tag:blogger.com,1999:blog-14772999.post1142633513881351471..comments2024-03-15T04:58:53.198-04:00Comments on ABC Therapeutics Occupational Therapy Weblog: Will a public health model make occupational therapy more relevant?Christopher J. Alteriohttp://www.blogger.com/profile/09489464791931315291noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-14772999.post-1328001596291857742014-12-04T21:45:36.718-05:002014-12-04T21:45:36.718-05:00Whenever I find myself concerned about something i...Whenever I find myself concerned about something in our profession, I always seem to wander my way back to this blog! <br /><br />The article that led me here specifically concerned the issue of "Will OT be relevant in 25 years?", and contained a link to your blog. <br /><br />The article focused mainly on hospital-based adult practice, citing issues such as a cringe-worthy quote from a New York Times article lamenting a $600+ bill for OT services that included an evaluation and the provision of an necessary sock-aid. What stuck with me about this article, and what concerns me the most about the profession, is that we struggle so hard to define ourselves. The article also said that we cannot define ourselves as "people who give good tips"---AMEN.<br /><br />I am concerned that I sort of agree with the Times article regarding OT in that context--the article points out that perhaps nursing or another professional could easily have provided the service given to that patient--unnerving, yes?<br /><br />I also work in pediatrics, as do you. And rarely do I ever question my relevance--sometimes I struggle with the significant crossover between OT or PT or SLP, especially between SLP and OT with my lower ASD kiddos, as we do so much of the same activities in terms of play skills, but perhaps this is only a reflection of my lack of experience. There is also a huge crossover between PT and OT with my little babies, but I find that the parents don't care as long as they're getting great services. But it does make me feel a little weird sometimes. <br /><br /><br />Could it be that it's easier to define our relevance in pediatrics? Do we see more progress than the myriad of adults who simply get an "OT/PT EVAL and TX" referral from their MDs post-surgery? Are OTs in adult settings seeing people who don't really need services, just because they're in the hospital and they need to keep up their productivity and they get the go-ahead from an MD who couldn't tell you the difference between OT and PT if they were asked?<br /><br />I also don't understand why we would move away from an individual approach to therapy...when I was in school just a few years ago, there was a bit of a push to place OTs in more of a health promoting position in the larger community. There are also non-therapy professionals with Health Promotion degrees at the bachelor and masters level (I have two friends with such degrees), so what exactly is our role there?<br /><br />I feel my response rambled, but these are the things that go through my mind when I wonder how the need to reduce healthcare costs in this country come to the forefront of the minds of citizens and governing officials will affect OT. I do very much want OT to be able to market us as "experts" in something very specific, much like PT has latched onto the "DPT" to market themselves as "movement experts."<br /><br />As an aside, down here in Atlanta, I see more and more SLP services being declined for reimbursement in peds, due to the service being "not medically necessary" unless there is an injury or specific ailment. Autism is getting the shaft here, for example. It's scary stuff, and I don't want it to happen to OT.Sarahhttps://www.blogger.com/profile/01847191864721133525noreply@blogger.comtag:blogger.com,1999:blog-14772999.post-2906332766472294122014-01-05T04:00:24.313-05:002014-01-05T04:00:24.313-05:00Continued.
My professor mumbled something about a...Continued. <br />My professor mumbled something about adaptive equipment and modifying the environment and one handed shoe tying. Nothing about addressing the actual hemiplegia / paresis of the dominant UE. <br /><br />OT will be relevant when we can address and improve the affected area rather than work around, modify the environment and offer bulky compensatory techniques. <br /><br />I realize the nature of OT is holistic, but to be relevant we must foster change, and in the most relevant sense "change" would be improved function, preferably long term.<br /><br />To borrow from the Christian saying of "don't be so heavenly minded that you're no earthly good", Occ Therapy shouldn't be so globally minded that we can't help a person who's had a TBI learn to re-write his name.<br /><br />I acknowledge that rehab (OT) in areas of neurological impairment (SCI, TBI, CVA) are frustrating for the OTR since we are tasked with helping one regain lost functions that require a higher level of neurological control and coordination; donning a sock and shoe is harder than walking - as evidenced by 11 months old walking and 5 years later a child ties his shoe. Making a sandwich is harder than climbing stairs or swallowing (huge generalizations I know, and the area of infarct greatly determines the deficit)... My point is, everyone wants to learn to walk and swallow. But so many many many neuro patients have told me, I want my arm to "work". While I'm delighted they are free of aphasia and can communicate with me, their attitude of " I just need to walk. My spouse or daughter will dress me, make me breakfast, write my checks" shows that patients view us as irrelevant. Since we can perhaps tape their subluxed shld, show correct pelvic tilt positions and side lying methods and do family edu on toilet transfers and ways to effectively "cope" with a subluxed shld to reduce or eliminate pain with ADLs we get our dozens of "OT eval and treat" orders. But I wonder, truly wonder, how much useable function is gained from going from requiring 75% A to 25%A? It still requires a caregivers assist. <br /><br />. I am in no way blaming the patient for us not being relevant. I'm merely stating that a lack of individual focus and skills to foster an improvement in function automatically makes us irrelevant. <br /><br />Yes, I've heard those comments about ADLs and BADLs hundreds of times since graduation from all ages and demographics. <br /><br />I'm trained in NDT but as we all know, it can only go so far. Kathrynhttps://www.blogger.com/profile/03060786991410915686noreply@blogger.comtag:blogger.com,1999:blog-14772999.post-40571806459961350892014-01-05T03:30:44.006-05:002014-01-05T03:30:44.006-05:00Mr. Alterio,
I appreciate your post.
This is not ...Mr. Alterio,<br />I appreciate your post. <br />This is not a new issue in our profession (the focus of academia on ethereal goals and future invasions into other fields). I knew 7 months into OT school 14 years ago that I had chosen the wrong school and perhaps even the wrong profession. During a lecture with invited guest speakers from other disciplines, my professor attempted to explain the role of the OTR/L in a phys disability acute rehab setting. While the PT and the SLP clearly defined evaluation of balance/ambulation and swallow and communicative functions respectively, my professor Kathrynhttps://www.blogger.com/profile/03060786991410915686noreply@blogger.comtag:blogger.com,1999:blog-14772999.post-49842392187279823832013-07-03T09:23:00.649-04:002013-07-03T09:23:00.649-04:00Thank you for your excellent commentary, Claudette...Thank you for your excellent commentary, Claudette. I am interested in how you describe Covey's explanations and I will try to learn more about them.<br /><br />Part of my concern is that when you start at broad system levels it may be that you lose focus on who you are and what your objectives might be. I base my concerns on some reading of how some OTs have described how interventions look when you practice as a 'sustainable' occupational therapist or when you are addressing broad population-based concerns within a social justice framework. It seems to me that this perspective changes the essential nature of what occupational therapy is.<br /><br />I think it is important for OTs to recognize system issues and to even address concerns - but still from the perspective of the individual who is receiving services and at their direction. General systems theory hierarchies help us to define these issues clearly. However, I agree that we need to work within our circles of control with people.<br /><br /> People have very different perspectives on those systems and I think we need to respect that broadly lest we end up pushing our own broad system agenda and forgetting the needs of the people in front of our noses.<br /><br />Thank you again for your comments.Christopher J. Alteriohttps://www.blogger.com/profile/09489464791931315291noreply@blogger.comtag:blogger.com,1999:blog-14772999.post-58065432134223742292013-07-03T08:32:36.109-04:002013-07-03T08:32:36.109-04:00Thank you for your review and comments. I will lis...Thank you for your review and comments. I will listen to the podcast later today, but I trust that your review accurately captured the gist of the presentation.<br /><br />I am reminded of the way Steven Covey describes an individual's impact. He spoke of two concentric circles, one larger than the other. The larger is the scope iof interest...everything that you have an interest in. The smaller circle is your scope of impact...things that you actually can do. <br /><br />For me global warming is in the outer circle...choosing an efficient car and combining trips are in the smaller circle as actions I can take. <br /><br />Covey stated that when you work within your circle of control it gets larger. I have experienced that in my career...where I have been asked to sit on committees or to join teams that were making system-wide recommendations because my expertise and effectiveness in working with individuals was recognized. <br /><br />I did not start out at the system (population) level, but my work with individuals allowed me an opprutunity to impact system issues. <br /><br />Would I be less of an OT to decline invitations to work at the system level and remain at the individual level only? Of course not. Not all OTs have the skills, analytically or interpersonally, to be successful at the system level, and most therapists who do continue to work clinically with individuals as well. <br /><br />Covey indicated that you cannot effectively work outside your personal circle of control...just because I recognize that economic banking policy impacts the declining availability of entry level jobs in small and mid sized businesses does not mean changing banking policy is in my personal circle. <br /><br />If the profession of OT wishes to increase the number of practioners who are working at the population level we should emphasize working within our clinical circle with excellence in order to expand into system areas. This is not an entry level activity. <br /><br />ClaudetteAnonymousnoreply@blogger.com