Occupational therapists (OTs) and occupational health professionals are frequently mistaken for each other. OTs Jain Holmes and Anne Byrne aim to demystify what their profession does, and identify what they contribute to the workings of occupational health.
The word “occupational” in occupational therapist (OT) and occupational health (OH) seems to cause confusion for people not from either profession; however, it also reflects our affinity with our colleagues in OH and our shared knowledge, skills and expertise in this area of practice.
OTs undergo undergraduate-degree training and then register with the Health and Care Professions Council (HCPC), our regulatory body. All practising OTs are registered and if you are going to request that an OT to do some work with you, then you should ask to see their HCPC registration or look them up online.
OT training centralises around understanding how a human being functions in everyday life (home, school, work and leisure) and we are medically dual-trained in physical and mental health and can therefore work with individuals who have problems in either or both areas.
Our approach is holistic, which means we look at the person, the tasks they want or need to accomplish and the environments in which they want or need to perform the tasks. Therefore, we spend a great deal of time during our training learning about how humans might function differently in various built (physical) and social environments, and how tasks and environments can be adapted to fit the person’s needs or their functional impairment in order to facilitate performance.
Dealing with daily requirements
In practice, we work with individuals across the lifespan – from neonates to frail older adults – and with every conceivable physical or mental health condition and disability, where optimising function and human potential is in question.
We work in a person-centred manner, as we understand that it is crucial to determine the individual’s motivation to progress, as well as assess and improve their ability to do so. A biopsychosocial approach is therefore intrinsic to occupational therapy – we consider all aspects of the individual and the environment that may impact on the individual’s ability to function.
We use activity (in both everyday and work occupations) as a therapeutic intervention to optimise an individual’s functional ability, and we are therefore experts in assessing activity (for example, work tasks) and identifying the necessary ability required to perform an activity (function). “Occupation” to an OT refers to all tasks that an individual will engage with on a day-to-day basis.
It has been suggested that occupational therapy is one of the best kept secrets in rehabilitation. However, we have been around in the UK since the 1930s and internationally since just after the First World War. Initially, OTs worked in mental health and then in physical rehabilitation in industrial therapy centres predominantly with injured service personnel and those with industrial injuries, then broadening our scope into all areas of medicine.
In the UK we now work in the NHS (in OH as well as on the wards and outpatient units), social services, the Ministry of Defence, in charities, in OH companies, in workplaces (in OH or directly for the employer), case management, medico-legal practices, children’s homes, nursing and residential homes and independent practice (contracted to or partnership OH companies).
There are more than 34,000 of us who are registered with HCPC in the UK and we are all working to improve function and ensure that individuals remain engaged in everyday activity, including work.
How does occupational therapy apply to OH?
OTs focus on where a health issue impacts on the individual’s capacity to do their job or remain in their job, and we can potentially be used to determine if the issue preventing return to work or remaining at work relates to work capability, the job tasks or the work environment. We do this by considering:
- the person (evaluating their functional capacity – physical, cognitive and psychosocial supported by any additional medical and social information);
- the task (identifying, quantifying and measuring the demands that the tasks place on the person – physical, cognitive and psychosocial and productivity, and if required we can do this to a very detailed level, ie which muscles and nerves are required, and whether it is auditory or visual spatial memory that is required); and
- the environment (measuring the demands that the built (physical) environment and the social environment place on the person.
An OT’s analysis – following the various evaluations we carry out in OH – predominantly involves matching an employee’s demonstrated capacity against the job and environmental demands, and identifying in specific terms what the employee can currently do, what they should avoid doing, what they will not be able to do and what they need to be able to do to return to work or remain in work.
We identify and translate the employee’s physical or mental health symptoms in such a way that describes the impact they have on that employee’s job, and employees and employers advise that this is often one of the most useful aspects of an OT evaluation.
Following an evaluation and analysis (dependant on the referral request), the findings allow OTs to recommend a variety of methods that will help an employee to stay at or return to work (RTW) in a safe and sustainable manner. For example, these could include:
- Rehabilitation leading to RTW: identifying the individual’s rehabilitation potential to improve work ability, providing rehabilitation (known as work hardening or work conditioning); advising on goals for rehab programmes; liaising with NHS colleagues, the GP, Jobcentre Plus and other key people such as solicitors, insurers and case managers.
- Detailed meaningful RTW plans that are generated from matching demonstrated function to the employee’s specific job demands and identify hours of attendance, duties to engage in and avoid, and building up of duties and hours within a negotiated time period.
- Practical guidance and support to the employee and manager in terms of managing symptoms at work, for example managing fatigue post head injury, pain in arthritis, low mood or anxiety or fluctuating symptoms.
- Advice on specific accommodations and strategies to support an employee to return to and remain at work.
- Educational support to key people regarding health conditions.
- Ongoing support on an as-needed basis if the employee is working and has a long-term or fluctuating physical or mental health condition that impacts on function, revising sustainable RTW and maintenance at work plans, accommodation and home life.
Ideally, together with the larger workplace team (OH, HR and line managers), we will chart an employee’s progress and solve issues if and when they arise to the point where functioning in the job role remains stable and the RTW is sustained.
Our core skills lie in evaluating human functioning – ie the whole person in the specific environment doing a particular task – and then improving function by building an individualised, goaloriented rehabilitation programme with the aim in OH of progressing a case-to-case resolution. Inevitably there is some overlap with other professionals in a broader OH team, and OTs view this positively as it allows us to understand roles and participate in the multidisciplinary team with greater effectiveness.
There is always a question about the evidence and effectiveness of interventions and rehabilitation, and rightly so. To support our ability to answer those questions, there is a growing body of UK evidence being developed to show how occupational therapy is effective and economically efficient at helping people to stay at work and return to work. The substance of the research straddles the areas of vocational rehabilitation and OH (see Examples of researchers and their projects).
The way ahead
How are things going to change for OTs and OH practitioners in the near future?
The new Health and Work Service (HWS), due to launch in 2015, is being developed by the Department for Work and Pensions (DWP) and is designed to cover England, Scotland and Wales, involving non-compulsory health assessments and treatment plans. OTs are involved at various levels in the development and planning for this service and are expected to be directly involved in the provision of services. It is understood that the HWS will support people back into work who have been on sick leave for four weeks or more. Referrals will be made by the GP and/or the employer, but the uptake of the referral by the employee will be optional at this stage.
Following referral, it is envisaged that the employee would undergo an assessment by an allied health professional with expertise in OH, who may be drawn from various professional groups such as OTs, OH nurses and physicians, physiotherapists and others. Using a case-management approach, the specialist will undertake an assessment either via the telephone or face-to-face and then offer guidance as to appropriate next steps. In terms of OTs would like to see this service progress, our very broad recommendations would include:
- having an individualised approach by assessors at the HWS;
- ensuring robust assessments, sharing data from multiple sources;
- ensuring evidence-based work assessment procedures are utilised; and
- focusing on the function of the employee matched to the intrinsic demands of the job.
We see this new service as an ideal opportunity to work together with our colleagues in OH to optimise an employee’s safe and sustainable return to work.
The core professional knowledge, skills and expertise of OTs, enhanced by various post-graduate training opportunities in OH and related subjects, can help add value to OH services.
Examples of researchers and their projects
Dr Kate Radford at the University of Nottingham
- A current study is FRESH (Facilitating Return to work through Early Specialist Health-based interventions) – involving 102 working-age people with traumatic brain injury seen within days of their injury to look at providing targeted support to assist return to work.
Return to Work OT Pilot – evaluation of an early stroke specialist vocational rehabilitation intervention.
- Work Rehabilitation following acquired brain injury – an evidence synthesis of models of vocational rehabilitation for people with acquired brain injury funded by Collaboration for Leadership in Applied Health Research, Nottingham, Derbyshire and Lincolnshire (CLAHRC-NDL) (2011).
Professor Alison Hammond at Salford University
- WORK-IA: development and evaluation of a work-retention programme for employed people with inflammatory arthritis.
Dr Gail Eva at University College London
- REJOIN study – a National Institute for Health Research (NIHR) funded study to determine the feasibility of a randomised controlled trial to evaluate a specific cancer vocational rehabilitation intervention.
Dr Carol Coole at the University of Nottingham
- Getting the Best from the Fit Note – an Institution of Occupational Safety and Health (IOSH) funded project to identify the content of the “ideal” fit note by investigating employers’, employees’ and GPs’ experiences and views about the fit note.
- Individual work support for employed patients with low back pain: a randomised controlled pilot trial to investigate the feasibility and effectiveness of individual work support for employed patients with low back pain.