Tuesday, March 17, 2015

Occupational therapy and case management

There is an RA Motion for consideration that charges the RA Speaker to appoint an ad hoc committee beginning the summer of 2015 to delineate the role in case management for occupational therapy in primary care and mental health.


The rationale for the motion states that "The practice of occupational therapists (OTs) allows for the role of case managers, however, the profession recognizes the need for OTs to better define their role in the new model of care which is primary care and in mental health."

I would like to have a discussion about whether or not the core premise behind this rationale is valid.  I believe that someone trained in occupational therapy may have the requisite skills to serve as a case manager, but I am not convinced that the activities of a case manager constitute the practice of occupational therapy.  This is an important distinction.  If it is determined that this is not the practice of OT, then we should consider whether we should be allocating resources to supporting this employment pathway.

Based on my understanding of the literature on this subject, the role of 'case manager' has recently been pursued more in international contexts than it has in the US.  In fact, several articles have appeared in international journals debating whether or not case management was a legitimate role for the profession. (Krupa and Clark, 1995; Lloyd and Samra, 1997; Culverhouse and Bibby, 2008; Michetti and Dielman, 2014).  Based on a reading of this literature, it hardly seems settled that this is a legitimate role of OT practice.  There is less evidence for this role in the US literature.

AOTA published a statement on this topic in 1991 but I couldn't find anything updated since then.  For a long time OTs have served in case management roles.  The AOTA statement says that OTs might serve as case managers but that many other professionals do as well.  In a response to a letter about this issue, Mary Jane Youngstrom (2000) stated that it was difficult to discern  what was the 'practice' of OT vs. what was 'using OT skills and knowledge.'  It is an old theme and has been repeated many times throughout our history.

The question remains pertinent today.  

Case management, per se, is not a recognized domain of concern in the OTPF.  There have been changes to the Scope of Practice documents and the OTPF that support the concept of advocacy, but these have been controversial - particularly in context of the ongoing debate about social justice/occupational justice.

I do not see adequate justification that case management is OT practice.  I see that it is definitely something that someone may do with their OT skills and knowledge.  Delimiting our practice is critical, particularly if we are interested in re-engaging and defining our roles in mental health.  

Unfortunately, OTs are not doing a good job at explaining their proposed role in mental health.  Case management is a distinct role.  Consultation to systems (trauma informed care) is another distinct role.  Treatment of patients is a distinct role.  I don't get the sense that there has been a well thought out strategy about what will delimit our practice as we re-engage.  That is a problem in my perspective.

Rather than pursue another half-baked strategy that confuses stakeholders about what OT is and what it does, I believe that we should all get on the same page and make coherent internal decisions before we approach others about how we will define our practice.



References:

AOTA (1991). Statement: The Occupational Therapist as Case Manager. American Journal of Occupational Therapy, 45(12):1065-1066.

Culverhouse, J., & Bibby, P. (2008). Occupational therapy and care coordination: the challenges faced by occupational therapists in community mental health settings. British Journal Of Occupational Therapy71(11), 496-498.

Hafez, A., & Youngstrom, M. (2000). Case management practice. American Journal Of Occupational Therapy54(1), 114-116.

Krupa, T., & Clark, C. C. (1995). Occupational therapists as case managers: responding to current approaches to community mental health service delivery. Canadian Journal Of Occupational Therapy. Revue Canadienne D'ergoth√©rapie62(1), 16-22.

Lloyd, C., & Samra, P. (1997). Professional issues. Occupational therapy and case management in mental health rehabilitation. British Journal Of Therapy & Rehabilitation4(2), 91-96.

Michetti, J., & Dieleman, C. (2014). Enabling occupational therapy: moving beyond the generalist vs specialist debate in community mental health. British Journal Of Occupational Therapy77(5), 230-233. doi:10.4276/030802214X13990455043403

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