Ron
You might use your experience with the COPM for establishing what is
meaningful to the client. If that turns out to be related to increased fine
motor control of hands so be it. It might make sense to ask how they handle
'noncompliant' clients. As we know that is often a case of the prescription
not making sense to the client in terms of occupational benefit.
Start off by asking lots of questions.  Ask what the commonest reasons are
for attendance at the clinic. Are there some situations where compensation
might be offered in addition to remediation? All the COPM questions can be
asked about the clientele generally. What can they do? need to do? want to
do? What does someone else want them to do? Use our language: occupational
dysfunction, occupational deprivation, activity analysis to establish plans
for compensation to facilitate occupation. Relevant occupation is defined by
the client etc. etc. 
Wow this might be your chance to market what we really ought to be doing!
Do they have vision and mission statements? That's a great place to start.
How can OT help to make them reality?

In my semi-retirement I've been rereading old journals and found a lot of
work that is relevant to the recent 'rant' discussion. I've been meaning to
write a post about it but it seemed such a big topic. However here is just a
bit that keeps coming back to me paraphrased from "Reflections on doing,
being, becoming" the keynote address at WFOT 1998 by Ann Wilcock. She quotes
the objectives of the first national US society as "the advancement of
occupation as a therapeutic measure: the study of the effect of occupation
upon the human being; and the scientific dispensation of this knowledge".
She uses the metaphor of a broad track to 'becoming what we have the
potential to become" which these objectives led us toward and posits that
almost immediately we wore a deep rut called 'advancement of occupation as a
therapeutic measure' which locked us into the medical model and led to other
even deeper or side ruts of ADL, personal independence, upper extremity
function. We described ourselves in those terms. The effect of occupation on
the human being got left behind.
I think you have seen the broad track (you seem to have started off on it)
and that a lot of your struggle and pain comes from being confined in the
ruts.  I want you to know that you are NOT alone. This was one of four
papers that I found especially relevant. Another was action research with 4
OTs in Nova Scotia who used reflection exercises to examine how to "engage
in and develop client-centred practice within the constraints of everyday
practice and the organizational demands of their unique settings".  They
found it was very difficult but identifying the barriers helped them to sort
out where and when they were most able to be client-centred. The payment
system which is neither holistic nor client-centred is a big barrier. Your
teaching near the beginning of your career gave you the opportunity to
really integrate theory and philosophy. You will always notice when you are
caught in a rut and I share your frustration that they have been created and
are being perpetuated by others. Count the victories, not the apparent
failures. I'm sure your awareness comes across to your clients.   

Joan 
 

> -----Original Message-----
> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf
> Of Ron Carson
> Sent: Saturday, January 21, 2006 2:57 PM
> To: [email protected]
> Subject: [OTlist] Suggestions...
> 
> Next  week,  I  am  meeting with a nationally-known outpatient clinic to
> discuss  the  possibility  of  my company providing OT services at their
> clinic.
> 
> I  don't  really know how to present myself. It seems that I practice in
> such  non-traditional  ways, I just can't see where my services will fit
> in.  At  the  moment,  the  clinic  has  no OT services (which is pretty
> amazing),  so  I assume (???) that they want an OT to do the traditional
> OT  stuff  of  UE  physical  dysfunction.  I  have not done that type of
> treatment  in  many  years. Primarily what I have been doing is mobility
> related  daily  living  skills.  Stuff  like  transfers and ambulation -
> probably  what  many  people  call  PT.  I  have lots of diversity in my
> practice,  including lymphedema treatment, wound care, and dementia care
> but the mobility stuff is what I have been mostly doing.
> 
> Now,  how can I market THAT to a PT clinic? What can I market? I am just
> trying to get some ideas before meeting with the clinic director.
> 
> Ron
> 
> 
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