An Experiment in the use of Social Media in Clinical OT Practice: Growing Together (1) Planting the seed

Posted on December 12, 2011 by Claire — 4 Comments

As a mental health OT, and an advocate for delivering services for people through multiple channels (including the use of Social Media), I am sometimes challenged as to how and why this is possible or indeed, desirable. The identified risks in service provision can be summarised thus:

Duty of Care
Learning information the patient didn’t disclose to you
Confidentiality
Privacy (of the practitioner)
Risk assessment
Vulnerability of the service users

I want to unwrap these issues, and to do so I want to tell you a story. It’s going to take a few posts, so do stick around if you want to find out more.

I developed a project, through my NHS Foundation Trust employer, which was my grounding in examining these issues and developing the innovative tools to address the needs of my service users encompassing the use of Social Media in Clinical Practice.

I worked in an Inpatient setting, where we had a greenhouse and regular gardening groups. An Allotment was being run by an OT who was based in a CMHT (Community Mental Health Team) and was employed as a Care Coordinator. I had previously worked with him, when we both had roles in a different, community based team, specifically for people with severe and enduring mental health issues.

When working on the Allotment previously, we had seen fantastic gains in the Recovery of the service users who were group members. It had been a real confirmation of the power of Occupation in mediating mental health issues. Some of “our” service users had progressed far enough in their Recovery journey that they were now attending other, community based or local authority funded gardening groups.

They had all developed skills, and had all improved their ability to communicate, to work as a team, and to enjoy social interaction, (we assumed) as a result of their participation in our supportive group.

My colleague found he was care co-ordinating for the same group of service users, as the old team had been integrated into the CMHT. He was able to do his Care Coordination during the group, which also facilitated peer support between group members.

This group of service users, beccause of the nature of their mental health needs, sometimes found themselves back in the hospital where I now worked. It occurred to me that it would be great if they had the opportunity to continue to participate in the Allotment group during Inpatient stays. Further, it occurred to me that the other people who were Inpatients could also benefit from attending a socially inclusive group based off-site. This is, after all, in line with principles of Recovery, and addressed risks associated with Inpatient sojourns such as institutionalisation.

I realised that during our Inpatient Gardening Groups, popular activities of planting and nurturing seeds and seedlings would lead naturally to the extension of the activity to include planting up in an Allotment to see the plants grow and develop. It struck me that there was a useful metaphor within the work: our service users, like our seedlings, would “grow” in their Recovery through initial nurturing in the safe and protected environment of the greenhouse/hospital, be “hardened off” by regular trips off site to the Allotment, and finally be “planted” back into the community they lived in, ready to continue to grow, “blossoming” on the Allotment at some later time.

My colleague and I decided to draft a proposal to pilot a scheme where we could attempt this. We decided to propose that I could bring a few identified service users off site each week to attend their regular gardening group, and when I had a keen gardener who became an Inpatient, they would be offered to join us on the Allotment (subject to risk assessment, leave status etc.) Meanwhile, he would continue to offer his Care Coordination through the medium of the group to his set of gardeners, and would pick up other suitaable referrals as we progressed.

Within the NHS it is important to put together a clear brief for any novel idea in order to get approval from the managers of the service. It is important to follow the process of full risk assessment, both of the activity and for the participants. One must consider how one will keep records, pay for resources, and evaluate the idea. But having done this, we were delighted to hear the pilot was approved and we could begin.

The pilot started slowly, in the Spring, as the soil was warming up. Seeds were planted, in the courtyard greenhouse at our Inpatient Unit gardening groups. They developed into seedlings, and were re-potted on to larger growing-on pots. Then, they were hardened off outside the greenhouse for a few weeks before they were transported over to the Allotment to be planted in the final position. Meanwhile, on the Allotment, the ground was cleared ready to accept the plants. We planned what to plant, where to plant it, and how to look after it.

An important element of the group was that the serice users and staff didn’t wear any identification on the Allotment. We were, therefore, treated like any other Allotment holders by the others on the site. They would offer us advice on the best times to plant different vegetables, and ensure we were aware of Allotment ettiquette and rules, such as path widths, and how to dispose of waste. We were, in essence, modelling social inclusion on a small scale, within the Allotment site.

We had a tea break halfway through each session. We brought, each week, large thermoses full of hot water. We brought the items needed to make tea and coffee. We brought biscuits, and we tried to make them special biscuits, to reflect the value and esteem in which we held the workers on the project- and to keep our energy levels up for the second half of the group!

We didn’t occupy staff and service user roles within the Allotment. We took turns to make and serve the tea, for instance. For some service users, this was a huge challenge as they might generally avoid social discourse. We were so happy, as the group progressed, to see that all of the group members were able to increase their confidence in social interaction. The service users responded well to the responsibilities of taking tea and coffee “orders”, making the tea and handing out the biscuits. It encouraged turn taking, spoken communication, reinforcing of social mores, and offered an opportunity to informally assess them in a typical domestic activity so loved by the OT profession- making a cup of tea.

We shared our feelings and plans about what to grow, and what to do next on the site during our tea breaks. One day, a service user said to me

“I wish I could show people what I’m doing here.

This is really good.

My Mum would like to see this.”

I agreed, it would be great to share his success with his family and friends.

I couldn’t stop refelecting on this remark. It became a bit of a challenge to me.

Why, when we were modelling a socially inclusive group, did it exclude the natural social networks of support that these service users had, outside traditional services?

Was there any way to devleop the service in order to respond to the challenge?

Please join me in my next post, when I will talk about the next phase of the project, Social Network Seedlings

About Claire

I am an Occupational Therapist, who writes about health, particularly mental health. I am interested in social media and Web 2.0, and where these technological advances can support wellness and health.