CPD: How occupational therapy can strengthen occupational health

Occupational therapy working with occupational health – a perfect match too long in the making? Mark Howard looks at how collaboration could bring about a ‘workplace health service’.

As OH practitioners are being urged to develop more educative and preventative solutions, working more closely with occupational therapists – who have specific expertise in rehabilitation – would appear to be a progressive and valuable step.

The working world is so different after the pandemic, and we need to reflect this in our practices. Innovative ways of supporting employee health and wellbeing can be seen in initiatives like the Growing Occupational Health and Wellbeing Together programme (NHS, 2022) and the Total Worker Health programme in the United States (National Institute for Occupational Safety and Health, 2022). This innovation is needed.

A ‘workplace health service’ (WHS), bringing together the expertise of OH and OT, could bring about an innovative, transformative, workplace approach to the management of injury, illness and rehabilitation.

Dr Richard Heron was recently quoted saying: “It is OK to challenge the status quo; especially in workplace environments that have ever changing business needs” (Make a Difference Media, 2023). We have been talking about OH transformation for long enough now, as can be seen in the online guides Talking Work (The Council for Work and Health, 2019); Health and work: what physicians need to know (Walker-Bone & Hollick, 2021); and Supporting ill or disabled individuals in (to) work (Frank, 2016).

Transformation has been too slow

Whilst a trustee for the Vocational Rehabilitation Association (VRA), I had the fortune to meet and discuss with Dame Professor Carol Black, while she worked on “Working for a Healthier Tomorrow” (Black, 2008), at the state of OH and the need for a more multidisciplinary approach. That was over 15 years ago. More recently she has stated that, “the OH community moved too slowly for my liking after 2008, but Covid-19 could be a great opportunity for development, not entirely an enemy.” (The At Work Partnership, 2020).

Much has been said about the need for a strong collective voice that embraces a multidisciplinary ethos; with various professional groups working closely together to influence and deliver better employee health more effectively (The At Work Partnership, 2015).

This now needs action. Dr Steven Boorman CBE recently said that, “OH needs to become genuinely proactive and accept the necessity to change and adapt”, while Professor Almuth McDowall, Birkbeck University of London, has said, “OH has to get better at rehabilitation” (Health and Wellbeing @ Work, 2023).

Hazards affecting today’s workplaces are not just physical; they are often to do with poor relationships, insecurity (financial and/or job), the working environment, or a mismatch between an employee’s sense of purpose and that of the employer. They demand OH professionals to consider multidisciplinary vocational rehabilitation, starting with the OH’s relationship with occupational therapy.

Why should OH work with occupational therapists?

Why start with OT? Quite simply because OT is a client-centred health profession concerned with promoting health and wellbeing through occupation.

OT was founded upon principles related to the benefits of work and supporting people with health conditions to gain or return to paid employment. As the only healthcare profession to work across physical and mental health, with a focus on occupation (people’s everyday activities), there is now a serious call being made for every OH team to include an occupational therapist (Royal College of Occupational Therapists, 2020).

The primary goal of OT is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement (World Federation of Occupational Therapy, 2012).

It is perhaps a story, so far, not well told. Work is integral to the ethos of OT. An occupational therapist offers advice and support at a range of levels; universal, advice on work for people with health conditions; targeted, developing vocational services that support people to return to/remain in work; and specialist, working with OH departments to support the health and wellbeing of employees (Royal College of Occupational Therapists, 2019).

What do OTs do?

OT practitioners are distinctly qualified to analyse the relationship between the person, environment, and occupation in order to promote participation in everyday life. They use a combination of “detailed occupational analyses; activities graded to meet personal needs; explicit time for planning to encourage balanced participation; education to provide individuals with the information about their occupational situations, with which to empower an individual to effect change; focused efforts to capitalise on strengths and build skills; and consultation and environmental modification to secure the best match between the person and the occupation in which she or he is seeking to participate” (Krupa et al., 2009).

OT is client-centred. Therapists “work collaboratively with people in a manner that helps to foster hope, motivation, and empowerment, as well as system change” (American Occupational Therapy Association, 2016).

Occupational therapists are experts in advising on future care and rehabilitation needs. Depending on the type and severity of the injury or illness, an employee may require ongoing medical care, OT, physiotherapy, community care, or psychological therapy.

Therapists are well placed to provide input on the extent of care, the future care needs of an employee, future costs, and the likelihood of recovery and return to/remain in work. They are invaluable in assisting businesses to make informed decisions on planning return to work pathways. Structured OT interventions have delivered better functional and economic outcomes (Rahja, et al., 2018).

Occupational therapists are used to designing, justifying, and creating detailed cost estimates. OT is cost effective (Rexe, et al., 2013) and has been proven to be so in a number of settings (American Occupational Therapy Association, 2016) including the NHS (Julia Scott, 2017) (Alison Keir, 2020) and social care in the UK. Wider evidence has been provided from a global perspective.

Replicating such effectiveness in the workplace would add significantly to the overall value proposition of an integrated OH service and would develop a ‘workplace health service’ (WHS).

Occupational therapists specialise in the area of adaptive equipment and home modifications. This is hugely important when looking at the modern work environment in respect of employer responsibility/liability, workplace adjustments and assistive technology alongside the demands for hybrid, remote and flexible working.

They are well-versed in assessing and determining the capacity of an employee to return to work. In some cases, an occupational therapist may conclude that an employee is unlikely to be able to return to their previous occupation following an injury or illness. If so, they will be able to explain in detail how the loss of physical and mental functioning is likely to prevent their return to work; even helping them find alternative work.

What would a workplace health service look like?

An OH/OT-led WHS would incorporate vocational rehabilitation (VR), focusing attention on the sustainable return to/remain in work.

VR is an enormous topic, not widely understood, that embraces a large number of skills. Its principles are used in a wide variety of ways in virtually all medical situations where the worlds of work and health/ability coincide.

VR is “ whatever helps someone with a health problem to stay at, return to and remain in work. It is an idea and an approach as much as an intervention or a service” (Waddell, et al., 2008).

VR takes three forms: preparing those with a disability, physical or mental health condition for the world of work, job retention for those in work and assisting those out of work into new work (Frank, 2016). It is a multidisciplinary intervention offered to those with physical, psychological and/or social difficulties, enabling a return to work or preventing loss of work. Techniques used can include:

• assessment, appraisal, programme evaluation and research
• goal setting and intervention planning
• provision of health advice and promotion, in support of returning to work
• support for self-management of health conditions
• making adjustments to the medical and psychological impact of a disability
• case management, referral, and service co-ordination
• psychosocial interventions
• career counselling, job analysis, job development, and placement services
• functional and work capacity evaluations.

We need to look toward the management of illness and injury through a VR lens. Early intervention only works when it is immediately supported by focused and appropriate therapeutic assessment of function (physical and cognitive) and interventions that deliver a return-to-work prognosis within appropriate, specific, sustainable and consensual pathways.

Currently, too little is really understood about just how effective a multidisciplinary VR approach is (Momsen, et al., 2012), especially when integrated within a return-to-/remain-in-work philosophy that accelerates the introduction of therapeutic interventions, assessment and implementation of workplace adjustments and the use of assistive technology. This acceleration enables earlier informed decision making and reduction in overall costs.

The approach will also enhance an organisation’s equality, diversity and inclusion practices, as well as corporate social responsibility programmes.

OH needs to expand its therapy-led programmes and educate organisations on the value of a vocational rehabilitation model. OT is a relevant part of the whole rehabilitation programme (Cole & Tufano, 2008).

The trend of organisations reviewing their workplace health and wellbeing strategies has been evident in recent times.  It is now even more important that we drive the conversation around how a focused, targeted, integrated WHS might be structured. OH and OT, with evidenced and proven value-based outcomes (Desiron, et al., 2011) working more closely together should be the starting point.

References

Alison Keir, 2020. Agenda: We need occupational therapists now more than ever. Herald Scotland. Available at: https://www.heraldscotland.com/news/18842639.agenda-need-occupational-therapists-now-ever/

American Occupational Therapy Association, 2016. Fact Sheet – Occupational Therapy’s role with mental health recovery. Available at: https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/MH/Facts/Mental%20Health%20Recovery.pdf

American Occupational Therapy Association, 2016. Occupational Therapy’s distinct value – mental health promotion, prevention and intervention. Available at: https://www.aota.org/-/media/corporate/files/practice/mentalhealth/distinct-value-mental-health.pdf

Black, C., 2008. Working for a Healthier Tomorrow, Norwich: The Stationery Office. Available at: https://www.gov.uk/government/publications/working-for-a-healthier-tomorrow-work-and-health-in-britain

Cole, M. B. & Tufano, R., 2008. Applied Theories in Occupational Therapy. Slack Inc.

Desiron, H. M., de Rijk, A., Van Hoof, E. & Donceel, P., 2011. Occupational therapy and return to work: a systematic literature review. BMC Public Health. Available at: https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-615

Frank, A., 2016. Vocational Rehabilitation: Supporting Ill or Disabled Individuals in (to) Work: A UK Perspective. Healthcare. Available at: https://pubmed.ncbi.nlm.nih.gov/27438864/

Health and Wellbeing @ Work, 2023. Delving into the Future of Health and Wellbeing at Work.

Julia Scott, C. R., 2017. Occupational therapy could save NHS and social care – but don’t call us OTs. Healthcare Network. Available at: https://www.theguardian.com/healthcare-network/2017/may/04/occupational-therapy-nhs-social-care

Krupa, T. et al., 2009. Doing daily life: How occupational therapy can inform psychiatric rehabilitation practice. Psychiatric Rehabilitation Journal, 32(3), pp. 155-161. Available at: https://pubmed.ncbi.nlm.nih.gov/19136347/

Make a Difference Media, 2023. Occupational health is best placed to lead the workplace wellbeing agenda. Available at: https://makeadifference.media/mental/occupational-health-is-best-placed-to-lead-the-employee-wellbeing-agenda/

Momsen, A.-M.et al., 2012. Multidisciplinary team care in rehabilitation: an overview of reviews. Journal of Rehabilitation Medicine, 44(11), pp. 901-912. Available at: https://pubmed.ncbi.nlm.nih.gov/23026978/

National Institute for Occupational Safety and Health (NIOSH), 2022. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/niosh/twh/default.html

NHS, 2022. Growing Occupational Health and Wellbeing Together: Our Roadmap for the Future, London: NHS England. Available at: https://www.nhshealthatwork.co.uk/growingoccupationalhealth.asp

Rahja, M. et al., 2018. Economic evaluations of occupational therapy approaches for people with cognitive and/or functional decline: A systematic review. Health and Social Care in the Community, 12 3, 26(5), pp. 635-653. Available at: https://pubmed.ncbi.nlm.nih.gov/29532555/

Rexe, K., Lammi, M. B. & von Zweck, C., 2013. Occupational therapy: cost-effective solutions for changing health system needs. Healthc Q. 2013;16(1):69-75. PMID: 24863311. Available at: https://pubmed.ncbi.nlm.nih.gov/24863311/

Royal College of Occupational Therapists, 2019. Good Work for Good Health – The difference Occupational Therapy makes. Royal College of Occupational Therapists. Available at: https://www.rcot.co.uk/news/latest-rcot-report-shows-value-occupational-therapists-helping-people-work

The At Work Partnership, 2015. Council for Work and Health – pulling together the strands of OH. Occupational Health at Work, 12(2), pp. 14-18.

The At Work Partnership, 2020. Occupational Health: The next decade. Occupational Health at Work, 17(4).

The Council for Work and Health, 2019. BREAKING NEWS! Talking Work. Available at: https://www.councilforworkandhealth.org.uk/news/breaking-news-talking-work

Waddell, G., Burton, K. & Kendall, N. A., 2008. Vocational Rehabilitation: What Works, For Whom, and When? Vocational Rehabilitation Association UK. Available at: https://vrassociationuk.com/resources/vocational-rehabilitation-what-works-for-whom-and-when/

Walker-Bone, K. & Hollick, R., 2021. Health and work: what physicians need to know. PubMed.gov. Available at: https://pubmed.ncbi.nlm.nih.gov/33947660/

World Federation of Occupational Therapy, 2012. Available at: https://www.wfot.org/