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A primary provision under occupation
Role-emerging placements – which occur at a site where the profession has no established presence - are not new in occupational therapy, but it was a novel experience for supervising speech and languageGwen therapist Leona Cook and staff at a primary speech and language provision. Looking back on the placement with occupational therapy tutor Jeannette Head and final year students Harriet Easter and Stefanie Roberts, Leona asks if it is an option for speech and language therapy too. A. LONG-ARM SUPERVISION – JEANNETTE HEAD
the on-site supervisor and the off-site supervisor both during the placement and when the assessment reports are being finalised. However, the challenges of being an offsite supervisor are balanced by the countless rewards. Enabling students to realise their potential, developing their professional identity, clinical reasoning, and resourcefulness has been satisfying and I have enjoyed the opportunity to be part of promoting the value of occupation in health and wellbeing. My professional practice has developed as a result and I would definitely encourage others to embrace the challenge. READ THIS IF YOU ARE INTERESTED IN • BROADENING STUDENT PLACEMENTS • MODELS OF SUPERVISION • INTERPROFESSIONAL LEARNING students.) After three heady days of digesting facts about learning styles, models of supervision, course structure and paperwork, the full extent of the preparation became apparent. I was initially doubtful that I would be able to support the students successfully or understand their competency frameworks! Meeting with Jeannette, their long-arm occupational therapy supervisor, was a reassuring experience, helping to hone ideas and smooth out anxieties. The placement was a 12 week full-time final block placement with built-in study and supervision. I was initially concerned that the role-emerging placement was the two students’ first experience of paediatrics. However, the profession’s focus on ‘occupation’ means that skills and approaches learnt in their adult work is directly transferable to working with children. Only students who are already coping well are sent on role-emerging placements, and they have weekly visiting clinical occupational therapy supervision and can contact the long-arm supervisor between visits if they need more support. When the students arrived we asked them to observe all the children and make up their own minds about who to work with. They took account of teachers’ concerns by giving them questionnaires to complete. The students did really well, and the benefits of supporting them have been enormous for me personally, for the provision and for the children. I now have a greater understanding of the occupational therapist’s role, particularly the overlap between the speech and language and occupational therapy professions. Both therapies put children at the centre of interventions, developing their functional skills for everyday life. These commonalities can include social skills, developing self-esteem, developing sensory integration, listening, attention, engagement, participation, music groups and use of games as a therapeutic tool. As a provision we have a deeper understanding of the children’s strengths and weaknesses in ad-

As with all health and social care professional courses, placements play a vital role in preregistration occupational therapy education. With the increasingly diverse needs of practice, Canterbury Christ Church University aims to provide occupational therapy students with a broad range of placement experiences. A role-emerging placement is a practice placement which occurs at a site where there is not an established occupational therapy role (COT, 2006). Informal supervision is provided by a member of the staff (from a non-occupational therapy background) in the setting. Formal professional supervision is provided by an off-site occupational therapist (longarm supervisor) either from the students’ university or a locally based clinician. Evidence supporting the value of roleemerging placements is well documented in occupational therapy literature (Fleming et al., 1996, Alsop & Donald, 1996, Bossers et al., 1997, Huddleston, 1999, Friedland et al., 2001, Totten & Pratt, 2001, Baum, 2002, Fisher & Savin-Baden, 2002, Thomas et al., 2005, Wood, 2005, Thew et al., 2008). These placements offer many benefits for the setting, for the profession and for the student. They enable the development of professional roles into new areas of practice, thus potentially creating future job opportunities. They offer the chance for service enhancement, providing service users with access to a service they would not otherwise receive. They also promote the profession, further developing opportunities for inter-professional and interagency collaboration. As a long-arm supervisor, I know that planning role-emerging placements is not without challenges and requires careful consideration. There needs to be a clear agreement of the roles and responsibilities of the on-site and off-site supervisors. It is especially important that there is regular communication between

As a speech and language therapist based in a primary speech and language provision, I had for some time been acutely aware of the children’s occupational therapy needs. The teachers and I observed issues around dressing, balance, coordination, body awareness, strength of movement, fine motor skills, sequencing, problem-solving, socialisation, spatial awareness and concentration / focus. A couple of the children had managed to access group occupational therapy sessions at the local Child Development Centre before entering our provision but, in Medway, there is currently no occupational therapy in community clinics and only a limited advisory service to schools. I was therefore very interested to hear about a speech and language therapy colleague’s experiences of supporting occupational therapy students within an education setting. Role-emerging placements offered a solution enabling us to access and learn about this important service. I enrolled on the three-day Practice Educator’s Course provided by Canterbury Christ Church University for people supervising occupational therapy students. (They also run a course for speech and language therapists supervising speech and language therapy

B. GREATER UNDERSTANDING – LEONA COOK

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dition to improved knowledge about aspects of development such as fine and gross motor skills. We have also noticed that, as our understanding of what occupational therapists do has improved, we are better at identifying children who may require their services. The children have had access to fun therapy that has aimed to develop functional abilities like writing, concentration, visual perception and social interaction. There have been challenges during the placement although these have all been overcome. Supporting students always takes time away from face-to-face contact with clients and having more personnel meant the need for flexibility in terms of room space. My greatest challenge as a speech and language therapist was stepping back without feeling guilty that I should be more hands-on in my supervision. The students were the experts, not me! Some practical tips based on my experience are in figure 1. cupational therapy, for example creating our own pictorial timetable for our sessions. Working in a non-traditional setting helped us to consolidate our understanding of our professional role. We recognised from the start Occupational therapy promotes the importance of remaining occupational independence and participation in all based in our approach and we found that this aspects of life. It aims to help children came naturally to us due to our training and do as much as they can for themselves experience. This enabled us to set up our own in spite of any physical, cognitive, service and focus on the areas we felt the chilsensory, psychological, behavioural dren would benefit from the most. We carried or social barriers. Information about out assessments and facilitated four groups: how occupational therapists work with fine motor, gross motor, visual perception and children is in the leaflets ‘Helping Children social interaction. Although we had a strong to Develop and Thrive’ at http://www. occupational therapy perspective, it was imcot.co.uk/MainWebSite/Resources/ portant that we organised time outside of the Document/OT-Children.pdf and ‘What are school to discuss our intervention with occuOccupational Therapists?: Child Health pational therapists working in paediatrics and Services’ at http://www.scotland.gov.uk/ access their assessment tools. The support we Publications/2005/09/06111938/19399. received from our university supervisors was also essential to gain reassurance that we were following correct procedures with this client group. We felt a weakness of the role-emerging placement was not being able to reflect with an occupational therapist l-r Leona, Stephanie and Harriet directly after intervention or learn from their practice. However, not having an occupaFigure 1 Tips for non-occupational tional therapist on-site allowed us to be creatherapy practice educators tive in our approach and gave us the freedom to learn by trial and error. As a result we feel 1. Be prepared! Draw up your induction pack and student resource file. more confident in our own skills and idenOccupational therapy students are tity. This is supported by Thew et al. (2008) proactive and ask for this information in their research of students’ experiences of prior to placements. role-emerging placements. An additional 2. Organise time during the placement for the students to meet and liaise constraint working within the school setting with occupational therapists in your was the amount of time we had to work with local area. the children. It was obviously limited due to 3. Discuss the needs of occupational the demands and timings of the school day. therapy students with colleagues in

Occupational therapy with children

During our third year at Canterbury Christ Church University, we were given the opportunity to work in this non-traditional setting. On site we were supported by the speech and language therapist in addition to guidance from two occupational therapy university lecturers. Although this placement presented us with unique challenges in terms of our role and responsibilities, we used the situation to promote our profession. This was our first experience of working in paediatrics and alongside a speech and language therapist. This, coupled with the challenge of there not being an established occupational therapy role in the school, led to our initial apprehension about this placement. However, the absence of an occupational therapist enabled us to be autonomous from the start and utilise our core occupational therapy skills in designing our service and managing our own caseload. We gained a positive experience from working with Leona, who provided us with continuous supervision and the opportunity to learn and observe her practice. Although she did not have the expertise in guiding our occupational therapy intervention, she supported our integration into an educational setting. As we had limited knowledge regarding speech, language and communication disorders, she provided us with invaluable information about the children’s development. For example, we were unfamiliar with augmentative and alternative communication (AAC), but were given guidance on how to implement these tools in our intervention sessions. This proved to be a successful and valuable learning experience which will enhance our future practice. Most of the materials available to us were geared towards speech and language. We needed to adapt the tools to make them specific to oc-

C. FROM APPREHENSION TO AUTONOMY – HARRIET EASTER & STEFANIE ROBERTS

Workshop for parents

As part of this placement, we conducted a joint workshop for parents. Our aim was to provide parents with guidance on supporting their child at home. We focused on activities to develop gross motor, fine motor and visual perception skills. This was delivered by a presentation and demonstration of activities and provided the opportunity to inform parents of occupational therapy. It was complemented by the speech and language therapist’s advice on reading at home to develop language and reading skills. We compiled an activity pack, which provided information on fun games and activities parents could try with their child. We felt this was a valuable approach to working inter-professionally to support parents in

4. 5. 6. 7. 8.

your setting, including reflection and planning time. This is particularly important within an educational setting where a teacher’s approach to training may be different. Send the students a timetable for the first week, building in settling-in time. Make contact with other Practice Educators working in non-traditional settings. Brainstorm with colleagues ideas for the placement, such as suitable clients, specific tasks. Orientate yourself through the paperwork. Ask for two students – this can be particularly successful as they are able to support one another.

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developing their children’s important skills. We gave a feedback form to the four parents who attended and their answers are in figure 2. This was our first experience of being on placement with another occupational therapy student. This placement would not have been as successful if we had not developed such good team-working and peer support. Our individual experiences and strengths complemented each other’s practice as we learnt how to use this effectively to develop our skills. For this placement, we created a peer-evaluation form as a tool for reflecting on each other’s practice (figure 3). This helped to consolidate what we had learnt from the experience and focus on how we could enhance our intervention further. As we co-facilitated the sessions, this was also important for ensuring we shared the same insights and common goals.

Acknowledgements

Figure 2 Feedback from parent workshop

The students would like to thank their supervisors Jeannette Head and Rupert Kerrell, Canterbury Christ Church University, for their ongoing support and encouragement throughout the placement. Thank you also to Andrea Holloway, Fiona Beck and Cathy Roberts for volunteering their time and guidance. They would also like to thank Warren Wood Primary School, Rochester for the opportunity to work in their school, with special thanks to Leona Cook and all of the children.

Number of parents (out of 4) who answered yes
Do you think your child would benefit from having access to OT at school? Before the workshop had you heard of OT? Did you find the activity ideas useful? Would you try any of these activities at home? 0 1 2 3 4 5

References

D. POSITIVE EXPERIENCES – THE COLLECTIVE VIEW

Our experiences of this role-emerging placement have been positive, and Leona is continuing to supervise other occupational therapy students in the provision. The placement enabled us all to exchange ideas and develop a greater understanding of each other’s roles. We feel the children have benefited from an additional perspective that has ultimately allowed them to develop a wider range of skills. Role-emerging placements require a preparatory time commitment from the on-site practice educator alongside an understanding that students need non-contact time away from the placement site. It is imperative that students incorporate reflective time including access to the university’s resources, and this needs to be planned into their timetable. The students would recommend a third year role-emerging placement in a non-traditional setting as this has provided them with a valuable experience that they will take into their future practice. Could role-emerging placements in pairs be part of the future for speech and language therapy students? Prisons, care homes and children’s centres all offer possibilities, as do opportunities to access hard-to-reach groups through projects run in the statutory or voluntary sector for people who are homeless or have suffered domestic abuse. Leona is not sure if this model is appropriate for speech and language therapy students, so would be very interested to hear from anyone who has already tried it out. SLTP Jeannette Head is a Practice Placement Tutor, Occupational Therapy, Canterbury Christ Church University, e-mail jeannette.head@canterbury. ac.uk. Leona Cook is a Highly Specialist Speech and Language Therapist / Dyslexia Teacher with NHS Medway, and a part-time lecturer on the postgraduate speech and language therapy course at Canterbury Christ Church University, e-mail cookl023@medway.org.uk. At the time of writing Harriet Easter and Stefanie Roberts were final year Occupational Therapy Students at Canterbury Christ Church University.

Alsop, A. & Donald, M. (1996) ‘Taking stock and taking changes: creating new opportunities for fieldwork education’, British Journal of Occupational Therapy 59(11), pp.498-502. Baum, C. (2002) ‘Creating partnerships: constructing our futures’, Australian Occupational Therapy Journal 49, pp.58-62. Bossers, A., Cook, J., Polatajko, H. & Laine, C. (1997) ‘Understanding the role emerging fieldwork placement: a qualitative inquiry’, Canadian Journal of Occupational Therapy 64, pp.70-81. College of Occupational Therapists (2006) Developing the occupational therapy profession: providing new work-based learning opportunities for students. College of Occupational Therapists. Guidance 4. London: COT. Fisher, A. & Savin-Baden, M. (2002) ‘Modernising fieldwork, part 2: realising the new agenda’, British Journal of Occupational Therapy 65(6), pp.275-82. Fleming, J.D., Christensen, J., Franz, D. & Letourneau, L. (1996) ‘Fieldwork model for nontraditional community practice’, Occupational Therapy in Health Care 10, pp.15-35. Friedland, J., Polatajko, H. & Gage, M. (2001) ‘Expanding the boundaries of occupational therapy practice through student field-work experiences: description of a provinciallyfunded community development project’, Canadian Journal of Occupational Therapy 68(5), pp.301-309. Huddleston, R. (1999) ‘Clinical placements for the professions allied to medicine, part 2: placement shortages? Two models that can solve the problem’, British Journal of Occupational Therapy 62(7), pp.295-98. Thew, M., Hargreaves, A. & Cronin-Davis, J. (2008) ‘An evaluation of a role emerging placement model for a full cohort of occupational therapy students’, British Journal of Occupational Therapy 71(8), pp.348-353. Thomas, Y., Penman, M. & Williamson, P. (2005) ‘Australian and New Zealand fieldwork: charting territory for future practice’, Australian Occupational Therapy Journal 52, pp.78-81. Totten, C. & Pratt, J. (2001) ‘Innovation in fieldwork education: working with members of the homeless population in Glasgow’, British Journal of Occupational Therapy 64(11), pp.55963. Wood, A. (2005) ‘Student practice contexts: changing face, changing place’, British Journal of Occupational Therapy 68(8), pp.375-78.

Figure 3 Peer Feedback Form (Stefanie Roberts & Harriet Easter, 2008) 1. Preparation: • Did the student adequately prepare for the intervention/session? • Was the equipment and environment appropriate? 2. Content: • Was the activity appropriate to the intervention aim? • Was the session / each activity an appropriate length of time? • Was the activity appropriate to the age of the child/ren? 3. Delivery: • Was the session clearly explained to the child/ren and brought to an appropriate close? • Did the student recognise the need for adapting the activity and respond appropriately (i.e. grading)? • Non-verbal 4. Positive feedback / further development (Plus children’s response and interaction):

REFLECTIONS • DO I LOOK FOR INNOVATIVE WAYS TO BRING A MUCH-NEEDED SERVICE INTO MY WORKPLACE? • DO I PREPARE ADEQUATELY FOR A NEW ROLE THROUGH A MIX OF FORMAL TEACHING, SELF-DIRECTED LEARNING AND NETWORKING? • DO I PROMOTE UNDERSTANDING OF SPEECH, LANGUAGE AND COMMUNICATION SUPPORT NEEDS TO STUDENTS FROM OTHER PROFESSIONS?
Do you wish to comment on the impact this article has had on you? Please see the information about Speech & Language Therapy in Practice’s Critical Friends at www.speechmag.com/About/Friends.

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