Lucy Clarke Dip COT, MSc ACP, MRCOT, Clinical Lead Occupational Therapist for Mental Health
Kim Jones BSc OT, MRCOT, Occupational Therapist
Betsi Cadwaladr Univeristy Health Board
The increased incidence of domestic abuse, following Coronavirus, jeopardizes service user’s physical and emotional wellbeing and affects daily social and cognitive function, affecting relationships, employment and daily living skills. Oliver et al., (2019) estimated the cost of domestic abuse to the economy as £34,015 per victim, per year.
The Occupational Therapy Department within the East area of BCUHB were successful in securing funding from the Elizabeth Casson Trust for a Band 5 Occupational Therapist, experienced in domestic abuse, to work within the local DASU. Our intention was to provide rehabilitation, through Occupational Therapy, to victims of domestic abuse, allowing them to re-engage in daily social, educational, occupational, behavioural and cognitive activities, helping to rebuild their identity and life.
This project aimed to provide an Occupational Therapy service, co-located within DASU to:
Provide early intervention and mental health rehabilitation ’upstream’, embedding self-management strategies to support wellbeing into daily routines, for people recovering from the trauma of domestic abuse
Use a person centred approach to identify individually meaningful occupational goals for daily living following domestic abuse, overcoming barriers, and enabling development of occupational identity through meaningful activity and roles within home, family and community life,
Harness a network of health, social care and third sector providers to deliver appropriate prudent support to individuals seen
This new service took additional time to establish due to the ongoing ‘lock down’ for COVID-19. Service users had to prioritise home schooling, and had difficulty attending 1:1 appointments. Not all service users were able to use virtual support, dependent on their ability to have privacy and access to digital technology. Many community activities, supports and 3rd sector services remained closed or with limited virtual programmes. Consequently, no group work was offered and networking with partners was done in small groups and remotely.
I addition, it became apparent through the project, that prudence would be improved through employing additional Occupational Therapy Assistant Practitioners, to support practice of skills developed within therapy
Approximately 500 people from partner organisations contacted, influenced or educated about Domestic Abuse, the Domestic Abuse Safety Unit and service, and the role of the Domestic Abuse Occupational Therapist.
Feedback from multidisciplinary/ agency colleagues within and without DASU has evidenced the positive impact of the Domestic Abuse Occupational Therapist on moral, engagement and multi-agency working:
“I think .. (the DAOT’s) ..specialist intervention has enabled far swifter progress for our ..(service user).. than would have otherwise taken place”
“I have seen the huge difference that ..(the DAOT).. makes to the clients that I support. This holistic and joint working approach has enabled my clients to move forward with their lives at a much quicker pace than my support worker role alone. I have supported clients that after working with .. (the DAOT).. have increased positivity and motivated to change their lives. It has provided me with more time to concentrate on the support needs of my clients and if I have a client that is struggling to move forward I know joint working with ..(the DAOT)..will drastically improve the clients future support plans and successful exit from the service.”
“I am a Care Coordinator in the… local CMHT… at (local area). I referred a citizen for occupational therapy intervention as she was experiencing severe anxiety and panic attacks which impacted on her daily functioning. …(the DAOT)... has been regularly visiting the citizen providing person centred and outcome focused treatment and support. ..(the DAOT).. has developed a positive working relationship with the citizen which has been central to the effectiveness of the treatment. The citizen has made significant progress in managing her anxiety and working towards her desired outcomes. ..(the DAOT)… has maintained regular communication with myself and attended meetings with the psychologist to ensure effective multi agency working.
CMHT Social Worker
“I currently work within secondary care adult mental psychology services and have been working with the occupational therapy team to plan appropriate support for an individual in the community who has severe mental health difficulties that are significantly impacting on her functioning across all aspects of daily living. It has been extremely beneficial to work collaboratively and devise a comprehensive plan based on the individual’s formulation and implementing an evidence-based intervention. To access psychological intervention often an individual requires a period of stabilisation prior and the work that the occupational therapist has completed to address this individual’s needs and to develop skills has been vital in her being able progress and be in the position to possibly access a trauma focused intervention in the future. The outreach element of the occupational therapy support has been extremely beneficial and this is something that in my opinion is essential as otherwise these individuals would not be able to receive the appropriate care. I have really valued the opportunity to engage in multi-disciplinary working and devising a holistic care package.”
Principal Clinical Psychologist,
Adult Mental Health Clinical Psychology and Psychological Services
Documents and processes for use within an Occupational Therapy pathway, from referral through to discharge have been created for this service, in readiness to adopt and spread the service across Wales.
30 people have been seen by the Occupational Therapist across the period of the project pilot. All of working age, and all female. Demographic information available below.
15 people made significant improvement with their ability to perform their chosen occupations as measured with the Canadian Occupational Performance Measure (COPM) (Carswell, A. et al. 2004).
15 people made significant improvement with their satisfaction with their ability to perform chosen occupations as measured with the COPM (Carswell, A. et al. 2004). See Chart 2.
We are exploring further funding streams to continue and expand the project across BCUHB, with the Occupational Therapy service providing clinical governance and acting in partnership with domestic abuse service providers, such as DASU. A service specification and training resource to support Occupational Therapists, who undertake such work, are in draft form.
Our Exemplar Experience
It has been fascinating, all-consuming and a steep learning curve to deliver this project. The Bevan exemplar education programme has been supportive, helping me to keep on track and developed my skills, helping me to manage, supervise, support and lead the Occupational Therapist providing the service. I would recommend the programme to anyone developing a prudent innovation within the NHS.