Occupation-Based Approach in Post Acute Care · 2013-06-04 · Occupation-based practice: Fostering performance and participation (pp. 3–15). Thorofare, NJ: ... Occupational therapy

An Occupation-Based Approachin Postacute Care

to Support Productive Aging

Lesson 5

Supports and Challenges

to the Occupation-Based Approach

1Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal

use by the purchaser. All other uses must be approved by AOTA. To apply, go to www.copyright.com.

Lesson Focus

1. Identify issues that support your ability to use the occupation-based approach.

2. Identify ways to manage the issues that challenge your ability to use the occupation-based approach.

Supports

Challenges



Pause the CD, and review your responses for Step 4 of the Practice Inventory on Worksheet 3.1.

Review Your Supports and Challenges



Occupation-Based

ApproachPeople

Administration

Documentation

SpaceSupplies and Equipment

Caseload

Time

Reimbursement

Issues That Can Be Supports and Challenges

ChallengesSupports

(Chisholm, Dolhi, & Schreiber, 2000, 2004)4Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal


Helpful Hints

Be open-minded.

Be aware that change requires planning.

Be familiar with and use the evidence(Hermann et al., 2010; Hoppe, Kopp-Miller, & Rice, 2008; Schroeder-Oxer & Kopp-Miller, 2001; Nelson et al., 1996;

Zimmerer-Branum & Nelson, 1995).

ChallengesSupports



People

Three subcategories:

1. Intradisciplinary team (occupational therapy team)

2. Interdisciplinary team

3. New staff.



People: Intradisciplinary Team

The occupational therapy team includes You and Your coworkers.

To promote a cohesive view of the occupation-based approach, the team can Develop a department mission, philosophy, and values

and Bring in an outside perspective.

It is important for the team to embrace the occupation-based approach as the standard of care.



People: Interdisciplinary Team

The interdisciplinary team includes the occupational therapy team, other health professionals, and the client/family.

To help other members of the interdisciplinary team understand the role of occupational therapy, therapists should Remember that we are responsible for educating the

team, Incorporate the language of the Framework when

explaining occupational therapy services, and Use terminology that matches the background of the

person and the situation.



People: Interdisciplinary Team (cont.)

To help other health professionals understand occupational therapy, the therapist can Orient all new employees and students, Present at grand rounds and journal clubs, Develop an “elevator speech,” Create an occupation-based “OT Month” activity, and Cotreat with another discipline.

To help the client and his or her family understand occupational therapy, the therapist can Develop an occupational profile and Provide relevant examples.



People: New Staff

If new colleagues (including experienced occupational therapists) are resistant to the occupation-based approach, articulate your reasoning for its use by

Using the Framework and other resources in your toolbox to justify the occupation-based approach,

Modeling the use of the occupation-based approach, and

Seeking out professional networking opportunities.

I have been an OT for a LONG time

We can’t do that here

We have always

done it this way

We don’t do that here



Administration

Lack of support from administrators may come from a lack of understanding; strategies for educating them include

Sharing the evidence relevant to your setting,

Joining facility committees, and

Measuring outcomes and sharing results.



Documentation

Improve documentation:

Streamline the process by Focusing on quality versus quantity and Identifying what you need to document, for whom,

and why.

Analyze forms and formats; consider Incorporating terminology of the Framework (Sames,

2010) and Making use of addenda.



Documentation (cont.)

Documentation should focus on the client’s occupational performance. Goal that doesn’t focus on occupational performance: “Client will

demonstrate a 5-lb. increase in grip strength by discharge.” Goal that does focus on occupational performance: “Client will

increase grip strength in order to independently open containers used in ADLs.”

Ensure that your documentation does not duplicate services of other team members.



SpaceEvaluate the space where clients are treated:

Analyze where you typically treat clients.

Determine whether the space is being used for the wrong purpose.

Do a “walk through” of your facility to find new treatment space.

Look at space outside of your clinic.

Use outdoor space.

Feeling crowded in your space?



Supplies and Equipment

Do you have the appropriate tools for occupation-based interventions?

Consider Steps 1 and 2 of the Practice Inventory (demographics, diagnoses, roles, and occupational performance deficits) on Worksheet 3.1.

“Prep” the clinic area: Take an inventory of supplies and equipment. Create a list of what you need.



Supplies and Equipment (cont.)

Occupation-based supplies and equipment are often readily available:

Coupons

Newspapers

Magazines

Gift boxes

Wrapping paper

Envelopes

Restaurant menus

Grocery bags

Canned goods

Junk mail

Cosmetic samples

Kitchen utensils

Cleaning supplies

Towels



Supplies and Equipment (cont.)

Time-saving opportunities:

Prepackaged occupation-based kits

Loaner items from vendors

Borrowed items from other departments.



Caseload

Streamline your client care:

Schedule clients with similar needs at the same time.

Conduct treatment in a group format (when appropriate).

Provide the “just-right” amount of therapy (review frequency and duration patterns).

Use preparatory methods directed at the client’s occupational needs.



Time

Evaluation process: Use a top-down approach. Focus on occupations rather than client factors.

Intervention process: Use a top-down approach. Use occupation-based kits.

Nonbillable services: Create volunteer opportunities.

So many clients, so little time

There isn’t enough

time

I don’t have time



Reimbursement

Know your payers and their rules and processes.

Familiarize yourself with reimbursement codes.

Use AOTA resources.

Be an active member in AOTA and your state professional organizations.



Occupation-Based Approach

Your Occupation-Based Toolbox



References

American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683.

Asher, I. E. (Ed). (2007). Occupational therapy assessment tools: An annotated index (3rd ed.). Bethesda, MD: AOTA Press.

Baron, K., Kielhofner, G., Iyenger, A., Goldhammer, V., & Wolenski, J. (2006). The Occupational Self-Assessment (OSA) (version 2.2). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.

Baum, C., & Baptiste, S. (2002). Reframing occupational therapy practice. In M. Law, C. M. Baum, & S. Baptiste (Eds.), Occupation-based practice: Fostering performance and participation (pp. 3–15). Thorofare, NJ: Slack.

Baum, C. M., & Edwards, D. (2008). Activity Card Sort (2nd ed.). Bethesda, MD: AOTA Press.

Boop, C. (2009). Table of assessments: Listed alphabetically by title. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard and Spackman’s occupational therapy (11th ed., pp. 1089–1152). Philadelphia: Lippincott Williams & Wilkins.

Brown, C. E. (2009). Ecological models in occupational therapy. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard and Spackman’s occupational therapy (11th ed., pp. 435–445). Philadelphia: Lippincott Williams & Wilkins.

Center for Social Development, Washington University in St. Louis. (2008). Civic engagement and service: Productive aging. Retrieved April 14, 2011, from http://csd.wustl.edu/CivicEngagementService/Pages/ProductiveAging.aspx

Centers for Medicare and Medicaid Services. (2006). Policy council document: Post-acute care reform plan. Retrieved April 15, 2011, from www.cms.gov/SNFPPS/Downloads/pac_reform_plan_2006.pdf

Chisholm, D., Dolhi, C., & Schreiber, J. Creating occupation-based opportunities in a medical model clinical practice setting. OT Practice, 5(1), CE-1–CE-8.



References (cont.)

Chisholm, D., Dolhi, C., & Schreiber, J. (2004). Occupational therapy intervention resource manual: A guide for occupation-based practice. Clifton Park, NY: Thomson Delmar Learning.

Christiansen, C., & Baum, C. (2005). Occupational therapy: Performance, participation, and well-being (3rd ed.). Thorofare, NJ: Slack.

Cole, M. B., & Tufano, R. (2008). Applied theories in occupational therapy: A practical approach. Thorofare, NJ: Slack.

de las Heras, C. G., Geist, R., Kielhofner, G., & Li, Y. (2003). The volitional questionnaire (VQ) (version 4.0). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.

Denton, P. L. (1987). Effective communication. In Psychiatric occupational therapy: A workbook of practical skills (pp. 1–40). Boston: Little, Brown, & Co.

Donnelly, C., Eng, J. J., Hall, J., Alford, L., Giachino, R., Norton, K., et al. (2004). Client-centred assessment and the identification of meaningful treatment goals for individuals with a spinal cord injury. Spinal Cord, 42, 302–307.

Dunn, W., Brown, C., & McGuigan, A. (1994). The ecology of human performance: A framework for considering the effect of context. American Journal of Occupational Therapy, 48, 595–607.

Dunn, W., Brown, C., & Youngstrom, M. J. (2003). Ecological model of occupation. In P. Kramer, J. Hinojosa, & C. B. Royeen (Eds.), Perspectives in human occupation: Participation in life (pp. 222–263). Philadelphia: Lippincott Williams & Wilkins.

Forsyth, K., Salamy, M., Simon, S., & Kielhofner, G. (1998). The Assessment of Communication and Interaction Skills (version 4.0). Chicago: Department of Occupational Therapy, University of Illinois at Chicago.

Friedan, B. Quotations Page.com. (n.d.). Retrieved January 17, 2011, from www.quotationspage.com/quotes/Betty_Friedan/



References (cont.)

Hermann, V. H., Herzog, M., Jordan, R., Hofherr, M., Levine, P., & Page, S. J. (2010). Telerehabilitation and electrical stimulation: An occupation-based, client-centered stroke intervention. American Journal of Occupational Therapy, 64, 73–81.

Hoppe, K. A., Kopp-Miller, B., & Rice, M. (2008). Occupationally embedded exercise versus rote exercise and psychosocial response in college-aged females. Occupational Therapy in Mental Health, 24(2), 176–191.

Ikiugu, M. N., Smallfield, S., & Condit, C. (2009). A framework for combining theoretical conceptual practice models in occupational therapy practice. Canadian Journal of Occupational Therapy, 76, 162–170.

Kielhofner, G., Mallinson, T., Crawford, C., Nowak, M., Rigby, M., Henry, A., et al. (2004). Occupational Performance History Interview–II (OPHI–II) (version 2.1). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.

Kielhofner, G. (2005). A scholarship of practice: Creating discourse between theory, research, and practice. Occupational Therapy in Health Care, 19 (1/2), 7–16.

Kielhofner, G. (2008). A Model of Human Occupation: Theory and application (4th ed.). Baltimore, MD: Williams & Wilkins.

Law, M., Baptiste, S., & Mills, J. (1995). Client-centered practice: What does it mean and does it make a difference? Canadian Journal of Occupational Therapy, 62, 250–257.

Law, M., Baptiste, S., Carswell, A., McColl, M.A., Polatajko, H., & Pollock, N. (2005). Canadian Occupational Performance Measure (4th ed.). Toronto, Canada: CAOT Publications.

Law, M., & Mills, J. (1998). Client-centered therapy. In M. Law (Ed.), Client-centered occupational therapy (pp. 1–18). Thorofare, NJ: SLACK Incorporated.

Lee, J. (2010). Achieving best practice: A review of evidence linked to occupation-focused practice models. Occupational Therapy in Health Care, 24(3), 206–222. doi: 10.3109/07380577.2010.483270



References (cont.)

Lee, S.W., Taylor, R., Kielhofner, G., & Fisher, G. (2008). Theory use in practice: A national survey of therapists who use the model of human occupation. American Journal of Occupational Therapy, 62, 106–117.

Liu, K., Gage, B., Harvell, J., Stevenson, D., & Brennan, N. (1999). Medicare’s post-acute care benefit: Background, trends, and issues to be faced. (Contract #HHS-100-97-0010). Retrieved April 15, 2011, from http://aspe.hhs.gov/daltcp/reports/1999/mpacb.pdf

Matsutsuyu, J. S. (1969). The Interest Check List. American Journal of Occupational Therapy, 23, 323–328.

Moore-Corner, R., Kielhofner, G., & Olson, L. (1998). Work Environment Impact Scale (WEIS) (version 2.0). Chicago: Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.

Murer, C. G. (2007). A patient-centered vision for post-acute care reform. Retrieved April 15, 2011, from www.murer.com/file/uploads/docs/vision4post-acutecarereform-mar07.pdf

Nelson, D. L., Konosky, K., Fleharty, K., Webb, R., Newer K., Hazboun V. P., et al. (1996). The effects of occupationally embedded exercise on bilaterally assisted supination in persons with hemiplegia. American Journal of Occupational Therapy, 50, 639–646.

Oakley, F., Kielhofner, G., Barris, R., & Richler, R. K. (1986). The Role Checklist: Development and empirical assessment of reliability. Occupational Therapy Journal of Research, 6, 157–169.

Pollack, N., & McColl, M. A. (1998). Assessment in client-centered occupational therapy. In M. Law (Ed.), Client-centered occupational therapy (pp. 89–105). Thorofare, NJ: SLACK Incorporated.

Reed, K. L. (1984). Understanding theory: The first step in learning about research. American Journal of Occupational Therapy, 38, 677–682.

Rogers, J. C., & Holm, M. B. (2009). The occupational therapy process. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard and Spackman’s occupational therapy (11th ed., pp. 478–518). Philadelphia: Lippincott Williams & Wilkins.



References (cont.)

Sames, K. M. (2010). Documenting occupational therapy practice (2nd ed.). New York: Pearson.

Schell, B. A. B. (2009). Professional reasoning in practice. In E. B. Crepeau, E. S. Cohn, & B. A. B. Schell (Eds.), Willard and Spackman’s occupational therapy (11th ed., pp. 314–327). Philadelphia: Lippincott Williams & Wilkins.

Schkade, J. K., & Schultz, S. (1992a). Occupational adaptation: Toward a holistic approach to contemporary practice (Part I). American Journal of Occupational Therapy, 46, 829–837.

Schkade, J. K., & Schultz, S. (1992b). Occupational adaptation: Toward a holistic approach to contemporary practice (Part II). American Journal of Occupational Therapy, 46, 917–925.

Schroeder-Oxer, S., & Kopp-Miller, B. (2001). Effects of choice in an art occupation with adolescents living in residential treatment facilities. Occupational Therapy in Mental Health, 17(1), 39–48.

Skubik-Peplaski, C., Paris, C., Collins-Boyle, D. R., & Culpert, A. (2009). Applying the occupational therapy practice framework: Using the Cardinal Hill occupational participation process on client-centered care (2nd ed.). Bethesda, MD: AOTA Press.

Venes, D. (Ed.). (2001). Taber’s cyclopedic medical dictionary (19th ed.). Philadelphia: F. A. Davis.

Wressle, E., Linstrand, J., Neher, M., Marcusson, J., & Henriksson, C. (2003). The Canadian Occupational Performance Measure as an outcome measure and team tool in a day treatment programme. Disability & Rehabilitation, 25(10), 497–506.

Zimmerer-Branum, S., & Nelson, D. (1995). Occupationally embedded exercise versus rote exercise: A choice between occupational forms by elderly nursing home residents. American Journal of Occupational Therapy, 19, 397–402.



Acknowledgments

Photograph of “Mrs. Rodriguez” is used with permission of Genesis Rehab Services.

Photographs in Lesson 1, Slide 20, and Lesson 2, Slides 26 and 27, are used with permission of Genesis Rehab Services.

Photographs of “Mr. Clark” and “Mrs. Seagle” are from the personal collection of the authors and are used with permission.

Cover image of the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2008) is used with permission of AOTA Press.

Copyright © 2011 by the American Occupational Therapy Association (AOTA). Material may be reproduced and adapted for personal


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Occupation-Based Approach in Post Acute Care · 2013-06-04 · Occupation-based practice: Fostering performance and participation (pp. 3–15). Thorofare, NJ: ... Occupational therapy