This practice evaluation describes the implementation of a 2-day workshop on
psychosis with third-year undergraduate occupational therapy students at
Brunel University. The work was undertaken by the teaching team at Brunel
University, a clinical psychologist working in assertive outreach and an
occupational therapist working in community mental health. The background
to the project and the way in which the 2-day workshop was adapted to
accommodate the university timetable are outlined. An evaluation of the
workshop, its place in the occupational therapy programme and the feedback
from students are presented

Blank, A

Craik, C

Gallagher, M

Hayward, M

British Journal of Occupational Therapy

English

 This practice evaluation describes the implementation of a 2-day workshop on psychosis with third-year undergraduate occupational therapy students at Brunel University. The work was undertaken by the teaching team at Brunel University, a clinical psychologist working in assertive outreach and an occupational therapist working in community mental health. The background to the project and the way in which the 2-day workshop was adapted to accommodate the university timetable are outlined. An evaluation of the workshop, its place in the occupational therapy programme and the feedback from students are presented. </jats:p

Alison Blank

Mark Hayward

Christine Craik

Margaret Gallagher

Crossref

Enabling Occupational Therapy Students to Take a Fresh Approach to Psychosis

Brunel University Research Archive

42 British Journal of Occupational Therapy January 2006 69(1)Introduction In 2000 the British Psychological Society published a reportexploring the psychological and social understandings ofpsychosis, which was welcomed by user and survivorgroups because it challenged the traditional biomedicalapproach. It also received positive comments from bothpsychiatrists and the Department of Health. A keyrecommendation was that there was a ‘need for a nationalprogramme of training for mental health workers toenable them to make use of the ideas and information inthe report’ (Cooke 2000, p7). This hope became a realitywhen in 2001 the Department of Health funded thedevelopment of a number of learning materials, one ofwhich formed the basis of a 2-day workshop. This nowtakes the form of a training manual entitled PsychosisRevisited: a workshop for mental health workers (Bassettet al 2003).The aim of the 2-day workshop is to create a spacewhere participants can stand back and take a fresh look at psychosis and examine the ways in which they canwork more effectively with people who have psychoticexperiences. The workshop uses a mixture of teachingmethods and experiential exercises, including art, role play,mime and discussion, sharing in pairs, in small groupsand in the large group. A pivotal part of the workshop isthe opportunity to learn from service users’ experiencesand the workshop includes a session on ‘The service userperspective’. The workshop presents many challenges totraditional ways of viewing psychotic experiences,particularly the biomedical perspective. There is anemphasis on safety and support during the service usersession and throughout the entire workshop.The workshop addresses the following areas:■ The breadth of perspectives on psychosis andpsychotic experiences■ The value of service user views■ The meaning of psychotic experiences■ The importance of hope■ Barriers to recovery■ The development of alliances and partnerships■ Developing strategies and putting them into practice.Developing the workshop manualThe draft workshop manual was piloted with acommunity mental health team and an assertive outreachteam in a mental health trust in West Sussex, withextensive contributions from an occupational therapist(first author) working in partnership with a clinicalpsychologist (second author). Subsequently, the workshop was offered to workers without a professional training,acknowledging that their limited ability to influence thepractice of teams and organisations was traded againsttheir closer proximity and greater availability to serviceusers. Five workshops were delivered to approximately100 workers from a variety of inpatient, residential andday service settings. Pivotal to the success and credibility of the workshopswas the continued involvement of service users, who sharedtheir experience of psychosis and receiving services withina space that was made safe enough for them to contribute(Hayward et al 2005). Service user involvement wasorganised through the CAPITAL Project Trust (Clients AndProfessionals In Training And Learning, an organisationPractice EvaluationThis practice evaluation describes the implementation of a 2-day workshop onpsychosis with third-year undergraduate occupational therapy students atBrunel University. The work was undertaken by the teaching team at BrunelUniversity, a clinical psychologist working in assertive outreach and anoccupational therapist working in community mental health. The backgroundto the project and the way in which the 2-day workshop was adapted toaccommodate the university timetable are outlined. An evaluation of theworkshop, its place in the occupational therapy programme and the feedbackfrom students are presented.Enabling Occupational Therapy Students to take a Fresh Approach to PsychosisAlison Blank, Mark Hayward, Christine Craik and Margaret Gallagher43British Journal of Occupational Therapy January 2006 69(1)that promotes the views of users of mental health servicesin West Sussex), which took responsibility for the sessionon service user perspectives. The pilot workshops were invaluable in testing out thetraining material and led to redrafting and changes thatthe present authors felt greatly enhanced subsequentworkshops. They also demonstrated that there are peoplewithin mental health services with both the desire and theability to provide training and education across thetraditional professional and user /provider boundaries.Following the publication of the manual by Bassett et al(2003), this desire led to the delivery of workshops acrossa range of disciplines. All subsequent workshops run bythe authors of this paper have been based on the PsychosisRevisited training manual. Of significant benefit duringthis process has been the increasingly collaborative andpersonal nature of the relationship that is evolvingbetween trainers and the local service user organisation.Further changes to the workshop were made inresponse to feedback and modifications have been made to the range of teaching methods to engage participants.Acknowledging that the workshop manual provides aframework for training that can be modified according tolocal need and context, activities such as mime, role playand visual demonstrations were introduced to engage anaudience for whom didactic teaching may be relativelyunfamiliar. Within professional education programmes,part of the workshop has been delivered to the Doctoralprogramme in Clinical Psychology at the University ofSurrey. As stated above, the authors of this paper havebeen keen to disseminate the workshop widely amonggroups of professionals who work with people whoexperience psychosis. Occupational therapists clearly are part of this group of professionals and an opportunityto deliver a workshop was presented to the authors via the first author’s contact with the undergraduateprogramme at Brunel University. The workshop alsoprovided an opportunity for an occupational therapyeducation and training course to operationalise some ofthe values that underpin the Ten Essential SharedCapabilities (Hope 2004), a Department of Healthframework for the training of the mental health workforce. AimThe aim of this practice evaluation was to establish if theworkshop could be successfully delivered as part ofundergraduate occupational therapy education and toobtain the views of students on its relevance. MethodAn approach was made to Brunel University, who provideboth a full-time and a part-time programme for a BSc (Hons)Occupational Therapy. At level three of the degree, a 20-creditmodule, ‘Contemporary issues in occupational therapy’, is delivered in the final weeks of the programme, whichenables both staff and students to reflect on the educationalready provided and to identify aspects requiring furtherdevelopment. These are then incorporated into a lectureand seminar programme, which assists students to select a topic to study to complement their experience on the degree. In 2004, among the topics identified bystaff was user involvement in intervention. Therefore, the workshop seemed a useful way to highlight thisimportant topic. The challenges of the implementation of the workshopwith occupational therapy students were many. Therewere two main areas of concern. One was the difficulty ofincorporating the workshop within the existing universitytimetable; the other was the challenge of delivering aworkshop designed for groups of 20-25 participants to acohort of 110 students. Following discussion about thepossibility of delivering the workshop to a small numberof students, a decision was made in the interests ofequality that all students should have the opportunity toreceive this training. At Brunel University various teaching methods areused, including small group seminars of around 16 studentsled by a member of staff, and it was decided that theworkshop materials could be disseminated through seminarleaders acting as workshop facilitators. Two seminars, eachlasting 2 hours on consecutive weeks, were used to deliverkey elements of the workshop. In addition, a large groupsession of 2 hours for all 110 students was used to presentthe service user perspective session. The seminar leaderswere provided with detailed seminar plans designed by thefirst author, who is an occupational therapist and visitinglecturer at Brunel University and therefore familiar withthe teaching methods used.Presenting service users’ perspectives was an additionalchallenge. Although two service users had extensiveexperiences of training, this had been in smaller groupsand here it was proposed to deliver this section of theworkshop to 110 students in a large lecture theatre. There were concerns about the loss of the intimacy andthe impact of delivering in this way. One of the serviceusers felt unable to speak in front of so large a group andher story was therefore presented via a video recording.The other service user initially felt able to address thegroup, but on the day of the workshop he was unable to participate in the session: he had been becomingincreasingly unwell over the days and weeks leading up to the workshop and his wife felt that it was unsafe for him to drive. The facilitators therefore decided toproceed using a videotape of one of the service users. It is clearly not ideal to use a videotape in place of a liveinterview and the facilitators were aware of the lack ofbalance in the two service user stories (one is verynegative while the other is a more positive, hopeful story). However, the facilitators took the view that it was necessary to have a pragmatic approach to teachingand to be flexible.44 British Journal of Occupational Therapy January 2006 69(1)Ethical considerationsAs part of quality assurance at Brunel University, allmodules are routinely evaluated by an end-of-modulewritten evaluation form and, in this instance, all thestudents were aware that this was a pilot piece of work.The evaluation was confidential and anonymous. Byattending the workshops and completing the evaluation,consent was implied. The two service users’ participationwas on an entirely voluntary basis and unpaid except fortravel and other expenses.FindingsFrom a cohort of 110 students, 48 evaluations were returned.Nine of these forms evaluated the whole module ratherthan just the workshop so these forms were discounted for this evaluation. The evaluation of the workshop wastherefore based on 35% of responses. From the qualitativecomments, four main themes emerged. Importance of the service user perspective The majority of the students cited the service userperspective as the most useful aspect of the workshop,particularly exploring the role of professionals and theimpact of client-centred practice. The studentscommented on the value of hearing at first hand aboutpeople’s experiences of using mental health services. Many felt that they had learned something that theywould remember in future practice – a lesson abouttreating people with respect and humanity:This has been an excellent experience, the focus on the patient being the expert and learning/listening and hearingyour patients has opened my eyes …Some students, however, felt that the workshop in generaland the service user session in particular were ratherunbalanced and biased against the medical model. Onestudent noted, ‘Not all doctors are megalomaniacs!’ Client-centred practice The students felt that the workshop enabled them to grasp more fully the concept of client-centred practice and to understand the client’s perspective on thisapproach to therapy:The involvement of service users and their stories reallymade me realise the importance of being client-centred and listening.A really useful workshop which made me think about how we as professionals should be working with clients (in a client-centred manner).I was able to gain further insight into what client-centred really means.The College of Occupational Therapists’ Code ofEthics and Professional Conduct (COT 2005) states thatservices provided to clients should be client-centred. Withthis approach to practice at the centre of assessment andtreatment, it is important to note how central this was formany students. Teaching methods The students commented positively on the teaching andlearning strategies used in the workshop and seminars and valued the interactive element of the seminars. Theystated that this approach had helped to develop furthertheir understanding of psychosis. The content of theworkshop was popular with its interactive discursive style, mixed teaching methods and wide range ofperspectives on psychosis. Others commented on the wayin which the workshop was arranged. One would haveliked more context for the workshop in terms of itsdevelopment; another would have preferred smallergroups and more continuity in terms of facilitators andless of a time lapse between the first and second parts of the workshop. Timing of session The majority of the students felt that the workshop wasinappropriately placed at the end of the undergraduateprogramme and would have been more useful if it hadcome earlier in the programme at level one or two. Somecommented that they found it difficult to understand why the topic had been included in this module and thatthey felt they understood the issues in question already.However, one student felt that it had enabled a review ofprevious learning and experiences.ConclusionThe part of the 2-day workshop that usually makes thebiggest impact is the session on the service user perspective.This was no exception in the Brunel University version ofthe workshop, where students clearly valued this aspect of the experience. An emphasis upon client-centredpractice was also pivotal to the students’ experience of theworkshop, reinforcing the philosophy for occupationaltherapists enshrined in the Code of Ethics andProfessional Conduct (COT 2005). Overall, the students appreciated the teaching methodsused in the module and this appears to endorse thedecision to use Brunel University lecturers to deliver thematerial in this way. Many students commented on the timing of theworkshop at the end of the final year of the BSc (Hons)Occupational Therapy, with most suggesting that it shouldbe delivered earlier in the degree. This advice has beenheeded and has influenced the relocation of the workshopto the second year of the degree for future cohorts. The value of including the workshop in the degree was encapsulated in the words of one of the students: ‘I’m really pleased we were given this opportunity. It hasbeen a positive experience … which I will be able to useand think about in … practice.’45British Journal of Occupational Therapy January 2006 69(1)References Bassett T, Cooke A, Read J (2003) Psychosis Revisited: a workshop formental health workers. Brighton: Pavilion.British Psychological Society (2000) Understanding mental illness: recentadvances in understanding mental illness and psychotic experiences.Leicester: BPS.College of Occupational Therapists (2005) College of OccupationalTherapists: Code of ethics and professional conduct. London: COT.Cooke A (2000) Pressing home the truth. Openmind, 105, Sep/Oct, 7.Hayward M, West S, Green M, Blank A (2005) Service innovations: serviceuser involvement in training. Psychiatric Bulletin, 29, 428-30.Hope R (2004) The Ten Essential Shared Capabilities – a framework for thewhole of the mental health workforce. London: Department of HealthPublications.Authors Alison Blank, DipCOT, MScOT, Senior Occupational Therapist, MidhurstCommunity Mental Health Team, West Sussex Health and Social CareNHS Trust, The Old Court House, Grange Road, Midhurst, West SussexGU29 9LT. Email: alison.blank@wshsc.nhs.ukMark Hayward, BA(Hons), DClinPsy, CPsychol, Chartered ClinicalPsychologist, Worthing Rehabilitation and Assertive Outreach Teams,West Sussex Health and Social Care NHS Trust.Christine Craik, MPhil, DMS, DipCOT, MCMI, ILTM, Director ofOccupational Therapy, Brunel University, Osterley Campus, BoroughRoad, Isleworth, Middlesex TW7 5DU.Margaret Gallagher, DipCOT, MA, ILTM, Lecturer in Occupational Therapy,Brunel University, Osterley Campus, Borough Road, Isleworth,Middlesex TW7 5DU.

Blank A

Occupational Therapists (2005) College of Occupational Therapists: Code of ethics and professional conduct.

Pressing home the truth.

Psychosis Revisited: a workshop for mental health workers.

Understanding mental illness: recent advances in understanding mental illness and psychotic experiences.

Enabling occupational therapy  students to take a fresh approach to psychosis

Enabling occupational therapy students to take a fresh approach to psychosis

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