Connections Autumn 2023

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Connections is a publication of Occupational Therapy Australia (OTA), the peak body representing occupational therapy in Australia.

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DISCLAIMER

This newsletter is published as an information service and without assuming a duty of care. It contains general information only and, as such, it is recommended that detailed advice be sought before acting in any particular matter. The materials included in this newsletter by third parties are not attributable to Occupational Therapy Australia, and are not an expression of Occupational Therapy Australia’s views. Occupational Therapy Australia is not responsible for any printed expressions or views in any third parties’ inclusions. Any enquiries regarding inserts, advertisements or articles placed by these third parties should be directed to them.

Occupational Therapy Australia

respectfully acknowledge the Traditional Custodians of the country on which we live, learn and work.

President’s Report

Professor Carol McKinstry | OTA President

One of the perks of being president is that I am always aware of the efforts of OTA in the advocacy space to promote and increase awareness of the roles of occupational therapists. The Board of OTA made the strategic decision to increase resources to the area of advocacy to capitalise on the number of opportunities currently presenting. Lobbying and making representation on behalf of the Australian occupational therapy profession can often be a slow burn to see results; however, it is really pleasing to see the increasing recognition of occupational therapists in areas such as working in schools. I know this has not happened overnight – it has been due to years of hard work behind the scenes by dedicated and passionate occupational therapists and OTA staff. Congratulations on what you have achieved not just for current occupational therapists and those who will benefit from receiving occupational therapy, but also for those in the future.

Unlike other occupational therapy associations, such as those in the United Kingdom, Sweden and Norway, who play a dual role of professional association and union, OTA is not a union and does not negotiate collective bargaining agreements or work conditions for occupational therapists. I think there is sometimes confusion because, while OTA is the peak association for Australian occupational therapists, we are promoting the value and need for our services with an emphasis on the benefits to those receiving our services, rather than the approach of pushing selfinterest. We do influence policy, which

can lead to increased recognition and employment opportunities. We have also seen an increase in government departments inviting us to the table when discussing reforms and policy change. I thank everyone who has assisted in representing OTA at such forums or collaborating to write submissions.

In 2022, an election playbook was developed to enable OTA to engage with all political parties to raise issues impacting those who receive our services. Focusing on topical areas such as mental health, disability and aged care helps raise our profile. We are building a reputation of an organisation that is trustworthy, balanced and not self-interested or just protecting turf. We are proposing solutions to complex problems by outlining how occupational therapists can play a role in addressing recommendations from Royal Commissions and other government or industry reviews.

At present, there is a major focus on the failings of our health system, particularly in primary care. Occupational therapists play a vital role in working as part of a multi-disciplinary team to adequately assist those with chronic disease, comorbidities and complex health needs. The role of occupational therapists in emergency departments has raised awareness of the need to provide adequate communitybased services to enable people to be the best they can, avoiding the need for hospital admissions. As a profession, we are very much about promoting health, as well as being a valued member of a rehabilitation team or promoting a

recovery-based approach for those with enduring mental illness. Highlighting and promoting our role in primary care is more important than ever, particularly given the challenges facing Australia as a result of the COVID-19 pandemic.

It is not just OTA staff or those occupational therapists actively working with OTA staff who can promote the profession – it is everyone. An important learning and development goal for occupational therapy students is to be able to articulate what occupational therapy is and what we do. Another important aspect is recognising and respecting our history, particularly the work of our pioneers who laid the foundations. As a profession, we all need to take every opportunity to educate others about occupational therapy. It is important that we retain our professional identity and be loud and proud about remaining an occupational therapist, even if our job description has a different title. Our approaches and perspectives are unique when we use an occupational therapy lens, and this is what distinguishes us from other professions. In the January 2023 WFOT Newsletter, the WFOT Leadership and Advocacy Tools were highlighted, including the WFOT Advocacy Toolkit. I encourage everyone to make use of your WFOT membership (an OTA member benefit) and look at this toolkit and consider using it in your practice, because it provides useful information about how to act strategically to influence change.

This year promises to be a very big year for OTA particularly in the advocacy area. I look forward to hearing about our success, both big and small, in positively influencing and collaborating with those who can create better opportunities and services for those we work with.

We all need to take every opportunity to educate others about occupational therapy.

Welcome to another year in the profession and as a member of Occupational Therapy Australia.

Christmas and the New Year were a welcome relief to many, and I have spoken with a number of our members who took the opportunity to take a longer than normal break. For those working relentlessly on the front line throughout the festivities, an enormous thanks for your continued commitment to the community.

This year is set to be an exciting one as OTA continues to dive deeper into longterm and systemic issues that face the profession and the communities we serve. We are researching, contributing to the conversation and coming up with solutions and stepping stones for our members to ensure we stay abreast of, or in front of, policies or practices that may pose a future impact, whether that be risk or opportunity.

Many of our members are aware that we commissioned the report Thinking Ahead: The Future of Occupational Therapy and Mental Health to provide us with an actionable road map for the future. According to the feedback at our Mental Health Forum in November 2022, this initiative and the resulting implementation strategy and activities are welcomed. The Mental Health Capability Framework has been released and foundational professional development courses

CEO’s Report

Samantha Hunter |

are under development. We are also improving, strengthening and streamlining the Better Access to Mental Health endorsement process with our new mental health endorsement program pilot, which launched on 1 March 2023.

Our work on the development of an aged care strategy is progressing, as we navigate the complex reform program currently underway in funding models and legislation.

Another large piece of work being led by our General Manager of Occupational Therapy, Erin Garner, is our Workforce Development Strategy. This will help us and those we aim to influence to better understand the current state of play, the gap, the risks and the opportunities that exist for the profession and for funding bodies and consumers to better utilise the wealth of skills and experience of the profession. In part, our findings will help us shape the way we can support and resource the profession into the future for long and rewarding careers, where occupational therapy is better valued and understood.

All these deep dive projects help inform OTA’s long term strategy, which the Board of Directors continue to work on. We have been undertaking many consultations as we develop a new strategy and I thank those members who have contributed to the conversations regarding the future of the profession and the association,

including what they might, could and should look like into the future.

Whether you are an occupational therapist with a wealth of experience, an early career clinician or a researcher, we are here to help support, protect and promote the profession and you. The strategy will provide us with a clear road map and allocation of resources on this journey. We are excited to see the strategy shaping up and how the association and profession can respond to the rapidly and ever-changing operating environment in which we work, live and play.

Once again, I would like to acknowledge the work of the member-elected Board of Directors who commit untold hours of dedication to ensuring that our association’s strategy, road map and investments support our member needs, speak for the profession and provide for a sustainable future, as well as the members who tirelessly volunteer their time to as convenors, contributors and collaborators – thank you.

Finally, on behalf of the association, I would like to congratulate our President and Chair of the Board of Directors, Carol McKinstry, on her promotion to Professor. Professor McKinstry is tireless in her commitment to the profession, not only chairing the Board but being an active contributor to many association committees, as well as a myriad of other health and community-led boards and committees in her local community.

OTA CEO

OTA continues to dive deeper into long-term and systemic issues that face the profession and the communities we serve.

Quarterly update – Member news

What we’ve been doing for members

Over the past three months, OTA has been representing occupational therapists across many areas in state and federal government. OTA has achieved several wins in disability, aged care, mental health and workforce areas.

Aged Care

AN-ACC survey results and meeting with Minister for Aged Care

The new Commonwealth aged care funding scheme, AN-ACC, came into effect on 1 October 2022. OTA and other groups have long been lobbying for targeted allied health funding in the new system, and we have been anticipating with concern the impact of the new system.

Our fears were realised when we received the results of a survey of residential aged care allied health workers, which OTA developed with Allied Health Professions Australia (AHPA). The survey showed that two in every five allied health professionals working in residential aged care say their job has been affected since the introduction of funding reforms. More than one in eight have lost employment, with another 30% expecting to leave the sector due to reduced hours and other significant changes to their working conditions.

However, as a result of the concerning data gathered through this survey, OTA, along with APHA and other allied health representatives, has been invited by the Minister for Aged Care, the Hon. Anika Wells MP, to meet with representatives from the Department of Health and Aged Care. We will report back on the outcomes from this meeting, which we expect to take place in the first quarter of the year. AHPA also met with the Minister on 16 February to represent the interests of all its members.

NACA meeting

Alex Eather and Alissa Fotiades (OTA’s Government & Stakeholder Relations General Managers) attended the February NACA meeting in Canberra. They heard from Minister Wells on funding and workforce challenges in the aged care sector. Reform updates were provided by the Department on the early evidence of the AN-ACC implementation with good discussion on the impacts being felt across allied health. OTA is committed to representing and advocating for all OTs working across the aged care sector.

Support at Home

OTA is also part of several consultations in relation to the Support at Home program. OTA delivered a submission on the Support at Home reforms in November 2022 and sent a representative to a consultation about short-term pathways for at-home care in January.

Submissions

OTA has made a number of submissions to the Department of Health and Aged Care over the past three months, including on Revised Aged Care Quality Standards, Support at Home and the National Dementia Action Plan. These submissions are available to view on the OTA website.

Mental Health

Better Access to Mental Health

OTA’s social media activity on the reduction of the Better Access to Mental Health initiative’s funded annual treatment limit from 20 to ten visits received an enormous amount of interest. Over 1,300 video views on Instagram alone indicates the amount of interest in this issue. OTA will be focusing on strategies to help address practitioner supply, particularly on a targeted communication campaign to key referrers such as GPs, to increase understanding of the areas in mental health that OTs work, as well as how mental health OTs can best work with other professionals in treating people with complex mental health issues.

On 30 January 2023, OTA had a say on the Better Access program, when representatives attended the Mental Health Equity and Access Forum at Parliament House in Canberra. Erin Garner (General Manager, Occupational Therapy) and Michelle Oliver (Lead Mental Health Advisor) engaged with many significant mental health stakeholders at this forum.

The forum was addressed by The Hon. Mark Butler MP, Minister for Health and The Hon. Emma McBride MP, Assistant Minister for Mental Health and Suicide Prevention. The forum was attended by health professionals across all disciplines. There was an emphasis on reaching and providing better access to mental health services for people in high-risk groups and those not living in major cities. The forum also discussed the targeting, clinical appropriateness, and efficacy of mental health services as part of a broader system of care.

NDIS

NDIS Review

OTA made a submission on 31 January to the Independent Review of the NDIS, which is expected to hand down its report in October 2023. To prepare the submission, OTA met with our expert National Reference Group and other key stakeholders. We also surveyed OTA members, receiving a phenomenal 320+ responses. Survey responses showed the passion OTs have for assisting NDIS participants, but also the frustrations and challenges many OTs face in navigating NDIA’s systems. This feedback helped us craft a detailed submission calling for changes to systems, processes and staffing at NDIA to ensure OTs can work at their full scope and reduce administrative burdens and red tape to ensure clients receive the support they need.

The Review Panel Secretariat also requested a meeting with OTA to discuss the treatment of children and

OTA advocated for improved recognition of the specific skills mental health OTs have in delivering early intervention and treatment for mental health disorders across multiple settings.

Mental Health Strategy

After the launch of OTA’s Mental Health Strategy at our Mental Health Forum in November, we are in full implementation mode. Following a rigorous tender and selection process, we have appointed Deakin

University to develop the first modules in a comprehensive suite of training developed by experts OTs. We very much look forward to sharing more information on this project as it progresses. Read more about Deakin’s work on this training so far on page 18.

National Psychosocial Support Advocacy Alliance Campaign (NaPSAAC)

OTA has recently lent its support to this campaign, which is being conducted under the auspices of Mental Illness Fellowship Australia (MIFA), to extend psychosocial supports to the 154,000 Australians who don’t currently qualify for supports under the NDIS, and to implement the recommendations of the recent Productivity Commission report into mental health. OTA will be attending regular meetings and building on existing government and stakeholder relationships through this involvement.

Other mental health forums

young people, as well as workforce, quality, pricing and interfaces with other mainstream service systems. This meeting took place on 3 February and was extremely positive. OTA outlined many of the issues we raised in our submission, including concerns with NDIS transparency and consistency of decision making. We expect to continue this engagement and see it as a great opportunity to continue to influence the Review outcomes.

Member forum with NDIA CEO

OTA is grateful to the incoming CEO of the NDIA, Rebecca Falkingham, for accepting our invitation to attend an online OTA member forum on 28 March at 1pm. This will be an excellent opportunity to meet the new CEO and ask her all those burning questions. OTA will be asking questions gathered from members in advance of the forum and there will be opportunity to ask questions during the forum.

In November, OTA attended the Queensland Mental Health Leading Reform Summit, an annual two-day forum for leaders in Queensland’s mental health, alcohol and other drugs, suicide prevention and associated human services sectors. As part of the summit, OTA delegates took part in a half-day workshop focussed on addressing critical whole-of-system workforce issues.

In December, OTA attended the first of a series of Mental Health Stakeholder Meetings lead by RANZCP (Royal Australia and New Zealand College of Psychiatrists) to develop relationships across health professionals working in mental health services.

In February, OTA attended the 4th National NDIS and Mental Health Conference in Sydney. Michelle Oliver hosted a booth and spoke with key stakeholders and consumers and their carers about the role of occupational therapy in mental health.

After the launch of OTA’s Mental Health Strategy at our Mental Health Forum in November, we are in full implementation mode.

Quarterly update – Member news

Department of Veterans Affairs

OTA has been continuing to work with the Department of Veterans Affairs (DVA) on the Occupational Therapy Fee Schedule Redesign Project. This work is ongoing, and we hope to have a final update soon.

Workforce

Skilled visas

The Department of Home Affairs has changed their long-term skilled visa procedures that prioritise the processing of visa applications for healthcare and teaching occupations.

Following ongoing lobbying by OTA, occupational therapists are included on this list and will be prioritised under the new arrangements. This process covers a range of skilled visas including subclass 186 (Employer Nomination Scheme). More information is available from the Department of Home Affairs website.

Injury and Worker’s compensation schemes

Over the last several months, OTA has continued our ongoing and regular engagements with the eight state and territory worker’s compensation schemes across the country.

As a result of ongoing collaboration and conversation in South Australia, OTA and ReturnToWorkSA (RTWSA) have collaborated on the development of a new OT mental health-specific fee schedule. The new fee schedule supports recognition of and simplifies communications about the services that mental health OTs provide to return to work clients. The draft fee

schedule was shared with OTA members for consultation in February as part of RTWSA’s annual fee review consultation process. We anticipate the final schedule will be released by RTWSA on 1 July 2023.

In Tasmania, OTA wrote two submissions to WorkCover Tasmania, resulting in the Board of WorkCover Tasmania deciding to recognise the mental health expertise of OTs in its provider accreditation framework.

In Queensland, OTA was involved in consultation on the Worker’s Compensation Regulatory Services’ (WCRS) final review of the Rehabilitation and Return to Work Guidelines for Insurers, which acknowledged and included feedback provided on behalf of OTA members. OTA has been collaborating with WorkCover Queensland on opportunities to increase recognition and awareness of the OT role in mental health.

OTA was also pleased to attend a stakeholder breakfast hosted by National Injury Insurance Scheme Queensland to support planning for their future strategy.

In Victoria, as a result of ongoing engagement with WorkSafe Victoria, OTA was invited to consult on proposed changes to the WorkSafe Victoria fee schedule.

OTA has been liaising with the Victorian Traffic Accident Commission (TAC) to

highlight concerns about unfair and inconsistent application of TAC’s Above Rate Service Agreements (ARSAs) across allied health professions. OTA has written to the CEO of TAC about our concerns about the application of TAC’s fee policies for occupational therapy providers. We will continue to advocate for fair and appropriate renumeration for occupational therapists from TAC and other agencies.

OTs in education

OTA continues to advocate nationally for the valuable role of OTs in education. We have had ongoing engagement with our membership and the Victorian Department of Education on this topic, contributing to the Department’s recent decision to employ OTs in schools as part of Student Support Services.

State elections

OTA advocated on behalf of members in the lead up to the Victorian state election in November 2022. We attended a meeting with the Shadow Minister for Health and wrote to the major parties contesting the election. Responses to OTA’s election priorities were received from the Victorian Greens and Labor Party.

OTA is taking a similar approach in the lead up to the NSW state election, which will be held on 25 March 2023.

Over the last several months, OTA has continued our ongoing and regular engagements with the eight state and territory worker’s compensation schemes across the country.

WFOT update

Associate Professor Emma George, 1st Alternate Delegate

The World Federation of Occupational Therapists (WFOT) promotes excellence in education by developing and maintaining standards for occupational therapy education worldwide. In 2022, the WFOT conducted an education survey with 98 member organisations responding and providing feedback on entry level education standards, competency frameworks and transitioning occupational therapy education from diploma to degree level where applicable. Consistent with the Minimum Standards for the Education of Occupational Therapists (WFOT 2016), in Australia, occupational therapists are required to have at least a Bachelor level qualification. Globally, there remain 15 countries where the minimum required standard of entry-topractice is a Diploma (WFOT 2022), and not all programs are approved by the WFOT. In 66% of these countries, degree level education is

already available and the WFOT advocates that member organisations support the transition to degree level training.

Results of the education survey were discussed at the 2022 Council Meeting (attended by WFOT Australian delegates Adam Lo, Emma George, and Lynette Mackenzie). It was outlined to delegates that nearly all organisations have a plan to transition diploma level to degree level training to align with the minimum standards, and that there was support from governments, educators, and professional bodies to facilitate this transition. Importantly, it became clear that the transition process takes time and deregulation of diploma level occupational therapists could be devastating in some regions if therapists and providers were to lose their professional position. Lobbying and advocacy within

countries, including the promotion of degree level training and awareness of competency requirements are important strategies for the WFOT in the future.

In January 2023, the WFOT published a new public statement on ‘Transitioning from Diploma-Level Occupational Therapy Education’. The statement reiterates the survey results and focus group discussion held at the Council Meeting. Strategies identified to address factors impeding transition to degree level education include:

• Engaging in lobbying and awareness raising

• Adopting a competency framework

• Creating opportunities for upgrading

• Seeking out collaborative partnerships

As a member of WFOT, OTA plays an important role in these discussions. Across the Asia Pacific region, we provide support to our neighbours and seek opportunities for collaboration through the work of the Asia Pacific Occupational Therapy Regional Group. OTA delegates Adam Lo and Lynette Mackenzie both serve on the regional executive team. There is a strong commitment from all country delegates for best practice, supporting the minimum standards for education of occupational therapy and the growth of our profession.

Countries/Regions with diploma level entry-level occupational therapy programmes (n=15)

References can be viewed by scanning the QR code

Are you partnering with consumers to co-design, co-develop, or co-create services?

Louise Gustafsson, Editor-in-Chief, Australian Occupational Therapy Journal

The Australian Commission on Safety and Quality in Health Care’s Partnering with Consumers Standard (https:// www.safetyandquality.gov.au/standards/ nsqhs-standards/partnering-consumersstandard) positions that the people who access occupational therapy services should be involved in planning at three levels: at the individual level in the planning their own care; at the level of service, department, or program planning; and at the governance and policy levels of health care organisations.

Effective partnering with consumers requires absolute power sharing, committed leadership, and continuing actions that prioritise the voice of the consumer in all discussions. Equally, effective partnering with consumers requires multiple methods in response to the contexts and the characteristics of the consumer group such as surveys, focus groups, advisory groups or consumer representatives on working parties.

The International Association for Public Participation (IAP2) developed the IAP2 Public Participation Spectrum to outline five levels of partnering ranging from Inform (information shared with consumers about

decisions) through to Empower (consumers are involved in all stages of the consultation and are responsible for the final decision). You can read more about these on the IAP2 website (https://www.iap2.org.au). The adjoining graphic outlines practical examples of the five levels of the IAP2 Public Participation Spectrum for a problem that was faced by many in recent years – how to continue to deliver an occupational therapy service during a pandemic.

The Australian Occupational Therapy Journal published a special issue focused on partnering with consumers in care, research, and education in December 2022 (https://onlinelibrary.wiley.com/ toc/14401630/2022/69/6). All articles are available to OTA members when you log in via the OTA website members area. Collectively the articles included within this issue offer insights into how occupational therapists can, or are, effectively partnering with consumers to enhance outcomes in education, clinical practice and research. A synthesis of some key recommendations (Chapman et al., 2022; Cox et al., 2022; Liddle et al., 2022; Pozniak et al., 2022) about effective partnering include:

1. Transparency:

a. Be clear about agreed roles and expectations

b. Commit to governance processes and the development of operational documents

c. Agree on the value and purpose of the partnership

2. Communication:

a. Be consistent and use person-first language

b. Ask and don’t assume how people would like to partner, their strengths and needs

c. Continue to check-in as situations change

d. Capable facilitation is important to ensure that all perspectives and voices are empowered and shared

3. Accessibility and inclusion:

a. Adopt flexible ways of working

b. Engage empowering processes and structures

c. Be open to unexpected barriers and tensions

d. Adapt your methods/ approaches as required

e. Be prepared to challenge “risk averse” institutions

Effective partnering with consumers requires absolute power sharing, committed leadership, and continuing actions that prioritise the voice of the consumer in all discussions.

Inform

You inform the clients of the risks and benefits that you and your team have considered, the alternatives or solutions generated, and the final decision about how you will continue to provide a service.

You inform the clients as above but add a step of consultation to ask for their input before making a final decision. You share with the clients how their input influenced the final decision.

Consult

Involve

Collaborate

You involve clients earlier to understand their wishes and concerns regarding risks and benefits, ensuring that these are reflected in the generation of alternatives and solutions. You share with the clients how their input influenced the generation of the alternatives, solutions, and final decision.

You collaborate with the clients from the beginning of the process including them in the analysis of the risks and benefits, generation of alternatives, and possible solutions/decisions. You include their input in the final decision as much as possible or practical.

Empower

As per collaborate but the clients are empowered to be responsible for the final decision.

There is increasing impetus for occupational therapy education, clinical practice and research to demonstrate how consumers have been involved in the planning, development, and delivery of services. You can start small and at any level of the IAP2 – but the time to start partnering with consumers is now. The

articles included within the special issue of the Australian Occupational Therapy Journal, the Partnering with Consumers Standard, and the information included on the IAP2 website are examples of some of the excellent resources available to support you and your team.

References can be viewed by scanning the QR code

Allyship with people with lived experience

Mary O’Hagan, Executive Director, Lived Experience Branch, Mental Health and Wellbeing Division, Department of Health Victoria

About allyship

Allyship describes the sustained efforts by people with relative privilege who work in partnership with marginalised groups to advance their interests, equity and inclusion. The term emerged in the 1970s among social justice groups.

Critiques of allyship come from across the political spectrum. Right wing critiques reject ‘divisive’ identity politics based on marginalisation; they favour a focus on ‘individuals and local communities united under common purposes [and not] riven by groups based on sex, race, national origin, or gender—each with specific claims on victimization (Butcher, 2020).’ Some critics of allyship from the social justice world believe it is performative –it validates people with a saviour complex rather than the marginalised, and it is often conditional or transactional rather than reflecting a lifelong moral obligation (Owens, 2017). This could be a critique, not of allyship itself, but of allyship done badly. Good allyship demonstrates sustained effort driven by moral obligation.

The lived experience movements in mental health and alcohol and other drugs (AOD), particularly the mental health consumer/ survivor movement, are social justice movements. They arose because people with mental distress experienced social exclusion and loss of self-determination, and not the benefits of ‘individuals and communities united under a common purpose’ as promoted by the earlier quoted

the oppression and cruelty by the bad people but the silence over that by the good people.”

right-wing critique of allyship. The consumer/ survivor movement is founded on identity politics where a shared experience of oppression leads to affirming identities, liberatory worldviews and advocacy for social inclusion and self-determination. The movement has always valued good allies.

About lived experience

Lived experience is personal knowledge about the world gained through firsthand experience rather than through representations constructed by other people. It usually refers to challenging or traumatic life experiences that have had a direct impact on people. In the mental health and AOD contexts, lived experience includes people with experience of mental distress, suicidality and/or addiction as well as their families, kin and supporters.

Lived experience exists across the wellbeing-distress spectrum:

• All people and communities at risk of loss of wellbeing, distress or substance use problems (including people currently experiencing these) benefit from whole of government equity

initiatives such as progressive taxation, welfare safety nets and free healthcare, as well as more targeted wellbeing promotion and suicide prevention and early intervention programs.

• People with moderately disruptive distress or AOD related harm may also benefit from primary mental health and addiction services.

• People with severely disruptive distress or AOD related harm may also benefit from specialist mental health and addiction services.

Traditionally, lived experience participation has been concentrated at the specialist service end of the spectrum but this is changing. It’s important to note that people with severely disruptive distress and AOD related harm tend to experience more marginalisation, based on their distress, than people further down the spectrum.

People with lived experience are a diverse and intersectional group. Lived experience includes people with direct experience as well as their families, friends or kin who may have

“The ultimate tragedy is not

– Martin Luther King

Mary O’Hagan

separate interests and different perspectives. There is also a distinction between mental health and AOD lived experience, not just in terms of the raw experience but the responses from service systems, the types of discrimination experienced, and the focus of their respective movements. Finally, there are intersectional lived experiences – indigenous people, cultural and linguistically diverse people, age diversity, LGBTQI+, dual disability and others who experience intersectional marginalisation, sometimes within mental health and AOD lived experience communities. Not all lived experience is equal and as a rule the people most impacted need their voices to be the most amplified.

A framework to support allyship

“Partnership moves beyond traditional participation and engagement models and is built upon a platform of power sharing. It recognises that people with lived experience and communities are likely to have experienced extreme power differentials. Power-sharing seeks to remove these differentials and to address their adverse impacts on people’s lives.”

– inside out & associates australia

Since the early 1990s, Australian Commonwealth and State government policies have encouraged participation and engagement with people who use mental health and AOD services, and their families, in the design and delivery of services and systems. The International Association for Public Participation (IAP2) has developed a spectrum on the degrees of participation that reflects these policies – they are to inform, consult, involve, collaborate, and empower (IAP2, 2023). All these verbs, except for collaborate, imply a more powerful party

is making decisions about the degree of participation of a less powerful party. The IAP2 spectrum and the historical government participation policies do not fully address marginalisation. It’s time to consider how we can move beyond participation and engagement. This was clearly signalled by the Royal Commission into Victoria’s Mental Health System when it stated, ‘the leadership of people with lived experience will be foundational to the new system’ and that they will be ‘central to the planning and delivery of mental health treatment, care and support services’ (State of Victoria, 2021). We are now moving to partnership –the coming together of two groups as equals, while maintaining their separate identities, to share perspectives and make joint decisions on matters of common concern. In today’s context good allies need to advocate for the transition from participation and engagement to partnership.

How to be a good ally

“You cannot declare yourself an ally because you don’t decide if you’re an ally, your actions do.”

– Hannah Litt

1. Acknowledge privilege and system harm

Those of us with relative privilege have often benefited from the same system that has harmed others. For instance, people who work in mental health have derived status, income and job satisfaction from the system, whereas people who use services have experienced loss of status, rights and opportunities, sometimes as a direct result of being in the same system. This can be an uncomfortable realisation, but relative privilege does not mean we are bad people. Acknowledging our relative privilege is the first step to good allyship.

2. Educate yourself on lived experience

world views

Getting to know people with lived experience and understanding their world views is essential for good allyship. Spend time with people with lived experience who are colleagues, go to their events and socialise with them. Be open and curious. Ask questions. Show respect and maintain confidentiality. Absorb lived experience stories, writing, art and research with an open mind and heart.

3. Establish trust and listen to feedback

As you get to know people with lived experience, work at establishing trust with them, through demonstrating genuine and consistent allyship. Stay aware of the ‘emotional labour’ of carrying a lived experience perspective in a clinically dominated context. When you receive critical feedback from people with lived experience, listen deeply to it and take time to understand it from their perspective. Accept criticism as a ‘difficult’ gift and learn from it.

“Allyship is not a one-week performative act. It’s a lifetime commitment to educating yourself, listening to constructive criticism, learning from your mistakes, doing your research, and staying aware.”

– @femalecollective

4. Ensure lived experience is ‘in the bloodstream’

Understand your sphere of influence and use your knowledge and understanding of lived experience perspectives to apply ‘nothing about us without us’. Work with people with lived experience to promote partnership. Ensure people with lived experience are fully ‘in the room’. Do they set the agenda and the language? Are they visible and Continued next page

Allyship with people with lived experience

heard? Is it safe for them? Do they have position power and influence? Don’t leave all the influencing work to people with lived experience – they need your visible support.

5 Call out exclusion and discrimination

All of us were brought up with some negative attitudes towards people with mental distress, AOD related harm and sometimes their families. We need to acknowledge our own prejudices and biases to move beyond them. Allies also need to address intersectional experiences of marginalisation, which are common among people with mental distress and AOD related harm. If you come across exclusion and discrimination don’t just leave it to people with lived experience to call it out. Point it out in the moment if possible. Work with people with lived experience to develop responses. Never say ‘I’m sorry that exclusion or discrimination happened to you’ and walk away.

6. Create opportunities for development

and leadership

Within your sphere of influence, ensure that colleagues with lived experience are growing in their numbers and influence. Give them opportunities to lead through agenda setting, chairing, managing projects and senior leadership positions. Ensure they are paid fairly for their time, can access peer-led supervision and support and have opportunities for professional development.

7. Build a community of allies

As allies you will be more influential if you work together. Create spaces with other allies to support each other, to discuss the complexities of allyship and any issues you feel you can’t safely or appropriately address with people with lived experience. Issues may include how you understand and respond to criticism and hostility, and how you change yourselves and the way you engage rather than change the people you are allies with. Allies often struggle with the fear of getting it wrong – of not speaking up, or of drowning out the voices of the marginalised, of losing their trust or

the trust of bosses and others who share their privilege. Use your collective wisdom to develop a knowledge base and resources to encourage good allyship in others.

Summary

Good allies, no matter where they are placed in the system, have been essential to the development of lived experience leadership and partnerships for the last thirty years. We could not have made nearly as much progress without them. All good allies share the ability and commitment to ask, listen, show up and speak up.

1. Take on the struggle as your own

2. Stand up even when you feel scared

3. Transfer the benefits of your privilege to those who lack it

4. Acknowledge that while you too feel pain the conversation is not about you.”

– Unknown

Further reading and viewing Mental health

Caroline Lambert, Ronnie Egan & Stuart DM Thomas (2021): What does effective allyship between social work and lived experience workers look like in the Australian forensic mental health context?, Qualitative Research in Psychology, DO I:10.1080/14780887.2020.1869357

Cameron Moss, Terri Warner, Brenda Happell & Brett Scholz (2021) Motivations for allyship with mental health consumer movements, Qualitative Research in Psychology, 18:4, 601618, DOI: 10.1080/14780887.2020.1718814

Way Ahead, How to be a Mental Health Ally. https://mentalhealthmonth.wayahead. org.au/how-to-be-a-mental-healthally/. Retrieved 25 January 2023.

General Harvard Business Review, Be a Better Ally. https://hbr.org/2020/11/be-a-better-ally. Retrieved 25 January 2023.

Lean In, What is Allyship? https://www. youtube.com/watch?v=EJW3wjy9gSI. Retrieved 25 January 2023.

Lean In, Allyship in Practice. https://www. youtube.com/watch?v=f3f_pHYo2rM.

Retrieved 25 January 2023.

Ted Talks, Melinda Epler. 3 ways to be a better ally in the workplace. https:// www.youtube.com/watch?v=k12jE1LsUU . Retrieved 25 January 2023.

Melinda Epler, How to be an Ally: Actions you can take for a stronger, happier workplace: McGraw Hill, 2021.

About the author

Mary O’Hagan was a key initiator of the psychiatric survivor movement in New Zealand in the late 1980s and was the first chairperson of the World Network of Users and Survivors of Psychiatry between 1991 and 1995. She has been an advisor to the United Nations and the World Health Organization. She has written an award-winning memoir called ‘Madness Made Me’ and was made a Member of the New Zealand Order of Merit in 2015. Mary is currently Executive Director, Lived Experience Branch in the Mental Health and Wellbeing Division at the Department of Health Victoria. All Mary’s work has been driven by her quest for social justice for one of the most marginalised groups in our communities.

“To be an ally is to:

References can be viewed by scanning the QR code

Implementing and evaluating occupational formulation

Mynard, Forensicare

Occupational formulation may offer a bridge between theory, assessment and therapy, addressing the difficulties that occupational therapists may experience with linking theory to practice, demonstrating an occupational focus and confidently articulating their therapeutic reasoning. This article describes the implementation and evaluation of structured occupational formulation within an occupational therapy team.

Occupational formulation

Occupational formulation is a theory-based approach for synthesising assessment information about a client to describe their occupational situation and guide input. Brooks and Parkinson (2018) described a three-part structure that can be used with any occupational therapy framework: occupational influences, occupational presentation and occupational focus. Drawing upon concepts from the Model of Human Occupation (MOHO; Taylor, 2017) they operationalised the approach (Brooks & Parkinson, 2018; Parkinson & Brooks, 2021): describing how, after conducting a comprehensive occupation focused assessment, therapists construct a narrative incorporating occupational identity (reflecting the person’s subjective viewpoint), occupational competence (an objective presentation of facts), and key issues/needs for occupational adaptation. A collaborative process, this leads to the negotiation of measurable occupational goals that guide therapy. Despite its strong theoretical underpinning and encouraging subjective outcomes (Parkinson et al., 2011), there is not yet a research base for the approach.

Project aims and approach

Having learned about occupational formulation at an OTA workshop facilitated by Sue Parkinson, the Forensicare occupational therapy leadership team planned to implement and evaluate the approach. The project aims to:

• Strengthen the practice process within the team by embedding a structured approach to occupational formulation and goal setting;

• Evaluate the impact of using the approach from the perspectives of different stakeholders; and

• Contribute to the evidence for knowledge-topractice translation in occupational therapy.

Forensicare (the Victorian Institute for Forensic Mental Health) is the Victorian provider of forensic mental health services for people who experience severe mental illness while involved in the criminal justice system. Service is provided within prisons, the secure Thomas Embling Hospital, courts, and the community. The occupational therapy team comprises approximately 35 occupational therapists, most in discipline-specific roles.

A participatory action research (PAR) approach was selected to empower all stakeholders to participate in learning, making change and conducting research (Taylor et al., 2017).

Continued next page

Lorrae

Photo courtesy of Forensicare

Understanding of the occupational therapy practice process is developing, supporting continuity of care as consumers move between parts of the service.

Implementing and evaluating occupational formulation

Taking action

The multi-faceted implementation commenced in early 2021, including:

• Monthly steering group meetings (team leads and educators reviewing progress and operational needs)

• Whole-day training workshops and focused tutorials

• Monthly online community of practice (COP) sessions for team reflection, peer learning and planning

• Inclusion of project on agendas for discipline governance and operational meetings

• Group and individual coaching opportunities

• Purchase of MOHO (Taylor, 2017) and occupational formulation (Parkinson & Brooks, 2021) textbooks for each work area

• Development of a Microsoft Teams channel with guidelines, templates, examples and recorded learning modules

The PAR process is cyclical, with an idea or challenge being identified and then considered by the community of practice reflective group, steering group and project leads, then trialled by therapists who report back on their experiences.

Research evaluation

Monash University provided ethical approval for all aspects of the longitudinal, mixed methods evaluation, which includes drawing from team records, surveys evaluating occupational therapists’ professional thinking and practice, interviews with occupational therapists about their experiences of using occupational formulation in practice

and interviews with consumers about their experiences of collaborating with an occupational therapist to develop and use an occupational formulation.

While evaluation will conclude in early 2023, initial findings indicate that occupational therapists believe the approach is beneficial, and COP attendance levels have been consistently high. Although the implementation has been challenging at times, many have articulated gratitude for the support available. Collaborative working with consumers has increased, leading to satisfaction in seeing consumers engage in the process and progress toward occupational goals. Some consumers have reported appreciating having a document that captures who they are, which can be shared with the multidisciplinary team.

Introduction

Greg is a 32-year-old man with a diagnosis of depression who is serving a three-year prison sentence and has been admitted to the acute mental health unit given an increased risk of suicide. This formulation has been informed by a Model of Human Occupation Screening Tool (Parkinson et al., 2006), informal discussion and observation. Greg reviewed a draft, provided further description for the identity section, and agreed the formulation “is me”.

Occupational identity

Greg is one of three children and lived with his mother prior to his sentence. He worked as a sales representative in the construction industry and felt appreciated by his colleagues as he values being “of service” to others. Greg has a close relationship with his mother and feels a strong sense of responsibility for her welfare.

Greg describes himself as “a bit of a loner” who has “kept to himself” since childhood. He feels “unnoticed” by those around him and describes feeling lonely, hopeless, and having difficulty making new friends. Greg enjoys playing guitar, is interested in gardening and likes going for walks when he “needs to get away from it all”.

Greg values the mental health support received from his community counsellor and is keen to engage with mental health services while in prison. He expresses remorse for his offence and describes having committed it to gain attention from those around him. He is concerned about how to occupy his time while in prison.

Occupational competence

Greg engages politely in conversation and provides detailed responses, although is hesitant to initiate conversation and make requests. His mother is a strong support, visiting him and speaking regularly via phone.

Greg can identify people, activities and interests that are meaningful to him. He agrees with his diagnosis of depression and is actively engaging with mental health services in prison. He is unfamiliar with the prison environment though curious about the opportunities for potential work in prison.

Key occupational needs:

• To learn about the prison environment

• To find a meaningful role within the prison

• To get better at meeting new people

Summary

Greg has a strong work ethic and values being of service to others and enjoys playing guitar, gardening and walking. Until sentencing he lived with his mother, supporting her financially. Greg agrees with his diagnosis of depression and wants to learn about the prison environment, find a meaningful role within the prison, and get better at meeting new people.

Example occupational formulation

There is a deeper understanding of concepts from occupational therapy theory, an increased focus on occupational needs and better articulation of occupational perspectives. Understanding of the occupational therapy practice process is developing, supporting continuity of care as consumers move between parts of the service. There has been positive feedback from colleagues about how the occupational formulations help them to see the consumer differently, from the lived experience team who are pleased to see the collaborative approach to care planning, and from executive leadership who value how the approach contributes to the organisation’s model of care.

Moving forward

Others are recognising the potential of occupational formulation: in Victoria it was identified by the Centre for Mental Health Learning as one of the top five learning priorities for public mental health occupational therapists. In Queensland, it was endorsed as a statewide priority by the Mental Health Occupational Therapy Clinical Practice Collaborative (MHOTCPC). These bodies are supporting occupational therapy teams to implement the approach. While these examples of uptake are from the mental health sector, as an approach that links occupational concepts and steps of the practice

Components of an occupational formulation based on MOHO concepts

process, occupational formulation may be a useful approach in any area of occupational therapy practice.

The Forensicare occupational formulation PAR project enables a multi-part implementation and evaluation approach to practice development, with initial encouraging benefits for occupational therapy practice. The completed evaluation may inform whether and how occupational formulation can support occupational therapists in working collaboratively with consumers and linking theory, assessment, and treatment planning to make their unique occupational therapy contribution.

About the author

Lorrae Mynard has worked in varied adult mental health settings in Australia, Canada and the UK, and is presently a lead occupational therapist at Forensicare in Melbourne, chairperson of the Australasian Forensic Occupational Therapy Network, and a doctoral candidate with Monash University, with her research focused on occupational formulation.

Acknowledgements

Lorrae Mynard’s PhD candidature is supported by an Australian Government Research Training Program Scholarship, and an OTA Research Fund Direct Gift Recipient award supported the occupational therapist interview component of evaluation.

Photo courtesy of Forensicare

New mental health eLearning resources coming soon

Danielle Hitch, Genevieve Pepin, Rachel Knight and Kirk Reed, Deakin University

OTA and Deakin University are currently developing the initial two modules of a suite of online mental health learning resources, scheduled for release in mid-2023. The aim of these resources will be to support and build on occupational therapists’ foundation skills and knowledge in a variety of service settings and will provide a pathway towards mental health endorsement.

How have the modules been developed?

The Thinking Ahead: Mental Health project was completed in 2022 to ensure OTA supports mental health occupational therapists effectively. The aim of the project was to reposition the profession as a key part of the contemporary mental health system and to significantly expand OTA’s capacity for support and advocacy in this field of practice. Extensive consultation was undertaken with members and other stakeholders (including government), along with research. The internally and externally focused outcomes of this project are now guiding the actions of OTA (including advocacy, identification of practice and communications) in this space.

OTA’s Mental Health Strategy was released on 25 November 2022, with a focus on the key areas of workforce, awareness and advocacy. The resources align with the workforce priority area in the strategy, and form part of Phase 1 of Strategy Implementation.

Two key design features for these modules are their alignment to Universal Design for Learning (UDL) principles, and the inclusion of consumers and carers in the development of content. UDL principles enable content and curriculum development that provides

all learners with equal opportunities and promotes equity and accessibility. Both modules will align with the UDL principles by providing multiple means of representation, action, expression and engagement. For example, all videos will be captioned and available as an audio file to provide multiple means of engagement. As noted by Scanlan et al. (2020), further efforts are required within occupational therapy to enable meaningful collaboration with consumers on curriculum design, delivery and evaluation. The topics and learning outcomes of these modules have been drafted by OTA and consumers will be consulted around the content of learning activities and will review the drafts of each module prior to their finalisation.

What will the modules contain?

Module 1 builds knowledge of mental health systems, mental health diagnoses and co-occurring factors. It will include approximately five hours of online content about relevant frameworks, systems and legislation, common mental health diagnoses and treatment, relevant theories (including occupational therapy models, recovery oriented and trauma informed practice and attachment theory), child and adolescent development, substance use and other addictions, and culturally aware practice.

Module 2 develops skills in mental health assessment and planning. This module offers approximately four hours of online content about functional capacity assessments, mental state examination, risk assessment, personal safety planning, environmental assessments, NDIS assessment and reporting, and physical health assessment and intervention.

Both modules begin with a self-assessment of the learner’s current knowledge and skills against learning objectives, and the identification of any additional personal learning goals. A brief revision of key concepts and terms is provided to activate the learner’s existing knowledge, followed by brief interactive presentations of content relevant to the topic. All content focuses on the unique approach offered by occupational therapy, and the modules use case studies to support practice activities for all newly acquired skills. Each module concludes with information about resources and strategies available to extend on the module activities and continue knowledge development, before the learner reassesses their knowledge and skills. Learners also have an opportunity to provide brief feedback about the module and any further content they would like developed.

If you have any suggestions for content or other feedback about the development of these modules, please feel free to contact the Project Leader, Danielle Hitch by emailing dani.hitch@deakin.edu.au.

About the authors

All authors are members of the Bachelor of Occupational Therapy team at Deakin University. They also have extensive clinical and academic experience in the field of mental health occupational therapy. Keep an eye on OTA’s website and other channels for news on how to enrol in these modules later in the year.

Groundbreaking new developments for OT in Australian schools

Lindsey Duffield, Monash University

Over the past few years, occupational therapists working in schools have seen a big increase of advancements in creating and extending more opportunities to provide services to children with educational support needs. Over the past year, in states such as South Australia and Victoria, education department roles for occupational therapists have expanded and/ or changed to enable better service delivery.

The national OT in Australian Education group, an OTA-supported group, has been instrumental in advancing a coordinated approach in this growing field. Some of the initiatives of this group over the past year include:

• Contextualising the WFOT Position Statement: Occupational Therapy Services in School-based Practice for Children and Youth (2016), for use in Australia

• Initiating the development of professional development for occupational therapists working in schools

• Connecting with the international group, School-based OT

• Supporting and facilitating research projects to advance practice

• Provision of resources for practice to be made available via the OTA website

• Development of a Special Interest Group

• Presenting a panel discussion at OT Exchange in July 2022

The national group aims to have representation from OTs and others in all Australian states and territories who have relevant expertise. It currently has around 12 active members with additional OTA representation and Lindsey Duffield is the convenor.

In November 2022, the WFOT Position Statement: Occupational Therapy Services in School-based Practice for Children and Youth (2016) was contextualized for use in Australia as a guide to support school-based practice. At an OTA meeting of the OT in Australian Education group on 18 October 2022, the expert national group agreed that the WFOT statement is appropriate for use in Australia and provided input into Australian-specific considerations.

The intended use of the position statement is:

• To promote a unified, national, shared vision across states and territories

• To support best practice and multi-tiered service provision

• As an advocacy tool to promote the role

• To support the understanding of the unique nature of school-based occupational therapy practice

• To assist with collaboration between teaching staff, occupational therapists and other disciplines

The intended audience for this document includes occupational therapists, education staff and leaders, parents, clients, government bodies, policy makers, universities and researchers. The statement will be made available via the OTA website.

Aspects that were important to consider in contextualizing the statement included the Australian legislation relevant to school-based services, the Australian Educational and Funding Systems and eligibility for School-based Occupational Therapy Services in Australia.

With this new and exciting momentum behind service provision in schools, Australia is following international trends in the growing recognition of the contributions of occupational therapy within the functional environments of children, reflecting current best practice. Keep an eye on communications coming through OTA and the OT in Australian Education group, or contact Lindsey Duffield at lindsey.duffield@monash.edu.

Kobie Boshoff, University of South Australia

Registrations are now open for the OTA

30th National Conference & Exhibition!

Held 21-23 June 2023 at the Cairns Convention Centre, Queensland, OTAUS2023 represents the pinnacle of Australian OT excellence, featuring an exciting and varied range of presentations, workshops, occupation stations, ePoster spotlights and more.

The conference showcases opportunities, innovations, solutions, and strategies informed through research and practice that can shape future practices, policies, and educational approaches to facilitate the growth of occupational wellbeing worldwide.

EARLY BIRD DISCOUNTED RATES AVAILABLE UNTIL 14 APRIL

CAIRNS ACCOMMODATION AND TOUR BOOKINGS

Visit the OTAUS2023 website for information on special rates for conference delegates at Cairns hotels and apartments, as well as discounted pre- and postconference tours and experiences.

EDUCATION DAY

Education Day brings together academics and educators to inform, update and discuss challenges and opportunities for OT education in Australia.

Benefits of attending:

» Earn up to 8 CPD hours

» Hear from inspiring presenters

» Engage in an interactive session, network and develop collaborations

Registration is separate to Conference registration. Book by 14 April for early bird member price of $250.

KEYNOTE SPEAKERS

Opening keynote presentation: Personal Stories Using OT

SOCIAL EVENTS

Sylvia Docker Lecture: Ignite your passion, and connect, to make a difference

Join us at a range of social events, including the Welcome Reception and Gala Dinner, to network and connect with your peers. Visit the website for full details.

MC

SPONSORSHIP & EXHIBITION

Sponsorship and exhibition opportunities are available at OTAUS2023. Act quickly to secure your place and join us in the tropical climate of Cairns. Visit the website to download the Sponsorship Prospectus or contact steven.ho@otaus.com.au for more information.

FOR ANY QUERIES

visit www.otausevents.com.au/otaus2023/faqs or contact info@otaus.com.au

TURIA PITT

PROFESSOR LEEANNE CAREY

CALEB RIXON

Stroke survivor, speaker, author and founder of social enterprise Genyus Network

To browse the program and register, visit www.otausevents.com.au/otaus2023

Supervision and mentoring: A call for clarity

Demi Germeroth, Sarah McMullen-Roach, Carolyn M Murray, Kobie Boshoff, Occupational Therapy Program, Allied Health and Human Performance, University of South Australia

Have you ever seen cilantro on a restaurant item, only to look it up and realise it is simply a different word for coriander? When a potential new occupational therapy staff member asks if they will receive supervision and mentoring in the role, is this a potential “cilantro” moment? Surely, they are the same thing?

Being confident about these terms and their application to practice is important for our profession. Using these terms interchangeably or simply combining them in a quick “supervision and mentoring” statement can create confusion. In 2022, we undertook a scoping review of the literature about mentorship in allied health and found that, while we understood what we wanted our definition of mentorship to include, the literature lacked clarity.

We first consolidated the differences, laid out in the below table (Doyle, Lachter & Jacobs, 2019; Speech Pathology Australia, cited in Speech Pathology Australia 2014, p. 5).

Inarguably, when used correctly and within context, both mentorship and supervision are powerful tools to support performance and career advancement. The benefits of supervision are widely researched and described in Occupational Therapy Australia’s Professional Supervision Framework OTA, 2019.

Professional supervision has been linked with enhanced work performance and problem-solving skills and is strongly endorsed by OTA (OTA, 2019). With just under half of the workforce currently below 35 years and the profession growing rapidly (Occupational Therapy Board Australia, 2022), there is an increasing imperative for supervision to ensure clinical competency, maintain performance standards and support wellbeing.

Mentorship is distinct from supervision because a key focus is career development, as well as participating in big picture conversations about both professional and personal goals. For mentoring to be successful, buy-in needs to be voluntary from both parties and conversations should be collaborative and not solely focused on clinical competency and operational activities.

Some issues associated with the current confusion of terms include:

• Occupational therapists claiming to offer supervision when they are offering mentorship (inadvertently misrepresenting their services)

• Occupational therapists claiming to offer mentorship but overstepping and providing supervision (inadvertently carrying responsibility for the competency of the mentee)

In an era of significant reform, there are incredible opportunities, but also risks of professional isolation and burnout that require adaptive and unique ways of supporting occupational therapists. This unsettled context provides a ripe niche for mentorship to develop communities of practice for mutual peer support and prepare the workforce for innovation. The reach and impact of mentorship is currently unknown, and this problem becomes accentuated when consistently confused and enmeshed with supervision.

As occupational therapists, we are very aware of the power of words – such as religion, ethnicity, culture, heritage and language – close but not identical; and when used incorrectly, may imply different things or be misunderstood. By focusing on using consistent and correct terminology, mentorship and supervision can co-exist and be used optimally for distinct but complementary purposes.

So, when a potential new occupational therapy staff member asks if they will receive supervision and mentorship in the role, is this a potential “cilantro” moment? No. Think of it more as a cilantro and parsley moment. On the surface mentorship and supervision look similar. Just as the true benefits of cilantro or parsley can only be experienced when paired with the right meal, the true benefits of mentorship or supervision can only be experienced when applied in the right context.

Meet the team of product experts at Vision Store

Why did you choose to work in Vision Store at Vision Australia?

Working in Vision Store diversifies my clinical skills. I can connect with our clients to find solutions and remove barriers while working within a multidisciplinary team. I have firsthand access to the latest assistive technology.

What are your most recommended products?

had enabled him to take up woodwork again. This jewellery box made itself a home on my desk and is a daily reminder of the opportunities that present with finding solutions that really help people.

Introducing occupational therapist

Alexandra (Alex) Lonsdale

Alex is cherished for her enthusiasm, passion and commitment to upholding high quality patient care in the low vision sector. The gaps in knowledge she has identified in the sector and amongst external occupational therapists have been the motivating factor behind the paper she co-authored, Working with people living with visual impairment (Lonsdale, Rix & Stewart, 2017).

Alex is an ambassador for Vision Store and continues to raise awareness of the importance of partnering with all occupational therapists to provide functional solutions to those with a vision condition. Here is her story:

How does a low vision OT differ from any other OT?

Occupational therapists play a fundamental role in promoting independence, selfefficacy and meaningful engagement for people living with vision loss. Our specialist assessments and interventions focus on light adaptation, assistive technology and developing compensatory skills. We work to promote occupational performance by maximising functional vision in occupational environments and performance contexts.

When sourcing products as a solution, I start small – small solutions that make big impacts on wellbeing and confidence. Here are a few products that have made a remarkable difference:

• Liquid level indicators for enhancing independence and safety in preparing a hot drink. When pouring liquid, this device makes a sound when the cup is almost full. It is astonishing to be alerted to the amount of times boiling liquid has been spilt or that clients have used their finger to measure the amount of hot liquid in a cup!

• Introducing an audible soccer ball into mainstream schools. This has allowed students to participate and engage in P.E. and participate in group activities during breaks.

• The new Vision Buddy allows clients to watch television or participate in gaming. An elderly client of mine expressed how meaningful keeping up with his favourite shows was to his everyday wellbeing. My role has been the bridge in sourcing these tools to fulfil the needs of our community.

Can you share a memorable client story?

Years ago, a dear client with low vision visited me in store and presented me with an intricate wooden jewellery box as a gift. On this jewellery box was a finely carved bilby. The gentleman explained how the desktop electronic magnifier I recommended

Occupational therapy is so broad and it’s about finding your niche area of practice. I was lucky to come to Vision Australia as a new graduate and discover my passion in low vision and blindness. I have enjoyed developing my awareness and understanding from a client’s perspective. In fact, I have learned by best compensatory strategies directly from clients. From painting fingernails and applying make-up to changing nappies!

Working in low vision gives me the opportunity to enhance everyday independence for the lady who dips her finger in hot water or the gentleman who is able to continue his woodwork; and for that, I am forever devoted to spreading the message and partnering with you on your journey to support those with vision loss.

References can be viewed by scanning the QR code

Managing Risk: Confidentiality, privacy & record storage

Tom Ballantyne,

Greg Emsley, Karen Brown

Record storage and cyber security are important aspects of occupational therapy practice across all settings and funders. When collecting health information, it is essential that clinicians protect their client’s privacy by storing all records safely and securely. By doing so, occupational therapists can proactively minimise the risk of a data breach impacting their practice or health service and, more importantly, their clients.

Occupational Therapy Australia’s Karen Brown spoke with Tom Ballantyne (Principal Lawyer) and Greg Emsley (General Manager Digital & Technology) from Maurice Blackburn Lawyers to discuss record storage and cyber security in the context of occupational therapy practice.

KAREN: I am delighted to have Tom Ballantyne and Greg Emsley join us to share their expertise and practical strategies on how occupational therapists can minimise their risk when it comes to record keeping. Tom, could you start by telling us a little about the legal framework governing personal & health records?

TOM: Firstly, it’s important to note that health record storage is governed by the Privacy Act 1988 at the federal level, as well as state-level legislation in all states and territories except South Australia and Western Australia.

The Privacy Act 1988 sets out 13 privacy principles and applies to all entities which provide a health service or otherwise hold health information (other than in an employee record).

KAREN: Are there any particular principles in the Act that you would like to highlight for our members?

TOM: One that is particularly relevant to this discussion is Principle 11 – Security of personal information. Under this principle, the health professional needs to take reasonable steps to protect their client’s personal information from misuse, interference and loss, as well as from unauthorised access, modification or disclosure.

What “reasonable steps” looks like will depend on the situation, including the amount and sensitivity of the information held, and the possible adverse consequences for the individual in case of a breach.

KAREN: Thanks Tom, that’s very helpful. When it comes to obtaining consent for collecting, using or disclosing personal information from clients, is there anything that occupational therapists should be aware of?

TOM: Yes, it’s important to ensure that consent is informed, voluntarily provided, current, specific and given with full capacity. A clear privacy policy can support the provision of informed consent. This may include:

• The name and contact details of the organisation or entity;

• The kinds of information being collected and stored;

• How and why that information is collected and stored;

• How to lodge a complaint about the handling of information; and

• How the information can be used, accessed and disclosed, including whether the information may be disclosed outside of Australia.

KAREN: On that note, could you tell us more about what occupational therapists’ obligations are if they use a third-party service that stores information overseas?

TOM: Good question. You must take all reasonable steps to ensure that an overseas third party storing sensitive information does not breach the legal obligations outlined in the Privacy Act. Australian practitioners and organisations who allow sensitive information to be stored overseas can be held liable for acts or omissions committed by overseas third parties.

KAREN: But I understand there are some exceptions to that?

TOM: That’s correct. In general, an Australian practitioner would not be liable if:

• You reasonably believe that the overseas third party is subject to laws or binding schemes that are substantially similar to the Australian legal framework; or

• An individual consents to the information being stored overseas, as long as they are informed of the consequences of providing consent.

KAREN: Thank you, Tom, it’s useful to understand the legal frameworks which underpin our responsibilities as health practitioners in the context of privacy and records.

Greg, it would be great to get some insights from you in regards to how occupational therapists can meet their obligations in practical terms.

GREG: I know that it can be quite overwhelming for busy health practitioners to think about how their data is collected and stored, especially those operating smaller practices or as sole traders. However, there are some relatively simple steps anyone can take to improve the security and privacy of their records.

KAREN: Could you talk us through some of those steps?

GREG: Most definitely. Firstly, review who has access to what information and make any changes as required. I would suggest following the principle of least privilege, which is an information security concept in which a user (such as a member of staff) is given the minimum levels of access –or permissions – needed to perform his or her job functions, and no more. This is considered cyber security best practice and reduces the risk of a data breach.

Secondly, if you haven’t already, consider digital file storage solutions which offer advanced security features. Many providers such as Microsoft or Google offer business software at a monthly cost with added security features.

KAREN: What sort of features should members look out for in their cloud storage provider?

GREG: Some key features to look out for would be advanced threat protection (ATP), advanced security, cyberthreat protection, data encryption, advanced endpoint management, multi-factor authentication and access and data control.

KAREN: Thanks Greg, that’s very valuable advice. In addition to storing data, occupational therapists often need to share sensitive information, such as reports based on assessments of their clients. How would you suggest they do this?

GREG: While email is generally the most common and convenient method of sharing information, digital file sharing platforms, such as Dropbox, Google Drive or OneDrive, offer the most secure option. When comparing your options, consider security features such as secure file sharing, access control, backup, encryption in transit, encryption at rest, data retention and multi-factor authentication.

KAREN: Thanks Greg. Given all this talk about digital platforms, it would be remiss of me not to ask you about cyber security. Do you have some top tips that members might be able to implement in their practices?

GREG: Absolutely.

1. Institute a training process to ensure that your employees can detect and respond to cyber security threats, such as fraudulent emails.

2. Improve your protocols around password management. Consider using complex password phrases, a password manager or, ideally, multifactor authentication.

3. Turn on automatic updates for your software wherever possible, or regularly check for updates if auto-updates are unavailable.

4. Ensure you have a regular and accessible backup of all of your critical information.

KAREN: If you had one key take away for our members to improve the privacy and security of their records, what would it be?

GREG: You don’t have to be perfect and doing a little is better than doing nothing at all. If your members can take one suggestion from this article and action it in their health service or practice, that would be a great step towards minimising their risk and protecting their client’s data.

KAREN: Thank you Tom and Greg for sharing your knowledge and insights with us.

About the authors:

Tom Ballantyne is a Principal Lawyer and the head of Maurice Blackburn’s Victorian medical law practice. Tom joined the firm as a trainee lawyer in 2006 and has practiced exclusively in medical negligence since 2007. He is also a member of the Law Institute of Victoria Council and the Australian Lawyers Alliance Victorian committee.

Greg Emsley is the General Manager of Digital and Technology, based at Maurice Blackburn’s Melbourne office. Greg has worked in IT for more than three decades in corporate and consulting roles, including the past 11 years as chief information officer for two of Australia’s largest professional services organisations.

Karen Brown is the Divisional Manager for NSW and the ACT at Occupational Therapy Australia. Karen has over 20 years of experience as an occupational therapist working primarily in public health across acute and rehabilitation hospitals, transition care and in the community in clinical, project and health management roles.

Maurice Blackburn offers OTA members free telephone advice and a free first consultation. For more information, contact Andrew McKenzie, National Relationship Manager: Phone: (07) 5430 8746

Email: AMcKenzie@mauriceblackburn.com.au

Website: www.mauriceblackburn.com.au/partnerships/ota/

article

*The content of this

is drawn from a Hot Topic presented by Tom Ballantyne and Greg Emsley in September 2022. For more information about OTA’s Hot Topic series, go to https://otaus.com.au/cpd-and-events/hot-topic-events.

Cyber security breaches – an HR perspective

OTA spoke with WorkPlacePLUS for an HR perspective on mitigating the risk of cyber security/data breaches and what to do in the event of an attempted or actual data breach.

What steps should workplaces be taking to ensure customer and employee data is secure and protected from breaches?

• Develop comprehensive workplace policies, for example a Privacy Policy, IT Security Policy, Data Risk Management Policy, and Security Policy.

• Establish a business continuity plan and test this plan in the case of a security breach or cyber-attack.

• Conduct regular Data Risk Management and IT Security Risk training.

• Perform a risk assessment on the organisation’s data, including where it is stored and the sensitivity of the data. This may mean conducting a risk assessment of any outsourced partners used to store any of the organisation’s data.

• Back up all business data regularly in a secure site.

If a workplace thinks they may have been the target of an attempted or actual security breach, what actions should they take? Investigate the possible IT breach through the IT department or specialist service providers.

The only choice for busy practices.

If a data breach has been identified that creates a risk to the customer and/or staff, the organisation must follow the requirements of The Privacy Act 1988, such as communicating the breach to the individuals affected and reporting the breach to the Australian Information and Privacy Commissioner.

What are the consequences of a security breach?

The potential consequences of security breach include:

• Reputational risk with clientele or staff, which may lead to loss of clientele or staff

• Losing access to computers including data, resulting in business down time (i.e., no billing).

Business Insurance Pack checklist

ABusiness Insurance Pack is designed to protect your tangible assets and equipment. Just like any other insurance policy, it needs to be reviewed and updated on an ongoing basis to ensure the cover is still relevant and in line with your business’s needs. Insurance documents can be confusing, so we’ve broken down the steps you might want to take to ensure your Business Insurance Pack is up to date. Here are a few things to check on your insurance documentation:

Is your named insured correct?

It sounds like a simple aspect of an insurance policy, but it’s one of the easiest details to get wrong. Why is it so important? In a nutshell, if the named insured is not the correct legal, you could be left uninsured. In the case of insurance for a business, the named insured can be a sole trader name or the legal entity name that corresponds with your ABN (which can be different to the business or trading name). Examples of mistakes include forgetting to add ‘Pty Ltd’, using the business name or trading name without including the legal entity name, or even leaving the company name off altogether and insuring under your personal name instead.

Has anything changed in your business?

Under most insurance policies, you are required to inform your broker of changes to your business. Certain changes may require you to update your insurance or take out a new policy altogether. Changes can include relocating, acquiring additional assets, changes to the ownership/ insured name, a change in the business’s activities, or even a sudden increase in revenue. Not informing your broker of

certain changes to your business could cause unnecessary complications in the event of a claim or could lead to a claim not being covered altogether.

Is your sum insured correct?

When insuring your business’s tangible assets, you will generally be required to insure for ‘new replacement value’. This means the nominated sum insured must reflect the cost of replacing all your assets brand new, for the same make/model and capacity. Business Insurance Packs typically contain an underinsurance clause, so if you do not insure your assets for ‘new replacement value’, in the event of a claim, the amount covered may be reduced and you may be at risk of financial loss. In some circumstances, underinsurance can be disastrous for the insured, resulting in them being unable to rebuild or having to refinance, so the time you take to consider the new replacement value of your assets could make all the difference.

Has your business’s equipment changed?

In addition to paying extra attention when calculating your sum insured, it’s also important to review it each year as your business’s circumstances change. For example, if you’ve carried out renovations or upgraded or purchased new equipment, then your Business Insurance Pack and the sum insured will need to be updated to reflect this. This also applies to how you now use your equipment. For example, if you are now taking certain equipment or items away from your office which you previously did not, then it is a good idea to notify your broker to ensure they will be covered if they lost or stolen while outside your office.

Do you need additional cover?

Business Insurance Packs are typically packaged policies where you choose from several different cover sections. The sections of cover you choose also may need to be reviewed and updated as you make changes to your business. For example, you might start as a purely mobile service business, but down the track grow your business enough to rent your own premises. In this case, you may need to consider additional cover sections such as Business Interruption, Theft and Contents.

Importance of keeping your cover up to date

When running a business, keeping your insurance up to date might not be the first thing that comes to mind, but it is an important step in preventing delays or hassles if you have to make a claim. Good insurance housekeeping involves thoroughly checking your insurance documents and ensuring all the details are correct and reflect your business’s current circumstances. Staying in touch with your broker and notifying them of changes to your business is also a wise step in keeping your business protected.

© 2022 Aon Risk Services Australia Limited

ABN 17 000 434 720 AFSL no. 241141 (Aon)

This information contained in this article is general in nature and should not be relied on as advice (personal or otherwise) because your personal needs, objectives and financial situation have not been considered. Before deciding whether a particular product is right for you, please consider your personal circumstances, as well as any applicable Product Disclosure Statement, Target Market Determination and full policy terms and conditions, available from Aon on request. All representations in this article in relation to the insurance products we arrange are subject to the full terms and conditions of the relevant policy.

Working arrangements: Contractor or employee?

WorkPlacePLUS

When engaging staff (employees) in your practice, it is important to be up front from the start about a range of employment factors such as:

• Working arrangements and understanding the employment contract

• Salary, entitlements and managing pay expectations

• Supervision, training and your process for managing performance

• The workplace values, policies and processes that underpin and guide the running of your business

This article focuses a common HR hot spot for practice owners who are engaging staff: working arrangements.

What are working arrangements?

‘Working arrangements’ refers to the approved or agreed upon employeremployee relationship, particularly around the patterns and design of work hours and how work is performed.

It’s important to have a clear understanding of the working arrangements in your practice and to be able to clearly communicate (and in some cases negotiate) these with you staff. For example:

• Is this an employee or independent contractor arrangement?

• Is the position casual or permanent? Part-time or full-time?

• What leave and entitlements are provided?

• What flexible working arrangements are available?

• Who supplies tools and equipment?

• Who is responsible for insurance and matters of work, health and safety?

Contractor or employee?

If your occupational therapy practice engages independent contractors, it is good practice to review the arrangements regularly to ensure compliance.

The Australian Tax Office (ATO) is clamping down on businesses that force workers to be independent contractors with so-called sham contracts as a way of avoiding paying an employee’s statutory entitlements. If the courts find that you have classified your staff incorrectly, they may impose a penalty of up to A$12,600 for individuals and A$63,000 for corporations per contravention.

What’s the difference?

An employee works in your business and is part of your business. An employee’s minimum entitlements are set out in the National Employment Standards (NES) and awards. Employment contracts can provide further entitlements, but they can’t be less than what’s in the NES or any applicable award.

An independent contractor (a.k.a. contractor or sub-contractor) effectively runs their own business and operates under their own business name. They are responsible for their own business compliance and commitments such as insurance, PAYG, superannuation, workers compensation, ATO, GST, etc. Contractors do not receive paid leave and can be legally liable for the work performed under their contract.

The distinction between contractors and employees is not always clear-cut. Courts look at the relationship, and there is no single indicator to determine if a person is a contractor or an employee, which creates added complexity.

The distinction between contractors and employees is not always clear-cut. Courts look at the relationship, and there is no single indicator to determine if a person is a contractor or an employee, which creates added complexity.

Factors to consider:

Employees

• Employees perform work under the direction and control of their employer. The employer generally controls working hours, work location and how work is done.

• Employees carry no financial risk in relation to the business.

• Work equipment is generally provided by the employer, or a tool allowance is paid.

• Employees are required to do the work themselves. They can’t ask someone else to go to their workplace and do their work for them.

• Permanent employees have an ongoing expectation of work. However, some employees may be engaged for a specific task or specific period or on a casual basis.

• Employees work standard or set hours (unless they’re a casual employee, in which case their hours may vary from week to week).

Independent contractors

• Independent contractors have a high level of control over the work they perform, including their hours, work location and how they do the work. They can perform the task at the time of their choosing.

• Independent contractors carry the risk for making a profit or loss on each task or job. They are usually personally responsible and liable for poor work, or any injury sustained while performing the task, and generally have their own insurance policy.

• Independent contractors use their own equipment and resources, and don’t receive an allowance or reimbursement for the cost of the equipment.

• Independent contractors can delegate or subcontract tasks to other people (dependant on contractors’ agreement).

• Independent contractors are usually engaged for a specific task.

• Independent contractors have the skill and ability to perform services as specified in their contract.

Changes to workplace laws: fixed-term contracts

From 7 December 2023, under the Fair Work Legislation Amendment (Secure Jobs, Better Pay) Act 2022, there will be limits to the use of fixed-term contracts. Instead of employees being on rolling fixed-term contracts, such as for six months or a year, employers will only be able to offer a maximum of two consecutive contracts or contracts that span two years – whichever of the two is shorter.

If your practice uses fixed-term or maximum term contracts, you should consider whether those contracts are necessary, and if so, seek advice on whether long-term or back-to-back arrangements will be lawful once the changes take effect.

• Independent contractors are paid via invoice arrangements for the result achieved, based on an hourly rate or price per service.

• Independent contractors usually negotiate their own fees and working arrangements and can work for multiple clients at a time.

• Independent contractors can accept or refuse additional work.

• Independent contractors do not necessarily work standard or set hours. Instead, an agreement is made between both parties regarding work hours to complete the specific task.

If you are unsure about how to interpret the working relationship between your occupational therapy practice and your staff, you can check your workers’ circumstances against the ATO’s online decision tool or seek advice from an HR consultancy that works closely with the allied health sector such as WorkPlacePLUS.

As the national HR and IR partner of Occupational Therapy Australia, WorkPlacePLUS provides support to OTA members on employment matters affecting your practice. For more information, contact Anna Pannuzzo on (03) 9492 0958 or visit www.WorkPlacePLUS.com.au.

The role of occupational therapy in achieving greater participation for people living with psychosocial disability

Since inception, the National Disability Insurance Scheme (NDIS) has been acknowledged as making a real difference to the lives of over 530,000 participants in Australia. In 2023, the NDIS will undergo a broad review of effectiveness (NDIS Review, 2023). This article highlights the role of occupational therapy in improving the effectiveness of the NDIS for people with psychosocial disability, across three priority areas. Increased effectiveness in these areas focuses on targeting and tailoring of existing supported funding as part of the NDIS.

Participation-focused outcomes as the measure of effectiveness

The NDIS recognises psychosocial disability as per the UNCRPD definition, the experience of people with impairments and participation restrictions related to mental health conditions (United Nations General Assembly, 2007). The intended outcomes of the NDIS include better social and economic participation for people with disabilities. Consistent with a social model of disability, this marks a paradigm shift from previous mental health treatment models, where the intended outcomes focus on treatment engagement and symptom reduction. The NDIS has meant a reorientation in service provision towards working with people towards their goals, while improving participation. This reorientation has been embraced by occupational therapists, as it offers greater alignment with professional values and recovery-oriented practice.

What does the data tell us?

The latest NDIS data insights from the psychosocial disability dashboard highlight that 76% of NDIS participants with psychosocial disability believe that the NDIS has brought them greater choice and control in their lives (NDIS, 2022). However, data insights also highlight current challenges facing NDIS participants in the following three areas:

1. Social and community participation

The NDIS measures engagement in a community, cultural or religious group over the past year, as an indicator of social and community participation. Data insights revealed by the disability dashboard (September 2022) highlight that only 32% of participants with psychosocial disability engaged in a community, cultural or religious group or event over the past year, compared to 43% for the Scheme as a whole (NDIS, 2022). This percentage is even lower for the cohort younger than 45 years old, dropping to 25% for young people aged 15-24.

The barriers to social and community participation are a complex interaction of broader factors including social, historic and environmental; and individual factors. Exploring these from a tailored, capacity building perspective has potential to bring better outcomes. Frequently, compensatory supports are funded by the NDIS, generally increased support worker hours, to the

detriment of capacity building supports. This can be costly and means the participant may not achieve the level of social and community participation as identified by the participant. Evidence-based occupational therapy interventions focused on tailored approaches to building motivation, such as re-motivation (De las Heras et al, 2003), and interventions focused on building habits and routines, such as the Action to Inertia intervention (Rees et al, 2021) and the re-designing daily occupations ‘Re-Do’ program (Erlandsson, 2013) (Scanlan, 2019), can provide helpful strategies to support social and community participation. Strategies and training for the NDIS workforce by occupational therapists can ensure a team approach to understanding and overcoming individual challenges associated with a dynamic disability. Interventions that place the participant in the driving seat of their support team can also assist with achieving meaningful outcomes (for example, by using evidence-based participant-led videos (Douglas et al, 2022)).

Occupational therapists also work with people within their natural environments, which frequently includes advising and collaborating with community clubs, venues and spaces, on principles of accessibility and universal design. These are critical environmental considerations that are frequently overlooked and make a difference to community participation options for people with psychosocial disability.

Muriel Cummins and Malitha Perera

2. Employment participation

The dashboard dataset highlights that only 12% of participants with psychosocial disability were in a paid job, compared to 23% for the Scheme as a whole. Carer employment is also low at 34%, compared to 50% for the Scheme as a whole (NDIS, 2022).

There are significant gaps in available disability employment programs, with disability advocates highlighting that employment rates have not changed in 28 years (Shine, 2022). For many people with a psychosocial disability, there is a need to focus on employmentrelated skills to enable the person to find and maintain employment. This can include a tailored approach to building skills that includes a deep understanding of dynamic aspects of functional capacity, including motivation, self-care abilities, planning and sustaining a routine (Erlandsson, 2013). A 2019 systematic review of occupational therapy interventions confirmed the evidence-base for these interventions as part of a consumer-led journey to the return to, or commencement of, paid work (Kirsh et al, 2019).

3. Reducing restrictive practice to enhance participation

There has been a concerning rise in rates of both authorised and non-authorised restrictive practice with people with disabilities, including psychosocial disability, in recent years (Henriques Gomes, 2021). Occupational therapists can provide interventions that prevent or reduce restrictive practices to enable participants engagement in daily living, and social and economic participation. There is a strong evidence-base and policy case for using sensory modulation strategies to reduce restrictive practice (Allied, 2023). However, there are barriers to people with psychosocial disabilities gaining access to funded sensory modulation strategies, including unclear guidelines (NDIS – Sensory equipment, 2023); and knowledge and understanding of NDIS planning workforce. Sensory contributors to behaviours of concern could be addressed through meeting participants’ sensory needs. A reduction of behaviours of concern would mean the participant has greater capacity to autonomously participate in daily living.

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Towards a more effective NDIS for people with psychosocial disability

There are many further areas where occupational therapists currently enhance the effectiveness of the NDIS, including in the provision of functional capacity assessment and supportneeds identification and working towards better housing outcomes.

In addition, there are areas where the NDIS requires policy change to ensure the needs of people with psychosocial disability are optimally met. 49% of applicants with psychosocial disability are approved to join the Scheme, compared to 77% for the Scheme as a whole (NDIS, 2022). The Productivity Commission (2011) predicted that people with psychosocial disability would represent 14% of total participants at Scheme maturity, and this current proportion sits at 10% (NDIS, 2022).

Occupational therapy is an under-utilised resource that can improve outcomes for psychosocial disability in the NDIS. The development of training opportunities, alongside focused research, will further enhance the evidence-base and practical delivery of occupational therapy interventions. Let’s hope the 2023 NDIS Review can recognise the potential of mental health occupational therapy, enabling the

profession to contribute the enhancement of the effectiveness of the Scheme for people with psychosocial disability.

About the authors:

Muriel Cummins is an occupational therapist and holds a Master of Public Health. She graduated in Dublin in 2001 and has worked in mental health and disability in Australia since 2003. She was granted the Australian Allied Health Awards’ 2022 Occupational Therapist of the Year title. Muriel’s previous roles span the clinical, not-for-profit, peak body and private practice sectors.

Malitha Perera is an occupational therapist who has worked in various operational, clinical and strategic leadership roles in mental health. He is passionate about addressing inequities that impact on our collective health and wellbeing. He holds a Bachelor of Occupational Therapy, Bachelor of Psychological Science and Master of Public Health.

References can be viewed by scanning the QR code

Challenging the obesity narrative of choice and personal responsibility: Why

occupational therapists

shouldn’t be talking about weight

Dr Claire Pearce, University of Canberra

Reviews of the literature have suggested that occupational therapists have a role in working with people living with obesity (Nielsen, Klokker, Guidetti, & Wæhrens, 2019). At an individual level, this can include being part of multidisciplinary teams whose focus is weight loss, supporting environmental modifications, providing education as part of prevention, and introducing or adapting occupations to increase physical activity or support dietary changes (Haracz, Ryan, Hazelton, & James, 2013).

But, in undertaking these roles, are occupational therapists just adding to the stigma and discrimination all too commonly experienced by people living in larger bodies?

Overweight and obesity affects two-thirds of Australian adults (AIHW, 2022) and yet it is commonly framed as an issue of individual responsibility – people are told they simply need to make ‘better choices’. In truth, the causes of obesity are a complex interplay between physical, social, environmental, and economic factors all impacting on a person’s ability to manage their weight (AIHW, 2017). Social inequity compounds dietary issues. High-quality food is often more expensive or harder to access, while energy-dense food is often relatively cheap and readily available. Many communities have seen a reduction in opportunistic energy expenditure as the physical demands of paid and domestic work have reduced, and leisure has seen an increased focus on sedentary screen-

based activities (Department of Health, 2015; WHO, 2018). In the language of our profession, a person’s weight is influenced by who they are as an occupational being – their context and their occupations.

People living in larger bodies report that one of the most significant sources of discriminatory behaviour is health services (Lawrence et al., 2021). This can manifest as difficulty accessing services due to a lack of bariatric equipment, which compounds feelings of shame (Sikorski et al, 2013). Health professionals also reinforce negative stereotypes such as a assuming a correlation between having obesity and being lazy or unmotivated, even linking characteristics not related to weight such as assuming the

Overweight and obesity affects two-thirds of Australian adults (AIHW, 2022) and yet it is commonly framed as an issue of individual responsibility – people are told they simply need to make ‘better choices’.

overweight person is dishonest or lacking intelligence (Brewis, 2014). A significant number of people with obesity receive inappropriate comments about their weight from health professionals (Puhl & Heuer, 2009). The consequence of this entrenched discrimination is that people may be reluctant to seek essential care due to the fear that every health concern will be linked back to their weight.

The social narrative around obesity is that it is problem of epidemic proportions. There is an assumption that health-service based obesity prevention means that during every health encounter, larger bodied people should be told about the risks of excess weight and given clear advice on what to do to avoid being obese. A ‘choice and responsibility’ paradigm reinforces the idea that it is then up to them to do something about their own weight or be prepared be held accountable for the consequences. This approach has not been shown to work as the determinants of someone’s behaviour are not primarily about choice, so it is simply not appropriate to attribute responsibility in this way (Dawson, 2011). Furthermore, it has been shown that framing of obesity as a matter of choice prevents health services from playing an effective role in the prevention of the health consequences of obesity (Pearce et al, 2021).

People with obesity know that they are overweight because they will inevitably have been on the receiving end of stigma and discrimination because of the way they look. Health is so often judged by body size with slim being seen as ‘normal and healthy’. Consequently, people in larger bodies are judged as not taking care of their health, regardless of their health status. Focusing on weight loss as a solution reinforces the idea that all overweight people are a burden on society (Bacon & Aphramor, 2011). Occupational therapists work with individuals and

communities, supporting them to do the things they want and need to do. We must be mindful that we do not project onto our clients what we think they need to do.

My proposal therefore is this: occupational therapists should not be focusing on weight and certainly not on weight loss because in doing so, we are overlooking the complexity of gaining and losing weight and reinforcing the framing of obesity as a negative state, a problem to be fixed. Focusing on weight loss reinforces the myth that all overweight people are a burden on society based on an arbitrary measurement such as body mass index. Instead, we should strive to maintain a focus on occupational participation, defined as “having access to, initiating, and sustaining valued occupations within meaningful relationships and contexts” (Egan & Restall, 2020). In doing so, we can support people to identify what life looks like for them, regardless of their weight. More importantly, collectively as a profession, we should strive to challenge the obesity discourse which frames obesity within a dichotomy of good (thin) or bad (fat) and speak out against and work to combat the bias and stigma that ultimately inhibits peoples’ occupational participation.

About the author:

Claire is an Assistant Professor in Occupational Therapy at the University of Canberra. She has extensive clinical experience in adult acute and rehabilitation services in Australia and the UK, has worked as a multidisciplinary team manager and has undertaken health service evaluation, development and project policy roles.

Claire was awarded a PhD from the University of Sydney in 2020. Her thesis entitled The Obesity Paradigm and the Role of Health Services in Obesity Prevention: a systems views utilised a systems thinking approach to explore the link between stigma and the concept of choice. Claire’s area of research interest is in the implementation of research into healthcare settings using a systems approach, with a particular focus on workforce development.

References can be viewed by scanning the QR code

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The meaning crisis and occupational therapy

What does the discipline of occupational therapy have to offer our collective existential crisis?

Just over two years ago, I accepted an offer to study a Master of Occupational Therapy at the University of Sydney. I have just received my registration certificate from the Australian Health Practitioner Regulation Agency (AHPRA), and I am on my way to practice as a new graduate OT.

The majority of my 20s involved a significant amount of exploration, successes, and supposed failures—which turned out to be important learnings—as I sought to find meaning in a vocational path. Now, after completing my OT training, I can honestly say with gratitude that I’ve found a profession that aligns well with me, my values, and the way I seek to serve others.

It is somewhat ironic, then, that OT so highly values meaning. At the heart of the discipline lies the notion that engagement in meaningful activity is vital for human wellbeing as both a means and an end and is therapeutic within and of itself. Thus, OTs are health professionals who help enable and empower people to engage in meaningful activities despite illness, impairment, injury or other life barriers. One could say that OTs specialise in meaning: we work to increase meaning in peoples’ lives in practical and evidence-based ways.

It is striking, then, that some have made the claim that we—including most of what we would term the developed world—are amidst a meaning crisis. According to Dr John Vervaeke, a cognitive psychologist and professor at the University of Toronto, our modern life is characterised by a profound lack of meaning. We feel increasingly disconnected from ourselves, one another, and the natural world. Suicidality, rates of mental illness, loneliness, and hopelessness continue to rise in materially affluent societies.

What is the antidote to this crisis? In seeking to answer this question, Vervaeke turns to the cognitive sciences, philosophy, and various wisdom traditions. His lecture series, Awakening from the Meaning Crisis, provides a comprehensive and integrated account of how we can respond. Vervaeke argues that two key things can help improve this perennial crisis: transformative spiritual practices and genuine human community. Both work to increase our sense of selfawareness and connectedness, which are

necessary ingredients for the cultivation of wisdom. Vervaeke insists it is ultimately a recovery of wisdom that will provide the cure to our crisis of meaninglessness.

The notion that we’re currently in such a crisis has gained traction amongst many. Clinical psychologist turned public intellectual Jordan Peterson is a prominent but controversial example. We don’t need to delve far into the past to encounter important figures who have pointed to the importance of meaning and how aspects of modern life breed meaninglessness, from the Jewish-Austrian psychiatrist and Auschwitz survivor Viktor Frankl to the existential psychiatrist Irvin Yalom, to the psychiatrist and founder of analytical psychology Carl Jung. A persistent lack a of a sense of meaning is not only detrimental to the individual but also reverberates out into families and societies.

What does this mean for OT? What can it offer this crisis and what can it learn from the likes of Vervaeke and his colleagues?

Shane Fenwick, Early career occupational therapist

“Meaninglessness inhibits fullness of life and is therefore equivalent to illness. Meaning makes a great many things endurable — perhaps everything.”

— Carl Jung (‘Memories, Dreams, Reflections’)

Through my studies, I’ve been energised by the way OT places meaning and people at the centre of its practice. That is, the therapeutic process is guided by individuals and their hopes, dreams and goals. The lived experience of the person is central: they define what is meaningful and what it means to live fully. Backed by rigorous science, OTs prescribe interventions that are both evidence-based and holistic. Indeed, holism is a core philosophical principle of OT. All aspects of the human person and experience are considered without giving in to any form of reductionism. Each person is viewed as an integrated human being within a wider web of relations, as opposed to merely being viewed as a list of pathological symptoms.

As someone who has lived experience of mental illness and engaging services as a mental health consumer, I can attest to the centrality of person-centeredness, meaning, and a genuinely holistic approach in fostering my own recovery. My friend Reverend Graham Long often says that “people are not problems to be solved but people to be met”. We are bio-psycho-social-spiritual creatures and treatments must take this into account if they are to be holistic. The services and clinicians/therapists I most benefited from in my recovery were those who were able to do this carefully, compassionately and patiently. They were able to treat me as a whole person rather than a particular diagnosis or list of symptoms. I have witnessed this in both my placements and previous work: bad outcomes would often follow where services were inflexible, rushed, reductionistic, and/or not attentive to the lived experience of those seeking treatment.

Whilst OT is holistic in its theoretical underpinnings, it is still developing and evolving as a profession. Ask those not involved with the profession what occupational therapy is, and you’ll be lucky to get an accurate response! And, for those that do have some idea, OT is often associated with physical therapy alone. It is less known that you’ll find OTs working in all kinds of settings, including across the mental health sector. Even in its origins, OT began within psychiatric settings caring for returned, traumatised war veterans.

When it comes to the meaning crisis, OT has an opportunity to play to its strengths as a discipline that places an emphasis on the centrality of meaning. As a deeply pragmatic profession, OT has the potential to offer evidence-based, practical solutions to the ways in which this crisis manifests in peoples’ everyday lives, particularly if it is leading to serious illness, injury, and/or occupational deprivation (which Vervaeke

and his colleagues would insist it is). What could OT provide to someone living with chronic, debilitating major depression or those journeying through the end-of-life process? Could greater links be made to pastoral/spiritual care professionals working in various clinical and community settings? What about the current “psychedelic renaissance”? Could OT-specific research be conducted into the functional outcomes of psychedelic-assisted therapies? And, in the academic space, what insights might be gained through productive dialogue between occupational therapists, other health disciplines, and philosophers/theologians?

These are just some of the many questions that have been sparked for me as I transition from student to graduate OT. The more I learn and reflect, the more I’m convinced that OT has something uniquely important to offer not just healthcare but society as a whole during this critical moment.

About the Author

Shane Fenwick is a new graduate OT who recently completed a Master of Occupational Therapy through the University of Sydney. He has degrees in psychology and theology and has previously worked in youth homelessness, disability care, community development, and with those seeking asylum.

Through my studies, I’ve been energised by the way OT places meaning and people at the centre of its practice.

OT Mental Health Forum 2022: Wrap-up and next steps

The OT Mental Health Forum was held on 25 November 2022 at the Sydney Masonic Centre and online. More than 400 delegates came together and shared ideas, practices and challenges with their OT colleagues. Samantha Hunter (CEO) and Carol McKinstry (President) welcomed attendees to the event and launched OTA’s Mental Health Strategy, with Priscilla Ennals, Mary O’Hagan and Gail Whiteford delivering keynote speeches.

The packed program featured presentations across areas including sensory interventions, recovery-oriented and trauma-informed approaches, education and professional development, forensic occupational therapy and more.

Priscilla Ennals, keynote speaker

Sam Hunter (CEO) and Rebecca Meyer (GM, Membership & Engagement) at the OTA booth

Carol McKinstry (OTA President) launching the Mental Health Strategy

Gail Whiteford, keynote speaker

Mary O’Hagan, keynote speaker

Mental Health Strategy

Launched at the Mental Health Forum, our Mental Health Strategy will see OTA deliver a range of actions over two stages, focused on these key areas:

• Workforce – Improved training to support the mental health OT workforce, and sustainable career pathways for occupational therapists working in this sector to support development and avoid burn-out

• Awareness – Building awareness of occupational therapist mental health capability across health services, funding bodies, and consumers

• Advocacy – Engaging with government and sector stakeholders to advocate on the value of mental health occupational therapy services

Visit otaus.com.au/media-and-advocacy/current-issues/mental-health to download the strategy document.

Thank you to our Mental Health Forum Premium Sponsors, Allied OT and Healtharium