Friday, April 8, 2016

Emerging roles: Occupational Therapy Practice Now and it's Future

In considering five to ten years from now how Occupational Therapists (OT) serve clients, patients and community, the future of that image is now.  The future appears bright with more than just acknowledgement of the profession.  Meaningfully established activity for the clients served will be greater accomplished.  Generally, what society creates in task (or occupation), establishes the needs and services at which an Occupational Therapist provides skillfully based access to those tasks.

Let’s consider what Occupational Therapy looked like when it was first founded in 1917.  The people of the community were facing “war, immigration, industrialization, exploitation of workers, poor schools, and inadequate medical care (Schwartz, 2009).” Today’s day and age, some may interpret that as meeting the physical, cognitive, psychosocial and emotional needs of productive members of society via, what is now called, Occupational Therapists or “OT.”

Throughout the decades, role for OTs has evolved, shifted, grown, changed. This is CRUCIAL for any work an Occupational Therapist embarks: to evolve with society’s needs. Here are 10 examples of how you will notice Occupational Therapy is evolving into additional roles:

Community Based:

  1. Domestic Violence (DV)  and Human Trafficking (HT):

This occurs when person’s who are victim of Domestic Violence and human trafficking are already saved or in a safe space from the previous environment.  Within the context of DV or HT, skilled needs of daily life occupations emerge where occupational deprivation has grown ( including basic needs/self care, child care, community access). Environmental factors establish “a way” of living where volition and values of meaningful task are stripped before the opportunity of development of the skill. One goal of an OT is to identify with the client new roles that have been unfulfilled.  These are explored, with retraining and implementation of skills for access to those purposeful and meaningful new roles.

     2. Habilitation services:

This is the ongoing persistence to facilitate a person’s ability to acquire, sustain, and grow the skills to continue to access the individual’s most meaningful activity of daily life.  When establishing an individual’s competencies and abilities needed for optimal functioning in interaction with their environments, habilitation is achieved. where task participation is accessible, an empowered individual may reside (habitat).

Establishment of the “Golden peers” Home Initiative (this is the name that I give it):

photo credit:

In recognition and appreciation of the American sitcom with the four “Golden Girls,” who share a home together and guide each other emotionally, spiritually, and when faced with medical conditions, support another while “living in place” It is so clear to me the need for planning ahead to set up an environment where individuals will come together as a collective to assist one another in not only the physical aspect (as they age) but to maximize independence and quality of life, decrease unnecessary long term placement, and promote improved socialization opportunities (decreasing isolation with losing loved ones ie. becoming widow, children living at a distance).  The more investment and strategizing we put into practice to develop a preventive outlook for our clients, the improved quality of life is achieved and the autonomy of participating in life occupation in place is established.

School/Community Based:

  1. Cyber bullying and other bullying concerns:

Utilization of Occupational Therapists in Mental Health is a vital component to client initiation and carrying over an independent lifestyle. Interaction between two individuals (the bullies and the bullied) in a media platform, decreases the opportunity to receive appropriate social cues for a healthy carryover in interaction.  Examples:
  • the tonal inflections or mannerisms are not recognized by the bullies.
  • The bullied, is deprived of the opportunity to practice how to communicate the response thereafter.
  • This also creates reinforcement of a behavior of the bullying party.

An OT role in bullying is to ensure access to the occupation of social participation is established.  Social participation retraining from an occupational therapist indicates

A.  a need for construction and recognition of social cues, interactions and outcomes; in turn, establishing healthy, functional social engagement with others
B. self efficacy and volition in empowering exploration of an individual’s unique role and value when faced with bullying
C. How to implement communication and coping strategies when bullying is received

Primary Care

Imagine, you arrive to the doctor’s office for your six month visit, a preventive measure to health and well being via appointment to ensure your health is in top shape.  Now imagine, you get a referral from the doctor to head next door to see the Occupational Therapist for your 6 month follow up check up….mind blown!  This is currently emerging in practice at the University of Southern California (USC) to maximize lifestyle management, and redesign as necessary, to promote maximum independence and quality of life for those served who participate in meaningful day to day occupations.
How is this different from outpatient?: An OT role in primary care is a continuous practice measure for clients and patients to follow up within the medical model.  This is to promote and receive preventive health care (fewer sessions over the lifespan time frame to maximize quality of life and decrease risk for injury or insult. In contrast, outpatient services addresses a need after ailment/injury for a short duration of time (ie.  three times a week for twelve weeks).

Why primary care? This is to establish and encourage implementation for preventive wellness, to decrease risk for barriers that may impact quality of life, and accountability upon the client who receives the services.

This may include private practice with more entrepreneurial Occupational therapists emerging.  Some factors for this include change in insurance coverage for those served, society and client needs in the community.  I foresee habilitative and community-based services that are non-traditional, emerging roles such as primary care and consultation to trend upward.

Emergency Department

An occupational therapist’s role is emerging in this setting.  As with what we see in the outcome of primary care, pre-screening procedures, assessments and consultation in the emergency department plays a vital role in determining the following factors:
  • To encourage early mobilization for functional tasks prior to admission to the hospital (ie. patients may be on strict bed rest until a therapy/rehab team member sees them upon admission into the hospital, waiting time, etc)
  • How to increase client advocacy in the discharging planning process
  • To rule out deficits (cognitive, visual perceptual, sensory, etc) post receipt of medical diagnosis that may have been overlooked if sent home too promptly with risk for decreased safety in the home and risk for readmission to the hospital.
  • To provide education to the client and caregivers to maximize independence in function to promote quality of life for the client and decrease readmission rates.
  • Providing tools for lifestyle management and redesign to support the indicated factors listed above.

Forensics/Mental Health -community and vocational:

This population includes socially excluded groups of individuals (incarceration, homeless, mental health diagnosis, etc). Establishing a shift in how Occupational Therapy can access this population, addresses the concepts of occupational justice. Clients include those of:
  • risk of being incarceration
  • have a history of incarceration.
Emphasis on determining if occupational well-being is accessible to these clients (and how to do so) is considered. An occupational therapist is able to establish engagement, facilitate self efficacy with functional performance, encouragement of independence and promote meaningful life activity participation within this population.

Terrorism and coping with trauma (physical and emotional):

Occupational therapists play a unique role in establishing connections with the client to determine shifts in role, identity of self with task participation and skills in social participation while addressing the concept of how environmental factors may impact one’s lifestyle and living. These factors all are impacted by the effects of witnessing and experiencing terrorism or other form of trauma.  Mental health conditions may develop, which also impact ability to access life occupations (particularly anxiety and PTSD come to mind). I see OT’s providing a crucial role in recovery, empowering and establishing goal with the community to breakdown barriers to participation in meaningful activity when fears or overwhelm are the outcome of the negative experiences occurring.

Service delivery model - Telehealth:

What does this mean for access?  Potential clients in rural counties with limited access will be able to receive consultation with Occupational Therapists. One factor most common, is the unaccessible commute (such as that where the client is unable to pay for a bus to commute, children unable to seek childcare, etc).

The possibilities of the Telehealth delivery service model are endless however the foreseen sight of Telehealth in five to ten years indicate establishment of access to payment sources where insurance coverage is an option, mainstream.

“Globally connected” and “ widely recognized” via social media reach/involvement

As established by the American Occupational Therapy Association (AOTA) this is the encompassing vision of what OT looks like in the future.

As of August 2015, I leapt into my purpose to share with the world what OT is and does by taking the opportunity to engage with the latest trend of social media: live broadcasting. The benefit I noticed of this included gratification and satisfaction of sharing the value of the profession with those who are able to listen, globally.

Multitudes of social media platforms (ie Instagram, Snapchat, Facebook, Twitter, Linkedin, Pinterest) carry the weight in promotion of “what OT does”  but does this connect with the community? Now, platforms such as Periscope, Facebook Live, (once Meerkat now I believe this platform has become extinct) and Blab provide opportunity for interpersonal connection;

Go to Periscope

Occupational Therapists are able to convey their message to the global community via live broadcast. In sharing my ventures and strategies with students, new grads, practitioners, and the community as a whole, being able to connect anywhere in the world, with whomever in the world, the AOTA, the vision is in fact something that can be achieved by many OT practitioners.  

....and then, there's this:

Closing Thoughts…

Occupational therapy is ever evolving with our society's needs.  There is a call greater than ever for each and every OT to get involved in legislation (or supporting those who represent the profession), sustain not only what our profession that our founders worked so so hard for just shy of 100 years ago!) but to create evolution of the task needs and wants of the population served.  It is suggested this is to be re-examined from decade to decade to ensure this goal of society occupational needs are met.

When I think “five to ten years from now, what does OT look like”  I see greatness in establishment of maximizing independence in quality of life.  Persistent growth and evolution in OT practice, establishing the ever fulfilling client centered approach will transcend our profession into infinite meaning. Happy Occupational Therapy Month! How will you evolve in practice?

Schwartz, K. B. (2009). Reclaiming our heritage: Connecting the Founding Vision to the Centennial Vision [Eleanor Clarke Slagle lecture]. American Journal of Occupational Therapy, 63, 681–690.

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