Full text of DOI:10.1002/oti.122

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Occupational Therapy International, 7(3), 206–212, 2000 © Whurr Publishers Ltd
An in-service part-time
undergraduate programme for
occupational therapy support
workers
FIONA M DOUGLAS School of Physiotherapy and Occupational Therapy,
Faculty of Health and Social Care, University of the West of England
ABSTRACT: This short report outlines the success of an undergraduate pro-
gramme designed specifically for mature students’ participation while they continue
with their work as occupational therapy support workers. The programme was estab-
lished to meet a local need.
Key words: mature students, part-time, undergraduate.
Introduction
The Bristol In-service Occupational Therapy Programme was established in
1987. The concept of in-service education is based primarily on the principle
of staff retention and maintenance of standards, through work-based educa-
tion. Staff are released from their duties with the consent of their employers,
and funding arrangements mean that this type of education is free for the par-
ticipant. In this instance, the staff were occupational therapy support workers
who were given the opportunity to study part-time for a professional occupa-
tional therapy qualification while still employed as support workers.
Background
National issues
In 1986 the National Association of Health Authorities stated that 19% of
funded occupational therapy positions were vacant and predicted that a
growth of 73% would be necessary to meet the demands for the next 10-year
period.
The Audit Commission’s report (1985) stated that there were only 1000
domiciliary occupational therapists employed in local government in England
and Wales, at a time when successive governments had been promoting

An in-service part-time undergraduate programme
207
community care. This same source reported that, given the growth in the
number of older people and people with disabilities, the situation was likely to
worsen. The commission emphasized the central contribution of occupational
therapy in rehabilitating and maintaining people in their own homes. It con-
cluded that the shortage could be a result of the limited number of institu-
tions offering occupational therapy undergraduate programmes. By the time
the Bristol in-service programme was established, the shortage of occupational
therapists had risen to almost 30%.
The national shortage was attributed to the increase in the demand creat-
ed by national policies that reduced long-stay hospital provision and increased
community-based services. The shortage was compounded by the fact that
occupational therapy was, and continues to be, a predominantly female pro-
fession. Many occupational therapists had left the profession to have a family
and had chosen not to return (Audit Commission, 1985).
Local needs
In 1986, Bristol and the area immediately surrounding the city had three
health authorities providing hospital-based services and one large local gov-
ernment authority providing domiciliary services. All of these employed occu-
pational therapists. In the hospital-based services, out of a possible 148
qualified occupational therapy positions, 32 of these were vacant (22%) and
had been vacant for a considerable period of time. The figures for the domicil-
iary services are not available, although anecdotal evidence indicates that
there were many vacancies, which was restricting developments in the ser-
vice. In contrast, out of a possible 135 occupational therapy support workers
employed in the hospital-based services, there was one vacancy (0.74%)
(Part-time Diploma Course in Occupational Therapy, Validation Submission
by Bristol Polytechnic, 1987).
For the purposes of administration and management of the health service,
the UK has been divided into regions. Bristol is located in the South West
region. Apart from the shortages in and around Bristol, there were many
vacant positions in this region.
In 1987 there was a well-established full-time undergraduate programme
offered by St Loye’s School of Occupational Therapy in Exeter. This was the
only source of professional occupational therapy education in the region and
it took three years for students to qualify for state registration. The funding
arrangements at the time did not restrict graduates from this programme to
taking up positions only in the South West region and, as a result, many took
up positions outside the region.
The in-service programme was established to help to address this specific
and acute regional shortage of occupational therapists. Funding was provided
by the South West Regional Health Authority and was limited to support
workers employed in the region. Employers agreed to staff being released for

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regular study for one and a half days each week for four years, with five field-
work education placements, each lasting five to six weeks. The graduates were
then obliged to secure their first positions in the region.
It was hoped that by educating the support workers who had strong work
and family ties to the region, these people would be less inclined to move
away once they were professionally qualified. This, in conjunction with the
graduates from the full-time programme at St Loye’s, would have a stabilizing
effect on the regional occupational therapy workforce.
Location of the programme
The local occupational therapy managers in Bristol were anxious to resolve
their recruitment and retention crisis and Bristol Polytechnic was keen to
expand its role in the education of health and social care professionals. The
distribution of a full-time programme at St Loye’s in Exeter to the south of the
region and the in-service programme in Bristol to the north seemed compre-
hensive and complementary.
Developments in the programme
The programme has a biennial intake and since 1987 has graduated more
than 70 students with professional occupational therapy qualifications. A
high proportion of these graduates have found their first positions in the
South West region – see Table 1. Those who went to their first positions out-
side the region did so because of family relocation. Anecdotal evidence sug-
gests that graduates who found their first position in the South West region
have continued to work in the region.
TABLE 1: Cohorts and first positions at state registration
Intake year Cohort size at start
of programme
Cohort size at
state registration
First positions
in SW region outside SW region
First positions
1987
1991*
1993
1995
21
18
25
20
17
15
21
18
14
14**
21
3
1
0
1
17
Total
84
71
66
5
1997
19
***
* No intake in 1989 owing to organizational changes
** One diplomate unable to work through ill-health
*** This cohort will graduate in 2001

An in-service part-time undergraduate programme
209
Contextual changes
The biggest impact has been the influence of changes in health and social
care organization and delivery in the UK. The changes in the geographical
boundaries of the region have meant that the South West region has expand-
ed. The main issue here has been in securing sponsorship for students and
ensuring availability of fieldwork placements. Funding students for this pro-
gramme has become complex and is now critical. At the outset, employers
agreed to release staff for the stated amount of time. However, funding has not
been provided to assist the employers to secure cover for the temporary
absences of the in-service students from their work duties. This is now becom-
ing a major issue in recruiting in-service students for the future.
Institutional changes
Since the programme started, Bristol Polytechnic has acquired university sta-
tus and is now the University of the West of England. The affiliation of the
programme in the university has changed several times, each move reflecting
changes of structures in the university. Currently, the programme is under the
Faculty of Health and Social Care in the School of Physiotherapy and Occu-
pational Therapy.
Programme changes
The programme now offers a four-year Bachelor of Science Degree with Hon-
ours instead of a Diploma in Occupational Therapy. The programme is deliv-
ered over two consecutive days a week, with four eight-week fieldwork
placements.
Current programme
The programme continues to be validated by the College of Occupational
Therapists, the Council for the Professions Supplementary to Medicine and
the University of the West of England.
The programme
Table 2 presents some of the content of the programme.
Knowles’ (1990) adult learning theory model of androgogy is used to under-
pin much of the delivery of this programme. For example, for the adult learner,
experience is the best resource for learning, therefore the programme team facili-
tates deep analysis of fieldwork experience when the students return from place-
ments. Similarly, in the assessment of the students as adult learners, the number
of examinations is kept to an absolute minimum, so a variety of assessment
methods are used to measure the students’ progress. These include team presen-
tations, poster presentations, open book exams and modified essay questions.

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Douglas
TABLE 2: Some of the content of the programme and stages
Year 1 – level 1
Year 2 – level 1/2
Year 3 – level 2
Year 4 – level 3
Basic sciences
Basic sciences
Sociology*
Occupational therapy Management and
core skills and thera- professional contexts
peutic concepts
Sourcing evidence*
including fieldwork
Occupational therapy Occupational therapy placement
– theory and practice process
Health promotion
and education*
including fieldwork
placement
Basic research skills* Occupational therapy
professional project
Occupational therapy
and specific physical Issues in health and
health issues** activity*
Fieldwork placement
Occupational therapy Occupational therapy
and specific mental
health issues
and specific learning
disabilities
Fieldwork placement Sociology
* These modules offer shared learning opportunities with other professions
** As part of this module the students have been offered the opportunity of shared learning
with physiotherapy students
The programme team makes every effort to support all the students in hav-
ing a full, varied and equitable experience.
In harmony with the monitoring and evaluation system in the university,
the students are invited to formally evaluate each module in terms of delivery,
content and relevance. Many changes have been made to the programme as a
direct result of students’ evaluations. These changes in turn are monitored
and evaluated for their impact.
Student-centred learning and experience
The programme has always focused on student-centred learning and is devel-
oping problem-based learning as its preferred approach. The students use
learning contracts in academic work as well as on fieldwork placements.
Methods of support for these mature students include a mentorship scheme in
the workplace, a student network and on-site counsellors. Individual tutorials
are also available and can be face-to-face, by telephone or by email.
The students
Several of the students travel for up to three hours in order to attend classes
and must stay overnight. The students have to contend with serious

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211
restructuring of family and work life. Not all of the students have had the
opportunity to study since completing their formal education. In spite of this,
they are very committed to the programme.
Supporting the supporters
The students’ employers and mentors meet regularly with the faculty. Field-
work educators are invited to attend courses to assist them to facilitate the
students’ learning on placements, and newsletters are distributed throughout
the year.
Commitment from employers
Commitment from the employers is vital for the success of the students and
the continuation of the programme. Without this commitment, it would be
impossible for staff to be released from their duties and to be given the ongo-
ing support that they need.
The difficulties of in-service occupational therapy education
Students report that the weekly change of role from support worker to student
can be difficult to accommodate. Even harder for some students is the issue of
returning to their own workplace on completion of a fieldwork placement:
It will be difficult returning to work as an occupational therapy assistant in a hospital.
This is partly due to the increased responsibility and sense of achievement felt from
working here, but also the frustration of working in a hospital which means that you get
the patient home and then cease contact. (extract from a student’s written evaluation
of her fieldwork experience)
The issue of ‘role change’ is also apparent in the students’ social context.
Most, though not all, of the students are female with dependants. Harmoniz-
ing working life, family life and studying can take its toll on some students,
but all of them have found coping strategies that are to be envied. A small
number of the students have had babies, several have coped with bereave-
ment, others with major illness, some relationships have suffered, and a few
students have changed jobs and moved house and still managed to complete
the programme.
Future directions
The programme is undergoing some new challenges. The College of Occupa-
tional Therapists states that the shortfall of occupational therapists is 20%
(Occupational Therapy News, February 2000) and once again this is being
attributed to new policies and insufficient numbers of graduates. In addition

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Douglas
there is a decreasing number of occupational therapy support worker positions,
mainly because of financial constraints. These same financial constraints
mean that many occupational therapy service managers find it almost impossi-
ble to release staff to study for two days a week over four years. In addition,
the eight weeks in fieldwork education during each of the four years increases
the financial pressure on these managers. As a result there seems to be fewer
occupational therapy support workers who might wish to enrol in the pro-
gramme.
Over the past two years there has been a steady increase in opportunities
for part-time undergraduate education available in the UK. Correspondingly,
there has been a substantial increase in the number of enquiries about the
Bristol programme from support workers in other health and social care pro-
fessions who wish to undertake a part-time undergraduate programme in occu-
pational therapy.
The future of this programme would seem to rest in two areas: first, in find-
ing a way to recompense employers who release staff, so that they can pur-
chase resources to cover the duties usually undertaken by the in-service
students. Second, the feasibility of widening access of this programme to sup-
port workers from other health and social care professions needs to be
explored.
Summary
The Bristol in-service programme has contributed successfully to the reduc-
tion in the shortage of occupational therapists in the South West region. Its
continued success depends on changes in funding arrangements and widened
access.
References
Audit Commission for Local Authorities in England and Wales (1985). Making a Reality of
Community Care. London: HMSO, paragraphs 138–44.
Knowles M (1990). The Adult Learner: A Neglected Species, Fourth edition. Texas: Gulf Pub-
lishers, Chapter 3.
National Association of Health Authorities (1986). Recruitment and retention of staff in the
professions supplementary to medicine. Report cited in Therapy Weekly 13(23; 4 Decem-
ber).
Occupational Therapy News (2000). Baroness Dean: Reduce shortage in three years. London:
College of Occupational Therapists, March, 8(3): 1.
Address correspondence to Fiona M. Douglas MSc DipCOT SROT DACE, Award Leader,
BSc(Hons) Occupational Therapy, School of Physiotherapy and Occupational Therapy, Facul-
ty of Health and Social Care, University of the West of England, Blackberry Hill, Bristol BS16
1DD, United Kingdom. Email: Fiona.Douglas@uwe.ac.uk