An exploration of occupational therapy practice in social enterprises in the UK

Introduction Occupational therapy in the UK has been heavily shaped by the medical model, however developments within the occupational therapy profession that have led to a re-focussing on the centrality of occupation for health have resulted in the need for new areas for practice outside of traditional, medicalised settings. The recent changing landscape of health and social care provision in the UK provides occupational therapists with new and different environments for practice. This research explored the provision of occupational therapy within social enterprises in the UK, and the compatibility of the occupational therapy philosophy with a social enterprise model. Methods This mixed methods exploratory study that was conducted within the pragmatic paradigm and had two phases. In Phase 1, twenty-one online questionnaires were completed by occupational therapists working in social enterprises in the UK and focused on their practice and the social enterprise they work for. Social enterprises that employed occupational therapists were also identified through desk based research. In Phase 2, eight of these social enterprises (which were identified in Phase 1) participated as case studies, using case study methodology to explore occupational therapists perceptions of their practice; service users’ experiences; and the social entrepreneur’s involvement in the provision of occupational therapy. The data collection in the case studies consisted of twenty-six semi-structured interviews with occupational therapists, social entrepreneurs and service users; unstructured observation and formal documentation was used for triangulation. The interviews were analysed using qualitative thematic analysis and the findings of the case studies were combined with findings from Phase 1. Findings Social enterprise has been used as an effective model for implementing holistic occupational therapy services that promote health, wellbeing and occupational justice. Occupational therapists benefit social enterprises to achieve their social and business aims. Funding social enterprise start-ups and ensuring their sustainability continues to be a challenge and government policy needs to be supported with finance to implement it, without which there is a risk of private companies taking over public sector services. Conclusions Social enterprises can provide an environment where occupational therapists have freedom to practise according to the principles of their profession without the limitations of the medical model and in a socially inclusive environment. Social enterprise can provide a rewarding and satisfying environment for occupational therapists to practise in client centred, holistic ways. The current health and social care climate provides many opportunities for occupational therapists to create and shape their own environments for practise. Alternatively, occupational therapists may need to promote the profession to existing social enterprises to gain employment in the new organisations that deliver public services.