David,
I speak from the perspective of long term care with the elderly where I've mostly
practiced. I volunteered in a nursing home when I was in my teens- a while ago! I
worked in PT and eventually found OT more holistic and interesting. At that time OT
ran recreation too. Activities were seen as therapeutic or diversional. After high
school I ended up first as a recreation director. When I was able I went to school for
my associates in OT. When I did my fieldwork at a nursing home (late 70's) OT and Rec
had split, but OT was still very craft based. What I did notice though was that the
poulation had changed - more impaired, physically and cognitively - and they didn't
seem to be getting a lot of OT. By the time I went back for my bachelors OT was
getting Medicare B reimbursement. We were seeing more people for shorter periods of
time. With OBRA we began seeing residents in the NH for things like restraint
reduction, adaptive seating, feeding and swallowing issues, pressure sores etc. And I
saw more residents who were very impaired. We used occupation in what ever way we
could, but there were pressures for productivity. I know that affected what we did. We
always kept the perspective of occupation in our goals though, for instance, if we did
adaptive seating it was for more that just getting someones head up off their chest;
it was so they could attend to their environment. We were lucky in that we had a well
stocked clinic, but we were in-house therapists and over the years had built up the
department. Friends of mine who worked for agencies often went into situations where
they had very little to work with, but were pretty creative. There was very little
support for the concept of occupation though. Sometimes it seemed to me that all that
anybody from OT was to do ADLS and/or solve a problem with someone that no one else
could figure out what to do with. Often too, they were not the ones to decide who
would get OT...that was decided by nursing or the rehab dir., often a PT. I think
reimbursement issues, for-profit organization priorities and productivity issues have
had a profound change on not only our profession, but on health care. Look at how
little time a doc spends with patients!
Another thing....we have done little to educate people about the whole elephant when
all they have seen is a tail or an ear (You know the blind men and elephant story,
right?) This is interesting....my university, Sacred Heart U. runs a Health and
Wellness Center in partnership with an inner city parish in Bridgeport CT. We have a
grant for OT, PT, and Nursing to screen seniors to increase access to health care. I
made up a list of about 1 1/2 pages of questions I wanted to use in my interviews.
When the nurse read it she said "Oh, this is more than OT." I told her no, this was
OT. I was looking at more than ADLS. I had questions to screen for that, but also for
cognitive issues, depression, environmental problems, support systems...in short
anything that was interfering with occupation now or that I could see could pose a
problem in the future. We're about the most holistic profession I know!
I don't know what the answer to the present muddle we find ourselves in is, but I know
we all need to pull together and be one profession, not segmented into educators,
pracs and researchers if we are going to be around in the future...and we need to get
to the 3/4? of the OT's who are not AOTA members and let them know they are needed so
we can have the clout we need to effect change. (AOTA needs to poll them and find out
why they left or never joined, and what would bring them in - a whole 'nother
subject!!)
Anyway...this is more than I've written to a list serve in a month-of-Sundays and I
need to go back to working!! Bye for now.
Mary-Ellen
-----Original Message-----
From: Lehman, David [mailto:[EMAIL PROTECTED]
Sent: Thu 11/20/2003 1:24 PM
To: [EMAIL PROTECTED]
Cc:
Subject: RE: [OTlist] 2 OT's with different approaches
May-Ellen...please share with me your understanding of the historical and
external factors to the defining of an OT in clinical settings.
Thanks.
David A. Lehman, PhD, PT
Associate Professor
Tennessee State University
Department of Physical Therapy
3500 John A. Merritt Blvd.
Nashville, TN 37209
615-963-5946
[EMAIL PROTECTED]
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Thursday, November 20, 2003 12:11 PM
To: [EMAIL PROTECTED]
Subject: RE: [OTlist] 2 OT's with different approaches
Yes, that was really good to hear. I think practioners can feel a little beat
up when they keep hearing about what they are not doing. There are a lot of historical
and external to the profession factors that have shaped current practice and maybe if
we all are on the same team we can effect change.
Mary-Ellen
-----Original Message-----
From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]
Sent: Wed 11/19/2003 4:38 PM
To: [EMAIL PROTECTED]
Cc:
Subject: Re: [OTlist] 2 OT's with different approaches
The good news is that there is interest in this issue. I was told
that at
the recent Program Directors's meeting last week that there is an
interest in
merging the efforts, practice, ideas etc of Researchers, Academics and
Pracitioners. The meeting including a discussion of ideas how to do
this.
Wendy
In a message dated 11/19/2003 3:26:11 PM Eastern Standard Time,
[EMAIL PROTECTED] writes:
> Ron,
>
> I just wanted to say that I also see the 2 different
> approaches in practice. Maybe it could help if the OT
> educators do inservices for clinical OT's on the
> importance of using occupation as a framework of
> practice. For those who have been away from university
> environments, I find it is very hard to grasp/apply
> the occupational framework and using the old, already
> ingrained medical model approaches seems easier.
>
> Naz
> 3 yr post graduaction
>
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