Wednesday, July 18, 2018

What Do Nelson Mandela Quotes Have to do with Occupational Therapy?


A single centennial celebration for our profession of Occupational Therapy does not stop in 2017; it signifies a legacy building upon itself.  In this proactive "journal entry" of mine, I want to take you on a journey of celebrating Nelson Mandela today (as today would have been his 100th birthday).

He is a historical landmark for what it means to be a peacemaker; for human and social rights.  Everyday as Occupational Therapy practitioners, we face circumstances where we advocate for our client's human and social rights to participate in meaningful day to day activity.

That is why I would like to question and break down how these top Nelson Mandela quotes relate and teach me about our practice in occupational therapy:  

(P.S.  I replaced all the "man" or "men" references to "person/people" cause I don't do rules)


"Difficulties break some people but make others. No axe is sharp enough to cut the soul of a sinner who keeps on trying, one armed with the hope that he will rise even in the end."


Hitting roadblocks, obstacles and circumstances telling us "no" in practice is familiar to many; it comes from administrators, peers, our own colleagues, and even our clients when they don't want to work with us. When we use those roadblocks as fuel instead, we rise and grow.  

Every time I use the very thing pushing me down as fuel, I gain greater momentum and strength to stand up again.  

REAL TALK: 

We will fall.
We will fall many times. 
Just like when little ones learn to walk.  

Then they try again after hitting their bums on the floor more times than not.  

...but isn't that the foundation of what we encourage our clients to do?: 

they are handed a barrier (or a wrench is thrown in their plans of life) and we assist in filling in the gaps along their journey in finding their footing?...isn't that the very thing to facilitating access so they can move, do and be in their meaningful activity?  

Question #1 I want you to answer for me:
Instead of defeat: How can we use our barriers as fuel for our soul?



"It always seems impossible until it's done."



If we haven't tried it yet, we will not know what will come of it.  

Instead of giving up...instead of giving it a label like "not being accessible" or "it's impossible," try embracing the journey one baby step at a time. 

We make it this big thing that if we snap our fingers, it will magically appear and be what we expect the results to be. 

Again, we must learn to take the small steps before walking, crawling, stumbling, and losing our footing.

We will never know what it is like until we get in the mix of it. 

As I say: 

"The first step is to take one"  -Alexis Joelle

in other words...

"Can't couldn't if it didn't try" -Alexis Joelle


That said, Question #2 asks you:
What baby step will you take first right after reading this post to embrace the impossible?


 "If I had my time over I would do the same again. So would any person who dares call himself a person."


When we own our lifestyle, we accept ourself for as we are.  This is a valuable professional lesson to live by.  If we live someone else's life, we disregard our own.





Question #3:
To ensure you have no regrets or missed opportunities: How will you live your life exactly as you are? 


 "I like friends who have independent minds because they tend to make you see problems from all angles."


Without diverse perspective, we live in a limited world subjected only to our own knowledge of it.  We will also feel isolated in our problems. When we expand our understanding of what we think we already know plenty about, we actually grow solutions rather than problems.


Question #4 for you:
How will you broaden your friend circle?  Who will you hang out with and ask questions of to gain a more well rounded understanding of the topic you struggle with?


 "Real leaders must be ready to sacrifice all for the freedom of their people."


When we signed up for this profession, no one told us we would need to be leaders; the truth is we are.  The moment we get that "L" to state we are licensed, we gain a responsibility to lead.



Question #5:
How will you lead in order to free your clients from their barriers...to be able to access their meaningful activity?


"A fundamental concern for others in our individual and community lives would go a long way in making the world the better place we so passionately dreamt of."


Plainly speaking, we care a lot! We do. 
No matter how you show it or phrase it for others to understand, we care and show concern for our clients and community.




However, I ask this in Question #6:
Do we live our world dream in the practice of OT?


"Everyone can rise above their circumstances and achieve success if they are dedicated to and passionate about what they do."



We are passionate about our work but, sometimes our passion does not lead us to being "successful."  So with that,






Question #7 asks you:
Do we do the work? Do we do OT?


[Now a bit of an explanation for this question 

- I didn't say these questions would be easy to answer or sweet and considerate of your particular circumstances.  

-They just come from my authentic self...real thoughts that run through my headspace about real circumstances...

-when I journal, I actually ask myself the hard questions I don't want to hear sometimes. I answer back to them to grow in learning! 

-If I ask myself these questions, I should ask them of my #OTtribe as well because it means you too are reading this to learn and grow yourself in life and in your OT practice.  

-When you get vulnerable and face the tough stuff (the stuff we don't talk about or admit to) I am here to support you when you are in that vulnerability....it's because you gave yourself permission to be vulnerable and it's in my blood to be sure you NEVER feel alone in that

...okay now back to our regularly scheduled blog entry]


"Education is the most powerful weapon which you can use to change the world."





We know education is huge!  We must pass along the knowledge to serve our clients.  However, it's less about what we can educate our clients on and more of what we can learn instead; that is where change happens.



Question #8:
What will you educate yourself about today to change the world?


"I learned that courage was not the absence of fear, but the triumph over it. The brave person is not those who do not feel afraid, but those who conquer that fear."



I feel we conquer a fear every time we are brave enough to step into the patient's room, space, or environment to offer our services to them.  

Confession: I get nervous every time I step in; shaky and gittery...and I've been practicing since 2011!!! 

Fearing that they will reject what we have to offer is the very thing that drives us to serve in our best efforts.  We want to provide a meaningful therapeutic relationship with our clients.  We want them to succeed. When we let fear take over, we miss the opportunity to truly serve our clients.

Question #9 for you is:
How will you face fear head on to serve in your purpose?


"For to be free is not merely to cast off one's chains, but to live in a way that respects and enhances the freedom of others."


We feel free when we succeed in getting our clients what they need. Freedom to me is feeling like my clients can access independence in their daily activity.  I feel free in my purpose when I achieve this.



Question #10:
How do you release the chains, holding you down, to free your clients from their burdens?  The burdens stripping them of their freedom to access meaningful activity?


"Resentment is like drinking poison and then hoping it will kill your enemies."



We can feel demoted from our position when a client prefers to walk instead of do daily activity with us... or we feel treated unfairly in being included as a part of the team....and we hold grudges towards our own clients and other disciplines.


The thing is: it's not worth losing sleep over it at night.  We do become poisoned over our own grudges.

Question #11 for you is:
How will you let go of resentment?


"Lead from the back — and let others believe they are in front."




Oh em G: this is our bread an butter.  We facilitate others to be able to lead their own lives; through independence in accessing meaningful tasks.

IT'S NOT JUST BELIEVING!  Our clients actually will take the front if we allow the opportunity.

Question #12: 
How will you allow your client to lead, not just believe?


"Do not judge me by my successes, judge me by how many times I fell down and got back up again."




We very well do this with our clients in encouraging them to fall because it means they are moving forward.




Question #13 is: 
Will you give yourself permission to trip, slip and fall, many times in the day, to be successful?


"I hate race discrimination most intensely and in all its manifestations. I have fought it all during my life; I fight it now, and will do so until the end of my days."



The physical characteristics of clients we serve (their race) is judged by many unintentionally.  They will be assumed to be a certain way when it comes to their health and well being. 

The healthcare services provided to them will have gaps unintentionally; there is no question of that.  

OTs do advocate on the regular for health literacy efforts; to bridge these gaps for our clients due to unintentional biasing treatment but, we forget to acknowledge the OT race.

Our physical OT characteristics are judged by others.  

The equipment we carry around in the halls.
The way we carry ourselves to others.

Truth is, we need help from those who can advocate for us to be as we are. We need support; we need a community to fight for and a community to fight on our behalf.

Question #14 is:
How will you fight for your OT race? 


"A good head and a good heart are always a formidable combination."



We toggle between listening to our head and listening to our heart; I always listen to my OT heart. 

Why you may ask: 

because it is a feeling greater than logic or knowledge.

That feeling creates deeper connections to myself in what I do and a deeper connection to what my clients need from me as an OT practitioner.  

Truly, no one cares about your 4.0 GPA or highest level degree.  

All they care about is if you spoke and acted upon your heart.

Final Question #15:
How will you live with a good heart in your OT practice?

PS: 

about 1% of you will actually answer ALL of these questions and get back to me

3% will answer a few

about 20% will answer 1 question  

What percent will you be?  

I personally would love to expand my knowledge by hearing your thoughts.  If it's too personal to share in the comments below, shoot the responses to me in an email.  

That is your assignment for the week. :)

PPS:  

Want to take on the assignment because you know you want to boost your OT growth but, need more time to answer? They are hard questions for me too...and you don't have to answer them all in one day!  Do one each day of the week and get back to me in 15 days!  (If you need friendly reminders, I'll post the question of the day in my instagram for the 15 days). Challenge accepted: let's do this.

-xo, Lex


I live for and teach fellow OT and OTA practitioners how to embrace "your best OT self"; no matter the barrier in your way. To stay up to date with resources and upcoming courses to support you in this, go to: creatingconfidentOTs.club 

Saturday, February 17, 2018

What the One Task of Toileting Taught me about Occupations

I walk into work today. A physical therapist comes up to me to inform me that they asked the physician for an occupational therapy order to assess a client’s ability to independently toilet themselves.

I think ok... there’s a few things going on in my head at the moment (which I can leave to your experience when you hear a co worker advocate for our services).

So I review the chart:

Without disclosing too much information or place identifiers to protect privacy of the client,  I will mention co morbities and conditions of their circumstances more generally than specific.

Chart review:

The client lives alone
The client is in their 50-60s
The client has a condition where they are wheelchair bound
The client has incontinence due to the use of medication to treat another medical condition ( This condition was only diagnosed in the past six months)

The reason for admission to the hospital is “non-compliance” in taking medication for recent diagnosis of their medical condition, resulting in complications of the severe symptoms of the condition

What are some thoughts that come to mind to assist the client?

Well here’s what came to my mind (at first):

They need a medication management system; assess what’s in place then go from there for what to implement for intervention. (NOPE, I WAS WRONG).

They need health literacy retraining for the importance of adherence to taking the medication...after all, this is a new diagnosis with new routines and understanding to it  (NOPE I WAS WRONG AGAIN).

So when I resolved those not being the concerns, I sat down beside my client to conduct their occupational profile interview:

The client has their own home business and takes great pride in their profession
The client is active in the community on a social level
The client has a condition that damaged the bladder many years prior
The client is modified independent in IADLs and ADLs

Here’s the barrier to their meaningful occupations:

Incontinence... consuming their time.

They would spend hours cleaning their bedding, multiple times in the night.
They would transfer to the toilet and incontinence would occur on the transition.
They would spend time cleaning the bathroom of the aftermath.
They would find minimal sleep and lots of time in the morning spent just cleaning up after them selves.... hours of time.

Not able to get out into the community
Not able to spend time with their clients
Not able to go to the grocery store
Not able to enjoy their coffee in the morning and read the newspaper (their most favorite thing to do).

So what did the client do? They  intervened with the barrier getting in the way of their most meaningful occupations; the medication causing the inconvenience. Problem resolved right?

What toileting taught me about meaningful occupations is these 3 things:

1. ONE MEANINGFUL TASK CAN BURDEN ALL THE REST
it’s not just about toileting; it’s about all the things that are impacted by that one thing. It taught me to dig deeper in what meaningful activity truly means to my client.

2. WHAT YOU THINK IS THE “PROBLEM” ISNT AT ALL
when reading the chart and the doctor’s interpretation of the clients “problem” on a medical level, it is our instinct in a medical model of treatment to focus on the diagnosis unintentionally... this circumstance reminds us as Occupational Therapy practitioners that we assess the occupational barriers, not the medical problem. We treat the client’s access to meaningful activity, not resolving the issue for why they are in the hospital.

3. LEAD WITH YOUR CLIENT AND STICK AROUND LONGER THAN YOU ANTICIPATE TO
I was out of my comfort zone with how to assess my client and ultimately treat them or provide intervention strategies. In finding out more about their story, their occupations of meaning, I can truly help them achieve their goals to break down occupational barriers. That’s why I firmly believe our clients are our answers to intervention. I spent over two hours with this client on eval; it was well worth the results to overcome their barriers

In closing, I hope this inspires you to face the discomfort to come in contact with something incredible.

 When did you feel out of your comfort zone with a client diagnosis or condition that you found unfamiliar?

What stories do you have about occupations teaching you something new about how to serve your clients on an elevated level?

Love, Lex

Tuesday, October 31, 2017

Changes to CMS. Changes to future OT licensure: Why I am Not Worried


Whether you have heard about proposals related to future OT and OTA students requiring higher level degrees or changes to how therapy services will be paid (i.e. Medicare coverage within skilled nursing facility settings) or Concerns about Medi-Cal coverage cutting therapy access...proposals will cross our practice path many times in our lifetime...and more change will call for adaptability within the lifetime of our practice.  

Some practitioners are worried, angry, and scared.  Practitioners are asking: "What will this mean for me?" "Will I be able to practice?" "Will I have a job?" "Will there be enough diversity in our profession?" "What about all the baby boomers receiving rehabilitative and habilitative services?" 

"What does this mean for the future of the profession?" 

To be honest, I'm not worried. I know, I know, some of you are thinking: what! Is this woman crazy?!

Yes, you heard right. I'm NOT WORRIED. SO why? Why am I not worried?

Number one: Graditude
Number two: I can’t afford to worry 

Is it scary? Of course. Will I settle for it? No. 

Graditude: I get to practice this profession! I love what I do as an OT too much to accept what doesn't align with my practice priorities. I cannot do as others say or back down if my gut says this isn't right. I have to take action instead with what aligns with my professional priorities. 

Don't get me wrong, it is initially worrisome when I hear the news because my first reaction like anyone else to any news of change is fear.  Fear that someone else has control over my profession. There's a fear that comes over us that we will lose a job, have less opportunity for work if others take over and more work to be done to show our worth. 

Any change is scary but here's the good news: We don’t have to settle for changes we are not comfortable with. We can take action towards what we need and want, always. When it is not perfect in result, we can and will adapt around them.  

Let's back up a bit before I tell you what you can do to take action for yourself: I want to define my definition of the word adapting because to some, adapting is interpreted as settling and dealing with change.  The kind of adapting I am referring to is not one where I settle or having that belief of "that's just how it is." 

Instead, adapting will mean reflecting on myself to convey a message more effectively, in order to pursue what I want.  Okay, let's get back to some good things to possibly reassure you at this time of scary things happening.

Here are some reasons why I am not worried:

* Because when I walk into a state OT conference annually, I see our state association giving us tools to breakdown barriers we face in daily practice.  

When I talk with OT's at these conferences (who spend their free time being representatives in governing affairs), I am not worried.

When I also see the lobbyists at these conferences who believe and advocate for our profession, on our behalf on the state and national level, I am not worried.

* When I run into other practitioners and speak one on one with those OTs and OTAs who have a differing perspectives on the things I cannot see, I am not worried. I have faith each practitioner will follow suit in helping to speak up, just as our representatives do.Their passion for their practice gives them the courage to speak up in time of need; it also gives me the strength to keep going too. 

I have faith each practitioner's passion for what they do will speak louder for action in advocacy, in turn, overriding acceptance or settling for what is or what might be their future. 

I see what happens when we are greater in numbers; coming together as a community of occupational therapists.  It is stronger than standing alone in our clinics or facilities; our voice is louder together.  The more dynamic it is, the more comprehensive our message is for getting things done. Perspectives from all angles brings inclusivity of everyone's concerns, which breaks down the barriers we are facing today. 

I have to say, bluntly, I believe these roadblocks are there because we were not more involved when things were and are going right.  The barriers are exactly what we need to push back.  

If the changes being proposed pushes therapists hard enough, they will fight back.  There will be no settling as long as we do it together as a unit. 

I am not worried because all therapists will get involved.  There will not be lurkers watching and reading the updates of proposals, only waiting on the sidelines for all things to crumble. Practitioners will comment on proposals, convey their wisdom from their personal experiences and will get engaged with the effective people who influence these decisions.

I am not worried.

* I am also not worried because there are ways to intervene. After all, would I have a job if I didn't have an intervention to address my client's occupational barriers? 

Sure sometimes we have to try another way of doing things to get the results we need. There is always another intervention to the barriers we face if we don't succeed in the first try.
Not one intervention fits all barriers so that's why I want to share a few of the interventions that improve the ability to be heard and minimize concern for changes that we may not see so optimal.

Here is why I cannot afford to worry and three ways to adapt to the proposed changes. 

(credit for my motivation to write a post about this goes to one of our very own occupational therapy colleagues who is an advocate on a governing level for my state, Sabrena McCarley):


1. Become Besties 
with your Local Legislators:


WHY: 

They don't know you and they most certainly do not know what a occupational therapist is. In fact, every legislator, senator, governor, and representative on a governing level do not know who you are, what you do and why it is valuable.  

They also would think you are stalker-like and creepy for coming out of no where when all of a sudden you have a favor to ask of them like a little thing of needing their vote on a decision that impacts our professional future.  

That's why we have to build a relationship with them first by becoming their bestie. 

It's like dating: we don't traditionally walk up to the door of someone we are crushing on and ask them to marry us before introducing who we are, getting to know about them and sharing a part of you and your history, your passions, your interests, your daily life.  Of course we wouldn't rush to the alter right away, that's why we would treat those who can help us get things done on a profession end the same way as our potential partner.

HOW: 

Get on their email list ( they will not spam you) This is to stay informed of their local events so you can attend. This is were you will shmooze, say hello and build a relationship over time.  Soon enough they will know what you do and who you are and realize you are the reason why they will still be able to do self care when they have a barrier get in their way one day.  Be sure to get on each of these representative's lists to be there before you need to be.

1. Google: "find your legislature" followed by typing in your state

2. Type in your zip code 

3. Click on their site

4. Join their email list

5. schedule out their events when they inform you to attend

6. schmoose, get to know them and let them get to know you

7. repeat #6 over and over again

I also recommend identifying who is your point of contact federally as well for your county. Go here as well: 


To be your accountability partner in this, I need you to do me a favor:
When you finish step one, I will know you did this by tweeting me a screenshot of your newsletter request completion at my twitter handle here and say in the tweet "I'm their go-to OT." 

Don't have twitter? That's okay post your screenshot on Instagram instead with the same comment ( do not forget to tag me so I know you did it).



2. Comment on the proposals 
(sent to you by your state and national associations that ask for your comments).


This is not only an email you find from your association but this applies for those facebook group posts and newsfeed shares that have your state or national association indicating a memo or link about the topic of interest.  

WHY:

because if no one comments on the proposals from our profession, it is assumed no one has an opinion about followed by the assumption that the proposal must be fine and dandy to more forward. 

If you comment, the more diversity in perspective regarding the issue can be considered.  That is why your voice counts, every single one of your voices. 

WHO: 

ALL can comment! You do not have to be a member of an association to have access in the proposal comments; this is put out to the public. The OT association acts as the messenger of these because they have to be on alert of anything that impacts change in our profession. 

HOW: 

Anytime you see a link provided by state and national OT associations for opinions and comment requests for proposals, take the five minutes to fill them out, FIVE MINUTES!  That's .003% of your day every once in a while to contribute your valuable opinion on the subject matter 

Accountability moment: tweet me #OTadvocacy each time you do this.  The proof is in the pudding, do your part in creating the mixture.


3. Email your state and national associations 
(to comment on their proposals or course of actions):


WHY: 

see the "why" in #2

WHO:

Everyone!  Being a member of your state and national association is critical....however, you are a OT or OTA practitioner who has a valuable opinion in the matter of decisions.  

It is spoken by the wise Lena Llorens at the most recent OT conference (during her Q and A session I attended):  

"I hope they think about this wisely" while sharing her thoughts about the concern for diversity in the decision to upgrade the degree level for incoming OT and OTAs.  

Share your unique perspective on the items of discussion that causes you to have questions, concerns or otherwise. 

Our association representation will not know how you feel if you do not speak up about it or share your solutions.

HOW:

Because there are many states with all types of contacts combined for each, I cannot list them all here so these are the chair titles you need to find:

* professional development and leadership chair
* Advocacy and Governmental Affairs chair
* practice and ethics chair
* political action committee chair

To locate them, 

1. Google your state OT association

2. Find the contact us button.

3. Search for the contacts above


Then contact national: Contact here

Now it says in their description that non-members are encouraged to join to support the future of OT (where messages typed there by non-members cannot be answered by staff).  

I of course would love for you to be a member too for many reasons but, that is not the point of my post today.  WHAT YOU NEED TO DO - Call and leave a typed message on that form anyway; it does not mean they ignore your inquiry if you do not get a response back. Your voice does influence their decision making.  It shows you care about your profession and you have an additional voice speaking up for change.

Accountability moment: you know what to do

Closing thoughts:

When the alarm goes off that there is smoke indicating a fire in our professional pathway, we rush around to find the fire extinguisher ( we react to danger).

More real talk for you today is: It is more of an alarm to me for practitioners to react rather than proactively respond. 

It is important to be in the know before there is a problem or a decision made.
To be involved in your future when things go scary is essential but do you know what is more important than that?  

BE THERE when things are going good too. BE THERE ALWAYS.

Proactivity from each of us will support our ability to practice. 

It’s never too late to get involved, get connected and support the validity in your worth.

- with hugs and support, 

Lex

PS: If I can ask for a favor of you: Please share this post with your colleagues who are feeling defeated about changes that come their way. They may find one of these interventions to be useful.




Friday, May 12, 2017

Wait...You Can Pull Off Over 90% Productivity??


If this is you and you are an Occupational Therapist, please speak now or forever hold your peace in this mastery of an unheard skill.




New value-based OT evaluation codes were released in January and some occupational therapists claim they are able to meet 90% productivity (and higher) when being asked to accomplish this at some settings! Can you believe it?


I am scratching my head at the confusion...this is so 2016 shenanigans.


We have been reminded that we get the permission to go back to our roots of what occupational therapy truly is, as well as being able to have the say of:


HOW LONG we spend with clients for evaluation sessions


AT WHAT COMPLEXITY LEVEL we evaluate them at (based on the complexity of their case) and....


no other non-OT person has the right to make this decision.


(and if you are a OTA, hang in there with me, this applies to you too!)


I was curious about the claims I read in social forums related to pulling off 90% + productivity...so I explored the break down (seen below) for the time allotted in a typical day to do evaluations and/or treatments for clients in a post acute setting:




8 hours in a shift (480 minutes)


90% productivity met would be 432 minutes in a shift which would equal 7.2 hours


For California therapists: add on two mandatory 10 minute breaks to that - now we are hitting 452/480 minutes in the shift leaving us with 28 minutes to do a few un-billable things:



🔁

1. SELF CARE: water and pee ( or #2) breaks


2. EDUCATION and information gathering where the client is unable to be present:


This could be discussing education or occupational performance with:


The client's nurse who is running around the floor getting medication for their other patients

The doctor who is not in the building

Other disciplines working directly with this client who is not immediately present in the room at exactly the time you are having your session or caregiver/family involved.

3. SUPERVISION AND GUIDANCE: of OTAs you supervise...and for the OTA themselves:


-the time for the OTA to be able to ask for guidance
-the time to provide feedback to the OT supervising them regarding upgrading and downgrading (or meeting) goals
-the time to receiving the coaching they are allotted as well

am I missing any scenarios?

OH YEAH....


4. DOCUMENTATION and INTERPRETATION OF ASSESSMENTS that cannot be completed when you have your hands on treatment with your client




If you are able to physically master documentation on an IPAD while doing ADL treatment in a bathroom... or in the patient room while treating them, you MUST share your secrets with us. As OTs we have impressive talents including adapting devices and their user-ability.


...I wonder how this so when the patient requires contact guard assist for standing balance while progressing their dynamic access to grooming at the sink side


...or needs MAX redirection cues for safe participation in lower body dressing at the edge of the bed


...or needing to monitor their vitals while the client takes that rest break.


...or is impulsive in their movements during a cooking activity at stove top/ meal prep and needs the therapist to have two hands ready at any moment


...or that hands on assist for that safe shower transfer training


...or they have an aspiration risk that needs our eyes on them for the whole meal they are being trained to feed themselves with.


...or it's their first time handling that razor to shave themselves for grooming and their cognitive awareness isn't quite up to independent standards.


Other additional things like transporting a patient to and from our evaluation/treatment space of choice (when this is not conducted in the client's room), clean up of materials and etc can likely be delegated right?....hmmm not sure if there is a designated rehab aide in all settings yet but, having an assistant is helpful when we cannot do it all.





Here's the flip side...

(I am all about seeing each side of the coin and I do forewarn you on the real talk):

1. SELF CARE: I see the burnout and lack of self compassion for my occupational therapists who are my students, colleagues and clients of mine.


They are conforming to a non-OT rule to the way of evaluation, practice and treatment. Sure there is business to be done, we HAVE to get paid to put food on the table and a roof over our's and our family's heads... and I am not even talking about this being about having "no other choice." It is to point out that some disregard themselves as even being human, imperfect and doing their best...and that human I speak of (you!) must come first to truly serve your clients.


2. CARE FOR COLLEAGUES: we want them to be their most successful in assisting their client and decrease their burnout as well. They flourish from our guidance and training to facilitate our client's access to their life occupations. Take that time to say "how are you?" "How can I help?" Connect with their human self.


3. CARE FOR CLIENTS/PATIENTS: Their occupations are at the center of our practice ...


and yet, are they getting their value's worth for the evaluation, practice and treatment we provide them?


Is it truly client-centered....a life occupation based practice...


...or is it a day at the rehab gym?


(is it me or have many client's taken up the hobby of cone stacking, arm biking and T-band pulling?)




What do they (your client) want to get back to? Do they want to:

Care for their dog?


Spend social time with their grandchild?


Get back into their golf swing?


Write that letter to their best friend on the other side of the coast?


Put on their make up every morning?


Pull the weeds from their garden?


Wipe their tuchus on their own despite being incontinent so they can live with their children at home and not worry about them cleaning up after themselves?


Play their favorite instrument again?


Make it to their Mah-jong game on time?



This is why I love and live off my copy of the Occupational Therapy Framework because I know if I get lost, there will always be it's guidance in getting back to my client's occupations.


I am also super grateful for my California State and National occupational therapy associations because they not only advocate on behalf of me to do be able to do my job...


They keep me in the loop about resources to use to defend my intention in everyday practice, as well as provide the up-to-date info impacting our profession AND when I need to step up and act to protect it


(and, and... let me tell you this much):


we need to protect our profession even when, and especially when, things are going right.

So here is some real talk ;) :


1. Go easy on yourself...you are productive when you are with your clients working toward their occupation based goals.


AOTA provides you with a copy of an occupational profile template to use with your clients to accomplish this.


2. Stay true to your value-based evaluations in choosing accurate codes to best serve your client


Didn't get formal training at your site for this?!


Here is the OT evaluation worksheet I compiled to help you figure out the formula of what code to choose for which patient (not every client or diagnosis fits all).


3. Ask yourself when your gut instinct cries and screams at you:


"what other resources are out there that can help me shift from defeat of ethical dilemmas to champion mode?"


Here is an additional document to use in defending your case to administrators of facilities/ parties that say you should do it differently than you have decided clinically (when you in fact, are in the right):


Consensus Statement on Clinical Judgment in Health Care SettingsAOTA, APTA, ASHA




My closing thoughts about this high productivity? I go for the goal of being 100% productive:

 when in an actual session...

From the time I enter a client's presence, to the end of that session, I am accomplishing one goal: 

understanding their occupations to their fullest, jam packing my assessment and intervention with therapeutic use of self and seeing them flourish on their own to access what is meaningful to them.

REMEMBER: productivity does not equate billable time; make either effort occupation based.

Two things I kindly ask of you:


1. Leave your comments below on ways you feel productive in a one-on-one session by answering this question:

When it comes to OT, what makes your heart sing?

2. Share this with your fellow OT colleagues as we don't know what we don't know and sharing the resources is mandatory so they too can do what they do best in practice.

Thank you for stopping by,

-Lex