Occupational Therapists and Occupational Health A great fit

Occupational Therapists have historically worked in hospitals, community and social care settings but our expertise is a great fit with Occupational Health (OH)!

Occupational therapists are a degree-level educated profession and are regulated by the Health Care Professions Council (HCPC). They are an Allied Health Profession and work to our Royal College of Occupational Therapists professional Standards of Practice and Code of Conduct.

Occupational Therapists understand some of the challenges within OH and recognise that industry-wide there is a skill shortage. We are ideally placed to enhance and support existing services, working alongside other health professionals and developing new pathways to provide vocational support.

However, due to the scarcity of OT’s in OH, the speciality is not really visible in the profession or easily considered as an asset. Let’s hope perceptions change in the near future.

Why OT’s?

Occupational therapy was founded as an Arts and Crafts movement with an ethos of learning through doing. Post WW2, it became better understood how a combination of social, economic and biological reasons could impact a person’s health and therefore activities, or “occupations”. Occupations are a basic human need, providing a sense of purpose, structure and routine. When we engage in meaningful occupations, there is a positive effect on health and well-being.

Occupations refer to everyday activities that people need, want or are expected to do as individuals, in families and within communities, to occupy time and bring meaning and purpose to life culturally and personally, according to our individual values.

Training is broad-based and covers both physical, mental health, cognitive and sensory conditions. Many of the core principles overlap with physiotherapy, all types of nursing, psychology and social work but what makes the profession unique is the focus on occupation.

Practice is shaped and structured according to recognised and respected theories, frameworks, concepts, national guidelines and research.

Occupational Therapists are trained to focus on occupation as the outcome goal when working with individuals. To do this, a person’s strengths, abilities and health care needs are taken into account.  A detailed activity (or task) analysis is undertaken to assess and identify barriers to independent function with the aim to develop, recover or maintain meaningful activities including work. The persons’ current situation and conditions affecting occupational performance are assessed and the development of skills to enable people to effectively manage their own occupational needs are promoted. This reduces a delay in recovery or prevents future health needs from negatively impacting work. The expert analysis of activity compliments occupational health provision.

Good work supports good health. Occupational Therapists aim to support those with health conditions to gain or return to paid employment if that is their goal – not all people wish to or can be employed, but almost all people wish to be engaged in activities that they value.

In common with other professions, a biopsychosocial approach is used with intervention, complementing a medical model. Occupational Therapists focus on function, how health impacts performance and ways that can improve function to enable greater participation in chosen occupations, which may include paid employment. The cost to the economy from ill-health upon those of working age is huge and in the UK, many working-age adults are living with a long-term condition – those who struggle with their health are more likely to leave employment, or not work in the first place. We also need to consider the needs of an ageing workforce.

A recent report published by the Royal College of Occupational Therapists – “Good Work for good health – the difference occupational therapy makes” suggests that there are 3 ways in which occupational therapists can deliver services around work:

1. Universal level: Advice on work for people with health conditions

• Encourage employers to value the health and well-being of their staff at work and for employers to ensure that advice on self-management at work is readily available.
• Promotion of early intervention and advice, such as identifying strategies to manage difficulties that employees may have in managing physical, psychological, cognitive and sensory workplace demands.
• OT’s can support GP’s with making judgements on fitness for work using the AHP “Health and Work Report”. This report is similar to the current Fit note but provides highly specific recommendations about workability. The RCOT report states approximately 93% of the 9-10 million GP Fit Notes issued between 2016 and 2017 stated unfit for work and no adjustments were suggested. Whereas the OT is more likely to provide a report with recommendations to help those with health conditions to better self-manage in all aspects of life.

2. Targeted level: Develop vocational services that support people to access and /or maintain employment

• Provide vocational focused interventions, or rehabilitation to those already experiencing difficulties at work, or getting into paid employment.
• Support people with health concerns, their employers and employment services to understand the range of factors that impacts their ability to work. Which could include the person’s skills, health, beliefs, roles and responsibilities, their occupation such as job demands and working patterns; regular activities such as family or care responsibilities and their environment including their physical, social and supportive network).

3. Specialist level: Work with employers and occupational health providers to support the delivery of health and well-being to staff by;

• Analysis of activity equates well with assessing a person’s job demands in their work environment with the tools and equipment required and therefore subsequently assessing fitness to work, plus the barriers to sustaining or returning to work.
• Recommending reasonable adjustments and return-to-work plans
• Providing “vocational rehabilitation” or vocational case management to work towards improving functional performance.
• Working as part of a multi-disciplinary team and recognising the importance of effective communication (verbal and report-writing) with all stakeholders.
• Sensitive to individual needs and have complex problem-solving skills.

Vocational rehabilitation is a multidisciplinary intervention offered to those with physical, psychological and/or social difficulties enabling a return to work or preventing loss of work” for use in external parties (VRA)

Occupational Therapists work in diverse settings and roles, collaborate with and act in the best interests of individuals to ensure their optimum health, wellbeing and safety.

There is a specialist section for Work within the RCOT supporting clinical practice within this field. This group has developed a core and extended scope of practice for OT’s in OH: –

• Analysis of occupational performance and participation
• Job demands analysis – physical, psychological, sensory, cognitive, environmental, social, behavioural
• Standardised physical, cognitive, sensory and psychological assessment
• Occupational therapy treatment
• Vocational rehabilitation
• Group treatment and educational programmes
• Transferable skills analysis and career re-direction
• Return to work plans
• Recommendation of reasonable adjustments
• Assess fitness for work and job match
• AHP “Health and Work Reports”
• Risk assessment and prevention of further injury/harm
• Ergonomic assessment
• Worksite assessment
• Mental health assessment and identification of adjustments
• Equipment and tool recommendations
• Seating and posture analysis, including wheelchairs.

The extended scope was deemed to be:

• Health and well-being promotion in the workplace
• Pre-employment screening
• Complex case management
• Functional Capacity Assessment

All of which align well with the tasks required of Occupational Health.

So how do occupational therapists work with occupational health?

Either in partnership with OH providers or directly with businesses/human resource teams.

Work alongside other professions to deliver broader organisational interventions to facilitate positive change within the workplace

Within an OH team these will usually be structured around an existing model of service delivery which is likely to be familiar to many OT’s due to their core training in physical and mental health and experience working in acute, primary and social care. The focus they bring on optimising function and promoting rehabilitative strategies broaden the services.

Occupational therapists working in primary care, including GP surgeries, will already be “in-reaching” to provide vocational support to individuals, which will certainly help many Small Medium Enterprises (SME’s) and their employees, particularly in cases where there is not an existing occupational health provider.

Occupational Therapists are also able to support individuals to navigate pathways into work, by identifying skills and needs for those who may have never worked, or have been out of work for some time.