Where is the profession heading?

Perspective from an early career therapist

Harley Hayes, Occupational Therapist, Everyday Independence

Workforce

Occupational therapists are in significant demand across Australia, with their talent and skills required across multiple sectors including disability, health, aged care, mental health and welfare.

This demand is providing occupational therapists with more opportunities and choice around career direction and progression than ever before. This demand does not look like slowing – not with Australia’s ageing population and ongoing funding for therapy services through the NDIS.

The disability sector has seen significant growth since the introduction of the NDIS. The NDIS workforce strategy indicates there is going to be continued growth in the sector over many years, and this is going to require a significant increase and development of the therapy workforce (Commonwealth of Australia, 2021) – providing new and exciting opportunities for occupational therapists.

For early career occupational therapists, I feel your pain with the ongoing pressure to meet this high demand for services. Arriving to the profession from university or a different sector, there is a steep learning curve to feel comfortable and confident working in this space. However, I have seen significant career growth opportunities for therapists who are passionate about working in the disability field. I appreciate the hard work of experienced occupational therapists to upskill early career therapists like myself, and their efforts in spreading a finite amount of talent to achieve the greatest impact. They would have spent many late nights and long days providing these additional supports. Since the sector has moved to individualised funding, many would have faced challenges pivoting to a commercial environment while ensuring evidence-based and high-quality services were provided.

Increased demand has presented significant challenges in the face of ever-increasing wait times. Being unable to access occupational therapy services in a timely manner has a significant impact on outcomes, and people being able to fully utilise their therapy plan budget. This presents a major risk to the profession, as early intervention and capacity building is a critical component of the NDIS success (NDIA, 2020).

As a profession, we have the opportunity to build a workforce that is leading disability practice and achieves high impact outcomes for people living with disabilities. But it will require the profession to be innovative and committed to ensuring that all Australians have access to occupational therapy services. While we have such significant workforce shortages, it is critical to be working at the top of our scope of practice to achieve the greatest impact with our valuable time. This will ensure therapists are delegating, and building the capacity of others to embed therapy into everyday life. Working at top of scope involves occupational therapists providing services that align with their skills and professional training. Initially, I found it challenging to utilise my full scope, as it took time to develop confidence in building the capacity of natural and formal supports. However, it has allowed me to continue to practise my craft through working more often at a higher level.

Opportunity

The NDIS is the first scheme in the world in which people living with disabilities are provided with individualised funding that is tailored to the person and their support needs. The NDIS is a unique system in that it utilises an insurance-based model and takes a lifetime approach for participants.

Currently, the NDIS is simply viewed as a funding body for disability-related services. The original architecture of the scheme was based on social insurance principles, and the main function was to fund long-term high-quality care and support. Currently the scheme is purchasing hours of service and support, not outcomes. Occupational therapists have a responsibility to realign the scheme with its original intent, and deliver evidence-based, high-quality services that will change people’s life trajectories and build a more inclusive community – a better Australia.

In addition, the value of occupational therapy interventions should be linked to positive impacts, a return on investment for the Commonwealth, and a reduction in costs

High-impact participant outcomes are, and always will be, the top priority. However, we need to broaden our lens ...

to other government departments like health and education. High-impact participant outcomes are, and always will be, the top priority. However, we need to broaden our lens to consider the impact of intervention on reduction in core supports, a re-direction of core supports to meaningful participation, strengthening of informal supports, building mainstream and community supports, and deferred SIL funding. Let’s stay focused on economic participation for people living in disabling situations and their families.

The OTA independent assessments taskforce has recently shown great leadership and had terrific success, with the NDIA advising it will not continue to pursue independent assessments. Occupational therapists can be part of the solution by ensuring any assessment of support intensity is a collaborative process, driven and codesigned by the participant, and considering the person in their entire ecosystem of typical roles and routines. It is a great time to be a member of the OTA, and I would recommend encouraging our peers to come on board. A risk for occupational therapy includes packaging being based on predetermined personas and a shift away from individualised funding. We know the only way to assess support intensity and funding needs is to consider the dynamic interplay between the person, their environment (social, built, attitudinal) and routines. Occupational therapists have been singing this tune forever, however we cannot keep singing without detailed music sheets. This is called evidence. Our evidence will have greater impact as a collective.

Impact and inclusion

The unique skills and knowledge of occupational therapists to assess and provide intervention that removes environmental barriers will allow occupational therapists

Occupational therapists have a unique skillset, and are one of the only professions with the relevant skillset to analyse and investigate the supports and environments around a person. This is a critical component in identifying the support needs of people living with disabilities. Knowing someone’s function is not enough to determine ongoing support intensity (e.g. core supports and therapy), as function needs to be viewed in the context of the relevant environment and ecosystem.

Research

The NDIS has encouraged occupational therapists to be innovative, and to build and develop new practices that will result in improved participation and inclusionbased outcomes. This will also place additional responsibility on occupational therapists to implement and champion evidence-based practice. We have the opportunity to support consumers in knowing what impactful therapy looks like.

Training

I envisage we will start to see more training that is tailored to the disability sector. Therapists will have great exposure to the disability sector through student placement or work opportunities, and those leaving university will have a more commercial mindset and awareness around providing value-for-money services. Personally, having the opportunity to complete a placement in a disability and commercial environment allowed me to translate those skills directly into workplace.

I also expect to see increased training opportunities for existing therapists seeking to obtain formal training to develop their skillset in disability. In ten years, Australia will be home to leading disability-based training for therapists, attracting global talent.

Over the next decade, the occupational therapy profession has the chance to cement itself as a critical piece of the puzzle in helping the NDIS achieve its purpose of supporting people with disabilities to live their best lives.

About the author Harley Hayes is an occupational therapist and behaviour support practitioner at Everyday Independence. Harley is passionate about supporting people living with disabilities to reach their potential through creating enabled and accessible environments. Harley was recently awarded the:

• 2019 Early Career Clinician of the Year – Australian Allied Health Awards • 2020 Rising Star – Victorian

Rural Health Awards • 2020 City of Greater Bendigo

Young Australian of the Year

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