occupation-based approach in post acute care · 2013-06-04 · occupation-based practice: fostering...
TRANSCRIPT
An Occupation-Based Approachin Postacute Care
to Support Productive Aging
Lesson 5
Supports and Challenges
to the Occupation-Based Approach
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Lesson Focus
1. Identify issues that support your ability to use the occupation-based approach.
2. Identify ways to manage the issues that challenge your ability to use the occupation-based approach.
Supports
Challenges
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Pause the CD, and review your responses for Step 4 of the Practice Inventory on Worksheet 3.1.
Review Your Supports and Challenges
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Occupation-Based
ApproachPeople
Administration
Documentation
SpaceSupplies and Equipment
Caseload
Time
Reimbursement
Issues That Can Be Supports and Challenges
ChallengesSupports
(Chisholm, Dolhi, & Schreiber, 2000, 2004)4Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal
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Helpful Hints
Be open-minded.
Be aware that change requires planning.
Be familiar with and use the evidence(Hermann et al., 2010; Hoppe, Kopp-Miller, & Rice, 2008; Schroeder-Oxer & Kopp-Miller, 2001; Nelson et al., 1996;
Zimmerer-Branum & Nelson, 1995).
ChallengesSupports
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People
Three subcategories:
1. Intradisciplinary team (occupational therapy team)
2. Interdisciplinary team
3. New staff.
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People: Intradisciplinary Team
The occupational therapy team includes You and Your coworkers.
To promote a cohesive view of the occupation-based approach, the team can Develop a department mission, philosophy, and values
and Bring in an outside perspective.
It is important for the team to embrace the occupation-based approach as the standard of care.
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People: Interdisciplinary Team
The interdisciplinary team includes the occupational therapy team, other health professionals, and the client/family.
To help other members of the interdisciplinary team understand the role of occupational therapy, therapists should Remember that we are responsible for educating the
team, Incorporate the language of the Framework when
explaining occupational therapy services, and Use terminology that matches the background of the
person and the situation.
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People: Interdisciplinary Team (cont.)
To help other health professionals understand occupational therapy, the therapist can Orient all new employees and students, Present at grand rounds and journal clubs, Develop an “elevator speech,” Create an occupation-based “OT Month” activity, and Cotreat with another discipline.
To help the client and his or her family understand occupational therapy, the therapist can Develop an occupational profile and Provide relevant examples.
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People: New Staff
If new colleagues (including experienced occupational therapists) are resistant to the occupation-based approach, articulate your reasoning for its use by
Using the Framework and other resources in your toolbox to justify the occupation-based approach,
Modeling the use of the occupation-based approach, and
Seeking out professional networking opportunities.
I have been an OT for a LONG time
We can’t do that here
We have always
done it this way
We don’t do that here
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Administration
Lack of support from administrators may come from a lack of understanding; strategies for educating them include
Sharing the evidence relevant to your setting,
Joining facility committees, and
Measuring outcomes and sharing results.
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Documentation
Improve documentation:
Streamline the process by Focusing on quality versus quantity and Identifying what you need to document, for whom,
and why.
Analyze forms and formats; consider Incorporating terminology of the Framework (Sames,
2010) and Making use of addenda.
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Documentation (cont.)
Documentation should focus on the client’s occupational performance. Goal that doesn’t focus on occupational performance: “Client will
demonstrate a 5-lb. increase in grip strength by discharge.” Goal that does focus on occupational performance: “Client will
increase grip strength in order to independently open containers used in ADLs.”
Ensure that your documentation does not duplicate services of other team members.
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SpaceEvaluate the space where clients are treated:
Analyze where you typically treat clients.
Determine whether the space is being used for the wrong purpose.
Do a “walk through” of your facility to find new treatment space.
Look at space outside of your clinic.
Use outdoor space.
Feeling crowded in your space?
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Supplies and Equipment
Do you have the appropriate tools for occupation-based interventions?
Consider Steps 1 and 2 of the Practice Inventory (demographics, diagnoses, roles, and occupational performance deficits) on Worksheet 3.1.
“Prep” the clinic area: Take an inventory of supplies and equipment. Create a list of what you need.
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Supplies and Equipment (cont.)
Occupation-based supplies and equipment are often readily available:
Coupons
Newspapers
Magazines
Gift boxes
Wrapping paper
Envelopes
Restaurant menus
Grocery bags
Canned goods
Junk mail
Cosmetic samples
Kitchen utensils
Cleaning supplies
Towels
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Supplies and Equipment (cont.)
Time-saving opportunities:
Prepackaged occupation-based kits
Loaner items from vendors
Borrowed items from other departments.
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Caseload
Streamline your client care:
Schedule clients with similar needs at the same time.
Conduct treatment in a group format (when appropriate).
Provide the “just-right” amount of therapy (review frequency and duration patterns).
Use preparatory methods directed at the client’s occupational needs.
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Time
Evaluation process: Use a top-down approach. Focus on occupations rather than client factors.
Intervention process: Use a top-down approach. Use occupation-based kits.
Nonbillable services: Create volunteer opportunities.
So many clients, so little time
There isn’t enough
time
I don’t have time
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Reimbursement
Know your payers and their rules and processes.
Familiarize yourself with reimbursement codes.
Use AOTA resources.
Be an active member in AOTA and your state professional organizations.
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Occupation-Based Approach
Your Occupation-Based Toolbox
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References
American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683.
Asher, I. E. (Ed). (2007). Occupational therapy assessment tools: An annotated index (3rd ed.). Bethesda, MD: AOTA Press.
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Center for Social Development, Washington University in St. Louis. (2008). Civic engagement and service: Productive aging. Retrieved April 14, 2011, from http://csd.wustl.edu/CivicEngagementService/Pages/ProductiveAging.aspx
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22Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal
use by the purchaser. All other uses must be approved by AOTA. To apply, go to www.copyright.com.
References (cont.)
Chisholm, D., Dolhi, C., & Schreiber, J. (2004). Occupational therapy intervention resource manual: A guide for occupation-based practice. Clifton Park, NY: Thomson Delmar Learning.
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23Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal
use by the purchaser. All other uses must be approved by AOTA. To apply, go to www.copyright.com.
References (cont.)
Hermann, V. H., Herzog, M., Jordan, R., Hofherr, M., Levine, P., & Page, S. J. (2010). Telerehabilitation and electrical stimulation: An occupation-based, client-centered stroke intervention. American Journal of Occupational Therapy, 64, 73–81.
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24Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal
use by the purchaser. All other uses must be approved by AOTA. To apply, go to www.copyright.com.
References (cont.)
Lee, S.W., Taylor, R., Kielhofner, G., & Fisher, G. (2008). Theory use in practice: A national survey of therapists who use the model of human occupation. American Journal of Occupational Therapy, 62, 106–117.
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25Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal
use by the purchaser. All other uses must be approved by AOTA. To apply, go to www.copyright.com.
References (cont.)
Sames, K. M. (2010). Documenting occupational therapy practice (2nd ed.). New York: Pearson.
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26Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal
use by the purchaser. All other uses must be approved by AOTA. To apply, go to www.copyright.com.
Acknowledgments
Photograph of “Mrs. Rodriguez” is used with permission of Genesis Rehab Services.
Photographs in Lesson 1, Slide 20, and Lesson 2, Slides 26 and 27, are used with permission of Genesis Rehab Services.
Photographs of “Mr. Clark” and “Mrs. Seagle” are from the personal collection of the authors and are used with permission.
Cover image of the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2008) is used with permission of AOTA Press.
Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal
use by the purchaser. All other uses must be approved by AOTA. To apply, go to www.copyright.com.
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