Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

Debora A. Davidson, PhD, OTR/L, Clinical Occupational Therapy Editor

Occupational therapists love to multitask, when it comes to designing therapeutic interventions. My sessions sometimes look simple, and I am sure that others have looked upon me at work and thought, “Why does it take a professional to do that?”

But just ask me, and I will be delighted to list all of the ways that making a sandwich or playing a board game can change my client’s life: fine motor skills, bilateral coordination, visual perception, impulse control, sequencing, problem solving, the list goes on.

And then there’s the occupational result: she has a sandwich to enjoy or now he can play this game with his siblings — abilities that most of us can take for granted, but that can mean the world to someone who has been unable to do them. OTs also like to achieve outcome goals that place our clients into the swim of things in their families and communities and that allow them to assume valued roles. We call this “participation in context.” Well, there’s an outcome goal can do all of the above:  facilitate ongoing therapeutic improvement, while placing adult clients into developmentally typical roles. It’s having a career.

A career, in this instance, does not refer only to jobs requiring a college degree or specialized training. Rather, it means any productive work that a person pursues for a significant period of time, with opportunities for growth and development. So, a person whose job at a restaurant progresses from bussing tables to washing dishes, and then to preparing the salads can be said to have a career. A career should be something that the worker cares about and wants to learn more about. There should be a sense of pride in identifying with one’s career. Anything that does not meet these criteria is a job. Jobs can be important, too, as they often lay the foundation of basic work skills, habits and stamina. But a career is a path that has continuity and allows opportunities to progress in roles that the careerist values and wants to achieve.

In my experience, having a career is a life goal for most people, regardless of their educational background or level of ability. However, people with disabilities do not feel that a career is possible for them. Traditional thinking about work for people with mental or physical disabilities has been that they must show adequate readiness and a solid period of stability before adding the stress of a job to their routine.

Recent research may cause us to question this logic. Research indicates that having a satisfying career results in better quality of life and can even help to reduce symptoms of illness. Rather than adding stress to life, a career can actually be therapeutic and help people to achieve and sustain mental and physical health. This appears to be true for people who are typical and for those with disabilities. For example, a large, longitudinal study published in the Journal of Autism and Developmental Disabilities in November indicates that adults with autism spectrum disorders benefit greatly from working. Subjects who worked were found to demonstrate significantly improved daily living skills and reduced maladaptive behaviors over the course of the 5.5-year study, as compared with those subjects who did not work. These differences held steady regardless of subjects’ severity of disability, age, sex or socioeconomic level.

In contrast, research indicates that unemployment and under-employment are detrimental to peoples’ mental and physical health. So, where does this evidence guide us? We will get a lot of therapeutic “bang for our buck” by helping our clients aspire, prepare for and achieve careers in areas that are a fit for each of their interests and abilities. This is a tall order, I know, but who else can get it done, if not OTs? School-based OTs need to join students’ transition planning teams, and provide needed input about current performance and appropriate goals. Cultivate working relationships with the counselors from the Department of Vocational Rehabilitation, and offer to consult and partner with them to get our clients appropriately trained and placed in jobs that fit. We must be thinking about our clients as future workers as we evaluate and write goals, and help clients and families to have the courage to hope and strive for jobs and careers. We must simultaneously work with the community to help employers become more open and confident about hiring people with disabilities. Offer to consult before, during and after a hire to help ensure success. Network with potential employers and learn about their businesses and needs. Find ways to spread the word about the benefits of hiring workers with disabilities and reduce unfounded fears.

By helping clients achieve careers, we can situate them to enjoy ongoing the therapeutic benefits that working can provide. They will learn to view themselves and be viewed by others as competent workers, contributors to the greater good and worthwhile individuals. They will be happier and healthier. What more can any OT hope to achieve?

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