The profession of occupational therapy has a wide scope of application creating a more just and inclusive society. To this end the professions governing body, the OCP Board, have embarked on a series of initiatives to make the profession more inclusive and sustainable. Awareness days, practitioner’s role in promoting mental health, and stroke rehabilitation and school-based interventions make the profession more relevant to the public at large. By bridging people with disabilities into the workplace and taking the profession to the streets, the Board hope to create new pathways to health.
The Board has also initiated a mentorship programme to ensure practitioners continue to have the skills, qualifications, and knowledge necessary to practise within a changing environment competently and safely.
Celebrating World Occupational Therapy
The OCP board is mandated to regulate occupational therapists and occupational therapy technicians/assistants and promote awareness of the profession so that the public and other health professionals are aware of occupational therapy practitioner roles and functions within healthcare and society.
World Occupational Therapy (OT) Day, celebrated on 27 October 2022 in recognition of the occupational therapy profession. The OCP board highlighted the role of OT in the different areas of practice by drawing attention to how leadership and mentorship can be developed for young practitioners to build capacity within in the profession along with and safeguards for the public. This year’s theme was Opportunity + Choice = Justice.
Many people, both adults and children, in South Africa face limitations and challenges in participating in activities that bring meaning to them due to socioeconomic barriers, lack of stimulation, illness, disability, natural disasters and, as we experienced during 2020/2021 global pandemic. Occupational therapists’ unique perspective allows them to create opportunities to improve the person’s quality of life and promote a more open and just society.
Therapist’s role in promoting mental health
Rulaine Smith, Deputy Director: Occupational Therapy District Specialist Mental Health Team (DSMHT) Johannesburg Health District points out that mental health is important at every stage of life i.e. across the life span. People diagnosed with mental health challenges, may experience a combination of cognitive, emotional, or behavioural deficits which impact their functioning in activities of daily living, work, social and leisure time activities. Mental illnesses can be classified as mild in that the functional impact is minor whilst severe mental illness results in serious functional impairment, which substantially interferes with or limits one or more major life activities such as work, school, family or community life etc.
Occupational therapists create opportunities for people with a mental health disorder to participate in occupations they want to, need to, or are expected to do by working with people and communities to enhance their ability to engage in the activity or task or by modifying the occupation or the environment to better support their occupational engagement. Occupational therapists are vital role players not only in the treatment of mental illness but also in the promotion of mental health. During the recent pandemic many people especially health professionals experienced burnout and an imbalance in their work-life roles. Occupational therapists work with people across the lifespan who are at risk of having mental health illnesses to ensure that they balance their work-life activities and gain life skills such as stress management and reengaging with tasks that bring the person meaning.
Occupational therapists use standardised assessments as well as a variety of activities to determine the mental health care users’ strengths and abilities, functional limitations, and activity restrictions. Additionally, they analyse the physical, social, cultural, attitudinal and legislative environments that impact the execution of these activities to develop individualised therapeutic plans that are designed to meet the functional needs of mental health care user at that specific time period in their lives.
Occupational therapists work collaboratively with other medical professionals, providing a unique therapeutic approach to regaining functional outcomes. Individual, as well as group occupational therapy treatment sessions ensure that mental health care users gain a sense of self-efficacy and accomplishment, thus treatment aims to address (but is not limited to): management of symptomology including cognitive rehabilitation, psychoeducation and relaxation therapy; establishing effective daily routines; building life skills, such as time management, planning, pacing and prioritising, stress management, coping and problem-solving skills; facilitating appropriate interpersonal skills such as effective communication, assertiveness and anger management; improving engagement in daily activities such as constructive use of free time, health and medication management, financial management and household management; developing prevocational and vocational skills such as compiling a CV, handling an interview, work competency skills, implementation of reasonable accommodations and case management; and promoting family involvement and community integration. Literature shows the effectiveness of occupational therapy in achieving functional outcomes for mental health care users. A multidisciplinary biopsychosocial approach is more client-centred and offers better outcomes for the person. Healthcare professionals are encouraged to work collaboratively in order to achieve optimal functioning for mental health care users.
OTs role in Stroke Rehabilitation
Rehabilitation is one of the more traditional and acknowledged roles of occupational therapy says Professor Deshini Naidoo, Occupational Therapy at the University of KwaZulu Natal. He highlights that occupational therapists offer services for clients who have had a stroke from the in-patient hospital phase to the reintegration into the home and community as well as return to work where possible. Occupational therapists assist clients who have had a stroke to engage in basic activities of daily living such as bathing, dressing eating, transferring from bed to the wheelchair or the bath as well as doing laundry or making a meal especially if the person lives alone. The occupational therapist facilitates engagement in these activities either through remediating the factors that prevent participation such as poor balance or being hemiplegic or providing assistive devices such as a bath board or shower transfer bench, to enable the person to get in and out of the bath or shower more independently or using a spike board to enable a person to chop vegetables or butter bread with one hand. Alternatively, the environment may need to be modified, for example a ramp over the steps to the from door to allow for w/c access or re-arranging the kitchen cupboard so that the person who had a stroke can reach the cooking items or spices to enable that person to engage in the activity of cooking.
Ultimately, the occupational therapist works with the person who had a stroke and their family, to decide on the goals for therapy that are most meaningful to the person or a task that the family is having challenges doing. Caregiver training before the person leaves the hospital is essential, as is, follow-up at home or at a primary healthcare clinic to ensure that the independence gained in-hospital translates to the home environment. Ideally, clients who have had a stroke need to be visited at home once discharged from the hospital especially to ensure that the person has the ability to reintegrate back into the community for example to be able to go to places of worship or get groceries, using a taxi or a hired car or just visiting friends to ensure that the person feels that they are contributing to their family, community and have quality of life. In cases where the client who had the stroke is a high burden of care, the occupational therapist needs to ensure that the caregiver is not burned out and engages in self-care.
School-based intervention: Case Study
Jaclyn Craig, a private practitioner provides a case study to illustrate the role of OT in school-based intervention.
TJ was referred for OT in March 2022. He is in Grade 3. The reason for referral was that the teacher was concerned about his postural control, motor planning, handwriting skills and fine motor skills. After a comprehensive assessment, the focus of therapy was on the improvement of his bilateral integration, postural control, motor planning, pencil grip, handwriting, refining fine motor skills and improving his self-confidence. During the assessment, the OT felt that a optometry assessment was necessary. As a result, TJ is now wearing glasses. The learner currently attends one 45-minute session on a weekly basis. He is now confident to run outside, participate in gross motor activities such as sport, and he has asked to audition for a main role in the school concert. TJ’s handwriting is neater, and his general letter formation has improved. His pencil grip is more consistent, and his art skills are improving. The child’s parents are appreciative and positive about the impact of OT has had on his overall functioning and performance in the classroom.
He will continue with OT to further consolidate his skills and assist with his transition into Grade 4.
Bridging people with disabilities into the workplace and ensuring ongoing productivity and employment
‘According to the Employment Equity Act, no.55 of 1998 in South Africa, people with disabilities are people who have a long-term or recurring physical, including sensory, or mental impairment which substantially limits their prospect of entry into or advancement in employment’, says Lesego Tau, OTASA Vice President Marketing, Advocacy and PR). According to the South African Depression and Anxiety Group (SADAG), only 61% of people diagnosed with a mental disability disclose their condition to their employer. If disclosure occurs, the focus is primarily around the impairment or perceived limitations of the person with a disability, as opposed to what abilities, qualifications, skills and traits they possess, that could be of value to the organisation they work for. Occupational therapists are instrumental in implementation of transformation policies and actions that ensure access and retention of employment by people with disabilities.
Occupational therapy is a client-centred health profession concerned with promoting health and well-being through occupation and facilitating people reaching their full potential. Occupational therapists bridge people with disabilities into the workplace by introducing the concept of disability awareness for employees on all levels, as well as providing a consultative role in the return-to-work process. Occupational therapists conduct functional capacity evaluations to establish temporary and permanent incapacity when incapacity is a result of a medical condition or disability. Once functional limitations have been identified, the occupational therapist will provide information on reasonable accommodation measures or workplace adaptations that can be implemented to compensate for the employees’ functional limitations and ensure that they meet their key performance indicators. Adjustments to work roles and job descriptions can also be implemented as far as operationally viable for the organisation.
Vocational rehabilitation is implemented as a method to facilitate the process of an employee returning to work with a disability or medical condition. Graded return to work is facilitated in conjunction with the Human Resource department ensuring that operational requirements and profitability of the organisation are not compromised, as well as maintaining the employees’ overall health and well-being. Occupational therapists are also instrumental in ensuring physical environmental accessibility to workplaces, to ensure that people with mobility restrictions (e.g., wheelchair bound), or those with visual and hearing impairments, can access physical workplace buildings and structures.
Work and healthcare concepts are interrelated, and adequate management of this connection is vital to maintain a productive and healthy workforce. A key role in supporting the workability of the workforce, is rendering effective occupational health and disability management. It is therefore vital for organisations to develop strategies that offer prevention, early intervention, rehabilitation, and health promotion to maintain a vibrant workforce through methods that address individual wellness.
Taking the profession to the streets
Chantal Christopher, an occupational therapy community lecturer at UKZN says mentions that a society still finding its way out of apartheid injustices, improving the health of people in accessible and affordable ways within a healthcare system, whose services range from early intervention to palliative care, is reconciled to utopian dreams. Occupational therapy working at a primary health care level within communities is an example of how seemingly small and sometimes big interventions can begin to change the trajectory of life for many.
Healthcare access and equity
Primarily working at a Primary Health Clinic allows us to provide a wide array of health promotions which cover the lifespan, with the thought of prevention and treatment but primarily promoting long-term wellness. We, therefore, may treat a hand injury while we screen a senior citizen with general body aches, while working through a young woman’s report of gender-based violence and depression. Antenatal care and screening for the mother’s wellness offers us an opportunity to create a space to thrive even before the child is born. Screening development, encouraging stimulation, and offering advice on novel activities for the growing child is a mitigation against developmental difficulties and poor school performance later. This is inadequate unless the social determinants of health are addressed simultaneously within the community.
Society and community context
A child growing up in a particularly violent unsafe society within, for example, a low-resourced community will be occupationally deprived by the nature of the context. As occupational therapists, we collaborate with structures, institutions, and organisations to promote access to mundane as well as unfamiliar activities. This however requires us to often be advocacy agents as the context must reciprocally change, to sustain occupations and activities. For example, a youth soccer group for both girls and boys that offers training and builds skills and identity while promoting socialization and belonging, physical and emotional wellness in a local soccer field requires all the above. We may begin with organizing a clean-up of the field, picking up pieces of glass, organizing bins from the local Solid Waste and the municipal’s parks department to cut the field. It is about collaboration.
Education and access and quality
Being an occupational therapist within a community requires us to work where the children are experiencing barriers. This then means at a primary and high school level and at formal and informal creches. Advocating for creches to develop stimulation programs and envisioning themselves as more than day centres remains a herculean chore. Development programmes, recycled toys and training of educators, creche owners and principals allow us to build sustainability into our work. Working within these gaps where a shortage of occupational therapists at local educational levels is unresolved, aims to fill these gaps in assisting children to thrive.
Economic stability
Children struggle to thrive and face obstacles from resource poor households. The pandemic, the high unemployment within South Africa and the economic downturn within the country has made the greatest impact on these households. As informal settlements grow, the majority of people we meet at PHC clinics report that they live in wood and iron dwellings in informal settlements. With economic instability, the problems are myriad within a household and in this case may not be the best foundation for a growing youth. Small strategies to mitigate against this is discussing food choices, and sustainable toys and facilitating women to begin to re-enter the workforce. We have created entrepreneurial training packages and skills development to set these women on their way but also offer them a stipend if they are below the breadline by working within one of the established entrepreneurial projects. This “whole of society” reach, working at grassroots levels near people’s everyday residences and life, not only affords us opportunities to provide health services in meaningful ways, but asks us as health professionals to create new pathways to health in collaboration with others through acute and long-term goals.
Leadership and mentorship
Professor Thuli Mthembu, Occupational Therapy University of Western Cape points out that leadership is one of the significant roles of occupational therapists, which involves actions of leading group of people or an organization with the vision of serving others while empowering them to gain skills, knowledge, and competencies needed in the occupational therapy profession. Additionally, leadership involves a process of motivating others and makes a way for them to develop so that they can enhance the mission of the profession.
In the occupational therapy profession, the role of mentorship is perceived as a capacity building for occupational therapists to develop their clinical reasoning substantiated with theory as part of their abstract conceptualisation that enhance their active experimentation of ideas in practice. The mentoring role provides occupational therapists with opportunities to develop their resilience and confidence when faced with difficulties existing in occupational therapy practice. Furthermore, the mentoring role in occupational therapy is vital because it promotes professional and socialization where occupational therapists gain skills and needed knowledge to achieve best practice and their professional identity. The new practice business incubator (NPBI) below, is an illustration of leadership and mentoring in action.
New Practice Business Incubator
OTASA will be implementing a New Practice Business Incubator (NPBI) designed to incubate newly qualified, emerging occupational therapists in starting their own private OT practices. Dr Ivor Blumenthal and Anisha Ramlaul (OTASA Professional Body for Management, Leadership & Fields of Practice) says that this will be done by partnering newly graduated and licensed novice practitioners with existing private practice owners and managers for an 18-month period. During this time, the new practice owner will be registered on a new venture creation learnership, with the Health and Welfare SETA. The existing private practitioner will be skilled and qualified by OTASA as a mentor or coach and will be expected to conduct a minimum of 60 hours of coaching in the course of a 10-month period with the new practice owner. An MOU will be entered into between the pair of businesses, placing the partnership in a position to apply to the National Health Insurance (NHI) to be registered as preferential providers, for OT Services, when the NHI is launched in 2023. The existing private practice will benefit from the automatic allocation of CPD points towards their own professional practice owner’s designation as well as additional CPD points for qualifying as a mentor/coach.
In addition, under Section 12H of the Tax Act, the existing private practice will qualify for a R40 000 tax deduction when formalizing the learnership agreement contract with the new business entrepreneur and an additional R40 000 tax deduction when finalizing and completing the learnership with the new business owner. This is in the context of the lead employer of that new business entrepreneur.
Conclusion
This article highlights some of the roles played by occupational therapy in its various fields. The common thread amongst all the areas of practice is that OTs create opportunities for people across the lifespan, to participate in the roles and activities that hold meaning to them.
Occupational therapists advocate for their clients, whether the client has a mental health illness, is struggling to return to work or even for a child requiring scholastic support such as therapy, adaptations in an educational environment.
Occupational therapists facilitate people having choices, by enabling them to modify their activity, providing assistive devices, modifying the environment, or remediating factors that hinder engagement in occupations.
Occupational therapy has a role to play in primary health care, especially in taking therapy to the streets or the community. At a primary healthcare level, the role is promoting health and well-being, preventing disease, promoting rehabilitation and advocacy for clients and the community.
There is a need for mentorship and leadership in the profession. The occupational therapy Association of South Africa will be implementing a New Practice Business Incubator (NPBI) designed to support and mentor young therapists who are starting their own private practice. The OCP board works with the professional association OTASA to ensure that key issues of concern within the profession are addressed, and key issues of the public are remediated, and that ethical practices of occupational therapists and occupational technicians/assistants are maintained.
Last Updated on 9 November 2022 by HPCSA Corporate Affairs