There are several specific concepts and notions in The Framework that I
question. For example:
5. One of my biggest disappointments with The Framework is the adoption's of
Pedretti's adjunctive or preparatory treatment philosophy. Table 8 (p. 628)
lists "Types of Occupational Therapy Interventions". There are basically 4
types of interventions; use of self, use of occupations and activities,
consultation and education. Three are three types of "therapeutic use of
occupations and activities"; Occupation-based activity, purposeful activity
and preparatory methods.
My complaint with preparatory is NOT that it is about modalities and
stuff, it's in the wording associated with the application of
modalities and stuff. First of all, occupation is a very complex
interaction of man, environment and activity. To reduce this
phenomenon to something like a physical agent modality (PAM) that
"Prepares the client for occupational performance" (p. 628) is
simply reductionistic.
If applying a PAM prepares the client for occupation, then every
practitioner using a PAM is preparing the client for occupation. I
do believe that PAMs have a role in OT but only in as much that
application of PAM is given to DIRECTLY improve occupational
performance, not to PREPARE to improve performance.
If occupation is our goal, then everything that we do should be done
to directly improve occupation. Other entities (surgeons,
physiatrist, PT, SLP, ATC, etc) should be the preparers for
engagement in occupation. Our role is NOT to prepare clients for
engagement but to actually engage!!
6. (MY ADL SOAPBOX, AGAIN) The term activities of daily living (ADL) should
not be in the framework; It is reductionistic and suggests that in order to
live, one only need be able to care for themselves. As I am sure that we all
recognize, daily living is MUCH more than just caring for ourselves! If our
lives consisted of only being able to eat, dress, poop and move from one
position to another, NONE of use would call such an existence living! We
might instead call ourselves prisoners! Living is about expressing ourselves
in ways that make us unique and happy. Living is about being competent in
our assigned and chosen roles. I hate the term ADL!! ADL is what I call the
"A" word. There's also the "F" word and the "N" word. I will leave it to
your occupational imaginations to figure them out!
7. My biggest and I mean biggest issue with the Framework is the following
statement: "The profession recognizes that in some areas of practice ...
occupational therapy intervention may focus primarily on performance skills
or on client factors ... that will enable engagement in occupations later in
the continuum of care" (p. 615)
What a cop out!!!! The whole Framework is about "engagement in
occupation to support participation" (whatever that means), and then
the authors give a sort of 'small print' disclaimer. What a bunch of
hooey!!! In writing the above statement, it appears that the
Framework authors are 'selling out' on the very foundation of what
they continually said was so important!!! The above statement pretty
much makes the entire Framework null and void and allows for
practitioners to continue doing things the same old way!!
8. Finally, the statement of 'engagement in occupation to support
participation" is redundant. Occupation is participation!! A person can not
be engaging in occupation without participating!!! Forget the 'participation'
and just let it ride as 'engagement in occupation'
On a closing note, the overall concepts of the Framework are pretty good!
Some of the specifics need to be worked out but in general I like the
concepts put forth in the document. I believe the profession will be better
served if the authors will narrow the focus of the document even more and
CLEARLY delineate the profession's role. Doing so will allow practitioners to
better identify when they are and when they aren't practicing OT.
I think I am done with my soapbox. Although I am liable to continue on this
for some time... I am a bit obsessed with the whole occupation thing and the
reading the Framework has really got me stirred up again.
A little while back, OTnow reader Greg wrote:
> You are sounding pretty stressed out from the latest two posts I read. I
> mean that there is a significant disparity between your reaction in
> proportion to the perceived wrong. Don't burn yourself out.
I thought a lot about what he wrote and I came to the following conclusion.
I get burned out when I am not stressing! Just the opposite of what Greg
indicated! If I am not involved in some sort of debate, conflict or internal
struggle involving OT, then I tend to become complacent and to 'not care'
about trying to change the profession.
Ron
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