How to be a better OT

How to deliver effective client education

• Clare Batkin - Your OT Tutor • Season 1 • Episode 3

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Are you tired of handing out generic education pamphlets that your clients never actually use? Discover how to move beyond the basic handout and deliver client education that results in meaningful change.

Episode Summary: In this episode of the How to Be a Better OT podcast, host Clare Batkin tackles a topic relevant to every OT clinical caseload: how to provide effective client education. It’s not just about rattling off information to tick a box; it’s about providing the right information, at the right time, and in the right way to empower your clients as active decision-makers. Clare introduces her signature RALFEY framework to help you evaluate client readiness, adapt your language, and ensure your clients truly understand and apply your recommendations.

 

Key Takeaways:

  • The RALFEY Framework: A step-by-step acronym (Readiness, Amount, Language, Format, Evaluation, You're Not Done Yet) designed to help you structure impactful education sessions.
  • R is for Readiness: Learn why you must think about what type of information your client is ready for before jumping into it. 
  • A is for Amount: Consider how much time you have and how much your client will be able to process.
  • L is for Language: Discover how co-designing examples with clients ensures your education is culturally relevant and matches their health literacy.
  • F is for Format: Why you should challenge your "autopilot" written handout approach and explore creative options like using videos, podcasts, or even sticking QR codes directly onto a client's splint.
  • E is for Evaluation: Understand the danger of simply asking, "Do you have any questions?" and consider alternatives such as practical demonstrations and gamification.
  • Y is for You’re not done yet: This is all about the evaluation that happens after the session is done, so you continue to improve your approach for your current and future clients. 

 

Links & Resources Mentioned:

  • Freebie: Access Annette Tonkin’s guide on working with clients with preconceived ideas, as well as over 100 other free resources in the Learning Library.
  • Deep Dive: Get the full client education tutorial and download the step-by-step worksheet by joining the Connector Membership.
  • Advanced Learning: Learn how to navigate conflicting goals and motivate hard-to-engage clients in the Alliance Membership.
  • Tool: Gamify your group education sessions and test client knowledge using Kahoot.

 

If you found this breakdown of the RALFEY framework helpful, please subscribe, leave a review, and share this episode with a fellow OT! 

Be sure to tune in next time when we will cover what an OT home assessment actually involves, whether you are facilitating a safe hospital discharge or conducting a community review.

Want to continue learning with Clare? Here are your options:

I'm definitely the first person to acknowledge that there is plenty of gray areas in what we do and plenty of complexity. But what I'd be encouraging you to do is to at least pause and consider if there's a better option. So is there a better option than just giving them that generic handout with 10 strategies or exercises or recommendations and expecting them to handle the implementation all on their own? Welcome to the How to Be a Better OT podcast. I'm Claire Batkin, an OT and clinical educator who is on a mission to make professional development simple, practical, and worth it for OTs. If you're ready to step back from the overwhelm and bring core frameworks to life, join me for step-by-step guides and practical solutions that will build your confidence and competence so you can deliver the best outcomes for your clients and truly love what you do. Hi, and welcome to another episode of How to Be a Better OT. The topic we're going to focus on today is one that I'm pretty sure would come up in every OT clinical caseload at some point. We're talking about how to provide effective client education. Now, the emphasis here is on effective. It's not just how to rattle off as much information as you can as quickly as possible, so you can tick that box as done. It's about providing the right information at the right time, in the right amount, and in the right way, so that it actually makes an impact for our clients. Now, there are lots of factors to consider, but never fear, as always, I've put together my very own framework to help you remember all the components of an effective client education session. The acronym we're going to work through is called RALFEY, and I'm sure you're very intrigued, so I promise I'll get to unpacking exactly what the RALFEY components are all about shortly. But first, let's rewind and start with a recap of the why. So why should we care about delivering good quality client education? The obvious answer is because if we don't provide clear education, our clients won't understand or use it. But I'm going to go a bit deeper than that. If we don't provide clear education, we're removing an opportunity for our clients to be informed, active decision-makers within the therapy process. If we give clear education, it also helps provide context for the recommendations we're making, which means it's more likely that our clients will understand them, that they've been made in a collaborative way with the client or their carers or family, and that the clients will actually follow through with those recommendations. This is what's needed if we want that education to actually have an impact on changing behavior, function, and participation outcomes. Now, the framework I'll teach you today could apply to any type of client education. So I'll give you a few examples. It could apply to education where we're trying to manage risks such as falls prevention or pressure injury prevention education. OTs also provide education focused on changing behavior to ultimately improve function, such as sleep hygiene education, or joint protection, or energy conservation strategies. It could also be in the form of educating a client about a home exercise program, so providing explicit instructions such as hand therapy exercises after a fracture. And we can also provide education where the client isn't the recipient. Sometimes the recipient is an informal carer, such as when we're doing manual handling training for a carer or a parent, and sometimes it's a paid carer, such as when we're teaching a support worker strategies that they can use when they're out and about in the community with a client. The audience could even be a group of people within a community. So in this podcast, I'm going to focus on that direct education with an adult client just to keep it simple, but the framework I'll present really could apply in any of these scenarios with a bit of tweaking. But now it's time to unveil this mysterious framework, the RALFEY framework, and I'll tell you quickly what each letter stands for. Then we'll go back and discuss each component with some practical examples one at a time. So firstly, it's RALFEY with an F, so R-A-L-F-E-Y. R is for readiness, so what type of information are they ready for in terms of content? A is for amount. How much time do you have to deliver the education? But more importantly, how much can the client actually process? L is for language, so the words we use matter. You need to consider the client's health literacy, their culture and preferences to use words and examples that are actually going to be relevant for them. F is for format, so how will the education actually be delivered? Is it just verbal instructions, written handouts, or something a little bit fancier? E is for evaluation, so how can you check your client has understood this important educational information before you finish that session? And then finally, Y is for you're not done yet, and this is a form of evaluation or reflection, but one that happens after that face-to-face session is complete. You need to reflect on how the session went and what you might need to continue or reinforce in a future session, and also reflect on your own performance. So is there something you could change to make the next education session even better? Now, before I start to unpack each of these RALFEY components, just a reminder that if you'd like a deeper dive into this topic, as well as access to a step-by-step worksheet with some prompts and examples, you can find it within my paid Connector membership, and that comes with access to over fifty recorded webinars, and I'll drop the link to that in the show notes if you'd like to find out more. Okay, let's dive into it starting with R for readiness. Now, when you're planning what content to cover in your education session, you need to think about what information your client is ready for. Some helpful approaches to look into here are the stages of change theory and motivational interviewing, which are all about behavior change. Now, as I mentioned before, often we are providing education because we want our client to change their behavior to ultimately improve their function. But we need to consider how ready they are for that change. Otherwise, if we jump straight to providing strategies when they haven't even accepted that a change is needed, we're probably wasting our time and theirs. So let's use the example of providing education about reducing pressure injury risks. So it's pretty pointless telling a client how to weight shift or the importance of skin care and skin checks if they're at that pre-contemplation stage, or they're not even motivated to change their risk factors because they don't realize how severe a pressure injury could actually be. We know the risks, but have we checked what they know? Before we jump straight to pressure relieving strategies, we often need to go back and explain the mechanism of how pressure injuries occur, but also share some real-life stories of the impact a serious pressure injury can have on someone's quality of life. Truly understanding what scenario they're trying to avoid means that they'll be more likely to pay attention when you start explaining how they can avoid that scenario. Sometimes when we think about readiness or what information a client is ready for, we can think about it in terms of where they're at in their health journey. So for example, if they're recovering from a hand fracture, what exercises are they up to at that stage of the recovery protocol? And have they met the criteria that suggests that they're ready to learn a new type of exercise? Or when it comes to introducing new assistive technology or equipment for the first time, we need to consider their more holistic journey, especially in the case of clients with progressive, degenerative, or palliative prognoses. We might be thinking, "Great, I've got this new piece of equipment that's going to make having a shower so much easier for them," and you start to plan out a session that will explain how to set it up and how to use it. But we need to remember that in scenarios like this, the AT may not be the symbol of positivity that we think it is. Our client could see it as a sign that their function is deteriorating, and this can be a reminder of their prognosis and the journey ahead of them. So these scenarios go beyond just are they ready for the education to are they even ready for the assistive technology and how much work you have done to support them in this realization and acceptance. But I think in this case, the R for readiness becomes an important reminder of these broader considerations, too. So that's R. Remember to think about what content is your client ready for in so many different ways. Now we're going to move on to A for amount. So how do you know how much education to provide? And there are two main perspectives to take here. So how much can they actually process in that session? And how much can you fit in while working within any funding constraints that you may be dealing with? So we'll start with the client perspective first, and we'll begin by thinking about their capacity to pay attention in the moment. So we can think about what their cognitive and psychological capacity is to take on information in that session. So do they have slower information processing due to an intellectual impairment where you can't talk at top speed to fit in as much as possible? Do they have fatigue, where fifteen minutes into that session they're going to lose the ability to concentrate and pay attention to what you're saying? And how much can they handle emotionally? So this can tie into that readiness angle too. If you're talking about a subject that's likely to lead to emotional overwhelm, lower your expectations for how much you can fit into that session. Another client perspective angle is if you're expecting the client to implement strategies or change their behavior after your education session, how much capacity do they actually have to do that outside your session? And I'll give you an example to explain what I mean here. So imagine you're providing education on sleep hygiene to a young adult who has difficulty sleeping. You consider how motivated to change he is, and in this example, you decide he's ready to hear some strategies because he's ready to implement them. So if you then give a generic handout and rattle off ten different things he could try to improve his sleep, including screen time, exercise timing, caffeine intake, and the setup of his sleep environment, how likely is it that he would have implemented all of those things when you do a follow-up session the following week? Now, there could be a client who makes it happen, but in many cases, what you'll find instead is that none of those strategies end up being implemented. The client ends up being so overwhelmed by the big to-do list that they don't action anything. And in this case, it would have been much more effective to pick one or two strategies and focus your education on the how of the implementation. So for example, if his chosen strategy to try first is to limit his caffeine intake, we could unpack his current caffeine habit and help identify some alternatives that he could try in different situations, or encourage him to keep a written log of how many coffees he's having in the first place so that number's being tracked if he's not doing that already. Now when we come back next week, hopefully we'll hear that there was some progress towards implementing that caffeine reduction strategy. Now, you may be thinking, "Yeah, this is all well and good, but we usually don't have endless time or funding to be able to give all the education the person might need bit by bit." And yes, this may definitely be the case, particularly in funding models where you only have a limited number of sessions. But what we need to do here is to make sure the goals of what we're trying to achieve is actually realistic. Is it even realistic to think that we can solve someone's chronic sleep difficulties in one or two thirty-minute sessions of just talking to them? Or should we be pushing harder for more sessions? Or when this isn't an option, is there a way that we can be facilitating more of a self-management approach? Now, this could be that we only unpack one or two strategies, and the rest is provided to a family member to help them implement after we've gone, once they've seen how we can tackle each strategy one at a time. Or can we use AI to help write a structured self-paced education plan where that one-page handout with ten strategies is turned into a ten-week implementation program that we start with the client and then that they can maybe finish without us. Now, I know you're probably thinking,"But this, but that," and I'm definitely the first person to acknowledge that there is plenty of gray areas in what we do and plenty of complexity. But what I'd be encouraging you to do is to at least pause and consider if there's a better option. So is there a better option than just giving them that generic handout with ten strategies or exercises or recommendations and expecting them to handle the implementation all on their own. Okay, so we're only a third of the way through the RALFEY framework, so let's keep moving. And remember, there is a full tutorial on this topic, along with the worksheet in the Connector membership. Now we're up to L for language. So education almost always includes either verbal or written communication, so language must be carefully considered. The key place to start here is to think about their health literacy. So how familiar are they going to be with the complex medical or health terminology? When we're working one-on-one with a client, we can take an individualized approach and target the complexity to suit the person. So while most health literacy recommendations encourage us to target writing at a year eight level, a highly intelligent professional or academic will likely be seeking more than that. So know that it is okay to use more complex terminology when it makes sense to your client. Now, when you're providing education that needs to suit more than one individual though, then usually a plain language approach is helpful, and this is where you can look into some tech tools that might be able to help with this. There are health literacy checker tools available online, and I'm sure it's something that Claude or ChatGPT could help with as well to actually simplify that complex clinician speak to something more client user friendly. But just remember to only put in generic information, not client specifics, if you are using some of those AI type tools. In terms of language, it's more than health literacy though. So it also considers things like culture, especially when it comes to giving examples that will be applicable to your client. So I'll give an example of what I mean here. Say you're providing education about strategies to help with self-care tasks, and you need to make sure that any examples aren't based on assumptions of how people within Australia typically complete tasks like showering or toileting, as chances are the way that your client from a different cultural background completes those tasks could be different. So my advice here when you're one-on-one with your client is to develop the examples together as part of the session when you don't already know what is or isn't typical for your client. Or if you're needing to put together a written education handout, don't assume that you know what examples will make the most sense. So actually consult your clients or their families, whoever will be reading the handout, and get their input. Co-design that content together if you can, so that you know the language you use or the examples you choose will make sense for the audience you're intending it to be used with. Now we're up to F for format. So this is all about the how. How will the education be delivered? Now, there are a few main go-to options, verbal instructions, written handouts, practical demonstrations, videos, and more. And what I'd like you to start with is think about what is your normal default go-to format when educating your clients. Chances are you have a written handout and you verbally talk them through that handout. Am I right? If you're already doing more than that, and if the format you're using varies between individuals, that is perfect. But if it's not, I want you to challenge your autopilot approach. So first of all, think about how do you like to learn. If you went to see another health professional for your own needs, and they needed to tell you a heap of information about things that you needed to understand or remember or do, what format works for you? So is it just a written handout and a brief discussion, or do you need more? Do you then go and do your own googling and look for infographics or podcasts or YouTube videos? And which format do you find most convenient or helpful for your learning? Now, before you freak out and think, "Clare's telling me I need to create a YouTube video or a podcast episode for everything I teach my clients," this is not the case at all. What I am encouraging you to do is to stop and think about whether this could be a better option, and you don't have to guess. Like in the language component I just spoke about where I told you to co-design with your clients, you can do the same here. So ask your client how they like to learn. They may love the handout and verbal instructions, and you can just double down on that. But if they want something different, try to make time to find or create something different. And if you provide the same education to multiple clients, this effort will have benefits not just for that one client, but for many others, too. So you could create your own YouTube videos or podcasts, and there are plenty of OTs out there doing that. But you also don't need to reinvent the wheel. You could do your own searching. Show enough due diligence to carefully screen anything that you might recommend onto your clients, so you know that it was from a reputable source and that the information that's provided in it is relevant to your client, and that it's something that's publicly available that you can freely share. But then you can just share that link with your client. So a good starting point here are the diagnostic specific, not-for-profit type organizations or advocacy groups, which often have short videos or longer webinars available, not just for health professionals, but for people with that condition, too, or for their families. So some examples could be the Dementia Australia resources or the Down Syndrome Australia resources. Now, there's a lot out there already, it's just a matter of finding it. So this could be a great student side project the next time you have a student on placement, or for those who are paying members of my Alliance membership, I keep my own list of recommended resources and websites for various conditions and topics that could be a really helpful starting point to save you going down Google rabbit holes, and I'll drop the link to find out more about the Alliance in the show notes. So think about some other ways your client may like to learn, but then also this is your permission to get a bit creative sometimes and think outside of the box. So here's an example. Imagine you're a hand therapist trying to provide education to your tradie client recovering from a flexor tendon repair, which for the non-hand therapists out there usually means quite specific exercises that need to be completed multiple times during the day, and they're usually wearing a splint for immobilization or protection for a number of weeks. So say you give them a paper handout with their exercises, but each week they come back, it's getting more dirty and torn up from being on a job site, and eventually it goes missing, and they miss five days worth of exercises. An alternative could be to think about what's going to be the most accessible for this type of client. It might be worth creating a series of videos of the exercises to keep in your own video library that can then be linked via a QR code that you could actually stick onto their splint. So then they'll have that visual reminder of the QR code that they need to do their exercises. Plus, they can easily scan it and do the exercises alongside watching the video without having to keep track of pieces of paper or understand written instructions with static images. So yes, this could be a little bit of a time to set up, so again, perfect student project, but then it could be a really big time saver, but most importantly, lead to better outcomes for your client. Okay, we've got two more components to go, and we're up to E for evaluate. So this is all about not assuming that you've nailed the delivery of your education, no matter how much planning or creativity went into it. You still need to check before you wrap up the session that the client understands what you've just explained to them. If they do, hopefully it's because you've got the content, the amount, and the format right. Now, I think sometimes we can fall into the trap of doing too much talking and not enough asking questions. So have a think about how you currently wrap up your education sessions. Do you say, "Okay, we're done now, so remember those key principles you need to remember are X, Y, Z?" Or do you ask,"Do you have any questions?" And if you do ask if they have any questions and you get a, "No, that's fine," how certain are you that they truly understand versus just being polite and smiling and nodding because they're so overwhelmed, but they don't have the heart to tell you. Now, instead of just asking, "Do you have any questions?" Ask them some specific questions to test what they understand and how they're going to apply it, but not in a threatening, this is a test kind of way. It could be something like, "Tell me which of one of those points was most surprising or most important for you." Or, "We've gone through some strategies, but tell me again what your plan will be for tomorrow. Walk me through your nighttime routine, and let's double-check that you have all the information that you need to start using that sleep hygiene strategy that we're gonna start with." Sometimes it's not about asking them questions but about getting them to show you what they understand. So giving education about assistive technology is the perfect opportunity for this. Rather than just showing them how to adjust the legs of the shower chair, ask the client or their carer, whoever will be responsible, to actually have a go. Even for things that seem straightforward, just having that opportunity to give it a go in the safety of your presence is enough for them to build their confidence to make those little adjustments themselves if the shower chair has a bit of a wobble in it on an uneven floor. It helps build that self-management potential that I mentioned at the start. Another evaluation method, if you have, say, like a group education program and an audience who enjoys a bit of friendly competition, is to gamify it. So Kahoot is a popular program where you can set your own multiple-choice questions, and people can join via their mobile devices, and they can even choose their own username so they can be anonymous. But that gamification element can be really powerful for reinforcing that engagement and maximizing learning with the right audience. And finally, we have reached the home straight. We're up to Y, which is for You're Not Done Yet. So random I know, but this is about the evaluation beyond the in-session evaluation. Yes, I can go a bit overboard when it comes to evaluation, but I honestly see that it's often very underdone within clinical practice. But it can really hold the key to maximizing outcomes and improving our efficiency and overall practice, so it needs all the attention that it can get. So whereas the in-session evaluation looked at their understanding and planning for implementation, this stage looks at whether they could retain that information longer term and more importantly, whether they can apply it to their day-to-day life. How you do this will depend on funding constraints, so whether you actually have the ability to see them for a follow-up session or not, or even just a follow-up phone call. But when you can see them again, these are some of the things you should be thinking about. So ask them how they went using the information in their day-to-day life, and don't just accept, "It's going good, thanks," if they can't really elaborate. So gently ask them some more questions to find out the details. If something didn't go right and they say they haven't been using the information, then you still need the details. So it's these details that will help you pinpoint whether it's the content, the amount, or the type of information that needs to be tweaked. If you don't ask some more questions and just repeat what you did in the previous session, you're going to get the same result. So let's use an example. Say you spent your last session providing thirty minutes of tips for energy conservation for someone with chronic respiratory problems. You thought narrowing it down to five top tips would be achievable, but your client tells you that after the session, they forgot the key points, they had trouble understanding the information handout because it didn't have the extra examples that you provided in your verbal instructions, and they couldn't decide where to start, so they ended up not changing anything at all. With this information, you go back and decide it'll be more effective to talk about one activity and the strategies that could apply to that activity rather than how one strategy applies across multiple activities. Bit of a mouthful there, but for example, it could be that showering ends up being the main activity that they want to focus on. So you talk through how to just make that one activity a bit better using the strategies that you mentioned, but giving them permission to just focus on applying it to that one activity. So in energy conservation, planning, pacing, and sitting down are key strategies. So you could say, "Plan your shower for the time when they have the most energy, and make sure there is a gap for rest before and after it." Pacing could be to split up the activities that take place in the shower and prioritise the ones that are most important. So it could be their feet only get a good scrub every second shower, or their hair only gets washed every third shower. You still need to be mindful of what their standards and expectations are, but it could avoid the need for that overwhelming everything shower where they had to do all of those things on one day because they think just saving up the energy and doing it all in one burst is the best option. And then you can talk about the benefits of sitting down while showering. Even if they think their balance is fine, make sure they understand how much energy it actually takes to stand up versus sitting down for tasks. In that example, you went back and tweaked your approach for that client, but now also make sure you reflect on your overall approach to how you gave that initial education session. Was there anything that you could have changed to avoid some of those issues from happening in the first place? Was it that you tried to fit in too much to the session? Was it that you went with the default paper handout option, but something else would have been more beneficial? Making sure you reflect on what you could do differently next time is essential for becoming that better OT who is constantly learning and growing, which is what this podcast is all about. And that is it. We have reached the end of our tour of the RALFEY framework. Hopefully, you found it helpful for inspiring you to think about your own approach to client education. Now yes, there will always be constraints on what we can achieve and how much time we can spend with our clients. But always start with the ideal and work back from there and deliver the best you can, rather than assuming something will be too hard or just not possible. Now, as I said, if you do want a deeper dive into client education, including access to a step-by-step worksheet, you can join the Your OT Tutor Connector membership. But if you'd like a deeper dive on a similar topic, the Alliance membership may be worth the extra investment. So within that library, I've got some topics that can relate to client education, including how to motivate and connect with those hard-to-engage clients, how to navigate situations where multidisciplinary team members might have conflicting goals, or just there's too many goals that are overwhelming the client and preventing them from using any of the education that you've provided. There's also a freebie in my learning library on working with clients with preconceived ideas from Annette Tonkin, who's a physio specializing in effective clinical communication. So definitely go and check that one out. And remember, if you haven't accessed the learning library already, it's got over a hundred free resources in there from downloads, videos, and webinars. Chances are you'll find something that's helpful in there for you, and it's all completely free to join. So that is it. We have reached the end of the episode. Tune in for the next one where we'll be talking about how to do an OT home assessment. So whether you're a community OT reviewing someone with a falls history or a hospital OT doing a review to ensure that someone's safe for discharge, we'll cover what a home assessment actually involves. We'll also look at the different formats it can take when we physically can't go to the house or have the client present, and I'll share some recommended tools that you can check out as well. Thanks for listening, and I'll talk to you then. The information shared on this podcast is for general educational use only, so please always use your own clinical reasoning and seek appropriate professional supervision for any individual client situations. If you'd like to learn more with Your OT Tutor so that you can be a better OT who loves what you do, check out the Your OT Tutor website. The links will be in the show notes. There are free resources in the learning library, paid CPD memberships, online courses, supervision and mentoring opportunities, and options for your team to all learn together with me.