A finishing touch

Throughout my blog, I'm sure you can understand that I am incredibly passionate about the support required by OT's for tertiary students looking to return to study after trauma. Looking at the facts, 10.5% of New Zealanders have potential needs that there simply isn't any current funding or facilities to meet. To me, this seems like a real injustice based on the fact that the vast majority of these people are striving to further themselves and add value to the kiwi workforce and economy. There is an inexplicable inconsistency between the funding provided to those currently employed and students, the gap urgently needs to be closed.

As outlined by ACC, working can often aid recovery. Stimulated people are more motivated, and a desire to succeed in university study having overcome adverse circumstances could well shine posative influence through to other factors of life.

I hope my facts and opinions, much of which have been based on personal experience encourage you to think about the issues I have presented in ultimately making a step to a more supportive, holistic and beneficial relationship between post-trauma student looking to return to study. 

Thank-you all for following    

A typical 'graded back to study' program

Filling the gap: 'OT's for tertiary'

What will this 'OT's for tertiary' service look like?
 It will be a holistic Occupational therapy service.
Based on the 'model of human occupation' (MOHO) a client centred framework. This framework is based on the person as a human system, how the environment presses and affords on that human system, and as a result what is the occupational behavior of that person.   
Also the bio-mechanical framework, which is divided into three areas of intervention, compensation, prevention and maintenance. Compensation is where OT's can issue students equipment to compensate for their physical deficits within the class room/ lab/ tutorials/ office and wherever else the student needs to be as apart of their studies. Prevention is where the OT can prescribe activities that will prevent further physical deformity. Maintenance, is the prescription of activity, positioning, to maintain the students current physical abilities, so that they can continue to study.
 
How would students access this sort of service? 
Anyone with a physical deficit that has affected them part-way through their tertiary study can be referred. Referrals will be accepted by hospital OTs, tertiary study staff, self referrals, friends and family.







Is one Occupational therapist per university needed? 
No, I think if we took this sort of approach, some of the smaller Polytechnics and tertiary study providers will miss out on funding, therefore it will not be a sufficient.

Will one private community service cover a city?
Yes, this approach will be location specific. In larger city's there will be more than one office for students to access. Any one office will cover all tertiary study providers in the area, and has access to all of New Zealand 'OT's for tertiary' offices to gain and exchange information if a student is looking to change their location of study. 

What is student friendly?
Accessible, close to tertiary study providers, being treated as an individual, good therapeutic relationships, a community service.

Do we need tertiary study providers to advertise our services for us?  
 Yes, we will have a partnership with the tertiary study providers, they will advertise for us and we will keep their students returning after trauma. Part of being student friendly is also about advertising in the right places so that the students are knowledgeable about our service, ensuring the students find us approachable and supported by their study provider.


Who will fund us? Private, government, tertiary study providers? 
 I think the first place I would be applying for funding would be the New Zealand education board for government funding. The government, as I have said before, views students as 'employed' so just as we return paid employees to work, let's apply for funding so we can return our studying 'employees' back to work. If we don't come away with 100% of funding from the government, I will then hold conferences with the larger tertiary study providers. I will educate them of our service, present the financial and personal benefits and apply for a top-up of funding from the study providers.


How will we ensure we will have the knowledge to help these students gradually get back in to their wide variety of courses? 
Simply the students will educate the OT's on their individualistic courses, so that they can learn about the demands, expectations, hours, roles, performance and participation the student has. We then have the skills and knowledge to do study space assessments looking for things pressing and affording in the study environment. With all this knowledge the OT's can provide grading back to study programs.

What process will 'return to study' follow?
A grading process, it will look different for each individual, depending on physical capabilities, mental capabilities, course studies and other daily demands on the individual. Refer to the picture above for a framework of how a typical graded back to study program might look. 



Will there be any other professionals/ therapist that will be involved in this service? 
Yes, I would like to see a careers adviser be a part of this service. This role will help students who are thinking about a potential change in study path. Together the careers adviser and the student can look at interests, new/old experiences, and potential paths the student could take. They will ensure practical aspects of the student's recovery are considered in partnership with the OT.
Depending on the demands of the service, I would expect to need an assistant who has a relationship with the local tertiary study institutes. An assistant would help the students fill out all the correct paperwork for enrollment and cancellation of courses.

Thank-you to Denise Peter for sharing your experiences with us - you have a very good point: "We recognize students as 'employed' in our employment statistics, why treat study as second rate?"

The government is recognizing students in society in many ways; why then is it not recognizing that they too need support to continue with their choice of 'employment' after trauma?

So how will we fill this gap?

What will this service look like?
How would students access this sort of service?
Is one Occupational therapist per university needed?
Will one private community service cover a city?
What is student friendly?
Do we need the universities and polytechnics to advertise our services for us?  
Who will fund us? private, government, tertiary study providers?
How will we ensure we will have the knowledge to help these students gradually get back in to their courses?
What process will 'return to study' follow?
Will there be any other professionals/ therapist that will be involved in this service?
Is this service primarily for physical trauma or is there a need for a mental health Occupational therapy service too?


Do I have any comments or thoughts on this? Students, what would you like to see?

A changing society

According to 'Education counts', a New Zealand government web page, in 2010 (which is the most recently published study) there were 466,000 students enrolled in tertiary study in New Zealand. "Enrollments increased from 2009 to 2010. That is, domestic students took on considerably
higher study loads in 2010 (on average), a trend which began in 2008" (Ministry of education pg 10).

The current New Zealand population is estimated at 4,433,935 according to statistics New Zealand. This means approximately 10.5% of New Zealanders are enrolled in tertiary study at any one time.

With this steady increase in tertiary study enrollments, this means the amount of the population that is not having access to the appropriate rehabilitation services after physical trauma is also increasing.

As the social society changes, the formation of services providing for society need to change. 
So why is there no support available for individuals that are choosing to further their education, in turn to give back to New Zealand?

Is it funding? Is it not valued? Is this just my experience?

References:
Ministry of education, . (2011, February). Profile & trends: New Zealand's tertiary education sector. In Education counts. Retrieved July 24, 2012
http://www.educationcounts.govt.nz/publications/series/2531/p-and-t-2010-stage-1.

New Zealand Government, . (n.d.). Estimated resident population of New Zealand. In Statistics New Zealand. Retrieved July 24, 2012
http://www.stats.govt.nz/tools_and_services/tools/population_clock.aspx. retrieved 24/07/2012

What's next?

I think this is our domain of concern, to help these tertiary students get back into their study. I am obviously very passionate about this topic.

I believe tertiary studies are just as important and valuable as work, for rehabilitation. With regards to returning clients to roles, values, providing purpose, integrating clients back into the community and ultimately rehabilitating our clients so they can return to all their previous occuaptions that they value, whether it is work or study.

Do you all agree with me? What haven't I considered?

Should Occupational therapists fill this gap?

All that I have learnt over the past three years leads me to believe that yes, this is our role. I have found a gap in our services. Can we do something about it? 

As Occupational therapists, we believe that peoples occupations are influenced by their environment. We value peoples individuality, the events that have shaped them. Their values, beliefs and roles in life make them who they are.  We work with this knowledge to enable our clients to achieve satisfaction in daily occupations and roles that the individual values. 

So, how do we help tertiary students who would like to get back to study after physical trauma?

ACC education and employment support

ACC 'education support' is for "claimants who, owing to their injury, find it difficult to participate in their early childhood or school education." It should be noted that this specifically leaves out tertiary education.

ACC 'work readiness' and 'return to work' programs are a comprehensive process of assessment and treatment most commonly by an Occupational therapist.
"ACC has a range of options to help your patient recover more quickly. This includes workplace assessments, vocational equipment, transport assistance, and rehabilitation programmes." (ACC pg6)


ACC provide great supports for individuals wanting to go back to work, justifying this by stating that:

"Work is often the best place to recover from injury, because it can provide physical, personal and financial benefits:

·       physical - staying active by staying at work has been proven to help speed physical recovery

·       personal - social connections at work build confidence and self-worth, and can prevent depression

·       financial - it’s usually better to remain at work than spend time off on a reduced income." (ACC vocational rehabilitation document pg1)

 "Consider a graduated early return to work plan to help your patient to return to work safely as they recover. The activity and psychosocial benefits result in a faster, more durable recovery." (ACC pg6)

ACC return to work documents: 

http://www.acc.co.nz/publications/index.htm?ssNextRow=11&ssBrowseTitle=&ssBrowseCategory=&ssBrowseSubCategory=Return%20to%20work 

ACC social rehabilitation assessment guidelines: including return to education information.

 http://www.acc.co.nz/search-results/index.htm?ssUserText=education+guidelines

University disability support

What about the university disability support person at Massey University?
I was given support from a woman who had many roles. One aspect of her job was working as in Disability Support. She was amazing, however I was studying Design, majoring in photography, so she didn't have many supports to offer. She took on more of a councilor role for me, ensuring I was coping emotionally with university.  

Disability Support: "Disability Services strives to provide a flexible and responsive service that is focused on a student’s individual needs. This involves identifying how a health or disability issue is making study more difficult, and how Massey University can accommodate students so they can focus on their chosen course of study". The services listed are equipment loan, vision and hearing impaired support, assistance in lectures, note taking and assistance in exams.

None of these services listed were of any assistance with a design degree. We don't sit exams, have lectures, and there is no room for equipment in a photography dark room.

Massey University disability support services:
http://www.massey.ac.nz/massey/student-life/services-and-resources/disability-services/disability-services_home.cfm

My personal experience

I feel the best place to start is with my personal experience.
My mother and I were involved in a car accident. A northbound drunk driver, who was on the wrong side of the road, being pursued by the police crashed into our southbound vehicle. It was the beginning of my summer holidays between my university years.

My mother and I were treated very well by Wellington Hospital for a month.
My mother had an Occupational therapist who assisted with a Return to Driving training course, ran a gradual Return to Work program, conducted ergonomics work station assessments, memory strategies and brain exercises and issued equipment.
I had an Occupational therapist who issued me with equipment.

At this stage my amazing step sister had just completed her first year of Occupational therapy. She stayed home for the summer to be my own personal Occupational therapist. She taught me how to get around in my electric wheelchair, gradually introduced me back into the community and helped me find a wheelchair accessible flat in Wellington (what a mission)!

The ultimate goal was to enable me to return to university.

Three months out of hospital, still in an electric wheelchair, on regular morphine, tramadol and other pain medication with two hours a day of physiotherapy and I wanted to go back to university! I have been told I was warned off by family and friends but I don't remember these conversations. I had all the support in the world; I was 19 and was fiercely independent, had a 30hr a week job and was enrolled in full-time study. I "only" had injured limbs - why couldn't I go back to university?

Where was the professional helping me through this process?
I hugely valued and listened to evertything my physiotherapist told me to do. Was there a professional that could have helped me gradually get back into my daily occupations, such as university?
Was it someone in the same profession that helped my mother gradually get back into her daily occupations, such as work?

So what is Occupational therapy?

According to the World Federation of Occupational Therapists it is a: "client-centered health profession concerned with promoting health and well being through occupation. The primary goal of occupational therapy 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."


Reference:
What is occupational therapy? (2011). In World federation of occupational therapists. Retrieved July 5, 2012, from
http://www.wfot.org/AboutUs/AboutOccupationalTherapy/WhatisOccupationalTherapy.aspx

Hi all, my name is Rachael. I am an Occupational therapy student in my third and final year at Otago Polytechnic. I have vast personal experience and particular interest in exploring the role of the Occupational therapist (OT) in regards to returning tertiary students back to study similarly to the way in which we already return paid employees back to work. I invite you to follow my blog as I learn more about the OT role, where the gaps are and how we can potentially fill these gaps in the future for tertiary students.