describe the philosophy, purpose, and benefits of …...23918 v1 describe the philosophy, purpose,...

23918 V1

Describe the philosophy, purpose, and benefits of diversional therapy, and the role and skills of diversional therapists

Name _________________________________________________

Careerforce reference number _____________________________

This work is licenced under a Creative Commons Attribution-NonCommercial Licence. You are free to copy, distribute and transmit the work and to adapt the work. You must attribute Careerforce as the author. You may not use this work for commercial purposes. For more information contact Careerforce www.careerforce.org.nz


US 23918 Version 1 Level 3 Credits 4

Name ________________________________________________

Employer _____________________________________________

NZQA number _________________________________________

Date _________________________________________________

“All the answers in this workbook were completed by me.”

Signed _______________________________________________

4 Getting started

8 Support systems over time

12 New Zealand Society of Diversional Therapists Inc (NZSDT)

14 NZSDT: historical milestones

16 Activity theory

20 The roles of a diversional therapist

24 Positive and meaningful and experiences

28 Maximising autonomy

32 Standards and ethics in diversional therapy

34 NZSDT’s Standards of Practice

44 NZSDT’s Code of Ethics

48 Negotiation and communication

56 Occupational therapy

57 The Occupational Therapy Board’s Code of Ethics

58 Diversional therapy and occupational therapy: similarities and differences

61 Article: Occupational therapy and diversional therapy – what are the differences?

23918 V1


4 Describe the philosophy, purpose, and benefits of diversional therapy...

Getting started

Look before you leap!Take the time to go through this workbook before starting on the activities. Read the sections and make notes as you go.

Welcome to Describe the philosophy, purpose, and benefits of diversional therapy, and the role and skills of diversional therapists: one in a series of workbooks especially developed for support workers in the CPQ (Career Pathway Qualifications).

Before you start Think about what you know about •the role of the diversional therapist, and the New Zealand Society of Diversional Therapists Inc.

Read the Resource Book for •Readings (Diversional Therapy) provided with this workbook.

Pre-requisite Unit Standard 23918 is a pre-requisite for Unit Standards 5786, 5788, 5791, 5792, 5795 and 25770.

This means that you must have successfully completed the assessments for Unit Standard 23918 before being assessed on these other unit standards.

Unit Standard 23918 is also a recommended pre-requisite for Unit Standard 5789.

How do I use this workbook?Use highlighters to identify •the important ideas.

Take your own notes.•

Complete activities as you go •through the workbook and write answers in the spaces provided.

What will I learn about?When you have finished this workbook you will have learned more about:

The history, philosophy, purpose •and benefits of diversional therapy.

The role of the diversional therapist •in promoting the wellbeing of a person taking part in a diversional therapy programme.

The skills required by a •diversional therapist.

The differences between diversional •therapy and occupational therapy.

5Describe the philosophy, purpose, and benefits of diversional therapy...

Acknowledgements This workbook has been designed to support your learning and prepare you for the unit standard assessments.

The contents of this workbook include scenarios, learning activities and activities for general health and disability settings. They are not specific to any setting and should be used as a general guide for learning.

Careerforce would like to thank the people who have contributed their time and effort into each workbook in:

Research and content validation.•

Advice and expertise.•

Testing of activities and assessments •and their personal experiences.

And the people who have contributed a human dimension to the workbooks.

In particular, we wish to thank:The staff and residents of

Bainswood Rest Home•

Metlifecare Merivale•

Rosewood Rest Home•

and John McCombe, photographer, who took photographs at the above locations.

We also thank Christchurch City Libraries for use of these images:

A young woman services the engine of a Gypsy Major aeroplane during WWII. File Reference: CCL, PhotoCD 7, IMG0045. Source: The Press, 2 Feb. 1942, p. 3

Members of the Women’s Voluntary Land Army. File Reference: CCL, PhotoCD 7, IMG0082. Source: Girl workers in New Zealand factories / Maude Eaton, opp. p. 8.

Getting started


Getting started

Stop activitiesYou will also come across this icon in places where you are asked to STOP (see the graphic on the left) and record your current knowledge or impressions, as a reference point to return to later.

Pause and Rewind activitiesPauses are for summarising, questioning, and reflecting as a reference point to return to later. Rewinds take you back to a PAUSE, STOP or TEST YOUR KNOWLEDGE and give you an opportunity to add to, change or validate some of your initial thoughts and ideas.

Learning activities These help you understand the content, and will help you with workplace verification tasks. The instructions and answer panels for learning activities have a light yellow/orange background like this.

Trainee assessment portfolioThe trainee assessment portfolio contains assessed activities and workplace verification which must be completed to meet the requirements of the unit standard. These questions or tasks must be completed by you and signed by your workplace assessor in order for you to be credited with the unit standard.


TEST YOUR KNOWLEDGE

Before you go any further in this workbook, think of what you know about diversional therapy in New Zealand.

What is the purpose of diversional therapy programmes?

Why is it important for employers to have a qualified diversional therapist as part of the team?

What are the skills required to work as a diversional therapist?


Looking back in time to the mid 1930s, there was a very different range of support systems in place to assist people affected by disability.

Most women stopped working in their •employed role once they married. Families provided the care and support at home for their relatives with a disability or an age related condition.

People remained in the same •neighbourhoods for life, and were supported by these neighbourhoods in their own homes as they aged or when they became unwell.

This section of the workbook explores:The history of diversional therapy in •New Zealand.

The philosophy, purpose and benefits of •diversional therapy and the role of the diversional therapist.

Support systems over time

The New Zealand health and disability sector has undergone dramatic changes over the past sixty plus years.

Ongoing changes in disability support systems led to the development of an “activities co-ordinator” role. People in this role later became known as “diversional therapists” which led, in turn, to the establishment and recognition of the New Zealand Society of Diversional Therapists Inc.

World War II brought changes to the role •of women in New Zealand. Women were required to take up new working roles, replacing the men who were serving in the armed forces.

Wartime roles and new skills provided •women with new opportunities. At the end of the war some women chose to continue working outside their home.

Through the 1950s and 1960s, more women •joined the workforce, which reduced the capacity of families to care for the elderly or those with a disability in their homes. Most local hospitals now provided residential wards for the elderly or people with disabilities.

A young woman services the engine of a Gypsy Major aeroplane during WW II

Members of the Women’s Voluntary Land Army harvesting spring onions at Abberley Park in Christchurch during WW II


Support systems over timeThrough the 1970s, more and more •residential beds were required.

By the 1980s, the Ministry of Health had a •funding issue as hospital expenses were escalating. The Ministry undertook a nationwide review of hospital services.

One of the issues the review highlighted •was the growing number of older people in full-time care in public hospitals.

The review acknowledged that: ageing •was a “normal process”; ageing could not be “cured”; and it was not the function of a medical hospital to provide long- term beds for people with normal ageing conditions.

Very quickly, private rest homes appeared •throughout the country to take over this range of care needs. Funding was provided by the Ministry of Health, but not at the levels given to medical hospitals. Good standards of food and care were provided by these rest homes.

These rest homes were often converted from •large family homes. Residents frequently sat all day in chairs around the perimeter of a room, which acted as dining room, lounge and recreation area rolled into one.

New Zealand society following World War II has witnessed a huge number of changes, particular in the roles and responsibilities of women; and in the care of the elderly and people with disabilities.

In this environment residents’ health •could deteriorate rapidly, and many developed depression or challenging behaviour patterns. Mobility was reduced or lost, and residents became more dependent on others.

It was at this point that staff, rest home •owners and residents’ families recognised that residents needed more than food, shelter and good care to maintain their wellbeing and quality of life.

Residents also needed to be engaged in •a range of physical, cognitive and social activities to:

Give their lives balance.•

Provide motivation.•

Promote self esteem and general wellbeing.•

Staff members and community volunteers •were given roles in providing activities. They learnt about the importance of activity programme planning as they struggled to provide for residents’ needs.

From this environment grew the New Zealand Society of Diversional Therapists Inc (NZSDT) and a recognised qualification known as the National Certificate in Diversional Therapy.


Think about how it would have been when older people with age-related conditions were permanent residents of elder care wards in a public medical hospital.

How would this situation have impacted on these older people’s

Independence?

Self esteem?

Community involvement?


What problems do you think activity staff or activity volunteers would have experienced in providing leisure activity for residents in those early rest homes?

How do you think the establishment of the diversional therapy qualification helped activity staff and activity volunteers working in rest homes?

What were the advantages to residents in a rest home once the diversional therapy qualification was recognised?


New Zealand Society of Diversional Therapists Inc (NZSDT)

Mission Statement

To improve the quality of life of the people in our care through diversional therapy

About the logo

The tree has through the ages, come to symbolise the thoughts and emotions

involved with families, life, strength and shelter. A tree is naturally bathed in

sunlight, watered, cultivated, developed and grows. All these elements are reflected

and are combined within the professional work of the diversional therapist, as we

strive to provide the services and activities to improve the quality of life of clients of all

ages in our care.

Philosophy of diversional therapy

Diversional therapy involves the organisation, design, coordination and implementation of client-centred meaningful, activity programmes. Clients will have a choice of leisure activities designed for them, to enhance their quality of life through ongoing support and development of their intellectual, emotional, spiritual, social, cultural, sexual and physical wellbeing.

Website: www.diversionaltherapy.net.nz

The NZSDT website contains the Code of Ethics, Standards of Practice, membership information and a range of information for diversional therapists and trainee diversional therapists.


NZSDT’s historyThe Society progressed from small local meetings of individuals from various rest homes and institutions in the late 1980s, into a professional body actively involved in the education and development of diversional therapy within New Zealand.

New Zealand Society of Diversional Therapists Inc (NZSDT)

Diversional therapy activities for individuals and groups focus on:

Freedom of choice.•

Maintaining use of visual, motor •and sensory skills.

Activities which enhance creativity •and have a worthwhile outcome.

Enabling clients to work within •their capabilities.

Giving purpose and meaning to life •through activity and involvement.

Encouraging communication, •expression, socialisation and reminiscence.

Strategies that help with memory, •orientation and emotional wellbeing.

The Society has been successful in recognising and establishing the rationale for, and development of, a national qualification for diversional therapists.

The NZSDT’s website tells the full history: www.diversionaltherapy.net.nz

Your Resource Book for Readings (Diversional Therapy) contains an abridged version of this history.


NZSDT: historical milestones

1989 1992 1993 1995 1996 1997

First meetings of the movement to recognise diversional therapy in its own right.

The members’ handbook is released.

The National Certificate in Diversional •Therapy is registered on the National Qualifications Framework.

The inaugural annual two-day •conference is held.

The New Zealand Society of Diversional Therapists is registered as an Incorporated Society.

First national seminar, AGM •and presentation of the first membership badge.

An advisory group is formed to •develop a national training course.

Diversional therapy is defined and the •national quarterly newsletter begins.

Standards of Practice for Diversional Therapists are finalised.


2000 2001 2002 2005 2009

NZSDT plays an important part in helping Careerforce to review and re-register the national qualification.

Significant changes are made to the national qualification.

The Mission Statement is written.

The annual conference decides that trainees •should be Society members for two continuous years before they can access the qualified badge and certificate.

The five-year Strategic Plan is developed.•

www.diversionaltherapy.net.nz is launched.•

The National Certificate in Diversional Therapy increases from 91 to 121 unit standards at Level four on the National Qualifications Framework.


Activity theory is relevant to all age groups: everyone needs purposeful activity to give meaning to their lives.

In essence, activity theory holds that active ageing is healthy ageing. (The main ideas and references in this section are sourced from Berger K.S., The Developing Person Through the Life Span.)

Activity theory

NZSDT states:

Each activity is tailored to the particular needs of each individual or group in order to achieve the maximum individual enjoyment and fulfilment.

According to many studies, the more activities older people engage in and the more roles they play, the greater their degree of life satisfaction.

Activity theorists argue that sometimes when an older person appears to withdraw willingly and happily from society, this is because the person isn’t, in fact, coping with what can appear to be an ageist society. Therefore, say activity theorists, when disengagement from society does occur, it should be considered not a normal sign of ageing but rather a symptom that all is not well in the older person’s life.


Activity theory

Activities that provide enjoyment and which produce positive results should be a part of everyone’s lives, whatever their age and health status.

What is purposeful activity?Purposeful activity is:

Any activity that is valued by the person •participating in the activity.

An activity chosen after discussing the •person’s preferences (likes and dislikes).

Purposeful activity may be an activity that the person has a history of participating in. It may:

Meet some of the social needs of •the person.

Be new for the person and something •that he or she wishes to try.

Give the person the opportunity to use •old skills and knowledge that the person has retained.

Read the short section in the readings book called “The Third Age”, and then answer the following questions:

Which age group is classed as the third age •(the young old)?

Which age group is classed as the fourth •age (the old old)?

How does Laslett (1991) expect people of •the third age to spend their golden years?

For which age group are the spiritual •dimensions of activity and long-term social relationships a priority?


Think about the activities that people participate in within the setting in which you work. There will be different reasons why people choose to take part in these activities.

Complete the question boxes below, recording an activity that people participate in, in each box.Then list the different reasons why people within your setting take part in this activity.

My first chosen activity is:

List the different reasons why people take part in this activity.

My second chosen activity is:

List the different reasons why people take part in this activity.


Take time to think about the wide range of activities that you personally are involved in on an average week, both at work and away from work. These activities could include employment-related tasks, sport and social activities, family life activities, work that is part of community related roles, hobbies and leisure pursuits, engagements with friends and much more.

List here the activities you are involved in that are most important to you personally.

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Describe how you might feel if you could no longer take part in these activities.


The roles of a diversional therapist

Mental health services

In their own home: leisure programmes for older people and people

affected by a disability, or an age-related

condition

Regional health boards, public hospitals

Diversional therapists’

rolesResidential/services

and hospitals for older people

Residential community houses

for people with an intellectual

disability

Community day programmes for

older people

Residential care services for people

with a physical disability

Community health support services:

Arthritis Multiple sclerosis Parkinson’s disease

Dementia Support groups


Think about the services in your area that employ diversional therapists or trainees and respond to the following questions.

List community health support organisations that employ diversional therapists to provide leisure programmes.

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•

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•

List services for people under the age of 65 that employ diversional therapists to provide leisure programmes.

•

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•

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•

•

•

List services for older people not in a residential service or hospital that employ diversional therapists to provide programmes of meaningful activities.

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•

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•


Before continuing on through this workbook, take time to think about the diversional therapist’s roles and the skills that the diversional therapist uses to promote people’s wellbeing.

The diversional therapist uses a range of skills to promote the best outcome from leisure activities for people participating in a leisure activity programme.


The roles of a diversional therapist

Socialisation opportunities By keeping well informed and up-to-date with changes that are taking place in society, the diversional therapist can plan leisure activities and events that are relevant to the people he/she is supporting and encourage their participation and socialisation.

For example:Planning a range of social opportunities – •i.e. small, medium and large events with a wide range of activities – caters for each person’s personal preferences.

People can be introduced to other •people with similar interests in a relaxed social situation.

Personal fulfilment When planning leisure activities for a workplace programme, the potential ability of each person to participate in the activity must be considered.

The activities should be structured so that people can participate in a variety of ways. The aim is that everyone taking part should experience a positive outcome and gain maximum enjoyment.

Community integration The diversional therapist assists individual or groups of people to maintain community links and interests.

For example: Inviting guest speakers.•

Organising outings to events or places of •special interest, one-on-one outings, and organising clubs and community volunteers to take people to events of their choice.

Providing displays of materials, books, •music, photos or other resources to enhance the continued interest of people in community events and activities.

Enhancing life skills People the diversional therapist works with may experience difficulty taking part in the activities of their choice. Your skill in adapting resources will allow peopleto maintain their former interests and hobbies and develop new interests.

Adaptation examples:Providing additional lighting in a reading •or work area.

Positioning and securing materials to reduce •the potential difficulties caused by a person’s tremor or loss of co-ordination.


Scenario

The diversional therapist is running a reminiscence group with eight people. They are happily discussing their memories and looking at resources the diversional therapist has provided about the town’s celebrations in 1956.

A member of staff brings Mr Brown in his wheelchair along to the group, which has already been underway for 10 to 15 minutes. The staff member leaves Mr Brown with the group, stating that he could do with some company.

Mr Brown does not appear to be happy about being left with the group, and the diversional therapist cannot leave the group of eight to return Mr Brown to his room.

The diversional therapist stops to explain to Mr Brown what the group is doing. However this is difficult as Mr Brown is very hard of hearing and also has poor vision. Mr Brown ignores the diversional therapist and the group and sits in his wheelchair fidgeting

Positive and meaningful experiencesWhat is a positive and meaningful experience for a person? The answer will be different for every person with whom you work.

To achieve positive experiences and meaningful activities, the diversional therapist needs to collect an extensive social history from all the people with whom he or she is working. Without the background knowledge that a person’s social history provides, it will be almost impossible for the diversional therapist to ensure that an activity is positive and meaningful for that person.

Continued on page 25

25Describe and apply culturally safe principles and Pacific values...

Positive and meaningful experiences

and mumbling to himself. The group carries on with its discussion but the zing has gone out of the group.

For Mr Brown this has not been a positive and meaningful experience.

Has it been a positive and meaningful experience for the eight original members of the reminiscence group?

Not really. It started off well and was positive and meaningful for the first 10 to 15 minutes. Then the group started to feel uncomfortable as the diversional therapist struggled to include Mr Brown who obviously did not want to be there.

It wasn’t a positive experience or outcome for the diversional therapist who had put in considerable time researching the discussion topic and gathering resources for this group activity.

Was it Mr Brown’s fault? No. He was brought to the group, not of his own choice, and the group was already underway. His poor vision and hearing would limit his participation in the


Remember that what is a “positive and meaningful” experience may differ greatly from person to person: do not make any assumptions that everyone will feel the same!


discussion. He had only lived in this area for the past ten years so the happenings back in 1956 in this area would not be of great interest to him.

Later in the week the diversional therapist spent some one-on-one time with Mr Brown. This happened in the quiet of his own room where there wasn’t additional noise impacting on his hearing.

The diversional therapist (who had checked Mr Brown’s social history) talked to him about his past job as a “harbour pilot” on Wellington harbour. This informal discussion went well.

As a result of this discussion, the diversional therapist set a time with Mr Brown to come to his room each week and read Wednesday’s shipping news from the local newspaper.

Positive and meaningful experiences

What made the talk in his room go well for Mr Brown?

For Mr Brown what were some of the positive and meaningful things about hearing the shipping news read to him?

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Think about the people in your workplace, and the important and meaningful activities that they choose individually to participate in.

Please answer the following two questions.


For a person you support, what is one activity that is important to that person?

What makes this activity positive and meaningful for this person?

For a person you support, what is another activity that is important to that person?

What makes this activity positive and meaningful for this person?


Maximising autonomy An important part of the diversional therapist’s role is maximising people’s autonomy. Maximising people’s autonomy means helping them to exercise personal freedom and independence for as long as they are able to. People in a residential facility or a support service can quickly slip into a dependency mode, leading to a range of negative emotions, poor self-image, low self-esteem and reduced quality of life.

The challenge for the diversional therapist is to engage people in a range of activities which interest them, organised in such a way that each person can function to the best of his or her ability and as independently (safety permitting) as possible.

When planning and carrying out activities, it is important to take account of the following factors. You should:

Understand each person’s abilities •and identify any potential risks that must be considered.

Analyse the activity and break it down into •parts: what does the person need to be able to do to participate in each stage of the activity?

Identify the parts of this activity that the •person could manage independently.

Identify the parts of this activity that the •person will require assistance with.

Prior knowledge of people and of their capabilities coupled with good planning, are the keys to implementing successful activities


Maximising autonomy Identify the modifications you can make to •this activity or the environment to enable the person to participate independently and maximise his or her enjoyment from taking part.

Review your role in the activity; check •that you are not over assisting by being “too helpful”.

Assist the person or offer assistance when •you observe the need for some help.

Structure the activity in stages or parts that •the person can work on independently. Providing help only at the stages it is required enhances a person’s autonomy and enjoyment.

There are also a number of practical steps that you can take to maximise participants’ autonomy through adapting the activity, the environment, or the resources to be used in the course of the activity.

You should be aware of the following considerations and think about their relative degree of importance as part of your forward planning.

TimeframeWhat is the best time of day for this person •to engage in activity? When is he or she more likely to be pain free, not fatigued, and able to concentrate?

Length of time for the activity: How long •can the person comfortably participate for? Can the activity be broken down into stages over several sessions?

Or can the activity have a break period about halfway through for people to rest from the activity?


Maximising autonomy

Materials and resources Review the materials to be used in the activity. How could they be changed to assist the person to participate without assistance? Think about:

Weight: can the materials be made lighter •or heavier?

Size: would smaller or larger be helpful?•

Positioning of the materials: can they easily •be reached?

Can some of the materials be prepared (e.g. •cut out, weighed or measured, shaped etc) in advance?

LightingAppropriate levels of lighting can make a significant difference to a person’s ability to participate in an activity.

Remove glare by drawing curtains or •blinds or repositioning the person out of glaring sunlight.

Provide table lamps to illuminate the •activity the person is working on.

Positioning Adjust the height of seating or tables. •

If hearing impaired, does the person •benefit from being positioned either to the left or the right of the diversional therapist, or positioned in front of the diversional therapist to lip read?

If visually impaired, does the person •benefit from being positioned in front of the diversional therapist to see what is being demonstrated?

Environment Consider all of the options in your •workplace setting that can be used to help people to participate fully in activities.

Where would the person be most •comfortable doing this activity?

Choice Have you structured this activity to provide •the person with opportunities of decision-making? Providing choice within activities enhances independence, and gives people control over their level of participation in the activity.


Choose two activities that you are familiar with running in your workplace. Describe the ways you could adapt these activities to maximise the person’s autonomy when participating in them. (Please do not give a list; just explain the details of the changes that you could make.)

My first chosen activity is:

Describe the ways you could adapt this activity to maximise the person’s autonomy when participating in it.

My second chosen activity is:

Describe the ways you could adapt this activity to maximise the person’s autonomy when participating in it.


Standards and ethics in diversional therapy

The New Zealand Oxford Dictionary defines:

Standard as: “a quality or specification by which something may be measured or tested”; •and

Ethics as: “a moral principle or set of principles”. •

The Standards of Practice issued by the NZSDT are the guidelines used by diversional therapists to demonstrate accountability.

They clearly spell out our responsibilities in our working role.

They identify what is considered best diversional therapy practice.

They are the standard by which the diversional therapy service we provide can be judged.

The Code of Ethics issued by the NZSDT identifies the obligations and responsibilities of the diversional therapist by setting out:

The standard of behaviour expected within the profession.•

The manner in which diversional therapy is provided for people. •

The diversional therapist’s responsibility to provide a diversional therapy service within the •scope of the workplace’s policies and procedures.


Think about any health and disability related services, societies, agencies or organisations which you know of that have their own Standards of Practice and/or a Code of Ethics to guide the service they provide. Please list them in the following box.

Other health and disability related services, societies, agencies or organisations that have Standards of Practice and/or a Code of Ethics.

Thinking about your own organisation, where would you find copies of a Standards of Practice and/or a Code of Ethics, together with related policies and procedures?

What do these Standards of Practice and/or Code of Ethics and related policies and procedures say about the provision of a diversional therapy programme/service?


NZSDT’s Standards of Practice

Please read the NZSDT’s Standards of Practice which are paraphrased on the following pages.

There are six Standards, each with a set of associated outcomes.

Standard OneDiversional therapists are accountable for their practice with all people in a supportive environment.

Outcomes:Practice is safe, legal and effective and •responds to the holistic changing needs of the client.

Individual rights are respected •and acknowledged.

The changing needs of the client are •addressed and documented.

Diversional therapy’s contribution to the •wider community is visible.

The image and value of diversional therapy •is enhanced and promoted.

Standard TwoWithin their scope of practice be it workplace or with residents in alternative environments (e.g. outings), diversional therapists are responsible for the safety and wellbeing of their clients, co-workers and themselves.

Outcomes:Clients feel culturally and spiritually respected •through the application of the following principles of the Treaty of Waitangi – participation, protection and partnership – and by diversional therapists meeting the obligations required under the United Nations Principles for Older Persons (1991) based on the Declaration of Rights by the International Federation on Ageing (IFA); the Health and Disability Sector Standards NZS 8134: 2001; and the Ministry of Health contractual requirements – National Contract for Age Related Residential Care Services.

The diversional therapist provides a wide •opportunity of choice, environment and decision-making, and respects the client’s decisions in terms of flexibility and freedom of choice.

Clients’ ways of life are supported, •encouraged and validated.



Standard ThreeThe diversional therapist must work within the framework of a multidisciplinary team with clients and their associates.

Outcomes:Diversional therapy practice develops •within the context of a negotiable relationship with clients, family and associates, and the professional support team.

The diversional therapist will develop •individualised approaches to clients’ needs.

Clients, family and community benefit •from diversional therapists’ professional expertise and their holistic approach.

Standard FourDiversional therapists are committed to ongoing professional development.

Outcomes:Diversional therapy practice is based on •current knowledge and experience within a changing environment.

Research is an essential component of •diversional therapy.

Diversional therapy practice is enhanced •by discussion of professional issues with appropriate health professionals.

Diversional therapists enhance their •practice with input from peers, professionals, non-professionals and other resource personnel.

A self-development resource manual •is compiled and updated on an ongoing basis.

The diversional therapist has an awareness •of, and access to, developing technology.



Standard FiveThe diversional therapist will manage resources efficiently and effectively to meet clients’ individual needs.

Outcomes:Wherever possible resources are •provided at the appropriate time, quantity and quality to meet the client’s individual needs.

The diversional therapist will be •responsible for facilitating the maintenance of all equipment and resources used in activities and special therapies to recognised standards.

Diversional therapy is included in the policy •and procedure manuals of the employers.

Standard SixThe diversional therapist will demonstrate an awareness of the need of advocacy and confidentiality within the diversional therapy setting.

Outcomes:The diversional therapist will be competent •to evaluate possible solutions to reduce social and individual inequities in client care.

The diversional therapist will meet the •practice requirements determined by the New Zealand Society of Diversional Therapist’s Code of Ethics 1995.

All work practices must meet the •obligations required under the United Nations Principles for Older Persons (1991) based on the Declaration of Rights by the International Federation on Ageing (IFA); the Health and Disability Sector Standards NZS 8134: 2001; and the Ministry of Health Contractual requirements –National Contract for Age Related Residential Care Services.

The diversional therapist will access •appropriate health professionals’ assistance as required.


Standard One: Diversional therapists are accountable for their practice with all people in a supportive environment.

One outcome states: The changing needs of the client are addressed and documented.

In your workplace, in what document do you record the changing needs of the people you support?

Where is this document kept in your workplace?

In your workplace, how do you address the changing needs of the people you support?

Now that you have read through the NZSDT’s six Standards of Practice, please answer the following questions.


Standard Two: Within their scope of practice, be it workplace or with residents in alternative environments (e.g. outings), diversional therapists are responsible for the safety and wellbeing of their clients, co-workers and themselves.

What are some of the safety issues you have observed while providing an activity programme?

Describe a safety issue you have encountered in terms of a particular person you support.

What might a safety issue be for a co-worker who is helping you?


Standard Three: The diversional therapist must work within the framework of a multidisciplinary team with clients and their associates.

The multidisciplinary team will vary in different workplaces depending on the professions represented and the roles that people fulfil.

A typical multidisciplinary team may consist of:

Manager or team leader•

Senior nurse•

Senior carer – more than one in a large facility to •receive input from all areas

Diversional therapist•

Diet supervisor •

Doctor •

Other members of the multidisciplinary team might be:

A supported person•

Family/whānau or support person•

Chaplain•

Physiotherapist•

Occupational therapist•

Speech therapist •

Psychologist•

Other health professional(s)•

The diversional therapist’s role with a person’s family or associates will vary depending on the workplace or the service that is provided.

Some of the roles the diversional therapist may have include:

Gathering background •information to assist people through the transition phases into a residential care facility.

Gathering information to assist •planning an individual person’s activity programme.

Giving feedback about a •person’s participation in leisure activities and a diversional therapy programme. This feedback is especially important if a person has difficulty communicating.


Standard Four: Diversional therapists are committed to ongoing professional development.

Standard Five: The diversional therapist will manage resources efficiently and effectively to meet clients’ individual needs.

The diversional therapist has a responsibility to keep his or her professional practice up to date.

Up-to-date practice promotes “good •practice” programmes of group and individual activities to promote people’s wellbeing and quality of life.

Ongoing participation in area •diversional therapy support groups provides the diversional therapist with support and access to information which will assist in the provision of workplace leisure activity programmes.

The diversional therapist’s resource •manual is kept up to date, and resources are suitable for the client group’s changing and ongoing needs.

The diversional therapist is responsible for activity resources, including staff assistance and volunteers, materials, equipment, and managing the leisure activity environment. The diversional therapist is responsible for:

Assessing the resource requirements •for the provision of a leisure activity programme.

Liaising with the appropriate workplace •person to ensure that the leisure activity resources are available within a timeframe suitable for the running of the leisure activity programme.

Using resources fairly to benefit all •people within the workplace.

Ensuring resources are safe for the •purpose for which they are intended, and stored in accordance with workplace policies and procedures.


Standard Six: The diversional therapist will demonstrate an awareness of the need of advocacy and confidentiality within the diversional therapy setting.

Advocacy

What is advocacy? It is support for an argument or for a cause. An advocate is a person who pleads on behalf of another.

As the diversional therapist’s role does not include “personal cares”, diversional therapists may be seen by consumers as “neutral”. Consequently they are frequently asked to talk to team leaders or management on behalf of people who would like changes to their care routines.

Some of the advocacy issues that people raise include:

Changes to timing of care routines.•

Personal appearance e.g. not in slippers all day.•

Leaving the residential facility to visit family or friends.•

The diversional therapist advocates for people’s personal needs by providing information •to the multidisciplinary team e.g. from observations of the person during activities, the diversional therapist might advocate for a person to have his/her glasses checked.



Standard Six: continued

Confidentiality of information is essential while providing activities.

Running a consumer group reminiscence session requires maintaining confidentiality of •individual people’s information. Maintaining confidentiality may require setting ground rules about the type of questions a person can ask of other people in the group.

Diversional therapists are frequently asked for information about people by other people, which •would breach confidentiality. The “need to know” rule is important, i.e. Does the person asking have a “right” to this information? If not, you cannot share the information. However, if a person asks about another person who is unwell, you can direct the enquirer to go and visit the unwell person to see how he or she is getting on.

Maintaining confidentiality may need a little planning, e.g. using a quiet area when •gathering a social history from a person, and making sure that the conversation cannot be overheard by other people.


What is your workplace policy for ordering leisure activity resources?

In your workplace, how far in advance must you order leisure activity resources?

What is your workplace policy for checking electrical appliances or extension cords used in a leisure activity programme?

How do you know that an electrical appliance has been checked and when it is due to be checked again?


NZSDT’s Code of Ethics

The diversional therapist has obligations and responsibilities.

By observing the basic principles of the Code of Ethics of any profession, an individual can aim to achieve the highest standards of conduct and ideals of service in this profession. In terms of the NZSDT’s Code of Ethics, as set out in the NZSDT’s membership handbook, the diversional therapist is required to:

Ensure optimum client care through a high standard of professional practice and personal conduct.

Not allow cultural and religious beliefs and values or political issues to deny or influence those seeking or receiving their care.

Maintain integrity, loyalty, and confidentiality with employers, fellow workers, clients and residents.

Respect the dignity, pride and privacy of person, place and property.

Encourage autonomy for those in their care.

Believe in self evaluation, peer review and on-going education.

Comply with facilities policies and procedures.

Accept responsibility for education within the Multi-disciplinary team concept.

Respect the confidentiality and privacy of documentation within the profession and other professions.

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Diversional therapists work with people from many different cultures and traditions. How do you make sure that people with different traditions or beliefs are not overlooked or discriminated against?

How does a high standard of professional diversional therapy practice promote the best service outcome for people who are being supported?



How do you show respect for people’s dignity, privacy, personal space and personal possessions?

Dignity •

Privacy •

Personal space •

Personal possessions•

How do you maintain confidentiality and privacy of documentation in diversional therapy and other workplace settings?


Encouraging the autonomy of people in the workplace and in a diversional therapy programme is very important.

When people are not supported to maintain their autonomy, they quickly lose their independence, confidence and self esteem, and slip into institutionalised behaviour patterns. This situation reduces their quality of life and can lead to depression.

Think about the leisure activities provided for people in your workplace. Describe how these activities are planned to encourage people’s autonomy.

Working within your workplace’s policies and procedures promotes:

A high standard of support services. •

Staff members’ clear understanding of •how they are expected to respond in particular situations.

Safety of consumers, visitors and staff •within the workplace environment.

Clear understanding of workplace roles •and procedures.

NZSDT’s Code of EthicsParticipating in an ongoing education programme within your workplace provides the diversional therapist with:

An opportunity to explain to staff the •diversional therapist’s role with people within a residential setting or as part of a service.

Up-to-date information and skills. •

Workplace review processes •and evaluations.

The diversional therapist maintains integrity, loyalty and confidentiality with employers, fellow workers and consumers within the workplace or as part of a service by:

Respecting the confidentiality of •information shared within the health professional team and other employees.

Not disclosing or discussing •people’s personal information outside the workplace.

Not disclosing workplace funding or •planning outside of the workplace.


Scenario

Jenny Brown attends the local multiple sclerosis society’s day programme, three days each week. She has told you that she is being picked up at 2pm on Friday week by her sister to attend the graduation ceremony for her eldest nephew.

Jenny is very proud of her nephew’s achievement and has shared her excitement about this event with three other friends who also attend the day programme with her.

Jenny has told you that she would love to go to the graduation parade through the city to the square where the Mayor addresses all the people graduating, but her sister cannot pick her up in time to do this.

Negotiation and communicationThere are many behind-the-scenes roles and skills needed by the diversional therapist when planning and organising people’s activities in a residential setting. In this scenario we look at the need for good communication and negotiating skills in the context of a residential setting.

Staff teams vary from facility to facility. The roles of team leader, manager, senior nurse and senior carer are all mentioned in this scenario to cover the most likely team members you may be required to communicate and negotiate with in your diversional therapy role.


Negotiation and communication

Communication, negotiation and confirmation are the key to successful planning for people’s activities in a residential setting.

Communication The diversional therapist discusses with Jenny her wish to attend the parade, and suggests that •he/she will check if it is possible for Jenny to attend.

The diversional therapist discusses the proposed outing for Jenny with the day programme •manager/team leader.

When the diversional therapist tells Jenny that this outing can be arranged, Jenny asks whether •Rachel, Carla and Anne, her three friends at the day programme, can join her in this special outing.

Negotiation The diversional therapist negotiates with the day programme team leader/manager for Jenny’s •three friends to take part in this outing.

Negotiation occurs about how many and which staff member/members or volunteers will •accompany this group on their outing.


CommunicationThe diversional therapist tells Jenny that the outing has been approved. •

Then Rachel, Carla and Anne are consulted to check that they do want to take part.•

Negotiation and communicationNext the diversional therapist discusses this outing with the day programme senior carer, •agreeing at what time the ladies will need to be ready for the outing on Friday week.

Checks are made if any medication or other items will need to be taken with them on this outing.•

Negotiation Arrange with the diet/kitchen team for the four ladies to have an early lunch on the day of •the outing.

The diversional therapist contacts Jenny’s sister to explain about this outing in conjunction with •the graduation ceremony.

A discussion takes place to organise where and when her sister will pick up Jenny from the •outing group in the city square, to go on to the town hall for the graduation ceremony.

Jenny’s three friends will return to the day programme after the parade, accompanied by a day •programme volunteer.




CommunicationThe diversional therapist confirms with Jenny and her three friends that this outing is now being organised.•

The arrangements made with Jenny’s sister are explained.•

Negotiation The transport service is contacted and the diversional therapist arranges a time for the four ladies •and staff member to be collected and taken to the square on graduation day.

A time to collect and return Jenny’s three friends and the staff member is also negotiated.•

The diversional therapist contacts the city events service and arranges for five seats to be booked •in the seating in the square for people to see the graduation parade (four residents and the day programme volunteer accompanying them).



Communication The day programme manager or team leader, senior carer, Jenny, her three friends, and Jenny’s •sister are informed of the arrangements made for this outing.

Communication on the day of the outing Checking the health status of the four ladies with the team leader, senior nurse, or senior carer.•

Checking the medication or other requirements for this outing with the senior nurse or •senior carer.

Checking with the four ladies that they all still wish to take part.•

Confirming the early meal with kitchen staff.•

Confirming with day programme carer and volunteer when the ladies need to be ready to leave.•

Confirming with the transport service the pick-up and return times for this outing.•

Checking with Jenny’s sister the final arrangements including the expected time she will be •bringing Jenny back to the day programme.



Ask the diversional therapist or activities staff in your workplace for the following information and write it below.

How far in advance must a resident’s outing be approved?

If a resident’s family members are involved in the outing, who is the appropriate workplace person to communicate/negotiate with them?


TEST YOUR KNOWLEDGE

Think about what you already know about the qualification, training and roles of occupational therapists.

Check your knowledge by answering the following questions.

What is the minimum level of qualification required for a person to work as an occupational therapist in New Zealand?

How many years does it take to gain the first level of qualification for an occupational therapist in New Zealand?


Where in New Zealand can occupational therapists train?

How many different occupational therapy professional roles can you identify?


Occupational therapy The New Zealand Association of Occupational Therapists (Inc) (NZAOT) provides services, support, representation and networking opportunities for occupational therapists. NZAOT has members across all occupational therapy practice areas within New Zealand and abroad.

The Association’s website is at http://www.nzaot.com/.

NZAOT’s mission is: To promote excellence in knowledge, standards, support and representation.

The Occupational Therapy Board of New Zealand has been appointed as a body corporate in accordance with the Health Practitioners Competence Assurance Act 2003. As an Authority under this Act, the Board is responsible for the registration and oversight of occupational therapy practitioners.

The main purpose of the Act is to protect the health and safety of members of the public by providing mechanisms to ensure that health practitioners are competent and fit to practise their professions. The Board will, amongst other functions, fulfil this purpose by: determining for each practitioner the scope of practice within which he or she is competent to practise; managing systems to ensure that no practitioner

practises in a capacity outside his or her scope of practice; and utilising its powers to restrict specified activities to particular classes of health practitioner in order to protect members of the public from the risk of serious or permanent harm.

Acts of Parliament, Regulations and Codes which directly or indirectly affect the professional practice of occupational therapy at present include the:

Health Practitioners Competence Assurance •Act 2003

Health and Disability Commissioner Act 1994•

The Code of Health and Disability Services •Consumers’ Rights Regulations 1996

Fair Trading Act 1986•

Consumer Guarantees Act 1993•

Injury Prevention, Rehabilitation, and •Compensation Act 2001

Privacy Act 1993, and Health Information •Privacy Code 1994

Health and Disability Services Act 1993•

Health and Disability Services (Safety) Act 2001•

Health and Safety in Employment Act 1992•

Health (Retention of Health Information) •Regulations 1996


The Occupational Therapy Board’s Code of Ethics This Code of Ethics presents standards of conduct expected of all occupational therapists registered to practise in New Zealand.

The purposes of the Code are:

To inform and protect current and potential •users of occupational therapy services.

To protect the integrity of the occupational •therapy profession.

The Code adheres to the provisions, spirit and intent of Te Tiriti o Waitangi/The Treaty of Waitangi.

The Code exemplifies core professional values and behaviour underpinning the most commonly encountered ethical considerations in practice, but is not intended to address every ethical issue. Occupational therapists are expected to use a process of ethical reasoning (refer to www.otboard.org.nz for an example) to guide and reconcile these issues, and to make careful judgements about the primacy of ethical principles operating when a conflict arises.

The Code should be read in conjunction with other relevant legislation, policies, procedures and standards defining professional practice and conduct, including the Board’s Competencies for Registration as an Occupational Therapist (2000).

The full code and competencies can be found on the Occupational Therapy Board of New Zealand website http://www.otboard.org.nz/index.php?page=Publications as well as in your Resource Book for Readings.


Diversional therapy and occupational therapy: similarities and differences

Diversional therapist Occupational therapist

Implementation of the role

Provides person-centred leisure activities. Facilitates and provides occupations for people through engaging their needs, preferences and capacities in the context of the environment, to optimise their ability and functional independence.

Safe legal ethical practice

Accountable to workplace management.

Members of the New Zealand Society of Diversional Therapists are accountable to NZSDT.

Health Practitioners Competence Assurance Act 2003

Occupational Therapy Board of New Zealand is responsible for the registration and oversight of occupational therapy practitioners.

Culturally safe practice


Provides a service that takes into account the socio-cultural values of the client and tangata whaiora, family/whānau and significant others.

Ongoing professional development


Uses and contributes to resources that develop self and the occupational therapy profession.

Qualifications National Certificate Level 4 (before 1999 there was a Level 3 qualification)

Ongoing education/professional development is required.

Bachelor of Occupational Therapy.

Occupational therapists have an annual practising certificate.


Diversional therapy and occupational therapy: similarities and differences

Diversional therapy consumer focus: Occupational therapy consumer focus:

Diversional therapy involves the organisation, design, coordination and implementation of client-centred, meaningful, activity programmes. The client will have a choice of leisure activities, designed for them, to enhance their quality of life through ongoing support and development of their intellectual, emotional, spiritual, social, cultural, sexual and physical wellbeing.

Occupational therapy has a clinical and rehabilitative focus and occupational therapy specifically mentions the promotion of health and wellbeing of individuals, groups and communities. Occupational therapists use processes of enabling occupation by the application of knowledge, principles, methods and procedures related to understanding, predicting and influencing people’s participation in occupations to optimise human activity and participation in all life domains across the lifespan.

Take some time to think about the diversional therapy Standards of Practice and Code of Ethics.

Next think about the occupational therapy Competencies for Registration and Code of Ethics.

Some points in both sets of Standards and Codes of Ethics are similar, but there are major differences in the boundaries of the roles and the expected outcomes from interventions. There are also differences of accountability.

The differences in the two roles are elaborated in an article on pages 61 – 65 of this workbook


Diversional therapists use activities to:

Occupational therapists use activities to:

There are Regulations that relate to both diversional therapy and occupational therapy, and Acts of Parliament and Regulations which directly or indirectly affect the professional practice of occupational therapy. Can you identify two Acts and/or Regulations that relate only to occupational therapy?

Diversional therapists and occupational therapists use activities to assist people they are supporting . Explain the difference in the expected outcome from these activities.


Article: Occupational therapy and diversional therapy – what are the differences?

IntroductionUnit Standard 23918 “Describe the philosophy, purpose, and benefits of diversional therapy, and the role and skills of diversional therapists” requires a diversional therapist to understand the differences between an occupational therapist (OT) and a diversional therapist (DT). These differences are concrete and evident when comparing the length and degree of training, registration requirements and standards of practice. However, to understand the roles –which intersect and differ between these two professions – it is also important to understand their similarities.

HistoryFirstly, it is important to understand the origin of diversional therapy as a vocation in New Zealand, and what was happening in the health and disability sector at the time. Traditionally, leisure/activity programmes were provided to patients in long-stay wards by occupational therapy aides under the supervision of an OT who was commonly employed in a hospital setting. However, once the long-term care of older people was transferred to the private sector, the role of providing leisure activities was taken up by a variety of people who were commonly called activity co-ordinators and did not necessarily have any training. On the whole, OTs were not employed in these settings to take on this role or any other roles relevant to this setting. Eventually, the need for training was recognised and established, as was the ability of the DT to take on this role independently. Therefore, it is clear that DTs and OTs come from similar vocational origins, and this is evident in the following definitions of occupational therapy and diversional therapy.



DefinitionsOccupational therapyOTs are Registered Health Professionals under the Health Practitioners Competence Assurance Act (2003). Townsend & Polatakjko (2007) define occupational therapy as “the art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; and enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life” (p. 372).

Diversional TherapyThe New Zealand Society of Diversional Therapists states that “Diversional therapy involves the organisation, design, coordination and implementation of client-centred leisure-based activity programmes. The aim of which is to improve the quality of life through ongoing support and development of clients’ intellectual, emotional, spiritual, social and physical needs and well being”.

The similarities between these two vocations are evident in these definitions; and both use activity to improve the well-being and quality of life of their clients. This is an important foundation of both vocations – their inherent belief in a person’s right to meaningful activity as part of daily life.

Breadth of rolesHowever, the difference is evident in the choice of words which describe the breadth of the roles. Occupational therapy uses the word “occupation” and diversional therapy uses the word “activity”. “Occupation” is a broader term than “activity”, which in the role of DTs generally refers to leisure and recreation. OTs are concerned with all the occupations that people carry out in their daily lives: self care, work and leisure. Both practitioners work in the area of leisure and recreation, but the OT also works in the area of self care and work. For example; OTs work with clients in their workplaces to facilitate a person’s return to work or in a rehabilitative setting to retrain a person to carry out occupations such as showering and dressing.



AssessmentBoth OTs and DTs understand the vital importance of seeing a client from a holistic perspective: that people are more than their physical body. The definition of diversional therapy refers to the intellectual, emotional, spiritual, social and physical needs of a client. Both therapists, as do many others, carry out assessments which attend to these dimensions. DTs do this mainly on the basis of their own observations and other health professionals’ documentation. This information is used primarily to facilitate the client’s participation in leisure activities.

OTs reflect on the dynamic relationships between people, their occupations and the environment. OTs may use observation in their assessments as well as a number of formal assessments which provide detailed information to inform the professional opinions required of them. For example, in terms of a person in a hospital setting, an OT will determine whether or not the person is cognitively and physically safe to return home.

Contribution to healthThe definition of occupational therapy specifically mentions the promotion of health and the use of occupation to restore and maintain a client’s good health. OTs have the capacity to prescribe and facilitate occupations specifically to meet the goal of health promotion, e.g. specific play occupations to facilitate the normal development of a child. DTs use activity to improve the well-being of a client but do not have the same depth of knowledge about the use of activity to facilitate good health.

Adaptation of activityOTs and DTs both understand the importance of activity/occupation to a person’s life. Both adapt or modify the environment and/or the physical, mental and social components of an activity to enable a client to participate in designated activities. The difference between the two roles often depends on the complexity of the activity analysis. For example, an OT may work with a client who has a complex set of needs such a person with tetraplegia (the inability to move the body other than the head and neck), and may need to design and prescribe technological equipment, teach the person new skills, or alter the home/work environment.



Role boundariesIn some respects, it could be said that what DTs do is to specialise in one aspect of the OT’s role: the planning and delivery of leisure activities. The vast majority of aged care facilities in New Zealand employ a DT in this role.

However, if both therapists were employed to work in an aged care facility, the role division would probably look something like this:

The DT would plan and implement a programme of leisure and social activities for individuals and/or groups. DTs can also educate caregivers about the importance of understanding the client as an individual, and facilitate activities which acknowledge and celebrate the diversity of people’s lives.

The OT would fulfil a number of other roles:

Work with individual clients, with a focus •on improvement/rehabilitation e.g. independence in activities of daily living.

Assess and recommend specialised seating •for clients whose posture has been affected by various conditions e.g. stroke.

Educate caregivers on a variety of issues •such as: enabling clients to carry out tasks for themselves; communicating with clients who have difficulty in this area; and correct moving and transferring procedures.

Use evidence to support assessments •and interventions.

Make recommendations about an •individual client’s needs.

One of the areas ODs and DTs could potentially join forces in is working with people who have dementia. There are many specialist activities used in this area of practice: diversionary activities to manage challenging behaviour, doll therapy, sensory stimulation and the use of music.



About the author:Alexa Andrew is a qualified OT who has spent many years working in aged care facilities with DTs. She has also taught the National Certificate in Diversional Therapy at Otago Polytechnic and is currently teaching in the Bachelor of Occupational Therapy programme.

SummaryThe intention of this analysis is to increase an understanding of the dimensions of diversional therapy and occupational therapy. It is not the intention of the writer to undermine or establish the superiority of one profession over another. OTs and DTs share similar ideals and values, and both have an important and vital role to play in the health and disability sector.

Referenceshttp://www.diversionaltherapy.net.nz/what-is-diversional-therapy/

http://www.nzaot.com/

Townsend, E.A., & Polatakjko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice through Occupation. Ottawa, Ontario: CAOT Publications ACE.

My notes



To page 7Do you agree with your initial thoughts and ideas?

yes

no

yes

no

If yes, do you have anything you would like to add?

If no, what would you change?


When you have completed the trainee assessment portfolio and have been signed off as competent by your assessor, your assessor will complete a Certificate and give it to you.

If you wish, you could frame it for display or mount it in a record book.

Check the following:

Please check over all the activities to make sure you have completed them.

Complete the trainee assessment portfolio and remember to sign your assessment portfolio in the place provided, verifying that you are the one who has completed all the assessments.

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