I would have done the same thing with one exception. I have always found a way to discuss faith issues. I find that lack of hope is related to lack of faith which is a great place to begin. When I say "faith" I do mean faith in God. It is an amazing thing to realize that the God of the universe who created all things created me/us with a purpose. In this one simple fact is meaning and hope and it is in Him that our faith should be placed. When we as therapists realize this it is a great gift we give to our patients to discuss these things and in fact build into the occupational framework of living. The more we look into ourselves for answers the emptier life is. When we turn our eyes/faith to Him and start everyday with that practice the world (no matter what our circumstances) is a better place.
Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of [EMAIL PROTECTED] If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Mary Alice Cafiero Sent: Friday, October 31, 2008 8:23 AM To: [email protected] Subject: Re: [OTlist] Client without goals I recently had this discussion with a good friend here who does home health. She had a patient that was very similar as far as not being able to identify goals. Her pt had a very flat affect and didn't do anything other than move from her bed to her couch during the day and occasionally get up to go to the kitchen for some snack food or similar that she just had to grab and eat. The referral actually got to home health because the lady had a shoulder arthroplasty done. However, when my friend did the evaluation, this lady was able to do all of her basic ADLs and even some IADLS in her home. PT was also on the case and was addressing the specifics of range and exercise for the shoulder. The first thought was that there were not really OT goals. My friend wasn't totally comfortable with this, and I'm sure that was, at least in part, because my friend does have some background working in mental health. She talked with the pt who agreed to have her come back to "check" on her. On the next visit, they talked about depression and how having a schedule of doing things during the day can help alleviate symptoms. They made a very simple plan/schedule for the pt to begin following each day with just 3-5 activities scheduled throughout the day. Simple things like getting dressed instead of staying in pajamas, brushing her hair and teeth, making a sandwich or microwave meal for lunch, stepping out into the front or backyard once or twice a day, etc. On just 1-2 follow-up visits, the pt was actually doing the things they scheduled and said she was feeling better and even smiled. The smile was huge because during the evaluation, the pt had an absolutely flat affect and showed no emotion the whole time. She was able to verbalize that she could understand why getting up for activities during the day made a difference in how she feels. Now, of course, we don't know if she will continue to do those things when no one is "checking", but I think the OT intervention was valid and meaningful even though the pt could not initially verbalize goals. Certainly, a recommendation was given to the HH agency and physician that a pscyh referral would be a good idea. My friend did a lot of education regarding depression and basic things that the pt can do around her home to combat the depression. What do y'all think? Was this appropriate US medical model home health OT intervention? Sorry for being long-winded, Mary Alice Mary Alice Cafiero, MSOT/L, ATP [EMAIL PROTECTED] 972-757-3733 Fax 888-708-8683 This message, including any attachments, may include confidential, privileged and/or inside information. Any distribution or use of this communication by anyone other than the intended recipient(s) is strictly prohibited and may be unlawful. If you are not the recipient of this message, please notify the sender and permanently delete the message from your system. On Oct 31, 2008, at 12:59 AM, FAY, Felicity wrote: > > Hi there, I'm a Mental Health OT from Australia and work with clients > who find it difficult to engage and identify their goals daily. > Sometimes just engaging with the person and building rapport for a > couple of sessions is enough for them to feel safe to work with you on > re-engaging and devising personal goals that require some level of > functional ability: thereby making physical therapy more meaningful > (?). > > > Occupational dysfunction often occurs previous ability, stability) > across many domains due to depression, poor motivation, grief (loss of > pet) and other mental health issues, in addition to aging and loss of > general function. A good general screen is the DASS (Depression, > Anxiety and Stress Scale) to inform treatment, or maybe a cognitive > screen to ascertain whether she is able to formulate appropriate goals > due to low mood and requires more support to identify them? Perhaps > there are some personality vulnerabilities present that compound her > current presentation of "rejecting" (or testing) you, then wanting > more > input. > > If her goal of being "normal" is strongly held then assistance to > manage > depression symptoms and education re same may assist her to return > to a > state that is more comfortable for her? I'm not sure how your system > works or whether there is provision for OT's to work in this way? > > Felicity Fay > Mental Health Occupational Therapist > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On > Behalf Of [EMAIL PROTECTED] > Sent: Friday, 31 October 2008 11:31 AM > To: [email protected] > Subject: OTlist Digest, Vol 43, Issue 44 > > Send OTlist mailing list submissions to > [email protected] > > To subscribe or unsubscribe via the World Wide Web, visit > http://otnow.com/mailman/listinfo/otlist_otnow.com > or, via email, send a message with subject or body 'help' to > [EMAIL PROTECTED] > > You can reach the person managing the list at > [EMAIL PROTECTED] > > When replying, please edit your Subject line so it is more specific > than "Re: Contents of OTlist digest..." > > > Today's Topics: > > 1. Re: D/C'd Patient For Lack of Goals (McLaughlin, Jennifer) > 2. Re: Best Practice (Ron Carson) > 3. Re: D/C'd Patient For Lack of Goals (Ron Carson) > 4. Re: D/C'd Patient For Lack of Goals (Joan Riches) > 5. Re: D/C'd Patient For Lack of Goals (Ron Carson) > > > ---------------------------------------------------------------------- > > Message: 1 > Date: Thu, 30 Oct 2008 11:39:15 -0400 > From: "McLaughlin, Jennifer" <[EMAIL PROTECTED]> > Subject: Re: [OTlist] D/C'd Patient For Lack of Goals > To: <[email protected]> > Message-ID: > <[EMAIL PROTECTED]> > Content-Type: text/plain; charset="us-ascii" > > Possibly a referral for depression screening or treatment. Sounds > fairly typical with lack of engagement and participation in daily > occupations. If she is unable to identify goals she may need medical > assistance to get to a place to be able to identify goals. > Just my humble thoughts. > Jennifer McLaughlin, OT/L > Geriatric Rehab specialist > The information contained in this message may be privileged and/or > confidential and protected from disclosure. > If the reader of this message is not the intended recipient or an > employee or agent responsible for delivering this message to the > intended recipient, > you are hereby notified that any dissemination, distribution or > copying > of this communication is strictly prohibited. > If you have received this communication in error, please notify us > immediately by replying to this message and deleting the material from > any computer. > > Thank you. > > > > > ------------------------------ > > Message: 2 > Date: Thu, 30 Oct 2008 20:05:12 -0400 > From: Ron Carson <[EMAIL PROTECTED]> > Subject: Re: [OTlist] Best Practice > To: "[EMAIL PROTECTED]" <[email protected]> > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=utf-8 > > Chris, I'm going to reply, but I need to take a break ... > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: [EMAIL PROTECTED] <[EMAIL PROTECTED]> > Sent: Wednesday, October 29, 2008 > To: [email protected] <[email protected]> > Subj: [OTlist] Best Practice > > Ron>> And, I do not think? a? therapist? can? mentally? switch? > from? > Ron>> component? level? to occupation? level? treatment. Maybe > I'm > Ron>> wrong, but I think it's one or the other. > > cac> But in your case study you are switching back and forth > from > the > cac> component level to eventually the occupational level.? > Standing > cac> tolerance=component level (cardiovasular, quad strength, > static > cac> standing balance).? Ambulation=componet level (cardiovascular, > quad > cac> strength both concentric and eccentric contractions, > dynamic > cac> balance).? All of this was leading to the individual's > personal > cac> occupational goal. > > cac> In my case study I was switching back and forth from the > component > cac> level to eventually the occupational level.? Estim to the > digit > cac> extensors=component level (facilitation of the neural > pathway > to > cac> enhance neuroplasticity which in turn leads to digit extensor > strength > cac> and control).? All of this leading? to the individual's > personal > cac> occupational goal. > > cac> Chris Nahrwold MS, OTR > > > > > > > cac> -- > cac> Options? > cac> www.otnow.com/mailman/options/otlist_otnow.com > > cac> Archive? > cac> www.mail-archive.com/[email protected] > > > > > > ------------------------------ > > Message: 3 > Date: Thu, 30 Oct 2008 20:10:08 -0400 > From: Ron Carson <[EMAIL PROTECTED]> > Subject: Re: [OTlist] D/C'd Patient For Lack of Goals > To: Joan Riches <[email protected]> > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=windows-1252 > > Thanks Joan and Jennifer: > > Because the patient is on HH, she is already > receiving a plethora of services; everything from social worker, RN, > aide to PT. > > You know the question of "why" was never answered, either by the > patient, her family or myself. When I earlier mentioned mind mapping, > it was because of this patient. > > I think something psychiatrically happened to her but she refuse my > suggestion for a psych eval. > > One of the things that was even odder and leads me to think that maybe > "I" was the problem is that the patient was doing well in PT and she > took a bathe with the assistance of the aide. But, I swear, this > patient would NOT verbalize wanting to do anything on her own. The > only thing she said, especially in the beginning is that she wanted to > be "normal". > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: Joan Riches <[EMAIL PROTECTED]> > Sent: Thursday, October 30, 2008 > To: [email protected] <[email protected]> > Subj: [OTlist] D/C'd Patient For Lack of Goals > > JR> Ron > JR> In a case like this I think that an OT eval may be the most > effective > JR> part of our offering. I am left with the question, "What referrals > have > JR> you offered to this family?" You have gathered valuable > information. > JR> This is certainly an extreme case of occupational dysfunction > due to > JR> ......what?? > JR> If you have read English novels you may have run across similar > JR> descriptions of 'invalid' (emphasis on the first syllable) upper > class > JR> women. It is an interesting brain twig to then put the emphasis on > the > JR> second syllable. Thanks for all the brain twigs now and in the > future. > > JR> Joan Riches B.Sc.O.T., OT(C) > JR> Specialist in Cognitive Disability > JR> Riches Consulting > JR> High River, Alberta, Canada > JR> 403 652 7928 > > > JR> -----Original Message----- > JR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] > On > JR> Behalf Of Ron Carson > JR> Sent: October 30, 2008 7:08 AM > JR> To: [email protected] > JR> Subject: [OTlist] D/C'd Patient For Lack of Goals > > > JR> Yesterday, I d/c'd a patient because she is unable to verbalize > ANY > JR> OT-related goals. It was a very strange and difficult case and I'm > not > JR> 100% comfortable with the d/c, but it seemed to be the best > choice. > JR> I'm VERY interested to hear others' opinions. > > JR> I evaluated a patient last week. Without going into a lot of > detail, > JR> the patient has mild arthritis, recently fell and had kyphoplasty. > She > JR> had been very active until about 5 years ago when she > "suddenly" > JR> became very sedentary. There assorted history and eval findings, > but > JR> this is basically a women who has disengaged from life. > She > JR> essentially lives on her couch and that's about it. > > JR> When I evaled her last week, she was unable to identify ANY OT > goals. > JR> Against, my better judgement, I "made up" a couple goals and > scheduled > JR> her for only two visits. > > JR> At the end of my second visit, I indicated that I was d/c'ing > the > JR> patient for lack of goals. The patient was OK with it but the > husband > JR> talked and asked me to stay on. After a long conversation with > the > JR> patient, one in which I was apparently "mean", the patient agreed > that > JR> she wanted me to come back. So, I signed her up for 5x/week > therapy. > > JR> On the next visit, I was told that the patient "did not like > me" > JR> because I was mean. I promptly apologized to her, expressed my > concern > JR> and methods and asked for forgiveness, which she readily gave. > After > JR> that, I again started talking about the patient's life and goals. > Her > JR> son had mentioned that the family had a pet that died and that > was > JR> sort of "the beginning of the end" for the patient. The son > had > JR> mentioned possible pet ownership which I followed up on, but > the > JR> patient denied wanting it. > > JR> I came back two more times, with each visit focused on > identifying > JR> goals. We did a mini life review but no matter what avenue I took, > the > JR> patient denied any goals. So, I reluctantly told her that in > the > JR> absence of goals, d/c was the only option. She agreed and said > she > JR> was sad because she was "starting to like me". > > JR> She and I agreed that my time had not been wasted but that > continued > JR> visits would be a waste. > > JR> Without doubt, this is one of the hardest and strangest cases > I've > JR> ever had. I've never met a person who was so unmotivated and yet > able > JR> to articulate the same. > > JR> I know all the bases are not covered in this message but it > hopefully > JR> provides enough information to peak everyone's interest. > > JR> Thanks, > > JR> Ron > > > > > > ------------------------------ > > Message: 4 > Date: Thu, 30 Oct 2008 19:04:50 -0600 > From: "Joan Riches" <[EMAIL PROTECTED]> > Subject: Re: [OTlist] D/C'd Patient For Lack of Goals > To: <[email protected]> > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset="us-ascii" > > So work at not feeling so badly, Ron. Have you never heard the saying > 'when all else fails refer to OT'. Because with all our angst about > not > being appreciated lots of folks know that OT expertise means we do > make > a difference many times when 'the others' were stumped. Sounds like > you > were a sacrificial lamb in this case. The fact that you are suffering > because you worry about not helping this woman shows what a good OT > you > are. > > Special blessings, Joan > > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On > Behalf Of Ron Carson > Sent: October 30, 2008 6:10 PM > To: Joan Riches > Subject: Re: [OTlist] D/C'd Patient For Lack of Goals > > > Thanks Joan and Jennifer: > > Because the patient is on HH, she is already > receiving a plethora of services; everything from social worker, RN, > aide to PT. > > You know the question of "why" was never answered, either by the > patient, her family or myself. When I earlier mentioned mind mapping, > it was because of this patient. > > I think something psychiatrically happened to her but she refuse my > suggestion for a psych eval. > > One of the things that was even odder and leads me to think that maybe > "I" was the problem is that the patient was doing well in PT and she > took a bathe with the assistance of the aide. But, I swear, this > patient would NOT verbalize wanting to do anything on her own. The > only thing she said, especially in the beginning is that she wanted to > be "normal". > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: Joan Riches <[EMAIL PROTECTED]> > Sent: Thursday, October 30, 2008 > To: [email protected] <[email protected]> > Subj: [OTlist] D/C'd Patient For Lack of Goals > > JR> Ron > JR> In a case like this I think that an OT eval may be the most > effective > JR> part of our offering. I am left with the question, "What referrals > have > JR> you offered to this family?" You have gathered valuable > information. > JR> This is certainly an extreme case of occupational dysfunction > due to > JR> ......what?? > JR> If you have read English novels you may have run across similar > JR> descriptions of 'invalid' (emphasis on the first syllable) upper > class > JR> women. It is an interesting brain twig to then put the emphasis on > the > JR> second syllable. Thanks for all the brain twigs now and in the > future. > > JR> Joan Riches B.Sc.O.T., OT(C) > JR> Specialist in Cognitive Disability > JR> Riches Consulting > JR> High River, Alberta, Canada > JR> 403 652 7928 > > > JR> -----Original Message----- > JR> From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] > On > JR> Behalf Of Ron Carson > JR> Sent: October 30, 2008 7:08 AM > JR> To: [email protected] > JR> Subject: [OTlist] D/C'd Patient For Lack of Goals > > > JR> Yesterday, I d/c'd a patient because she is unable to verbalize > ANY > JR> OT-related goals. It was a very strange and difficult case and I'm > not > JR> 100% comfortable with the d/c, but it seemed to be the best > choice. > JR> I'm VERY interested to hear others' opinions. > > JR> I evaluated a patient last week. Without going into a lot of > detail, > JR> the patient has mild arthritis, recently fell and had kyphoplasty. > She > JR> had been very active until about 5 years ago when she > "suddenly" > JR> became very sedentary. There assorted history and eval findings, > but > JR> this is basically a women who has disengaged from life. > She > JR> essentially lives on her couch and that's about it. > > JR> When I evaled her last week, she was unable to identify ANY OT > goals. > JR> Against, my better judgement, I "made up" a couple goals and > scheduled > JR> her for only two visits. > > JR> At the end of my second visit, I indicated that I was d/c'ing > the > JR> patient for lack of goals. The patient was OK with it but the > husband > JR> talked and asked me to stay on. After a long conversation with > the > JR> patient, one in which I was apparently "mean", the patient agreed > that > JR> she wanted me to come back. So, I signed her up for 5x/week > therapy. > > JR> On the next visit, I was told that the patient "did not like > me" > JR> because I was mean. I promptly apologized to her, expressed my > concern > JR> and methods and asked for forgiveness, which she readily gave. > After > JR> that, I again started talking about the patient's life and goals. > Her > JR> son had mentioned that the family had a pet that died and that > was > JR> sort of "the beginning of the end" for the patient. The son > had > JR> mentioned possible pet ownership which I followed up on, but > the > JR> patient denied wanting it. > > JR> I came back two more times, with each visit focused on > identifying > JR> goals. We did a mini life review but no matter what avenue I took, > the > JR> patient denied any goals. So, I reluctantly told her that in > the > JR> absence of goals, d/c was the only option. She agreed and said > she > JR> was sad because she was "starting to like me". > > JR> She and I agreed that my time had not been wasted but that > continued > JR> visits would be a waste. > > JR> Without doubt, this is one of the hardest and strangest cases > I've > JR> ever had. I've never met a person who was so unmotivated and yet > able > JR> to articulate the same. > > JR> I know all the bases are not covered in this message but it > hopefully > JR> provides enough information to peak everyone's interest. > > JR> Thanks, > > JR> Ron > > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > No virus found in this incoming message. > Checked by AVG - http://www.avg.com > Version: 8.0.175 / Virus Database: 270.8.5/1755 - Release Date: > 10/29/2008 5:27 PM > > > > > > ------------------------------ > > Message: 5 > Date: Thu, 30 Oct 2008 21:31:04 -0400 > From: Ron Carson <[EMAIL PROTECTED]> > Subject: Re: [OTlist] D/C'd Patient For Lack of Goals > To: Joan Riches <[email protected]> > Message-ID: <[EMAIL PROTECTED]> > Content-Type: text/plain; charset=windows-1252 > > Joan it so funny you mention sacrificial lamb, because that's > exactly > how I felt. It seemed that no matter what, I could not "connect" with > the patient. But in the end, we both agreed that OT had been very > helpful. The whole experience was just strange! > > I like your saying! Here's one that I made up: > > OT - the Other Therapy! Sort of goes hand in the hand with your > statement! > > Ron > -- > Ron Carson MHS, OT > > ----- Original Message ----- > From: Joan Riches <[EMAIL PROTECTED]> > Sent: Thursday, October 30, 2008 > To: [email protected] <[email protected]> > Subj: [OTlist] D/C'd Patient For Lack of Goals > > JR> So work at not feeling so badly, Ron. Have you never heard the > saying > JR> 'when all else fails refer to OT'. Because with all our angst > about > not > JR> being appreciated lots of folks know that OT expertise means we do > make > JR> a difference many times when 'the others' were stumped. Sounds > like > you > JR> were a sacrificial lamb in this case. The fact that you are > suffering > JR> because you worry about not helping this woman shows what a good > OT > you > JR> are. > > JR> Special blessings, Joan > > > > > > > ------------------------------ > > -- > Unsubscribe? > [EMAIL PROTECTED] > > Change options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] > > Help? > [EMAIL PROTECTED] > > > > End of OTlist Digest, Vol 43, Issue 44 > ************************************** > > > > > _____________________________________________________________________ > > Disclaimer: This message is intended only for the use of the > addressee(s) named > above and may contain privileged information. If you are not the > intended recipient of > this message you are hereby notified that you must not disseminate, > copy or take any > action based upon it. Please delete and destroy the message from > your computer. If > you received this message in error please notify the Healthe Group > of Companies > immediately. Any views expressed in this message are those of the > individual sender, > except where the sender specifically states them to be the views of > the Group. > > > -- > Options? > www.otnow.com/mailman/options/otlist_otnow.com > > Archive? > www.mail-archive.com/[email protected] -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/[email protected]
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