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Archive for category: Occupational Therapy At Work

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My Animals Support Me, But Are Not Support Animals

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

Every day I benefit from the love of my animals.  In fact, being an animal owner is not only part of my lifestyle, but has absolutely become part of who I am.  My animals provide me with love, comfort, they calm me and make me smile and laugh.  I have one at my feet right now and he is the one that tends to keep an eye on me – never too far away, watching, waiting, and looking for moments to connect with me, steal some cuddles or give me a quick wag to show his support.  My animals also provide comfort and security to my children and it is not uncommon to see a kid doing homework or relaxing in her room while surrounded by her four-legged beasts much like Snow White.  However, like children, animals are not always easy and at times can be all-consuming, frustrating, and difficult to manage.  Pets are not for everyone, especially during times of trauma, transition, or change.  In the end, my dogs provide me and my family with a “service”, but these are far from “service animals”.  I will explain.

Pets are animals that we keep inside to provide us all the comforts and joys that animals can provide.  Sure, we take them outside, but that is equally for their benefit as it is for ours (dog parks, nature walks, doggie play dates).  Maybe to the vet, groomers or to visit with dog-friendly friends.  But pets are typically a hot mess in public spaces.  My dogs are wonderful at home and are trained to be good here, but If I took one of them to a restaurant he would pretend to be looking for some affection while simultaneously snatching the steak off my plate, or diving to grab that roll that landed on the floor.  He would be underfoot and anxious, nervous of the chaos and commotion.  And in getting him into the restaurant he would not hesitate to chase a squirrel across the road while dragging me as the leash holder into traffic with him.  After all he is a pet; he is not trained in how to properly manage public spaces.

True service animals are pets, sure, because they provide all the supports of an animal at home.  But they are also exceptionally well trained to behave in public.  They can navigate public spaces with focus, comfort and ease because they have experience here, and know what is expected.  They are not distracted by squirrels or steak and get used to being so attentive to their owners such that affection from strangers when out of the home is not something they crave.  They are trained to react to situations with consistency and based on what the owner needs – they will not jump on someone in an elevator, bark, urinate in the lobby, or wrap their leash around someone’s leg.  They won’t bite anyone because they are screened as non-aggressive and are trained to have restraint (unless they are a trained guard dog in which case they provide owner protection on appropriate command).  Service animals provide just that – a “service” to someone in need.  They are not just “pets in a vest out in public.”

In Ontario, owners of service animals, in addition to donning the animal in a vest, are required to carry a “prescription” to explain that they need the dog in public spaces.  This “prescription” can be written by a health professional, and to protect the privacy of the animal owner, is often discrete and vague (“requires the service animal for medical reasons or reasons of mental health”).  Many people with these scripts won’t look or act disabled on the surface, hence the need for supporting documentation.  Unfortunately, with service and support dog vests available online, the note becomes necessary to prove a need and to allow the owner of an establishment to be comfortable having the animal inside.

As occupational therapists, we can provide these scripts and notes to owners of service and support animals.  In many settings, we also assist people to obtain funding for the animal and its training.  What we need to understand, however, is the responsibility that comes with this.  Should the animal misbehave at home or in public and harms someone or the owner, the prescriber of the animal could prove liable as the one indicating the animal was needed and was suitable for the purposes of service and support.  To protect ourselves from this, there are things we should consider:

1.      Ensure the animal is not a pet in the first place.  Confirm that the animal is trained, has been vetted to be suitable, and can handle the important responsibilities that come with wearing a service animal vest.  The best way to do this is to ensure the animal was provided by a reputable facility that works with animals for this purpose.  A list of such facilities in Ontario is included below.

2.      Ensure your note has an expiry date.  An open-ended script that could be carried for years or decades does not ensure that you are referring to “this animal” at “this time”.  Consider dating your script to ensure it is reviewed perhaps annually like other processes that involve our signature (parking permits, tax forms, etc.).

3.      Recognize that supporting the funding for someone to obtain or purchase an animal could also be considered a “script” whereby you are taking ownership for this animal as a service dog.  If you complete a letter of recommendation, complete with funding support, that could be enough for someone to carry with them, written by an “occupational therapist” as proof of the need.

4.      In the cases of mental health, consider the value of having this prescribed by a psychologist, psychiatrist or psychotherapist if warranted.  Consider your own knowledge, skills, and experience with the client and their disability in recommending this type of need.  Ensure there is an appropriate diagnosis of mental health which is best obtained from a registered mental health professional.

In researching for this blog, I was provided a very informative and helpful document written by a Psychologist, Registered Dog Breeder, and Executive Director of Hope Heels Service Dogs: Dr. Aanderson.  This resource is also included below.  This document explains service animal laws across Canada, and clearly outlines the differences between a guide dog, service or support dog and pet.  It provides a decision tree to help professionals like myself navigate the important conversation with clients regarding the use of a service dog, and how this differs from a pet, in deciding whether to “prescribe” this or not.

I am sure many of us have witnessed an animal in a public space that was wearing a vest and misbehaving.  In one instance, someone in an elevator with me said to the owner of a vested “support animal” that was climbing on people “there is no way that is a service dog.”  The owner just exited the elevator without responding.  Service animal or not, it is an abuse of process and blatant disregard to the training and time that goes into true service animals to try and present a pet in this way.  Service animals provide an immense amount of support to those they are trained to help.  As professionals, we have a responsibility to continue to safeguard the true use of these animals, the programs that train them and the people that need them.  Consider using Dr. Aanderson’s guide before providing written support for these valuable four-legged aids to daily living.

Resources:

Aanderson Service Dog Prescriber Guidelines

Service Dog Providers in Ontario – Current as of October 2019

 

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Improve Safety in Your Bathroom

Let’s discuss the most dangerous room in the home: the bathroom. For those with limited mobility, or seniors, it is important to consider the fall risks that exist in the bathroom to ensure that people are safely able to go about daily routines. In the video below we will review bathroom hazards and will discuss the many suggestions an Occupational Therapist may make after a home assessment.

We hope you enjoy this video from our Occupational Therapy Video (OT-V) series and can use some of our tips to stay safe at home!

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Disability and Weight Management: Helping You Tip the Scales in the Right Direction

Julie Entwistle, C.Dir. (c), MBA, BHSc (OT), BSc (Health / Gerontology)

I find that while many of my clients initially lose weight following trauma (hospital food diet); eventually the net impact of a disability is often weight gain.  This is often the result of many factors – most interacting to make the solution difficult to isolate.  Medication side-effects, altered routines, reactive eating, friends and family that provide unhealthy sympathy foods, increased use of fast food because preparing meals is difficult, inactivity, depression, and even hormonal and physiological changes to the body as a result of the trauma.

But we do know that 70% of weight management is diet and assuming this is true, then the solution to weight management should be simple – you can’t eat it if you don’t buy it.  Purchasing unhealthy food is the first step to a weight problem.  And weight problems in disabled people are exponential.  Everything becomes harder – transfers, walking, completion of daily tasks, caregiving, and many pieces of equipment have weight limits that when exceeded result in equipment failure.

What is even more problematic is the role of the caregiver in the maintenance of weight in the person they are caring for.  When people cannot shop for food and cannot cook, then helping them to maintain weight becomes the job of the caregiver.  Just buy and prepare healthy foods – perhaps food prescribed by a nutritionist or dietician.  However, often caregivers rely on the disabled person to dictate the food choices but if people are emotionally eating, or eating out of boredom, then the caregiver cannot always rely on the individual to make the best decisions.  Often raising awareness about healthy eating starts with asking people to track what and when they are eating and drinking.  Then, problems can be identified, and a list of doable solutions can be developed. 

In one instance, in helping a client with weight loss as a functional goal, we discovered through tracking that she was barely eating breakfast and lunch but was consuming all of her calories from 5-10 pm.  We made the goal that, over time, she would consume breakfast, lunch, two snacks and dinner, and would stop eating after 7 pm.  Within a few short months, she lost 30 pounds, and this greatly improved her mobility and tolerances for activity.  Another client discovered through tracking that he was consuming far too many large bottles of pop a day.  By changing his large bottle to a smaller one, and eventually to only one pop per day and the rest water, he was able to drop 20 pounds.  In both cases, the problems, solutions, and commitment to change were made by my clients (with my guidance and support), making the results far more meaningful and lasting.  Further, the client was shown a framework for how to check and modify eating habits should they deteriorate again in the future.

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Redefining “Disability”

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

I love the saying that we are all “temporarily able-bodied”.  How true.  Each one of us, at any time, is one situation, condition, virus, bacteria, accident, or even random event away from becoming disabled physically, emotionally, behaviorally or cognitively.  Or, really, many of us are already disabled – visibly or invisibly, and I truly believe the saying: “be kind to all you meet as everyone is fighting a hard battle” – Plato.

This definition of disability from Wikipedia speaks to how all-encompassing the word really is:

Disability is the consequence of an impairment that may be physical, cognitive, mental, sensory, emotional, developmental, or some combination of these. A disability may be present from birth, or occur during a person’s lifetime.

Disabilities is an umbrella term, covering impairments, activity limitations, and participation restrictions. An impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus, disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.

The last sentence is especially true.  A disability is an interaction of the person and their environment.  This is why I love being an Occupational Therapist.  While I do enjoy helping people to function better through therapy that improves physical, cognitive, behavioral or emotional abilities, I also take pride in tackling the environmental aspects of functional problems.  If we can’t change the person, we can try to change the environment in which they live, and the spaces in which they need to function.  This “holistic” view of disability is, in my opinion, one of the key facets of Occupational Therapy.

I wanted to celebrate this important day by listing some of my most favorite quotes about disability:

“The only disability in life is a bad attitude” – Scott Hamilton

“I choose to not place “DIS” in my ability” – Robert M. Hensel

“Just because a man lacks the use of his eyes doesn’t mean he lacks vision” – Stevie Wonder

“One’s dignity may be assaulted, vandalized and cruelly mocked, but cannot be taken away unless surrendered” – Michael J Fox

“We know that equality of individual ability never has existed and never will, but we do insist that equality of opportunity still must be sought” – Franklin D Roosevelt

“I am only one, but still I am one.  I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something that I can do” – Helen Keller

So, consider that we are all vulnerable and only temporarily able-bodied.  We need to celebrate humanity – in all its forms, including the form that is “disability”.

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A Day in the Life of your “Occupations” — Bedtime Routines

Contrary to the traditional understanding of the word, occupational therapists define “occupation” differently. For OTs, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for Occupational Therapy month, we will explore “A Day in the Life of Your Occupations” complete from morning to night, highlighting common important occupations and how OT’s can help when things breakdown along the continuum that is living.

This week we discuss the important occupations that arise before bed.  If you missed our “Rise and Shine,” “9 to 5 “Workday,” and/or “Eventful Evening” posts, we encourage you to view them here.

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A Day in the Life of Your Occupations: Eventful Evenings

Contrary to the traditional understanding of the word, occupational therapists define “occupation” differently. For OTs, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for Occupational Therapy month, we will explore “A Day in the Life of Your Occupations” complete from morning to night, highlighting common important occupations and how OT’s can help when things breakdown along the continuum that is living.

This week we discuss the important occupations that arise in the typical evening. If you missed our “Rise and Shine” and/or “9 to 5 Workday” posts you can view them here.

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Healthy Workplace O-Tip of the Week: Properly Set Up Your Screen

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.

October is Occupational Therapy Month and Healthy Workplace Month!  In celebration, for the month of October, we will be providing you with OT-Approved tips for a healthier day at work.

Many jobs today require long periods of screen time. If this is the case for your workstation, make sure that there is an arm’s length distance between your eyes and the screen. Also, make sure that the top of the monitor or screen is level with your forehead. This allows for the head and neck to remain in a neutral position by avoiding continued periods of looking up or down. If a job requires frequent paper reading or phone use alongside computer use, consider a document holder or headset.

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A Day in the Life of your “Occupations” — 9 to 5 Workday

Contrary to the traditional understanding of the word, occupational therapists define “occupation” differently. For OTs, the word “occupation” does not only include “paid” work, employment, or jobs. Rather, we define it as the way people “occupy” their time and as such it actually includes all roles involved in living (therapy for living, who knew?). So, for Occupational Therapy month, we will explore “A Day in the Life of Your Occupations” complete from morning to night, highlighting common important occupations and how OT’s can help when things breakdown along the continuum that is living.

This week we discuss the important occupations that arise during the 9-5 Workday. If you missed our “Rise and Shine” post, you can view it here.

 

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Mental Health Services for Youth

Nicole Kelday, Student Occupational Therapist (University of Toronto)

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

 

It is staggering to realize that 39% of Ontario high school students show active symptoms of anxiety and depression. And while there are a multitude of resources available to help students that may require mental health services, only 40% of Canadians aged 15-19 reported they have not accessed these when needed. This begs the question…why are these youths not seeking services?

Reaching out for help can be daunting and many report stigma related to mental health concerns, especially in high schools. So, how do we encourage youth to access the services available to them and talk to those who may be experiencing similar concerns? A new emerging trend in mental health care is the concept of youth-led groups. Youth-led groups involve a shift in thinking, instead of viewing youth as our clients; they are viewed as partners and leaders to improve the practice of youth engagement in the mental healthcare system.

Across the province, community agencies have begun to initiate youth-led groups by involving youth with mental health illness in leading each other to raise mental health awareness and fight existing stigma. With support from a clinical adult ally, youth have participated in the creation of youth-friendly services by designing waiting rooms in clinical environments to encompass the interests of this group.

It is known that participation in meaningful activities and roles can enhance emotional well-being and social competence. Occupational therapists (OTs) have the unique ability to evaluate and facilitate supportive environments in order to promote mental health amongst children and youth. By involving all key stakeholders, OTs are able to determine factors that influence the ability of a youth to fulfill their primary roles and occupations and provide interventions to promote maximal functional participation in such.

As a student occupational therapist, I could immediately recognize how this concept strongly resonated with the core beliefs of client-centredness. Youth-led groups truly highlight the client as not only an active partner but also a leader, in their healthcare experience. Youth are equipped with vast knowledge and perspectives that we as healthcare professionals may not immediately recognize, which may help to explain why youth are not seeking available services in the first place.

 

References

1. Centre for Addiction and Mental Health (2018). Transforming mental health for children and youth. Retrieved from https://www.camh.ca/en/camh-news-and-stories/transforming-mental-health-for-children-and-youth

2. Hartman, L., Michel, N., Winter, A., Young, R., Flett, G. & Goldberg, J. (2013). Self-Stigma of Mental Illness in High School Youth. Canadian Journal of School Psychology, 28(1), 28-42.

3. The New Mentality (2016). TNM Groups. Retrieved from https://www.thenewmentality.ca/what/tnmgroups/

4. The American Occupational Therapy Association, Inc. Mental health in children and youth: the benefit and role of occupational therapy. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/MH/Facts/MH%20in%20Children%20and%20Youth%20fact%20sheet.pdf

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Healthy Workplace O-Tip of the Week: Follow the 20-20-20 Rule

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.

October is Occupational Therapy Month and Healthy Workplace Month!  In celebration, for the month of October, we will be providing you with OT-Approved tips for a healthier day at work.

Staring at a screen all day? Try applying the 20-20-20 rule… your eyes will thank you for it! Here’s how it works: Every 20 minutes look at something 20 feet away for 20 seconds. Get into the habit and you will significantly reduce the risk of vision-related headache and fatigue.