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Tag Archive for: occupational therapy

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Being an Advocate – Prompting Change as an OT

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

As Occupational Therapists, we spend a significant amount of time with people in their homes and in the community.  In this role, we witness daily injustices, challenges or problems that our clients unnecessarily or unfortunately experience due to vendors, landlords, or business owners / operators failing to understand, care, or address the needs of people with disabilities. 

Recently, a student I was supervising on placement experienced an accessibility challenge with a client as they attended a local coffee shop.  We blogged about this in our post, Accessibility Issues in Our Daily Lives.  As her mentor, I discussed with her the need to advocate for change and to send the owner a letter about the problems that client experienced.

That situation made me reflect on my history of advocacy as a person and an OT.  I remember as a teen writing a letter to a restaurant who would not book us a reservation on the “main floor” such that my two disabled grandparents could attend my birthday dinner.  As a young adult, I wrote a letter to an Alaskan cruise line about the challenges my grandfather experienced using his scooter around the boat and on the gangways.   Then I became an OT and the advocacy continued.  I have written, and continue to write, letters to equipment vendors, drug and department stores, public and private places, major banks, landlords, the CCAC, and fast food restaurants.  Sometimes my letters are specific and highlight an “incident”, while others speak more to general accessibility or service problems.  My advocacy initiatives even resulted in me building a training program aimed at helping the “average Joe” best service people with disabilities.  I personally feel that advocacy is how I will make my mark on the world, regardless of how small, with the hope of leaving this world in better shape than how I found it.

For this blog, I wanted to take the spirit of advocacy further, and to embrace our human responsibility to try and be catalysts of social, environmental and institutional change, by sharing a guide of sorts that could be used by other therapists, clients, caregivers or really anyone who wants or needs to bring an issue to someone’s attention.  Give this a try and keep us posted on your outcomes:

DATE

Name of Person / Establishment

Address

Dear Representative/Manager/Person:

I am X.  On DATE (I, my family member, client etc) experienced the following problems (when accessing your establishment, using your services, interacting with your staff, etc):

In bullet or paragraph format, list the problems you had.  Be factual, truthful and professional.  Avoid judgement, anger or threats as these will not result in change.

Provide some input on how you feel the problems you had might be impacting their service, business, etc.  Try to hit home with how the issues you experienced will turn people away, or jeopardize their reputation. 

Next, explain what you feel the solutions are or how it can be better for you next time. Help them to know what to do.  You don’t have to be prescriptive or specific, but maybe they need to consider some building modifications, better trained staff, to understand disability codes or acts, an easier to navigate website, consultation with someone who can develop solutions with them etc.  This is where you can really try to be helpful.

End the letter by thanking them for considering your feedback and provide your contact information.  Be prepared to have a discussion with them about it.  Some might ignore your letter, but I hope most will not.  Either way, if your letter stays friendly and is perceived as helpful, they may want to thank you for your time or seek more input.

Of course, add a final sign off like “sincerely” and your name.

I hope this format / suggestion will be helpful as you venture forward and try to educate, share and advocate for the change you hope to see in the world.

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OT Improves the Quality of Life for Those with Chronic Pain

Pain is real.  It can prevent people from engaging in activities that are important to them, or at the least inhibit enjoyment and full participation in those things they want and need to do. It doesn’t matter if the cause of the pain is fully understood — the person’s experience of pain is what is important, and is what affects function.  As the role of an occupational therapist is to enable clients to engage in activities that they want, need, or are expected to do, OT’s have the capability to help individuals with chronic pain to better manage their lives.

The following from article from Medical Xpress sheds light onto the benefits of OT for managing chronic pain and helping sufferers maintain a better quality of life.

Medical Xpress:  Occupational therapy shown to improve lives of people in chronic pain

Learn more about how OT can assist with chronic pain in the following episdoe from our OT-V series, Managing Chronic Pain.

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O-Tip of the Week: Shed Some Light on Fall Prevention

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. 

For the month of November, Fall Prevention Month, our O-Tip series will concentrate on preventing falls at home and in the community.

This week’s O-Tip of the Week focuses on a simple, yet often forgotten aspect of the home that can prevent falls:  proper lighting. 

Seniors need to be attuned to the physical, balance and vision changes they are experiencing as they age, and need to consider the importance of proper lighting to help them navigate and reduce the risk of falls in their living spaces.  Helpful and simple lighting suggestions may include:

–        Night lights around the home

–        A bed side lamp

–        Illuminated light switches

–        Storage of flashlights in the bedrooms, the kitchen and bathrooms

–        Change of light fixtures to provide both ambient and task lighting based on needs

An Occupational Therapist can assist in assessing the living space to suggest lighting modifications and more.  Learn more about how OT’s assist in fall reduction in our OT-V Episode, Fall Prevention.

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Accessibility Issues in Our Daily Lives

Guest Blogger: Carolyn Rocca, Occupational Therapist

As I stroll into my favourite coffee shop to start my morning, I am reminded that this is a part of my day that I take for granted. Particularly, I am reminded of an observed experience that I encountered with a client who had a personal goal around using his walker to go into his favourite local coffee shop, something he had not been able to do since his brain injury.

After weeks of working up to this goal, it was finally time to assess his mobility in the community. As soon as we arrived at the coffee shop’s parking lot I could tell that this was going to be much more challenging than I had anticipated, as it quickly became apparent that there were several accessibility issues we would need to navigate.

Although the accessible parking spots provided us enough room to safely transfer out of the vehicle, and the ramp onto the side walk was graded appropriately, once up on the sidewalk, the client could sense a shallow slant in the pavement causing him to panic as he felt he was going to fall over. What became even more challenging was that there were no automatic doors at either entrance, and that the front entrance had a tightly-spaced vestibule with two sequential, single-passageway doors. On top of all of these challenges, there was about a 2-inch difference in the threshold of the door meaning the client had to lift his walker while already feeling nervous about the slanted pavement. Ultimately, the inaccessible nature of this establishment meant that it took over four people to safely get the client into the coffee shop, which not only increased his nervousness but also completely decreased his level of independence.

Although this experience was largely a success and the client was incredibly proud of what he had accomplished, it also brought to light some issues in our society. It was shocking that a well-established company (who shall remain nameless) had not yet invested in making all of their franchises accessible.

According to the updated accessibility requirements of the Ontario Building Code, buildings are required to have a barrier-free path of travel by having powered door operators at their entrances, meeting minimum requirements for doorway widths and ramp dimensions, and having adequate turning space (Ministry of Municipal Affairs, 2015). The unfortunate part is that these requirements do not affect existing buildings, and are only applied to newly constructed buildings or those undergoing extensive renovations.

What this means is that the current level of accessibility of this coffee shop will not be improved until this franchise decides to undergo major renovations. As a result, this franchise is not only impacting those who use gait aids or wheelchairs, it is also impacting individuals who have mobility challenges, low vision, and parents with strollers, to simply name a few. Additionally, according to the Royal Bank of Canada, people with disabilities have an estimated spending power of about $25 billion annually across Canada (Accessibility Ontario, 2017), meaning this franchise is also losing valuable business from a population who happens to love their coffee.

In being reminded of this experience, it also brings to light the impact that the profession of occupational therapy can have in terms of advocating for their clients needs and promoting equal access for all. Occupational Therapists (OTs) have a unique skill set in terms of assessing the needs of individuals, and identifying barriers in their environments that prevent their access or ability to engage in occupations that are important to them, such as grabbing a coffee. OTs teach people how to be proactive in their own lives, but bigger than this, also have the ability to communicate their clients’ / societies needs to others, and to offer solutions to barriers by involving appropriate stakeholders.

As such, I have written a letter to the coffee shop to bring awareness and attention to the challenges my client experienced while at their establishment. Moreover, in the future, I plan to examine buildings and public spaces beforehand to make sure I am helping my clients to be familiar with, and access, places that have the appropriate supports in place to maximize their level of safety and independence.  In doing so, I will increase my clients’ future independence as they venture out without me, while also supporting businesses that have dedicated their time, effort, and resources to creating welcoming and barrier-free environments.

 

References

Accessibility Ontario (2017). About the Accessibility for Ontarians with Disabilities Act (AODA). Retrieved from https://accessontario.com/aoda/

Ministry of Municipal Affairs (2015). Overview of updated accessibility requirements. Retrieved from http://www.mah.gov.on.ca/Page10547.aspx

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With PTSD Every Day is Remembrance Day

Tomorrow, November 11, is Remembrance Day, a day where Canadians pay respect to the men and women who have fought and continue to fight for our country’s freedom.

On this day we remember those who lost their lives and have suffered injury and/or illness fighting for our country.  One of the largest illnesses afflicting our veterans is Post Traumatic Stress Disorder (PTSD).  It is estimated that, in the military, one in six are reported to experience PTSD as a result of their service.  The following article care of Global News discusses how for those who suffer from PTSD, Remembrance Day can be one of the most difficult.

Global News:  Remembrance Day a time of anxiety, stress for some veterans

Learn more about PTSD:  its causes, symptoms and treatment strategies in our post PTSD and Occupational Therapy.

 

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O-Tip of the Week: Hydrate to Prevent Falls

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. 

For the month of November, Fall Prevention Month, our O-Tip series will concentrate on preventing falls at home and in the community.

This week’s O-Tip of the Week focuses on a simple way to prevent dizziness and balance issues which can lead to falls:  hydration. 

Learn more about how to properly hydrate yourself in the following post from our blog Help with Hydration – How Many Glasses Do You Really Need?

Learn more helpful fall prevention tips from our infographic:  An OT Knows How to Prevent Falls: 

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Book Review: Licit, Illicit, Prescribed – Substance Use and Occupational Therapy

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

As an occupational therapist working in private practice, I have been involved with many clients who have substance abuse issues sometimes before, but more so often after injury or trauma.  Sometimes these substances were prescribed and become misused, and sometimes clients turn to substances to cope with their new life circumstance.  Either way, it is essential that the OT role include understanding, assessing and treating the whole person while recognizing the role addiction can play in influencing a recovery path and overall function.

Released in 2016, the book Licit, Illicit, Prescribed by Dr. Niki Kiepek is an all-in-one resource to help Occupational Therapists to advance their foundational knowledge and practices skills when working with clients who have problems with substance abuse.

This book is so thorough at addressing the very complicated clinical facets of substance use and abuse that it could very readily become a textbook for OT’s in their schooling, job-training, and ongoing clinical work.  It starts by providing the important background into the occupational perspective on substance abuse and links this to the models of human occupation and engagement that are the essential backbone of our profession.   It then moves to really define addiction and the many factors that influence this and how it fits with models of health and behavior.  After a very detailed look at psychoactive substances and their pharmacological properties, and the concept of harm reduction, it dives deep into Occupational Therapy Assessment and Intervention. Complete with clinical scenarios, examples and direct techniques, any OT reading this book will be able to elevate their practice and work with clients who use substances – licit, illicit or prescribed.

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O-Tip of the Week: Ways to Prevent Sitting Disease

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

This week’s O-Tip of the Week focuses on ways to get you moving throughout the day in order to keep a healthy lifestyle and prevent sitting disease.

Bring a pair of running shoes with you to work and take a walk on your lunch and/or breaks.  Walking is great for cardiovascular and bone health and will help to prevent the negative effects of sitting all day.

Learn more ways to combat the negative effects of sitting disease in our post, Solutions to Stop Sitting Disease.

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A MUST READ New Guideline for Insurance OTs in Ontario

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

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

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

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

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

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

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

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

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

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

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

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

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

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Occupational Therapy, Social Work, Both or Neither?

Guest Blogger: Carolyn Rocca, Occupational Therapist

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

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

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

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

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

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

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

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

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

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

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

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

 

Resources and References

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

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

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

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

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