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A professional’s guide to training

by Louise Martinez

Introduction

This guide has been produced to assist the reader in understanding of the role of an occupational therapist in providing training for clients within the context of current legislation, best practice and the statutory and private sectors.

There are many misconceptions about what training an occupational therapist may automatically provide under their professional registration (HCPC) and what requires additional training. This guide aims to clarify some of these pre- conceived notions. It also aims to provide the reader with a taste of the broad range of different types of training scenarios an occupational therapist (OT) can offer to clients.

What do we mean by training?

Training is defined by The Oxford English Dictionary as ‘the action of teaching a person a particular skill or type of behaviour’.

An OT engages with training in a variety of contexts, providing a wide range of guidance, support, training and interventions. An OT will make the decision if they are competent to deliver the scope of the training identified through using their own knowledge of their experience and capabilities as guided by their Professional Standards. OTs are expected to ‘work within your competence and the remit of your job description and within the terms of your employment’ (Professional Standards 2017, page 1).

Teaching a client or carers, a new or adapted skill is a crucial aspect of the service OTs provide. As well as imparting knowledge and/or skills to another human being, with the correct training, individuals can achieve a sense of mastery, accomplishment and increased independence.

Occupational skills are vital to maintaining a client’s independence in the home and at work. These are specific to the individual. Training is used to build a person’s knowledge, skills and attitudes, enabling them to be competent in a task identified by them as meaningful.

What is the role of the occupational therapist in training?

We can divide the training provided by OT’s in their role into both formal and informal. The approach to training provided by an Occupational Therapist will of course depend on those receiving the training, their background, their skills and the knowledge transfer that is required.

Formal training might include training a care team on moving and handling techniques or enabling processes. The trainees would be receiving competency-based approvals from their trainer in a paper format for their records. Informal training is very much part of the OT every day role. After the initial assessment, an occupational therapist identifies which activities of daily living a client is having difficulty with. The reasons why training may be required are dependent upon the client. They range from OTs training carers in the use of a new piece of equipment, or perhaps training carers in the use of safe manual handing techniques following a change in the client’s level of function. OTs can train clients in using pain management or energy conservation techniques to enable them to pace themselves throughout their day.

A client’s family may need, for example, to understand how best to support their loved one following a brain injury. A common problem which may present after sudden or unexpected illness, is the actions of family members completing too many tasks or helping over and above what is required. This is a well-intended attempt to care for the loved one and comfort them following illness or trauma. This can result in limiting the client’s recovery or independence. It is best addressed with a two-pronged approach, training both the client and the family to adopt appropriate strategies to enable the individual’s independence and to maximise their ability to cope with the injury.

Training provided by an Occupational Therapist may therefore include (but is not limited to):

  • Training the client to pace themselves; to undertake the activity in component parts or smaller more manageable steps
  • Training the client how to complete the activity in an alternative manner
  • Training the client how to use compensatory equipment to complete the activity
  • Training the family member(s) how to support the client in completing the activity (when to physically assist, when to step back and encourage)
  • Training on energy conservation or pain management
  • Training the family how to use manual handling equipment with the client
  • Training the client how to use manual handling equipment
  • Training the carers how to perform manual handling tasks safely
  • Training the client how to don/doff prosthesis after amputation

Professional Registration, Standards of Practice and Code of Ethics

All qualified Occupational Therapists (OTs) are expected to have sufficient knowledge and skills suitable to their level of responsibility. The Professional Standards stipulate that as an OT you ‘only work within your professional competence, seeking advice or referring to another professional when required’ (Professional Standards, 2017 page 14).

Within their degree level training, OTs are provided with a foundation of knowledge of ‘how an individual’s health and wellbeing affects, and is affected by, their occupational performance and participation’ (Professional Standards 2017, page 2). An analytical approach is encouraged, ensuring that practice is informed by evidence based practice (HCPC), and outcome measures are used to monitor the effectiveness of interventions.

All Occupational Therapists are required by law to be registered with the Health & Care Professions Council (HCPC). The HCPC requires that all OTs practice within their given scope of practice in order to practice safely and lawfully. They state; ‘If you want to move outside of your scope of practice, you should be certain that you are capable of working lawfully, safely and effectively. This means that you need to exercise personal judgement by undertaking any necessary training or gaining experience, before moving into a new area of practice.’ (HCPC 2013, page 4). The responsibility is placed on the OT as to how they meet these standards, particularly in private practice. This requires autonomy, reasoned decision making and seeking professional advice and guidance where necessary to ensure that the wellbeing of the service user is paramount.

The College of Occupational Therapists in their Code of Ethics and Professional Conduct (2015), stipulate that OTs are responsible for their professional competence and lifelong learning: ‘You must only provide services and use techniques for which you are qualified by education, training and/or experience. These must be within your professional competence, appropriate to the needs of the service user and relate to your terms of employment…..remaining up to date with relevant training where necessary’ (page 32). Should an OT diversify into another specialist field, for example, they are required to ensure they are appropriately qualified, and seek out relevant training and or support.

What do the legal requirements look like in practice?

The key to excellence in practice, is that an OT should recognise that they are not expected to have all the answers in a particular field. Hence seeking appropriate guidance and resources to enable them to deliver is expected. This may involve referral to a third party. For example, an OT may have identified a need for specialist bathing equipment based on a client’s functional ability due to their injuries. The company representative who demonstrates and fits this equipment several times per day is likely to be far more qualified than the OT, to train the client and their carers/family on how to use it safely.

Working within your area of expertise is as much of an expectation as the responsibility for all Occupational Therapists to seek out professional development opportunities and dedicate time to learning.

Like medicine, Occupational Therapy is divided into a multitude of specialist areas, such as hands, brain injury, trauma and orthopaedic, paediatrics, to name but a few. Many Occupational Therapists will be specialists in one particular field, having devoted much of their career to learning about this particular specialism. Many have a broader range of experience from which to draw upon. For example my background ranges from elderly therapy, chronic fatigue syndrome, neurology and trauma and orthopaedics. Within my career I have acquired skills within each area, such as becoming a manual handling trainer for other staff under my responsibility. I regularly provide training to carers and families regarding a client’s manual handling needs.

Competency/Training for Occupational Therapists - Statutory Services versus Private Practice

Those working within statutory services and the NHS will be familiar with the annual expectation to update mandatory training on a wide variety of topics, some seemingly outside of their area of practice. Staff are encouraged to ensure their training does not go out of date. For example, a hand therapist working in outpatient setting within the NHS would be expected to attend regular manual handling training involving use of more specialist moving and handling equipment e.g. hoisting equipment / pat slides, despite rarely or never putting those learnt skills into use. This is the expectation of their employer, but not necessarily of their professional governing body.

In the world of private practice, the OT remains responsible for ensuring they are equipped with the right skills for the job, and competent. The Professional Standards and College of Occupational Therapists do not provide legislation or best practice guidelines stipulating updating or undertaking mandatory training to exacting timescales. It is the responsibility of the individual practicing OT to ensure they have the skills and are qualified for the role.

For example, a privately practicing Occupational Therapist in the field of hand therapy, would not be expected to attend annual manual handling training, unless, they were regularly working with less mobile patients, for example in an inpatient hospital ward setting. Conversely, an Occupational Therapist who regularly provides manual handling assessments within the community, or training for clients and carers, would be expected, according to their Professional Standards, to regularly seek out opportunities to expand their professional knowledge in this area. In reality, This would involve much more regular and intensive dedication than the annual NHS refresher course, and may involve courses of up to one week in length, and focusing on the latest technology/equipment.

Private practice requires a greater level of professional autonomy, and responsibility by practicing Occupational Therapists to ensure they meet these standards.

What does a training session look like?

Any training session, whether it be a 1:1 session with clients, or carers, or on a larger scale as a group must include the following: - Assessment of the client’s needs - Assessment of the background/skills/level of understanding of those receiving the training - Preparation of the session – consideration of best method of delivery (practical, theory, both?) - Preparation of handouts, information and guidance – should be succinct yet informative (consider when/how it will be used, confidentiality) - Consideration of the environment in which training is being delivered (sufficient space, consent) - Guidance regarding what necessitates a revision of the training provided (change in the carers, change in the client’s needs, or a change in environment such as moving property) - Competency Signing off – It may be pertinent in training scenarios for the carers to be provided with evidence of their training session with an OT. Training records should be provided detailing the type of activity demonstrated/observed/practiced and whether the carers were observed competently completing the task being trained in.

Conclusion

Within this guide we have presented an overview of the role of the occupational therapist in providing training, within the context of current legislation, best practice and the statutory and private sectors. To discuss how The OT Practice might assist your clients, their families or their carers with a bespoke training session, please contact one of our dedicated Client Managers on 0330 024 9910 who will be able to discuss in detail how we can support you in delivering the best possible service to your clients.

References

Royal College of Occupational Therapists, Professional Standards for Occupational Therapy Practice, 2017 – available via RCOT website.

Royal College of Occupational Therapists (2015a) Code of Ethics and Professional Conduct. London: COT. Available via RCOT website.

Harvey L (2014) Analytic quality glossary. [s.l.]: Quality Research International. Available at: http://www.qualityresearchinternational.com/glossary/

Health and Care Professions Council (2016) Standards of conduct, performance and ethics. London: HCPC. Health and Care Professions Council (2013) Standards of proficiency: occupational therapists. London: HCPC. Health and Care Professions Council (2012) Your guide to our standards for continuing professional development. London: HCPC.

Useful web links

Royal College of Occupational Therapists (RCOT) https://www.rcot.co.uk/

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