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Organizing a Backpack Awareness Event Helping People With Addictions Working With Veterans Proposed 2013 Amendments to AOTA Articles of Incorporation and Bylaws
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AOTA wants to specially thank our sponsors and exhibitors for the 2012 AOTA Specialty ConferenceAdvanced Practice in Traumatic injuries & PTSD. We could not have done this without their support.
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FEATURE
Setting One Goal at a Time
Donna Costa: Chairperson, Education Special Interest Section Michael J. Gerg: Chairperson, Work & Industry Special Interest Section Dottie Handley-More: Chairperson, Early Intervention & School Special Interest Section Kim Hartmann: Chairperson, Special Interest Sections Council Gavin Jenkins: Chairperson, Technology Special Interest Section Tracy Lynn Jirikowic: Chairperson, Developmental Disabilities Special Interest Section Teresa A. May-Benson: Chairperson, Sensory Integration Special Interest Section Lauro A. Munoz: Chairperson, Physical Disabilities Special Interest Section Linda M. Olson: Chairperson, Mental Health Special Interest Section Regula Robnett: Chairperson, Gerontology Special Interest Section Tracy Van Oss: Chairperson, Home & Community Health Special Interest Section Jane Richardson Yousey: Chairperson, Administration & Management Special Interest Section
AOTA President: Florence Clark Executive Director: Frederick P. Somers Chief Public Affairs Officer: Christina Metzler Chief Financial Officer: Chuck Partridge Chief Professional Affairs Officer: Maureen Peterson
2012 by The American Occupational Therapy Association, Inc. OT Practice (ISSN 1084-4902) is published 22 times a year, semimonthly except only once in January and December, by The American Occupational Therapy Association, Inc., 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449; 301-652-2682. Periodical postage is paid at Bethesda, MD, and at additional mailing offices. U.S. Postmaster: Send address changes to OT Practice, AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449. Canadian Publications Mail Agreement No. 41071009. Return Undeliverable Canadian Addresses to PO Box 503, RPO West Beaver Creek, Richmond Hill ON L4B 4R6. Mission statement: The American Occupational Therapy Association advances the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public. Annual membership dues are $225 for OTs, $131 for OTAs, and $75 for student members, of which $14 is allocated to the subscription to this publication. Subscriptions in the U.S. are $142.50 for individuals and $216.50 for institutions. Subscriptions in Canada are $205.25 for individuals and $262.50 for institutions. Subscriptions outside the U.S. and Canada are $310 for individuals and $365 for institutions. Allow 4 to 6 weeks for delivery of the first issue. Copyright of OT Practice is held by The American Occupational Therapy Association, Inc. Written permission must be obtained from the Copyright Clearance Center to reproduce or photocopy material appearing in this magazine. Direct all requests and inquiries regarding reprinting or photocopying material from OT Practice to www.copyright.com.
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DEPARTMENTS
News Capital Briefing
Practice Perks
Housing First Meets Harm Reduction: Adapting Existing Social Services Models to Help People With Addictions
Evidence Perks
Perspectives Careers
Breast Cancer and Occupational Therapy: Developing an Oncology Occupational Therapy Program
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OT Practice serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants to succeed professionally. OT Practice encourages a dialogue among members on professional concerns and views. The opinions and positions expressed by contributors are their own and not necessarily those of OT Practices editors or AOTA. Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor does acceptance of advertising imply endorsement, official attitude, or position of OT Practices editors, Advisory Board, or The American Occupational Therapy Association, Inc. For inquiries, contact the advertising department at 800-877-1383, ext. 2715. Changes of address need to be reported to AOTA at least 6 weeks in advance. Members and subscribers should notify the Membership department. Copies not delivered because of address changes will not be replaced. Replacements for copies that were damaged in the mail must be requested within 2 months of the date of issue for domestic subscribers and within 4 months of the date of issue for foreign subscribers. Send notice of address change to AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449, e-mail to members@aota.org, or make the change at our Web site at www.aota.org. Back issues are available prepaid from AOTAs Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last.
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SPECIAL Proposed 2013 Amendments 16 to AOTA Articles of Incorporation and Bylaws Organize a Backpack Awareness Event CE Article
Home Modifications: An Introduction to Practice Considerations
Earn .1 AOTA CEU (1 contact hour or 1.25 NBCOT professional development units) with this creative approach to independent learning.
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News
AOTA News
ore than 700,000 people in the United States experience a new or recurrent stroke each year, resulting in cognitive disorders, muscle weakness, vision loss, and other effects on their ability to live independently. The AOTA Adults with Stroke Specialty ConferenceNovember 30 to December 1 in Baltimore, Marylandis a special opportunity for occupational therapy practitioners to advance their stroke rehabilitation knowledge and skills from top-level speakers and earn up to 13 contact hours. Registration opens September 5 at www.aota.org/ confandevents/stroke.
he American Occupational Therapy Foundation (AOTF) will offer more than 40 Scholarships in the 20122013 academic year. AOTF will be accepting online applications from students currently enrolled full time in either a profesAUGUST 20, 2012 WWW.AOTA.ORG
sional occupational therapy educational program or an occupational therapy assistant program. You must be a member of AOTA to be eligible to receive a scholarship. Additional eligibility requirements can be found at www.aotf.org. Online applications must be submitted by November 15, 2012. Please direct questions to Jeanne Cooper at jcooper@ aotf.org. Scholarships will be awarded based on academic merit and leadership potential.
the SIS Quarterly publication. The chairperson represents the SIS with all bodies of AOTA and is a member of the SIS Council. Each nominee will submit the information outlined in the SIS Chairperson Nomination Form (Attachment E of the SIS SOPs) to the Nominating Chairperson via e-mail. This form is available on the AOTA Web site in the Nominations and Election Areas area of the SIS section. Nominees may also request this form by contacting the SIS administrative assistant, Barbara Mendoza, at bmendoza@aota.org or 800-SAY-AOTA, ext. 2042. Selfnominations are welcome.
A O TA B u l l e T i N B O A r D
OUTSTANDING RESOURCES FROM
Pain, Fear, and Avoidance: Therapeutic Use of Self With Difficult Occupational Therapy Populations
(CEonCD) R. Taylor Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). iscover strategies for managing three of the most common and difficult client reactions in occupational therapy practicepain, fear, and avoidance. Learn how to best manage these emotions and behaviors so that treatment goals can be accomplished. $68 for members, $97 for nonmembers. Order #4836. http://store. aota.org/view/?SKU=4836
he AOTA Recognitions Committee encourages you to recognize colleagues who have made significant contributions to the profession by nominating them for one of the awards offered by the Association each year. Descriptions of the awards, nominations forms, FAQs, and the general point system can be found on the AOTA Web site at www. aota.org/practitioners/profdev/ awards. Questions can be directed to awards@aota.org.
New Resources
o you work with older adults? If so, you might find a new OT in Productive Aging PowerPoint to be helpful. Look for it in the Resources on the AOTA Web site at www. aota.org/Practitioners/Presenta tion-Resources.aspx. A new AOTA information sheet on grief and loss is being offered as part of the online School Mental Health Toolkit. Find it at www.aota.org/ Practitioners-Section/Childrenand-Youth/New/Grief-and-Loss. aspx?FT=.pdf.
Industry News
ominations are being accepted until September 15 for the next chairperson of four Special Interest Sections (SISs): Education, Gerontology, Physical Disabilities, and Technology. The term of office is 3 years, beginning July 1, 2013. The chairperson coordinates the projects and activities of the Standing Committee, including the sections program(s) at AOTAs Annual Conference & Expo, SIS Internet activities, and the topics for
OT PRACTICE AUGUST 20, 2012
ont let Falls Prevention Awareness Day slip your mind. Its coming up on September 22, 2012. National Falls Prevention Awareness Day is observed the first day of fall to promote and increase public awareness about how to prevent and reduce falls among older continued on page 4
Questions? Call 800-SAY-AOTA (members); 301-652-AOTA (nonmembers and local callers); TDD: 800-377-8555
c a p i ta l b r i e f i n g
lection years always pose unique challenges for addressing business before Congress. Extended campaigning and a hypersensitive focus on politics and political ramifications tend to make Congress tentative when it comes to addressing difficult and complicated issues. 2012 is no exception and may be worse than usual. The 112th Congress has developed a record for inactivity and futility that is historic. In addition, that inactivity has led to a laundry list of critical tax, spending, and health care issues that must all be addressed within the last month of the year. The perfect storm of critical issues facing Congress will continue to grow larger and more complex, making solutions at the end of the year extremely difficult to find. As members of Congress are on recess for the month, they are trying to meet with constituents all over their districts in anticipation of the November elections and their hoped-for return to office next year. Recess and the remainder of the electioneering yet to come present occupational therapy with an opportunity to educate these policymakers about the challenges occupational therapy faces as a profession. Although occupational therapy has significant issues hanging in the balancesuch as the Medicare therapy caps, Medicare provider payments in general, and a scheduled 8.4% cut to federal funding for general and special education through the sequestration processthe larger issues facing Congress portend even more dire circumstances for the entire country unless Congress can work together to determine a moderate and thoughtful path ahead. In the last month and a
AOTA continues to work for you, but your individual voice is critically important. [Members of Congress] are home this month and off and on through the elections in November. This is your time to talk with them and educate them.
half of 2012, Congress must address a whole range of budget busters, from the expiration of the George W. Bush administrationera tax cuts, which cost $3.3 trillion over 10 years; to the Social Security tax holiday, which reduces middle class tax cuts 2% and will cost $33 billion in 2013; to passage of the National Defense Authorization Act, which will cost $554.2 billion in 2013; and much more. One key issue for occupational therapy is sequestration, a process for engaging in mandatory across-theboard cuts to achieve $1.2 trillion in federal spending reductions. Sequestration was created as a blunt instrument to cut federal spending in the event that members could not come to an agreement on targeted cuts to achieve deficit reduction goals passed in the Budget Control Act of 2011. They did not. As a result, on January 1, 2013, we will be faced with uniform 8.4% cuts (with just a few exceptions) that may cripple the nations economic recovery and its programs and services, including education, special education, and the militaryall the things that are so critical to the countrys safety and future. For occupational therapy, the challenge to special education is most significant. Federal funding is already inadequate, with most of the burden on local school districts. The 8.4% cut in federal funding could have devastating consequences for jobs and certainly the quality of education. Medicare is exposed to a maximum of 2% cuts and Medicaid is barred by statute from any cuts at all under sequestration. How do we get back on track? We talk to each other. The political differences that separate us are far less significant than the principles that unite us. Political leadership is the art of the possible and stems from thoughtful consideration and compromise. Tell Congress that the time for action on issues important to you is now. Members are home this month and off and on through the elections in November. This is your time to talk with them and educate them about your beliefs and your frustrations. Do it politely, do it civilly, but be clear and be assertive. AOTAs Legislative Action Center has a Web page (http://capwiz. com/aota/home) with information about how to reach your members of Congress, and we are sharing information about town hall meetings that members traditionally hold during recess to hear from constituents. Use the resources AOTA provides to educate yourself, and then educate your elected officials. AOTA continues to work for you, but your individual voice is critically important. n
Tim Nanof is AOTAs director of Federal Affairs.
PrACTiCe PerKs
Q A
Andrea McElroy
I am pursuing my masters degree in occupational therapy and am interested in Level II fieldwork opportunities in the area of mental health, particularly related to people with drug and alcohol addictions. In what ways can the profession support these types of clients and provide related fieldwork opportunities?
As the occupational therapy profession moves toward 2017 and AOTAs Centennial Vision, it is evident that the mental health area of practice is becoming revitalized and embraced by the new generation of occupational therapy practitioners. Level II fieldwork students in particular have the opportunity to experience a wide range of interesting and challenging settings within mental health, some of which are considered emerging or nontraditional. Community-based facilities that provide services to people who are homeless or at risk for homelessness and have drug and alcohol addictions are being seen more and more as grassroots efforts to aid people in this population. These facilities often combine models used by other social services such as social work or psychiatric services, to support consumers in their goals to maintain sobriety and housing. One such combination is the Housing First/Harm Reduction Model.1 Housing First provides clients who are homeless or at risk for homelessness with supportive housing as a way to reduce overall stress and anxiety and support individuals in eventually maintaining their own housing.1,2,3,4 The Harm Reduction model provides for practical intervention aimed at minimizing negative consequences associated with drug use.1,5,6 Improving quality of life and not necessarily abstinence from drug use is the goal under harm reduction.1,6 Per the tenets of this Housing First/ Harm Reduction model, some facilities now in operation provide supportive housing and utilities, case management, and occupational therapy services to people who are experiencing homelessness and addiction to heroin. Additional support often includes peer mentors, basic furniture, clothing, liaisons for educational opportunities, and employment and legal services. According to this combined model, individuals being accepted to the program are overwhelmed with attempts at navigating homelessness and managing addictions and are not able to participate in activities that lead to secure employOccupational therapy has a specific skill set to bring to the table under this combined model. Occupational therapy practitioners are able to focus on client interest in meaningful occupations, provide experiences that lead to selfworth and self-efficacy, and address all the other barriers faced by individuals in this population through a variety of frames of reference. Occupational therapy complements the Housing First/Harm Reduction model by meeting clients where they are, not where we would like them to be. To a Level II fieldwork student, assisting a client who is homeless to develop self-worth and self-efficacy
Occupational therapy complements the Housing First/Harm Reduction model by meeting clients where they are, not where we would like them to be.
ment or keeping and maintaining a home. These individuals are not only homeless but have many additional barriers to recovery such as a lack of employment history, lack of education, lack of basic employment skills such as computer use, past criminal history, co-morbid mental health diagnoses, and poor overall health. In addition, these individuals also have a loss of self-worth and self-efficacy that can affect their desire to pursue a more healthful lifestyle. Housing provided through the Housing First focus of the model allows clients to experience life without the stress of homelessness. The Harm Reduction focus provides for an open agreement with the client in which they do not have to utilize services that do not interest them, and the focus of treatment is not on disciplinary action for noncompliance. may seem overwhelming. However, the skills needed to successfully work with this population, according to the Housing First/Harm Reduction model, are in keeping with the skill set of an entry-level practitioner and Level II Fieldwork student. The knowledge and skills needed for this area of practice are described in the AOTA paper Specialized Knowledge and Skills in Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice,7 which includes an appendix that identifies entry-level knowledge and entry-level performance skills for occupational therapists and occupational therapy assistants. The official document also lists a sampling of approaches for group and individual interventions that are commonly used in mental health. Another official AOTA paper, continued on page 8
AUGUST 20, 2012 WWW.AOTA.ORG
n 2005, Janie Lucas stared down from the bleachers at her second graders baseball coach. She noticed how patient Mark Fox was with his young players. Do you think he would be interested? Janie whispered to her sister, Trudy Newton. Janie was not involved with her sons father. Trudy and Janie were close. They even worked together at the same home care agencyTrudy as a care provider and Janie in the intake department handling referrals. So when Janie asked Trudy what she thought about the coach, Trudy told her sister to go for it. That proved to be good advice. As a couple, Mark and Janie enjoyed simply spending time with each other. They liked to stay home and work in the garden. They lounged around the pool and read, basking in beautiful Maine summers. In the winter, they revved snowmobiles through the states untapped wilderness. She is a very kind person. Always worried about other people more than herself, Mark says of Janie. But soon, Janie would need other people to care for her, and occupational therapy would become the service to help her regain lifes meaning.
How occupational therapy helped a client and her loved ones rebuild their lives, one step at a time.
Janie underwent chemotherapy successfully. But while she beat cancer, the treatment beat her up in other ways. In April 2011, Janie caught a cold. With a weakened immune system, the cold caused her to have double pneumonia, and it set in really fast, Mark says. I let her sleep for a while, then I couldnt wake her up. Mark called Trudy, who was in Florida at the time, and she told Mark he needed to call 9-1-1. Doctors in Maine werent certain what happened to Janie. They said she had developed an infection that had gone septic, and her heart stopped because of that and she went into septic shock, Trudy says. They basically were telling us that she wasnt going to live. During this time, Trudy got to know Mark on a deeper level. I dont think I knew his character as well before, Trudy says. We ended up staying at the hospital and just sort of having those quiet times when you dont know what else to do but sort of sit there and stare. I remember having conversations in the hospital about more philosophical type things, like how did this happen and why. Trudy saw Marks optimistic spirit and began to more completely understand the man her sister had fallen in love with.
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CANT WAkE UP
On July 31, 2008, Janie called Trudy. And it wasnt to chat. Janie had been diagnosed with breast cancer at the age of 45. She was very frightened. She had a young son, a steady relationship [with Mark] and two other kids in her life [Marks from a previous marriage]. It was scary for everyone, Trudy recalls.
OT PRACTICE AUGUST 20, 2012
Miraculously, Janies health improved quickly. She was back home and back to almost normal in less than a month. Sensing there was no longer a need to put life on hold, Mark proposed to Janie, and she said yes in May 2011. We seemed to be more in love with each other after that time in the hospital, Mark recalls.
SLIPPING AWAy
But before she and Mark could begin planning their wedding, Janie began to slip away. The first thing that we noticed was her laugh, which sounded really bizarreher personality had started to change, Trudy says. She used to have a great laugh, but this was almost hysterical. Mark and Trudy thought maybe Janie was overextending herself. They decided the change was something to monitor but not something over which to fret. But then Janies walking altered, too. It became more of a shuffle, almost a stumble, Trudy says. And Janie would forget things. Mark and Trudy talked again. Finally, they admitted to each other that something wasnt right. Mark, once again, took Janie to the hospital. They did an MRI and didnt really see anything, Trudy says. But Trudy and Mark knew better. They were watching their loved one lose little parts of her personality, piece by piece, until she steadily sank into a coma less than a month after getting engaged. That was the scariest moment for sure, Mark says. Because you just saw somebody that you love slipping away. And somebody was showing up that you didnt recognizesomeone that wasnt her. After about a week, the doctors in Maine referred Janie to Massachusetts General Hospital in Boston. Janie had another MRI, and this time, the doctors had an answersort of. Janies myelin sheath, which essentially allows the nervous system to function properly, had frayed. Her brain matter was intact, but the white matter of her nerves was not able to transmit signals. Doctors said it was very rare to see because it was such a delay in the
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onsetusually it wasnt delayed like that. I said, well, thats my sister, one in a million. And they said, more like one in 2 million, Trudy recalls. They didnt have any treatment for it. So, we finally had a name for it, but we didnt know what it meant. The doctors said sometimes, on rare occasions, people will get a little bit better. But often they get worse and sometimes they die.
SHARED CONNECTIONS
While Janie was in a coma, Mark and Trudy spent more time in the hospital, staring at vending machines and flipping through magazines. Trudy was worried about her sister, but Mark hung onto hope. He has a very positive outlook on things, so he had the belief that she was going to get better. I tend to be a little more cynical. Or maybe just a little more realistic, she says. Janie came out of the coma after a few days, but she was minimally responsive. Mark went into the hospital room to spend some alone time with his fianc. She still needed a feeding tube and could hardly keep her eyes open. But it was there that Mark realized the strength of the connection he and Janie shared. She could look at me; she could see me. Just with her eyes she would try to follow me around the room, Mark remembers. I was the only one who could get her attention, and she would try to keep her eyes open for me. Mark believed then that he wasnt going to lose Janie. Despite the doctors grim prognosis, Janie improved. Very slightly, but
still. And it was enough for them to move her to a nursing home in Maine and eventually to RiverRidge Center, a Genesis HealthCare inpatient clinic in Kennebunk, Maine, about an hour and a half from Janie and Marks home. Janie had been diagnosed with anoxic brain damage, encephalitis, contracture of multiple joints, and dysphagia. Medically complex patients require an occupational therapist to assess cognitive abilities, physical performance, and psychosocial drives in order to provide them the opportunity to reach minute incremental goals during the recovery process, says Tracey Samela, OTR/L, Rehabilitation Program director at Genesis HealthCares Skyview Center in Wallingford, Connecticut. Due to the significance of Janies impairments at the onset of her illness, her occupational therapist needed to establish goals that required a passive treatment approach.
REHAB AT RIvERRIDGE
When Janie arrived at RiverRidge in July 2011, she had almost no function. During Janies initial evaluation, Melinda Morgrage, MS, OTR/L, set goals of tolerating activities of daily living (ADLs) for 10 minutes and improving passive range of motion in her upper and lower extremities. In addition, Morgrage wanted Janie to visually scan her environment with moderate assistance. Another goal, and this seems so primitive, was to maintain eyes open during a treatment session for 5 minutes, Morgrage says. Christine Rosa, MS, OTR/L, Inpatient Program manager at RiverRidge,
AUGUST 20, 2012 WWW.AOTA.ORG
says setting such small goals is imperative in the recovery process. We knew that she could use visual scanning for an actual purpose. She could use it to identify what she needed. Like if you held up two different colored shirts, she would be able to pick what shirt she wanted, Rosa says. Patients tend to respond so well to occupational therapy because its in a real-world environment. We do our best
isnt going to be functional for them at a different point in their recovery. The therapists at RiverRidge began looking at activities like upper-body bathing and hygiene and grooming tasks with a goal of moving from moderate to minimal assistance. And Janies transfers were upgraded from mechanical lift to stand lift, Morgrage says. Janies loved ones saw her come back, too.
meaning she likes to do tasks she sees that are meaningful. And the family has been able to communicate with the therapists to say these activities she might not connect with, but doing things that she sees are getting her closer to things she might have to do for herself at home are really important to her.
to imitate home life. If the issue is she wants to be able to pick out her own clothes, then we are helping her reorganize her closet, were not bringing her to the gym. We are actually working in her closet. Relatively quickly, the therapy team at Genesiss RiverRidge moved Janie into a wheelchair. Once we were able to get her up into a wheelchair, we started progressing the length of time and started doing more of the edge-of-mat sitting activities, Morgrage recalls. But more importantly, occupational therapy helped Janie re-learn practical skills that once seemed rote. OTs have a unique ability to know that something as simple as brushing your teeth is a 12-step task by the time you reach up, turn on the faucet, bend your elbow, twist the cap, squeeze the tube, and so on. So with our ability to look at nothing but function, function, function helps to keep it more real for the patient and brings the pieces together, Rosa says. The whole purpose is that [occupational therapy] is unique, and its individualized. So whats functional for one person isnt going to be functional for another. Not only that, whats functional for one person at a certain point in their recovery
OT PRACTICE AUGUST 20, 2012
I think I was the most hopeful when we started to get her personality back. I would say it took months to get her personality to come through, Trudy says. Her laugh came back, her smile came back. Shes a very gentle person, and that came back. Her calm personality came right through. She started to get her vocalization, her memory. And thats the soul of a person.
NExT STEPS
Around that time, Janie told her therapists that she would soon be leaving RiverRidge to marry Mark. We had a meeting toward the beginning of October, and she was convinced that on October 31 she was going to be getting married. She said, I am walking down the aisle no matter what. She still had a ways to go, but she was confident, recalls Heidi Fullerton, MSPT, Janies physical therapist at RiverRidge. But Janie remained at RiverRidge, undergoing a therapy regimen 6 days a week. She started to be able to move the wheelchair herself. She was working so hard to push that chair, but she could
do it herself. She could get herself to the dining room, she could get herself up at 7 am every day to watch her morning shows, Rosa says. She wasnt just wandering the hall. She was saying, I want to watch TV, and she was going to the TV room. She was not only able to have that thought, but she recognized, this is how I am going to do it and then she did it. Meanwhile, Mark and Trudy would visit the clinic as often as possible. I do whatever I have to for her, Mark says. I always tell her that if she can get through what she has to, then I wont have trouble getting through what I have to. Mark and Janie found ways to make their relationship work, even though their nuptials remained on hold. Two nights a week after work, Mark would commute the 1.5 hours to the clinic to be with her. And on Christmas and Thanksgiving, Mark took Janie to her brothers house in Kennebunk. Many patients with catastrophic medical complexities set milestone goals such as a visit home for the holidays, a trip to a childs ball game, or even to plan a wedding, Samela says. These out trips require extensive planning and training by the patient, therapist, and their families, including such tasks as car transfers, stair performance, wheelchair mobility and accessibility, assistive device use, ADL performance in the home or public environment, and medication management in order to be successful. These milestone goals created by the patient and facilitated by the family and occupational therapist create the motivation the patient needs to progress their functional abilities to a level needed for a successful transition to home. Around the time Janie resolved to be married to Mark, she also began believing in her ability to regain her life. As with Mark, Janies positivity triumphed. Trudy thinks occupational therapy was especially beneficial for her sister. She is very practically based, meaning she likes to do tasks she sees that are meaningful, Trudy says. And the family has been able to communicate with the therapists to say these activities she
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might not connect with, but doing things that she sees are getting her closer to things she might have to do for herself at home are really important to her. Instead of doing some sort of matching activity, putting [the activity] into a kitchen setting and making it practical works better for Janie, Trudy continues. Samela says the skill of an occupational therapist is to continually evaluate the patients functional abilities and progress while staying mindful of what the client wants to be able to do. We provide therapeutic interventions that are patient specific and relate to their lives prior to the onset of illness. In this case, Janie preferred kitchen tasks as a means to improve her cognition, balance, coordination, and problem solving, where another patient with similar deficits might prefer computer use.
ment. But she is at a point where she can function on her own. At the time Janie and her therapists were interviewed for this article, they were preparing for Janies discharge. She would still have to follow a discharge plan, but she would be able to Ways of Living: Intervention Strategies to Enable do it at home, where she could live with Participation, 4th Edition Mark, her now 14-year-old son, and Edited by C. Christiansen & K. Matuska, 2011. Marks sons. Bethesda, MD: AOTA Press. ($79 for members, $112 for nonmembers. To order, call toll free 877The first thing Janie planned to do 404-AOTA or shop online at http://store.aota.org/ after arriving home was Kiss the boys, view/?SKU=1970B. Order #1970B. Promo code MI) tell them how much I love them, and tell Mark how much I love him. I know CONNECTIONS its been hard on him, but hes been Discuss this and other articles on here for me the whole time, she says. the OT Practice Magazine public forum Mark admits that the entire situation at http://www.OTConnections.org. with Janie has been trying. But even when discussing how hard its been, his hopefulness persists. There are times that Im upset that we probably wont ever have the It really just confirms life we used to have, but then I look at it and I say, At least our ability to teach the body we still have her. Things may to adapt and learn new strategies, never be what they used to and it proves that hard work be, but well just be happy with what we have and not pays off. worry about what we dont have. Morgrage says Janies story is a testament to the value of therapy, particularly occupational therapy services. Its not always butterflies and roses, doing things like attend her sons but with Janies story it sort of is. We baseball games. But in May 2012, after can be proud that we have done every10 months in rehabilitation, it was time thing we can to make her as indepenfor the next step. Janies therapists dent as possible, she says. It really told her she was ready to ditch the just confirms our ability to teach the wheelchair. body to adapt and learn new strategies, They told me that I was going to and it proves that hard work pays off. have it for the weekend, and then after Trudy says she and Mark were the weekend was over I was going to recently discussing what to do for be without it. Then I got nervous, Janies discharge. Janie says. I didnt want to be without We talked about this huge welcome it because I really got good at moving home party and making it a crazy day, around with it. she says. But the closer it gets and Janie vividly remembers the moment the more I think about it, I think that she finally stood on her own. can be off in the future someday, too, I had to get to the edge of the Trudy explains. chair and position my feet correctly, That big party can be Mark and and I had to say, Push, push, push. It Janies wedding, which Janie says is worked. I could get up that way. So I coming sooner, not later. n did it. I felt independent again. Id come a long way, she says. Janie, her therapists, and loved ones Andrew Waite is the associate editor of OT Practice. say Janie is about 80% back mentally He can be reached at awaite@aota.org. and about 60% back physically. She still has trouble with her memory, and her muscle tone still needs major improveThe Texture of Life: Purposeful Activities in the Context of Occupation, 3rd Edition Edited by J. Hinojosa & M. Blount, 2009. Bethesda, MD: AOTA Press. ($59 for members, $84 for nonmembers. To order, call toll free 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=1209B. Order #1209B. Promo code MI)
AUGUST 20, 2012 WWW.AOTA.ORG
PersPeCTives
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PHOTOGRAPHS LEFT: COURTESY U.S. AIRFORCE / U.S. ARMY. CENTER: PHIL SCHERMEISTER/CORBIS. RIGHT: COURTESY OF U.S. ARMY.
felt an almost overwhelming wave of anger as I stood in front of the Vietnam Veterans Memorial one morning in 1996. My colleague and I were in Washington, DC, presenters for a workshop on integrating technology into small colleges. She had coaxed me into accompanying her on her daily runs and suggested we visit the memorial one morning. It would be my first visit, one I had put off for 14 years, since the Memorials dedication in 1982. We searched for and found the name of one of my friends. Of the three of us who went to war, he was the one who did not return. Now I stood there feeling abandoned and absolutely alone as my colleague no longer stood beside me. How could she do this? I wondered. Then, in the mirror-like surface of the wall, I saw her. She had taken a step back, giving me personal space but remaining close by if I needed her support. For occupational therapy practitioners working with veterans, I would suggest following my friends lead: Stay close by but be respectful of each veterans need to deal with emotions in his or her own way. War, experienced at any level, changes the warrior forever. I would argue, however, that time spent as a warrior should be regarded as only one of many occupations a servicewoman or man will experience in his or her
life. To effectively work with veterans, we as practitioners must not lose our historical focus on treating the whole person. Each veteran will bring his or her own personal story, coping mechanisms, and needs. Occupational therapy practitioners are well trained in dealing with both the physical and psychosocial aspects of a wide variety of clients. However, dealing with veterans presents some unique challenges: 1. There may be a latency period in which we cannot or do not want to talk to anyone. Many veterans want to focus forward, to reintegrate with families, occupations, education, etc. We do not want to waste time talking about events that we are more comfortable forgetting. When I left active duty services after 4 years, I was acutely aware that many of my cohort group had already completed college and begun their professional lives. Talking about wartime experiences was absolutely the last of my priorities. I would not likely have spoken to anyone even if the opportunity presented itself. It would be 12 years after my tour in Viet Nam before I began to question how that experience might have changed me. 2. We may not want to talk to you. Its not that we do not appreciate your concerns, but veterans will often feel that because you are a nonvet, an outsider,
you cannot understand what we experienced or what we feel. That is not so very uncommonthink of experiences you would feel most comfortable speaking about with those whom you know will understand you. Add to this memories that evoke guilt or extreme sadness. Thus, veterans often prefer to talk to other veterans. 3. Returning to civilian life often feels hollow and with little meaning. Warriors are engaged in possibly the most intense activity in which humans can participate. Wartime service demands absolute dedication to the mission and ones fellows. My father was a WWII veteran and for years we used to travel to New Hampshire to spend time with one of his wartime friends and his family. These two men would often retire to a local restaurant to talk about their experiences and lives. Years later, I found myself in the same restaurant, talking with that mans son about our respective time in Vietnam. At one point he looked at me and said, Bill, I am going to say the stupidest thing you have ever heard. But those times were the only time in my life when I felt like I was doing something important for the world. His comment mirrored another point: many warriors return to civilian or even peacetime military life struggling to find a focus. War, for many
13
Careers
Y
PHOTOGRAH MICHAEL COURTNEY / ISTOCK
ou have breast cancer. An estimated 226,487 women and 2,190 men in the United States will hear these words in 2012.1 These words strike feelings of disbelief, fear, anger, and even despair. Many people report feeling overwhelmed with the myriad treatment options, or lost when they complete their treatment. Many are left with challenges following surgery, such as decreased range of motion, tightness, or pain and discomfort with movement. Still others battle potentially devastating lymphedema, which is a swelling in a body part resulting from damage done to the lymphatic system through surgery, radiation, or other cancer-related treatments. Cancer also involves a number of psychosocial issues that may impact women and men before, during, and after treatment. Cancer or treatments related to cancer may lead to changes in an individuals physical, cognitive, or emotional identity, leading to decreased participation in desired daily occupations.2 Penfold noted that the role of an occupational therapist in oncology and/or cancer care is to facilitate and enable an individual patient to achieve maximum functional performance, both physically and psychologically, in everyday living skills regardless of his or her life expectancy (p. 75).3 Human occupation is varied and complex. Thus, each individual diagnosed with breast cancer can experience a number of challenges in his or her various occupations and/or roles. In addition, these may fluctuate throughout the course of the disease. A persons abilities and desires to participate may change dramatically from initial diagnosis, through chemotherapy and/or radiation treatment, to end-of-life care.3 Occupational therapy is an effective, nonpharmacological option to enable an individual with breast cancer to partici-
INITIAL INTEREST
My affinity for oncology began with my first Level II fieldwork experience. I was 6 weeks into a 12-week mental health rotation in urban Kansas City, Missouri, when one of my clients was diagnosed with cancer. She was devastated. Our sessions focused on using positive coping strategies and stress management in order for her to participate in her desired daily occupations. It was then that I began to research oncology, treatment side effects, survivorship, and other issues, and I discovered the vital role for occupational therapy. Oncology has now grown into both my career specialty focus and passion. When searching for employment opportunities following graduation, I was having difficulty finding oncology-specific occupational therapy positions, so I created my own. In January 2011, I began working at Methodist Hospital and Methodist Estabrook Cancer Center in Omaha, Nebraska. I was employed as an occupational therapist with the intent of developing an outpatient oncology occupational therapy and lymphedema program as well as inpatient oncology
therapy services. Although Methodist has had a longstanding reputation in the Omaha and rural Nebraska communities for excellence in cancer care, therapy services onsite at the Estabrook Cancer Center and an occupational therapist dedicated to oncology rehabilitation had not existed prior to my being hired. I quickly learned I needed to acquire new skills and knowledge in order to best serve this unique population. I was a generalist practitioner on the acute side, but I strived for a specialist role in oncology. In April 2011, I attended a certified lymphedema therapy course to gain additional knowledge specific to lymphedema. To compensate for a lack of therapy-focused courses specifically geared toward oncology, I began reading medical journals from a broad range of specialties to familiarize myself with cancer and its effects on an individuals performance, and I began attending tumor board meetings at least once each month to learn about the latest developments in breast cancerrelated surgery, staging, pathology, and treatment options. To educate our in-house staff about the benefits of occupational therapy, continued on page 17
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Occupational Therapists (#13) in Forbes Top 20 BestPaying Jobs For Women In 2012! http://ow.ly/ciH6p
446 people like this. Sheila Ann Olis: Oh heck yeah!! Thats whats up ppl!!!
July 17 at 1:29pm
Joe Patrick: Also a great profession for men :) July 17 at 1:44pm Christina Ross Hint hint Stepahie Stephanie Zangroniz, Hannah Jewel Conner July 17 at 7:11pm Kris Kagawa: I wish. I work as an OTR for pennies and love. But its all good because I love being an OT! July 17 at 10:11pm
www.aota.org/twitter
Amy Jo Lamb@ajlamb1216 : Students, join me in Columbus OH for the National Student Conclave Nov 910, 2012. A conf tailored for you...our next gen leader @frankaota 7 Jul 12 Cindi Petito@CindiPetito: See our latest blog post regarding AOTAs Policy Statement on Complex Rehab Technology and H.R. 4378.... http:// fb.me/1qZJsR5UO 21 June 12
BACKGROUND ILLUSTRATION WILLIAM CRAIG / ISTOCKPHOTO.COM
www.aota.org/youtube
PutMeBackTogether @pmbtogether An OT guide for assessing children ages 3 and up #pediOT #OTpeeps #OccupationalTherapy http://ht.ly/cvpkH
26 July 12
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or this years AOTA National School Backpack Awareness Day, to be held on September 19, AOTA is encouraging members to start planning their own event now. Occupational therapy practitioners and students can help educate the public about how to avoid pain and injury by holding a weigh-in targeting backpacks, purses, briefcases, purses, or other heavy bags.
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Schools and universities are the natural choices for venues, but you can also target locations wherever individuals with backpacks can be found.
avoid the aches and pains associated with heavy suitcases. Airports and commuter stations are natural choices for venues, or wherever individuals who buy, sell, and use suitcases can be found.
Purses Over the years, purses have grown larger to accommodate the daily load that women carry every day. Although these large purses seem convenient, theyre also potentially causing future neck, shoulder, and back problems. n Shopping malls are the natural choice for venues, or wherever individuals who buy and sell purses can be found.
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Briefcases Many men and women haul documents, laptops, and notebook computers back and forth to work each day. If improperly packed and carried, these briefcases can cause serious neck, shoulder, and back problems. n Corporate parks and commuter stations are natural choices of venue, or wherever individuals who buy, sell, and use briefcases can be found.
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To learn more about AOTAS National School Backpack Awareness Day, and to download tip sheets,
artwork, event strategies, media tips, and more, visit www.aota.org/backpack. For more suggestions on organizing events, and to share outcomes of events for possible future promotion by AOTA, contact AOTA Media Relations Manager Katie Riley at 301-652-6611, ext. 2963, or kriley@aota.org.
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Suitcases Suitcases can be a burden to the already stressful task of traveling. If properly packed and carried, consumers can travel stress free and
CALENDAR
To advertise your upcoming event, contact the OT Practice advertising department at 800-877-1383, 301-652-6611, or otpracads@aota.org. Listings are $99 per insertion and may be up to 15 lines long. Multiple listings may be eligible for discount. Please call for details. Listings in the Calendar section do not signify AOTA endorsement of content, unless otherwise specified. Look for the AOTA Approved Provider Program (APP) logos on continuing education promotional materials. The APP logo indicates the organization has met the requirements of the full AOTA APP and can award AOTA CEUs to OT relevant courses. The APP-C logo indicates that an individual course has met the APP requirements and has been awarded AOTA CEUs. September
visABILITIES Rehab Services: www.visabilities.com or (888) 752-4364, Fax: (205) 823-6657. exploration of critical elements of neuroanatomy and nerve physiology, evaluation of peripheral nerve involvement, treatment of nerve injuries, surgical intervention for peripheral nerve injuries and the therapists role in post operative care, management of the painful UE, corrective orthosis fabrication, and future trends in enhancing nerve function. Contact University of Wisconsin-Milwaukee, 414-227-3123; visit our Web site at www.chs-ce.uwm.edu.
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St. Louis, MO
Sept. 1215
NEW! OT Manager Topics, by Denise Chisholm, Penelope Moyers Cleveland, Steven Eyler, Jim Hinojosa, Kristie Kapusta, Shawn Phipps, and Pat Precin. Supplementary content from chapters
the field of low vision rehabilitation and research while earning valuable continuing education credits. Attend the multi-disciplinary low vision rehabilitation and research conference dedicated to improving the quality of low vision care through excellence in professional collaboration, advocacy, research, and education. Envision Conference, September 1215, 2012, Hilton St. Louis at the Ballpark. Learn more at www.envisionconference.org.
November
Chattanooga, TN
Nov. 313
On-Line Course
and PT practitioners with the Individual with Disabilities Act (IDEA), Wis Administration Rules for special education and related services, school-based assessment and intervention including paperwork requirements and evidence-based best practice standards for school therapists. The educational model of service delivery will be distinguished from the medical model. Contact University of Wisconsin-Milwaukee, 414-227-3123; visit our Web site at www.chs-ce.uwm.edu.
Orientation for OTs and PTs New to School-Based Practice. This course is designed to familiarize OT
Sept. 1728
in Complete Decongestive Therapy (135 hours), Lymphedema Management Seminars (31 hours). Coursework includes anatomy, physiology, and pathology of the lymphatic system, basic and advanced techniques of MLD, and bandaging for primary/secondary UE and LE lymphedema (incl. pediatric care) and other conditions. Insurance and billing issues, certification for compression-garment fitting included. Certification course meets LANA requirements. Also in Dallas, TX, November 313. AOTA Approved Provider. For more information and additional class dates/ locations or to order a free brochure, please call 800863-5935 or log on to www.acols.com.
in The Occupational Therapy Manager, 5th Edition with additional applications relevant to selected issues on management. Earn .7 CEU (8.75 NBCOT PDUs/7 contact hours). Order #4880, AOTA Members: $194, Nonmembers: $277. http://store.aota. org/view/?SKU=4880
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basic ethics information that gives context and assistance with application to daily practice and rationale for changes in the Occupational Therapy Code of Ethics and Ethics Standards 2010. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4846, AOTA Members: $105, Nonmembers: $150. http://store.aota.org/view/?SKU=4846
NEW! Everyday Ethics: Core Knowledge for Occupational Therapy Practitioners and Educators, 2nd Edition, by AOTA Ethics Commission and presented by Deborah Yarett Slater. Foundation in
Carmel, IN
Driver Rehabilitation for Drivers Using Bioptics by Occupational Therapy Process and Intervention.
Nov. 811
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Syracuse, NY
Eval & Intervention for Visual Processing Impairment in Adult Acquired Brain Injury Part I. This
Sept. 2930
intensive updated course has the latest evidence based research. Participants learn to identify visual processing deficits, interpret evaluations, develop interventions and document. Topics include: visual inattention and neglect, eye movement disorders, hemianopsia and reduced acuity. Faculty: Mary Warren PhD, OTR/L, SCLV, FAOTA. Also New Orleans, LA, March 9 to 10, 2013. Contact: www.visabilities. com or (888) 752-4364, Fax (205) 823-6657.
A focused workshop sponsored by Adaptive Mobility Services, Inc. for the OT practitioner who is interested in evaluation and in-vehicle interventions with persons who are visually impaired and/or use bioptic lens. Our instructors are master clinicians with this specialty group, knowledgeable in state licensing requirements, and skilled in focused interventions in this sub-specialty practice area. Teaching strategies include classroom instruction, working in the car with the instructors, and observing real clients in the car. Instructors: Mary Ellen Keith, COTA, CDRS; and Carmen Palanca, OTR, CDRS. To register, call 407-4268020 or click on educational workshops for therapists at www.adaptivemobility.com.
NEW! Ethics TopicDuty to Warn: An Ethical Responsibility for All Practitioners, by Deborah Yarett Slater, Staff Liaison to the Ethics Commission. Professional, ethical, and legal responsi-
bilities in the identification of safety issues in ADLs and IADLs as they evaluate and provide intervention to clients. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4882, AOTA Members: $45, Nonmembers: $65. http://store.aota.org/ view/?SKU=4882
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Ethics TopicsOrganizational Ethics: Occupational Therapy Practice In a Complex Health Environment, by Lea Cheyney Brandt. Issues that can
October
Ongoing
Webcast
other soft tissue conditions of the upper extremity. Differential diagnoses of various conditions are explored. Evidence to support surgical, non surgical, and therapeutic approaches to treatment of these conditions including new and future trends are presented. Contact the University of Wisconsin-Milwaukee, 414-227-3123; visit our Web site at www. chs-ce.uwm.edu.
Encore Presentation of WI Hand Experience 2012: Treatment of Soft Tissue Conditions of the Upper Extremity. Course focuses on tendinopathy and
Oct. 131
influence ethical decision making and strategies for addressing pressure from administration on services in conflict with code of ethics. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4841, AOTA Members: $45, Nonmembers: $65. http://store .aota.org/view/?SKU=4841
Two great options: $177 for 7 months or $199 for 1-Full Year of unlimited access to over 640 contact hours and over 90 courses. Take as many
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courses as you want. Approved for AOTA and BOC CEUs and NBCOT for PDUs. www.clinicians-view. com 575-526-0012.
Ethics TopicsMoral Distress: Surviving Clinical Chaos, by Lea Cheyney Brandt. Complex nature
of todays health care environment and results in increased moral distress for occupational therapy practitioners. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4840, AOTA Members: $45, Nonmembers: $65. http://store.aota.org/ view/?SKU=4840
San Diego, CA
tion of Part I course, this intense practicum provides hands-on experience in administering, interpreting, and using evaluation results to develop intervention for visual processing decits including eye movement disorders, hemianopsia, reduced visual acuity, and visual neglect. Offered only once a year. Faculty: Mary Warren PhD, OTR/L, SCLV, FAOTA. Also Boston, MA, November 810, 2013. Contact
Eval & Intervention for Visual Processing Decits in Adult Acquired Brain Injury Part II. Continua-
Oct. 1214
OTR/L, MS, FAOTA. Over 22 years specializing in design/build services, technologies, injury prevention, and ADA/504 consulting for homes/jobsites. Start a private practice or add to existing services. Extensive manual. AOTA APP+NBCOT CE Registry. Contact: Abilities OT Services, Inc. 410-358-7269 or info@aotss.com. Group, COMBO, personal mentoring, and 2 for 1 discounts. Calendar/info at www.AOTSS.com. Seminar sponsorships available nationally.
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Official documents and materials that support OT concept of wellness, interdisciplinary literature, and models from other disciplines. Earn .25 CEU (3.13 NBCOT PDUs/2.5 contact hours). Order #4879, AOTA Members: $68, Nonmembers: $97. http://store .aota.org/view/?SKU=4879
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DVD Course
Exploring Injuries and the Recovery of Peripheral Nerves in the Upper Extremity. A comprehensive
Open enrollment
Exploring the Domain and Process of Occupational Therapy Using the Occupational Therapy Practice Framework, 2nd Edition, by Susanne Smith Roley and Janet V. DeLany. Ways in which
AUGUST 20, 2012 WWW.AOTA.ORG
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CALENDAR
Framework supports practitioners by providing a holistic view of the profession. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4829, AOTA Members: $73, Nonmembers: $103.00. http:// store.aota.org/view/?SKU=4829 NBCOT PDUs/10 contact hours), AOTA Members: $129.50, Nonmembers: $184.10.
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tact hours). Order #4878, AOTA Members: $105, Nonmembers: $150. http://store.aota.org/view/?SKU =4878
Online Course
Occupational Therapy in Action: Using the Lens of the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition, by Susanne Smith Roley and Janet DeLany. Oc-
NEW! Using the Occupational Therapy Practice Guidelines for Adults with Alzheimers Disease and Related Disorders (ADRD) To Enhance Your Practice, by Patricia Schaber. Evidence-based
cupational therapy and the occupational therapy process as described in the 2008 second edition of Framework. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #OL32, AOTA Members: $180, Nonmembers: $255. http://store.aota.org/ view/?SKU=OL32
perspective in defining the process and nature, frequency, and duration of interventions and case studies of adults at different stages of Alzheimers disease. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4883, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/ ?SKU=4883
velopment for youth with diagnoses that challenge cognitive and social skills, such as autism spectrum and attention deficit disorder. Earn .7 AOTA CEU (8.75 NBCOT PDUs/7 contact hours). Order #4833, AOTA Members: $175, Nonmembers: $250. http:// store.aota.org/view/?SKU=4833
Creating Successful Transitions to Community Mobility Independence for Adolescents: Addressing the Needs of Students With Cognitive, Social and Behavioral Limitations, by Miriam Monahan and Kimberly Patten. Community mobility skill de-
Occupational Therapy and Home Modification: Promoting Safety and Supporting Participation, edited by Margaret Christenson and Carla Chase. Education on home modification for OT
professionals and an overview of evaluation and intervention and detailed descriptions of assessment tools. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3029, AOTA Members: $259, Nonmembers: $359. http://store.aota.org/ view/?SKU=3029
quired professional reasoning and ethics for making final recommendations about the capacity for older adults with dementia to drive or not. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4842, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4842
Determining Capacity to Drive for Drivers with Dementia Using Research, Ethics, and Professional Reasoning: The Responsibility of All Occupational Therapists, by Linda A. Hunt. Re-
ment and training with highlights of skills deficits, methods and tools that address driving skills, assessment techniques, and intervention techniques. Earn 1 AOTA CEU (12.5 NBCOT PDUs/10 contact hours). Order #4837, AOTA Members: $249, Nonmembers: $355. http://store.aota.org/view/?SKU=4837
Driving Assessment and Training Techniques: Addressing the Needs of Students With Cognitive and Social Limitations Behind the Wheel, by Miriam Monahan. Critical issues related to driving assess-
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The Short Child Occupational Profile (SCOPE), by Patricia Bowyer, Hany Ngo, and Jessica Kramer.
Introduction of SCOPE assessment tool and description of documenting child motivation for occupations, habits and roles, skills, and environmental supports and barriers. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #4847, AOTA Members: $210, Nonmembers: $299. http://store. aota.org/view/?SKU=4847
public awareness strategies on expertise in transitioning early childhood development into occupational engagement in natural environments. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3026, AOTA Members: $259, Nonmembers: $359. http://store.aota.org/view/?SKU=3026
Early Childhood: Occupational Therapy Services for Children Birth to Five, edited by Barbara E. Chandler. Federal legislation in OT practice and
sensory processing based on Dunns Model of Sensory Processing and comparison with other sensory based approaches with evidence reviews for best practice assessment and intervention methods. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4834, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4834
Sensory Processing Concepts and Applications in Practice, by Winnie Dunn. Core concepts of
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Collaborating for Student Success: A Guide for School-Based Occupational Therapy, edited by Barbara Hanft and Jayne Shepherd. OT collab-
Structured, semi-structured, and general clinical interviewing and set of norms and communication strategies that can maximize accurate, relevant, and detailed information. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4844, AOTA Members: $68, Nonmembers: $97. http://store.aota. org/view/?SKU=4844
orative practice with education teams using professional knowledge and interpersonal skills to blend hands-on services for students and system supports for families and educators. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3023, AOTA Members: $259, Nonmembers: $359. http:// store.aota.org/view/?SKU=3023
of occupational therapists at each tier, case studies, and highlighted opportunities for OT within RtI frameworks in public education. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4876, AOTA Members: $68, Nonmembers: $97. http:// store.aota.org/view/?SKU=4876
Response to Intervention (RtI) for At Risk Learners: Advocating for Occupational Therapys Role in General Education, by Gloria Frolek Clark and Jean Polichino. Core components of RtI, the role
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Model of Human Occupation Screening Tool (MOHOST): Theory, Content, and Purpose, by Gary Kielhofner, Lisa Castle, Supriya Sen, and Sarah Skinner. Information from observation, interview,
Autism Topics Part I: Relationship Building, Evaluation Strategies, and Sensory Integration and Praxis, edited by Renee Watling. Content from Au-
Staying Updated in School-Based Practice, by Yvonne Swinth and Mary Muhlenhaupt. Informa-
chart review, and proxy reports to complete the MOHOST occupation-focused assessment tool. Earn .4 AOTA CEU (5 NBCOT PDUs/4 contact hours). Order # 4838, AOTA Members: $125, Nonmembers: $180. http://store.aota.org/view/?SKU=4838
tism, 3rd Edition to expand OT practice with children through building the intentional relationship, using evaluation strategies, addressing sensory integration challenges, and planning intervention for praxis. Earn .6 CEU (7.5 NBCOT PDUs/6 contact hours). Order #4848, AOTA Members: $210, Nonmembers: $299. http://store.aota.org/view/?SKU=4848
tion and strategies on issues, trends and knowledge related to services for children and youth in public schools with topics on IDEA 2004, NCLB, and Section 504 of the Rehabilitation Act. Earn .15 AOTA CEU (1.88 NBCOT PDUs/1.5 contact hours). Order #4835, AOTA Members: $51, Nonmembers: $73. http://store.aota.org/view/?SKU=4835
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3 Diagnosis-Specific SPCCs. Core SPCC: Core Concepts in Neurorehabilitation: Earn .7 AOTA CEU (8.75 NBCOT PDUs/ 7 contact hours). Order #3019, AOTA Members: $91, Nonmembers: $128.80. http://store.aota.org/view/?SKU=3019. Diagnosis-Specific SPCCs: Neurorehabilitation for Dementia-Related Diseases (Order #3022 http:// store.aota.org/view/?SKU=3022), Neurorehabilitation for Stroke (Order #3021 http://store.aota.org/ view/?SKU=3021), and Neurorehabilitation for Traumatic Brain Injury (Order #3020 http://store.aota. org/view/?SKU=3020). Each: 1 AOTA CEU (12.5
Neurorehabilitation Self-Paced Clinical Course Series, by Gordon Muir Giles, Kathleen Golisz, Margaret Newsham Beckley, and Mary A. Corcoran. Includes 4 componentsthe Core SPCC, and
NEW! Autism Topics Part II: Occupational Therapy Service Provision in an Educational Context, edited by Renee Watling. Second in 3-part CE
The New IDEA Regulations: What Do They Mean to Your School-Based and EI Practice?, by Leslie L. Jackson and Tim Nanof. Purpose and impact of
series with content from Autism, 3rd Edition addressing OT practice within public school systems and early intervention through elementary years and transition process. Earn .6 CEU (7.5 NBCOT PDUs/6 contact hours). Order #4881, AOTA Members: $210, Nonmembers: $299. http://store.aota. org/view/?SKU=4881
2004 reauthorization of IDEA and Part B regulations on school-based and early intervention practice. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4825, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4825
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issues of autism in adulthood and knowledge and tools to advocate health and community participation of young adults and adults on the autism spectrum. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 con-
Young Adults on the Autism Spectrum: Life After IDEA, by Lisa Crabtree and Janet DeLany. Critical
addressing transition needs as part of a students IEP and the key role of the occupational therapy practitioner as a potential collaborative member of the transition team. Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour). Order #4828, AOTA Members: $34, Nonmembers: $48.50. http://store.aota.org/ view/?SKU=4828
AUGUST 20, 2012 WWW.AOTA.ORG
Occupational Therapy and Transition Services, by Kristin S. Conaboy, Susan M. Nochajski, Sandra Schefkind, and Judith Schoonover. Importance of
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apart
www.OTJobLink.org
PR-207
EMPLOYMENT OPPORTUNITIES
Faculty Northeast South
Fall 2013 CHP-N-2601 The Department of Occupational Therapy and Occupational Science at Towson University, established in 1975, is currently recruiting a tenuretrack faculty member with experience in teaching research and with graduate programs. Current programs include a combined BS/MS degree, professional and post-professional masters degree programs, and a doctoral degree program in occupational science. Position Responsibilities: Teaching and advising Conducting scholarship in a research line consistent with the mission of the department, college, and university Developing and obtaining external grant funding to support research line Contributing to service mission of the department, college, and university Qualifications: Applicant must be licensed or eligible for licensure as an occupational therapist in the state of Maryland, have a minimum of 3 years of occupational therapy practice experience, have an earned doctoral degree with a research component (i.e., PhD, ScD, EdD), and a commitment to excellence in teaching, scholarship, and service. Prior academic teaching experience is required. Ongoing involvement in professional activities and evidence of scholarship outcomes with external funding are preferred. Candidates for the rank of associate professor must have 6 years at the rank of assistant professor and a well-established line of research. Application Process: Applications will be reviewed beginning on October 29, 2012, and should include a letter of application; curriculum vitae; transcript(s) from degree granting institutions; evidence of initial certification as an OTR; and names, addresses, and telephone numbers of four references to: Sonia Lawson, PhD, OTR/L, Search Committee Chair, Department of Occupational Therapy & Occupational Science, Towson University, 8000 York Road, Towson, MD 21252-0001 slawson@towson.edu Upon submitting your curriculum vitae to indicate that you are an applicant for this position, please be sure to visit http://www.towson. edu/odeo/applicantdata.asp to complete a voluntary online applicant date form. The information you provide will inform the universitys affirmative action plan and is for statistical purposes only and shall not be used to illegally discriminate for or against anyone. F-6114
Assistant/Associate Professor Occupational Therapy and Occupational Science College of Health Professions, Towson University
Amedisys Home Health is now hiring Occupational Therapists in the Chautauqua County area: Occupational Therapists (Full-time) $5,000 Sign-on Bonus!!! Relocation package offered Occupational Therapists (Part-time, Per Diem)
Apply online at amedisys.com/careers. For additional information, please contact Mary Ann Pereira at (877) 263-9613 or maryann.pereira@amedisys.com.
S-6105
EOE
Faculty
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A must-read book for occupational therapy professionals and students to consider cognitive intervention strategies as critical to promote occupation-based, client-centered care and everyday participation in a fuller life!
Each model includes (1) a theoretical base; (2) intervention, including evaluation procedures, assessments, and treatment methods; (3) individual and group treatment case studies that illustrate the intervention process; and (4) research supporting the evidence base of the model or parts of it. Chapters feature learning objectives and review questions.
ISBN: 978-1-56900-322-0
BK-244
EMPLOYMENT OPPORTUNITIES
Faculty Faculty
hatham University, a thriving dynamic institution with three colleges and one schoolChatham College for Women and the co-educational College for Graduate Studies, College for Continuing and Professional Studies, and School of Sustainability and the Environmentinvites applications for the position of assistant professor to teach in our Master of Occupational Therapy Program. This is a 9-month, renewable term position. We are seeking candidates with clinical experience in mental health and evidence-based practice who value a collaborative, collegial environment in which to further the programs excellent reputation for entry-level education. The successful candidate will hold an earned doctorate, a minimum of 5 years of clinical experience, and eligibility for occupational therapy licensure in Pennsylvania. Responsibilities include teaching, student advisement, scholarship, and service to the university and community. Chatham University offers a competitive salary; an excellent benefits package, including tuition remission for qualified personnel; and a generous retirement plan. Applicants should send a cover letter with salary requirements, resume, and the names of three professional references to: CHATHAM UNIVERSITY ATTN: H.R. Dept. Pos. #1463 Woodland Road Pittsburgh, PA 15232 E-mail: chathr@chatham.edu Visit: www.chatham.edu
Chatham University is an Equal Opportunity Employer
F-6096
Faculty
Northeast
Outpatient Adult Neuro Specialty Clinic Community Rehab Care (CRC) is looking for FT and PT occupational therapists/COTAs for our Quincy, MA, outpatient rehabilitation clinic. The position is MondayFridayno nights, weekends, or holidays. We are a great small team still providing old fashioned rehab values like communication amongst the team and with families and potential to be creative in the clinic and in the community! Send resumes to quincrc@brain-injury-rehab.com
Occupational Therapists
Avante Skilled Nursing and Rehab facilities South in FL, NC, & VA are seeking Occupational Therapists to add to our in-house therapy Avante Skilled departments forNursing and rehab Centers the following locations: in FL & VA are seeking Occupational Inverness, FL Ocala, FL Therapists for our in-house therapy Reidsville, NC Harrisonburg, VA departments at the following locations: Lynchburg, VA Waynesboro, VA Inverness, FL Leesburg, FL Responsible for evaluations,Lynchburg, VA Harrisonburg, VA direct patient treatment, and discharge planning. Will communicate Waynesboro, VA with families, physicians, and other health care Responsible for evaluations, direct patient treatteam and discharge planning. Will communiment, members; and maintain documentation of services in the medical records. cate with families, physicians, and other health care team members; and maintain documentaJob Requirements: Must be licensed in the tion of services in the medical records. appropriate state as an Occupational Therapist Job Requirements: Must be licensed in the with a Bachelors as an occupational therapist. appropriate statedegree. New Grads welcome to apply! Avante offers to apply! Avante offers an New grads welcome an excellent starting salary excellent starting salary package. and a premium benets and a premium benefits
package. Sign-on bonus or relocation assistance is available! Please contact: Gretchen Nolte Please apply at Inc. website: Avante Group our 954-790-9589 www.avantecenters.com Fax: 800-611-7457 For information: gnolte@avantegroup.com gnolte@avantegroup.com
S-6117
N-6113
www.avantegroup.com
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Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Participation in meaningful activities in the home and community contributes to health, wellness, and good quality of life. Occupational therapy fills a unique role in environmental modification and facilitating the creation of a safe, accessible home through evaluation, intervention, and outcomes measurement. This Self-Paced Clinical Course consists of in-depth text, an exam packet, and a CD-ROM with hundreds of photographic and video resources, all of which provide education on home modification for both occupational therapy professionals new to the practice area and to practitioners experienced in environmental modification. Professionals who work with either adults or children will find an overview of evaluation and intervention, detailed descriptions of assessments, and guidelines for client-centered practice and occupation-based outcomes. Course Highlights Section 1: Evaluating the Client and Environment Section 2: Developing and Implementing the Plan Section 3: Moving the Profession Forward
Specialty
The American Occupational Therapy Association
Certification
AOTA Specialty Certification in Environmental Modification (SCEM or SCAEM) is a major achievement for occupational therapy professionals in the field of environmental modification. This SPCC supports those efforts by offering a broad range of topics that may assist occupational therapists and occupational therapy assistants to become SCEM certified. To learn more, go to www.aota.org/certification.
CE-192
eMPlOYMeNT
West
Occupational Therapy Practice Guidelines for Productive Aging Community-Dwelling Older Adults
By Natalie Leland, PhD, OTR/L, BCG; Sharon J. Elliott, DHS, GCG, OTR/L, BCG, FAOTA; and Kimberly Johnson, MS, MSW
Phoenix, Tucson, & Burbs 602-478-5850/480-221-2573 Schools, 16 wks off, 100% Paid: Health, Dental, Lic, Dues, CEU-$1,000,401K, Hawaii/Spanish I trips Jobs@StudentTherapy.com
ARIZONA OTs$65,000
By 2030, nearly 20% of the U.S. population will be ages 65 or older, and the fastest growing segment among them will be people ages 85 or older. Individuals in this oldest age group have the highest rates of health care utilization, morbidity, and disability. To support productive aging and continued participation despite occupational shifts in habits, roles, and routines, preventive care models that include self-management programs and strategies to support participation are needed that will support older adults in the management of their chronic conditions and prevention of illness and injury. This Practice Guideline will help occupational therapists and occupational therapy assistants, as well as the individuals who manage, reimburse, or set policy regarding occupational therapy services, understand the contribution of occupational therapy in treating community-living older adults to facilitate productive aging.
ISBN: 978-1-56900-332-9
Midwest
he Comprehensive Group, A HealthPRO Rehabilitation Company, is Illinois leading provider of rehabilitation services. We offer a Career for Life with opportunities that fit your lifestyle as well as your career goals. The Comprehensive Group provides Occupational Therapy services in a wide variety of placement settings including: Skilled Nursing Facilities Hospitals Senior Living Communities Schools Private outpatient clinics Visit us online at www.comprehensiveonline.com or contact Robin Luman, VP of Staffing, at robinl@ comprehensiveonline.com or call 847-904-5057
M-6118
31
RESEARCH updAtE
chmid and colleagues1 investigated the relationships between demographic, clinical, and psychological characteristics and social role functioning (SRF) at 4 months after stroke, and the association between depression improvement and 4-month SRF. Performing a secondary data analysis of the Activate-Initiate-Monitor Study, researchers used the data from a randomized clinical intervention trial that included 371 adult survivors of ischemic stroke, with and without depression (depressed only n=176). Depression was measured with the Patient Health Questionnaire (PHQ-9), and depression improvement was defined by a 50% decrease in PHQ-9 scores. SRF was measured with the social domain of the Stroke-Specific Quality of Life Scale. After performing a multiple linear regression, researchers found that out of the potential variables (depression, stroke severity, functional status, social support, and personal factors), depression and comorbidities were independently associated with SRF at 4 months after stroke. Moreover, depression improvement emerged as the only variable to independently predict SRF in the depressed-only group. This finding underscores the importance of rehabilitation providers screening and treating poststroke depression because a satisfactory return to SRF is associated with improved quality of life.
References
1. Schmid, A. A., Damush, T., Tu, W., Bakas, T., Kroenke, K., Hendrie, H. C., & Williams, L. S. (2012). Depression improvement is related to social role functioning after stroke. Archives of Physical Medicine and Rehabilitation, 93, 978982. 2. Arbesman, M., & Mosley, L. J. (2012). Systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling older adults. American Journal of Occupational Therapy, 66, 277283. doi:10.5014/ajot.2012.003327 3. Cosbey, J., Johnston, S. S., Dunn, M. L., & Bauman, M. (2012). Playground behaviors of children with and without sensory processing disorders. OTJR: Occupation, Participation and Health, 32(2), 3947. Susan H. Lin, ScD, OTR/L, is AOTAs director of research.
Note: To view the abstracts of these articles, visit Google Scholar http://scholar.google. com/schhp?hl=en&tab=ws or go to PubMed at www.ncbi.nlm.nih.gov/sites/pubmed and type the article title in the search box, then click on Search. If you would like your in-press or recently published research featured in this column, please contact Susan Lin at slin@ aota.org or 301-652-6611, ext. 2091.
32
AOTA
in
BEFORE
you drive to work tomorrow
BEFORE
you run errands over lunch
BEFORE
you kiss your kids good night
Set Up a Solid Safety Net to Help Protect Your Familys Tomorrow with AOTAs Term Life Insurance Plan
As an occupational therapist, you see the real-life stories: A sudden car accident caused by a rain-slicked highway leaves a family without a mother. Chest painoverlooked as indigestiondevelops into a full-fledged heart attack and a healthy man never makes it home. What if tomorrow your loved ones became one of those families in the waiting room? Hearing the devastating news that theyd need to move on without you. How would your family continue the life theyve built without your paycheck to help make ends meet? What about your familys dreams of the future? College for your children? Who would help out your parents as they got older or take care of other family members who already rely on you? A Safety Net to Reinforce Any Coverage You Have Through Work Think of your own family. Would one or two times your salary take care of the bills over the long haul? Would it pay off the mortgage? What about credit cards, car loans or student loans? To help you bridge the gap between the life insurance you have through work (or may have bought on your own) and the level of coverage your loved ones may need, AOTA set up the Occupational Therapists Term Life Plan. AOTA Program Delivers Solid Coverage Without Application Hassles Dependable benefits up to $250,000. Applying extended on an easy-access, buy it directly through the mail basis. It all adds up to one of the most hassle-free ways to help protect your loved ones against the financial impact of facing tomorrow without you.
f you rely strictly on life benefits from your employer, you face the real risk of watching those same benefits disappear if you switch jobs or if your employer cuts benefits because of tough economic times. But with the Occupational Therapists Term Life Plan for AOTA members, you can rest assured your financial safety net will be there when your loved ones need itno matter what changes your career brings.
Many occupational therapists have some life insurance through work. But for many families, coverage equal to just one or two times your salary simply isnt enough.
Plus, AOTAs Occupational Therapists Term Life Plan automatically comes with group rates designed to fit in almost any budget.
Please dont put this off. Reinforce your family safety net with special AOTA-sponsored benefits today: Call 1-800-503-9230 or visit www.aotainsurance.com
Underwritten by: Hartford Life Insurance Company, Simsbury, CT 06089 The Hartford is The Hartford FInancial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life Insurance Company.
P-6087
AR Ins. Lic. #245544 CA Ins. Lic. #0633005 d/b/a in CA Seabury & Smith Insurance Program Management
All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life Insurance Company detailed exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.
55512, 55823, 55824, 55825 (8/12) Seabury & Smith, Inc. 2012
AGL-1550
Education Article
(one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.
Home Modifications
MARNIE RENDA, MED, OTR/L, CAPS, ECHM
Private Practice, Destination Home LLC; Adjunct Professor, Xavier University; Adjunct Professor, Cincinnati State Technical and Community College Cincinnati, OH This CE Article was developed in collaboration with AOTAs Home & Community Health Special Interest Section.
ABSTRACT
Occupational therapy has included home modifications for many years, but because both the scope of the services we provide as well as the practice settings for these services has expanded, it is considered an emerging area of practice. As with all areas of practice, occupational therapy practitioners must remain vigilant of the ethical, legal, and practice considerations shaping this area, and use our official documents to help guide current and future practice. This article defines the ethical, legal, and practice issues related to home modifications, and it explores their impact on occupational therapy practice across settings, including the need to use home modifications in all settings to meet consumer needs.
LEARNING OBJECTIvES
After reading this article, you should be able to: 1. Identify the ethical and legal considerations for home modification services across practice settings. 2. Identify the American Occupational Therapy Association official documents used to provide guidance for home modifications practice across settings. 3. Recognize the knowledge, skills, and experience necessary for competent practice in home modifications in emerging areas of practice.
INTRODUCTION
Home modifications are defined as adaptations to living environments intended to increase usage, safety, security, and independence for the user (Siebert, 2005, p. 28). Home modifications are defined as both a process and a product. The product is the alteration, adjustment, or addition to the home environment (Siebert, 2005, p. 3). The process is the combination of services to deliver the product. This includes evaluating clients, identifying and selecting solutions (assistive technology or alteration to the structure of the home), acquiring and installing products or solutions, training end users and caregivers, and assessing associated outcomes (Siebert, 2005, p. 4).
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continued
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of home modifications may differ drastically, depending on the location of services. Providing services in a clinic setting can prevent practitioners from conducting home site visits, significantly impacting their ability to make informed recommendations about the clients specific home modification needs. On the other hand, like home health practitioners, outpatient practitioners providing services in the home are able to perform comprehensive evaluations and implement home modification recommendations. However, time can also affect home modification services in this setting. Often, outpatient services are discontinued prior to acquiring assistive technologies or structural changes to a home. As with practice within SNFs, this turn of events can prevent clients from receiving any training or alterations for home modifications. Private Practice Private practice practitioners often work as consultants and do not typically provide skilled treatment. Practitioners in this setting generally provide consultation on general home modifications or more extensive services such as architectural changes or complex assistive technologies. When expanding into more complex services, practitioners must obtain additional skills, training, and experience to ensure competency and prevent harm to clients. Finally, private practice practitioners accepting private pay have the ability to provide the full scope of occupational therapy services and are not limited to reimbursable services identified by the various funding sources, such as insurance providers or state or federally funded agencies or waiver programs. Table 1 on p. CE-3 provides a summary of occupational therapy home modification services in different practice settings.
AUGUST 2012
OT PRACTICE, 17(15)