Welcome to theTrump Rehabilitation Centre

The Search for a New Vision

WANTED

Head Occupational Therapist

Overview

Rehabilitation Center & research institute current practices.

Vision for future Holism & client-centeredness. Research & evidence based practice.

Conclusion

Current Practices

Focus on client’s individual occupational performance components. Ex. Lifting teapot off

shelf.

Research is not occupationally based.

Vision

Holistic approach to occupational therapy. Client-centered practice.

Focus on research in occupation. Evidence based practice.

Holistic Approach

A person is a whole being — mind, body & spirit.

Client-centered practice enables treatment of the whole person.

Canadian Model of Occupational Performance — accepted model in Canada. CAOT (1997).

Physical Institutional

SocialCultural

Environment

Canadian Model of Occupational Performance

Occupation

ProductivityS

elf-c

are

Leisure

PersonSpirituality

Cognitive Physical

Affective

Benefits of Holistic Approach

Comparative Study Buddenberg & Schkade (1998). Rehab for hip fractures in elderly patients. Biomechanical versus Holistic Treatment.

ResultsHolistic treatment greater improvement on

client chosen tasks.

Benefits of Holistic Approach

Comparative Study Jackson & Schkade (2000). Rehab for hip fractures in elderly patients. Biomechanical versus Holistic Treatment.

ResultsHolistic treatment higher improvement rate.Holistic treatment greater client satisfaction.

Benefits of Holistic Approach

Case Study Capitulo & Silverberg (2001). Mount Sinai Medical Center, New York. Provider-Centered Patient-Centered

delivery model of care.

Results of changeImproved quality of care.Increased patient & staff satisfaction.Decreased costs.

Benefits of Client-Centered Approach

Case Study Rebeiro (2000). Hospital mental health services. Not client-centered.

Client raised issues:Focus was on illness rather than individual.Lack of choice.Not part of decision making process.Lack of partnership in treatment.Decreased therapeutic value of occupation.

Benefits of Client-Centered Approach

Continuous Quality Care Improvement Model (CQI) McLaughlin & Kaluzny (2000). Patient-centered care provides optimal services

compared with site-centered. 1960s, 80s: Patient-centered; not EBP. 1980s, 90s: EBP, but site-centered.

Focus of Model Goals set by patient. Treat patient, not impairment. Practical in light of financial constraints.

CQI Model

Mass Customization Module: A treatment component.

Ex. Psychotherapy, splinting, etc.

Client selects modules. Modular approach supported by EBP. Decreases need for later services. Assures long-term effect on quality of life.

CQI Example: Client Pathway

Psychotherapy

Functional Assessment

Splinting

Orthotics

Hand TherapyAssistive Devices

Work HardeningPsychotherapy

Hand Therapy

Orthotics

Splinting

Research on Occupation

“Occupational therapists… will advance occupation and participation through… utilization of research knowledge.”

Leadership Forum (2003).

Evidence-based practice.

Evidence Based Practice

“Evidence-based practice (EBP) encourages the integration of high quality quantitative and qualitative research, with the clinician's clinical expertise and the client's background, preferences and values to implement interventions that produced the desired outcome. " Sackett et al. (1996).

Benefits of Research on Occupation

Perspective Law (1998). Importance of evidence based practice

Financial accountability.Maximize benefit for allowed cost.Fosters client-centered perspective.Ensures best practice.

Benefits of Research on Occupation

Perspective Dubouloz, Egan,

Zweck, & Vallerano (1998).

Evidence Based Practice identifies clients most likely to benefit from services.

Perspective Stewart (1999). Evidence Based

Practice enables therapists to set goals and measure outcomes.

Concluding Remarks

A holistic approach to treatment will benefit the client, the therapist, and the organization.

Research on occupation supports EBP, and will lead to improved credibility of the organization, decreased costs, and improved intervention outcomes.

Discussion

What did you think of Monika's vision? Do you think we should

hire her? Why? Why not?

Monika, you’re HIRED!