Hi Ron :) > > Thanks for your post. Will you please share a little information about a > couple of things: Sure! > 1. What is it like to practice OT in Nova Scotia? Well, I graduated from OT School (at Dalhousie University) where Liz Townsend was (and still is) the director of the School of Occupational Therapy. So our program was excellent in educating re. Enabling Occupations. I went directly into private practice so my experience in the hospital based practice is limited to the past month. Unfortunately in private practice where it is primarily economy driven, it was much more difficult to incorporate Enabling Occupations theory into everyday practice. Various factors (in my opinion) impacted this problem. 1. Most of my clients had legal representatives and were involved in ongoing legal suits so it was difficult to identify what was "meaningful" to them. Essentially you could be working "with" your client toward a goal they identified as important to them, when in fact they had no real desire to obtain that goal. It was difficult to discuss this with them, again because of the legal involvement - if you said the wrong thing, the client would claim you were "on the side of the insurance company" and their lawyer would get heavily involved putting up roadblocks to communication and rehabilitation. As I gained more experience with the legal reps this was easier to handle - they knew me and weren't worried that I was being underhanded in any way. Still though, this was almost always a factor with every client. 2. Most of the insurance companies I worked with had a fairly good understanding of Occupational Therapy and the benefits of our services. However, not all insurance adjusters were open to addressing the client's issues re. occupational performance. So again the roadblocks on what was and was not approved for treatment. Now that I'm in the hospital based practice I'm finding roadblocks, albeit different roadblocks, to practicing Occupational Therapy. As I mentioned in my previous post I'm on an acute unit (actually it's a teaching unit for physicians). On the one hand this is a great opportunity to educate up and coming physicians to occupational therapy and our role in the health and well being of our clients. On the other hand it's sometimes difficult to implement the Occupational Therapy plan when the teaching physicians oversee the students. The goal of the physicians (from my perspective) is to get the client out of the hospital as quickly as possible (one more day in hospital = $1200). Thank god I'm outspoken :) and already in the past month I've gone head to head with a few physicians in advocating for the client. I've also had to be creative in trying to find loopholes in the system or alternate pathways to send my client so that his/her needs are met in addressing the occupational performance issues. Our Occupational Therapy Dept. is trying to ensure the OT staff use the COPM in everyday practice. The Dept. is very supportive and excellent in advocating for OT and the client. Right now our team (general medicine) is working on the goal of addressing the barriers to using this tool - as many feel that it's difficult to use (i.e., why use the COPM when we're not able to address all of the performance areas identified). Hopefully we'll brainstorm and come up with a solution. Ok, I rambled on quite a bit on that question :) > 2. What is disability management? It sounds very interesting. Essentially insurance companies (auto, life), WCB, Canada Pension or legal representatives of the client, often hire people to help coordinate, evaluate and direct the rehabilitation of their clients = disability management. The goal (from the referral source) is to maximize rehabilitation in a cost effective way. In some instances, a successful case (again to the referral source) means the client returns to pre-disability function. In other cases this means that the rehabilitation potential of the client has been deemed not likely and the referral source is able to close their active file. It can be a cut throat industry and again is very medical-legal based. Most of the clients have been injured or have disease/disorder, etc. which impacts their ability to return to work or return to their previous level of functioning on a day to day basis. The disability management person meets with the health care professionals and develops an appropriate rehabilitation plan for the client. Traditionally, in Nova Scotia, this person was a nurse. However, over the years more and more Occupational Therapists have been getting involved. The referral sources seem to like the Occupational Therapy frame of mind when approaching rehab and in general have been more open to addressing rehab in a holistic manner. Of course, there is plenty of red tape as well as policies which influence how you can direct rehab, but I have noticed a change (for the better) in terms of what the referral source will cover or address. I was the Clinical Supervisor in a Disability Management company which staffed physiotherapists, kinesiologists, psychologists, and occupational therapists..as well as the more experienced nursing rehab consultants. We performed functional capacity assessments, ergonomic assessments, pain management programs, return to work programs, independent medical examinations, as well as disability management. Ok, rambling again :) Hope this provides some info though. 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