Practice Education is a core component in the training of healthcare professionals, with fieldwork providing important opportunities to consolidate curriculum-based teaching through the integration of theory with practice. The School of Allied Health (SAH) in the University of Limerick (UL), has a long history of engagement in innovative community-based student placements; developed in order to expand placement capacity and offer a unique learning opportunity to students. Research conducted by SAH demonstrates that the outcomes of these collaborative fieldwork placements had been predominantly positive but host organizations also requested a more sustainable model of university engagement with services and communities. Responding to this call, the Occupational Therapy Practice Education Team (OT PET) engaged in an extensive process of face-to-face collaboration to map community need and identify opportunities for sustainable engagement through ongoing student fieldwork placements. On completion, it was identified that a funded community-based student-led clinic was an optimal means of meeting the needs of all stakeholders and maintaining a continual Higher Education Institution’s (HEI) presence in the local regeneration areas of Limerick City.
Innovation within Practice Education: The Journey to Date
Practice Education is an essential aspect of health professional training where knowledge, skills, and attitudes converge to enable competent practice to emerge (Hocking and Ness, 2002). However, globally it has become increasingly challenging for HEI’s to source sufficient practice education placements for their students (McGrath & Dillon, 2010; Larkin & Watchorn, 2012). In response, the OT PET of the SAH within UL developed non-traditional community-based placements in emerging areas of practice; using the role-emerging placement model (REP) to establish and deliver these unique fieldwork opportunities. REP’s occur in settings where there is no occupational therapy service. Students benefit from the invaluable experience gained through identifying and piloting occupational therapy services within the organization under the supervision of both an onsite supervisor and a profession-specific supervisor who is usually from the HEI (Wood 2005). The community partner benefits from the opportunity to get a “taster” of what occupational therapy can offer, allowing service users to access expertise that otherwise would not be readily available.
The first REP was rolled-out by the School of Allied Health in 2009 within Access Campus (Warren et al, 2010). Access Campus is an educational outreach center developed in partnership with UL and Limerick Enterprise Development Partnership (LEDP), with a remit of addressing employment regeneration, skills training, education, and community development. Initially, occupational therapy students worked with children and teenagers linked with the Access Campus study club. They engaged with both the well population and young people with known diagnoses; common mental health issues, Attention Deficit Disorder, Autism Spectrum Disorder, and sensory processing difficulties. Interventions focused on the development of life skills such as stress management, occupations to build self-esteem and resilience, developing effective study skills, social participation, sensory regulation, and coping with key transitions within the school system. To date, the OT PET collaborated with six core community organizations in the Mid-West region of Ireland, with multiple placements implemented in partnership with varied client groups across diverse service areas. In recent years the array of client groups served through REP expanded significantly to include homeless people, victims of domestic abuse, individuals with dementia, active retirement groups, and people with acquired brain injury. What remains constant is the focus on health promotion and/or the use of meaningful activity to positively impact health and well-being.
Exploration of Views and Perspectives of Community Partners
In order to determine the effectiveness of these placements, from the perspective of the host organizations and service users, a qualitative research study was conducted. Semi-structured interviews were completed with participants who were involved in the on-site supervision of students and consented to engage in the research process. Data was analysed using Braun and Clarke’s six phases of thematic analysis (2006). The results indicated that:
- Positive outcomes outweighed challenges;
- Challenges included the effective management of expectations from the perspectives of all stakeholders, and also the overseeing of student welfare secondary to exposure to the emotional narratives of clients;
- Positive outcomes related to the fact that successful collaborative practice & reciprocal learning occurred organically;
- Pre-placement preparation and support from the HEI during placement were deemed to be essential components in ensuring a positive placement experience for all; and
- Community organizations called for sustainability around community engagement, requesting a consistent roll-out of student placements to allow for one to build upon the other over time.
Following this research, a process was undertaken to determine how best to expand these successful and innovative student placements. The initial stage of this process was the execution of focus groups to which a small group of community organizations were invited in order to explore the potential for future student engagement. Most were based in the regeneration areas of Limerick City; communities where people generally experienced a lower quality of life than other sectors of the city, being disadvantaged in terms of health and life opportunity. These discussions were positive in nature, highlighting possible benefits to all stakeholders including the HEI, the student, the community organization, and the service users. However, it was also apparent that further collaboration was required to advance a successful expansion of the existing placement structures. At a later date, and over an extended period of time, a further process of collaboration occurred on an individual basis with a wider group of organizations. Based on the outcomes of these combined discussions it was identified that:
- Organizations were keen to have closer collaboration with HEI’s but again called for a continuous student presence rather than sporadic engagement;
- There was considerable opportunity for interprofessional practice education placements, in addition to an unidisciplinary approach, both across disciplines within the SAH and also across faculties within UL;
- An interagency placement model was established to be an optimal approach for placements. This model allows for shared student supervision between traditional placement sites and non-traditional community sites, hence providing a diverse learning environment for students and facilitating closer working relationships between professionals in the delivery of services to the local community;
- It was emphasised that students operating within non-traditional placement settings, needed to be clear about the parameters of their involvement with service users from the outset, being careful to avoid raising the expectations of clients and their families in relation to what could realistically be delivered in the available timeframes;
- Priority client groups were identified for student involvement including youth, older persons, asylum seekers, and the traveller population;
- Priority areas for intervention were identified as youth mental health, speech and language development at preschool and primary school level (but not confined to these age-groups), and health promotion across the lifespan; and
- It was emphasised that community needs changed over time and therefore interventions needed to be responsive to community need, adapting and evolving as required.
An extended period of collaboration between the University of Limerick and local community organizations supports the development of an interprofessional student-led clinic/health hub, to provide continual service to the regeneration communities of Limerick. This new initiative is expected to be beneficial to the HEI in terms of expanding placement capacity, to students in increasing the diversity of learning opportunities available to them, and the community organization and their service users in accessing services that would otherwise be absent or limited. However, adequate funding is required to support the continuity of service provision and hence funding streams are currently being explored to move this initiative forward in a sustainable manner.
Braun, V. and Clarke, V. (2006) 'Using thematic analysis in psychology', Qualitative Research in Psychology, 3(2), 77-101
Hocking, C. & Ness, N. E. (2002), WFOT Revised Minimum Standards for the Education of Occupational Therapists. Sydney: World Federation of Occupational Therapists.
Larkin, H & Watchorn, V. 2012 Changes and challenges in higher education: What is the impact on fieldwork education? Australian Occupational Therapy Journal, 59 (6), 463-466
McGrath, T. & Dillon, M. (2010). Development of a mental health practice tutor role in the Irish Practice Education context. Irish Journal of Occupational Therapy. 38 (1), 50 – 57
Warren, A., O’Leary, D., Mooney, E., O’Grady, S. and Costello, S. (2010) “Learning with the Learners: Innovation in Role Emerging Occupational Therapy Practice Education” Irish Journal of Occupational Therapy, Winter 38(2), 37-40
Wood, A. (2005) ‘Student Practice Contexts: Changing Face, Changing Place’. British Journal of Occupational Therapy, 68(8), 375-378.
Fiona McDonald (Dip COT, MSc OT) is a Regional Placement Facilitator within the Occupational Therapy Practice Education Team in the School of Allied Health in the University of Limerick
Tanya McGarry (BSc OT, MSc OT) is a Regional Placement Facilitator within the Occupational Therapy Practice Education Team in the School of Allied Health in the University of Limerick
Donal O’Leary is the Access Campus Co-ordinator within Student Affairs in the University of Limerick
Dr Nancy Salmon (BSc OT, MSc OT, PhD) is a lecturer in Occupational Therapy in the School of Allied Health in the University of Limerick