Close

Archive for category: Occupational Therapy At Work

by

Reporting Unsafe Drivers: The New Role of Occupational Therapists in Ontario

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

Co-written with Samantha Hunt, Student Occupational Therapist

My father-in-law was terminally ill and suffered from dementia.  Eventually, his decline became significant and his doctor filed a mandatory report with the Ministry of Transportation (MTO) to suspend his license pending a driver’s exam.  He refused to attend the exam yet continued to drive even without a valid license.  He still paid for car insurance because he knew this was important but was not well enough to connect his own disabilities to his safety and the safety of others.  The family planned to remove his vehicle from his possession but before we could he ventured out one night, got lost, and the police found him 8 hours later driving in a farmer’s field.  The good news was that no one got hurt and his car was beyond repair.  Now, he could no longer drive even if he wanted to.

Driving is an important daily activity for many and provides drivers with an independent means to get around and to manage our own needs outside of the home.  It reduces our reliance on others and provides us with freedom and control.  But it is a privilege, not a right, and sometimes people reach a point where driving is no longer safe, but yet they don’t voluntarily stop.

Up until recently, the ownness to report unsafe drivers has fallen to the legal responsibility of doctors, nurse practitioners and optometrists.  However, on July 1, 2018 the legislation will change to add a new class of “discretionary” reporting, and occupational therapists will be included in the list of professionals that can submit these “discretionary” reports. 

Considering this major change to the Highway Traffic Act (HTA), and the significance of this on OT practice in Ontario, we wanted to provide a brief overview of the key facts and guidelines for the OT’s that this may impact.

Background on Medical Reporting Legislation

Mandatory medical reporting for physicians and optometrists in Ontario has been in place since 1968 and was enacted to help protect the public from drivers diagnosed with certain medical conditions or impairments that made it dangerous for them to drive. Mandatory reporting is a legal requirement to report that pertains to physicians, nurse practitioners, and optometrists, outlined in the HTA. The legislation states that every prescribed person shall report to the MTO “any person who is at least 16 years old who, in the opinion of the prescribed person, has or appears to have a prescribed medical condition, functional impairment or visual impairment that may impair driving ability.”

What’s New

In 2015, amendments were passed that allowed for a new reporting model to be introduced in Ontario and were approved in February 2018. These include:

·       A combination of mandatory and discretionary reporting

·       Authority to add additional healthcare professionals

·       Specific requirements regarding what must be reported

Resulting from these amendments, the MTO regulations state that as of July 1, 2018, occupational therapists are identified as discretionary reporters. Discretionary reporting is not a legal requirement but gives authority for reporting to occupational therapists, physicians, nurse practitioners and optometrists for: “any person who is at least 16 years old who, in the opinion of the prescribed person, has, or appears to have, a medical condition, functional impairment or visual impairment that may make it dangerous for the person to operate a motor vehicle”. Discretionary reporting therefore allows OTs to report concerns about a client’s fitness to drive if they choose.

With respect to consent and confidentiality, OTs are protected from legal action for breaking confidentiality when making a discretionary report; the HTA states that the authority of a prescribed medical professional making a report to the MTO overrides the duty of that professional to maintain a client’s confidentiality. Nevertheless, an OT making a report would be expected to advise the client of this decision.

Summary of Discretionary Reporting Rules for OTs

·       OTs can report concerns about a client’s fitness to drive directly to the MTO.  There will be a standard MTO form to be used for this purpose.

·       OTS may report a driver but are not legally required to do so.

·       OTs can make a report without client consent to prevent or reduce risk of harm.

·       OTs can only make a report if they have met the client for assessment or service delivery.

·       OTs can report on both prescribed conditions and any other medical conditions, functional impairments or visual impairment that may make it dangerous for a client to drive.

Prescribed medical conditions include the following:

1.     Cognitive Impairment: a disorder resulting in cognitive impairment that,

                 i.      Affects attention, judgment and problem solving, planning and sequencing, memory, insight, reaction time or visuospatial perception, and,

                 ii.     Results in substantial limitation of the person’s ability to perform activities of daily living.

2.     Sudden incapacitation: a disorder that has a moderate or high risk of sudden incapacitation, or that has resulted in sudden incapacitation and that has a moderate or high risk of recurrence.

3.     Motor or sensory impairment: a condition or disorder resulting in severe motor impairment that affects co-ordination, muscle strength and control, flexibility, motor planning, touch or positional sense.

4.     Visual impairment:

                 i.      A best corrected visual acuity that is below 20/50 with both eyes open and examined together.

                  ii.     A visual field that is less than 120 continuous degrees along the horizontal meridian, or less than 15 continuous degrees above and below fixation, or less than 60 degrees to either side of the vertical midline, including hemianopia.

                 iii.    Diplopia that is within 40 degrees of fixation point (in all directions) of primary position, that cannot be corrected using prism lenses or patching.

5.     Substance use disorder: a diagnosis of an uncontrolled substance use disorder, excluding caffeine and nicotine, and the person is non-compliant with treatment recommendations.

6.     Psychiatric illness: a condition or disorder that currently involves acute psychosis or severe abnormalities of perception such as those present in schizophrenia or in other psychotic disorders, bipolar disorders, trauma or stressor-related disorders, dissociative disorders or neurocognitive disorders, or the person has a suicidal plan involving a vehicle or an intent to use a vehicle to harm others.

·       OTs who make a report in good faith are protected from legal action but failing to report when they should have could be a breach of professional obligations.

OTs are NOT expected to report on conditions that, in their opinion, are of:

·       A transient or non-recurrent nature

·       Modest or incremental changes in ability

Lastly, although OTs are not legally required to make discretionary reports, a professional obligation to identify a potential safety issue with a client (such as a concern about fitness to drive) and, taking action to address this concern, is expected of the OT. Taking action may or may not include making a discretionary report to the MTO.

Next Steps

Reporting, Intake, and Review Process

The three types of approaches for assessing fitness to drive include a General Functional Assessment, Driving Specific Functional Assessment, and/or a Comprehensive Driving Evaluation (more information can be found in the resources below). Once an assessment has been completed or a concern has been identified, an OT may fill out a report. A new standardized form that OTs (along with physicians and nurse practitioners) must use when making a report has been approved and will be available online as of July 1, 2018. Once reports are received by the ministry, they will be reviewed and the MTO is to take appropriate action following within 30 business days.  When an OT is reporting to the ministry, this does not mean the OT is taking the person’s license away. The licensing body has the responsibility to make this decision or to decide if more information is required.

For more information and resources, the College of Occupational Therapists of Ontario has created an Interim Guide to Discretionary Reporting of Fitness to Drive, which can be found at:  https://www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

Resources

www.coto.org/news/changes-to-medical-reporting-of-drivers-gives-ots-new-reporting-authority

www.coto.org/resources/interim-guide-to-discretionary-reporting-of-fitness-to-drive-2018

www.mto.gov.on.ca/english/safety.medical-review.shtml

www.youtube.com/watch?v=dOIJ7CrDTT0

by

Concussion Recovery: An OT Can Help!

If you ask a crowd of people if they have ever had a concussion, about 1/3 will raise their hand. Direct hits to the head and closed head injuries are not uncommon in children and young adults, decrease in frequency in adulthood, but increase again in seniors.

Symptoms of concussion range and some can dramatically impact someone’s ability to work, drive, go to school, manage daily routines, or even participate in social or leisure activities.  Occupational Therapists can help those who have suffered a concussion manage symptoms and for those who are struggling to participate in important life roles, we can help them to return to work / home / school / fun! 

Learn more about Occupational Therapy’s vital role in our OT-V Episode:  Managing a Concussion

by

Stay Sharp with the 30 Day Healthy Brain Challenge

June is Brain Injury Awareness Month and, in recognition, Solutions for Living created the 30 Day Healthy Brain Challenge.  We challenge you to complete these 30 simple activities and tips which, when incorporated into your lifestyle, can help improve memory, boost mental health, prevent brain injury and reduce cognitive decline.

Try the 30 Day Healthy Brain Challenge and after the month let us know how many activities you were able to complete!

by

O-Tip of the Week: Simple Ways to Turn of the Tech and Get Kids Moving!

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. 

Spring has finally sprung and what better time than to add some healthy activity to your life.  So, for the month of May, our series will be providing tips to help you get physical!

Do you struggle to get your kids to power down and get active?  Devices can be addictive and detrimental to mental and physical health so it’s important to create a healthy balance.  Our Printable Technology Pass can help parents get their kids to power down and get active!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Learn additional tips to tame the technology habit in our post The Detriments of Screen Time and a FREE “Technology Pass.”

by

Occupational Therapy and Physical Therapy: Key Differences and Similarities

The differences and similarities between Occupational Therapy and Physiotherapy have long been confused.  Although both Occupational Therapy (OT) and Physiotherapy (PT) are registered healthcare professions specifically in the domain of rehabilitation, each profession has it’s unique role and purpose in one’s recovery following injury or illness, as well as in the prevention of disease, further injury, and disability. 

Learn more about the key differences and similarities of these two extremely valuable therapies in the following infographic:

by

Innovative New Medication Management Solutions

We love to share new and innovative technology that can assist in day to day living.  Managing medications for yourself or someone you care about can often be tricky, especially if cognitive deficits are present.  A great new product, Memo Box, is a smart technology that can vastly improve how medications are managed.  Memo Box is a digital pill box that syncs with multiple devices to track, remind, and send alerts to family members about medications and more.  Take a look and ask your health professional if you think this device might be helpful for you or your loved one.

Memo Box

 

by

One in Five Youth Struggle with Mental Health Problems – Do you Know the Signs?

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

I was recently reviewing my daughter’s school handbook and noticed the section on child and youth mental health.  According to this (and the Canadian Mental Association) 1 in 5 children and youth struggle with mental health problems.  While great strides have been made over the last several years to destigmatize and demystify mental health problems in both adults and kids, I feel this remains generally misunderstood.  In my practice, I still see the common misperceptions that people with anxiety don’t leave the house or appear nervous and anxious in public, or that people with depression sleep all day, don’t attend to their appearance, and sit around crying and feeling sorry for themselves.  The truth is that mental health is a spectrum, or a continuum if you will.  It can vary and no one’s experience will be the same.  In children, mental health problems can present differently.

As per the handbook I was reading, the signs might include:

·        Anxiety and fear that does not go away

·        Frequent crying and weepiness

·        Loss of interest in activities that were a source of pleasure in the past

·        Difficulty concentrating

·        Lack of energy or motivation

·        Problems at school with falling marks

·        Withdrawal from family, friends and school activities

·        Increased school absences

·        Loss or increase in appetite

·        Sleeping too much or too little

·        Increased irritability, anger or aggression

·        Neglect of personal appearance

·        Frequent stomach aches or headaches

·        Increased alcohol or drug use

In general, parents should be able to monitor most of these and overt changes might be obvious (suddenly disconnecting from friends, drastic changes in grades, behavior change at home, quitting enjoyed activities, not eating food or participating in meal times, etc).  But like with the continuum of mental health in adults, some of these might present some days and not others, or be so subtle that they deteriorate very slowly over time.   As parents of teens we need to be the barometer for our kids as they may lack the ability to relate some of these signs to mental health or internal struggle.

Luckily, in Southern Ontario anyway, I see the mental health problems of kids being taken seriously and there are publicly funded community supports available.  But getting your child connected with these can be the challenge.  It can be hard to convince a teen to do anything they don’t agree with, let alone getting them to the myriad of appointments with doctors and clinicians that can help.

Occupational therapy plays many roles in helping kids and teens address issues with mental health.  While some occupational therapists are trained to provide psychotherapy, others use meaningful and enjoyable tasks to help with mood elevation, reactivation and reengagement.  We are skilled at looking beyond the obvious to get a better sense of what might help at home, school or in the community to get your child or teen on track.  Sometimes it is as simple as helping them to reorganize their school work, create a process for managing assignments and tests, teaching them how to study in a way that works for them based on their learning style, or even looking at how their week is managed to make changes.  Occupational therapists tackle things like sleep / wake schedules, eating and diet, activity participation, grades and school success, managing friends and relationships, motivation through engagement, and dealing with negative pressures that create more stress and anxiety.

My advice if you are concerned about your child?  Start with your family doctor and discuss your concerns, even if your child won’t attend with you.  Involve the school in your concerns to get their support and guidance, after all your child spends several hours a day in their supervision and care.  Teachers can be a great resource and form of support as well, but you need to open those lines of communication.  Don’t expect the school to come to you – often they don’t.  If your child is in crisis, call your local Crisis Outreach and Support Team (COAST) and ask them for help.  They can (and should) also connect you and your child to other community programs.

If you have coverage for mental health treatment for your teen (extended benefits, other insurance funding, out-of-pocket), including occupational therapy, consider enlisting a private therapist.  Private therapy often provides a larger scope of service, is more specialized, and can be provided over a prolonged period if appropriate.  Any good private therapist will try to work themselves out of a job by getting your child on track as quickly as possible and they will want you to immediately feel the benefit of their involvement.  Also, if you have private dollars or insurance coverage, I would suggest a psycho-educational assessment.  These are extremely thorough “brain tests” that look at all aspects of how your child processes information, manages cognitive tasks and addresses the complicated relationship between our brain and our emotions.  The outcome of these assessments can be extremely helpful and will provide both you as a family, and the school, with suggestions for how to best help your child to succeed.

I have always said watching my kids grow up is the best and worst part of parenting.  It is especially heart-wrenching if your child is struggling.  Watch for the signs, talk to your child and get them (and you!) support if they need it.

by

Pillows for Neck Pain – Do They Actually Help?

For those that suffer from neck pain, many aspects of daily life can be altered, including sleep.  Sleep is an important part of your overall health, therefore, working with a Physician or Therapist to find solutions to help you achieve quality sleep is important.  Many health professionals recommend the use of special pillows.  The following care of the McMaster Optimal Aging Portal shares scientific research about the use of these specialized pillows and their effect on neck pain.

McMaster Optimal Aging Portal:  A pain in the neck! Does a specialized pillow really help?

by

Returning to Work after Illness or Injury: OT Can Help

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

In 2011, Statistics Canada reported that 5.9% of full-time employees were absent from work due to illness or disability. The costs associated with workplace injuries are vast.  Studies have shown that the duration of work disability, as well as costs, are significantly reduced when the workplace has contact with a health care provider coordinating return to work interventions. In fact, well-designed return to work programs are now recognized as the best practice to reduce costs associated with worker’s compensation.

Occupational therapy is a cost-effective strategy to accelerate the client’s recovery and rate of returning to work. With an effective return to work plan coordinated by an occupational therapist, injured or ill employees can recover quicker and return to work faster, significantly reducing employer costs associated with workplace injuries.

In the following video from our OT-V series, we will discuss how occupational therapists can help to support the critical transition back to the workplace following an interruption of work duties due to physical or mental health issues.

For more information on promoting employee wellness in the workplace visit our Healthy Workplace blog page.