Come to the table: Key reasons to join in decision-making

Recently, I read a compelling Facebook post by Brent Braveman, PhD, OTR/L, in which he wrote: “In another thread on a state association’s Facebook page I suggested that in order to be successful in responding to bundled payments by CMS, we need to have a seat at the table and understand the conversation. A colleague responded by describing my words as ‘trite and overused.’ So I provided 10 examples of ways my staff and I have found a seat at the table to promote the distinct value of OT.”

Braveman proceeded to list 10 excellent examples of ways that he and his staff have used or created opportunities to be included in decision-making groups within their hospital system. These committees included falls prevention, procuring DME and hospital safety. They make decisions that hugely affect patient care and therapists’ everyday work lives. I applaud Braveman’s active participation, encouragement of his team’s involvement, and willingness to take time to endorse and explain why taking a seat at the table is necessary and good.

No matter where you work, whether in a large and complex system or a solo practice, there are small groups of people making big decisions that will affect your everyday work performance and quality of life. Whether informed or uninformed, these people open and close the doors to your ability to practice occupational therapy fully and your quality of life on the job. If they do not have an assertive occupational therapist in the group, your perspective will be absent. Let’s be real. Who else on the team thinks as you do? Can you count on other professionals to look at patients’ needs with the breadth and depth that you have, or to look out […]

Good things come in small packages: Starting a private practice

Judging by comments from our readers, many of you have great, innovative ideas that you cannot always use in traditional workplaces. There are three ways to gain increased control of your practice:

1) Locate and get hired by a facility that honors your expertise and supports the kind of OT you want to provide. Fabulous, when it works!

2) Overcome resistance and gradually infuse great OT practices into settings that did not previously have them.

3) Start your own independent practice and control the quality and nature of your services.

Before you get the vapors and generate 500 reasons why you cannot start a private practice, let me just say that it’s OK to start very small and to take your time. Actually, that’s best. Also, it does not have to be all or nothing. In fact, giving up your day job one day to jump into a small business the next is not generally ideal.

Small is wonderful. Slow is fine. Part time is beautiful, too.

Not pursuing the career that you truly want and love is neither wonderful nor fine. Not fully developing your unique translation of authentic occupational therapy is a tragic loss for yourself and the many people who would have benefitted from your service.

Occupational therapists and occupational therapy assistants are well-positioned to be successful entrepreneurs. We offer services that are unique and valuable. We can craft novel and effective solutions to real-life problems. We are passionate about our work and emotionally connected to those we serve. Our clientele can access our services directly, without needing a physician’s referral.

If you’re intrigued by the idea of working with a few private clients, here are some initial baby steps to get you started:

• Read about OT practitioners who […]

A little bit of effort can have a huge impact

For several years I was the occupational therapist at a residential treatment facility for children with severe mental health problems. Initially I was hired to provide school OT services for students with fine motor/handwriting goals. Clearly, these children had problems beyond poor handwriting. In fact, they were referred to as the “sickest kids in the state” by some of the staff and administrators. I eventually initiated a number of OT programs at the center, but the after-school OT activity program was my favorite due to its simplicity and amazing impact.

I was the school OT for at least a year when I started asking to expand into the residential units. Initially I hit strong resistance because there was no budget even though I offered to staff it with OT and OTA fieldwork students. We also were told it wouldn’t be safe, even though we all passed  crisis prevention and intervention classes. In addition, we were told the child-care staff would feel intruded upon, even though it turned out they wanted us. After months of persistent effort we were allowed to observe in the units and offer ideas. What we saw was very sad.

Although the center’s newly built living spaces were clean and bright, life in the units was occupationally sparse and monotonous. The children spent a lot of their after-school and evening hours waiting — waiting for dinner, waiting to take a shower, waiting for a turn at the video games. Time was largely spent quietly in their rooms or in front of the TV, with bursts of excitement when behavior escalated into arguments, tantrums or fights. No wonder they had incidents of misbehavior and aggression. Boredom is painful, especially when there’s no end in […]

Your OT DNA: Theoretical frames of reference revisited

What makes one an occupational therapist, beyond the earned credentials, certification and licensure?

What are the shared features and beliefs that bind us together as a tribe?

One component of OT DNA is our philosophy, as reflected by our founders’ and leaders’ inspiring essays and lectures. Another is the OT Practice Framework: Domain and Process, which gives us a common language and structure regarding what, how and why we perform our trade.

Yet another aspect of our genetic code is our complex theoretical heritage.

During the years I taught OT theory, I saw the emergence of wonderful OT meta-theories that provided a scaffolding and large pattern for OT practitioners’ clinical reasoning, such as the Model of Human Occupation and the Canadian Occupational Performance Model.

Using a meta-theory can structure and guide clinical reasoning to ensure a thorough approach to OT evaluation and intervention. It gives us language that clearly reflects OTs’ domain and process, and encourages us to be logical and consistent in our actions.

In some regards, we could look at the OT meta-theories as large toolboxes.

Both the MOHO and Canadian Model offer assessment tools, most of which focus on determining the client’s perspectives and goals related to their occupational needs and priorities. The MOHO also offers standardized tools for assessing environments. These are essential pieces of an OT evaluation. Usually, we also need to obtain objective assessment of clients’ task skills, physical and cognitive abilities, environmental supports and obstacles, activity demands and information about habits and routines. With so many variables that may be relevant to occupational performance and an intervention plan, it’s no wonder that we need to have access to a number of approaches.

For example, a child may be disruptive in school because of sensory processing […]

Stand up for what’s right

There are so many things to love and respect about our profession. We serve people in need with our knowledge, skills and hearts. I want to celebrate these beautiful qualities — we are, after all, celebrating OT Month! However, the state of things in some of our workplaces requires us to add some additional virtues and behaviors, such as courage and toughness.

Occupational therapists are known for optimism and a can-do attitude. It’s part of what makes us popular with our care teams and clients. We can bring this positive attitude to advocacy to our clients and to those we supervise, and we can adopt this positive attitude ourselves. We love our profession because it is occupationally focused, client-centered and holistic. We want to practice to the fullest extent of our capabilities and to encompass these values. OTs value harmony, and that’s what makes us good team members and co-workers. Our easy-going and flexible styles also help us to create success with many difficult clients.

Of course, there’s another side to being so agreeable. Unlike groups that are trained to expect adversity and conflict in their daily work (think attorneys and police officers), the clinical OTs I know are often unsettled and upset when they have to generate or deal with disagreement or unhappiness. When I researched what we teach our students in university OT programs about sharing bad news, some educators were offended that I would even suggest such a topic. Not doing so may ensure our popularity, but there are times when being nice and popular is not in the best interest of those we serve or ourselves.

It’s no secret that occupational therapists and other professionals can be pressured to maintain impossible levels of […]

When routine becomes a rut

“Habit is necessary; it is the habit of having habits, of turning a trail into a rut, that must be incessantly fought against if one is to remain alive.” — Edith Wharton

In my practice I work with young adults who have “failed to launch” because of some combination of developmental, mental health and social factors. Each of my clients is unique, but many share key features. Here is a (fictionalized) example:

Rob is a young man who is very bright, though often socially awkward. At age 18 he went to college, but stopped after two semesters because of low class attendance and failing grades. His parents brought him home and took him to numerous psychiatrists and therapists. Rob was diagnosed with Asperger’s syndrome, depression and anxiety. He disagreed with all of these diagnoses, and refused to take medication. Rob felt he just needed to rest up and that he would return to college next year. That was six years ago.

When I initially met with Rob, I saw an overweight, poorly groomed young man who rarely looked at me, rubbed his hands together continuously and perspired a lot. His mother said they had to bribe Rob with dinner at a favorite restaurant in order to convince him to meet with me. During our first session, I asked Rob about his daily routine of activities, which he described as:

Wake up and start the day: Sometime between 10 a.m. and 2 p.m.
Eat breakfast
Play video games
Watch TV
Dinner w/ parents: 6:30-7 p.m.
Video games
Sleep: Sometime between 11 p.m. and 4 a.m.

Weekdays and weekends are undifferentiated. When I asked how Rob felt about his activities, he stated, “I’m bored and embarrassed.”

“Well, thank goodness!” I think. Signs of health and readiness for change.

I’ve […]

Get the referrals and practice you really want

Catherine, a TodayinOT.com reader, recently commented: “I know this question has nothing to do with this article, but here goes. I currently work at an acute care hospital and the hospital primarily treats elderly; gastric bypass; hip and knees; and geri psychology. We are having limited success in getting referrals for OT from the doctors. Suggestions?”

What a great puzzle to solve — and an opportunity to actively shape your practice. I really hope we’ll hear from other readers who have ideas. In the meantime, here are some of my thoughts:

I have never left a professional position the way I found it. By actively shaping my roles, I have met a wider range of clinical goals and my own need to experiment with new ideas. We are experts at modifying and personalizing things; why not do so with our roles and practices to benefit our clients and ourselves?

For example, in my first job, prior OTs had focused on sensory integration. I continued doing SI, but I added cooking and crafts groups because I saw our kids had a need for more social skills with peers, and they were super-motivated by making things that they could eat or take home. In a youth residential treatment program, I provided the traditional school-based sessions, then added a lunchtime club to teach and practice good manners and nutrition. As an educator, I initiated problem-based learning courses.

With some imagination and planning you can expand your role to best utilize your full capabilities and interests. Start by adding some new twists to therapy sessions. Soup them up by enriching and personalizing the environment and tasks. It could mean having your session in the kitchen, preparing a snack rather than staying in […]

Occupational balance in the digital age

I recently listened to a Diane Rehm Show broadcast on NPR, during which experts in child development and digital media discussed the latest research on how digital technology affects children’s lives. They described large studies showing the use patterns of children in the U.S. ages 8 to 18. Researchers found teens engage with electronic devices on average for nine hours each day outside of school and homework. One expert observed that today’s children spend more time interacting with screens than they do in any other activity, including attending school and sleeping.

None of this will come as a surprise unless you have been off the grid for the last couple of decades, but here’s what may give you a moment’s pause: At least one of these experts said it was inappropriate or impossible to limit anyone’s screen time, given the pervasiveness of digital devices and their everyday usefulness. I have encountered this sense of passivity or powerlessness in some of my clients and even professional colleagues, and I hope you will join me in refuting this misconception.

Here’s an example from my practice. I work with young adults who have failed to launch because of combinations of mental health, developmental, learning and social constraints. One such young man, “Jason,” typically looked exhausted and entirely disengaged when I arrived at his home in the mid-afternoons. He rejected 99% of my ideas for activities, yet always wanted me to return the next week. His sleeping/waking pattern was flipped, and he stayed up until 4-6 a.m. playing video games. Our 2 p.m. session was in the midst of his sleep cycle. He also showed signs of depression and anxiety, for which he was seeing a doctor. Jason said he […]

Toward truly interprofessional teamwork

Last month I had the honor of co-presenting at the annual convention the American Speech-Language-Hearing Association, along with Kathy Fahey, PhD, CCC-SLP, OnCourse Learning clinical editor. I was so impressed by the participants’ enthusiasm and dedication to their professions. I often have sensed the same energy at occupational therapy gatherings, so I felt oddly at home although I was the only OT in the room.

Interprofessional education and practice was a major theme of the conference. The World Health Organization has emphasized interprofessional teamwork as a priority in improving health because it improves clinical outcomes, decreases medical errors and adds to worker retention and satisfaction. The concept may seem obvious, but practicing it is anything but automatic, simple or typical.

Genuine interprofessional teamwork involves:
• Knowledge of and respect for other professionals’ roles, knowledge and skills
• Clarity regarding each team member’s role and ways to proactively negotiate role release, overlap or merging as situations indicate and/or occur
• Consistent communication and collaboration among professionals
• A core set of agreed-upon ethics and values, and a common sense of mission

I cannot imagine any practitioner disagreeing with these values, yet we often work alongside one another in a “parallel play” model of teamwork. This occurs for a number of reasons. Here are some ideas for solutions to common obstacles.

Problem No. 1

We have been acculturated to focus our attention and loyalty onto our chosen professions. I am absolutely guilty of this, as I just love OT so much that I frequently act like an evangelist. We need to balance our professional pride with humility and curiosity about others’ ways of knowing and doing.

Solutions

• View patients’ progress as a result of the whole team’s efforts. Listen well to others’ reports, ask meaningful […]

By |December 7th, 2015|Categories: From the Editor||1 Comment

Yerxa’s Authentic OT

“Occupational therapy begins when everyone else has given up.”

—-E.J. Yerxa, OTR- 1966

The Eleanor Clark Slagle Award and Lecture is an annual event that honors an American Occupational Therapy Association member who has made unique and substantial contributions to the body of knowledge of our profession through scholarship or clinical practice. In 1966, the brilliant Elizabeth J. Yerxa, PhD, OTR, FAOTA, was honored with the award. The words she shared during the lecture resonate with wisdom, and can guide and challenge us as much today as then. Yerxa is a distinguished emeritia professor at the University of Southern California, Los Angeles.

In her lecture, Yerxa reflected on whether occupational therapy would achieve its status as a true profession. That this was ever in question might be unsettling, but it was an issue many occupational groups were debating in that era. Sociologists defined occupations as “professions” when they met certain criteria, such as: a unique and well-defined body of knowledge, a unique vocational niche, a common language, university-level educational programs, a national association, a code of professional ethics and a credentialing process.

Occupational Therapy has long had well-designed and rigorous standards for OT and OTA education and credentialing and a unique body of knowledge. We have standards of practice and a code of ethics. More research always is needed, but key occupational therapy theories and methods have been tested scientifically. Occupational therapy’s position as a true profession is no longer controversial, but we must continuously grow our science and guard the integrity and fullness of our practice if we are to maintain our professionalism.

Yerxa’s viewpoint
Yerxa’s writings reflect strong themes of the value of professional autonomy: “The occupational therapist of the future will need to understand medical thinking but […]