Greetings All: There have been some interesting questions that are being tossed around. For the most part (since 1999) when I became a member of this list Ron you always championed and advocated, very strongly I might add, occupation-based practice but now it seems you are extremely disappointed of anything the term has to do with in the OT profession. And you contend that occupation-based practice has no teeth and that even many OTs do not know what it means. The way I have defined occupation for myself is quite simple and clear. I believe that occupation consists of activities and processes that are integral and intrinsic to human life, meaningful or otherwise. Occupation is ubiquitous, it is everywhere. Even inside a toilet human beings have an occupation-based experience let alone anywhere else. Talking about toilets, for some individuals the bathroom is a place of sanctity and they design them as incredibly lavish and beautiful structures what with walk-in closets, marble jacuzzis, spacious dressing areas with ambient lights, coffee table and chairs etc. And are luxurious by ANY standard and extreme though excellent examples of what I mean. As far as I am concerned not only does occupation-based practice have a full set of teeth, often it has deep pockets too.
I am not at all concerned whether others share my definition of occupation, regardless if they clients or other OTs. But I respect any OTs definition of occupation as long as it gives me a genuine appreciation of what it means. Years ago on this list I shared that to me it does not matter whether or not clients or non-OTs appreciate the terminology or jargon of OT. I still hold true to that. Because for me discovering or understanding what OT is has been a two part process. OT was a major career change for me (and not only because I was one of four guys in a class of 64), I was a mature student who graduated with my OT degree in 1999. At OT school here in Toronto, Canada I was constantly intrigued, and quite puzzled I might add, at what the concept of "occupation" actually referred to. I found its various definitions frustrating at worst and extremely ambiguous at best because the words quite simply didn't add up or so I thought at the time. During my level 2 placement I surveyed every OT at the facility I was placed at as to how they would define or describe OT. The majority of OTs surveyed had at least 8-9 years of experience behind them. I was able to gather some very interesting working definitions (non-theoretical I might add). Things slowly began to add to add up and I realized that understanding what OT is was a two part process (at least for me). It meant firstly to break down the terminology (or deconstruct if you will) and understand it for myself; and once this was done to convert the terminology into everyday expression in order to make it transparent for me to practice OT. This required that I not worry about imposing OT terminology on non-OTs, clients in particular or even other OTs for that matter. My reasoning for this was that who cares what "occupation-based practice" means and whether my clients have got it right if clients cannot experience its benefits in their lives. The definition of OT is important to me, but its practice is what is important for my clients. When one goes to a physician while it may be helpful to know the diagnosis and the physiological terms involved it is not essential for healing to occur. In fact working in mental health as I do I have found that clients are often very averse to labels of diagnosis which apply to them. In mental health this is due to the stigma associated with mental illness. But it has helped me to understand the impact of technical terminology on the layperson, for lack of a better term. My work consequently focuses on what I have to offer to my clients, rather than on trying to convert them into some sort of OT with whom I can discuss the distinctions between occupation-based practice and performance components or what have you. Perhaps if I do my job right the client might come and ask me some questions about my profession, or goes away knowing that he came across someone known as an OT who made a difference to her or his life. To me client-centred care is more meaningful than educating my clients about OT. Though if I can do both that is great, but my focus is generally the former. I don't know if what I have said here adds any light to the discussion but I thought I would share my perspective on the issue. On the issue of memberships with professional bodies, the other discussion that our colleagues in the U.S. are mulling over and trying to decide "to be or not to be" members of AOTA, NBCOT or their state OT organizations. I find this discussion very interesting. Because here in Toronto, Canada (about a 90 minute drive north from Buffalo, New York) we do not really have the option of considering whether we want to be members or don't want to be members. We quite simply are required to by law. The province (state) I live in, we have a piece of legislation known as the "Registered Healthcare Professionals Act (RHPA)". The RHPA requires that each professional OT (or for that matter pharmacist, psychologist, physician, dentist, nurse, social worker or any of the allied health professionals, but not Recreation Therapists or Kinesiologists, at least not yet) be registered with the "College" of their profession. Just as physicians are all registered with the College of Physicians and Surgeons, OTs are registered with the College of OTs of Ontario (COTO). It is COTO to whom we pay a fairly hefty (C$ 500 presently) annual registration fee. And COTO is a regulatory body which is the public's watchdog to ensure OTs provide responsible and accountable care to their clients. Failing which an OT can lose their license to practice. All disciplinary proceedings against an OT whether for negligence or other concern around malpractice are conducted and investigated by COTO. In fact about 4-5 times annually COTO also asks OTs to complete educational modules prepared by them. And COTO also happens to conduct random competency reviews once annually on OTs to ensure they provide a certain standard of care. If the competency review raises concerns COTO can conduct an audit of the OTs work by going on-site and investigating every chart, interviewing peers on the team and consenting clients of the OT in question. I am also a member of the Ontario Society of OTs (OSOT) which requires a payment of another annual fee (currently $ 270) but this also includes malpractice insurance premium. Here I have the option whether I want to be a member of the state society (which I am) or national association (Canadian Assoc. of OTs, of which Joan said she is a member but I am not). Malpractice insurance is bundled with the membership of each of the two organizations. And I am required to be a member of one of them because COTO requires proof of malpractice insurance before our registration licence is renewed each year. The system works pretty smoothly, and as most people know being quiet goody-two-shoe Canadians we don't care whether or not our institutions provide us value for our money, we just accede to whatever they wish to do. lol!!! (just kidding). On the other topic that is being discussed of late on this list, I DON'T agree with the idea that occupation-based (or any other kind of OT lol!!) OT makes the profession of OT extinct or endangered. However, from what I have followed of the various discussion threats (oops I meant threads) the experience of our U.S. colleagues is somewhat unique. Needless to say being in Canada I may be misinformed of what is actually happening in the U.S.. I initially thought that OT was hit by the Balanced Budget Act (BBA) introduced in 1999 which as I recall put a financial cap to costs incurred by Skilled Nursing Facilities (SNFs) i.e nursing homes. A couple of years later this financial cap was raised, but still compared poorly with costs covered before the BBA. This sent the allied health professions in the U.S. into a tailspin, and was specific to the SNF sector. But then I remember seeing some numbers which if I recall correctly showed that there were about 20% of U.S. OTs employed in the SNF sector, so it may have had a large fallout. Perhaps I am wrong but my guess is that presently too it is OTs who work for SNFs who are particularly vulnerable to experiencing limitations in their work because quite often they are competing for the very same dollars that a PT or other professional is vying for. Because each SNF can only spend dollar amounts within the capped amount regardless whether it is for OT, PT or speech etc. But I am not sure if this is the experience of OTs who work in hospitals (or schools for that matter) throughout the U.S. It would be interesting to find out though. However, I also believe that since health care in the U.S. is funded through private insurance companies the focus of interventions is on tangible services, performance component based or functionally focused. And occupation-based OT being a relatively abstract notion it sounds quite airy fairy to corporate minded, profit oriented financiers who are closely watching their dollars and cents. Another issue that generically tends to cloud what OTs do at a tangible level is the fact that EVERY single client who gets OT services does not get the same service, because each individual's OT intervention needs are different based upon what is occupationally relevant to the client's life. This prevents OT from being described or defined in prescriptive terms, as is the case with PT for example. All PTs are more likely to give the same label or description to their intervention and its scope for a particular kind of deficit the client has. In my opinion the unique experience of OTs in the U.S. (and those working with SNFs in particular) taken in conjunction with the uniqueness of every OT intervention makes for the notion amongst some that perhaps the OT profession is endangered, since it cannot be described in occupation-based terms. My thinking is that we need to reorient how we market OT services. In my opinion the terminology we use to market our services needs to be meaningful to those funding our services, and this is particularly so in the U.S.. One of the ways of doing so is through the use of outcome measures, which need to become a part of daily OT vocabulary, Of course it is possible I may be grossly misinformed considering that most of what I have gleaned about the experience of U.S. OTs is from media and what I may have picked up from this list. And I hope someone will set me straight if I am wrong in what I have said above. Thanks Joan, and it is good to hear from you. And of course with best wishes to all OTs (occupation-based or otherwise), all over the world and thanks to Ron for continuing this list, Biraj Khosla Occupational Therapist - Reg. (Ont.) & Clinical Education & Training Coordinator Centre for Addiction and Mental Health Law and Mental Health Program Outpatient Service 1001 Queen Street West, Toronto Ontario, M6J 1H4 Canada ----- Original Message ----- From: Joan Riches<mailto:[EMAIL PROTECTED]> To: [email protected]<mailto:[email protected]> Sent: April 20, 2006 10:20 PM Subject: Re: [OTlist] questions (answers rom Canada - Hi Susanne) Biraj Where are you? Speak up and keep Susanne and me company. Joan > -----Original Message----- > From: [EMAIL PROTECTED]<mailto:[EMAIL PROTECTED]> [mailto:[EMAIL PROTECTED] On Behalf > Of susanne > Sent: Thursday, April 20, 2006 6:46 PM > To: [email protected]<mailto:[email protected]> > Subject: Re: [OTlist] questions (answers rom Canada - Hi Susanne) > > Hi Joan! > > Ah - so great to see you around - I was beginning to question my > statement of this being an international list - imagining I was the only > none-US left. And thanks for the recognition - you made me blush! I too > cherish this list - I think it adds greatly to the quality of > discussions that we practice under such different circumstances - > payment, legislation etc. It sure provides us with very different > problems - but this also breeds different ideas, different > work-arounds -from which I'm inspired much more than when just talking > to OTs that eat from the same soup bowl as I do! > > Warm spring greetings from Denmark > > susanne > > (right now only a passive member of the Danish OT union - as I had to > join another union for my current job) >
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