I recently had some time, when first stuck at home because of recent events, and while reflecting on the impending changes about to happen because of Covid-19, realised my learning from a project running between in 2011 and 2012 to address healthcare delivery challenges facing Cornwall might be useful to fellow OT’s. This work was to become the focus for another 2 years as part of a PhD application and early pilot study entitled; “Addressing healthcare delivery challenges facing Cornwall; does service-user participation improve wellbeing and promote early adoption?”
Cornwall by its location in the far Southwest of England stretches from its border with Devon right down to Land’s End and includes the archipelago Isles of Scilly. This narrow county means that many families would need to travel for over 2 hours to attend therapy, and in holiday traffic over the summer this might be even longer.
For those just over the water, on the beautiful Isles of Scilly, this is even harder; tricky weather, travel and accommodation costs being formidable barriers.
This work was to be a part of my intended PhD. An innovative solution to a rural problem, some of the answers are now applicable in this challenging time while we find creative workarounds because of Covid-19.
In 2013, when I started my PhD. Journey it was to solve a local problem. At the time, my learning and ideas were used to inform a parent education programme developed by a national organisation providing parent education about Ayres’ Sensory Integration online. Sadly this was without my direct participation.
The pilot work I did before my PhD, allowed us to move swiftly to offer our first webinar about remote working to help occupational therapists address some of the delivery challenges facing us all during Covid-19.
This article below is part of my early writing for my intended PhD. It was a solution to address healthcare delivery challenges facing rural Cornwall and the Isles of Scilly entitled, “Does service-user participation in design improve wellbeing and promote early adoption?”
The solution then was to explore how best to deliver and support families with sensory integration challenges using telehealth to do this online.
Sadly, although I completed the initial pilot study and early focus groups, sudden family illness meant I did not complete the rest of the exciting journey to complete my PhD.
However, this is a summary of my proposal and the relevant parts of my literature review presented at Falmouth University 2nd year PhD Presentations 2014.
Addressing healthcare delivery challenges facing Cornwall; does service-user participation improve wellbeing and promote early adoption?
New and emerging research is showing strong links between sensory integration and processing difficulties and problems in development, behaviour, and ability to carry out activities of everyday life.
Ayres’ Sensory Integration (Ayres, 1972) happens when a person uses sensory input from inside their own body and from the world around to understand the world, what just happened, is happening and what might happen next. To do this, the senses, nerves and the brain collect, filter and organise sensory information so it can be used.
Sensory Integration makes it possible for people to successfully carry out all the activities that make up our daily lives. When the senses cannot be adequately integrated or do not work as well as they should, life becomes hard, and some things are impossible to do. Sensory difficulties can make coping with feelings, getting along with others, moving about and doing things like working and play, learning and being able to care for themselves or others difficult. (Allen and Smith 2011)
In 2004 in Cornwall, UK, the author, an Occupational Therapist, developed and piloted a parent psychoeducation group run in a variety of ways; for 2 hours weekly over ten weeks, as a day workshop and various iterations in between. Since then, the delivery has also been online using technology, including via Skype.
This programme, Parenting through the Senses won an UnLtd award for innovation in 2007. It is an innovative combination of a crash course on the brain and interactive group support that offers parents and carers the opportunity to learn together about how the brains’ ability to take in, process, integrate and respond to sensory inputs is critical to everyday life and wellbeing. There is also time to talk and share fears and solutions while generating new ideas and possibilities.
While discovering their unique sensory preferences, parents and carers are supported to become ‘sensory detectives’. They learn to understand their children’s behaviours in terms of sensory integration theory. This learning and consultation, alongside a parallel parent support group, helps the parents to feel comfortable advocating about and creatively meeting their child’s sensory needs at home. They do this exploring practical ideas and ways to use available equipment to provide workable practical solutions at home, at school and out and about.
The programme was extended to neighbouring counties and abroad following positive feedback from the first three local courses and its impact on family lives. This model of psychoeducation, with consultation, coaching and peer support running parallel, has been used to set up similar projects other areas and online, where it has won awards and commendation.
Technology can be used to address health and social care delivery challenges facing Cornwall today; rurality, ageing, financial strain, family breakdown, and diffused population.
The project will interrogate and build on ongoing innovative clinical practice. Stage 2 will explore and exploit technology to be able to offer more parents and carers in disparate rural areas of Cornwall and on the Isles of Scilly (and further afield) early education and proactive preventative sensory-based approaches in an innovative way. Stage 3 would see parents enabled to deliver sensory strategies in the home.
The project will creatively apply contemporary design theory and practice to the development of a healthcare technology to address some of these challenges, informing development and prototyping of the healthcare technology, enhancing early adoption and user outcomes.
Early innovation theory describes a simple stepwise process (Rogers, 1995) now acknowledged as being too simplistic. In contrast Van de Ven et al. (1999) and Akrich et al. (20021) describe complex processes and methods to capture the non-linear complexity of the process, while Akrich et al. (2002) also focuses on the interactive processes throughout the phases of iteration.
Historically Occupational Therapy (OT), rooted in the medical model, used quantitative methodologies to demonstrate efficacy. (Jadad et al., 2003). A dialectical shift from clinician centred quantitative to qualitative research reflected OT’s early adoption of client-centred practice (CAOT 1991), including processes for individualised problem identification and intervention. (Townsend and Polatajko 2007)
Strauss and Corbin (1990) and Haak et al. (2001) have focused on the limits of qualitative research. Naïve enquiring stance of the researcher, small sample sizes, lack of study replication, generalisability of findings and inability to build on and further explore promising results has limited the development of the body of knowledge. Perhaps a reason prolific commercialised innovation by OT’s remained largely unsupported?
Societies’ understanding of neuroscience and emerging evidence of neural plasticity across the lifespan, is facilitating this paradigm shift away from ‘delivery of care to a passive person’, supporting the necessity of user engagement in the process.
Recent advances in interactive technology, connectivity, and social media can be harnessed to facilitate a step-change required to redefine health and social care to wellbeing and “everyone’s business”. Reframing of health care as the responsibility of all means finding new ways of delivering healthcare research and innovation, including new methodologies and processes.
There is a growing understanding of issues that prevent local, national and international adoption of health and social care e-solutions. (EC 2012). Adoption of innovative healthcare technology means solutions developed must be cost-effective, scalable, integrate and add value.
Bohmer (2009) considers changes to the ways that individuals, organisations, and society engage with delivery and receipt of care. Jones (2013) explores broader definitions of wellness, patient empowerment, environmental and cultural context. Research supporting adoption should explore user clinical condition and meaning, what ecosystems value and therefore, would adopt.
Zuckerman et al. (2013) support user-led innovation to ensure products and services best meet service user needs suggesting the vital contribution of user-led innovation is the marrying of clinician and service user understanding of each other’s dilemmas within current practice. Jones (2013) highlights the importance of ongoing circular processes of iteration in healthcare, characterised by ongoing problem solving and modification.
Madsen (date unknown) cites Gamborg 2007 and the Danish Association of OT’s in describing the OT as a creative innovator; “… think and act inventively in order to promote the activity and participation of the citizen” and “… contribute to individual courses of rehabilitation and treatment, which is characterised by consideration, fantasy, and untraditional solutions”. He questions if OT as a profession is organised and mature enough “to meet rising demands for renewal, modernisation, and innovation” due to its reluctance to use innovation as a term, recognising professional creativity.
The work of OT researchers Hammell et al. (2012) recommends OT’s client-centred practice should also underpin collaborative research. This is ensuring the research agendas are informed by clients’ priorities, highlighting a need to generate research methods that can capture the individualised nature of occupational therapy, with research methodology to reflect both qualitative data and quantitative data collection strategies.
Interactive research methods should inform product and technology innovation by OT’s addressing potential barriers to meaningful participation in the research, with parallel innovation processes being developed to enhance engagement and shift ownership. Doing this will ensure quantitative data measures demonstrated adoption alongside health and wellbeing outcomes.
Schaaf’s (2011) data-driven intervention process guides therapist reasoning, hypothesis generation, and intervention strategies, ensuring methodologically precise testing of defined outcomes is possible.
A question arising is if the Double Diamond’ Design Process Model – Design Council (2005) is a logical fit as a design approach for OT’s involved in innovation in the area of Ayres’ Sensory Integration?
Proposed Study Aims:
This study will delineate and then engage with the service-user ecosystem; to inform the development and prototyping of healthcare technology – to promote early adoption of the innovation, improving health and wellbeing outcomes.
Full participation of the user ecosystem in all project phases will be achieved by early education and engagement of the ‘key-actors’ in the presumed user ecosystem to help define, identify and confirm the user ecosystem.
The initial ecosystem will participate in and inform the process of product development (including look and feel) using aspects of the creative design process and the therapeutic ‘data-driven intervention’ process.
Prototype pilot testing will occur in subsequently matched ecosystems. This implementation of the product and process evaluation will measure early adoption and user outcomes.
Study Design: Mixed Methods – qualitative and quantitative research methodologies, scoped and agreed during initial ‘Discover’ phase, delivered creatively, supporting participation and transfer of health and wellbeing ownership.
Proposed Prediction of the Form of the Final Presentation:
- Wifi/technology prototype training and education
- DVD with taped user stories
- A written thesis and related publications
Article shared by Kathryn Smith, Occupational Therapist, © 2013