Part 4: Of culture shocks, mentors and a professional language

Moving to the north west of England on a cold, wet day in January 1991 was an experience. We were moving to a small, one-bedroom flat in the grounds of one of the local hospitals (with it's own duck pond) and so much of our stuff was going into storage temporarily - as it turned out it was two years before I saw a lot of my things again - it felt like christmas when we finally received it all. We were also unable to have pets in the flat so my two beloved cats went to stay with my parents - however after 2 years they had settled and it was unfair to move them again - so they stayed.

Everything that was staying in the flat was dumped into one room. As the removal men drove away - I looked around and then burst into floods of tears - what had I done!

Make the bed - my Mum always used to say the first thing to do was make the bed - then you always had a place to go that was calm and ready for you when it all got too much.

We soon settled into the place - although realised that the lovely chapel next door was in fact being used as the morgue and at night we would often hear trolley's trundling over the cobbled road leading to the chapel ..... and the flat was haunted!

The culture change moving from East Anglia to the northwest was more difficult than I realised. The pace of life, the cultural references, the very nature of the people felt so different. It did take me a while to adjust and to be honest I'm not sure I'm totally there yet - a big piece of my soul belongs in the Fenlands and the coastal region of the east of England.

My induction involved various meetings at different hospitals and clinics around the borough - before the days of satnav! I lost count of the times I got lost - I had an A-Z and each night would study the next day's route (I felt as though I was in training for "The Knowledge") - but unless you know the area and which way is West or South with unfamiliar place names you were stumped. I'd also not had much experience on motorway driving (we don't have motorways in east anglia) so all in all a STEEP learning curve.

I was made to feel very welcome in my new role as Head OT for Mental Health and soon felt part of the team. I consciously became "Angela" rather than the "Angie" I had been known as in Norfolk. I expected this to give me a little more gravitas, I should be a grown up as I was in a responsible role, everything else was changing - so might as well have an identity change as well! Not sure it made a great deal of difference.

It was a good experience to work with so many OTs and technical instructors but it soon became apparent that as a whole the occupational therapy service was not being used to the best advantage of the patient group. The OTs had already made a great start in making changes and I learned a lot from them - not least all about the new models of practice that had been developing. I supported their intentions and took up the baton.

For the first year or so we worked on developing a service that was using the developing evidence based practice. We adopted Kielhofner's Model of Human Occupation which gave us our professional language and helped us to explore roles and boundaries with our multi-professional team colleagues. This was not an easy road by any stretch of the imagination and we had many battles and disagreements - most especially with a few of the Consultant psychiatrists.

The Science Bit:

We moved away from the "one size fits all" engagement in group activities and ensured that referrals were only received for assessment rather than for prescribed activity. This meant that we were able to treat each person as an individual and look at their needs with them and therefore develop a treatment approach that would enable them to meet their goals (with some it may be independence, with others a return to work, greater self-esteem, developing communication skills etc). Using occupations that held positive value to them we were able to facilitate choice and balance - all these things were starting to be explored more fully as the relationship between wellbeing, health and occupation (those things we need, have and want to do on a daily basis) was explored in occupational science.

Using our professional language and the language of the model we were able to respond to those who said "anyone can teach someone to bake scones" and explain how we are trained to analyse the form of the occupation, the developmental structure of the individual ( look at what motivates them, what they value, what habits, roles and routines they have or would like to obtain) then grade the occupation to consider mastery and control, adapting either the form, the environment or the skills/knowledge of the individual in order to meet a specific goal. We use occupation to assess and to treat.

This was a successful strategy and the OT service grew. As the 1990 Community Care Act kicked in then community mental health teams in both adult and older adult services were formed and it was good to see that occupational therapy was identified as a core member of each of these teams. Eventually the day hospitals closed (along with our light workshops and craft/skills areas) and all of our work began to take place in local environments and community based facilities - all good development but a small part of me mourns the loss of the light workshops.

We had fun too - I worked with such a great group of people in a shared office with nurses, OTs and Technical Instructors. There was a lot of teasing and a lot of support on offer. In the early years at the Day Hospital we would have fund raisers (Madame Angela put in another appearance) and each December the staff would serve the Christmas dinner in fancy dress (always snatch an opportunity to dress up!). There seemed to be endless celebrations of leaving do's, babies, marriages, promotions etc with either a meal out, or ordering the pies in!

During these times, I did hold a small caseload but I tended to work with more complex behavioural cases and held a weekly social skills training group working mostly with the patients who had a diagnosis of schizophrenia. I loved these groups! Much of my work also involved clinical/managerial supervision of the occupational therapy staff (I think there were 27 in all and one art therapist) and the continuing development of the service in line with new changes. There seemed to be so many changes with major overhauls of the NHS including Purchaser/Provider splits, GP fundholders/commissioners and then the advent of NHS Trusts as the NHS became a political pawn (but that's not for this blog).

After a few years a change of management occurred and we got a new boss. It was then that I understood the value of having a mentor - and hopefully she won't mind being named - Linda Agnew!

I was encouraged and supported to take a BSc(Hons) degree to top up my diploma - I chose to do a degree in Health Management at Lancaster University with specific specialism in Ethics and Law in healthcare. Wow - what an eye opener! It made me more aware of wider issues and the value of stretching the mind. I was also encouraged to work with a small team to set up our own Fieldwork Educator's training programme (for training those OTs taking students). These were usually provided by the local HE institutions - but with the support of the University of Salford we ran many successful courses that also started to include other professional groups too. It was because of this my interest and skills in teaching developed. I was also awarded Recognised Teacher status at John Moores, Liverpool University around this time and delivered a few sessions to the occupational therapy undergrad students.

In 1999 I was seconded for a year to the Greater Manchester West Confederation to design and deliver a multi-professional fieldwork educator programme for allied health professions. Again, working with a couple of experienced OTs from University of Salford who had started to create such a programme with a few of those groups, I developed a programme with optional Level 6 credits that was recognised by the professional bodies of Occupational Therapy, Physiotherapy, Radiography, Podiatry, Dietetics, Speech & Language, Prosthetics & Orthotics and Audiology.

1999 was a successful year as I completed the development and first delivery of the programme, graduated with a 2:1 degree in Health Management and, after 10 years of living together, Steve and I decided to get married and set about organising the wedding to be in 2000 in Cromer.

A lecturer role came up at University of Salford towards the end of 2000 which I applied for and was successful - so I moved the focus of my career once again from management to education/academia and started my lecturer probation period in October 2000.

TO BE CONTINUED...................................

Part 1:Validation, the Early Years

https://ichabodsday.blogspot.com/2020/09/validationthe-early-years.html

Part 2: Of First days, Roles and Responsibilities

https://ichabodsday.blogspot.com/2020/09/of-first-days-first-roles-and.html

Part 3: Developing, Progressing, Evolving

https://ichabodsday.blogspot.com/2020/09/part-3-developing-progressing-evolving.html

Part 4: Of Culture Shocks, Mentors and A Professional Language

https://ichabodsday.blogspot.com/2020/09/part-4-of-culture-shocks-mentors-and.html

Part 5: Technology, Publications and Collaborations

https://ichabodsday.blogspot.com/2020/09/this-next-period-spans-20-years-so-i.html

Part 6: Of National and International Involvement, Swansongs and Goodbyes