Tag Archive for: occupational therapy


Protecting Client Confidentiality in Public: Public Networks

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

Free Wifi?  Great…but what about having your device and its content available to others?  In our previous blogs we talked about confidentiality in public places with conversations (Confidentiality in a Coffee Shop? Conducting Business in Non-Private Places), phones and computers (Protecting Client Confidentiality in Public: Laptops and Phones), but what about accessing public and shared networks?  Care of Wired Magazine and our IT department, here are some tips to protect yourself:

  1. Know your network – only connect to networks you recognize and feel you can trust.
  2. Make the connection secure – choose HTTPS when on public networks.
  3. Only provide the bare minimum – when signing into public WIFI you are often asked to provide personal details.  It is advised to provide only the minimum necessary.
  4. Read the fine print – know what exactly you are signing up for before logging in.
  5. Use two-factor authentication  –  Basically, enabling two-factor authentication requires an additional password or code to sign into certain sites and apps.  Learn more about this extra security layer here care of PC Magazine.
  6. Disable file sharing – although file sharing may be a handy feature at home, as you can easily share files between devices when in public you definitely want to remember to disable this function so others do not have access to your files.
  7. Use a virtual private network (VPN) – although you may need to pay for this service, if you are working in public spaces often, it is worth it.  Basically, a VPN acts as a “middle man” between your device and its files/information and the world wide web, protecting your information from those who may want to see it.

See the entire Wired Magazine article here to learn more about protecting your information online.

Remember that if you are a professional and have access to confidential and private information, you have a responsibility to protect this from others.  At work, home, or in public, keep information safe.


The Cost of Disability

The cost of disability due to injury or illness is significant and stems from lost work time, medications, equipment, costs of personal care, therapy and more.

When struggling to make ends meet, people encounter stress, anxiety, panic, excessive worry, loss of sleep, relationship issues, poor decision making, and can result in addictions as a form of poor coping.  You can imagine how hard it would be to heal from injury or trauma when significant money stressors are created as a result!

Our OT-V episode below provides insight into how an Occupational Therapist can help you or someone you love plan for future costs related to the specific disability, provide treatment to help you manage your finances more efficiently, and deal with any associated symptoms.


Protecting Client Confidentiality in Public: Laptops and Phones

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

My recent blog Confidentiality in a Coffee Shop:  Conducting Business in Private Places” highlighted the things professionals need to keep in mind when having private conversations in public spaces.  But the issue of privacy does not just include conversations that can be overheard.  It also includes using our electronics to carry out business anywhere where our screen could be visible to others. 

I was at two conferences recently where I was able to clearly see the work of others who were multi-tasking.  At one, a psychologist was sitting beside me and was editing reports with his computer on his lap.  His screen was fully visible. I could see everything he was doing including client names, claim or personal identifiers, and the written account of each individuals’ psychological assessment.  Of course, I had no business reading the material so I glanced away, but had I been interested, I could have clearly obtained information that was not meant for me, and information that a client did not consent for me to have.  In another conference example, a professional was sitting in front of me at another table.  She too was working on her laptop and I was able to see, even one table over, what she was doing.  She was not writing reports, but I did see her managing some personal financial material which I am sure she didn’t realize was visible.  As a close colleague, I reminded her at the break to be careful with her computer and what she was working on.

I am also often on the GO train venturing in and out of Toronto.  That is a hotbed of people working while they commute – on both their phones and their computers.  In my interest about this topic of privacy, I have noticed that some people have found ways to protect the privacy of their devices.  With some help from a trusted techy-friend, I wanted to provide some of these strategies to you, in case you are using your computer or phone to manage confidential or private information in public places:


On Andriod devices (sorry iPhone users) there are applications (apps) you can download that will put a filter on your device that allows you to only see the screen head-on, leaving those at different angles unable to clearly see your information.  Some of these helpful apps are:


Products exist to put over computer monitors, laptop screens and phones that will distort the view from different angles.  For example, take a look at the complete line of privacy screen protectors from 3M3M offers an entire line of screen protectors that work on multiple devices and offer varying levels of protection.

The big picture is that the protection of privacy is everyone’s business, but this is especially true in health care.  Taking steps to conceal devices and screens is just as important as storing other confidential information properly.  The more portable our work-life becomes the more we need to safeguard the information we possess.


My Child is a Picky Eater… Help!

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

Do you have a child that is a picky eater?  You are definitely not alone!  Picky eating is a common issue, and while it is normal for kids to have food preferences and dislikes, it can be quite concerning for parents.  The good news is an Occupational Therapist can help!

Occupational Therapists can work with families to create solutions tailored to the individual child. Some general suggestions may include some of the following tips:

  • Remove the pressure
  • Allow the child to “play with their food”
  • Encourage food exploration on their own terms
  • Maintain a consistent meal-time routine
  • Introduce changes and new foods slowly – overcoming picky eating is a very gradual process

Watch our popular video below to learn more about how an Occupational Therapist can help families overcome the picky eating problem and raise healthy, happy eaters.


Occupational Therapy Approaches for Substance Use in Clients with Brain Injuries

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)
Co-written by Ashley Best, Student Occupational Therapist

In our previous blog post titled “Brain Injury and Substance Use”, we discussed how the cognitive and emotional changes associated with brain injury can overlap with substance use.  But what wasn’t covered was the role of the Occupational Therapist when working with clients who have these challenges.  While our role is complex in cases like these, we have tried to simplify how we use function and meaningful activity in combination with direct treatment to address some common themes as outlined below.

1. Harm Reduction

Arguably the most important strategy of any professional working with someone who uses substances is Harm Reduction. An Occupational Therapist can work with a client to better understand the process of using a substance with the same skill used for analyzing other daily activities. By breaking down what a client’s substance use looks like, from the trigger to being under the influence, the OT can identify areas of potential harm or danger. Some common concerns with substance use, and some OT intervention examples are:











It is important to recognize that the above strategies are not meant to encourage substance use but ensure the safety of the client when they are not willing or able to stop.  Sometimes just reducing the harm is all we can offer until the harm can be eliminated.

Clinical Example: A man with previous regular alcohol use prior to an accident, now has seizures when he does not have alcohol in his system. Thus, it is actually more harmful to ask this client to not use alcohol. Instead, monitoring the amount he drinks and ensuring he has regular supports at home are two strategies that can reduce the harm that alcohol may cause.

2. Recognizing Substance Use as a Barrier to Goals

The financial, behavioural, and health effects of substance use often negatively impact a client’s ability to reach their goals. An occupational therapist can help a client to understand and hopefully address the gap between substance use and being able/unable to move forward in other areas of life. An OT may also strategize ways to achieve goals despite substance use by planning use around occupations and this, in turn, may help decrease use over time.

Clinical Example: An individual with a brain injury has a goal to return to work but does not have the insight to recognize how using narcotics would impact their success on the job. Thus, helping the client break down the requirements of a job, recognize poor fits, and then implementing strategies to change substance use behaviour so that it doesn’t impact work (in the case that abstaining from use is not an option) could be an intervention focus.

3. Using Activity to Avoid Triggers

Often, substance use is time-consuming between acquiring, using, and coming down from the influence. This becomes a major challenge when people stop using because there is a lot of free time that may lead to boredom and relapse. This is an important place for occupational therapists to intervene by helping the client identify meaningful activities to engage in when they are feeling an urge to use. This could involve interests and values, or just discussing past activities that the client would like to resume.

In the case of someone with a brain injury, more guidance may be required to identify triggers (if the client has low insight what is triggering). In addition, activities that the client can perform may be different following a brain injury, and thus they may need support in finding new meaningful activities to fill the time that was previously taken up with substance use.

What is the take-home message?

As the above indicates, implementing any of these strategies will require the client to exercise a high level of control over their addiction. Thus, an OT can help support and accommodate each client’s unique situation by providing remedial and compensatory strategies to help clients transition from the occupation of substance use, to other, ideally more meaningful and healthy alternatives.


“The Cost of Caring” — Coping with Compassion Fatigue

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

Co-written with Kayla Colling, Student Occupational Therapist

There are many reasons we become health care providers.  Sometimes it is a passion for helping a certain population, a desire to help people achieve specific goals, or the recognition that people are needed to fill gaps in health care delivery.  Whatever the reason, there are physical and emotional risks that come with “helping” work.

If you are a helping or social professional who uses compassion and empathy with your clients who have experienced trauma and suffering, you may already be familiar with compassion fatigue.  Nurses, physicians, trauma therapists, social workers, workers in child protective services, and military healthcare teams are recognized to be at risk of exposure to second hand trauma through their work and may benefit from understanding and recognizing compassion fatigue.  Other health care providers, such as occupational therapists, advanced practice registered nurses (APRNs), respiratory therapists and physical therapists may also suffer the consequences of compassion fatigue in their work with people and their families that are experiencing a health crisis.

What is compassion fatigue?

Compassion fatigue is often described as the “cost of caring”.  It can also be called “secondary traumatic stress”, which is a more clinical term, but it is generally agreed that these terms are interchangeable.

Compassion fatigue occurs when providers are exposed to another person’s trauma and suffering.  This could be through routine interactions at our workplaces, when we provide compassion and empathy to clients or patients who have experienced trauma.


Compassion fatigue impacts individuals physically, emotionally and spiritually, and tends to have a rapid onset of symptoms.  The symptoms listed below are not exhaustive and not exclusive to compassion fatigue, so they should not be used to diagnose.  If you are concerned, consider making an appointment with your physician or other mental health worker to discuss your concerns.

Physical:  chronic fatigue, frequent headaches, gastrointestinal complaints, sleep disturbances, muscle tension, aches and pains, and anxiety.

Emotional and Spiritual:  heavy heart, emptiness, decreased sense of purpose, low self-esteem, high self-expectations, helplessness and hopelessness, numbness, apathy, depression, anger, irritability.

Behaviour Changes: avoiding or dreading work, calling in sick frequently, inability to maintain empathy, chronic lateness, overworking, and difficulty focusing and concentrating.

So it’s like burnout?

Burnout has a more gradual onset and results from an accumulation of ongoing, daily stressors at work that wear us down if we do not take proper care of ourselves and try to address the contributing workplace issues.  Symptoms of burnout tend to be more subtle and are sometimes misinterpreted.  It is still very important that we try to both address and prevent burnout, but this is clinically different from compassion fatigue.

Building Resiliency/Prevention

Although we cannot entirely prevent compassion fatigue from happening, we can take steps to reduce the risk, recognize warning signs and seek support early in order to reduce the impact on ourselves, our coworkers, our clients and our friends and families. 

By reading this blog, you have already taken a step toward learning more about it.  If we can normalize these emotions after exposure to these types of situations, it might help us to seek and accept support when we need it.

If your workplace permits, it can be helpful to have regular debriefings, even if a specific incident or crisis has not occurred.

Self-care strategies have been shown to help prevent compassion fatigue.  These strategies will likely include enhancing your boundaries to separate your work life from your home life as much as possible.  It also often involves balancing your activities outside of work as well, including engaging in a variety of relaxing, pleasurable and productive activities throughout the week.  Importantly, getting enough sleep at night and eating healthy and regular meals are also parts of self-care.  Avoiding maladaptive coping mechanisms (such as turning to alcohol, increasing smoking, eating or spending) is also important, including recognizing when things are deteriorating to get help quickly.

Practicing self-compassion can also help us to build resilience against compassion fatigue.  You can find meditations to help cultivate self-compassion, or it might be something you explore through reading, watching TedTalks, attending a course or workshop, or talking to your therapist about.  Having a regular mindfulness or meditation practice may also help you build resilience, along with other positive and adaptive outlets like exercise and social time.


If you are interested in learning more about compassion fatigue, check out the references below.

If you want to “check in” with yourself, you may be interested in looking at the Professional Quality of Life Scale (ProQOL) available here.  This scale will allow you to calculate scores on scales that consider compassion satisfaction, burnout and secondary traumatic stress (compassion fatigue).  I am not suggesting using this scale for self-diagnosis but it can sometimes be helpful to indicate if there is a concern you might want to speak to a professional about.

The symptoms of compassion fatigue can be severe – if you are concerned for your safety, please call your local crisis/distress line for support.  Find a crisis line near you.


Sorenson, C., Bolick, B., Wright, K. & Hamilton, R.  (2016).  Understanding compassion fatigue in healthcare providers: A review of current literature.  Journal of Nursing Scholarship, 48(5), 456-465.  doi: 10.1111/jnu.12229

Sorenson, C., Bolick, B., Wright, K. & Hamilton, R.  (2017).  An evolutionary concept analysis of compassion fatigue.  Journal of Nursing Scholarship, 49(5), 557-563.  doi: 10.1111/jnu.12312

Vu, P. &Bodenmann, P.  (2017).  Preventing, managing and treating compassion fatigue.  Swiss Archives of Neurology, Psychiatry and Psychotherapy, 168(8), 224-231.  doi: 10.4414/sanp.2017.00525



What are Common OT Recommendations After Assessment?

Research completed by student Occupational Therapists Ashley Carnegie and Natalia Puchala, Supervisor Julie Entwistle.
Blog completed by Ashley Carnegie, Occupational Therapist

As an Evidence Based Research Project through McMaster University, Solutions for Living set out to summarize and highlight common OT recommendations after initial assessment.  The goal was to publish these findings to help student OTs, or OTs looking to enter the sector, to understand the scope, depth and breadth of the recommendations we tend to make.  Here are the highlights of our research findings, the completed study will be submitted for publication to OT journals when finalized.

Occupational Therapists play a valued role in Ontario’s auto insurance sector. In this, Occupational Therapists are hired by lawyers for assessment and treatment, or by insurers to conduct Insurance Examinations. Assessments usually start the OT service delivery process and serve to determine and outline the impact the client’s motor vehicle collision, and resulting injuries has had on all aspects of their previous life (e.g. self-care, productivity, leisure).  These assessments end with recommendations for the treatment and care that are needed to help the client recover. Occupational therapy treatment recommendations are designed to support clients in maximizing their potential to return to pre-accident function in all areas of life.

Despite the 1000+ Ontario Occupational Therapists working in this role, available literature about this sector is limited and does not adequately capture the role of occupational therapy in this setting. Therefore, in this study, a retrospective chart review was conducted of 205 occupational therapy assessments conducted with clients who had a motor vehicle collision. The aim, as indicated earlier, was to summarize OT recommendations post-assessment to help others interested in learning more about this area of practice. Recognizably, Solutions for Living by Entwistle Power Occupational Therapy was the only company involved in this chart review, and different companies may, and are likely to, have different findings.  Further, clients seen for OT assessment are already pre-screened to be eligible candidates for service, and thus assessments with “no recommendations” are unlikely.

Through the 205 charts reviewed, the results demonstrated the following:

Common Injuries

















Intervention Recommendations



















These interventions are in-line with best practices and standard treatment for the most common injuries identified in this study.

Surprisingly, only 3% of OT assessments recommended use of the OTA in treatment delivery, highlighting that most OTs tend to initiate treatment directly.  It is felt that therapists may introduce OTA later in treatment once rapport with the client has been established, but the use of OTA early for some education and device delivery may prove more cost-effective and is something OT’s should consider.

Additional Results

Attendant care: 91% of clients needed attendant care. The average dollar amount recommended for attendant care was $3565, the median was $1733, and the range was between $0 and $10,544. A trend was identified between number of injuries and attendant care recommendations; The amount of attendant care recommended increased with the number of injuries.

Assistive Devices: 91% of clients needed assistive devices. The average dollar amount for devices was $757.46, the median was $397.94, and the range was between $0 and $5670.

Occupational therapy treatment: The average number of occupational therapy treatment sessions recommended was 6; with an average duration of 12 weeks. Injury or number of injuries was not predictive of OT sessions or duration recommended.  Notably, however, recommendations are often made to conservatively encourage insurer approval and only represent the first treatment block.  Multiple blocks of treatment are common.

This retrospective chart review outlined typical injuries, common intervention recommendations, and recommendations for attendant care and assistive devices following an occupational therapy assessment. Although there is some uniformity in recommendations, the lack of consistency indicates the customization taken by OT’s in assessing for client’s unique and specific needs.  This individualized approach is necessary and encouraged as being best-practice and client-centered.  Of further note, it was evidenced that OT’s play a very important part in system navigation and help to outline and connect the client to other necessary providers.   Doctors, lawyers, insurers and other professionals should recognize that OT’s are valuable front-line providers and can be the keystone to helping clients to get the help they need.

As demonstrated, Occupational Therapists play a vital role in Ontario’s auto insurance sector and their assessments are pivotal in helping clients to get care, devices, education and treatment, along with connection to other professionals. This study is the first to showcase the OT role in Ontario’s insurance sector, and more research is needed to look more closely at OT service delivery.

Stay tuned for the entire research study with its methods, findings and recommended next steps.  We will be sure to circulate the article on our blog once published


Invisible Disabilities and the Impact of OT

A new interview series by fellow Occupational Therapist Karen Gilbert called The Art and Science of Everyday Living is shedding light onto the value of Occupational Therapy for those with “invisible” health conditions.  Covering topics like living with chronic pain, chronic fatigue, and anxiety, Karen interviews Occupational Therapists who share their resources and best practices.  Check it out!

The Art and Science of Everyday Living


The A to Z of OT: Q is For… Quality of Life

One of my favourite quotes about Occupational Therapy is, Medicine adds days to life… OT adds life to days.”  Occupational Therapists provide solutions for living and therefore, help individuals achieve optimal function and maximum quality of life based on each person’s unique situation.

Take a look at our Occupation Is series, where we explore the journey of “occupation” complete from morning to night, highlighting how OT’s help to improve quality of life when things break down along the continuum that is living.