I could not agree more!!
Neal C. Luther,OTR/L Rehab Program Coordinator Advanced Home Care 1-336-878-8824 xt 3205 [EMAIL PROTECTED] Home Care is our Business...Caring is our Specialty The information contained in this electronic document from Advanced Home Care is privileged and confidential information intended for the sole use of [EMAIL PROTECTED] If the reader of this communication is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please immediately notify the person listed above and discard the original.-----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Sue O Sent: Monday, September 08, 2008 10:12 PM To: OTlist@OTnow.com Subject: Re: [OTlist] expertise, goals, and my 2 cents Hi all - very interesting discussion. If, by expertise, you mean what differentiates us from other rehab professions, I would say that our expertise is (or should be) facilitating occupational performance. We may include preparatory interventions to accomplish occupational performance goals, but if we stop at the preparatory step, or write our goals to reflect preparatory skills (like strength, ROM, etc.) then we are not doing OCCUPATIONal therapy. I don't write ROM or strength goals, nor do I teach my students to do so either. Once you shift your thinking, it's not that difficult to write goals that reflect occupational performance. I would never start a goal with the performance skill or client factor (increase ROM to do something). That, to me is like describing OT by how it's not like PT. I always start (and end) with occupational performance. Why not simply state as a goal that the client will don pullover clothing (if that is what they identify as the problem), or even something more general like complete self-care tasks requiring overhead reaching (and maybe give a couple of examples), if the physical problem is shoulder ROM? The intervention plan itself will spell out that I might work on ROM or teach the client some self-stretching, but that should not be the goal. I respectfully disagree with those who say that just because something is done by an OT, then it's OT. That mentality has, in my opinion, caused some of the identity problem we now wrestle with. That's like saying I'm a dentist, so if I happen to be good at giving massages, and I choose to give you a massage while you're in the chair, then it is dentistry (I realize my analogy is a bit absurd, but in a way some of what we do isn't that different). We have tried to be all things to all people, and it's taken us away from our roots, which is the power of occupation to promote mental and physical health. Therapists trained during the heavy "medical model" years were taught a more reductionistic perspective. But in the past 10-15 years there has been a decided shift back to a more holistic foundation based on the power of occupation. I really like the language that the Canadian model uses, which is exemplified in the COPM, which asks the client "what things do you need to do, want to do, or are expected to do, that you can't do, don't do, or aren't satisfied with how you do them, due to your (fill in the blank diagnosis, health condition, situation)"? Starting with an assessment like the COPM, it's almost impossible not to be both client centered and occupational based. Once the occupational performance deficits are identified and goals developed, then we can address the "why" and add in the necessary assessment and interventions to address the appropriate performance skills in pursuit of the occupational performance goals. The bottom line, to me, is if there are no occupational performance goals (i.e. the client's condition is not affecting their occupational performance in any meaningful way, as perceived by the client), then OT is not indicated. I know by reading the posts on this topic that some of you will disagree with me - no problem. But as someone who has been teaching OT for the last 11 years and has experienced the shift first hand, I see the handwriting (no pun intended) on the wall. I have tremendously enjoyed the debate and look forward to more! Sue Ordinetz Assistant Professor of Occupational Therapy American International College Springfield MA 01109 -- Options? www.otnow.com/mailman/options/otlist_otnow.com Archive? www.mail-archive.com/otlist@otnow.com
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