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Occupation: Changing the Paradigm of OT

Last post 05-03-2017, 3:48 AM by strong peter. 9 replies.
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  •  04-11-2011, 1:57 PM

    Occupation: Changing the Paradigm of OT

    This thread is a discussion forum for ADVANCE's Power of Occupation project. This is a venue to tell us how you'd like to change your clinic or practice, or what you've already done to put the focus back on occupation where you work.
  •  04-12-2011, 6:04 PM

    Re: Occupation: Changing the Paradigm of OT

    I loved Florence Clark's essay on dancing a few months back on the AOTA website. It was a personal experience that showed occupation so vividly. In order to try to win AOTF's Dancing with the Stars event at last year's national conference, she talked her husband into taking dancing lessons - not sure which kind, it may have been tango. Anyway, she had to kind of drag him there at first, but he got into it as they continued. He got so good that the two of them actually won the contest. Then Florence had to travel for a few weeks, but her husband kept on with the dancing lessons!  She was a little taken aback, but realized that this had become important to him. I hope they're at the event this year to defend their championship.  Any similar stories to tell about the power of occupation?

    E.J. Brown
  •  04-28-2011, 11:21 PM

    Re: Occupation: Changing the Paradigm of OT

    This project is just what I have been looking for!  I love being an OT, it is who I am and have been for 20+ years.  I know what OT is and BELIEVE in its power to heal and restore people's lives.  "Occupation" has always been my modality of choice but I find others rarely understand what this means.  It is often difficult to find support and budget money to provide the appropriate tools and environment needed to be more than a "reacher teacher".

    For the past year I have been working part time in a small acute care hospital and out-patient clinic.  I am per diem and the only "regular" OT on staff in both places.   I am so ready to be inspired again and bring OT to the forefront in these settings.  I think back on some of the great teams I have worked with over the years and hope to facilitate a similar environment in my current work settings.  However, I admit, my energy is running low and too often I am just plodding through the established status quo. My foremost accomplishment so far is that I have acquired a table at each facility, where clients can work on occupational tasks that do not involve only dressing, bathing, exercise bands or gym equipment.  Believe me, this was a huge step forward! 

    I also have started my own private practice 2 years ago.  My goal is to reach individuals who are at risk of losing the ability to safely remain in their homes.  I offer skilled out patient OT to client's in the setting of their own homes.  I have always felt that working with clients, in their own environments, is the most effective way of truly addressing their individual occupational needs.  However, referrals have been few and far between.  Physician's, nurses and even families say this is a great idea and a much needed service but referrals do not follow.  So far, my marketing and education attempts have resulted in disappointing results to say the least.  I am in the process of revamping my approach.

    Again, it is most wonderful to have a resource to get inspiration for making occupational therapy truly "occupational"!  Thanks for being there for us.

  •  05-12-2011, 10:05 PM

    Re: Occupation: Changing the Paradigm of OT


    I love what you wrote about being able to put occupation back into occupational therapy. As an upcoming graduate I find myself worried that facilities will not promote occupation based treatment and that it will be hard for me to change their current system. I value occupation and want to be a practitioner that is true to the field. Do you have any advice on how to promote occupation in a facility where they may not? As a new graduate I don't feel confident yet to change the way a facility works, however I refuse to loose my occupation based roots.

  •  06-02-2011, 1:21 PM

    Re: Occupation: Changing the Paradigm of OT

    Megan (and others);

      The story in this week's OT Advance about Dr. Lucy Jane Miller and how she first came to learn about OT is a wonderful example of the power of occupation as a modality. Her first day of vision after 6 months of having her eyes bandaged post surgery was her birthday. Her OT was a student who knew it was her birthday and took her to the rehab kitchen to make her own birthday cake! That sealed the deal for Dr. Miller; after that she left her plans for law school and pursued OT. Those moments ought to be our goals as OTs and OT students to find what's important to the patient and then match what they need with what they want for the optimal therapy session. The joy of that connection and ideal matching is what fuels us as therapists and helps the public (our patients, their families, other professionals..etc..) see "what" OT is! And you never know who you will be inspiring to become the next Dr. Miller...

      As fieldwork coordinator in an OT program, I am frustrated along with my students who often witness something in fieldwork other than best practice and then worry how they will inject occupation into their own sessions without upsetting the apple cart too much in their fieldwork setting. I encourage students to plan ahead and show the list of suggested treatment activities for that session to their supervisor and be ready to give the justification for each. Provide references so that they see that there is evidence for it. The more occupation-based activities on that list, the better. And since showing the list to the supervisor gives them veto power, the situation can be less threatening. I would also encourage students to go into their fieldwork with objectives for that experience that include mastering the use of occupation-based treatment and evaluation. If the supervisor/educator (and other clinicians) see that this is part of YOUR goal, they may feel empowered to support you in that effort and in turn may become more so themselves. The AOTA's Fieldwork Educator Certificate Program teaches that the fieldwork experience is as much a learning experience for the educator as it is for the student. It takes some finesse, but students can be some great teachers..but be ready to practice humility and grace through the process and keep communication open.

     Another thing to keep in mind throughout our careers is that if WE don't use occupation-based treatment, who will? Will we give away that unique piece of OT to another profession? How can we justify doing things that aren't occupation-based? Isn't that practicing another kind of therapy, for which we have not been trained? These are ethical and political questions. What will happen to OT if we don't stay true to this approach? Just look at the health care changes in various other professions' practice acts and you will find the answer. Our very future depends on us remaining true to our mission and ethics.

       Stay active with OT groups such as your local district in your state association. Create article and topical discussions at your facility. Present an inservice over lunch time to get the staff talking about it. Partner with your local OT/OTA educational program to discuss the topic and get some additional training if needed. There are many things we can be doing about this as students and professionals.

      Best wishes to all aspiring to practice best practice! Hitch your OT wagon to the Centennial Vision and see where we can go together as a profession!

    --Christine Achenbach, MEd, OTR/L

  •  06-06-2011, 9:13 AM

    Re: Occupation: Changing the Paradigm of OT

    The true use of occupation in particular settings has definitely gone away.  I can relate to how you feel regarding the need to be inspired. I would love to hear what activities you have been able to incorporate into the treatment session that do not involve thera-bands or gym equipment.

    I believe one way to bring occupation back to OT is for us to share concrete activities that are appropriate and functional. I feel that in the arena of geriatrics we often use pediatric activities to address physical and cognitive deficitis; and although the adults go along with the task, they recognize the task was created for children.

  •  06-14-2011, 5:13 PM

    Re: Occupation: Changing the Paradigm of OT

    As a fellow OT who works in geriatrics, I understand and agree with your post. I would love some ideas for occupation based activities that don't revolve around ADLS which are already done by the time I arrive to work. I am at a point where I am extremely close to burnout working in this setting and I don't know how to turn it around. My residents need a therapist motivated and inspired and I know I have been lacking in that department and it isn't fair to them.
  •  07-19-2011, 3:50 PM

    Re: Occupation: Changing the Paradigm of OT

    LTC-OT and others:  Be sure to  take a look at the new Questions, Answers and Ideas section by Charla Holst. The way in which she brings occupation into everyday patient encounters is phenomenal. One of the newest ways she's suggested is to let the patient speak first, and often he or she will actually tell you what the occupation should be! 
    E.J. Brown
  •  02-29-2012, 11:26 PM

    Re: Occupation: Changing the Paradigm of OT

    A great challenge is simply defining occupation-based practice. Over the years, I've read many examples of occupation-based practice. Therapists have put forth everything from cleaning a mirror to driving a car as examples of this practice.  Before we move ahead, we must first agree that we are moving in the same uniform direction.  Unfortunately, I suspect we are not.

    The moment the AOTA Framework was promulgated, the OT profession nominated itself as "experts" in occupation.  While I applaud this move, I also wonder how OT's never educated on human occupation, suddenly became experts.  I think the lack of formal and thorough education on human occupation may leave practitioners with a less than comprehensive understanding of occupation's complexity and importance.

    Perhaps then, we should start by first agreeing about what we are talking about.  And keep in mind, that if occupation-based practice is a new direction, then it must look vastly different than what we've been doing. So, I encourage readers to ask themselves, am I doing something very different than before I was occupation-based.  I clearly remember the time when I became an occupation-based practitioner. And, I remember it with a fond smile on my face.


    Ron Carson MHS, OT



  •  05-03-2017, 3:48 AM

    Re: Occupation: Changing the Paradigm of OT

    This is my most visited site now! If your lurking just go ahead and register and join the fun!