Posts filed under ‘Occupational Therapy’
Documenting Occupational Therapy
Yesterday our almost a year long education for new assessments (such as the MOHOST = The Model of Human Occupation Screening Tool) ended with a bang! With a bang because I thought it was the single most efficient day within the education. All was pulled together and I really feel like I’ve finally taken some steps forward. Now we also have a process model for the ot evaluation process in the Health Care Center of Helsinki, Rehabilitation Unit which I think is major. Had some fiery debate regarding it before everyone was satisfied… 😉
Anyway, we were also handed a paper about OT documentation which I think has some brilliantly important points as in what to focus in when documenting. The paper has been translated and put together by Riitta Keponen (OtM). Here are the key points:
- an occupational therapist should recognize and document the meaningful occupations for the client and base both the long and short term goals on the strengths and limitations in those (Mc Guire 1997)
- besides documenting the goals it’s crucial to document how the therapy effects the client’s occupational status (Cederfelt et al. 2003)
- the summary of the report should be put together in a way that the reader gets an impression of a form of therapy which requires expertise and skill (Mc Guire 1997)
- Mc Guire suggests that it would be wise to document the plan for evaluation, interventions, the guidance given and the collaboration with other professionals included in the situation as well as the recommendations
- Both Mc Guire and Cederfelt (et al.) state that an OT should learn to document orientating in effectiveness rather than orientating in procedures. Ots should not document a list of helping aids or solutions but to describe how they effect the occupational performance and participation of the client.
Would gladly hear about your opinions regarding documentation. Please share your thoughts in comments.
Meet Jess Banda: coach with an OT background
Thanks to some coincidences, I’ve recently gotten to know a coach, the founder of The Banda Strength Institute, Jess Banda. As it happens, Jess also has some occupational therapy background. Jess was kind enough to return my plea to answer some questions and here’s the interview. Especially interesting to occupational therapists, but also some wise words for all people working with well-being and health. As Jess says, it’s important to surround yourself with like-minded people. That’s just what I’m doing getting to know him. 🙂
Who are you and what do you do?
My name is Jess Banda, I’m a strength coach and licensed massage therapist. My practice is located in Mystic, Connecticut (where the Julia Roberts movie “Mystic Pizza” was filmed). However, thanks to the internet, I am able to provide my expertise to people located beyond my immediate area. Currently, my practice has clients across 9 different countries.
I started in the strength and conditioning field in 1987, when I joined my first gym, and eventually was hired as a trainer. After university, I joined the US Navy, where I was a Deep Sea Diver. It was during my US Navy service that I developed my methodologies for rapid strength and conditioning development. I was fortunate to travel to numerous countries, which afforded me the opportunity to meet with coaches from around the world and not only discuss training, but actually spend time with them “under the barbell.”
You are also an occupational therapist. What made you interested in studying ot in the first place?
While I studied occupational therapy in university, I did not complete my studies in the field. It was during my last few semesters that I made the faithful decision to eventually seek a career in strength and conditioning. At the time, I knew numerous occupational therapists working for the state of Texas, who were extremely frustrated by all the bureaucracy. In conversations with them, they all revealed the same thing: too many cases and not enough time to devote individual care and attention.
Initially, I was attracted to occupational therapy because it seemed to combine 2 fields that intrigued me, social work and medicine. As you know, being an occupational therapist, you have to be extremely well versed with a host of medical conditions and disabilities, as well as the medication and therapy aspects. I always felt drawn to occupations that allowed me to help people.
When did you graduate as an occupational therapist and what kind of experience do you have working as an ot?
Though I am not an occupational therapist, I do provide similar services for some of my clients. For instance, this past year, I have been working closely with two young adults who suffer from epilepsy and anorexia. One of them is in high school and the other is in university. For these clients, I educate the people (professors, school staff, etc) who will have contact with them, as to how to best provide for them and support them.
Why did you decide to focus on something outside your ot education and are you able to use some ot knowledge in your current job?
I looked outside of occupational medicine for a few reasons, but mostly because I wanted to ensure I had enough time to treat each client as an individual and not as a “disorder.” For instance, one of my friends, who’s an occupational therapist, is currently working with five individuals with epilepsy, but each one has a different set of needs. If my friend, who works a private practice, was working for a local or state government, he wouldn’t have the time to treat each case as an individual. Instead, he would have to treat his cases based on generalizations based on clinical descriptions of their disability.
One other reason for going outside of occupational therapy was what I consider the abuse of medicine by some doctors. In the US, I believe doctors are too quick to reach for the prescription pad. I would often see friends and clients who were put on a course of medication by a doctor, but did not have a plan to get off these medications. In the majority of instances, these people were put on medications for a “life sentence”. It was this observation which started me on my quest for knowledge in the nutraceutical field. When I work with clients who are on medications, the first thing we do is to develop a plan to provide their body with the nutrients it needs to heal itself, so eventually, their doctors can take them off medications. Fortunately, my practice is associated with nutritionally orientated doctors who keep an open mind.
Can you imagine ots working on some areas that they are not already working (such as health promotion, prevention, lifestyle coaching etc. I don’t know how it is in Connecticut!)?
I believe most occupational therapists are limiting themselves when it comes to their role in health care. Due to the increasing world-wide obesity epidemic, occupational therapists are starting to work with people who are extremely overweight and suffering from a host of related complications. For instance, I know of an occupational therapist that was hired to work with a client who weighed over 360 pounds (163 kg) and was having issue with their mobility. Together, they were able to re-design her house and work space to assist her with her limited mobility. The occupational therapist had to use techniques usually reserved for those with amputations or confined to the use of walking implements.
I believe the biggest impact occupational therapist have, is on prevention. By nature of the occupation, occupational therapist deal with clients afflicted with debilitating conditions and they can use these stories to “shock” people, to prepare them for what they might eventually have to prepare for it they do not take responsibility of their health.
What do you think is the uniqueness or strength of an occupational therapist as a therapist professional?
All successful occupational therapists share the same strengths”: the ability to multi-task, to see the “big picture,” are compassionate, and tenacious. When working with clients, you must take their different environments and their potential hazards into consideration. This requires the unique ability to bring together multiple factors in a short amount of time.
What do you dream of achieving through your work or how do you think you’d want to make a difference in the world?
Regardless of limitations, I want my clients to realize they are much stronger emotionally, physically and mentally, than they usually believe. Unlike most of my colleagues, I want to become eventually become dispensable to them. I’m like a parent that teaches and nurtures their children, preparing them for the day they start to live life on their own.
Is there something else you’d like to say to the blog readers, especially ots?
One of the reasons of my success is that I surround myself with like minded professionals. I created a network of the most successful doctors, physical therapist, psychiatrists/psychologist, and nutritionists, people to whom I can refer my clients. It’s vital that you establish relationships with people you trust.
It’s also vital to keep an open mind. What matters is that your clients/patients feel better about themselves and their conditions…regardless of the techniques used.
Surprising Science on Motivation
One of my all time favorite TED Talks is the one by Dan Pink, in which he talks about motivation and incentives. Based on scientific testing it’s obvious, that after people make enough money to satisfy basic (by welfare state standards) needs they need something other than money to motivate them to perform their best. Money actually makes people to perform worse. (Suggest you listen the Talk! It also presents the “Candle Problem”, a classical example of functional fixedness.)
So to receive extraordinary results, we need fresh methods. Dan Pink lists these three qualities of intrinsic motivation the ones needed to create a efficient, inspiring and engaging work place:
- autonomy (the urge to direct our lives)
- mastery (the desire to became better and better in what you do)
- purpose (the yearning to do what we do in service of something larger than ourselves)
As an occupational therapist, mastery as a term is close to flow experience where the skills are just adequate to perform a task that is a bit tricky but still manageable so it engages the attention and motivates to solve it. Purpose is also in the center of occupational therapy: we work with our clients to able them to participate in their meaningful tasks so it goes without saying that our job needs to be meaningful as well. Of course, it’s a different thing is it. I believe that most of the time the work of an occupational therapist still is quite rewarding since we’re working with people with limitations and help them overcome them. But, one may always disagree and the lives are forever changing.
Our work is also pretty independent, so at least some degree of autonomy is achieved. Still, to empower people to act and perform on their full potential requires constant evaluation and development. That’s just what I’m trying to learn to do… Bit by bit, mastering my own task a leader. By the way, the autonomy of the job is a quality I highly respect: still it’s one that sometimes exhausts or overwhelms. It’s not easy to always be so organized, sometimes it’s wonderful to just get to told what to do!
Pink continues: “Management is great, if you want compliance. If you want engagement, self direction works better.” This is something to deeply consider as a head of a unit. How to able enough freedom to let people do what they do best the way they would do it in a clinical and strictly defined environment (a hospital)? There’s also a careful balance between equality and autonomy. Some people are willing or capable to work more autonomously than others.
(By the way, functional fixedness is a cognitive bias that limits the person to using an object only in the way it’s traditionally used (according to Wikipedia). That said the creativeness needed in our profession is an everyday struggle against functional fixedness. Creativeness is a key element of the therapy when figuring out the best way to perform tasks that have been complicated by different disabilities in a way that is acceptable for the client. I dare doubt, that occupational therapists would have any problems solving The Candle Problem… ;-))
Rehabilitation Seminar, Day II (notes)
On the second day at the seminar I participated a workshop with a big name: Physical Functioning, Activity and Participation: research and education for health professionals in rehabilitation. Focus on physiotherapy and occupational therapy. So I started listening very eagerly. Esko Mälkiä, PhD. PT from The University of Jyväskylä, hosted the workshop and did it quite humorously and excellently. Nevertheless, I was a tad disappointed: the focus was clearly on physiotherapy and in my opinion it didn’t quite fill all the expectations regarding participating.
A couple of excellent speeches though. PhD, PT Birgit Steffensen from The National Rehabilitation Centre for Neuromucular Diseases in Denmark told how remarkably they’d managed to put together a continuous, guaranteed rehabilitation pattern for children (and adults) with the disease in question. Some unique team effort had been put together by the rehabilitation professionals and the Centre (being an NGO) to both develop the actual rehabilitation and to also put on the political pressure to guarantee the needed services. Quite impossible to imagine that happening in Finland. I think the political climate and willingness is far from Denmark’s historically flexible, human and empowering politics. Feel free to argue, please do that in the comments! 🙂
The maybe most interesting speech was the one by Reg Urbanovski, EdD, OT from Canada, who talked about rehabilitation and labour market. He stated that the on-going practices are not flexible enough and actually let the most vulnerable ones always fall first. There’s not even a beginning of a change for displaced people with non-adequate workplace constitutional skills. Regarding employment of the least likely Urbanovski stated it’s critical to ask: how to improve the quality of life of an entrepreneur (as to make it profitable to hire these outcasts)? Considering the problem from the employee’s point of view makes it possible to create long-term and hopefully human solutions for the labour marker. Win-win.
Urbanovski presented that in a modern world all the citizens need the skills for life-long learning. The emphasis has shifted from having the routine manual skills into having the routine cognitive skills which are the ones usually lacking within marginalized groups of people. And this is so true as I can tell from experience: my own dear big sister has MBD (current ADHD) and a mental handicap and yet she is a hard working, loyal, precise and priceless employee. Until sudden changes take place. Changes require flexibility, flexibility requires adequate cognitive skills and quick, abstract thinking to be able to organize your work again. Fast learning skills are a key skill at any work place. That’s when she’s in trouble, unfairly.
I know these marginalized (usually part-time working or long-time unemployed) groups of people are mostly not like my sister. I still believe that making it happen for different kinds of people, not just the surviving types, would make the world a more gentle place also for people like my sister. And as a result, for everybody. So for me making the entrepreneur want to employ and cherish the well-being of the employee makes a great starting point for better labour marker. And a human one. Now only if I worked in the employment office… 😉
Rehabilitation Seminar, Day I (notes to self)
Today was the first day of the two day National Rehabilitation Seminar here in Helsinki. The event is hosted by The Rehabilitation Foundation. The theme for this year’s seminar is rehabilitation partnership and participation. Here are some notes and thoughts that caught my attention today.
- the early retirement (mostly due to illnesses and/or disabilities) costs 24 000 000 000 euros per year
- from these a growing number is under 34 years old raising their share from 4,8 billion to 6,6 billion within the last six years
- early retirement caused by clinical depression has risen from 4,4 billion to 6,6 billion
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The outcome of a work community = The Will x The Ability x The Conditions. If either one of these is zero, the outcome is zero. Will includes attitude and motivation, ability includes competence, experience and tendencies, conditions includes leadership, leading, team-work, culture, structure, systems and the functional processes.
Productivity, innovation and the quality of work-life create outcome. The economical, human, social and ecological sustainability must be considered.
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Money is a secondary motivation for working: meaningful activity, work mates and reputation and respect mean more. The lack of motivation to work isn’t the problem with unemployed people. According to Marie Jahoda The psychosocial or latent function of employment include:
- time structure
- social context
- participation in collective purposes
- regular activity
- provided status and identity
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Juho Saari talked about perceived welfare and the politics of social possibilities. This approach would in a research look for the reasons why some group of people is succeeding instead of looking at the problems they’re facing to gather knowledge how to able other people from the same group to participate in the society.
He also talked about happiness and how the institutionalized structures define happiness (according to surveys Finns are among the happiest people in the world). Perceived welfare is relative: you might be perfectly happy until you see someone else is doing better. The single most significant factor contributing happiness is the perceived sense of inequality. Also the research (World Value Survey 1981-2000) shows that people who participate in volunteer work are the happiest! (I do.) Other factors are balanced time management (not too much activity, not too little), positive expectations for future and trust.
To increase happiness we should:
- increase (perceived) equality
- enable more volunteer work and to support associations
- organize better daycare and free time for family carers (omaishoitajat)
- cherish the trust in the government
- create positive expectations for future, to keep up hope
Is increasing happiness as a goal for politics conflicting with the financial goals?
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Liisa Björklund from Diakonissalaitos presented the capability approach (by Nussbaum and Sen) in her philosophical and passionate introduction to human conditions for functioning. She stated that the paradigm is shifting from Rawls’ “veil of ignorance” to a more dynamic view on participation. She had some excellent quotes such as this:
Human rights are the moral state in which the person is able to act in a community and to take care of her duties. (Jaana Hallamaa) Human rights are being fullfilled when in use, not given. Already Aristoteles has said that a person wants to participate in the life of her community within her own abilities and skills.
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Erkki Kemppainen from THL (The National Institute for Health and Welfare) defined rehabilitation as enabling and encouraging participation in unrestrained environment. Janne Jalava stated that the survival or well-being of a person in rehabilitation should not be evaluated based on discrimination rhetoric.
R.E.S.P.E.C.T.
A study was done in 2006 that aimed to identify the interpersonal and environmental characteristics for the best substitute living environment (ie. a nursing home), as perceived by residents and their families. As a result 11 life quality indicators were identified by the participants. The number one life quality characteristic was feeling being respected by the caregivers as an individual. The second one was being involved in relationships and the third was clearly linked to our work as occupational therapists: perceived competency trough technical (nursing) acts and attitudes.
Based on this study occupational therapy in nursing homes and similar substitute living environments should be focused on enabling opportunities for self-actualization and a continuing sense of identity. The practical methods are multiple and may vary depending on the home and the therapists, but as an occupational therapists working in an some kind of substitute living environment (an acute hospital which is very limited by it’s possibilities) I’ve found that some of the tools for nourishing these characteristics might be:
- using a narrative to explicate the occupational history of a client and to validate his/her life experience. A narrative also broadens the picture of the client from a mere patient to a whole human being and might help the staff to understand his/her behaviour and preferences better. A narrative, in my experience, is a powerful tool for empowerment.
- creating possibilities in participating in occupations as a viewer, if nothing else. As the studies show, also observing others to perform strengthens a person’s sense of occupational competence.
What are functional methods and practices in your experience? Please post any ideas to comments.
The study can be found at The Canada’s Occupational Therapy Resource Site.
Meri Pekkanen: Occupational therapy, nutrition and other hot health stuff 
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