0. The role of occupational therapists in reablement services: a realist synthesis
Lisa Dibsdall

1. Today.. Overview of my realist synthesis Reflections on the process
Definitions
Mapping the territory
Literature search strategy
Identifying context mechanism outcome configurations
Second search of the literature
Findings and conclusions
Reflections on the process

2. Where I’m coming from PhD Student – part time
An occupational therapist
Interested in my topic
Self funded
New to realist approaches

3. Occupational Therapists
Starting point
Reablement
‘services for people with poor physical or mental health to help them accommodate their illness by learning or re-learning the skills necessary for daily living’
Developed following government focus on personalisation and preventative services
Occupational Therapists
Support people to complete the occupations that are important to them
Educated in how physical and psychological disabilities affect engagement in occupations.
Trained in rehabilitation techniques

4. Reablement and Occupational Therapists
No blueprint for the delivery of reablement services
Service embedded in a complex social system
Little research on occupational therapists in reablement services.
How occupational therapists work in reablement and what influences their effectiveness
‘what works for whom in what circumstances and why?’

5. Mapping the territory Who are my stakeholders?
Using experts in the field
Professional networks
Publications from College of Occupational Therapists

6. Identifying possible programme theories

7. Identifying possible programme theories

8. Research Question
How do configurations of occupational therapy practice in reablement and their underlying mechanisms influence best outcomes for service users and reablement teams?

9. Initial literature search
Terms for reablement
enablement, restorative care, rehabilitation
Terms for adult social care
147,000 results
Searched for adult social care and occupational therap*
Exclusion criteria - iterative process

10. Identifying contexts mechanisms and outcomes
Screened 2297 articles
appraised full text of 190 articles
Individual appraisal sheets

11. context mechanism outcome configurations

12. If...then statements
If occupational therapists are available for informal and formal supervision and training of support workers [context] and support workers have confidence in the ethos of reablement [mechanism] and are open to changes in their practice [mechanism] then support workers are effective enablers [outcome]

13. If...then statements
If service users have quick access to occupational therapists to assess for and provide equipment and/or adaptations [context] and service users accept using equipment or adaptations [mechanism] then service users are able to complete daily living tasks more easily [outcome] and quality of life improves [outcome]

14. Second review of the literature
Search for evidence of theory.
Broadened search out from reablement
Focus on occupational therapists working with service users in the community
Training support workers
Provision of equipment and adaptations
Goal setting
Following initial screening, appraised 187 articles.

15. Second review of the literature another table

16. Training and supervision of support workers
Need for a change in culture from ‘doing to’ a person
Staff retraining is ‘crucial’ particularly for those from traditional home care settings.
Greater training and supervision leads to increased job satisfaction
Occupational therapists have knowledge and experience to train support workers.
Occupational therapists currently have a greater role in informal training and support leading to increased skills for support workers.

17. Provision of equipment and adaptations
Provision of equipment and adaptations can increase independence for service users and prevent or delay admission to care homes.
Equipment is acceptable to most people and still used over a period of time
Quick access to an occupational therapist is more important that having an occupational therapist within the team
Delayed access to occupational therapists leads to bed dependency and prevents new service users joining the reablement service.
Delays in provision of equipment is frustrating for service users.

18. Goal setting and reablement planning
Occupational therapists complete assessments, identify goals and write reablement plans with service users.
Occupational therapists assert that their knowledge of medical conditions enables them to take more risk in designing reablement plans
Some managers assert that occupational therapists can work with a medical model approach and be risk averse.

19. Conclusions
Some evidence to confirm and refute the programme theories of the conceptual framework
Few studies contain significant information on the role of occupational therapists in reablement services.
Few occupational therapists were participants in studies of reablement services.
Need for further research on the occupational therapists working in reablement services from the perspective of occupational therapists, their managers and reablement support workers.

20. My Research Multiple case study design Three Local Authorities
Observation of occupational therapists
Interviews with occupational therapists and managers.
Focus groups with support workers.

21. Reflections New terminology
Realist synthesis helped to identify contexts, mechanisms and outcomes relevant to my topic.
This information has guided my case study research.
Director of studies has not used realist approaches.
It is an iterative process to be presented in a linear format for my thesis
Benefit from connection with RAMESES network.