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The Next Chapter…

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

Seven years ago, I realized that very few people were talking about occupational therapy online.  At the time, blogs were “the thing” and people found them both informative and helpful.  While this may be true today, the reality is that video, clips, and podcasts are now the preferred way for people to stay informed, connected, and to learn about interesting topics.  Evolving with the rapid pace of societal change is an important survival skill, and with that, I wanted to announce that this will be my last blog.

I have enjoyed writing about occupational therapy, and even about some personal stories (and rants) over the many years of having this platform.  I engaged with many who had questions or comments, or who found the information helpful.  I have endured the negativity that can come from having a public opinion that is not shared by all and have grown through those experiences.

From the information I have, this blog has reached over 250,000 people, included 315 pages of original content, and communicated 136,928 words.  Not bad as a side project to a full-time job providing rehabilitation services, my work on boards and committees, teaching, lecturing and training, coaching and volunteering, and while trying to stay active and manage my four girls, pets, family and household that fill my days with lots to do.

Writing and posting on this blog has reminded me of all the things that OT’s know, and the great work we do.  I believe the public is slowly catching up to this, and one day OT will be not only be known, but even requested, and recognized as a profession that helps others to live better.

I continue to have a passion for this profession that is unwavering.  So much so that I have decided to leave my industry to become a regulator, with the dream of having an impact at the highest level.  This decision was difficult as I leave behind a team of great people that inspire and teach me daily.   A team of people that I see making a huge difference in the lives of those that need them, with a ripple effect that extends so far it is immeasurable.  I am proud to have contributed to the growth of many wonderful therapists in this sector, and that perhaps my existence here has helped (directly and indirectly) thousands of clients, and hopefully bettered an industry that allows us to truly make a difference. 

As I sign off, I encourage our readers to continue to follow Solutions for Living and FunctionAbility online as they forge ahead and continue to be Ontario’s leader in private rehabilitation.

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Recovery from Trauma and the Vital Role of Occupational Therapy

Guest Blogger: Carolyn Rocca, Occupational Therapist

Motor vehicle accidents account for countless injuries annually and are one of the most common traumas individuals experience. Trauma can be understood as one’s unique experience of an extremely stressful event or enduring conditions that overwhelms their ability to cope. These experiences can often disconnect us from our sense of safety, resourcefulness, and coping. As a result, survivors of severe and traumatic motor vehicle accidents are at increased risk for experiencing mental health difficulties, with posttraumatic stress disorder, depression, and anxiety being the most common.

Post-traumatic stress disorder (PTSD) is a mental health condition that can follow a traumatic event involving actual or threatened death, serious injury, or threat to the physical integrity of oneself or others. Although every individual experiences PTSD differently, following a motor vehicle accident PTSD symptoms can involve:

·       Psychologically re-experiencing the trauma through distressing thoughts or dreams about the accident,

·       Avoidance of thoughts or situations associated with the accident, including a reluctance to return to driving,

·       Extremes in emotional responsiveness, by either having greatly reduced or heightened emotions, and

·       Increased physical arousal, such as hypervigilance, exaggerated startle, irritability, and disturbed sleep (Beck & Coffey, 2007).

The symptoms associated with PTSD can leave individuals to feel emotionally, cognitively, and physically overwhelmed. Naturally, this can result in difficulties in one’s daily functioning, including one’s ability to care for themselves and others, as well as their ability to successfully engage in their life roles of being a spouse, parent, employee, student, or volunteer, to name a few. For these reasons it is recommended that those experiencing PTSD seek help from a team of healthcare providers and consider occupational therapy.

Using a trauma-informed care approach, occupational therapists can support clients through the following three Phases of Trauma Recovery:

Phase I – Safety-stabilization:

Since trauma often results in a sense of helplessness, isolation, and loss of control, the aim is to restore a sense of safety and empowerment. Following trauma, creating a sense of safety is the foundation of one’s recovery process.

The first step to building and creating safety is to first identify things that help us feel safer. Occupational therapists can help their clients to identify objects that bring about a personal sense of safety and imbed them into their daily routines. These safety objects may include: special people such as a trusted friend, engaging in certain activities like looking at photographs or making crafts, or being in a certain place, such as being outdoors in the sunlight.

Occupational therapists can also assist in establishing safety through practices such as meditation, mindfulness, deep breathing exercises, yoga, and Thai chi, as these approaches have been shown to be effective at decreasing stress and soothing the nervous system (Manitoba Trauma Information & Education Centre, 2013).

Phase 2 – Remembrance and Mourning:

A traumatic event like a motor vehicle accident is often associated with a form of loss. One might feel they have lost their independence, sense of identity, or purpose following a car accident.

Counselors and occupational therapists are well-equipped to guide individuals on their recovery by allowing them time to grieve and morn their own personal losses. This is often achieved through individual or group-based therapy by processing the trauma, putting words and emotions to it, and making meaning of it.

Phase 3 – Reintegration:

The goal of the third stage of recovery is that the person affected by trauma recognizes the impact of their experience but is now ready to take concrete steps towards a lifestyle that is no longer controlled by the trauma. Recovery and reintegration will look different for everyone, but often involves resuming important life roles and responsibilities, and returning to a lifestyle that is meaningful to them.

Occupational therapists can assist during this phase of recovery by supporting their clients in re-establishing healthy routines, building strong support systems, learning and practicing coping strategies during their day to day activities, and gradually increasing their exposure to anxiety provoking triggers, ultimately enabling them to reintegrate into their communities and preferred lifestyles.

For more information about PTSD, trauma-informed care, and how healthcare professionals can support someone following trauma, be sure to take a look at the Trauma Toolkit or call an Occupational Therapist to start the process of recovery.

 

References & Resources:

Beck, J. G., & Coffey, S. F. (2007). Assessment and treatment of posttraumatic stress disorder after a motor vehicle collision: Empirical findings and clinical observations. Professional Psychology: Research and Practice, 38(6), 629.

Manitoba Trauma Information & Education Centre (2013). Retrieved from http://trauma-recovery.ca/

The Trauma Toolkit: A resource for service organizations and providers to deliver services that are trauma-informed (2013). Retrieved from http://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf

 

Previously Posted April 2017

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Technology and Anxiety

Guest Blogger:  Susan Wang, MSc (OT)

Technology has increased access to information, entertainment, and connection with others.  However, it is not without consequences. With the rise of social media and the prevalence of smartphones, people are spending more and more of their lives looking at screens. Teenagers and young adults are particularly susceptible to the negative adverse effects of excessive technology use due to their developing brains and progression into adulthood.

Adolescence is a time of learning, growing, and challenges. Wanting to fit in, developing social relationships, and figuring out your identity are important pillars of adolescence. Social media provides a platform in which adolescents are able to satisfy their need for belonging and social interaction. However, excessive use of social media also increases the risk of several mental health symptoms, including depression and anxiety.

Staying in touch through technology has become a normalized way to connect with each other.  Data indicates that 88% of teens say they spend time with friends through texting, and 55% say they text their friends every day. The numbers are likely higher in 2020. There is increasing evidence supporting a link between social media use and higher levels of anxiety, depression, and low self-esteem amongst adolescents.  These findings can be attributed to a number of factors. For example, anxious adolescents tend to use social media more; this is consistent with previous findings in which adolescents higher in neuroticism prefer social uses of the internet. Furthermore, depressed adolescents may use social media more to regulate their low mood, causing a cyclic reaction that further exacerbates those symptoms. Other studies have found a linear association between the number of social media platforms used and depression and anxiety.  It has been found that individuals who used 7-11 social media platforms had substantially higher odds of having increased levels of depression and anxiety symptoms, compared to those who used 0-2 social media platforms.

Another factor contributing to poor mental health stems from the fact that many adolescents engage in nighttime use of their smartphones, resulting in later bedtimes and poorer sleep quality which also contributes to anxiety and depression.  It has been found that teenagers aged 15-19 who were regular users of mobile phones reported health symptoms such as tiredness, stress, headache, anxiety, concentration difficulties, and sleep disturbances more often than less frequent users.  Additionally, studies show that nighttime social media use was a predictor for poorer sleep quality.

There are several components of social media that cause stress and anxiety, including:

  • Seeing friends posting about events you weren’t invited to
  • Comparing your life/appearance to that of others you see on social media
  • Feeling pressured to post positive content about your life
  • Anxiety associated with getting comments and likes on your posts

FOMO

Fomo is defined as apprehension that others might be having rewarding experiences from which one is absent and a desire to stay continually connected with what others are doing. 

The term FOMO is associated with the first component of social-media induced stressors. For adolescents, being invited to events and having social interactions is extremely important to satisfy their sense of social connectedness and a sense of belonging. Seeing posts of their peers engaged in activities which they weren’t invited to causes FOMO. Why wasn’t I invited? Is it because they don’t consider me a good friend? What if everyone’s talking about this party on Monday and I can’t contribute?

Adolescents with predispositions of psychopathological problems (especially anxiety and depression) could develop higher FOMO because of their existing perceived social deficits. Individuals with poor emotional state and life satisfaction are also more likely to confront FOMO. Research has shown that social media users with high FOMO are more likely to spend more time on social media and suffer from depressive and anxious feelings. They may feel compelled to check their social media more often to keep up to date with their friends’ plans and activities, further feeding into a cyclic cycle of social media usage and symptom exacerbation.

“As being connected is of utmost importance in adolescents, young teens use social media prominently more in order to achieve greater levels of social involvement. By using social media, adolescents may satisfy their need to belong, but they also have greater risk of suffering from anxiety when they feel they are missing out on important shared experiences, or feel that they do not belong” (Oberst et al., 2017).

Common Symptoms of Social Media Anxiety

  • Interrupting conversations to check your social media accounts
  • Lying to others about how much time you spend on social media
  • Withdrawal from friends and family
  • Trying to stop or reduce your use of social media more than once before without being successful
  • Loss of interest in other activities
  • Neglecting work or school to comment on a social media account
  • Experiencing withdrawal symptoms when you are not able to access social media
  • Spending over six hours per day on social networking sites like Facebook, Twitter, or Instagram
  • An overwhelming need to share things with others on social media sites
  • Having your phone with you 24 hours a day to check your social media sites
  • Using social media more often than you planned
  • Severe nervousness or anxiety when you are not able to check your notifications
  • Negative impacts in your personal or professional life due to social media usage

Tips to Help With Social Media Anxiety: for Teens and Parents

  • Think critically about the accounts you choose to follow and unfollow accounts you are comparing yourself to, or that make you feel anxious or self-conscious
  • Recognize that everything on social media is highly orchestrated and not reflective of reality.
    • Think back to moments from your own life that you’ve omitted from social media
    • The “perfect” people you follow likely have the same negative experiences that they are not posting for everyone to see
  • Screen Time on your iPhone allows you to track how much time you are spending on your phone as well as on each app.
    • Set a limit on your phone to how much time you spend on each app.
    • When you reach the daily limit, your phone will automatically stop those apps and display a message indicating you have reached your daily limit
  • Set screen-free times where you put your phone away completely and spend time doing other activities.
    • This can be a goal set together as a family, for example, at night for an hour before bed, turn off all phones and spend time together as a family watching a movie.
  • When you start to feel anxious or experience negative thoughts about yourself, put your phone down.
    • Find another activity to keep your hands busy instead (adult colouring books, knitting, painting, exercising, etc)
  • Practice mindfulness to become aware of your surroundings
  • Spend more time outside with friends
  • Participate in a social anxiety group to relate to others with similar issues

References

Duggan, M., & Smith, A. (2013). Demographics of key social networking platforms. Pew Internet & American Life Project. Retrieved from http://www.pewinternet.org/2013/12/30/demographics-of-key-social-networking-platforms/

Oberst, U., Wegmann, E., Stoft, B., Brand, M., & Chamarro, A. (2017). Negative consequences from heavy social networking in adolescents: The mediating role of fear of missing out. Journal of Adolescence, 55, 51-60.

Hamburger, Y.A., & Ben-Artzi, E. The relationship between extraversion and neuroticism and the different uses of the Internet. Computers in Human Behaviour, 16 (4), 441-449.

Van Der Goot, M., Beentjes, J. J., & Van Selm, M. (2012). Meanings of television in older adults’ lives: an analysis of change and continuity in television viewing. Ageing & Society, 32(1). 147-168

Primack, B,A., Shensa, A., Escobar-Veira, C.G., Barrett, E.L., Sidani, J,E,, Colditz, J,B,, & Everette-James, A. (2017) Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults. Computers in Human
Behavior, 69 , 1-9.

Woods, H.C., & Scott, H. (2016). #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. Journal of Adolescence, 51. 41-49.)

Jackson, ML, Sztendur, EM, Diamond, NT, Byles, JE, & Bruck, D. (2014). Sleep difficulties and the development of depression and anxiety: a longitudinal study of young Australian women. Arch Women’s Men Health, 17 (3), 189-198.

Dhir, A., Yossatorn, Y., Kaur, P., Chen, S. (2018). Online social media fatigue and psychological wellbeing—A study of compulsive use, fear of missing out, fatigue, anxiety and depression.  International Journal of Information Management, 40 , 141-152.

Desjarlais, M,, & Willoughby, T. (2010). A longitudinal study of the relation between adolescent boys and girls’ computer use with friends and friendship quality: Support for the social compensation or the rich-get-richer hypothesis? Computers in Human Behaviour, 26 (5), 896-905.

University of British Columbia (2019). Social Media Anxiety Disorder. Retrieved from http://etec.ctlt.ubc.ca/510wiki/Social_Media_Anxiety_Disorder

Fader, S. (2018) Anxiety and Depression Association of American – Social Media Obsession and Anxiety. Retrieved from https://adaa.org/social-media-obsession

Cuncic, A. (2019) Very Well Mind – Social Media and Social Anxiety Disorder. Retrieved from https://www.verywellmind.com/social-network-use-and-social-anxiety-disorder-4117143

Shafer, L. (2017). Harvard Graduate School of Education – Usable Research. Social Media and Teen Anxiety . Retrieved from https://www.gse.harvard.edu/news/uk/17/12/social-media-and-teen-anxiety

Soderqvist, F., Carlberg, M., & Hardell, L. (2008). Use of wireless telephones and self-reported health symptoms: a population-based study among Swedish adolescents aged 15–19 years.  Environ Health, 7: 18-10.1186/1476-069X-7-18.

Lenhart, A. (2015). Pew Research Center – Report: Teens, Technology and Friendships. Retrieved from  https://www.pewinternet.org/2015/08/06/teens-technology-and-friendships/

 

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Understanding Elder Abuse

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

Co-written by Darren Schutten, MSc (OT)

Today, June 15th is World Elder Abuse Awareness Day. Elder abuse has been a growing concern worldwide. In fact, it is estimated that 16% of older adults have been abused in the community setting in the past year.  This number jumps to a staggering 64% within institutional settings.  However, it is felt that these figures are unrepresentative of the true problem, as only 4% of elder abuse gets reported due to fear of retaliation, worry about getting the abuser in trouble, mental incapability, or feelings of shame and embarrassment.

The World Health Organization defines elder abuse as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.   This type of abuse typically occurs when there is an imbalance of control between the abuser and the elderly individual.  The concept of elder abuse has evolved over time to include: physical, psychological, sexual, neglect, and financial abuse.

I’m sure most of us have seen examples of this happening.  When I worked at the bank, we had a senior who was repeatedly withdrawing money for a roofer. We contacted her family with concern, and they determined that the client was in fact being taken advantage of. Or, in another example, I am aware of an elderly woman who went to buy a coffee and discovered that she no longer had money in her bank account. Her daughter was managing her finances and through review, it was discovered that these had been squandered through gambling and the purchase of things such as a “money-making machine” off the internet (true story!). Or, of course, there are the stories whereby a senior is scammed on the phone, or the news shares examples and videos of elder mistreatment by staff in long term care. Or, what about those seniors you may know or worked closely with who refused to take their prescribed medications, refuse help, and try to take care of themselves? This behaviour is considered self-neglect and actually falls under the umbrella of elder abuse.

As occupational therapists (OTs), we work closely with seniors both at home and in the community. We assist people with self-management of things like personal care, finances, homemaking, and of course symptom management and the overall ability to function. Through our work, we may see or hear about all types of elder abuse.  For example, we may notice unexplained injuries such as bruises, bumps, or grip marks on a senior client’s arm indicating potential physical abuse. Or, maybe we may notice a sudden change in the senior’s psyche such as increased fearfulness or nervousness during an OT treatment session that was not present during prior sessions. This may be a sign of recent psychological abuse. Or, it is quite possible that an OT who works in an institutional setting may be told by residents that they are feeling neglected in their care. These are just a few examples of how an OT may encounter elder abuse in their practice, but regardless it is important for all OTs to learn about the different signs of elder abuse as they may be a key stakeholder in preventing the abuse from continuing. And whatever type of elder abuse we may be exposed to as OTs, it is important to know our reporting obligations.

In Ontario, anyone who knows or has reasonable grounds to suspect that a senior resident in a long term care home or retirement home has been, or might be abused, it is mandatory for that person to report the abuse.  The same obligation to report applies for seniors with developmental disabilities.  Reports can be made by calling the police or relevant support agencies.  Support agencies can be located by calling a local helpline (e.g. Seniors Safety Line).  However, OTs are not required to report abuse if the senior lives in their own home or in any setting other than what was mentioned above.  Seniors have the right to live at risk and refuse help with the abusive situation they are involved in, and as OTs, as long as the client is competent to make their own personal care or financial decisions, those rights need to be respected.  As OTs who may be put in these types of situations, we can still help by staying in contact with the senior on a regular basis. Overall, whatever practice setting we work in or the company we work for, it is important as OTs that we know the relevant legislation, policies, and codes of ethics that we are bound to in order to practice as competent OTs.

References

  1. World Health Organization. (2016). Elder abuse: The health sector role in prevention and response. Retrieved from https://www.who.int/violence_injury_prevention/violence/elder_abuse/Elder_abuse_infographic_EN.pdf?ua=1
  2. Elder Abuse Ontario. (2018). Elder abuse prevention (ON). Retrieved from https://www.elderabuseontario.com/
  3. Ontario Human Rights Commission. (n.d.). Elder abuse & neglect. Retrieved from http://www.ohrc.on.ca/en/time-action-advancing-human-rights-older-ontarians/elder-abuse-neglect
  4. Canadian Association of Occupational Therapists. (2012). CAOT position statement: Elder abuse prevention and management and occupational therapy (2012). Ottawa, ON: CAOT Publications ACE.
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Brain Injury: Caring for the Caregiver

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

We cannot (or should not) discuss brain injury awareness without spending time recognizing the family and friends that take on the caregiving role after someone they love has an injury of this nature. A few years ago I co-facilitated a workshop for caregivers of brain injury survivors. What a great event! Not only was this well attended, but the speakers provided an amazing amount of education, skills and insight into how to both cope, manage, and achieve success as the care provider of someone with a brain injury. I wanted to take a moment to highlight my personal takeaways from this event:

Everyone has a story. As someone who lost a brother-in-law to the effects of a catastrophic brain injury, I understand how telling our story – be it about loss, change, remorse, guilt, fear, or triumph can bring people together and has immense therapeutic benefit. Caregivers benefit from collaborating, talking, sharing, laughing, crying and growing together. Our health system needs to create these opportunities, or caregivers need to find ways to make this happen.

Grieve. In my undergrad, I studied grief and loss and even worked in hospice. What I realized at our workshop, however, is that the permanence of death allows people to grieve their loss, achieve acceptance, and eventually move on. When dealing with survival from a traumatic event, however, grief is not always experienced as our loved one is still present, albeit different. Yet, our speakers emphasized the importance of grieving: the life that once was, the life that may never be, and the changes and adjustments that have occurred. Caregivers need to let this grief process happen, or should seek support from a trained professional to experience this important emotion.

Find a new normal. Clients, caregivers, and health care professionals need to always consider that the old “normal” may never return. In that case, we all need to collaboratively look ahead to creating a “new normal”. Different does not always have to be bad, and it requires an open and optimistic mind to think that way. For OT’s that means taking the abilities of the individual, considering their resources, and helping them to create that new life of function, fulfillment, meaning, and productivity.

Put on your own oxygen mask first. We spoke extensively about the importance of caregivers taking the time to attend to their own personal needs, to have positive coping mechanisms and sources of support. Then, at break I was speaking with a man whose wife suffered a brain injury. He talked about the “airplane analogy” and how this applies to caregivers – put on your own mask before helping another. I smiled and told him that I wrote a blog on that exact topic, with that exact title last year. As he found that analogy practical and helpful, I thought I would share the contents of that previous blog here, to highlight this important third point:

Posted September 25, 2013

If you have ever travelled by air you are familiar with the drill. Instructions on how to buckle and unbuckle your seatbelt, where the life vest is located, emergency exits, and “should cabin pressure change, an oxygen mask will fall from the overhead compartment…passengers should always put on his or her own mask before assisting children, or a disabled passenger”.

I read a mommy blog the other day that called this the “airplane example” and the writer related this to how moms should approach motherhood. Ultimately the message is this: as a mom, put your own health first because you are useless to your kids and spouse if you ignore your own needs. Really, you can’t help a child with an emergency escape from a crashing plane if you pass out helping them with their mask.

While I do agree that mothers (and fathers for that matter) need to consider their own needs in providing for the family, this is also true of people that provide care to a disabled person. My experience is that often caregivers do not really “elect” that role. They are not trained to be a caregiver, and really just try to do their best with the skills and resources they possess. However, where many fall short is maintaining their own health and wellbeing in dedicating their physical and emotional time to another person: a person with challenging and multiple needs. The job of a caregiver is often 24 hours, and resources don’t often permit, nor does the government provide, sufficient relief from this responsibility. Caregivers are often sleep-deprived, suffer from muscle and joint pain in fulfilling their role, and can become isolated and depressed due to the changes they have made to take on these new responsibilities. Sound familiar? This very closely mimics motherhood (especially for new moms).

The answer? Put on your own oxygen mask first. What can you do to breathe easier? What helps you to feel clear-headed, energetic and optimistic? What gives you that ability to stay positive, appreciate and take on your responsibilities with some enthusiasm? The answers are often different for all of us. In the end, figuring out how to wear your oxygen mask first requires you to be honest about your abilities and skills, to utilize the resources available, and to ultimately ask for help if this is needed.

And for us health care professionals? We need to be very careful of the responsibilities we place on caregivers. This is especially true in the medical community where we repeatedly discharge people into the care of family, without family really knowing what the responsibilities will entail. As health care providers our responsibility is always to the client, yet we need to take that extra time to check in with the caregiver, talk about how they are coping and managing and if needed, offer them an oxygen mask.

I hope the caregivers that attended our workshop felt that by spending a day focusing on themselves, expanding their knowledge, and learning the keys to success, that this was one step towards them being able to put their own mask on first. This was highlighted at the end of the day when the caregiver of a survivor, whose loved one was injured 13 years ago gave this advice: “If I could do it again, my priorities would be self, family, then my loved one with a brain injury”. What a great lesson for me to take forward in my practice.

For more posts related to brain injury please visit our Brain Health Archive.

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Occupational Therapy: Three Must Knows for Working with LGBTQ+ Individuals

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

Co-written by Brittany Aldworth, MSc (OT) Candidate 2019 at McMaster University

Occupational therapists encounter all kinds of people and our reality is that accidents, injuries, and trauma don’t discriminate.  They can happen to anyone.  But it is true that the recovery from accidents, injury, and trauma is always impacted by the person involved – shapes, sizes, stories, strengths, challenges, resources, support, ethnicity and yes, sexual orientation and gender identity…it can all impact rehabilitation outcomes.

Understanding the way we are all different prepares us to have the skills and knowledge necessary to have the most impact.  This includes looking at the LGBTQ+ community and recognizing common factors and themes that impact their experience with the health care system.

Canadian Census data from 2014 reports that approximately 3% of Canadians identify as either homosexual (1.7%) or bisexual (1.3%) (Statistics Canada, 2015), however, it is thought that this percentage is actually much greater, as the Census did not include options for those who do not identify within the ‘homosexual’ or ‘bisexual’ umbrella of the LGBTQ+ community. So, what does this mean? There are at least 1,110,000 Canadians who openly identify as part of the LGBTQ+ community.

LGBTQ+ individuals are more likely than their heterosexual peers to feel that they required healthcare in the past 12 months, yet not received it, are more likely to have seen a psychologist, and are less likely to have a regular family doctor (Statistics Canada, 2015). As healthcare professionals, we should be asking ourselves, ‘why?’ and ‘what should I know so that I can make sure I offer better care to this community?’.

Here are three key ‘must-knows’ when working with this population:

Minority Stress:

It is important to recognize and acknowledge the history and experiences that LGBTQ+ individuals’ have faced and continue to face. The minority stress theory first described by Meyer in 2003 outlines the stress that individuals within minority groups experience as a result of being a member of a marginalized and/or oppressed group (Busa, Janssen, & Lakshman, 2018). In LGBTQ+ individuals, minority stress has been linked to a higher prevalence of mental health issues and psychological distress, due to the chronic stress experienced from prejudicial encounters like violence, discrimination, social exclusion, bullying and rejection that is often faced by this population (Austin & Craig, 2015). By understanding the impact that minority stress can have on a person, OTs are well positioned to analyze how theoretical underpinnings can inform potential barriers to occupational engagement. For example, as an OT working in a mental health setting, minority stress may help to inform a client’s experience with anxiety and depression and may impact the way the OT treats their occupational issues.

Identity:

For individuals within the LGBTQ+ community, the societal stigma that is experienced as a result of their gender identity and/or sexual orientation of not ‘fitting in’ with what society deems ‘normal’ pushes many individuals to avoid disclosure, or engage in occupations that better ‘fit’ their outward appearance in order to hide their true gender identity and/or sexual orientation. This is important to recognize as OTs as many individuals within the LGBTQ+ may not necessarily be needing to relearn or adapt their skills, but rather learn how best to perform occupations that they have not have been initially taught in order to create a better fit with their gender identity and/or sexual orientation (Beagen et al., 2013). The meanings and values that LGBTQ+ individuals place on their chosen occupations are numerous, however, these occupations are often chosen to either hide gender identity and/or sexual orientation or to present more convincing gender displays (Beagen et al., 2013). Therefore, as OTs, we are able to assist individuals within the LGBTQ+ who are seeking to project, portray, construct, or affirm their gender identity through occupation. For example, an OT may assist a person who is transitioning genders with dressing and grooming occupations in order to live more successfully in their identified gender.

Past Experiences with Healthcare Providers:

Although in recent years, society and the healthcare system have changed their views and policies regarding LGBTQ+ issues and individuals, there remains a historical fear and mistrust from this community towards the healthcare system. The healthcare system was one of the main offenders where LGBTQ+ elders experienced a lack of control over their lives due to being labeled as ‘mentally ill’ and/or as an object that ‘needed to be cured’ (Brotman, Ryan, Cormier, 2003). Although forced medical interventions have now been banned in Canada, the scars that have been left by the healthcare system on this community will take many years to fade. As healthcare professionals and OTs alike, we must take into account and acknowledge the past experiences of this population in order to provide truly holistic, client-centered care that acknowledges all aspects of the person and their well-being. By considering the client and their history, an OT is able to provide culturally competent care that reinforces safe spaces, openness, and positive rapport and starts to debunk the discrimination that this population has faced in order to make sure that all clients feel that they are able to approach and confide in healthcare providers.

Moving forward, regardless of whether or not we are health professionals, allies, or members of this community ourselves, it is important to recognize and acknowledge not only the history and the struggles faced by the LBGTQ+ community, but also those of all minority or oppressed groups in order to truly provide the most client-centered care, and continue striving towards an all-inclusive community. 

Looking for more learning about the LGBTQ+ population? Check out some of the resources below:

References

Austin, A., & Craig, S. L. (2015). Transgender affirmative cognitive behavioural therapy: Clinical considerations and applications. Professional Psychology: Research and Practice, 46(1), 21-29.

Beagan, B. L., Chiasson, A., Fiske, C. A., Forseth, S. D., Hosein, A. C., Myers, M. R., & Stang, E. (2013). Working with transgender clients: Learning from phyisicians and nurses to improve occupational therapy practice. Canadian Journal of Occupational Therapy, 80(2), 82-91.

Brotman, S., Ryan, B., & Cormier, R. (2003). The health and social service needs of gay and lesbian elders and their families in canada. The Gerontologist, 43(2), 192-202.

Busa, S., Janssen, A., & Lakshman, M. (2018). A review of evidence-based treatments for transgender youth diagnosed with social anxiety disorder. Transgender Health, 3(1), 27-33.

Meyer, I.H. (2003). Prejudice, social stress and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.

Statistics Canada. (2015). Same-sex couples and sexual orientation… by the numbers. Retrieved from https://www.statcan.gc.ca/eng/dai/smr08/2015/smr08_203_2015

 

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Coping with COVID — Finding the New Normal

In the following video, the team at FunctionAbility discusses the emotions of COVID and provides helpful strategies to help people cope through uncertain times.

For more helpful information check out our Coping with COVID video series on our YouTube channel.

About the Experts:

Brenda Power Ahmad, BSc(OT), BSc(Hons Psych), OT Reg.(Ont.), – Brenda obtained a Bachelor of Science degree in 1999 in Occupational Therapy from Dalhousie University and a Bachelor of Science (Honors) degree in Psychology in 1996 from Memorial University of Newfoundland. Brenda also completed post-secondary education in the fields of Criminology and Linguistics. Brenda has been practicing occupational therapy since 1999 in the provinces of Newfoundland and Labrador, and Ontario. She has extensive experience working with people of all ages with a variety of developmental and physical disabilities and works mainly with clients who have complex orthopedic, psychological and brain injuries. Brenda is trained in administration of the AMPS and the PGAP program and is a Canadian Certified Canadian Life Care Planner. She has completed additional training in catastrophic assessment through the Canadian Society of Medical Evaluators and has successfully completed the C-CAT Certification exam. Brenda sits on the Board of Directors for the Hamilton Brain Injury Association. As Vice President of Clinical and Community Partnerships in one the largest rehabilitation firms in Ontario, Brenda is responsible for training and mentoring other therapists and also leads the Catastrophic Assessment (CAT) program at FunctionAbility. Brenda maintains an active social media presence and co-hosts an educational video series called OT-V which aims at educating the public about the various roles of her profession.

Lynne Harford, BA, MSW, RSW, D.VATI is a Registered Social Worker, Director of Pediatrics and a Clinical Supervisor with The Social Work Consulting Group. She obtained a Master of Social Work degree from the University of Toronto and a Bachelor of Arts degree in Sociology from Glendon College-York University. Prior to her university studies, Lynne pursued a career in business and received a Marketing Administration Diploma from Seneca College of Applied Arts and Technology. In 2013, Lynne achieved her designation of Art Therapist graduating with an advanced diploma in Art Therapy from the Vancouver Art Therapy Institute.

Emma Fogel, MSW, RSW is a Registered Social Worker with a Master of Social Work degree from the University of Toronto. Emma’s true passion is working with youth and families whereby she draws upon an eclectic framework to provide client-centered counseling support, which includes Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, Mindfulness-Based Therapy, Solution Focused Therapy and Play. Wendy Gage MSW, RSW is a registered social worker with a Master of Social Work Degree from the University of Toronto. She received her Honours Bachelor of Arts in Psychology at the University of Western Ontario with a focus on child development. Wendy is a certified Emotionally Focused Couples Therapist (EFT) with advanced training in EFT for families, individuals and trauma. Wendy has training in child-led play therapy (Watch, Wait and Wonder) for children ages 6 months to 6 years. Wendy joined The Social Work Consulting Group with 18 years’ experience practicing clinical social work on the Neurology Program at The Hospital for Sick Children. At Sick Kids, she developed expertise in child and family adjustment to illness, loss and trauma. Wendy has participated in research, teaching and speaking events related to pain management for headaches, managing behavior in children with neurological conditions, and long-term family functioning and adjustment to children’s neurological conditions. She was invited to provide input to the provincial government on gaps in service to children with mental health conditions arising from neurological illness and injury.

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COPING WITH COVID– Staying Active

FunctionAbility’s Elly Baker and Lynne Harford discuss staying active while working from home and review some helpful exercises to help keep you moving.


About the Expert:

Elly Baker is the Director of Physiotherapy Services at FunctionAbility. Previously to this role, Elly spent many years in the role of Physiotherapy Practice Leader at Toronto Rehab, University Health Network, as well as a physiotherapist on the inpatient, Acquired Brain Injury program. She has extensive experience helping individuals living with mild to complex neurological and orthopedic injuries and has special interests in concussion management and higher-level balance re-training post-traumatic brain injury.

Lynne Harford, BA, MSW, RSW, D.VATI is a Registered Social Worker, Director of Pediatrics and a Clinical Supervisor with The Social Work Consulting Group. She obtained a Master of Social Work degree from the University of Toronto and a Bachelor of Arts degree in Sociology from Glendon College-York University. Prior to her university studies, Lynne pursued a career in business and received a Marketing Administration Diploma from Seneca College of Applied Arts and Technology. In 2013, Lynne achieved her designation of Art Therapist graduating with an advanced diploma in Art Therapy from the Vancouver Art Therapy Institute.

Lynne has had an extensive work history in both the private and public sectors. Prior to joining The Social Work Consulting Group in 2008, she was employed at The Hospital for Sick Children (SickKids) where she spent five years providing clinical social work services to children and their families in the Trauma Program. Throughout her career, Lynne has been an active member in the larger community participating in various committees as well as presenting at a number of community-based, insurance and legal conferences. Other areas of specialization in which Lynne has focused and devoted her practice to include, acquired brain injury in children and youth, acute and chronic illness, domestic violence, separation/divorce and issues related to grief and loss. Lynne is both a therapist and advocate who is committed to enriching the lives of children and adults in the aftermath of physical and emotional trauma.

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COPING WITH COVID — Youth and Teen Mental Health

 

Social Work Consulting Group’s Emma Fogel MSW, RSW and Lynne Harford, MSW, RSW discuss strategies to help teens and youth cope with “the new normal” with COVID-19.

About the Expert:
Emma Fogel, MSW, RSW is a Registered Social Worker with a Master’s degree in Social Work from the University of Toronto.

In 2016, Emma joined The Social Work Consulting Group, a large community-based clinical social work practice within the Greater Toronto Area established in 2006. In 2017, Emma co-created MindCALM, a therapeutic counseling service within The Social Work Consulting Group, specifically designed to assist youth and their families through the provision of counseling/psychotherapy, psychoeducation and the implementation of effective strategies to promote emotional regulation, increase resilience, coping capacity and overall emotional well-being. The program aims to help improve children/adolescents’ experience of varying psychoemotional challenges such as stress, anxiety, sadness, and navigating social/family relationships.

MindCALM offers both in-home or in-clinic counseling to youth and families within the GTA in addition to offering a variety of educational training and presentations to schools and camps across Ontario.

MindCALM is proud to be a preferred vendor the Ontario Camp Association (OCA). Emma provides camps throughout the OCA with mental health training for both staff and campers to ensure happy and healthy summer experiences at camp.

Emma’s true passion is in working with youth and families whereby she draws upon an eclectic framework to provide client-centered counseling support, which includes Cognitive Behavioural Therapy, Dialectical Behavioural Therapy, Mindfulness-Based Therapy, Solution Focused Therapy, and Play.

Lynne Harford, BA, MSW, RSW, D.VATI is a Registered Social Worker, Director of Pediatrics and a Clinical Supervisor with The Social Work Consulting Group. She obtained a Master of Social Work degree from the University of Toronto and a Bachelor of Arts degree in Sociology from Glendon College-York University. Prior to her university studies, Lynne pursued a career in business and received a Marketing Administration Diploma from Seneca College of Applied Arts and Technology. In 2013, Lynne achieved her designation of Art Therapist graduating with an advanced diploma in Art Therapy from the Vancouver Art Therapy Institute.

Lynne has had an extensive work history in both the private and public sectors. Prior to joining The Social Work Consulting Group in 2008, she was employed at The Hospital for Sick Children (SickKids) where she spent five years providing clinical social work services to children and their families in the Trauma Program. Throughout her career, Lynne has been an active member in the larger community participating in various committees as well as presenting at a number of community-based, insurance and legal conferences. Other areas of specialization in which Lynne has focused and devoted her practice to include, acquired brain injury in children and youth, acute and chronic illness, domestic violence, separation/divorce and issues related to grief and loss. Lynne is both a therapist and advocate who is committed to enriching the lives of children and adults in the aftermath of physical and emotional trauma.

Links to resources:
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/talking-with-children.html

https://www.who.int/docs/default-source/coronaviruse/helping-children-cope-with-stress-print.pdf?sfvrsn=f3a063ff_2

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COPING WITH COVID – Emotional Well-Being

COVID-19 has had a major impact on almost everyone. FunctionAbility, Solutions for Living and Social Work Consulting Group social work experts Wendy Gage, MSW, RSW, and Lynne Harford, MSW discuss practical strategies for coping with the new reality many of us face on a daily basis.

About the Experts:

Lynne Harford, BA, MSW, RSW, D.VATI is a Registered Social Worker, Director of Pediatrics and a Clinical Supervisor with The Social Work Consulting Group. She obtained a Master of Social Work degree from the University of Toronto and a Bachelor of Arts degree in Sociology from Glendon College-York University. Prior to her university studies, Lynne pursued a career in business and received a Marketing Administration Diploma from Seneca College of Applied Arts and Technology.  In 2013, Lynne achieved her designation of Art Therapist graduating with an advanced diploma in Art Therapy from the Vancouver Art Therapy Institute.

Lynne has had an extensive work history in both the private and public sectors. Prior to joining The Social Work Consulting Group in 2008, she was employed at The Hospital for Sick Children (SickKids) where she spent five years providing clinical social work services to children and their families in the Trauma Program. Throughout her career, Lynne has been an active member in the larger community participating in various committees as well as presenting at a number of community-based, insurance and legal conferences. Other areas of specialization in which Lynne has focused and devoted her practice to include, acquired brain injury in children and youth, acute and chronic illness, domestic violence, separation/divorce and issues related to grief and loss. Lynne is both a therapist and advocate who is committed to enriching the lives of children and adults in the aftermath of physical and emotional trauma.

Link to Canada’s economic plan: https://www.canada.ca/en/department-finance/economic-response-plan.html