law. enabling occupation chapter seven

8/18/2019 Law. Enabling Occupation Chapter Seven

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I

I

I

I

I

I

I

I

I

I

Purpose

To

olTer

examplcs of e|abling occupation.

Obiectives

To show how occupntioD{l

thcrapists enable occupa¡ion

si¡h

.

Vignetle

#1:

.

Vignere

#2:

.

Vignere #3:

.

Vigne¡te #4.

'

VgDclLe #5:

Aduk wirh

lvlcnl¡l

Healih

lssues

Child

m

Lhc

Conln1uniry

Religm\

Org¡¡izario

Summary

The core concepts of occuparionil

lhe¡apy

pra*ice

are bascd

on

válues

and

beliefs about

occupadon.

pelsons.

environmcnt,

heállh.

and

clien¡ cenfed

pracLice. File vigneftes

are

üsed io

sho\r

hox¡

cole

concepts can bc

aFlied ln difiere¡t sjluation .

Thcse

visüelles illusl¡ate thc

rclalionship between iheory

and

pr¡cLice.

TheraPY

Perspective

Enabl¡ng

Occupation:

An

Occupat¡onal

Therapy Perspective

157



¡

ri

$

1l

{

i

t

3

ii

.,f

,

_{

/o

{

/.c.p¡or.,l.he.Jp)

role.JndJ.Io..\Jr\

sroe¡)

Lri\.r, L i.or

occupatjonal therapy

¿re based

on

a

comnon

se

of occuparional ther¡py

vxlues,

belieli

a¡d corc concepts. abour

occr¡p¡lion,

perso¡s,

¡he

environm.nl,

hc¡lth,

and

clicnt

ccnl¡cd

p.acLice

(ouLlined

h

alhapler 3) r

common Occupational Perlbnnance

Process

can be applied

with

i¡dividual, organizati,:,nal or other clients

(see

Chapter

4). Whil.

lhe

organization of occupational thcrápy

scrvices

ditfers

ro

respo¡d

¡o

rhe

nccds

and

circumshnces of

each

set¡ing, occupationnl ¡herapjs6 slrivc ú

incoryorale rhe

valL¡es,

beliels. conc¿pts a¡d

frocesses

which ¡rc

ch¡rácter¡tlc

of occupation¡l therapy

lsee

Ch¡pler 5).

An occupational iherapy client

nay

be

an

indjvidual. family. con¡¡u¡it)

social

¡gcncy,

poliric¡l

agency

etc.

Occupational tl)drapist

nay

work $i:i

clients ol xny

agc or

culLur¡l

group

in any

scuing.

Chrplcr 7

presenls tl..

ignctlcs lo shorv

how rhcory a¡¡l

practice

are

i¡legraled

whe

en¡bln

occupa¡ion. The vigne¡te which

describes

workrng

with a Re¡irenenl

Village

shows

how occupalional

iherapists integrate

theory

and

prectice

:::

services

úilh

an

organizatjon

(see

Chaplels

4

and 5).

A

second

ign.[€

describes

a

positive

result when an

occulation¡l

thcrapist lvorks

'vith

d

wo¡ran rvho

is hospitalized

briefly becaus. ofmcnlal

hcxhh

isnrcs. It

shows

how

¡ focus

on

oc.upationxl

ferfon¡ancc

is intcgratcd

\ith

Cognitivc

Bchalioural

atprcxchcs

to

cnablc

occupxtio¡ and

pro¡role

mcntal

healú. The need to

coo¡lin¡le cor nuni¡y

and

instituiional

serlices

is

evident

rI) ¡he

thrrl

vig¡retle

iri

which

¡ child and his ¡nnhcr

r:

clienls

A¡other

vignette

illusrales

an

occupational

Lhcraty

co¡sultatio.

with

¡rembeN

of

a Board

of

Direcrol\

who

are mainly

rolunleers,

in rhr'

case.

in a

religious

organjzation concerned abou

its

scntur mcmbers.

Since ¡hird

party

payment

is increasins in Carada,

¡he

fifth

vigncLrc sh.-:

an

occupalional ¡herapist

llorking

for

payment

from

one

clien

(a

law\r:

lvhlle $orkjng wrih

¡ secondary clien¡. the tawyer's client.

Thc

isncttcs

arc b¡sed on

real

situations,

üith

nxmcs.

locali(ms,

aDLl

oi:=

idcnlific.s changcd

to

protcct anonymily. Th.y

torlray

\hat

thc

occupational

th.rapisl

is

doing

b€cause these arc

güidclincs li)r

occupational lherapy

practjce.

Tte underlying

assumption

is

lhat

occupatlonal

therapisis collabor¡Ie

in teaÍrs

wilh

clie¡ts.

professionals.

coru¡runity

workers,

Ia¡rihes, and others

who

a¡e

\orking

on lhe sam3 :l

diilerent

goals

\rith

clients.

In

essence, Ihe

occupaijonal lherapis

worL

with a tean

which

varies

dep¿nding on rhe

circumstances.

The

leam r:

bc lormally o.gá¡ircd or il may bc brought logelher to ¡esolve

a

panic:

-

oc.upadonal

pc.lom¡ncc issue. An

occup¡tional

ücraplsts leadershil

skrlls

can

facilitate

the

collaboratron

and

coordination

requi..d lor

¿

t.:-

to

work eft¡crively and

efticic¡rly

in rhe

inle.ests ol

a client. All the

vrgn.ttcs apply

thc cor€ concepts

ofthe

Canadian

Modcl

ol

Occup.tli.rl

P¿rlorlnance

and

client-cent.ed

prac¡ice.

oí\

,it'

752

Chapter

z:

VigrleE5



-

IGNETTE

#T: RETIREMENT

VILLAGE

Scenario

A conniunity

based

occutarional

therapy consulrjng g¡oup

was

app¡o¡ched

by

a

nartrDally

ope¡ared

rcrirement

vj

¿gc ro

devetop

and

coordinate

a

rcb¡bilitalion

ser\icc

which

inctudcd

occupatronat ücrapv.

Stage

#1:

Name,

Vatidate

and

Prioritize

Occupationat

Performance lssues

A meeli¡g was

arnnged wilh

rhc Service

ptannins

Group

which

inctuded

represeniativcs

fro¡n

the

residcnrs ol the reriremcnr

village,

lhe

Viltase

Ope¡ations

Committee

and thc rcrireme¡l villagc

N¡tbnrl

Officc. In

rhc

meeling

it \$ cvident

thar changes i¡

ihe occutarional

perfoniance

ofthe

residents.

¿nd

rheir

jncrcasing

üse

ofacutc ¡¡d

rehabititation

scrvjces

within

thc conrnrunity.

hád led

rhe

group

ro exptore

rh¿

need tor and

feasibil]ly oftroviding

rehabilitltion

ser ices

o¡ si¡e. Meering

te

icipanrs

com¡nenled:

Nlany ofthe

residcnts have

lived

in lhc

lilt¿ge

lor l5

20 ye¿rs

and no$ have

he¡lü p¡obtens

lhit

¡re

frevenrjng

theDr

liom doing

things thcy s,¡n¡

ro do.

ID rhe iar

1t

monLhs,

nrany

of

rtrcm

hale had to sFnd

norc li¡re

away liom

the

vjllage

lo

gct

rhe

rehabitir¡tion

ser iccs

th.y

need. Whcn thev rcturn ir lxkes

rrme

ro

adjuf

and

¡econnccr

with

fiicnds

A f¡w

ol

rhe residents

$,ould

ratber

rrugglc

rtran

use thc off

sitc scrvices,

bu¡

wc

yc

seen

so¡re oflhcm wilhdrarving.

and heing

less and

less

ablc ro

do

things.

Smce

it

seens üal more peopte

arc

nccding

seNic€s.

wc

think i

may

bc

bc[er

to

lrolidc

rhe

ser ices

herc, in rhe

village

itself. Ir was

apparenr rhar

gn)up

¡rembc¡s also

believed lhlt

other

rcsidenls

could incrc¡se

thei¡

pafiiciparion

jn

occr¡txlions,

and

jn

donrg

so,

mairtain

and/or

irnprove

their tuncr()n ¡nd

health.

The

occuparional ücrapist

facilit¡Lcd

a

djscussion

in rhe

meeting rr)

name.

trioririze

and

ralidate

tbe occurrrionai pe¡t¡m¡nce

issues.

In order

of

i¡rfot1anc¿

drey

wcrel

.

So¡ne resiLlcnrs a¡e

un¡ble

ro parricipard

jn r¡tued

seti-carc.

fo.ir.rir

t d..

ern

.¡".Lprr

or.

.

Clthe¡

residcnrs

are

porenri¡lly

unable ro

pxrticipale

in vattrcd

self-

rJr,.

f

Jr,r

\I\

Jn

l i

I( o..Lt

u

.

Nfcr¡bers

ofthe

pl¿nning

group

pe¡cciled

rhar

therc

wds

an

urgent nccd

to

provide

rehabilitation

sellices ln üc illage

so ¡h¡L

thc i¡.st

occupalionat

tefonnance

issuc

could

be addrcsscd, and wherc possjbtc

resotved.

Thc

second

occuparional performance

ilsue

could

rhc¡ bc

frcvenled.

Croul

menbers rcc.gnized

thal beiorc

serlices

we¡c dcv.loped,

it was nccessary

1o

asscss

the

occL¡parion¿l

tcúonnance

nccds

ofresidents ro;

(¡)

jdentil,

what was

contribuLing

10

these

occup¡Lional pertonnancc

issues.

and

(b)

detenninc

rh.

number

ol

r.sidents

wirh aclu¡l

versus potenrial

occufational

perlomancc

issues.

Tbis

inlorn]arion

\oul¡t

gurde

the

cor¡tletion

ofrhc rcrnaining

srcrs

in

rhe

planning

process

These $,cre

t{)

idenljfy

larg.lcd seNjce

ortcomcs. est¡blish

¡ scrvice

10 mee¡ those

needs.

:_ebt¡ng

Occupat¡on:

An OccupatioñaL

Therapy Perspective

753



-a\

id¿nritr'needed servicc rcsour.cs, and dcvclop

a

markering and

evalu¿r:::

pl.tD

(sce

Plan Scrviccs, Chaftcr

5) Group

members egreld

dra

üe

initial occupatioral thcrafy conrac

rlould

jnclude

conpletion

of

dre :..

seNice

phnning

stcps

The

group

developed üc

linlowirg

trincitlcs

anLl param.rcrs

f¡r

th.

.

mernbeN

oftbe

vjllage conr¡runity

and

dre

planni

ggroups,-:

plr.rcrlJre.n p,-rrrnr

.no dL

'qn.rr'he

er\..

.

'

all serlices

would

occur

wilhjn

the retiemen

vill¡ge, wjlh

rh:

exceplion of

those

for

residenls rcquiring specialized service.

..-

s.

rld

(e

"et. r-d

ro,or , LJrr\ Jle

..

.

the needs ofthe ¡esldents

would djrect

decisions aboul

requir:;

lersonnel:

md

.

rh. scr i.c\

w¡üld

hc

(r,$

.ff..riy.

t

i

^{

,í\

.*l{,

Stage

#2:

Select Theoreticat Approach(es)

,\long

s,ith the pla¡¡i¡g process

described h rhe

Clienr, Servicc. Soci.r.

Niodel

(scc

Chatter

5l,

nrarketi¡rg.

¡ranageme i. educ¡tion¿], e ¡h¡¡ti..:

and

orgxnizatrnral

developnrent

theories

gLrded s€rv,ce

tlanfLig.

Consistc¡t

$,iih oth.r vigneltes.

the tinadian Nfodel of Occup¡tio¡al

Perfonr¡ncc

¡¡d thc

OccDfxiiofal

Peú¡n¡an.e

Pnrcess guided

the

xsscssmcDt

oi rcsidcnts occupational

telfomance

¡eeds

Stage #3: ldentify Occupational

Performance

ComponenG

aDr

EnvironmentaI Conditions

A

varietv of

assessDent nredrods were

used

to identiil

lhe occLrpalion.,

peúornrance conrpo¡en1s

and

envi¡onrnenr¡l conditions rcl¡ted lo lbc i,,

:

occupalio¡al

perforrrance

issLrcs. to conlim thc n¡turc ¡nd c\Lcnt

ol

residents occupa¡ional

pcrl¡miancc

nccLls.

Many of

dre

reside¡ls

were

of

onc

crhnic

background

and

rcligious

elTili¡tion. though

the

village

was

non llenonin¿lLon¿]. Fo¡ mof, Enll:::

w¡s

^

second langu¡Se wj¡b

a ix

ol

$,cll activc clders

¿nd

clders

\r-

specific

he¡lth

issues. r¡

was

elidcnl

lh¡l

physical.

cognrtirc and/or

¡1lective cornponcnc ol

occupation{l p.rlon¡ance lvere

ln¡iring

or

h::

::

totcnLial

Lo

limit

particitation

in

occuliations. lndividual

ifteNiews

¡i

residents using the

Canadian Occupational Perl¡rrnance l4easure

(COP].

suttorcd

this finding.

'lhe

resuhs

indicaied thar 60'¿ ofresidenls

\e::

experien.ing

reduced

f^rticipalion

in

valueit

oc.upaiions

$hile

lhe

remainins'10%

were

at

risk. Ma¡y rcstrlenE l¡ck¿d knorvledge abour ::

.

p¡nicipation in occupalions coul.l prcrcnr LllsfuncLion

¿nd

promotc hi:l

Focus

group

discussions

rclcalc¡l

that

r.si¡icns

wrntcd on

silc

r.h{bilit.rtion

scrviccs

th¡l

incorporated

a

holistic approach to

lifest}le

-:

heelth

issues In ¡ddirion.

they

wanlcd

programmcs

lhat would

cn¡bl.

754

Chapter

7:

VignetE



-

thefr lo

be

more

actiye

and

ablc

ro

participarc

in vatued

occuparjons

xs

long

as

tossjble.

For the

lnosr paÍ,

the social. cultural

and physical

cnvironmenL

supported

rather

lhán

const¡aincd

occuparional

perfonnancc.

Some rcsidents

rcportcd

that úey found

rneannrg

i¡

life from participarjon

in fa]njty

events

and hclping

their rrcighbours

who

were

trait.

Olhers wcre

rrarjierl

J,

r(n.,hcJb|t-e,,,..te,;,t,(.,r

r

.

er"nJ.

t

r

o

¡"og

.r,ne

r'rrh

,nearby daycare

ccnt.c.

Here. rhcir life

expericnces

and

nurrudng

ski

s

werc

wclconed

and

v¡lued.

The

Villare

Operatuns

Coln¡irlcc

and

srafl ofrhc

retirenenr

vitiase

werc

...,.rpfon.ve

here..a(nr

1,ed.to.

pdflr.ipJUon

hc..mr,

1.rl.

rnd

sorne asslsLance,

supporr ánd resourccs

were

avaitablc

(e.g.,

lax

scnices,

domcstic cleaning

lo. apatmcnr

residents

anLt

a

shutte lo

downtown

shopting

area). Consuhants

were

rcgutarty sc¡eduled

tor

educrtional

sessions

on legal

and social

issucs.

In contraf.

rhe insti¡ulional

environment (1he

conrmuni¡y

ar l¡rge/ri

agc)

$,as coninbuling

to

rhe

occupational

pcformancc

jssues

by

¡or providingreh¡hiliration

se.vices

and healrh

promotio¡ progr¡m¡res

ihal

mer

rhe

chxnging

nccds

of resldclrrs. In

sumnrary,

the

occupario¡al

pcrfümance

components

and

environnental

condirions

ihat

rvcrc

conlribulins

to

each

occupational pelfornrancc

issue were:

Some

tusidents werc

unahle

ro

paficipate

in

¡hred

set-c¡r€,

froducliriry

and/or

lcisure

occupalions.

due to:

.

ó0%

ofresidcnrs had

physic¡I,

cognjtivc

andTor

allccrive

occupational

perfo

nancc cornponcnts

thar

ljmircd

rherr

tol|.ro,.r.n

I \J,red.,

rt,rron..

.

lack

ofclicnr cenired

rchabilitation

services

that

address

rcsiilenrs

occupatron¡l

teformancc

needs

(issues)

^nd

1¡ci|rated

desj.cd

p.,rri.

it

'r

ol

r1

'

l,

eo

o.r

Lt.

r'on..

Orher residcnts were

porentjally

un¿ble

1(]

párricipaie

in

valued

setl-cxrc,

producriviry

and/or lcisure

occupxrions,

duc

ro:

.

iack

ofknowledge

about

the rolc of

occuparion

jn

promorjng

healrh

and

prevcnring

dystunctiona

'

lack ofaccess

ro health

p¡omolion

servic€s and

progra¡nnes.

Stage

#4:

ldentiry

Strengths

and Resources

Residcnts were

nrolivared

io rc¡nin

acrivcty

engaged

in village

acliyjties

and in publlcly

offered

socio cuhurat

arb¡crions

to thc erlent

rhar

úeir

health

nadc

rhar

possible.

The

yiltage

had bccn

chosen

by its

aging hur

wcl1

occupants bccause

il

oli¡r€d

suppofive bul unobrusive

assifa|ce

to

nrdividuals

committed

ro

¿rn

active

lilcsryle.

:¡abL¡ng

Occupation:

An Occupational

Therapy

perspective

755



a\

The

intercr,

suppol and availability

of

funding 1br

rehabililation ser'::-

by the

Vill¡gc Ope.ntio¡s Co¡rxnlltee

and

stafi,

¡nd thc Na¡onal ofil;-

were

an

assct

and cnabled residenis ¡o

continue

liling in the

villase

comnunity

unless

cmcrgcncy.

acu¡e

ca¡e or residenti¡l

rcktbilila¡ion

scwiccs \\ere

required.

Thc

p¡sL

cxp.rie¡ce of the occupationAl

ther:::

consulting

group

led

Io effective. anliciparory

planning.

Circn

the

occupalionel

frolilc

ot

thc rcsidents.

their

actu¡l

a¡d

polen:::

occufarional

perfonnance

issues

(occupaúo¡a]

perfomancc

needs)

:: .:

n,

n¡hcr .f residenls with thesc needs.

it

üas

evidcnr

thal

on-sire

occup¡lional therapy

serriccs wcrc ¿ppr.ipriate.

In ¡ddition 1()

corr'lñr

:-:

thc nccd

ibr

occupalional

thcrl]py, lhc iindings

inLlic:rlcd that

other

sr,-

::

(e.g..

physical themp,v)

and

tersonncl

(e.g..

personal arLcnd¿nls)

qou ¡

stage

#5:

Negotiate

Targeted Outcomes,

Devetop Action

PIar

Follo$ ing .liscussion

jn

a seconLl

mccting.

rhe

plantring

group ¡srecLl

-:

thc largeted

outcor¡cs

f(tr thc scr icc, in order of

triority,

wcre

thal:

.

Residents

who rccci e rehabilita¡ion services,

¡nd ri¡nely

¡ei.--

o

co¡rnnmity

spccialty

servrces

úhen

n.ccssary.

will

nrainl:i:

and/o

incrcasc lhcir

parlicipalion in occu|llions ther'

value.

s,illtwithout ass¡lance

lion others

¡nd/(tr cnvironmenlal

ad¡ttationsi

.

\l

,rp.r(rpJr"3

¡\rll

-Fl'.ol,l.Drv,

ri

nt oqr

1 ,.

resdenrs

will

be

ablc ro usc k¡owledge about

he¡lth ¡nd

lile ..

.

lssues

that

ar. ir¡portanl lo

lhcrn in ¡raking

choiccs lhai

will

¡rraintain

xct¡c

paricip¡tion

in

valued

occufarions

and

oplin:

heahhl

.

Residents

who

recci c rch¡bihtation services

xnd

t¡rricipar.:.

1. .lrr

t..

r'

'

o

t'.;r.

I n..,h.l

pa¡ticipatio¡

i¡ valued

occuparioDs

will

hale

a

lowcr

r¡rc ol

adnrission

1o cor¡munit) hcalth iácililies.

In lhc

process of dercloting thc action

plans.

the

1¡st four plan¡ing sr.:,

.\.

rc.o|

pre'.. \ r ¿.,

.

l(

up-.|1,..

.. oi',

r

,\

',

...(

utiliz¡tion ratistics

av¡ilable

fir)m thc rcli¡cmen¡

lillage Nxtional Ol:::

Cri¡erix

frrr scrting

priorilies

for services

rvcrc cst¡btished in

colhb..:r :

$ith the

vilhgc conmunily. The Service t'lannnrg

Group\

plans

to

¡r:::

thc Iargeted outcor¡cs

iDclu¡lcd:

r,

.--

)l

.J

;\

.

til

.l

Se

up

single

cntry holiric. client-centred

rchrbili¡aiion seni::

.,r.,

rn

i.rerd

.

rI 11

D

n..l

'\.rL

,

ro 1

i .

..

'..e

proliders

and

conxnunily specixlr)

scrvices:

Hire

qualiiicd pcrson¡cl and ensure

ihe,v

¡cccirc sullicieft

or

cr.1..o' opro.'lerl

.

n

cJ'J..-

.-cenr,eJ

'

1..

\l r

.

L

,

Jrl.

/..

e :a'nt.

.J

.,rr

.'bo

rr .l'.

n(s

n

"

rehabilit¡tion

scrviccsi

156

Chapter

7r

VigneE



Develop a

rchabilit¡tion

scr\iccs

data

bxnk

for

referal

requests,

rLidlr r .rLt.r.'lI

li

".

,dre,.

d..o

ulilization

and

occupatio¡al

peformance

outcomesi

Collxbora¡e

with

contnrunily and/or uni\ersity resea¡chers Lo

ensure drat

lhe ser\ice evalualion

ll¡n

will

providc inli)mr¡tn,l

about thc cll¡ctiycness ¡nd

efficienc)r

of

services, and other data

to

guide

fulure decision-¡rakjnsi

Provide

i¡dilidual

l:,ccup¡rional

lbcirp]

scryicos lusing

rhc scvcn

slage Occupational Pcrlbrmancc

ProccssJ

lo residcnls

$ho

requcr

ser ice and have occuparjonal

perlbrmance

issues:

D€velop and offer edr¡calional

progra¡nrnes

that malch the heahh

promotion

and liiesryle

needs

ofthe

rcsidenls:

Conducl mo¡IhlJ- rcsidcnt

lbcLrs

groups

tbr ieedback to

guide

Gilcn

(hc

s¡rtislaclion

otall p¿rtics

wilh

rhc

scrvicc plan,

thc

consulting

group contfac was

exrended

lor

slx

monlhs

lo

implcment

the

plan.

Likc

the

flanning

contr¡ct. it in.luded direcl, in'direct,

non dircct,

and

travel

limc.

Thc linal contract

was

¡pfroved

by dre m¿nagers ir the retiremenr

vrltage

Narional

Otlicc.

It

stxtcd that

crxlurlion of

scrvices

r ould he

based on rhe

exlent ro which

th.

LargctcLl

outcomes

wcrc mct

prior

to dre

conclusion ol Lhc

1iñ si\

monrh conlracl.

Conlrrct

rcnc\r¡l

$,as

contingent

on a

satisfactory cvaluation.

Stage

#6: lmplement

Ptans

Through

Occupation

Onc ol

thc

consulting

grout

¡rcmbcrs

$sumed

ihc rolc olProicct

.^orlnrror

Ind.D.r.Lnro.- rpJi

n.. l\(r.t.

tr..

riu1(r"'.

rec¡ui¡ed as sub-contr¡cto.s.

Whcrc

possiblc,

ncw slall

wirh sccoDd

languages lbar narchcd lhc nccds ol residcnts

wcrc

rccruiLcd. With

e)ipenence in otlering cduc¡rion¡l

prcgrammcs,

the scr\icc

proyidcrs werc

able

to

educale

personal

aucDdanls and

othcr st¡ff cllicicntly

on sitc.

During orienlalion. tine

was

spen¡ on

slralcgics

ro incorpor¡rtc

hc¡lth

tr.motion

ideas

durins conlact wirh

residenrs.

With an

understxnding

ofthe.etjrer¡ent

village's vision

and

philosophy.

the Projec Coordinato¡ facililaled tlre translarion ofoccup¿lional üc.apy

s

holistic appr.,ach ro scrvicc inlo ¡ languagc thrr wrs compatiblc {iLh th{r

uscd

by thc rctircmcnt

vilhge oFrat(rs

rnd the

resideDts

Imtlcmcntxtion \ras

donc by

sub conhacted

occupationrl

therxtists \vho

developcd

rclaLionships sith villxge slxffand residents. Concurently, the

development

of policies,

procedures

and a data

€nrty

system

set the

proje.t

up i¡r accounlabjlily and

programme

evalu¿tion. Much time

was

spenl on

rhc

p¡crniscs

organizing occuprtionrl thcr¡py scrliccs

(c.9.,

scring ut

.tn

administrxrive

area

in

the heal¡h

cenre. aranging

a

stor¡ge

area

for

prinled

nralerial

and

frequenlly

used assessments), and isrlrng

wjlh

residenls.

Occupation:

An

Occupat¡ona[

Therapy Perspect¡ve 157



r{t

;\,

til

'il

Noticc

ofdre comncncemenl

olo,r,si¡e

scrvices was

scnr

o

alt

rcsiden¡:

and faff,

and

an

announcemcnr

was

nadc

using

üe

ri

ege

communrcation

syfem.

Posrcrs were

displayed

in

highljghring

üc various

occuparjonal

rherapy

services

and

how

ro

acces

thelrl.

A

sch.dule

was

posred.

t¡r

cxanple,

t¡r

the elde¡s

,'High

Living

P¡og.a¡nne.

This pccr

run

parriciparory.

heatth

evenr

used

a

workshop

l¡mrat

thar

f¡cuscd

on l¡od

lreparalion

and acrivc oc.upatjo¡s

Lhat

incorpor¿tcd

physical

excrcise

The

s¿rvicc cvolved

through

onsoing

(vitlage)

communiry parriciparion

rnd

direcrion. The

retjremcnt

village

tocus g¡ouls

provided

residcnts

an;

illage

sral wuh

direcr

acccss

ro the

projec¡

Coordjnaror

and

oppoíunjt,

to

sbare

pcrceptions

ol

scr ice

develop¡nenr.

mcaningful¡ess

¿nd

bcnefiF

Feedbrck

was

iminedi¡r.ly

incorporaled

into rtre

detjvery

and

nlonilonni

syrem to

enhance

outcomes.

Rcsidenis

prcgress was

conrnru¡1ly

re

eralL¡¡tcd a¡d programme

goals

rcnegorialcd

by

lbe occuparional

therafs

and

the

individuals

cclnccrned

Stage

#7:

Evaluate

Occupational

Performance

Outcomes

As

a

s¡rall

business, rhe

supplicr

had

a

goat

o

¡ulnrain

úe

conracr.

dr

:

consumcr,

lhe

¡eriremcnt

villagc and

its National

Otitcc

$,¿n¡ed

ttmc

ro

assess

üe

service.

When

üc

scrvice

was

evrluated

rowards

the cnd

ofthe firsr conrfact

soE

changes

ln occuparional perldmance

wcre

evjdenr. Eighiy perccnt

ofrlj.

residcnls

who

had

rcceived

individuat

scrvices

had

manrhined

or increer-

¡heir

pr¡ticipalion

in

occuparions

rhai werc inrponanl

lo rheln.

Simileh

607. oI

rcsiden¡s

who parlicipntcd

jr

rhe hcatth

promorjon

programm.

were

lbund

to

be

more

activety involved

in

actjvities

jn

the vi agc

and

surounding

commrnity.

Atrhough

rhc

sralirics

rverc

1ow.

it

appcared

rt_j:

tbe increased parricifarion

in

frogranmcs

¡ray

have contribured

lo the

downrurn

in

admission

rares

ro

conmunity

he¡tth

t¡cjlilics.

Howeve¡.

i:

was recognized tha¡ thc ourcomcs

afte¡

onc

ycar

ofservice

,vould

be

mi=

belp{ul

in

judging

the cffec¡ivencss

of servjc.s

Ouico¡ics were

also measured

in

rerms ot village

oñncrship

olsenjce

and individuals

sadsfacrion

wltb

se¡viccs.

tndicarors

were

reter¡l

of

n:u

residents

by lhosc ¡beady

rcceiving

scrvices,

or rcsidenrs

using

Lhe

inlbmratro¡

liom

the

educ¡tional

scssions

1{]

rcach

ortre¡s.

Il

was

p¡rricularly

rcwa.ding

to have

famill members

ask

for

int¡¡marrcn

lhel

rclxtives

had

told them

abour.

Thesc

ourcones

coutd

onh

be achieve¡t

through

prolidi¡g

and ad¿pling

rhc

seNjces

10 mee

cljenr

trioriries,

in

case

lhc rctirenren¡ village

as ¡

unir.

Renewal

ol

the

co¡¡¡act

¡nd

any iulure

expansion

of se¡lices

requ;cit

rE

occupational

therapy consuliing

group

1()

report the

programme

dcsign_

e o.

Ir¡.n

o'

\€..rJi\.

oI onc..

rrd

ir,.1.

J dr...L

D,t

\

I

¡

158

Chapter

7:

Vignetb



VIGNETTE

#z:

ADULT

WITH

MENTAT

HEATTH

|SSUES

Scenar¡o

Allison Jones is

a

28-year

old female.

She

was

adnjlrcd

ro

a

hospiLal,s

mood

disorde¡

unit. On adnissjon,

hcr

rouiines

ánd

peúormancc

in

cveryday

occupatio¡s were

very

disrupted duc

ro her depresscd

mood

and

obsessivc rhoughts.

Stage

#1:

Name,

Validate

and

Prioritize

Occupat¡onat

Performance lssues

The

Canadian

occupational

Pcrfomrance

Mcasure

(COPM)

was used

in

the initial

inlcrview

with

Allison.

Her initiat rarjngs

o¡

performance

and

satlsfaction

on rhree

occupaürnal performance

jssues

which

shc na¡ned

as

being her priorities werc:

Performance

Satisfaction

Importance

II

t0

Ovc¡

attention

to

pcrsonal

occupalions.

"I

feel

likc

I

spe¡d half ofnry

day in the

bathroon checking

mysclf."

Ildecision

about

cffeer

furure aDd possjble

carcer

changc(p¡oductivity)

"I

measurc myself in

terms of

ny

productivily

and

rny

comp¡rison to

others."

Pa¡ticipalion

in

prcvious

physical

and

social

occupaúons has

subsided.

Stage #2:

Setect Theoreticat

Approach(es)

Thc

occuparional

ihcrapist

was

guidcd

by ihe conceprs

of client-ccnrred

praclice

and

the Can¡dian

Model ofOccuparion¡l

pedormance.

psycho-

emotional

(primarily

Cognilivc Beh¿ivjoural

techniques),

socjo-adaprjve,

xnd

environmenral

approaches

were also

used

as

the

occupational therapisr

worked

wirh Ailison.

Stage

#3: ldentiñ/

Occupat¡onat

Performance

Components

and

Environmental Conditions

Self-care:

Over-attenljon

ro personal

hygiene

was reláred ro:

'

obsessive

thoughts

and

ruminalions

regarding appearance

E

abling Occupat¡on:

An Occupational

fherapy

perspective

759



evalualing

sell xg^insl

external

variablesi

I

will

onl)

hrrc

¡

r¿lationshipifIma¡llaclive. I 1l1

getting

older and

all

my frienG

¿re

mar¡ied. Now ll1y

age

is

workng

agains¡

üre.'

absolurc thinkng o¡ expectations ofsell

and

lack of constNctir.

i\

";

rl

a*

'

1

'.,i

:.J

f\\

\lll

jl

Productivity: Indccision

about ca¡eer

luture

and

possible

career change

.

frustration tolcr¡¡cc

and

troblcm

sohing abilily clouded by

abs)lutc. imb¡lanccd ¡hinking: I

assume

the

wolsi.

and

personalizc cvcryrhing. Therefore.I eilher avoid lhings or

give

up whc¡ baricrs

prcscnt

lhcr¡rsclles

'

lack

of

cl¡rity rcgx¡ling vocarional inrcrests and capabilitiest

'

ru¡ nation abou the

fxcl

th¡t

she

did not

pursLrc

posl

scconda¡

education and

feels

she is

1oo old to

do so

al this Linrc. Hcr

rumination

is

ofparticular

imporlance

in the

climatc

of¡

vcry

high

xchicrnrs l¡nily.

Leisure:

Parlicipation

in

p¡evious physical

and soci¡l occupations has

subsided. related to:

.

a

recent

move to

a new

cilyi

.

external

changes

in

her support

network

and decreased

av¡ilabilily of lriends/peers:

.

self depr.cating

statements and fe.lings of nradcqu¡cy.

In analyzi¡g rhe idenlilied

occupational

peribnn¡nc¿

components and

cnvironn1enlal

condi¡ions.

the

occupalional

tberapist noied some

snnil¿rnies. It

appea¡ed

ibatAllison\

s¡yle

of¡hinkng,

pa¡ticul¡rly

her

obscssilc, ¡bsolute and self-deprecaling

perceplions.

as

\\e]1

as her

tcndcncy

ro

ruminate rbout lhc

pas1

and

mcasurc herself agajnst extema

vaiables, wcrc negatively influcncins bcr scll eslee¡ri in doing so. tlre*-

behaviours conlributed ¡o the three occupational

perfor¡rance

issues.

Stage

#4:

ldentify Strengths

and

Resources

Allison s

peNonal

stre¡gdrs

were:

.

si¡cere. fair. kind and honesti

'

A

cood

sense

oihumour;

'

musical

lálcnl

tl¡ycd

a

nunrbcr ol instrumcn6

an{] has

tralel .¡

inlcnraLir)nally

with

music

gr)upsl

.

aficul¡tc. with

good

salcs

skills.

He¡ resources

rvere:

rppofl

L orn her fxn.l\.

'

fin¡ncia1 sccurity.

Tbe occuparional

lherapists

rrenglhs and resources lay

in having

lhe

knowlcdgc, skills

¿nd resources ncccled ro

work wirh Allison.

Chapter

7:

Vi,60



Stage #5: Negotiate

Targeted Outcomes,

Deve[op Action Plans

ln the innial

rages

of

nego¡iatrng

thc l$gcred

our.onres

and developmg

aclion

th¡s.

the

occupahonal thcratists anal,vsis

of the assessncnl

lindirgs

(see

Staee

3)

was discussed

wrth,

and

valid¿ted

by Allirnr. I

lvas

clear that

she was

cxgcr io

begin to

work

on thcs.

iLcms

{nd re.ognjzed

thi\

w.rs

.ssential

for the

occupalion¡l

pcionnance

issues ¡o be

rcsolvcrl.

In

this, as

in

othcr silualirnrs.

the occupa¡ional

therapist

considcrcd plefs

tha¡

could

be

drrccred

rt

the

perso¡

(i

e

skrll building

m rhinking,

feeli¡g

and

dorng), occupxiion

(i.e

the occupalions, ad¡pt¡rioD and grxding)

and/or enlironmcnt

(e.g.,

advoc¡cv.

adapr¡rion). Oncc rhcy h¡d

ioinrly

discusscd and dcr.mnred dre

tlans.

the occuparional ücrtpist xnd Allison

.lecidcd $ho would

do

what

and

when

Io f¡cililálc lhc xchi.vcment

of

each

Occupationa[ Performance

lssue #1: Over

attention to

persona[

hygiene

(self-care)

fargeted Outcomes:

By

the

iirne ofdischarge from

hospital,

Allison will:

.

deürDnslrale knowlcdgc ld integraling

cogniri c rhcrapy

techniques

in¡o

occupaLion hy

complering

three ThoughL Rccords

in

wrilten

lbImaL. a¡d n¡tl.menting

use

ol

rhis rechniquc inro

occupalions üar cvokc socss

or anxiery:

lThoughr

Rccords

(r

Cogni¡iv¿ Therapy tcchniquc) consists

of

a

selen c.nunn rccord

b),

ivhich

clienrs nroniro. situarions. fc.lings. xnd eutonra¡ic

lhoulbts and gxiher evidence

lh¿L supfofs or

docs n.t

supporl a

¡houghl $ith

a

vicw

to deleloping

mo.c

balanccd thoüghrs ¡nd

feellnss.l

.

deüronsl¡atc lwo rch{xrion

lechniqucs

$,hich shc

is

ablc ro

use

in

at leasl

oDc

occufation in which

shc

b¡s

frcrn)uslr-

exferienced

ditl¡rcnLirtc bciveen

internal

¡nd cxtcmal

sourccs

.f sell

ereerni

brainslorm

¡

iist

ol

occupations

which

shc

Lbinks $

ill

boosr

her

self-esteern

inLcrnally rnd panicipate

rn

at lcar

rwo ol th¿se

reduce

lhe anrunt

oftinre

spen¡

in lhc w.tslroonr to check

palti.ipate

i¡ re-cyalu¡ting her occupalional p¿rfoÍnancc

issucs

(all

three) aI rhc

cDd

ol

her

hospLtal

admjssion.

Action Ptans:

Alier

discussion wirh rh.

occupational ther¡pisl, Allison indicarcd th¡1$e

was

inlc¡crcd

in

attendi¡g

stress

nanrg.mcnt, .claxxtion

and life

s¡yles

groups.

Since

drese

groups

wcrc dcsigned

to help

pariicip¡nts

to

dcyclop

constructi c copirg strategies,

and also ad¡lrcsscd thc occupational

fcrlinmxDce

issues

drat

we.c

.claLcd

to self

estee¡r.

Allison lelt lhcy rhcy

$ould

be

¡¡eaninglul

and

r¡lu{bl.

ro her

l¡

was

decided Lhxr during

individual

cognilirc

rhcr.tpy

sessio¡s

wfh

thc occuf¡rioral rherepisl,

,é*'\

L.o

.-

E

5

^l#ff""

f

:rabting

Occupation: An

Occupat¡onat fherapy Perspective

161



AllisoD would

use techniques

lo iDlcrigxl¿

hcr thought

processes

wrth :

view to

nrovrng

lowards

nrore

balxnccd

thinkmg.

Thc

occupational

lher¡pist

would

cncourage Allison

1o

xccess

hcr

scnsc

of

hu¡lour

as an

addition¡l

tnrl ior m¡inlainins

a balanced

perspecti e.

-As

ir

was

Alli\.:;

dcsLrc

1o

spend

less

liDc in lionl of lhe rninor checking

herscll or

b.in

wonied rboul her

appearance,

she

dccidcd that shc woukl also moniror

j:

record

this

on

a

wcckly basis over

ihe

course

oflher¿py.

Star

'i\

¡

.tl

15

Occupational

Performance

lssue #2: lndecision

aboa

career

future and

possible

career change

(productivity)

Targeted Outcomes:

By

lhe

li¡re ofdisch¡rsc

lro¡t

hospilal,

Allison

vill:

.

have

direction

a¡d

i¡lbnnation

¡egading 2-3 diffcrcnt

vocati.j

toqsibniliesi

.

arange to i¡vestigatc

carccr choices

through

volunteer work. i:

though conl¿ct

wilh

acaLleniic

or voc¡tional training

progranrnrcs.

Action

Plans:

It

wxs agrccd

that

AlLson would

particip¡tc in

voc¡tidrai

iúercsl

bali.:--

and

aftitu.lc rcsLs in

Ih¿

work

readiness

group.

I¡

so

.lomg.

shc

w.,uld

begin

to gathcr the necessary infornration

io consi.lcr in

1u¡ure career

planning. Hcr

absrJlure.

u¡balanccd

thinking rcl¡tcd lo

her career

dccisions

would

be

addrcsscd as shc cng¿ged in

\ocation¡l occupation

¡nd

used

cosnitivc thcnpy lcchniques

las

denrified

under

scll

carc

outcomes

(s.c

#l nborc)1.

Occupational Performance

lssue #3r Participation i

prev¡ous phys¡cal

and social occupations

has subsidd

(teisure)

Targeted Outcomes:

By

th.

ti¡rc

oldischa¡ge

liolll

hospital.

,{lljson will:

.

idcntil_y lwo r¿crea¡ion occupations ih¡t

$e

wishcs

to pursue

¿,.É

inco+rr'rtc desired

phlsical

and social en ;ronnrcnrxl

clcmcni::

.

obs.rvc

thc two chos.n recre¡Ironal

occupatjoJrs

(i.e.,

meer

th.

Iearn.

see

the scrring,

and

so

on) and il

]rossible,

hale rcgisrerr:

lor üre

upcoming

sessions

Action

PLans:

ii

was

dcciLlcd

rhal

Allison

would complete

the

Pic

olLil¡ and the

Lei ¡

Needs

and

I¡tcrcrs Survey. Ailer ideniifying interests

in kccpnrg

$itL

E

personal

needs.

Allison

$1)uld cxflorc inlirÍnalion regarding cor¡¡runi.r

and

rccrc¿Lir)n ccntres. and

other resources.

Allison

ñould also

usc

weekends

¡nd

eyenings to

call

and obrain

inl¡:,mralion

abou

drose

th¡¡

nighl

be

appropriate

from

her

point

ol

vicw.

As wcll.,\llison

plan¡ed::

máke

usc

ol lhe nusic room daiiy o

practise wilh ibc

irstrumcnls ¡n.i ::

Chapter

7:

Vig¡et -

:ra-b

[rg

Stat

I

l

I

i\

rul,

162



-

par¡icipate

in

an

ntco¡ri¡g

musical

and social

cvcnt

xs a

¡reans

oI using

her srcnglhs ro

overcome t¡ars

about

rcconnccting

with

others.

Stage

#6: lmptement

Ptans

through

Occupation

The

plan

thal

was dcleloped

m

ptulnership

srrh Allisr)n was c¡ried

our.

Using role playing

¡o addrcss occufational pedomrance

issues relared ro

selfes¡eemi usi¡g clcáring. thoughl

stopprng and

creative worying in

occupations thar

f¡¡1)ked

stresst and

coÍrplellng

a

llJi

scütt

in

rhc

Litest)les

Group

¡re some

speciiic exanples of

the occupalions Aliison

and the

occupadonal

therapis

utilized

¡o reach the

t¡rgelcd

outconrcs.

^ttenlion

to

turlos€ful

occupatio¡ is of utmosl imp.)rlance in this strgc ln

Allison's casc, choosi¡g

meaninglul occupalions lbr

productivit

r¡d

lcisure

las emphasized.

Stage

#7: Evatuate

Occupationa[

Performance Outcomes

Ev¡hratioD

$,ith Allison

look

place

approiinr¡tcly ft)ur wccks lfter

she

se¡

her

original

go¡ls.

Arcpexl

use

ofthe COPNI cnabled comparison

of

Peúornance I

and

Sadsl¡ction I rvith Perlo¡nance

II ¡nd Sarisl¡crion II

Occupational

Performance

lssue #1:

personal

hygiene

Pei{ormance

I Poformance

U

Over-attention to

Satisfaction

I

Sátisfaction

II

t1

The¡e

*as

a

50r'. n¡frovernent in

Allison

commented on mccting her go¡ls:

''I

aúrall-t.l l

"tary' "¡orc

¡ha

the three Though¡

Recods

tar

I

l¡dtl

\¿t

as

n\

Roal

7h.|

helpul

nte ¡o

u"de^t¿

¿ rhar I

vas

re.tLlJ

h.1r¿

on

"L\t¿Ll

I wa

litins

otom.r,.loútg

ofhng

a .l tt¿k¡118

n\self

o

t

.t trying

an\thing. I

feh

¡hú

rhe

o l\ nli'tg t had

l.Ji

ttus

,r.\

app(afttrce an¿ ttu¡t úas d?reriotutittg

lhc

Ihought

Reúnls

gare

h1.

the únli¿en.e d ¿ tnotiraf¡on to

tt.\' acti\,¡tíes rhat

I hrkl

beú

trun¡ing

to ttl. What

Snod

Ji.edb.1(k

Lt

)ir¡s

¡o

b¿

.tt¡it. usai

pertoÍnancc

and ¡ 60t

nlprcrenrenl

in

:nabting

Occupation:

An

occupationat Therapy Perspective

163



occupationaI

Performance

lssue

career

futufe

and

Possibte

career

Performan.e

I

Performance

II

#2t

lndecision

about

change

Satisfaction

I

Satisfaction

II

l3

Ther.

*¡s ¿

20%

imprLr\ctlent

t'r

pc¡hmance

and ¡

l0%

inprolemcnt

L'

\

J

i

{,

Itr

the

client

s

wordsl

''''',;-

'.,,.

p .tt -1

^|

., It t

.,

^

d'

r-P

|'

',,,,,r,

..

1.,

r,t.,

.

o1

rLlt¡ars

tortsls

\hi.:h

nú\

b' b¿

tJiL¡ÚL

an¿

Plú

tu

'r

'r'

¿¡

¡r:

tt|t.. t

tlt

b

.,.' . . t ' .,,t

t

t

'

'1,)',

"i,rr'¡;,1t¡,'

-".

M\

Ptd

s

ta

r

'^

Thoutht

R'conl'

¿l

skrnüet

t.)

gt¡ ,E i¡

rood

sho't

l'r

¿oi|lg

n1¡s

occupationat

Performance

lssue

#3:

Participation

i-

oiJ'o"t

pf,vt¡."f

and

sociat

occupations

has

subsided

Pc.tormxncc

I

Pertbrnunce

ll

Sátisf¡ction

I Satisfaction

Il

28

Ph sical

xnd

soci¡l

(l¿isurc)

occufxrLons

shosed

¡

40'l¡ LnP'olcnrenr

t.rr

'("r

",'0

'no'

'

í:\

I

lj'

,,)

i

PI r,:t

-

',',,t

..,.r. tt.

/

-

¡11 '-

d

t'

I

,¡,¡x,t

r

,i,¡

b¿"¿.

"autiatl

n¿¡t

¡tttk

Pk\¡n

vtl¡:\hatl

t ¿''

.",. .t."'.

1¡

",

;,..

.,- ./

.t

I,

,,,tltr

pL"n'e,t

Th¿t.r.ft.1k'tf

p¿ollt

nt\ a1e

fht¡ \tasd

¡

l.^,

.

.

..

'",."

.,.,,,',,

t

t

^

f

i '

t

tJ

lf

a,ut

".r

tl^"

a t-

l

',t.,,

,,,

il,"

"",",

ónce

I

got

¡¡oury

t

rtnLtntbcrcLl

thaL

an'

nJ

t;

'

1",¿

^.*.'

t,"^

'n"

,ntsital

group

I

rcet

to

ttt¡r'¿l

ri¡¡

1iL'-:

164

Chapter

7,

Vlgne:=



the arca.

I

called

h¿t parenrs

onl rhet

connecte.t rte wíth

het d?ain.

Iye

rc

Eoing

tu rry

ro get

sane people

toge¡het

ev\

no\r

d

dthenfo¡

a

jant

sessíon.

I

donl hde the

tine ta

wat-r

about

nt

appearance

arynorc,

people

wíLL hare

to

take

E d,

I

an_,

-4ft€r completing conracr

wirh

occuparionat rbcrapy.

Allison

wrote

a nore

to

the occutxlional

therapisr:

"IJn h:au,"

sot

ry

I

"Ltsse¿

)au,

m)

ttane

teaws at 2:

l0

so

I had r.

IeaNe

4

l2:A0. I tNa

t.d

ro

sar

rhank

\o

fot

a

vut

hclp,

yu

shore 1

nE sone

th¡ngs

I redb needed

to see

& I

hope

that

I La

put

fhent

into

prdcÍíce

so

that I

n.wrJ¿eL

rhu

\ut

again.

tt,sgaingr.

útke a lot

of

Nín

b

ge¡

trc but

-

the

neslage is

Do,

Donj

rhink

so

nüch. Anr||q,,

rhank

)ru

dgain

An¿ nqúe t'll

s¿e

fou

sonetilne

in

Lút.

Take

carc

S¡ncerelf, Allison

klLnnl

clíent

messose)

VIGNETTE

#3:

CHILD lN

THE

COMMUNTTY

Scenario

An

occupaLional

iherapisr ü'ho worked tor

a

Home

Ca.c

agency

¡eccilcd

a

¡equesl to rvork with

a

9

year

old boy who

had acqujrcd

a

brain injury in

a

hit and rün car

accidenL.

The

refeÍat ca¡re

from

a

locat childre¡

s

rehabilil¡tion

facility

whcre

the

chitd h¡d

received

jnparicrt

rehabiljrarion

for 2

months.

Stage

#1: Name,

Val¡date

and

prioritize

Occupat¡onat

Performance

lssues

The occupalional

ihcr¡pis

contaclcd

rhe

childs mother

ro set up an

injtial

appoinlmen .

Thc morher

explaincd

rhat

she

would

be

rhe

prtmary

cont¡ct

sincc

she

was

responsible

to¡ rhc

family

s

child care

and

homc

¡nán¡gemerr

¡deds. Since

rhe

child coutd

nol

p¡rricipare

¿clivcly

in

rhe

screening

Nsessme¡r,

the

childs

mother

was

inrcrliewed io

name.

vali.hrc

and

priüiti/e

lhe occuprrional

perlomance

issr¡cs. The

most

imforlanr

occupational perfbrnance

issues

for

rhe

chitrt. rhar were

namcd and

valid¡tcd

by the morher

úere:

child:

.

Diliiculty

man¿ging

dressjng and

bathing ¡crivities,

and

f¿rlicipating

in play

activilics, in

a sate

man¡eri

.

U¡abie

to conrnunicare

nccds

re occuparions effectivcty

ro family

membcrs and

caregilcrsi

.

Unablc

o

paÍicip¡tc

successfully in

school and o.g¿Dized

rccreational

acri i ies.

Whjle

all ollhese

jssues

were

impo¡tálr.

lhe fi¡st isstlc, which plac.d

rhe

child and his

siblings

ár risk. was

mosr urgent

to

address

fron rhe

rnorhers

perspccrive.

During rhe

inre¡vicw it

became app¿rent

lhar thc

chitd\

ltr

Enabting

Occupat¡on:

An

Occupational

fherapy

perspeaüve

76s



\

']

,l ,

..t,

"

nxfhcr

had oc.upaiional

t.rli)nn¡nce

issucs

olher own

that

lvere

rclevanl

¡o

b€r sons

carc.

She named

dnd

valid¡1ed

rhcse

as:

Mother:

'

I

am

unable

to

hclp rny son

m

thc

$a)' I Bould lik.

to

i

'

'l have

dilircully

n]ainttinlns

org¡nizatio¡

of frnilv

aclilrrics

:

.

i can't adloc.tLc

l¡r

rny son

s

needs"

'lhc

Ho¡re

Care agency

had identificd

Lhc child

{s lhe

pri¡urv client

U\c

though

the occut¡tional

therltir

considcrcd

the

nrothcr

as

the

sccoDdary

clicnr. her

rolc in rhe ther¡pcutic

frrccss

was

recognized

$

crucial

in

prcridr¡g

an

.nviron¡rent

which en¡blcd

occnfation

l¡r

ihc

child.

The

occuparionaL

¡hcrapif

was dwarc

¡l]nt

üe

¡nodrcr

$ars

not

lol]nellr

recognircd.

or refercd

to

as

¡

clicnr'b,v thc

Hüne Cer'

ageic\

In Ibis

ignelle,

thc

agency

wxs idcn¡ified

as

thc

third

clicni beL:a¡sc

lhe

occutxlional

lh.rapif

had

entcrcd in¡o

r

coDLraclu¡l

{grcc¡rent

wilh lhe

ag.nc]

lrJ

provi¡le

occufation¡l

lherafy

scrv"

ec

r. lls .li¿nt. thc child

Stage

#2r

Select

Theoreticat

Approach(es)

The

client

ccnlred Crnadian Nlodel

01

Occupa¡ioD¡l

PednrmáDce

$ns

u"'

to

guide

hc

Occupalional

Perlorm¡ncc

Prr,cess.

Psycho emoLion¿l

afproaches

\rere

ide¡tilicd ¿s

valuxble in ¡ssessing

llre

rictors

dr¿

$crc

conlrrbuting

to th.

occulaiion¡l

p.rlonnanc.

issues

ol

thc child and

rhc

nrother.

For thc

chilcl,

neuro

dcvelopmentll

and

behariou.al

rtproaches

$crc als., us..l.

Envtronmcnral

¡pproachcs

guided thc ¡ssessmcDL

and

fl¡Dning

reletcd

Io sality

issues.

stage

#3r ldentiry

occupationa[

PeÍormance

Components

and

Env¡ronmentat Conditions

Obs.B¡lron

of bch¿\'iour

an.l

pc¡lor¡r¡nc.

ol activiLics

chosen

bv lhe

chilLL int¡

¡¡tion iior¡

th.

noLher

regarding her

reccnl

observ¡tions

ns

rcll

as

|er

rccollectio¡

of prc

accident

bch¡vioutfcrtb¡m¡nce.

xnd

¿

homc assess¡cnl

úere thc mctlrods

trs.d Based.n

these

asscs{lr.nl

finLlings it

$¡s elrdent

th¿t lomral

essessmcn¡

of

cognitile

¡nd

thvsical

function

could

not oc.ur,

givcn lhe child

s

\cr limitc¡l

auentiur

stan.

distrn.ribiltl,

imfulsrvtty- his

inxbiliil

Io

initiatc

and

complele specilic

.

tre

l.J,

\'

.Jl'r'., l..L

\

-\lthough

lhc

childs

p¡rlicipalion

in

occLrpaljons

$rggested

a

salisi¡cL'¡l

rcturn of

fhlsical

rrength

and

fine

mot.rr con¡

ol.

some

froblc¡rs

lverc

obscrvcd

in

gross

motor

cooÍlinaljon

xnd balance.

He had

sul{lciert lif¿

morn

skills to

nr.tn¡ge self

fcc.ling anrl

loil.ting.

and

was

spontancousll'

but inconsi\Lcnlly,

.rhl.

lo nanage

)mc

componcnls

ofdr.$rnS

¡nd

bathing

Verbrl an.lphysicel fronpting/dirccrion $erc

olien

requi¡jd

rc

rniijate

anLl conrtletc

scll

care

lisks

s ch ¡s dr.ssrng

and

bathing

Gcnerally.

hc

was

l)erccivcd

Io be

-hltcr¡clile

¡nd

his

beh¡viour

illri

"\

lil

.

t

,)

166

Chapter

7:

Mgnettes



_______

ll:",,_:",:

:,:

rll

"d

by

rhe

no,her

s,rn

re,,er

,o,

2.¿

h^1,

pe,

od.

, ,,

(r

u¡re(

¡

s

Eeh

trom

e\renJpd

irnit\

.,,

I

H,,,ne

Supfor w;rk,

r

he.chrtd

,

nep

ir ¡er

"a,

nor

,ecn

"

¡rí

rhe

t-rnrt.¡.

ne

ua"

rrety

avdihb

e

rñ

d.si.t

¡t

home

b.rJu,e

or tx.

in,ot cment

rn

üre

lJm,n

.

J.rj\,'ie.,hJr.{e,-

rece,..,

.

*pp",,,r,",,_,1i.-"_"

*,r"i,.'l.

o ¡ger

ren.te

.rb'.n,

terdeü

ro

.ho$

he.irün.y

ros

r

their

b¡olher

á\

¡r.

uggreíhe

hehrv.urrufr,r

rr,¡.u¡¿

¡,,.fn

The

re¡ures

0,,¡e

ru"

srore)

ldm¡jy Iome

conll,bl."d

ro

conccrn.

Jbour

rhe.hild,

urery.

h-.,s,"..

rng rt€

r

hrtJ. rhe

o. cup-uunrt

,her¿pr.,

wd,

jb.e

ro

ob.en

e

rhe

,¡,oLner

rn

(tuep,\rng

siruJr,^n..

lhc.e

ob.cad|lor.

*"*,,

.".

,,,;

he

Home

Süppof

Worker

and

rhe

mofte¡\

answe¡s

to

queslions

conLibured

ro

the

iden¡jfica¡ion

ol factors

rha¡

we.e

ljmiting

the

morher,s

occupalionat

peffomnnce.

Iheo.cJpdrion.t

therdfr.r,

dnlt).i\

or

rhe

J5.és.¡,enr

tjndrng\

rJentitjed

Ine

oc.

up"l.o¡JI

per.or¡

Jnce

.rrnpñncn,\

¿nd

en\

iro"..n.,,

.on¿,,,o.r_

rha

w\re

ronlrihu

ng

to,retr

e¡l.o,

rhc

"ccupdrionrr

pcrtom,nce

is,ues

tor

rhe

chrld

rnd

rhe

moth

Childl

Drr,i.

urry

mrn"brng

ür-*,ng.

b:¡t,irÍ.

c¡o

pt1l.

rn

d

.dtc

rndnne",

rc,arr

d

.

difficukies

wi¡h

grcss

moror

coordination

and

batance;

'

gg

e...\e

irnput\i\e

'.eh.r,rour,a

bá

.

r,;i.¡"

""pp,i,,_"

p;ñ;ffi;,ilil,::ff,fflililiiiill;

optjmat

occupalional

pe.formance:

'

d:lfr.ui,l

1r.1di1sro/ti,t,osrngin,r¡ucrron,

Unablc

to commu¡ic¡te

his

needs

effectivety

ro

iamily

nembcrs

and

ca¡egivers,

related

to:

'

insuffrcicnt

concenrration

ro

iisLen

and

respond

to

questio¡sa

.

inability

ro o.ganjze

and

extress

thoughts.

Urdhle ro

pJflr.

ip.

e

,n ,.

hoñt

and

o.gari/ed

rc.

re,,Ior.,t

r.

,i\

r.ie.,

reldted

ro:

.

;nrb,ii,)

.o

.

on.

en.m,c

r..

mJre

rhxl ,1,

.e.

Jno,i

.

d,.r'1.red

.n

r\en

Inrtdt)

,

nu,dring

envi,onrncnt.,

.

¡eff.

ot

tho\e

inrcmJ.in¡,

s,lh

rne

LJren,.

anJ

drr,r.utr.e.

managing

his

aggressive,

iml,utsjve

oulbursrs.

Mother:

I

Jrn

un"b,e

o

nelD

m\

con

rn

rhr {d\

I

\oLtJ

tr^e

r,...,r"tarcd

r .

'l

Jor

¡

hi\e

Jn\

Int

.n

drion

"bou,

whJr

I

rJn

do

ir

n,,mc

ro

be.L

-

hrrp ¡n) ,on lo,.k

:rfie¡

hrmsetr

ánJ

ptl)

ü

h

oJlc^,.i

'

rJ.(

oJ

llm¡roc,.e,^r

h,rr.,n

rlrJJ

r..n

t,,¿tJoth.rh,.rnc

JnJ

fam

jty

responsibjli¡iesi

'

Iack

ofenersy

to

cany

our

rotesi

,

I

feet

complerely

exhausted.

¡

Enabling

Occupat¡on:

An

Occupationat

The-rapy

perspect¡ve

767



hoth

Dh srLallY

rnd

emoLronoll

'

,li,:.'"l.

ir'''.."

',

.*";.''"r"'

'

"

r"J

':rce

h

i'i,L',t"¿

",,'.*"*

*.""ing

hc'

nuúrcrous

Fsponsibiliries

ül

)

D1f

r'.uxv,niallTjilii

:, :e1Ji:il::."ii1T:':iJili::":1il;':,':,,,"

.

.

.

lllil"":"'j"j"lnl:1lii

ll

ll',i'illiiliJ,i'"",

'

son

s

u¡Pr'dictable

behallour'

D,,..úr

)

dd.o

"

"

:' i: ::" ;:"1;L'i.."",

.

n".

"",,0.

'

l¡ci

ol

LnL'sleJ c

ot

the

ne¡r$

rr

.

i":,

:1,",,eJrJ,:.ü

l:\t

:"

:.:;.t..;,"J'

l i

:;,i,;:;,

'

l'tr:k ut

knñ$lcdge

¡borrl

shi h

5cr

tlmrl\r

s

he.rlth

in\urrn €

f'l i

InJ:

r''Jr""'"e'nd'."1'

"''-l::.ii

1^.ll

i':;'il

;';l::1.::"'

.l'J:';:"J]"""i:i';"'ii';'

uop

Li'"h'

enviro¡neDi

lor

the

child'

s"1:,io;

llit1

.slr."i{":i

$l

li'j

il'jl;r,:,

I

il

i

"li'],''".1i"

i

ill:.:":'-

;''"";'r

rh'r

sn

rr

\

:i'1"

:;il};

;:.il.;r

¡',.::

l[l.:,;i;l

:,

.',i,

I

I

l:i:'

;"1:,;;i,

i';'

:

;

:i:

rrii,a;

i';;:.;

""0

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":,

:

,;li,:i)

;1"";1..:1",iliil':l:i:'

.'i;r,,.,.

::."Ji,

i

:'

I

.:li'.,ll,

.l;:'

;:l

,nc

,ñ,

h

,.,.¿'."

.:*"'i"-

Ij

ill::

lll'.,1:::,'.

1,"l,il"l

:J'"1:"':.:lir:"'

":':l"l;

;;;

;"j

r""'o'

rli.

.",.,1"

".j"lt

;1,1,13;;'

;

iill

"^:..rl

l1

;.

I

"',

. mnrúnrrl

ph)

sr(11

¡'h

rbilrLatron

Chapter 7:

V

ró8



Stage #5: Negotiate Target Outcomes, Develop

Action Plan

Bccause the

p¡imary

clienl

was not able to comnn¡nicate hls concerns in

a

mex¡ingful, unde¡siandable manner, oulcomes

were ncgotiatcd \rith thc

child s

molhcr

thc

Homc

Support

Worke¡, occupational

ther¿pisi and thc

Home Care agency

wilh ¿ view

ro

ñrccting

thc best inlerests

of

the chjld

xnd 1¡mily.

Because lhe

child

s

behaviour

' ¿is

so

unprcdictable

and

imtulsive,

xnd the

safcry

ofthe

child

and

the

sihlings

rvcrc

conside¡ed

a

risk,

the mother's

lirsl two occupational

pefomr¡ncc

issucs

rclated

to coping

and

n¡nrging

thc l¡mily

were

jdentified

as

the prturily

issues.

All

parljes

agreed

rhat

thcsc larnily coping

issues

as

well as the

child

s

behaviour

(aggressive.

i¡rpulsilc oLrlbursls)

needed

to

be

addressed

bcibre

the

implementation

of

any

plans lor othcr occupational

performance

issucs

could

be efi¡ctive.

fargeted Oútcomes:

Occupational therapy outcomes

de difiicuh

to es¡ablish a1 such

a time.

when

clients

are involved in crisis/rc¡ctive

stages.

Tberefore,

management

of

dre sitüation through thcse

stages

becomes

an

oulcome

in

ilself.

Outcor¡€s specific to

thc

identified

issues

of self

c¿re

and l€isure

occupations

ol lhc

prim¡ry

client were discussed among

lhe

p¡rties,

but

given the Llillicuhy

gathcring

accurale

and

reliable

baseline

infomaLion o¡

lhe

child's occupatlonal

pc¡lbrmance

al the time,

it w¡s mutually dccidcd

1o rclisil

these lssues

alier ihe

more immediate safely

and limily

coping

lssues

were

resolved. Tlereftrc.

thc lirst targeled outcome

was:

Within one

¡ronlh ofrcicral. adequale comnuni¡y and

inslilütionrl

supports

will bc acccsscd

and used

by the mother

(and

family)

to:

.

suppof the Inorher and olher

lamily

nembers

in providmg a

physical

and social hone

entironment tha

will

enable occup¡lion

for

themsclvcs

.ind the child:

.

providc

a saic cnvironnenl for

all lamily membeNi

'

meet üe

immediale

needs ofrhe child

for

a

safc. consistcrt

and

rructured

environmen .

and

daily

rehabiliktbn

serlices;

.

idenlify sl¡alegies

1¡r

the

effeclive

managcmcnl ot

childs

aggressive.

impulsive behaviour

Action Ptans:

.

Facililale

a

short lemr

rcadnission of the child to the children

s

rehabilitation facilily

to addrcss thc immedjate

needs

ofthe

child

as outlinedi

and

to

providc rclicl to üe l¡mily

who.

despjte

com¡runiiy-based

suppo.ts,

wcrc unable to cope,

and

who were

unabie

to

provide

the

supelvision,

structure.

programming

and

rc$urces necded at

this

par{icular

Slage

ol

rccovcry;

.

Prior to rcadüission and

xlLcr discharge home again, request

an

increase

in Home Support

SeNices

1(r

assisl the

i¡¡rily

in

copjng

with the

curent

situarion.

relieve

the

mother

fron

somc ot bcr

rcsponsibililics

so

that

she can

care for her son

and

paficip¡tc in

Enabling occupat¡on:

an

occüpationa[

Therapy Perspect¡ve

169



his rehabililalion.

and

ensure

th¡t

thc

mother

obtains

sutficien

rest

to

functio¡

as

an

effecljve

parent:

lniliale

a

refcral

to the local

hospital b¡sed

social

work

ou -

p¡iicnt deparimcnt

to

assist

the

molh€r i¡

copinga

Providc

infoflnation

and

suggestions

to

both

parents

that

will

enable thcn

1o

p¡ovide

a homc

cnljfonmen

th¿tt

cn¡bles

occupation

for the

chlld

and

family,

and also manage

Lhc childs

Stage

#6: lmptement

Ptans through

Occupation

All refemls

ánd

requests

for scrvices

(and

readnission)

w€rc made

as

f'lanned.

Documentation

was

provided

to úe

Home

C¿r€

agcncy

lo

advocxlc

for a shol

tc¡m readnission

to

the

rehabilitalion

facility

which

would

allo\

the family

supports to be

put in

place.

Docümcntaiion

was

prepered with the

molher's

inpul and copies

provded

for her

Thc occupaional

thcr¡pisr

provided ioioniation and suggestions

to

the

rnolher

and

the

Hone Supporr

Wo¡kc¡ on ways ofenha¡cing

the

child's

occupational

pcrfonnance.

This included: copiDg

str¡legies: behavtuur

managemenli

use

of

support

syslcmsi

activity

choiccs

for

lhe

child;

environmenhl

changes

to

improvc

hoÍre safety;

provision

of a

rooiIL

wilh

few distractionsr

visual

prompts

a¡d

reinforcemcnt;

and

methods

by which

Ihe molher

could nake

her concerns and

firsirations known

to

rhe

appropriale

sources.

Wcekly

sessio¡s

at rhe lamily ho¡nc

took

place

pending re-admission

ofrhe child

io the rehabilii¡tion

f¡cili¡y.

Docu¡rentation

a¡d conmunicatio

followed

profcssional

and

Hone

Care

service

providcr

policies.

Three

weeks aflcr the

plans were

nridaled.

the child's

aggressive behávioü

cscalared 1lr ¡he

point where the rehabilitation

facility

readmj¡ied

the

child

upon the

physician's request.

Aftcr

1-2 weeks. rhe

dccision

was madc

between

thc lanlly and children's

Éhabilitaúon

facili¡y

o refer

thc child ro

a

specializcd

treatmeni c€ntrc

elsewhe¡e.

Since

it

was

aniicipatcd

that ihe

chjlds

lcnglh of

stay

in

thc ccntre would likely

bc

long, Home

C¡re

services

lor lhe child

were completed with rhe

documented

recommendalb¡

fo¡

occupalio¡tl

thcrapy follow

up once the

child

retu¡ned holne.

Stage #7:

Evaluate Occupational

Peformance

Outcomes

Due to the unexpeclcd

carly

conplelion olservices.

all

parts ofta¡geted

outcomcs

were not

achicved. The occupalional

the¡apist

nrade infonnal

conlact

with the mother o

cnsure her understanding

ofthe disch¡rge

and

the

recomnendalion

for later follow

up

with

the fanily

and the child

As

the

prim¡ry

caregiver,

üe

mother was salisficd

that

she

had

rccelved

sufficient

inlormation

and suggesiions that

would

cnable her and

olhcr

iamily menbers

to

get

ready ro

providc

a

mo¡e supportivc

Physical

and

170

Chapter

7:

Vignette5



-

o.irl

homc en\ronmenr

1¡r

occa|¡lion

when

thc chil.t

.cruúred

home

Postscript:

Thc .lienr

cyentu¡1tr

r¿rur¡cd

ro his

honc

alproxnndtely

onc

).ea¡

hrer

\idr

Ho¡re

Carc

¡fd

occupalrcn¡l

¡her.tp),,

tbthw up.

Thc

OccrpdLton¡l

PerliD¡¡ncc

Process

resumcd

Sincc rhe

family

repo¡rcLt

.onsi¡tcrablc

rmt(¡eincnr

in

úc

chjld

s

occuparional

pcrf.trmancc

dnd

rhcn

oe.n

xbitl¡r

I.

ce

,1-

i,.. rtrr1..,

'.,r.

.t,-

r,

...

scrri.es

lo lir

clicnts'nec¡ls,

r

decism

was

¡r¡de

to¡

rhc

o.cutlti¡n¿l

Lhcrlpisr

to

be

ayaitxbte

on ¡

co¡sulriDs

basil

for

the child.

iinilv

an.j

.lc.h.

.,1

r,..rr

-onr

,,1 I

rhe

torai

reh¡bilir¡tion

pr)cess

Uton

conctusion

ot.Ltr.

consutrins

,,.r

....r.,.,t"

r,

.

"r.,t.

,.r.r

.

t¡r.n,tc

to,.rJr(.

.e.

but indic¡red

lh¡t

she

i$ frurrlted

bl

ttre

inilial ta.k

of coodin¡rion

beii .cn

rehabitirxrion

lacilil

and

col¡mu¡i¡ -b¡scd

seniccs

Il

, es

¡fparenl

lh¡t

dre

scn

jcc

cnri¡onmcnt

¿¡d

rhe

socjelat

conle¡t

úunding)

constf¡ined

lhe

Oc. parron¡l

l)erJ.,mance

process

\yittr

rhe

clicnrs i\;

Chaprcr

5t.

VIGNETTE

#4:

BOARD

OF

A

REUGTOUS

ORGANTZATTON

Scenario

'l

he Board

of

Diredo¡s

of

a

rcligious

orga¡ization

conl¡ctcd

¿¡

oúcupalion¡l

tberatjst

wjrh

a

requcst

to

assisr

rhe

orginjzalion

wrü

jrs

Ba

.r

Free campaign

Stage

#1:

Name,

Validate

and

prior¡tize

Occupationat

Performance

lssues

t he

occutali.inxl

rheratisr

¡uc¡ded

Lhc

nerr meeting

oi

rhe

Bo¡rd

uhcre

he

e\pl¿ined

rhe

siagcs

ofhis

to¡enri¡l

in\ol .menr

güided

br

''

'o,

J..h,,

)..e.,

I.

J

tro.,.,ntr.,i

i,,,..

Pro.ess.

The

occufarion¡l

rhcr¡tir

rccomrnendcd

a

selcral,sragc

conrdci

which

úc Board

apNro\cd.

Ar

a

second

me¿ünc

with

rh. Boa¡Jot

Directors,

dre

occupa¡ionat

iherafisr

lacilitared

a

round

lable

disculsion

lo

rl.,'r

"^..,.t-r or'L,.rt

,

,..

..re\..

\le.r

D.r.

-..,

no. , 1

.urllnc¡l

their

ideas

i¡r inrptcmen¡ing

rheü

B¡rrier

Frcc carnpai n

ro m.er

,l

n.ed.

I

-nb..¡r.n1,b

r) trn,dri.{

B\,te..

t.,r

tl(

r,..riii

rn.

"..rt

,ri^.d.

Ler.p.r

,,.,1..,r

,,.Jr

-B.r-

l.

^n.

.l

.,rnu

il

r)

,r tp

,

ri

tt.,r...

.n B.Jr

.,J

ná¡red

onc occupari{rnat

pofo¡nance

rssucr

acru¿l

or

Dorenrill

b¡ni.rs ro

'

I'lJr

, d

"

_1"

fJr'

.

|

.on,,

re,..i,hit

.

_

"

ducalrcnal

p¡ograürncs

at

th..eligjous

ce¡rc.

Stage

#2:

Select Theoreticat Approach(es)

'lhe

ciicnl

cenrr.d

Can¡di¡n

N{odet

of Occup¡rio¡al

pcrtomra¡ce

ras

used

to

guidc

the Oc.up¿ri('rat

pcriorlnanc.

proccss

In

addjrion.

bnnechanjcal

and c¡ ironmcnral

rhcorjes.

a¡d

heatrh

p¡onnfron

aptmachcs

Eunjc.t

¡hc

EnabL¡ng

Occupat¡on:

An O(cupational

Therapy

perspect¡ve

771



a\

ür;

t"l)

identihcalion

of occuprtional

terfomance

compo

en$

and

cnviron

r

Stage

#3:

ldentiry

Occupationat

Performance

Components

Environmental

Conditions

it," o"-p"rin*t

rt'"rapist

survcveri

nembcrs

of

the

rchgious

org¡lizi

to

sce

rvho

rvas

having

difficultv

¡¡IenLling

or

paÍiclpaúrg

in

lrogra

r

Thc

lurpose

lvas

Io

fiül

our:

a)

holv

man)

membcrs

wcre

ha\ing

¿iriicul¡ r

tl

'u¡at

'"cre

thc

banicrs

or ¡easons

ii)r not

a(e¡'li¡g

or

.-ru. o..

'1:

:'no

$r'' Tlsr'r

lre { dl

r'¡lr"

¡o

c

e

l-

n

e

:

;,

;,"

1,,"

o'

''

"

o'''''..¿r'u

\.Jr

"'

rrnerrld:

sho\ed;h¡r

lhe

occupalional

periorm'ince

issue'

aclual

or

por¿ntial

i"r'i-.

,"

-",t¡*t

"u""dance

an'l

parlicif^rion

in thc

woAhip'

soci

^n¿

"¿"."ri"*i

p",gto'"tnes

¡l lhe

religious

ccnlre

was

rclaie'l

lo

thc

rorro"i^g

"..up"tinnor

p"rfom¡ncc

comfonents

an'l

en ironmc¡ral

'

fcar

of

talling

wben

gojns i¡

and

out

of

th'n

hones'

ca¡s

ar

rclign)us

centre:

'

.itlliculty

negotiating

st¡i¡s,

specific¡l]v

üe l2

sr¡irs

ro

entc¡

cenlrc

and

6

rairs

ro drc

wo6hip

ahar:

'

difficulty

rising

f¡oln

scnls

(Fws

a¡d

chairs):

'

inadcquate

spa;e

tur

n'gotiatlng

\v¡lkers

an'l

$treclchairs:

'

lerr

oi incon¡incnce

¡lue

10

long

distances

to the

accessible

wásh(úms:

'

need

bv

pe¡sons

trsing

walkers

and

wheelchairs

tbr

phvsic¡l

assist¡nce

in üsing

washroo'ns:

'

inability

to

procure transport'rtio¡

r' the cenire:

'

lack

oiawreness

of lhc

Volunteer

Drivcr

Programme'

At

rhe

s¿me

linre.

Bo¿trd

rDcnbe¡s

a¡d

volu¡Leer

drivers

at

thc org¡n

wue

^1so

suNcled

They

\ere

usked

their

perccplions

about

actLi¡l

n.teniiál

environmcntal

bxrfjers

Tlis

survcy

revealed

tb¡t:

.

vol,,n¡eer

drilers

f¡lt

üa

ihev

lacked

the

kDowledge

requir

assi\t

mcnbers

with

mobilitv

limitatio¡sl

'

Board

¡rcmbers

lclt

the)'

lacked

the

knowledge

to

prolide

lcrocr'hr¡

n

rn"rr

Br-tr

I- r

'

'no'i-r'

ln

aLltlilion

to

the identiiicalion

ol

thesc

occupalion¡l

pcriolDance

co-pon"nts

an,j

en"i.onrncntal

conditions'

the

occupxtional

therafir

lhtr'15.z

ofthc

membe¡ship

was over

65

vears

ol

age'

Stage

#4:

ldentiry

Strengths

and

Resources

ihc

oc.,pationat

lr'crap;st

identilied

nuncrous

rtrengths

and

re$ur

which coul¡l

assisr

the

Board of Directors in

rcsolling

thc

occupati(

ñr.1.rmxnce

rssue

The.r

rnLluded:

l,e memhcr.nro'',rd

Borrd

I nir"'lor'

I J

'

rr rrr'l

I'rJr.

rn.i

,n

'

or

'1

orrr

'

InP

Brr

cr I

I

c

"rr'

'

Chapter

7:

v¡

a72



-

¡dcquatc sp¡cc lbr

building r¡mlsi

worship, common room

{nd

washunn

arcas

wcrc ¡ll

Iocatcd on

wheelchair

accessible

washrcorns

j

¡ well cstablished iünd

ra¡ing

comnjr¡eei

a

large

pool

ol

d vers

who

were rvail¿rblc in the

VolLrntee¡

Dnvcr

sharcd

spiriru¡l

bclicli

aboul assisring

nembers

in

need.

'l

he

occnfatioMl

thcrapist summarizcd

and

presenred his

fi¡dings

from

these

suNeys in

¡

repon l¡mat th¡l

souki

be undenlandable

1o

dre Board

The

Board

of

Directors discusscd lhc rcpoÍ and developed

a

conract s,idl

the

occup¡tional

theratist to

assist

¡ commiltcc

oflhe

Board in

lonnula¡ing targeted ourcornes

and

develoting.tction

plans.

Stage

#5: Negotiate Targeted Outcomes, Develop

Action Plans

The

occutatioral

thcrapisl facilitatcLl

thc

dcvclopmen¡ of

ta¡geted

outcoDrcs

and

¡crion

plans

wiLh

rhe

commiLle¿ ¿slablished

by lhe

Boad of

Dircclors. In ordcr

ro respond

Io

tbe r¿sults ofthe two

suNeys.

one

ta¡g¿ted

outcoÍr¿

was

deined

as:

all

actual and

potential members ofth.

rcligious organizatlon will

be able to

paficjpale

in any

trogra¡n¡e

of

choice oitered al lhc cenr¡e. C¡i¡eria ofsuccess

were

defined

in

mcasurable. obser ¡ble

ierms.

Iha¡

aclual

and

polential

members

could:

.

achieve

physical

access

to

the are¡s requir.d

to ¡llo\

altendance

¡t their

trograr¡mes

ofchoicc

(c.g.,

¡tlcnding

.rn

educ¿tional

scssion

nrigbt

also

rcquúc

physic¡l

access o

ihe

w¡shrooms)i

'

o....lo' l'.

pdrrripo.ñ

I'rr:. tx'r

.'n)

prcgr¡¡rnrc

ol choicc.

Given

rhc suNcy lindings, thc t¿rgctcd outcomc,

and

the three criieria 1¡r

success,

rccorn¡rendcd action

tlans

nrcludcLll

.

coDslrucrion oIümps

as

an ahcrnarc choice to stairs

at

the

cnl.ancc

lo

lhc

building

and the

ñorship

allari

.

noditrcarion of $,onhip and cornnon rooms o a.comnrodale

¡ais.d scating lor

casc

ol

rising and negoliation of

mobility

aids

such

xs

whcclchxirs

.tnd

walkcrsl

.

exp¡nsion

ofthe

Volunteer Driver

Program

c lnto aVolunrccr

Assislance

Service:

.

devclopncnt of

¡

specialized iraining

program¡re

for ihe

Vol¡nrc.r Assis¡¡n.¿ Servicel

.

pubhcity

ro rncrcasc alvarc¡ess ofthe availability

ofvolunteer

d c$i

'

inclusion

ofmembers

who were experiencing b¡ricrs to

p." pr

ronoli lpl'nn.r .or

n.r.e..

Tb¿ occupational therapist

also

outlined the servi.es

hc

could ollcr

to

nnplement lhis

plan.

The Boaril

olDirectors

discussed

the

Comnritlees

Énabling

occupation:

An Occupat¡onal fherapy Perspective 773



4

t

protosed

plan ol action

a¡rd

vot.d lo proceed

wilh

implemenulion

Fu¡di¡g

was

apfrrvc.l

lbr

the occnfaLional

iherxfist

to:

.

consult

tith the

consüuction

co

rpan,v

r.gardin- acc.ssibililY

slanda¡ds. and

is\ues

relaled

to Lhc ranps

and

raised seatingi

.

tuciliLale d¿velofmcnl

ol

lhe

newly

cf¡blisheLl\¡olun¡eer

Assistrncc

Scrlice Ste.ring

Cortnnitt.c

{wjlh

¡he

srnrc co¡r¡rrli::

mernbeN

who¡r Lhe Bo¿rd

h¿Llmanda¡ed

to

¡lclelol

t¡igclcd

outcorres

and nclioD

flans)i

.

fro\idc

ini¡r¡rition

to üre

Boxrd

ol Directors

r¡nd

coDrnritrccs

..

phlsic¡l accessibilirr',

healthy

xging.

pelfomance

ir¡flicarion

.'

disc¡se

processcs, and

olher

is{rcs relate.l

to üre

targ.tcd

.

.valuate lhe l€lel

oi

success

in

rc¡chr.g

the t¡rgeled ourcoÍre

i:

complcln)n

0f lhe

actioD

tla

s.

stage

#6r lmplement

Plans

through

Occupation

.\. o.

rl.,r ¡.lrl'erJt

r r','r.,e

ed

¡

'ru'pr"'

p(.

eJl

conn¡ct

\ ilh lhe Board

ofDircclors

Stage

#7:

Evaluate Occupationat Performance

Outcomes

Evalu{tion

oflhe

targ.l..l outco¡re

$¡s done

by

re suneying

lh.

t¿rg.r

potulation. i.e.,

the si¡rc melrbers

lvho

sere surveycd

r¡rl1iallv

Thc

occupalional

therapist

asked

questions tha¡

fo.uscLl on

dre

thrcc cnlena

:

nrcccss

Evaluation revealedr

.

85L ol lhe target

populalion

reporcd h¡li¡g

fhvsical

¡cc.ss

1.

thc

relgious

centrc üilng tbe

r¡mp

when volurlcer drivers

\1..:

..\..-

.,ble

: l

rh

|,

r.

lle

1

e

.

85',¡ ol

dre

tlrgcL

topul¡tion

rcfor¡ed haring

thvsic¡l

acc.s\

r.

pdficrpale in

progtnrmes ol dren

choicei

.

oi

thc

85t¡

ilho au.¡dcd

lrogranrs

ol rheir choicc.

601¡

indic:::-

,1.'r

'l

.\

$e.e

.Jr:.

:.J

.

',r

t

,r

1

r,

.

fr.r

r

The

ev¡luarion retoú

frct¡rcd

b)-

ihe

occupa¡ional

thcratisl

oL¡tlined

rl::

largetcd

outco¡re.

lhe

crilcri¡

lbr

succcss.

and

¡he outcones

achiev.d

foUo'ving

nnplemen¡alioD

ol

rhe

action

tl¡ns

He als.

rcconnended

rl:::

Ilre Bo.rrd

ol Di¡ecloN establish

r

cornlnrllcc

\rhrch

ivould

lroride

ongorng

moniro¡nrg,

promotion.

and

clalL¡ation

ol

Lhe Barricr

lrr.c

ca¡rpargn.

ln ¡nticifation

ot a r¡pid Y

¡grng mer¡bcrship.

anoth.r

re.omnen.latjon

lvxs thal lhis commilLcc

¡ddress

thc specrlic

ne.ds oi

seniors.

The

occup¡Lir)nal

therapist

rl$ suggested

lhdl

the

conrmi(c.

erplorc

$hy

15t¿

oflhc

ta¡get

popul¡tion h¿d no

utilized

the nee

Ba-:_

Free

prograrnme. and

ho$

Lhc

cornmittec

could

promorc

g.e¡ter

frnicipatjon

rn¡l s¡rislllcilon

among

membets.

í\

t\

ilri

-¿lI

1,.i

a74

Chapter

7:

V¡gnettes



-

IGNETTE

#5:

LAWYER

Scenario:

An o..ufxti..xl

thempv

gr.iLrp

prllclice:

¡per¡linS on a busin¿ss

¡nod.l.

ú¿s

conlac{ed br

¡ hw}c. Tlrc

c ¡rrrxc¡'¡s lo .r,scss ¡he l¡¡nbihr_} 1¡r

¡

m¡D

rho $¡s onc

oi

thc

l¡$y.rs

cli.nrs t.

c.¡tiDr. hi\ $ork

rs r

drill

hafd

on

rn

oil

rig

the fee

schedLrle

i\as

agreed upon

Stage

#1:

Name,

Validate

and

Prioritize

Occupationa[

Performanre

lssues

Thc

in.li i¡u¡l

ro bc ¡\\.ss.d $¡s

¡

l5

r-.¡r

old nr¡n

\ith

lhre. school

¡s.d

.hildrcn

Thc mrn h¡¡l

r

gfu.lc

j

.du.xrior .tnd ¡n .r¡nual inco¡rc ol

l1i-i6.1)ll0ll0 H. \y¡s i¡t.rdjnS to qtr;t his

job

rs hc

\.Ls

no longcr xhl.

ro

tdera¡e

rhe

pain in

his

righr

shoulder. l¡irer be.k,

r¡d lcJi lcg r.sulti¡S

ironr ¿

¡rotor lehi le

ac.ideJrI

1NI\A).

Withour

a refl ..¡r.¡r

in.onr.

ol

si¡rl¡r

w.nh,

he

afd

his l¡n1l)

were

ar

rLsk

oi lollfg

rh.n

nc\ly

furch¡s.d

h.m.

¡nd

rru.k. There rere el$ tdrily r.l¡ri.¡shif \Lr¡irs.

Thc

o..ut¡tior.tl

fcrft¡m¡ncc

i\suc

thrl \¡\ Drmc.l

r¡d alidalcd

b)

lh.

la$rer

ñ¿s: polcnri¡l

in¡bililr- lr, conlinuc

trcscnl

cn)plolrlenl

¡s a

drill

hand

o ¡n

oll rig

The

laÑyer

eeded

ttro

qucslrons

ans{ered

irbour lhrs

orcupalio|¿]

perJ¡ünance

issue: ll How.ap¿ble

\¡

lhe

nnr

rf

sray

fg

in

hrs

p¡esenI

robl

¡fd

2r \har

skrlls

úould

tie usetul

in

seekl.

.rlr.r .nrdo nr.nr Lt

th. mrni

thtsicrl....qniti .

en,l ¡tlciti\c

st¡tus

$d Lh. \ork

cnvircnr¡cn(

frcclu.lcd

:cmainjng

in his

cur.nt.

fh)sic.rllj-

dcm¿¡Jms

Th¿ occupalional lhcr¡pt contrxct \¡ druqn up rrLh dre l¡\yer as thc

tri

r¡rl

clcnt.

The man Lo b. ¡s\c\s.d

\¡s

¡ sccon¡¡ry cli.nt in lh¡t

hc

\xs

lhc l¡$

ycis

.licnr. Thc .ontr¡.r n¡s to

tro\

idc

a

wri(l.D rcf

orL

to th.

l¡$\cr I(

$us

c\fc.tcd that thc rcfori $r)ul¡l

dcLdil

rssessncnl rcsults thrl

could

be detended

in

¡

court

01

1a\'. No

¡cLion

pl¡ns

beyond thc

¡ssesrnerl

trere

discusscd.

Stage

#2:

Select Theoretical Approach(es)

Thc ¡ttror.h rr¡s clic¡t

entfed

ir

nreeting

rh€

l.gul

inJi¡¡rrio.

¡c.ds

oi

dre l¡wyer. and in

respe.¡ing lhe ¡r¡n s

needs r¡d

sirurrio¡

duri¡f

rhe

¡ssesrnen¡. The

Canadr¡n

N{od.l of Occup¡tional Pertirlrrla¡ce

pIo\1ded

rhe conceplu¡l li¡ r.$'ork lor th. ¡ssess¡nent. A bio¡rechan cal ¡tpro¡ch

and

pstcho

emotion¡ll ¡tpr)¿.hcs

sur.led

rh¿

¡-\sess¡renl of dre

oc.ufalron¡l

pcrl¡mr¡¡c.

conr¡nrcnts ¡nd cn i¡l nent¡l conditions dul

vcr. inllucn.in. th. nrr¡s

olcufalionrl

crftmr¡ncc

aL $ork.

:nabL¡ng Occupation:

An

OccupationaL

Therapy Perspect¡ve

175



\

t,

,¡

r

j

:'

L

Stage

#3: ldentify

Occupational

Performance

ComponenG

and

Env¡ronmental

conditions

Wirh üe

h$y.r

as

thc

lrrmary

client. ¡

major

consideratrcn

in

as 'ssmen¡

was rhc legxl

cnli¡o¡mcnt

The

l.twler

l o rded

r¡luable

mlorrnation

b)

sharr¡g

medic¡l

rccords.

s.hool ¡¡d

work hisLories,

a¡d

ollrer

dat¡ 1hc

occup¡li¡n¡l

lhelapist

adbere¡l

Lo the

arnadi¿n

Assocjarion

ol

Oc.up¡lio¡rl

Therapisr'

and

p¡o\incial

Codcs of

ELhics

bv

discussing

inlomr¡lion

.nly

wiih

rhc

r¡n

xnd his

h$r'cr

Pen¡isvon

w¡s

sought

lo

cortacr

the

m¡n

s

wife {nd er¡lLo)cr

Io

gtin addition¿l

i¡foErari'¡

on hi

0c.ntxlio¡xl

te¡lonn¡D..

Wilh

thc secon¡l¡rJ-

li.nl

(ihe

m¡nJ, th.

tucus

'f

¡ssess¡r'nL

w¡s

'n

idcnliflmg

lhe

pcrtormancc

comf.ncn¡s

a¡,1

e¡Yir(Nren¡¡l

collditions

lh:'

wcre

atlccling

th.

nr¡n\

rhility to

coD¡nLre

his

present

'rnplor'nlen¡

Asses mcnI

i¡clu¡l.d

¡llecti\e.

cognitire.

a¡d

phlsicxl

co¡rpo¡cnls

¡s

$cll ¡s

üre

¡ren s

ecofor¡i.

ler¡],

rnd soci¡1

cn ¡onnrc¡t

Asscss¡re¡r

g¡lh.rc.tqurlit¡Live

anil

qu¡n¡itrtivc inl¡

¡aLion b)

using

sinn¡l¡¡ed

wo¡l:

¡i¡uaLions

¡nrl seni

strucluled

inrcr¡c¡io$

\ilh th'

m¿n

lhe m'ln

anclllr'

wilc

$er. rlso

asked

Lo

r¿Ie

fxDrilY

sl¡ein

t hl.h

' {s

high'

The emllo}':

wrs

¡ske¡l

to

cl¿rify ofrr.iIIs

lor

nakr¡.{ iob

¡c..mnodations 'A¡rl sis

r:

11 llnLlinlrs

nroeed

drai

lhe o.cuf¡tion¡lterformance

isstrc

polenri¡l

''\,.r"

l

'r¡

r''

'n

i

.

I

¡m not sleefing

$ell

bccruse

.l

l¡in

¡nd

¡nxiety

orer

rlre

r¡¡¡ill hnan..s

50

am

b¡rcLy abl.lo

conccnúa¡e

xr

*o'k

i

.

inirabrlirv Ic

his

pairrr

inrc.JercLl

silh

his abililY

to

*ork

wnh

othe.s o¡

th. úgs:

'

rjsk

ol

atldirx)nal

physicdl

iniurics

His

¡nriclv o\cr

his

fa¡¡il'

'

fin¡Dces

drc\'c

hirn to

.onrinue

lvorking

helond s¡fe

producti\

r:

levcls,

pl¡cing him at

risk

lh)si.allr-

c¿ch

time

h¿

*orked

a

d] :

.

incll¡clilen.ss

o1

pain m¡nagement

rrategics

in

rcducmg

pri¡

.luri¡g

hvsic¡lly

derndnding

v.rki

'

modilyr¡g

his

present

iob

Io

rcdu.c his

l¡in

(as

not

Possibl'

Si¡cc

rlr.s.

lmdlngs

indicaled

thrt cf¡rtlnring

enrflov

re¡t

in liis

tres€r:

phtsic¡lly

d.m¿Dltr¡rg

job

\ould

nor

b. 1¡r\iblc

or

wisc.

rlre

'¡¡n

Í¡s

¡::

aS¡i¡

to crplorc

his careelwork

inrer.sG.

and

ro rlentiü

skilli,

.ducation¡l

opporrLrrrties

¡n¡i ¡rcllrods

LI

I

$1

ld be usclul

in

ieeknrg

olher.ntloy¡r.nr'

stage

#4:

ldentiñ/

Strengths

and

Resources

'lh.

lawyei

s cxse ¡l.Inig.Ine|t

tr-lc

rndicrLed

th¡i

hc recognirc'l

dre

¡il

nced to

he

producrr\e

r¡úcr

üran Io bc

merelr'

.o

rpe¡s

cd ior

er¡flo,Yn.nl

losses. Thc

¡]a¡

s

strcngtbs

rnll

res'ur"s

$erc his

conr¡ntrnenl

rr)

being a

lully corüihrling

¡rcnhcr

of lhc

ng

cres

ll'

_

xlso

d.drcaled

to thc

well

b.mg

a

d

ñ¡rncr¡l

s.cn.ir)

of

his $1te

¿nd

1¡¡ril,v

lr)

t'i

/

776

Chapter

7:

Vigner.=



Stage #5t Negotiate

Targeted

Outcomes,

Develop Action Plans

The lawler'\

targctcLl ouLcomc was lo h¡vc á

del¡¡sible oprnlon

on

lris

clients oclupario¡¡l

perlonnancc ¡r thc

lbm

ol a

¡cporl

tbat

would

be

acccpt¡ble in

a

leg¡l ervironmenl. Actron

plans

rclatcd

lo rhis

oulcomc

lvere

Lhnt

thc occupadon¡l drcrapist

would

integrale and synthesize lhe

varied

assessmenl findjrg and

recomnrcndarions,

and

write the reporl

Stage

#6:

lmplement

Ptans

Through occupation

JnrplemenratioD

inrolv.d

complclion

oflhe conract

with thc

frim¡.y

clienr

who.

in

this situalion.

was lhe

lawye¡.

Ihe

occupational thcrapist

prepared an

Occupationxl Praiilc oflhe

man based

on

thc

asscssr¡cDl

findings.

The retoft fomr¡L {nd

content

\ere

organized

to suii

thc

adversarial

nature

ofcivil

litig¿tion. The occupation¡l

iherrfi(

freprrcd

thc

rcpof, anricipaling

the

need

to dcl¡n¡l its contenls in

a

court

of law.

Th¿

report

highlighted thc occupational

pcrl¡rnance

issue

for

lhe ma¡,

and addressed

thc two

qucfions

posed

bt ihe lawyer

(could

the man

-qo

back to wo.k? if nol.

wha

else could

he

dol)

Ihe

analysis

oi

thc

occupational

pelfofln¡n.e componenls rnd environmc¡lal conditions

idcntili¿d

i¡

Stxge

#:l güided

the

o.cutation¡l

thcrapist in answering

these

A

pre-¡rial meeting $¡s held

betrveen

rhc lawyer and the assesnnent ¡ea¡r.

which included

the o.cupational therrpist ¡nd

a

vocalioul pstchologist.

The

nran s

Occupation¡l

Profilc

w¡r

submj¡ted

to ihc

lawyci

Thc l¡$,ycr

nsed

thc infomution

to

prepare

a

t'inancial

cl¡im

ln

rhis stage,

as

nr

earlier

fages,

th.

occuparion¿l

tlrerapir

was

an

ad ocate

for the

¡rxn

s needs. elen

though lhe man was aclually

tlre

la\. Jers client.

Recomnendaiions wcrc mxdc

lo

lhc

lawyer

lb¡ ftrlure

c¡\.ironrnenlal

assessmenl

ofthe man

homc,

and

ftrr explor¡tion

of

opportunities

for educalional

upgradins

ancl

aptrcnticcship tr¡ining.

No

olher hrget.d

outcomes

or

aclion pl¡Ds

for

lhe

occr¡pational therapis

to

work

dire.lly

with

thc

scconddr- clienl.

rhe

injured man. rlere

developed

in this con¡r¡cl.

Stage

#7:

Evaluate Occupational Performance

Outcomes

Thc oulcomc of occrpaiional therapy serljces

ú¡s

thc

wrilrng of an

OccufxLioDal

Prolilc rcpo¡t 1¡r

use

by

¡he

laúter

ii prct¡ring

a

lcgal

otini{rn.

Thc Occutatbnxl Prolilc \\'as occupa¡ion

fr)cuscd and clicnL

cenlfed

in

thrt

it

documcntcd

thc

occupalional

perfomxDcc issuc, lhc

occupation l

Frfon¡¡nce.o¡rpo¡cnts

¡nd

enviroDmentxl

condiLi.¡s

contributing

to dre

prioritized

occup¿tional

pcrfonnance

issue,

j.e.,

ihe

man s

polentral

inabilil) ¡o conlinue

presen

e¡rployncnt

as

a

drill

band on

an

oil

rjs.

Onc

qL¡cstion

aboul the elTecliveness

of

lhe

Oc.ufaLional

Protilc ln

mcctiDg

¡hc

l¡wye¡s

needs was:

What

elTect did lhe

Occut.irioD.il

Prolilc

Enabting

Occupat¡on:

An

occupational

Therapy

Perspective

177



h

\.

ui

th€

ILw\(r'.

.uLris(

in

rrsou-rrrLri

th

.

tu,

rt.

rht

ti['

n¡

tht'

\

r-]ncit{

rre

\¡r

lL

¡n

out

oi-couÍ

settlclllenll

1l

open

aficr

rhree

)enrs

ol

Thc.e

$¡(

Di

.ralnation

of

Lhe

n)an

s

s¡tisfrcllon

viLh ¡hc

o'cupllionxl

,

",."'.i";.

"Lr"r

o

e'

r'''

,.i".,,

'r'r'rr''r''

i",,i.","",

i''",,,

'""*t

^nd

¡

r¡ial

'lat'

se¡'

IIre

olculari'{rxl

thcrapisr

.',;:

i'.oLpr,

o-rn'I

r5i

ne'

rn-'JLi

L"'r

:

-

,.,'

"

";,";'";,.'

o

Ji,.,,n,

n\

ur

"'

I r"

P'

"

¡

\'

l,'

.'

."'.1

"'

,r.'1.r.,4

re'r

níi\

tr)

. ¡f

I

l,J

)

Chapter

7:

vignettes

a78

law. enabling occupation chapter seven

Documents