use this blog post to briefly introduce the model to those who are not familiar with the Outcomes Star (the Recovery Star is the Mental Health version) a bit about what it is and where it can be used.

The Outcomes Star was developed and is supported by Triangle Consulting Social Enterprise Ltd. Triangle was founded in 2003 as an outcomes consultancy to enable value driven organisations to "count what really counts" in their work. The enterprise combines research and evaluation skills with an understanding of human behaviour in order to develop systems to support change.

The Outcomes Star both measures and supports progress for service users towards self-reliance or other goals. The Stars are designed to be completed collaboratively as an integral part of rehabilitation.

There are currently fourteen Outcomes stars designed for a range of different services and client groups. The fourteen different stars are:

• Alcohol Star
• Community Star, 
• Drug and Alcohol Star
•  Empowerment Star (domestic violence services)
•  Family Star
•  Homlessness Star
•  Life Star for LD’s
• Mental Health Recovery Star
• Music Therapy Star
• Older Persons Star
• Teen Star
• Spectrum Star for Autism and Aspergers
• Well-being Star
• Work Star

I will be using the Recovery Star in my place of work. The Recovery Star is made up of ten core dimensions which are shown in the diagram below:

Individuals are supported via their MDT care team to use a ladder system to score how their recovery process is progressing. The 'ladder' of places for each branch on the star is broken down into the following areas:

A detailed explanation of the Stars and the scoring and working of the ladder of change can be found at the Outcomes Star website: http://www.outcomesstar.org.uk and I would highly recommend you read into the Outcomes Star if it is of interest to you.

There are many benefits of using the Star, some of which being; It helps improve rehabilitation programmes and provides evidence for outcomes, it is engaging, visual and collaborative, helps both service users and professionals to gain a greater insight into the individuals areas of strengths and needs and supports MDT working.

There are also some really strong and positives benefits reported from Service users on the website given above. One which caught my attention was as follows:

The Star made a massive difference to me because it showed me that there were things I could do to become the person I wanted to be - a more rounded person with a more rounded star.It showed me that there were goals I could achieve. When you're ill, the thought that you can be well seems very daunting but the Star breaks it down into baby steps and you start to feel, "Yes, I can do this". That really built my confidence and gave me hope.

 I am looking forward to continuing my group planning and then implementing the Recovery Star group in my place of work and will use this blog as a place to update you about the positive impact which the group will hopefully have in the future.

Happy OTuesday,
Kate :)

Thoughts on a BJOT Article: Activity and Participation - self assessment according to the ICF.

The September edition of the British Journal of Occupational Therapy arrived on my doorstep this week and I was excited to see more articles about Mental Health Practice. One article in particular caught my eye so I decided to read it and share my thoughts on it as my latest blog post.

The chosen article:

'Activity and Participation - self assessment according to the International Classification of Functioning: a study in mental health.' by Lena Haglund and Susanne Faltman (2012)

The aim of the study was to explore the use of adding a fifth element to the International Classification of Functioning, Disability and Health (ICF) in order to utilise clients experience of satisfaction and enjoyment in activity and participation.

An important requirement in OT and rehabilitation as a whole is to work in a client centred way taking into consideration the needs and views of the individuals we, as health professionals, work with. Using self-assessment reflects that standpoint since the clients themselves make the assessment and convey their views and experiences of how they perceive their ability to handle their situation.

Research indicates that the client’s engagement and participation is decisive to the outcome of the rehabilitation. Consequently, it is important to develop tools with which the clients can highlight their own opinions regarding their everyday life. To manage everyday life, humans need to be engaged and to find satisfaction and meaning in the actions and tasks included in their daily life (Bejerholm 2007).

Twenty-nine clients with schizophrenia and other forms of psychosis participated in the study by using a self-assessment which was then linked to the Activity and Participation qualifier sections.

Currently the ICF component Activity and Participation consists of four qualifiers. The first qualifier describes performance, that is, what a person does in the current environment, which also includes the overall societal context and can be understood as ‘involvement in a life situation’ or ‘the lived experience’

of people in their actual context. Performance can involve assistance, such as technical aids. The second qualifier is about capacity. This describes the client’s ability to execute a task or action. It is intended to indicate the highest probable level of functioning in a given situation. The third and fourth qualifiers make it possible to code capacity with assistance and performance without assistance (WHO 2001).

As proposed by the study the fifth qualifier would make it possible for the rehabilitation process to reflect clients views.

The results of the study revealed that the ‘Major life area’ was rated with the most dissatisfaction and displeasure by the clients. ‘Communication’ and ‘General task and demands’ also had low ratings. ‘Self-care’ was rated with the most satisfaction and enjoyment. There was a correlation between the assessments made by the occupational therapist and the nursing staff, but their assessments differed from those made by the clients. 

The study indicates the importance of using self-assessment when understanding everyday life as presented in the ICF, and the importance of using different assessment methods to gain a broad picture of clients. Below are some of my thoughts on the strengths and limitations of this article and on using self assessment in Mental Health:

Limitations:

• The study was conducted in Sweden and so results may had differed had the study been conducted in the UK.
• The ICF assessment is long and complicated. The clients self assessment used in the study was a combination of two constructed assessments consisted of a seven-page list of 248 categories each - my concern is with how many clients would actually be able to sit and complete the assessments effectively and in one setting, or have the motivation to do so. 
• The results of the ICF assessment are not particularly accessible or easy to understand.
• One trouble which I have found with combining self assessments with professional assessments is the potential difficulty in sharing the professional assessment results when the clients disagree and/or perceive their abilities differently.

Strengths:

• As mentioned above it is crucial to include clients throughout the rehabilitation process and using self assessment is a powerful tool to doing this. 
• Allows greater insight for the professionals into the clients, for example in areas of insight and cognitive areas.
• Helps professionals to gain a therapeutic rapport with clients as they feel respected being able to have an active part in their rehabilitation.
• Using the ICF framework and assessment allows for greater MDT working as a range of professionals are familiar with it and it also shows the significance of Occupational Therapy. 

If you are able to read the article than I would recommend you do as it is a interesting insight into just one way of how professionals can encourage and support client participation in their rehabilitation process.

Happy OTuesday,
Kate.


Reference:

Bejerholm U (2007) Occupational perspectives on health in people with schizophrenia. Unpublished PhD thesis. Lund: Lund University.

Haglund L, Faltman S (2012) Activity and Participation - self assessment according to the International Classification of Functioning: a study in mental health. British Journal of Occupational Therapy, 75(9), pp.412-418.

Word Health Organisation (2001) International Classification of Functioning, Disability and Health (ICF). Geneva:WHO.

Citation du jour.

Interview tips - from the Interviewers perspective.

Last week at work, I was on the interview panel to find the new OT Technical Instructor for my ward.
It was a long day interviewing the eight shortlisted candidates with myself, the Head OT, a Charge Nurse and a MH service user forming the panel.
We had some great candidates and I'm thrilled with the successful applicant that we have chosen, and am looking forward very much to working with them in the near future.
Being back in an interview room made me think back to when I was being interviewed for my job. That was a nerve wracking day!

So, in order to hopefully help some of you who may be reading this and going through the job interview process I thought I would share some tips into what we are interviewers where looking for.

(Although the interview was for an OT TI and not a qualified OT I'm sure that most of the points will be transferable.)

Kate's top tips for OT interviews:

1. Make sure you have read through the job description/know what post you are applying for and have read round about the particular area of practice. If you already have experience of the particular area than demonstrate all your valuable knowledge.
2. Use past life experiences to make you stand out and prove that you are up to the job. Volunteer work, past paid work and travelling is all important. Travelling, especially solo or in dangerous parts of the world can demonstrate maturity, independence and an ability to cope which are all important traits to posses.
3. Bring your CPD folder with you and know where everything is in it. Bring examples of past work which would be relevant for the role you are interviewing for. For example the post we were interviewing for required the individual to run groups and be creative so candidates who made a good impression where those who showed us examples of their past work whether formal groups they had been involved with or art and craft projects.
4. DO NOT LIE IN YOUR SUPPORTING STATEMENT. It was obvious from a couple of the applicants we interviewed that their supporting statements were not a true representation of themselves. When asked questions and expanding on answers it was obvious who had been truthful and was able to expand on their supporting statements and those who were not. 
5. If you have experience in OT then draw upon your knowledge even if it is from a different clinical area of setting. One of the candidates had experience in physical OT only however did not draw upon any of their experience or knowledge within these settings. Although Mental Health OT is different to Physical OT there are also many similarities and transferable skills so show the interviewers that you can work in the new setting.
6. Try not to let your nerves get to you. It is important for your personality to shine through, interviewers are looking for someone who can not only do a great job but who will slot in well with the team.
7. Dress to impress. You are interviewing for a professional job so jeans and a top don't give the right impression. You don't have to wear a suit if you are going to be uncomfortable in it but smart wear is definitely the way to go. 
8. Prepare some questions to ask the interviewers. It shows that you are taking the interview/job seriously and that you have thought about it and show a real interest. Include questions with relation to the service and their goals, future aims etc. as well as general questions such as shift patterns, supervision access etc. 

These are the main tips that arose from the interviews. If any of you reading this are in the job interviewing process than good luck, I hope you get the jobs you all want. 

Happy OTuesday,

Kate :).

Citation du jour.

Occupational Engagement in Mental Health Recovery.

One of the major challenges I have to try an overcome at work is motivating the individuals whom I work with to engage in their recovery process. Individuals who have enduring mental health conditions often lack motivation and the drive to effectively move forward in their rehabilitation.

After discussing with the head OT where I work about how I could best motivate the service users on my ward to engage more in occupations and activities, we began to speak about the different stages of recovery for individuals. When thinking about recovery it is crucial to apply a client centred approach to formulating treatment plans. There is no one size fits all solution to recovery in Mental Health and so a knowledge of the different stages and ideas surrounding the recovery process can aid OTs and other health professionals in gaining a greater understanding of the needs of their service users.

A recent article published in the Canadian Journal of Occupational Therapy (June 2012, 79(3), pp.142-150) explores different stages in occupational engagement in Mental Health Recovery. I found the article an interesting read and it certainly helped me understand more about the process of engagement in recovery and has developed the way in which I am going to formulate treatment plans for my service users in the future.

This blog post is going to be a brief discussion about the article.

“A phenomenological study of occupational engagement in recovery from mental illness.”  

Sutton, D.J., Hocking, C.S., and Smythe, L.A. (2012).

The purpose of this article was to explore the experience and meaning of occupation for thirteen people who self-identified as being in recovery from mental illness. Recovery narratives were collected from participants in conversational interviews that were recorded and transcribed. These transcripts were then analysed and the finders were as follows:

·         A range of experiences were evident in the recovery narratives and these have led to implications for practice being that all forms of occupational engagement, from disengagement to full engagement can be meaningful in the recovery process. The article calls for therapists to understand these different modes of engagement in order to support their service users through recovery.

The findings of the article were most interesting. The authors explained how a range of occupational experiences emerged from the participants stories. Four points in the recovery continuum of engagement were proposed, there are; disengagement, partial engagement, everyday engagement and full engagement. Each of these were characterised by particular dynamics and each have the potential to support service user’s recovery.  Below is a brief summary of the four points.

Disengagement

This is the stage where individuals completely disengage or cut themselves off from everyday occupations. Individuals in this stage described themselves as feeling numb and having lost all intentionality for being in the world. During this point the absence of routine occupations and everyday living can cause a potential loss of meaning and sense of self. This point in an individual’s recovery can act as a kind of asylum which protects the individual from the demands of the outside world. Stripping back everyday existence and disconnecting from routine occupations can create space for individuals to gain a fresh perspective and reconnect with their volitional foundations of everyday life.

Partial Engagement.

This is the stage where individuals could not engage themselves full in the everyday world however could connect in some way with the immediate world around them. Individuals in this stage often express it as a slow process which provides a grounding for them in the future. Partial engagement ideally creates a space of respite where individuals can gradually get back in touch with the everyday world by slowly engaging more in occupations. The process of occupations in this stage are more about the process than the enjoyment or outcome.

Everyday engagement

This is the stage where individuals enter everyday engagement which involves having direction and increased commitment, meeting expectations and synchronising with others space and time. It is about individuals learning how to be a part of something shared and engage more in community and social situations.

Full Engagement

This is the stage which sees individuals create a sense of flow through deep engagement in meaningful occupations. It is characterised by focused attention, great enjoyment and integration of the individual with their environment.

I feel that from having an understanding of these four points in recovery and recognising that individuals dwell in them at specific and often varying times can help therapists when planning their treatment plans for service users. I particularly like the first stage mentioned, disengagement, this is a stage which I see often with my service users and this article has provided me with a new way of looking at their current place in their recovery process. Before reading this article I had not viewed disengagement and the characteristics of this as being a very positive stage and struggled with knowing where to start really with my service users in this stage. This article has given me a deeper understanding of disengagement in the recovery process and how it can be looked on a positive part of the process and therefore how it can be a springboard for individuals to more onto a more functional area of occupational engagement.

Having a picture of the four stages of occupational engagement in the back of my mind when thinking about my service users, I feel, will help me to formulate both individual and group activities and opportunities on my ward. I am looking forward to returning to work tomorrow and thinking more about these stages and how I can incorporate some of the ideas which the article explored in my practice.

Happy OTuesday!

Kate.

Reference:

Sutton, D.J., Hocking, C.S., and Smythe, L.A. (2012). A phenomenological study of occupational engagement in recovery from mental illness. Canadian Journal of Occupational Therapy, 79, 142-150, doi: 10.2182/cjot.2012.79.3.3

First eight months as an OT.

About eight months ago I started my first job as an Occupational Therapist, working in a Medium Secure unit for mentally disordered offenders. This was the area which I had wanted to work in since completing my final and role emerging placement in a Male Cat C. Prison. 

After waiting three months from accepting the position to starting the job I was both incredibly excited and also nervous about starting. I had had to move away from home to a new county where I didn't know anyone so that was also another added change. The first few weeks at work were an induction as the unit I would be working in was brand new, meaning, new staff and a new service to run..and I soon found out, I would be running my own 15 bed Male Assessment and High Dependency Ward.

The past eight months have included copious amounts of challenges which I have had to overcome as well as many successes and rewarding moments. From speaking to other newly grad. OT's in a variety of settings it was reassuring to see similarities and know that it wasn't just me struggling at times. My hope from this post is to share with you my top 5 main challenges/reflections from my past eight months at work in the hope that it can not only inform but also reassure others in similar positions that they are not alone and to 'Keep Calm and Shine On.'

1. It's OK not to know everything! - Probably the most important lesson which I have learnt over the past eight months is that it is OK not to know everything. I have learnt an incredible amount about OT and about my identity as a practitioner simply by working and developing my skills as and when situations arise. Being able to bounce ideas off other OTs and other professionals is also a great way of fine tuning skills and increasing your competence as a professional. I had to learn that it is OK to be unsure about some things and to get second opinions and advice from others - it is so important to work as a team! Don't be shy about asking for help. It doesn't make you weak, it only means you are wise. 
2. Utilise Clinical Supervision! - Probably the most helpful tip I could give is for newly grads. to really take their supervision seriously and to make the most of it. I find that in my job I am so busy all the time that I rarely have the time to just sit back an think and plan what I am doing with my residents. I often found (and still find if I'm being honest) that I spent a lot of time outside of work planning and thinking about my intervention plans and strategies for my ward. One really valuable part of supervision for me is being able to discuss my plans and the progress of my work with my supervisor who, as a senior OT, can give me the advice and support that I need to increase my skills and effective practice. Supervision is also a good time to be able to talk things through and to get situations out of your mind and problems solved. Working within the Forensic settings means working regularly with challenging behaviours, unpleasant and upsetting circumstances for example assaults and restraints. Being able to have a space and time set aside to talk about the effects of these situations is vital to be able to maintain a professional manner whilst at work and not allowing circumstances to affect you personally. Finally another point to make about supervision is that it is a brilliant time to receive reassurance and praise that what you are doing is actually good and making a difference. 
3. Age! One challenge which I didn't anticipate meeting was the way I was perceived and treated by some members of both staff and residents due to my age. Being young for some of the staff caused them to treat me like a child and I felt like I wasn't taken seriously or treated the same as the other Band 5 staff members I was working with, also some of the residents have found/find it hard to be much older than a staff member. I found that simple steps such as dressing smart, acting maturely and being able to maintain a professional manner and stick to your personal and professional boundaries has been crucial in proving that just because I am only 22 I can still perform my job to a high standard.   It takes time, but eventual once people get to know you, age won't matter. 
4. Working in a secure setting! Working in a secure setting with policies and procedures to follow. I started the job and had so many ideas which I arrived with and thought of within the first few months. Working in a secure setting however comes with barriers and limitations and interventions and ideas which would have worked perfectly in another environments are no longer suitable. A big learning curve for me was in having to problem solve and be flexible in altering ideas and interventions which could be carried out in the secure setting. It has been, and still is, a test of my creativity and perseverance however I feel will make me a stronger and more adaptable OT in the future.
5. Working in today's economic climate! I don't need to inform anyone of the tough economic times which we are having to live and work in. The NHS is having to make cut backs and tighten up on areas such as spending and resources. For me this has directly resulted in budget cutbacks and a radical change in shift patterns for staff. Having to contend with this has meant that my skills in prioritizing have been tested as well as having to be able to reorganize and restructure activity programs and adjust to working new hours. However despite the challenge I have been able to adjust to the changes and still run a structured and purposeful activity program on my ward. Despite the cutbacks which the NHS are facing I believe that OTs and other professionals can still function and perform their jobs to high standards. After all being an OT takes patience, ingenuity and determination. Lets rise to the challenge and make the most out of what we have.

For me working with this group of individuals is a real privileged and the opportunities to make a difference in their lives, helping them to move forward, are endless. I am looking forward to the challenges and the successes that the next eight months, and years to come, will bring. 

Kate. 

Gordon Behind Bars – Part three.

Final episode: Tuesday 17^th July 2012

The final episode of Gordon Behind Bars showed the Bad Boys Bakery showed Gordon persuading Caffe Nero to stock the Bad Boys Bakery's lemon curd treacle slice for a 'make or break' showcase week and asking Justice Secretary Ken Clarke for vital financial backing. The show showed how with the help of a branding Guru, the prisoners themselves packaging the slices using their own personal stories and aimed the treat at the socially conscious consumer. I really liked how the prisoners were so involved in every stage of the business from their name, food production and then through to the branding and packaging. Plus the fact that the packaging revealed a bit about the project and the stories of the prisoners would hopefully help the consumers understand more about the backgrounds of prisoners and hopefully begin breaking down negative stereotypes. My favourite quote from the packaging was along the lines of ‘once a criminal, not always a criminal.’

The program also spent time following the journey of two of the ‘Bad Boy Bakers’ as they got jobs in two restaurants after release. One Gordon had found a job for in the Savoy Restaurant. Unfortunately despite the individual doing well to begin with the pressure of returning to his previous drug habits proved too much and he returned to using drugs and consequently lost his job. One of the biggest worries for the residents that I work with who are close to release or moving on surround the amount of support they will have when they leave. For someone who has perhaps spend decades or at least many years in secure environments where they are constantly living within strict rules and procedures to suddenly move back into society where there are pressures and freedom which can prove to be stressful and lead to relapse. This just highlighted to me how important it is that people leaving Prison and other similar settings need support once they are back into the community to reintegrate into society and live pro-social lifestyles.

Gordon also spoke to and showed Ken Clarke around the Bad Boys Bakery attempting to secure future funding for the project. Unfortunately funding was not secured although at the end of the program it was said that funding and support was trying to come from a social enterprise.

Of the twelve Bad Boy Bakers now:

2 work in restaurants.

3 are looking for work.

4 have moved Prisons.

1 continues with his struggle with drugs.

2 remain in the Bad Boys Bakery with 10 new recruits.

There are two main points which I reflected on whilst watching both this episode and the series as a whole.

The first being I wondered how the celebrity endorsement of the project being fronted by Gordon Ramsey affected the overall success of the project. I don’t think that it can be overlooked how the filming of and the work of Gordon Ramsey one of the world’s most famous chefs would have promoted an instant success and positive vibe for this project. His hands on approach throughout production to market research, having contacts in the food industry and through selling the product would have undoubtedly advanced the success of Bad Boys Bakery. I don’t feel like a normal social enterprise of project which was being run in either Prison or similar setting would necessarily achieve the same success without having celebrity endorsement. I think that it is brilliant to have celebrities such as Gordon promoting such valuable vocational rehabilitation and projects however can’t help but wonder about how Prisons and other settings could attempt similar projects on their own and gain such success.

The second reflection which I had was concerned with the sustainability of the project. With Gordon only being able to support the project for six months and having him not been able to secure funding for its continuation after this I have concerns with regards to expectations and hopes of the prisoners involved. At work it is important for me to not offer services or interventions with residents which I am not able to continue through to completion. I think that it is vital that when working with individuals in secure settings and indeed throughout Occupational Therapy and health and social care settings that as professionals we are able to see work through to completion and not just provide a service before stopping within a short amount of time of before objectives have been met. I do however understand and acknowledge that projects and interventions etc. may have to stop due to unforeseen circumstances or similar reasons.

I sincerely hope that funding and support will become available for the Bad Boys Bakery and that its success and the awareness generated by the program will spur on the creation and development of other similar projects.

In my opinion vocational rehabilitation is a key part of the rehabilitation process for individuals in Prisons and other Secure Units. 

Kate

Gordon Behind Bars - Part Two.

Gordon Behind Bars. Channel Four, Episode Three: 10th July 2012. 

It was episode three of Gordon Behind Bars and yet again another interesting watch. The week saw Gordon and the Bad Boy Bakers attempt to set up a local gourmet lunch delivery service and then pitch a sweet treat snack to several major coffee shop chains.

It was clear to see throughout that the pressures of working ‘behind bars’ and adhering and running a functioning kitchen within such strict and rigid regimes and protocols was taking its toll on the Gordon and the team.

The ideal to have the team produce a high volume lunch service to local businesses is one that would have made excellent use of the facilities within the Prison and as the program explained had potential to generate just under £1million pounds a year along with providing needed vocational rehabilitation to the offenders involved. However this idea proved to be too much off a challenge considering it would require a change in routine and would equate to adding more pressure on the already overstretched Prison Staff. It is a shame that this initiative could not come to fruition however as seen in the program Gordon and the team were able to work within their limitations and find a more manageable and cost efficient product.

Plan B; a sweet lemon treacle tart which they aim to sell in a major coffee shop chain. This new product was able to be produced in higher volumes than previous ideas and was also more cost effective whilst fitting in well with the regimes which the kitchen has to work within. I was impressed with the way that Gordon was able to move on from the initial disappointment and frustration of not being able to uphold the lunch service and come up with another, more effective idea. This is something which I often find I have to do at work. It is often that within secure services new ideas and initiatives are not able to happen due to security procedures and other contributing factors. Being able to think outside of the box and work within a challenging environment to achieve the best opportunities for the residents/offenders is a pivotal skill for OTs/other professionals working in these environments to grasp. I am really looking forward to finding out in the next episode whether the Bad Boy Bakers will have found a supplier for their sweet treat.

Whilst watching the episode it was interesting to see how the public reacted to produce being sold by offenders. The majority of the public who were featured in the show were supportive of the project and brought the lunches from Gordon which I was pleasantly surprised by. However there were some who wouldn’t as they were unsure of the cleanliness of the food and the sorts of offences which the bakers had committed had a definite effect on whether people would buy the lunches or not. It was interesting although not surprising to hear the most common worry the public showed was whether or not the prisoners were sex offenders. Public perception and stigmatisation are massive challenges which need to be overcome if offenders whether in Prisons or in other facilities are truly going to be accepted back into society. I believe that a large part of rehabilitation and reducing reoffending rates stems from whether this group of socially excluded offenders are able to mix back into society, feel accepted and be supported into living pro-social lifestyles. Having projects which bring the skills and rehabilitation of this group of society into the public eye can only be a positive step in improving

Finally it was really encouraging to hear the following from one of the ‘Bad Boy Bakers’ at the end of the program:

‘...for me I believe now when I get out of jail. I believe I can be something. What Gordon’s done is he’s put that fire in people’s bellies to make people want to do something when we get out. To think yeah we can do this. I actually can do it.’

In my opinion projects like these are testament to the fact that engaging in meaningful and productive occupations aids not only the rehabilitation of offenders but also in the development of individuals as a whole.

Kate

Citation du jour.

Gordon Behind Bars - part one.

Gordon Behind Bars - Channel Four. Episodes one and two: Tuesday 26th June 2012 and Tuesday 3rd July 2012.

I took a little break from blogging so that I could concentrate on my current professional work load, however I'm back and what better way to restart the blogging than with some reflections on the new Gordon Ramsey show; 'Gordon Behind Bars'.

The documentary series follows Gordon Ramsey as he starts up and runs a catering business in Brixton Prison (a category B prison in South London) for six months. In an interview with Channel 4 Gordon said the following:

What is Gordon Behind Bars all about?This isn't just a 'let's go and cook along with Gordon in prison' thing. The idea came from the fact that there are approximately 80,000 inmates across the country now, which is a hell of a lot. It was about getting them doing something with their time, giving something back, and also getting job-ready. The biggest problem is the re-offending percentages, people just go round and round in the system.

Brixton prison homes 800 prisoners whom spend up to 21hours locked up in their cells. Prisoners have access to a variety of exercise programs and can also pursue a range of educational opportunities. By setting up a catering business inside the prison Gordon would be adding to the rehabilitative opportunities available to the inmates whilst working towards Government initiatives to get more inmates across the prison system working full time job roles. 

The first two episodes of this series saw Gordon choosing 12 prisoners to become a kitchen team able to sell produce outside of the Prison walls. Week one showed the 12 inmates decorating cupcakes to be sold within the Prison and then cooking dinner for the Prison. The challenges were raised during week two which saw the team baking produce to be sold in a pop up shop in London. 

  

As a Forensic Occupational Therapist working on a medium secure ward (for mentally disordered offenders) I have been finding the programme incredible interesting. The benefits of vocational rehabilitation and projects such as this can be excellent in providing prisoners with structure, meaningful occupations and a chance at building positive identities and roles for the future. Below are a few of my reflections on the past two episodes:

The main point which I have been thinking about during these episodes is the dynamics between security and therapy. Both in the prison and in my work setting the balance between maintaining security procedures (which are vital to uphold as you can imagine) and allowing the men to work in a therapeutic and efficient way is at times a hard balance to maintain. I try and incorporate an environmental model with regards to the relationship between therapy and security. Aiming to place security within the context of therapy, in doing so emphasising the importance of safe practice whilst providing a holistic approach to providing meaningful occupations. Security procedures and the tight structure of secure environments can play a fundamental role in creating occupational deprivation and so it is important for OTs and other key workers to maximise the occupational opportunities in a safe and effective way. Relational security is also another important factor. Relational security describes the importance and effect of developing therapeutic relationships with this client group. It is interesting looking at how important gaining a therapeutic, or working, relationship with the prisoners has been in the two episodes. I find that this is a pivotal part of the work which I do as an OT as well. Without gaining a rapport with the men I work with it is difficult to get them to open up and engage in goal setting and then interventions. I think that Gordon has demonstrated well in this programme that treating the men with respect and genuinely taking an interest in them and what they would like to achieve has helped him begin the process of forming a kitchen team in a safe and therapeutic way. 

The challenges which Gordon has faced from both the prison system and from society has made interesting viewing. Within the prison system there are staff who hold more of a security and punishment view as apposed to secure recovery, this coupled with stigmatised views of offenders and a view by some members of society that they should not be given such opportunities can be damaging to offenders and only add to the cycle of re-offending rates and lack of rehabilitation of offenders. These views can create challenging environments with projects such as this and other occupational and educational based works to successfully run and make a difference to these individuals lives. It should be noted however, that there are a great number of prison staff and members of society who hold a very rehabilitative view to secure recovery and it was encouraging to see the attitudes of members of the public who brought products from the pop up shop. 

Finally the past two episodes have also highlighted to me how even little successes can build self confidence. As the men in the program were shown increasing their skills and producing baked goods you could see their self esteem and confidence growing. This is also something which I have witnessed at work. The pride and hope which can be gained from little accomplishments should not be overlooked by professional working with this client group. This in particular, I feel is where OTs are able to utilise goal setting and grading and adaption techniques to help these individuals to accomplish great things through the completion of little successes. 

The programs have both been really interesting and I'm looking forward to seeing how the series develops, if you haven't already been watching I encourage you to do so. They are available in the UK at the following link: http://www.channel4.com/programmes/gordon-behind-bars/4od . I will continue to blog about the series as the weeks go by so keep your eyes peeled! 

Kate :)

Clinical Supervision.

Today I attended a days training on clinical supervision. It was a really interesting day and a great time to spend with my fellow colleagues from across the range of Forensic wards at work, discussing the barriers and enablers which surround clinical supervision in our area of practice. 

As a newly graduated OT throughout all of my placements and my studying, supervision has been a key part of my training. Also since starting my first post I receive weekly clinical supervision with my band 6 supervisor and also attend MDT ward based reflection forums weekly. My clinical supervision over the past three months of my job have been my back bone of support in a difficult time of transition across my place of work. Without these regular and protected times I am sure that my clinical practice and clinical reasoning would not be developing as much as they currently are. The access to these regular supervision was also something which was offered to me and not something that I had to request of fight to obtain.

I was surprised  therefore when I heard from both the nurses and nursing assistance that were on the training with me that they do not currently receive any form of clinical supervision and that it is not something which is prioritised or protected  for them.

The differences highlighted today between the two professional bodies has definitely left me feeling proud to be part of a professional body which values such a pivotal and important part of clinical practice.

Another point which we discussed was the confusion which can surround what clinical supervision actually is and how as practitioner we can best utilise their supervision. Below are some definitions and useful tips which I picked up from the day:

Definitions of clinical supervision:

Bond & Holland (2001 p12)

• “Clinical supervision is the regular, protected time for facilitation, in-depth reflection on clinical practice…...The process of clinical supervision should be continued throughout the person’s career, whether they remain in clinical practice or move into management, research or education”. 

Howaston-Jones (2004 p 38)

• “Clinical supervision is a designated reflective exchange between two or more professionals in a safe and supportive environment which critically analyses practice through normative, formative and restorative means to promote and enhance the quality of care”.

Tips to best utilise supervision:

We discussed that supervision is often a process or cycle of stages which should eventually lead to action points and the development of skills and knowledge. One good way of ensure this grow is through the use of  models of reflection.

Some of the models we as a collective find most useful are:

Other useful tips:

• Be ready to learn, improve and consolidate.
• Have courage to share things that are challenging as well as successes.
• Communicate openly with issues expressed honestly.
• Be open to receiving support.
• Be open to feedback (positive and developmental).
• Be prepared to find new ways of doing things.
• Stick to agreed actions.
• Be punctual.
• Keep record of evidence for CPD.

Hopefully this post will be both interesting and helpful to any of you who are involved in clinical supervision. If I have learnt anything from today's training session it is that clinical supervision is to be valued and protected in clinical practice in order to  health care practitioners that are constantly learning and developing their skills and knowledge. 

Kate

Dying Inside

Earlier this year I listened to a radio programme broadcast on BBC Radio 4 about the growing phenomenon of older prisoners in the UK. The program was presented by Rex Bloomstein a documentary film-maker, whose films on human rights, crime and punishment and the Holocaust have become major themes in his work.

The programme explained how the UK has the largest European prison population of over 8000 older prisoners. This group of offenders is also the most rapidly growing, which is in part due to the fact that forensic evidence/advancement is continually developing and improving meaning that more 'historical' cases are now being solved. Also the number of offenders serving long term or life sentences has increased over the years. 

The programme spoke to a number of older prisoners who shared their experiences of being 'older' and living in prison either for the a long time or for some the rest of their lives. Older prisoners have a higher incidence of diabetes, hyper tension and coronary heart disease as well as the general mobility and cognitive disabilities which older people develop with age. However added on top of these are problems of adjustment, loss of liberty, loneliness and isolation caused by living away from family and loved ones. Living in a prison and/or secure environment where the majority of the population are younger individuals can prove to be a frightening and threatening environment for older prisoners/offenders which can have a detrimental effect on their mental health. 

There is currently no national strategy for older prisoners/offenders, meaning that this client group is at risk of being overlooked and needs not being met.

Whilst reflecting on my current client group in the secure unit where I work last week and realised that there were some reoccurring themes with regards to needs between the clients over the age of 50 (which is classed as being an 'older' offender). This was not surprising as it is universally acknowledged that with age comes different obstacles to overcome both physical and cognitively. What I realised through my reflection however was how this client group and their specific needs run the risk of being unintentionally overlooked by the service. I began to think back to my work experience in a Prison and found that the same issues arose. 

The diagram below depicts some of the common problems which in my experience older prisoners/offenders have faced.

From my work in a Prison setting I tackled some of the problems by doing things such as:

• Collaborating with the gym instructors to provide a separate gym room which did not have the 'loud' music channels playing in, had cardio. exercise equipment and which provided specifically designed exercise classes for the older client. 
• Providing different activities for the older clients to engage in, activities such as dominoes and card games which proved most popular.
• Setting up support groups/ social events for older clients.
• Practical solutions to physical/mobility problems such as moving the clients to a cell which was on the ground floor, had grab rails/ had little obstacles or stairs to negotiate.
• Finally many of the older clients complained about the noise which the younger clients make whether whilst socialising or when watching their TVs or playing their music loudly and late at night. By creating quieter sections on the wings where the older and quieter clients were based reduced this problem effectively.
• The provision of mobility and functional aids. Eg, wheelchairs, walking frames/sticks, grab rails etc.

This is obviously only a small snap shot into some of the solutions which can be found for meeting the needs of this particular client group and depending on the individual concerned solutions may differ or completely different needs may arise. 

With the increasing number of older prisoners/offenders in the UK, health professionals, including Occupational Therapists, should be ready to meet the needs and solve the problems of this client group and be more aware of the implication that being 'locked up' has on the older prisoner/offender. 

Kate.

Further information can be found at the following sites:

http://www.recoop.org.uk/pages/home/index.php

http://www.ageuk.org.uk/documents/en-gb/for-professionals/government-and-society/older%20prisoners%20guide_pro.pdf?dtrk=truehttp://

www.prisontalk.com/

Thoughts on a BJOT article.

The February edition of the BJOT arrived on my doorstep this week and I must admit the contents got me just a little excited - I'm just a little bit of an OT geek.
The article which struck my eye immediately, and unsurprisingly, is the focus for this blog post.

"The use of the Wii Fit in forensic mental health: exercise for people at risk of obesity." Nicola Bacon, Louise Farnworth and Richard Boyd, BJOT, Feb 2012 75(2)

The article looks at how OTs in Australia have utilised virtual reality technology to promote fitness and weight loss in a secure hospital. 

From working in a medium secure unit I have really noticed how at risk and already obese this group of clients are. This is due to many factors such as restrictions on physical activity and a lack of motivation however one large reason is due to the side effects of psychotropic medications. Adverse side effects of the medications used to treat the symptoms of psychoses often include sedation and decreased metabolism, leading to rapid weight gain.
These are definitely side effects which are discussed at work as being very problematic to this client group. It is also important to consider environmental difficulties in addressing weight gain. Within secure environments there are many physical, legal and institutional barriers which prevent clients from accessing exercise opportunities that are available in the general community. Although at my place of work there is some limited gym and sports hall access, due to the majority of the clients being between 20-30yrs old many of the sports which they are interested in, such as extreme and team sports are not accessible to them and that causes a lack of motivation to participate in the opportunities that are available.
This is where the authors of the article feel that virtual reality games such as the Wii fit can provide a stimulating and motivating medium for weight loss within secure settings.

The Wii fit which is a commercially available virtual reality system which utilises motion-sensitive technology to transfer players' movements onto a television screen and a virtual Wii environment. The Wii fit games allow individuals and multiple players to engage in an array of sports and fitness activities ranging from yoga to baseball to kayaking.
One particular benefit to the Wii fit is as follows:

"The 'gaming' factors of virtual reality (VR) technology such as earning points, are believed to help motivate and sustain players engagement in tasks. VR interventions also may be very normalising for forensic patients especially because the average demographic of a video game player is similar to that of the average forensic patient, a 30year old male."

Literature suggests that these Wii Sports games are motivating, enjoyable and realistic forms of physical activity for a variety of client populations although, until recently, little research has been focused on the forensic population.

The method of the study had participants playing the Wii fit up to four times a week in both individual and group sessions which lasted between 7 to 127minutes. The study only had a small population of two clients which were discussed however results showed that when using the Wii fit, participants increased their overall time spent actively moving their bodies in physical activity. Using the Wii fit also changed participants attitudes towards exercise as they realised that it could be 'fun' and 'challenging', especially when staff members also participated.

This article provided an interesting insight into a potential intervention which Occupational Therapists can utilise to both prevent and combat weight gain in secure units. The challenge for forensic occupational therapists is to find a 'better match between the person, environment and occupation in this scenario, in order to assist forensic mental health patients to participate in exercise within a secure setting, to improve their health and well being, and potentially to assist them to lose weight." The Wii Fit and other VR systems could be the perfect way to achieve this. 

Back to the blogging world...

Hello everyone,
As you may or may not be aware this blog has been rather quiet for a few months.
The past couple of months have seen me move away from my friends and family to start my first OT post! Despite being incredibly busy I have immensely enjoyed the transition from student OT to Band 5 OT and am so excited about the prospects that the job holds.

Now everything has settled down a little bit I hope I can continue with my regular blogs, so keep your eyes peeled folks!

Kate :)