Hello Cheri: WOW!, you really provide a ton of information!! :-). I am interested in all that you said but I am most interested in your comments about Enabling Occupation. About three years ago, while working in in-patient rehab, I adopted the enabling occupation/COPM model into my treatment. What an eye-opening experience it was to see clients from a enabling perspective. I never ran into any difficulty implementing the model except when it came to the physician. Like you, I butted heads on several occasions in order to advocate for clients' occupational needs. I am curious as to what 'road blocks' you experienced in your setting. What, if anything, have you successfully been able to do in order to overcome the blocks? Thanks, Ron -- On 8/7/2001, cll said: c> Hi Ron :) >> >> Thanks for your post. Will you please share a little information about a >> couple of things: c> Sure! >> 1. What is it like to practice OT in Nova Scotia? c> Well, I graduated from OT School (at Dalhousie University) where Liz c> Townsend was (and still is) the director of the School of Occupational c> Therapy. So our program was excellent in educating re. Enabling Occupations. c> I went directly into private practice so my experience in the hospital based c> practice is limited to the past month. Unfortunately in private practice c> where it is primarily economy driven, it was much more difficult to c> incorporate Enabling Occupations theory into everyday practice. Various c> factors (in my opinion) impacted this problem. c> 1. Most of my clients had legal representatives and were involved in ongoing c> legal suits so it was difficult to identify what was "meaningful" to them. c> Essentially you could be working "with" your client toward a goal they c> identified as important to them, when in fact they had no real desire to c> obtain that goal. It was difficult to discuss this with them, again because c> of the legal involvement - if you said the wrong thing, the client would c> claim you were "on the side of the insurance company" and their lawyer would c> get heavily involved putting up roadblocks to communication and c> rehabilitation. As I gained more experience with the legal reps this was c> easier to handle - they knew me and weren't worried that I was being c> underhanded in any way. Still though, this was almost always a factor with c> every client. c> 2. Most of the insurance companies I worked with had a fairly good c> understanding of Occupational Therapy and the benefits of our services. c> However, not all insurance adjusters were open to addressing the client's c> issues re. occupational performance. So again the roadblocks on what was and c> was not approved for treatment. c> Now that I'm in the hospital based practice I'm finding roadblocks, albeit c> different roadblocks, to practicing Occupational Therapy. As I mentioned in c> my previous post I'm on an acute unit (actually it's a teaching unit for c> physicians). On the one hand this is a great opportunity to educate up and c> coming physicians to occupational therapy and our role in the health and c> well being of our clients. On the other hand it's sometimes difficult to c> implement the Occupational Therapy plan when the teaching physicians oversee c> the students. The goal of the physicians (from my perspective) is to get the c> client out of the hospital as quickly as possible (one more day in hospital c> = $1200). Thank god I'm outspoken :) and already in the past month I've gone c> head to head with a few physicians in advocating for the client. I've also c> had to be creative in trying to find loopholes in the system or alternate c> pathways to send my client so that his/her needs are met in addressing the c> occupational performance issues. c> Our Occupational Therapy Dept. is trying to ensure the OT staff use the COPM c> in everyday practice. The Dept. is very supportive and excellent in c> advocating for OT and the client. Right now our team (general medicine) is c> working on the goal of addressing the barriers to using this tool - as many c> feel that it's difficult to use (i.e., why use the COPM when we're not able c> to address all of the performance areas identified). Hopefully we'll c> brainstorm and come up with a solution. c> Ok, I rambled on quite a bit on that question :) >> 2. What is disability management? It sounds very interesting. c> Essentially insurance companies (auto, life), WCB, Canada Pension or legal c> representatives of the client, often hire people to help coordinate, c> evaluate and direct the rehabilitation of their clients = disability c> management. The goal (from the referral source) is to maximize c> rehabilitation in a cost effective way. In some instances, a successful case c> (again to the referral source) means the client returns to pre-disability c> function. In other cases this means that the rehabilitation potential of the c> client has been deemed not likely and the referral source is able to close c> their active file. It can be a cut throat industry and again is very c> medical-legal based. c> Most of the clients have been injured or have disease/disorder, etc. which c> impacts their ability to return to work or return to their previous level of c> functioning on a day to day basis. The disability management person meets c> with the health care professionals and develops an appropriate c> rehabilitation plan for the client. Traditionally, in Nova Scotia, this c> person was a nurse. However, over the years more and more Occupational c> Therapists have been getting involved. The referral sources seem to like the c> Occupational Therapy frame of mind when approaching rehab and in general c> have been more open to addressing rehab in a holistic manner. Of course, c> there is plenty of red tape as well as policies which influence how you can c> direct rehab, but I have noticed a change (for the better) in terms of what c> the referral source will cover or address. c> I was the Clinical Supervisor in a Disability Management company which c> staffed physiotherapists, kinesiologists, psychologists, and occupational c> therapists..as well as the more experienced nursing rehab consultants. We c> performed functional capacity assessments, ergonomic assessments, pain c> management programs, return to work programs, independent medical c> examinations, as well as disability management. c> Ok, rambling again :) c> Hope this provides some info though. c> Cherie c> ******************** c> Unsubscribe by sending a message to [EMAIL PROTECTED] In the message's body, put the following text: c> unsubscribe OTlist c> ------ c> OTnow messages are archived at: c> http://www.mail-archive.com/[email protected] (and) c> http://www.mail-archive.com/[email protected] c> ********rC*********** ******************** Unsubscribe by sending a message to [EMAIL PROTECTED] In the message's body, put the following text: unsubscribe OTlist ------ OTnow messages are archived at: http://www.mail-archive.com/[email protected] (and) http://www.mail-archive.com/[email protected] ********rC***********
