A Human Rights Based approach to Rehabilitation – What does that mean and what does it look like?

The Allied Health Professionals Dementia Network for Wales, provided an opportunity for 5 professionals across Wales to attend a CPD opportunity in Scotland in November 2023: Rehabilitation for people living with Dementia: Promoting an AHP Human-Rights-Based approach. This opportunity provided successful applicants with the opportunity to increase our understanding of what the ‘Right to Rehab’ means and how we think about “what is a Human Rights based approach?”. This is a team summary of our learning, which stimulated deeper thinking into what we currently provide in all our health boards and what is already out there. It provided a great opportunity to improve networking and work with others in Wales, increased our knowledge about Scotland’s practice’s and how we can incorporate them in Wales by involving the people it affects the most.

Our reflections:

How do we give our patients a voice?  What is an active voice of an individual living with dementia and their care givers? How we can change our practice to ensure a more patient centred approach?  It has challenged our ideas of how we engage patients in our current practice by commencing patient engagement meetings, and providing feedback to dementia advisory groups within their health board.  It has increased our awareness, leading us to be less prescriptive in our practice and truly understand what the patient wants from therapy in each of our settings. Early collaboration with the care giver was an issue highlighted and engaging in this provides some control to the individual and care givers.

What does the right to rehab mean? This focussed our therapeutic approach on the ‘can do’ approach. Using the advanced resources available, the skills we have, through liaising and working with wider teams in our areas, we have guided patients to the right pathway in the rehab process. This has been the case for all of our individual settings and as such we are able to optimise the environment for each individual.  

It provided us with information on communication resources; how do we best facilitate the conversations and utilise different communication styles to engage our patients in all settings? We learned about ‘Journeying through dementia’: an occupation-based group program aiming to support individuals in their dementia journey. Engaging people in conversation and cognitive stimulation can be hugely influential in achieving active rehab goals. It made us think about how we can adapt and use the work researched and developed in Scotland in our current practices for example, the Linus cognitive screening assessment: Using digital technology in evaluating cognitive health and detection of cognitive impairment. Finally, the importance of brain health; health care professionals can have a significant influence and impact in helping to prevent cognitive impairment and dementia. Understanding this has given us the knowledge and confidence to contact other professionals and groups for example, diabetes groups/professions, brain injury specialists and early years teams, to work collaboratively to try to reduce modifiable risk factors across the whole lifespan and increase brain health.

Reflections on workshops and content:

Journeying through Dementia

This had provoked interest and created opportunities to improve networking and linking in with others in Wales. Since the course we have been in touch with an Occupational Therapist who is providing this program in Wales. The group program focuses on the emotional well-being and occupational function that matters to the person and is facilitated by an occupational therapist. The workshop has made us start to think about our local input and increased our awareness to challenge how we use our skills more effectively, be it OT, Physio, SLT (or any other AHP not represented within our small cohort!). We are trying to avoid reinventing the wheel and it has been helpful to be made aware of many useful resources. Some of our group are now looking at OT specific assessment tools. The course also made us consider how we evaluate the service we are currently providing.

The Active Voice

The active voice was facilitated by people living with dementia. As therapists we are more aware of ensuring patient engagement and this has continued to expand our practice to involve individuals in changes that are being made in service delivery, such as future groups. Another attendee recalled how she had been tasked with setting up a group for managing chronic pain, which once all the work had been completed to set up, was poorly attended. She is aware now of the value of consulting and liaising with everyone to find out what they want from a group. We are trying to be less prescriptive in our input, preferring to discuss or offer options which a person might choose to use if they feel it’s going to work for them.

Brain Health

The brain health workshop provided the impetus to commence the group mentioned above, coming up with an appropriate strategy and OT focussed programme. We are looking into co-working more with, for example, diabetes nurses or those dealing with concussion or brain injury.  The aim is to work more effectively with other professionals. In the future, upstreaming to early years colleagues or health visitors will be explored to help work more preventatively. During the course we heard about the STARS project for youngsters. This was aimed at: Spending time with friends and on hobbies, Tucking in (healthy eating) Active Health, Rest and Relaxation, and Safely avoiding brain injury or concussion.

The points raised are a snapshot of the learning gained. The course has encouraged us to review our current services and evaluate how our assessments and interventions can be provided using a human rights-based approach – Right to take Part, Right to a personal life, Right to live independently and be an individual with no expectations.

Overall, we all felt we learnt a lot of new information and it has given us motivation to change our practice. We had the opportunity to share ideas and current practice with our Welsh and Scottish colleagues and would highly recommend attending if a further opportunity arises.

Contributors

Kirsty Bowen, Occupational Therapist, HMP Usk & Prescoed, kirstybowen@monmouthshire.gov.uk

Andrea Duffy,Occupational Therapist, primary care, Andrea.Duffy@wales.nhs.uk