Are you a pain in the butt?

I'm pretty sure that all OTs set out on their career paths full of ambition and desire to do the absolute best for those  in their care. They believe they can make a difference to quality of life, independence and participation -  regardless of the client group they ultimately specialise with. This is certainly true for me, working with children and their families.

For most of us however, at some point along the way we come to realise that doing the absolute best for our clients costs money, and most of the organisations we work within cannot meet all of the costs all of the time. Systems are in place to manage budgets - eligibility criteria, bulk procurement, recycling, reduction of non-essential spend, reduction of regular spend, freeze on spend (perhaps depending on the time of year). I'm not criticising organisations who impose these financial restraints by the way - this is a necessary evil to ensure that (in theory) resources are used fairly and wisely. ​But it does mean that it leaves the the OT facing a client or family with the demoralising and difficult task of having to say 'no' fairly regularly. 

However, what I am critical of is when statutory financial restrictions are accompanied by a lack of empowering families to source alternative means of provision for themselves. Or worse still, when families are actively blocked in their path to other solutions. I recently heard of two separate cases where managers prevented OTs from supporting families' charity applications for equipment for their child (it was considered outside their remit), although the OTs involved felt the equipment was both clinically appropriate and beneficial (very much within their remit). This makes my blood boil, if I'm honest. Not being able to access a particular item or service of choice is not something that generally happens in the absence of disability. And, it's one thing not to be able to access statutory provision - the vast majority of parents understand that resources are limited - but to be actively prevented from investigating solutions elsewhere is a disgraceful double whammy and one which is at complete odds with my core values as an OT. It's not just managers though. I've seen and heard of individual therapists who are rude, condescending or obstructive to families. 

There is no need for this. At all. It serves to alienate families from our services, it creates unnecessary stress, but mainly, it's really difficult for me to understand. I don't believe that supporting families to achieve their goals raises their expectations of having costly statutory provision further down the line - although that seems to be one of the fears which drives these decisions. Most families fully understand their child's capabilities in the context of their family's needs, and also learn the limits of statutory provision very quickly. Supporting them here and now in whatever way possible surely should always be our goal? Yes, it might be a pain in our busy butts to investigate wider options, but is that not what we're supposed to do?
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​This is why we need to become pains in butts - for the right reasons.

We need to be the champions of children and their families - they may not have anyone else to help in our area of expertise. We need to work closely with them, and encourage them to run new ideas past us first - this will help us identify the clinical appropriateness. If a solution happens to be inappropriate, we need to assist in finding a suitable alternative. To be pro-active and positive on behalf of families, we need to find unconventional ways to act as advocates - which might include encouraging families to complain. I'm not stirring here (I'm really not). These sort of complaints should be seen as indicators of unmet need, and should be looked at seriously by the purse-string holders. We need to provide evidence for commissioners and managers so that saying 'no' becomes much more difficult. And for us, saying no is not an option - at worst, we should be saying 'we can't do it that way, what about this way.'

​And there's another reason why we should be in families' corners. Increasingly, families are using the internet to find solutions; talking to each other via social media; and generally fast becoming super-informed, knowledgeable carers. Heads-up - we don't hold all the power any more - and if we're not there to help, families will do it without us. But they shouldn't have to - life is stressful enough for the family of a child with additional needs. Plus, we lose our hard-earned professional value if we're content to take this approach - and being a devalued health professional is not what I want for me or my profession. So, let's be pains in the butt for the right reasons - reminding commissioners, directors, managers and colleagues that we are here to do the best for these families. Budget restrictions are one thing, but withholding support for access to alternatives is not ever acceptable. 

When we become a pain in the butt for advocating on families' behalf, we can say we are doing a good job!

I'll hop off the old soapbox for now...but I'm interested in your views. If you're an OT, are you a pain in the butt (for the right reasons)? Families, what has been your experience? If you're a manager, what are the challenges you face?

By the way, the two families I spoke of earlier got round their blockage. One pain-in-the-butt OT wrote a letter of support on blank paper outside of work; and one pain-in-the-butt charity agreed to accept the family's application without support from a therapist. How terribly sad that it came to that. But well done to both for being pains in the butts and putting the needs of families first.