Enabling participation through positive risk: An OT approach to chronic illness written over a group of people undertaking an exercise class. One uses a cane and another is in a wheelchair.

Enabling Participation through positive risk: An OT Approach to Chronic Illness

Student PlacementOccupational Therapy

Hey everyone, my name is Tegan and I’m currently on a placement with JBOT. I’m studying an MSc apprenticeship in Occupational Therapy.

This is my final placement out of three. My first being in adult social care, and my second being in an inpatient intensive care mental health hospital. During my time as a student, I have come to learn of many interesting theories within occupational health research.

One standout theory for me personally has been Positive Risk Taking (PRT) . In a nutshell, PRT is the process of making informed, person-centred decisions that involve some level of risk but are taken to promote growth, independence, choice, and well-being. Rather than avoiding all risk, it involves carefully weighing potential benefits and harms, putting safeguards in place, and empowering individuals to live fuller, more meaningful lives, even when that includes some uncertainty.

This topic speaks to me on a personal level; as a person who has been a victim of chronic illness since childhood. I know all too well the occupational barriers that come with it. I have strived within my working life to support others to regain their identity through occupations which are meaningful to them, because I know what it can be like to lose this. Meaningful occupations might be productive (like work), self-care (like day-to-day living), and leisure (hobbies and social activities). Everyone is an individual, with a unique experience of social, cultural, environmental, and institutional influencing factors which shape their lives, and intrinsic and extrinsic motivations. No one human being is the same. But, what we all have in common, is that human beings are doers- we want and need to do things.

You might have come across terms such as “the medical model of disability”, and the “social disability model”. The medical model, in layman’s terms, is a way of looking at health that sees illness or disability as something that’s wrong with the body; something that needs to be diagnosed, treated, or fixed by medical professionals. It focuses on symptoms, test results, and treatments like medication, surgery, or therapy. In this model, the aim is usually to try to get people “better”, or at least to manage the condition so it causes fewer problems. You go to see a doctor, they try to figure out what’s going on inside your body, and then they give you something to help.

So what does this mean for people living with chronic conditions? If you’re living with a long-term condition (something that can’t be “cured”), the medical model can feel frustrating. It can start to feel like your life is being measured in symptoms and setbacks. Everything becomes about what’s “wrong” with you or what you can’t do. While this can be absolutely beneficial in providing treatments and medication to reduce symptoms, you might still be left with a feeling of occupational loss, or lack of occupational identity. Managing symptoms is essential, but it does not necessarily provide what we as humans really need, in order to achieve a sense of wellbeing. What about your day-to-day living, your relationships, your routines, your hopes and dreams? Are they not equally important? Well- of course they are! It can be just as important to move away from “what’s wrong with me?”. Instead, start thinking about “how can I still live well?”.

In contrast, the social disability model sees disability as something created by barriers in society, like inaccessible buildings, rigid systems, or unhelpful attitudes.

In this model, the problem isn’t that someone uses a wheelchair. The problem is that the building doesn’t have a ramp. The focus is on changing the environment, not “fixing” the person. For people with long-term conditions, the social model helps shift the focus to living well with your condition. It’s not about being “less ill”, but being more included, empowered, and supported. It recognises that you can still have agency, goals, and purpose, even if you’re not symptom-free.

The social model encourages people to make choices, try new things, and live fulfilling lives, even if there are some risks involved. It asserts that everyone has the right to participate in life, and those who follow the principles of positive risk taking will support that, rather than just keep you safe from harm.

Still with me? Great! Let me provide you with some examples of positive risk taking in action, before we wrap this up.

These are fictional people, but the situations are based on real-life experiences that come up a lot in practice.

Jessica – individual perspective

After being quite isolated for a couple of years due to chronic fatigue, Jessica decided she wanted to try joining her local book club again. She was nervous about how she’d cope socially and whether she’d have the energy to keep up. But she worked out some ways to make it easier, like choosing a daytime group and having a plan to leave early if she needed to. It took courage, but it helped her feel more connected and like herself again.

Sam and Dave – professional perspective

Sam, an occupational therapist, was supporting Dave, who has early-stage dementia. Dave really missed cooking, but his family had taken over the kitchen because they were worried about his safety. Sam suggested they try cooking together once a week and see how it went. They started small, with simple lunches, and used prompts and timers to help with memory. There were still some risks, but with the right support, Dave felt proud and more independent.

Lena – organisational perspective

When Lena moved into supported accommodation, the standard care plan didn’t reflect who she was. It focused on keeping things safe and predictable, but Lena loved going to her local karaoke night and didn’t want to give that up. With support, staff agreed to make her plan more flexible. They talked through the possible challenges and how to manage them, while also making space for what mattered to her. It was a shift in mindset that allowed her to enjoy life on her own terms.

Tom and Ellie – family perspective

Tom had always managed everything for his daughter Ellie, who is autistic and has sensory processing difficulties. He was great at helping her avoid overwhelm, but as she got older, Ellie wanted more freedom. When she asked to go shopping with friends, Tom was unsure. He worried about everything that could go wrong. But they made a plan together. Ellie took her headphones, kept her phone charged, and had someone she could call if she needed to.

Tom still had concerns, but seeing Ellie manage it gave him confidence to trust her a bit more.

Positive risk taking doesn’t mean throwing caution to the wind, it’s about recognising that life is messy and imperfect, and avoiding all risk only leads to loss of joy and freedom. Whether you want to enrol onto a sailing course, take on a new role at work, or help support your nearest and dearest regain some independence- these actions shouldn’t be viewed as reckless, but as important and meaningful. At the centre of positive risk taking is trust, in ourselves, in others, and in the notion that people can succeed and flourish when given the chance.

Thanks for reading. I’ll finish with a quote that I think reflects the spirit of positive risk taking:

“What if I fall? Oh, but my darling, what if you fly?” – Erin Hanson

If you’d like to hear me talk a bit more about this subject, I’ve also created a short narrated Powerpoint on positive risk taking, which you can watch on soon in an upcoming blog post!

Useful Links

Further Reading

Morden, A., Jinks, C. and Ong, B.N. (2012) ‘Rethinking “risk” and self-management for chronic illness’, Social Theory & Health, 10, pp. 78–99. Available at: https://doi.org/10.1057/sth.2011.20

Newman, C., Whitehead, P. and Thomson, M. (2023) ‘Investigating the effect strength of positive risk-taking barriers on discharge decisions in occupational therapy intermediate care: A factorial survey’, British Journal of Occupational Therapy, 86(4), pp. 293–301. Available at: https://doi.org/10.1177/03080226221141320

Royal College of Occupational Therapists (RCOT) (2017) Embracing risk; enabling choice: guidance for occupational therapists. London: RCOT. Available at: https://www.rcot.co.uk/explore-resources/rcot-publications/embracing-risk

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