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Archive for category: Original Posts

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A MUST READ New Guideline for Insurance OTs in Ontario

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

With all the legislative changes in the very contentious auto insurance industry, it can be hard to stay current.  Case law, reports, position papers, and of course the high-profile circulations of the Toronto Star.  But sometimes what goes unnoticed is the work of the Colleges or Professional Associations that spend time and resources trying to provide guidance and support to those of us working in this everchanging area of practice.

In the world of Occupational Therapy, one recent document has been posted by the College of Occupational Therapists of Ontario that thoroughly speaks to the challenges, college expectations and tug-of-war that OT’s experience in this difficult sector.  This circulation, entitled “Guideline for Working with Third Party Payers” is a must-read for OT’s in the insurance industry, and serves as a useful tool for anyone (clients, lawyers, insurers, other professionals) who retain, work with, or otherwise engage with an OT for assessment or treatment services.  The guideline (https://www.coto.org/news/new-guidelines-for-working-with-third-party-payers) covers all important aspects of practice in the world of third party work, and includes the following summarized sections:

Providing Ethical and Competent Client Care reviews the Ethical responsibilities of the OT to be transparent, fair and impartial.

Defining Your Role and Setting Expectations with Stakeholders addresses how important it is for OT’s to follow the Standards for OT Assessment and to understand the limits to their own competencies when accepting referrals.

Consent and Personal Health Information discusses how to manage difficult consent situations, for example if another person indicates they got “consent” for the OT, or if a client later withdraws consent during an assessment or treatment. Importantly, it also talks to an OT’s requirement to get new consent when presented with a request to review or comment on new information that was not received when initial consent was obtained.  The submission of reports in draft form to third parties is also covered.

Managing Records and Reports reminds OT’s of their responsibility with record keeping, privacy legislation, and of course the client’s right to access their records.

Managing Conflicts of Interest considers the challenges in this high-stakes industry that is fraught with important funding decisions, conflicting agendas, and relationships that can be formed with clients, insurers, lawyers and the like.  This section deals with these competing interests, conflicting standards and opinions, personal conflicts between oneself and third parties, companies or even other professionals.  Also covered in this section is referrals received from friends or family members, being requested to observe an independent medical exam, and treating clients that are related.  OT’s are reminded that practicing within a conflict of interest (perceived, real or implied) is considered professional misconduct.

Managing Professional Boundaries are addressed and this section highlights different types of potential boundary crossings with clients and referral sources / payers.  It speaks to monetary relationships and financial / gift incentives as a boundary crossing and one that can jeopardize client outcomes and breach professional boundaries.

Use of Title is discussed as a reminder to the different titles an OT may have in providing service, and how to be clear about their role at all times.

Independent Practice reviews the nature of being an “independent contractor or provider” and the resources available to set up, and run, an independent operation.

Lastly, the guideline covers the expectations for providing services to clients who Live Outside of Ontario and reminds OT’s that the client’s location, not theirs, is the jurisdictional boundary and practicing outside of Ontario is not permitted unless the OT has a license in that location as well.

Overall, this document is a useful tool and hard reminder to OT’s of their obligations and expectations as licensed professionals in Ontario.  It may also prove helpful for other stakeholders to review, such that they too understand the rules and boundaries on OT’s so that they can be mindful of these in their working relationships with us.

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O-Tip of the Week: A Smart Solution for Printing Success

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

This week’s O-Tip of the Week focuses on ways to assist children who are struggling with printing and handwriting.

Using a small pencil or broken crayon is a great way to help kids learn how to properly hold a pencil.  Learn more about how Occupational Therapists help kids with printing and handwriting in our OT-V episode:  Solutions For Printing Success.

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Occupational Therapy, Social Work, Both or Neither?

Guest Blogger: Carolyn Rocca, Occupational Therapist

When dealing with any form of injury, illness, or life changing event, clients may find themselves being referred to social work (SW) or occupational therapy (OT), or even both. As there can be overlap between the roles of these professionals, it can be helpful to take a closer look at what each profession specializes in, how they differ, and what they can offer you throughout your recovery.

What is similar about both of these health professions is that their role greatly varies depending on which context the professional is working in, making it challenging to define either simply.

Note: While a SW had input into the content of this blog, the objective here is not to fully explain the SW profession, but rather to try and clarify the similarities and differences between SW and OT.  For more information about Social Work, a few Ontario-based resources are listed as follows, and of course more information is available online or by connecting with a SW directly about the services they offer:

Ontario College of Social Workers and Social Service Workers (OCSWSSW) website:  http://www.ocswssw.org/

Ontario Association of Social Workers (OASW) website: https://www.oasw.org/

The Canadian Association of Social Workers (CASW) describes Social work as a profession that aims to help individuals, families, groups, and communities to enhance their individual and collective well-being, by assisting them in developing their skills and abilities to use their personal and community resources to resolve problems (2017). In most provinces across Canada, the minimum educational requirement to become a SW is a 4-year undergraduate bachelor degree in Social Work, while master’s and doctoral degrees are also available (CASW, 2017).

SWs are trained to provide services across many diverse settings including children’s aid agencies, family services agencies, school boards, general and psychiatric hospitals, correctional facilities, welfare administration agencies, federal and provincial departments, as well as private practice. Not surprisingly their roles vary greatly in each of these settings however, some skills and responsibilities are common across practice contexts.

SWs are unique in that they focus on relationships as the basis of their interventions and are experts in providing services not only to the client, but also to their families. In many settings, SWs often play the role of case manager by linking the healthcare team with the client and family, and connecting the client to relevant agencies, services, or programs based on their needs and community resources (i.e. financial assistance, legal aid, social programming, and housing, employment, and education supports, etc.). Certainly, a large difference between OT and SW is that the latter can provide assistance with parent-child relationships, marriage counselling, and mediation services to assist families in resolving disputes. Fundamentally, they are experts in connecting people to one another and to essential resources.

Whereas, the Canadian Association of Occupational Therapists (CAOT) describes OT as the art and science of enabling engagement in everyday living by empowering people to perform the occupations that foster health and well-being in order to participate to their potential in the daily occupations of life (Townsend & Polatajko, 2013, p. 380). Essentially, OTs focus on helping people manage and participate in the day-to-day tasks that are important to them, including their ability to care for themselves, or carry out their role as a spouse, parent, or employee. In most provinces, to become a registered OT, one must complete a 4-year undergraduate degree, and subsequently a 2-year Master’s degree in Occupational Therapy.

Although OTs can provide services in many of the above listed areas of practice, what they offer can be much boarder in scope. While both professions can provide case management services, individual or group-based interventions (i.e. support or psychoeducational groups), and counseling services to assist people in their recovery from an injury, illness, substance use disorder, or major life transition, OTs can also offer a breadth of rehabilitative services. These services can include prescribing and teaching the use of assistive devices and mobility equipment, and providing recommendations, strategies, and education to find solutions to clients’ day-to-day functional challenges and barriers.

Although there are several differences, OTs and SWs have many overlapping roles, meaning they must communicate and collaborate to ensure they are each offering unique services when both working as part of a client’s healthcare team. For example, consider an individual who has sustained physical injuries and secondary mental health challenges as a result of a motor vehicle accident. Throughout their recovery, an OT will be essential in prescribing and training the client in the use of a wheelchair, suggesting environmental modifications so that the client can navigate in their home, and providing recommendations and education about how the client can safely perform daily tasks like showering and meal preparation. Additionally, the OT would provide psychoeducation and coping strategies to support the client in managing with their mental health symptoms, change in daily routine, altered life roles etc. Meanwhile, a SW might focus on providing counselling services to the individual as well as their spouse or children, who would be adjusting to the change in family dynamic considering the accident and resulting challenges of their spouse / parent. Further, a SW would be helpful in terms of assisting the client in accessing disability support services, funding programs, and local peer support groups.

Overall, despite any shared roles, each profession offers unique strengths, skills, and expertise that the other cannot. Their individual areas of specialization make these professionals vital members of multidisciplinary healthcare teams, and together they offer many needed services throughout the rehabilitation process.

 

Resources and References

Canadian Association of Occupational Therapists (CAOT) website: http://www.caot.ca/default_home.asp?pageid=2412

Canadian Association of Social Workers (CASW) website: https://casw-acts.ca/en

Canadian Association of Social Workers (CASW). (2017). What is social work? Retrieved from https://casw-acts.ca/en/what-social-work

Ontario College of Social Workers and Social Services Workers (OCSWSSW) website: https://www.ocswssw.org/

Townsend, E. A., & Polatajko, H. J. (2013). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, ON: CAOT Publications ACE.

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O-Tip of the Week: Simple Medication Management

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living.   

This week’s O-Tip of the Week focuses on ways to effectively manage your medications, ensuring each dose is taken at the correct time.  There are many effective ways to assist including the use of a dossette, smart phone alarm reminders, printable checklists and more. 

Learn more ways to help you manage multiple medications in our previous post, Medication Management.  

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The OT Role with Medicinal Marijuana Use

Guest Blogger: Carolyn Rocca, Occupational Therapist

The current legislation on medical marijuana use in Canada greatly shapes our role as health professionals. Under the Access to Cannabis for Medical Purposes Regulations (ACMPR), Canadians who have been authorized by a physician to access cannabis for medical purposes can purchase safe, quality-controlled cannabis from the 52 authorized licenced producers in Canada (Health Canada, 2017). With the legalization of marijuana in Canada being on the horizon, we can anticipate that many more of our clients may turn to it when seeking relief.

But first, it is important to consider why people are turning to cannabis for medicinal use. While some risks do exist, evidence suggests that the use of marijuana can offer several benefits including: reductions in nausea, decreased pain intensity, and improved sleep quality (Health Canada, 2013; Whiting, et al., 2015). Additionally, some clients report experiencing reductions in anxiety, increased relaxation, and relief from tension, headaches, and migraines. With these benefits and relatively mild side effects, this paints quite an enticing picture for those who may be consuming much more potent medications with more serious risks and side-effects.

If more clients are beginning or continuing to turn to cannabis as a source of relief, we as healthcare providers need to identify what role we play in supporting their decision to do so, including the role of Occupational Therapy which is explored as follows:

  1. Focus on safe use of cannabis: As part of the OT role, it is important that we ensure that clients are utilizing medicinal cannabis under the care of a physician, and are using it within the parameters set out in their prescription. Clients should be advised to discuss their cannabis use with her physician, as they would with any medication, as this falls outside of our OT scope. However, OTs can be involved in the process of helping clients track their relief from symptoms and potential side effects, according to the strain, dosage, and time of day and can help people to direct certain questions / concerns to their physician as appropriate.
  2. Monitor the impact of cannabis on daily activities: Our role is to be aware of the potential risks and benefits of medicinal cannabis use, to identify when cannabis use may be impacting clients’ abilities to perform day to day activities, and to subsequently provide strategies as needed. For example, if a client typically becomes drowsy when taking cannabis which may then impact their safety in the kitchen, an OT may be able to recommend strategies such as the use of kitchen timers, or help to schedule cannabis use at safer times of the day.
  3. Review available pain management strategies: As cannabis use is only one option for pain management, our role is to ensure that clients are aware of other available pain management strategies. Some strategies include: pacing activities to conserve energy, resting, massage, exercising, stretching, other medications, staying active (counterintuitive but true!) as well as compensatory strategies. Our focus as OTs is on helping clients to resume increased function by utilizing the pain management strategies they are open to given all the options available and the training we can provide for each.
  4. Assist in navigating resources: For clients who wish to produce medicinal cannabis for personal use, our role is to ensure that clients are aware of the guidelines set out in the ACMPR. We may also have a role in assisting clients in completing required application forms (found here) and planning for safe production, use, and storage of cannabis if they become registered to do so with Health Canada. Further, under the ACMPR, it is a client’s responsibility to make sure that all medicinal marijuana plants or cannabis products in their possession are secure, and that other people, including children, cannot access them. Therefore, OTs can assist in developing strategies to ensure they can meet the grow, safety and storage requirements.
  5. Consider affordability: As clients can expect to spend about $7-$12 per gram of medical marijuana (Medical Marijuana, 2016), it will be important to consider if their prescribed cannabis is covered under insurance funds, or whether they require budgeting strategies for this expense. An OT can also assist in this process, along with ensuring that the affordability is monitored and budgeted for long term.

Considering how imminent changes to Canada’s cannabis legalization are, being aware of the legislation changes in our society is highly valuable in our line of work. The OT profession is well-positioned to support clients in navigating their medical marijuana options in the most safe and functional manner possible. Seek the assistance and guidance of your healthcare team, including an OT, if you are thinking about, or currently incorporating, medicinal cannabis into your healthcare routine.

Resources & References

Government of Canada (2016). Information bulletin: safety and security considerations when producing cannabis for your own medical purposes. Retrieved from https://www.canada.ca/en/health-canada/services/information-bulletin-safety-security-considerations-producing-cannabis-for-own-medical-purposes.html

Health Canada (2013). Information for health care professionals: Cannabis (marihuana, marijuana) and the cannabinoids. Retrieved from http://www.hc-sc.gc.ca/dhp-mps/alt_formats/pdf/marihuana/med/infoprof-eng.pdf

Health Canada (2016). Drugs and health products: Information for health care practitioners. Retrieved from http://www.hc-sc.gc.ca/dhp-mps/marihuana/med/index-eng.php

Health Canada (2017). Authorized licensed producers of cannabis for medical purposes. Retrieved from https://www.canada.ca/en/health-canada/services/drugs-health-products/medical-use-marijuana/licensed-producers/authorized-licensed-producers-medical-purposes.html

Medical Marijuana (2016). Frequently asked questions. Retrieved from https://medicalmarijuana.ca/resource-center/faq-2/

Minister of Justice (2017). Access to cannabis for medical purposes regulations. Retrieved from http://laws.justice.gc.ca/PDF/SOR-2016-230.pdf

Whiting, P. F., Wolff, R. F., Deshpande, S., Di Nisio, M., Duffy, S., Hernandez, A. V., … & Schmidlkofer, S. (2015). Cannabinoids for medical use: A systematic review and meta-analysis. Jama, 313(24), 2456-2473. doi:10.1001/jama.2015.6358

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O-Tip of the Week: Save Time and Energy in the Kitchen

Our O-Tip of the week series we will be providing valuable “OT-Approved Life Hacks” to provide you with simple and helpful solutions for living. 

This week’s O-Tip of the Week focuses on ways to conserve energy in the kitchen by saving you time and effort.

When preparing meals we recommend that you gather ALL necessary  ingredients before beginning.  Doing so will save you time and energy by reducing trips back and forth from the pantry or refrigerator, and avoiding a last minute run to the grocery store for that missing ingredient!

Learn more about how to conserve energy in the kitchen in the following episode from our OT-V series:  Smart Solutions to Make Life Simpler (and Safer!) in the Kitchen.

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Dear Everybody: Let’s Put an End to The Stigma of Disability

Children living with disabilities often face a number of physical and mental challenges, however, on top of this are also facing social challenges such as bullying and lack of inclusion.  In fact, Holland Bloorview Kids Rehabilitation Hospital states that 53% of children living with a disability have zero or only one close friend.   Holland Bloorview has created a new campaign to help put an end to the stigma of disabilities.  The Dear Everybody Campaign aims to provide awareness, knowledge and resources to help put an end to the stigma of disability.

Learn more about the campaign and help create change by visiting their website deareverybody.hollandbloorview.ca.

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The GOS-E and Catastrophic Determination – Gathering EVIDENCE of Pre-Accident Function

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Over the last few months we have had the privilege of presenting to a multitude of Personal Injury Lawyers on the June 1, 2016 changes to catastrophic determination, most specifically on the Glascow Outcome Scale Extended (GOS-E).  If you are working in motor vehicle accident (MVA) rehabilitation or personal injury law, this scale is one you need to be familiar with.

To qualify for catastrophic under the GOS-E, it speaks openly about changes to QUALITY and FREQUENCY of participation in pre-accident tasks under the facets of independence in and outside the home, travelling locally and abroad, productivity, social / leisure participation and relationships.  Within this, it considers HOW OFTEN someone did something, but even bigger than that is FOR HOW LONG and at WHAT INTENSITY.

As OT’s working in this sector, it is important that we gather this information in great detail during our initial assessment to not only get a better picture of pre-accident lifestyle and function, but to create early records that could relate to catastrophic determination at 6 months, 1 or 2 years’ post-accident.

During a presentation, one lawyer questioned the “qualitative way” by which pre-accident information is usually gathered (by asking family or through client self-report).  He asked if there was better evidence, “proof” if you will, that could speak objectively to “pre-accident function”.  This was a great question because right now the only pre-accident “evidence” the industry tends to gather are medical records and these speak to health, not function (and the two can be very different).  Function is best outlined by finding out how people spent their time – something that one would think would be difficult to objectively measure for the purpose of “evidence”, but let’s think again.

The evidence of how people spend their time is actually everywhere.  My morning dog walk and sleep habits are tracked on my fit bit and transferred to my computer and phone.  My car logs the kilometers I drive, and the repair shop inputs these with every oil change.  The gym tracks my attendance.  My phone apparently stalks me by recording everywhere I take it, the websites I visit, the apps I use and the people I speak to, text and email.  The photos in my phone also tell the story of my life and where my time is spent.  My computer records the number of emails I send and receive and the places I visit online.   My emails are sorted and can detail the time I spend organizing and taking trips (local and abroad), socializing, and even my relationship communication habits.  If I had a personal Facebook account this would detail for you the people I chat with, how often, and the places I visit, take photos and upload.  Twitter, Instagram and Snapchat would do the same.  But honestly most of the information about my time spent would be easily revealed through my financial records.  Most of the things I do cost money.  My credit card and bank statements will show you the frequency by which I get a latte, the costs for my gym program, the amount of shopping I do, the people I pay to help manage aspects of my house, the places I eat or indulge, the number of times I visit the movies or do something fun, the things I enroll my children in, etc.  These will even tell you the therapies or treatments I might get privately that my doctor doesn’t even know about.

We know that being involved in the insurance system exposes aspects of people’s lives that they may not want to share.  All privacy is forgone when you want and need help from an insurer, or when you want and need to sue someone who was at-fault for causing you injury and harm.  Unfortunately, with the changes to Catastrophic Determination, the gap just widened in terms of the information that needs to be gathered and the “proof” that needs to be provided to access the benefits an injured person may need.  However, the information is out there – little is sacred or private anymore. 

If this is helpful, here is a list of information that could be gathered to support changes to FREQUENCY and QUALITY of participation in most activities before and after an accident.   Getting someone’s personal records for the year prior to an accident, and then for the first-year post, will be highly informative, helpful and revealing…if they are agreeable to share:

Bank Statements / Financial Records will show MOST purchases related to social / leisure activities:

Memberships / clubs / subscriptions
Dinners / coffees / movies
Vacations
Shopping habits
Sports / fitness
Gas / driving / parking habits

Other places will also have records:

Gym / rec center attendance
Schools / school records
Employment records
Evidence of trips / vacations / social events on SM – FB, Twitter etc (before the accident)
Car / vehicle records – how often the car was driven based on KM’s
Points cards for anything like movies, Starbucks, Airlines, etc
Call / cell records and communication habits
Medical records

I hope this helps the lawyers and injured people of the insurance system to find the “evidence” they might need to really demonstrate to an insurer how their life has been impacted following an accident.  And for the OT’s gathering similar data subjectively, be specific and thorough in your questioning under the GOS-E spheres.  Your reports are highly important and may become the difference between someone being deemed catastrophic or not.

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Understanding Your Rehab Therapy Professionals

Navigating the world of rehab therapists can be confusing – there are multiple types of therapists, whose abilities may seem similar when taken at face value based on general terms like “supporting rehabilitation goals” or “providing treatment”. However, when you compare these professionals based on their educational backgrounds and requirements, as well as their defined roles and responsibilities as set out by each profession’s respective college, professional association, or employer, it can become clearer which professional is best suited to help serve your personal needs.

Below is a simple summary guide of the hierarchy of educational backgrounds and core roles of each therapist/professional- please contact your healthcare provider or Occupational Therapist if you have further questions or think the services of these professionals may benefit you.