Occupational Therapy’s Roles in PEACE

Occupational Therapy Role:

Occupational Therapy’s role, within the context of the PEACE pathway, is much the same as the role generally in either Eating disorders or neuro-developmental services. Both conditions are somewhat unique in their effect on an individual’s physical, mental & neurological health. Occupational Therapists are therefore well suited, with their ability to consider physical, social, psychological & environmental factors on an individual’s daily activities, roles & routines. This can be wide ranging from social isolation, compromised educational & employment plans, as well as activities of daily living in the areas of self-care, leisure & productivity. 

Occupational Therapists have contributed with this perspective to the on-going development of the PEACE pathway. We have undertaken additional training in diagnostic tools and interventions to supplement our knowledge and fulfil the role of Autism Champion. This means we can offer specialist advice to other team members working with those with ASD or ASD traits and can provide an alternative perspective on clients in MDT team meetings. Furthermore, we have introduced the sensory screening tool into the induction pack for the day service and this information is included in goal and intervention formulations for treatment. This has broadened professional discussion to consider and include the breadth of neuro-developmental differences that may be present for a person with both ASD and an eating disorder. This applies not only to their experience of psychological therapy but their wider life outside of treatment such as work, education, home life, self-care and leisure. Each client will have different goals relating to their neuro-logical differences, whether that be to manage and/or improve this experience, and the OTs can advise both client and team on appropriate interventions and support.

Clinical Work:

In clinical work within this pathway, the Occupational Therapist will look at a functional goal and will collaboratively work with the client to work towards this. The aim of the intervention, will be the development of skills or reduction in barriers associated with achieving this goal, rather than being symptom focused. 

In my clinical experience of working with those who meet the criteria for the PEACE pathway, some of the more frequent themes of work have included, but are not limited to:

1. Task or environment adaptation. This has often been linked to sensory modulation and registration, which can impact one’s level of arousal and behaviour. Here the use of sensory screens and collaborative goal setting to create adjustments as trials has been used to enable participation in the occupation.
2. The use of graded goal setting and task-specific planning. This has felt important to create explicit and predictable behavioural goals. Difficulties with flexibility, rules and the emotions associated with these have frequently entered the sessions as challenges. The role of reviewing the experience of the goal and grading the intensity of it with the use of planning has allowed for the pace to be negotiated at each session, allow for change to feel more manageable and with less uncertainty.

Key Learning:

Developing an awareness of the individual’s needs & adapting to these within the therapeutic encounter has been helpful to enable participation and change between the sessions. For instance, assessing the therapeutic environment for challenging sensory stimuli, reducing uncertainty with consistency & organisation, getting to know the individual’s preferences to enable contribution (example: anxiety peaks at the start of session, so reduce small talk at this point & use bridging of sessions to feel more settled at the start) & to negotiate with the individual adaptions to communication within the session (examples: allow time to answer each individual question, model & encourage clarifying when either person aren’t sure they’ve understood/ areas of ambiguity, provide a clear rationale for decisions to create a shared sense of meaningfulness). The co-creation of these therapeutic adaptations can create evidence for change & new experiences, as well as enable in-session engagement.