Working for the Canadian Armed Forces and Veterans Affairs ...

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Association canadienne des ergothérapeutesCanadian Association of Occupational Therapists1

CAOT Professional DevelopmentNews & Resources Webinar

Association canadienne des ergothérapeutesCanadian Association of Occupational Therapists

Working for the Canadian ArmedForces and Veterans Affairs Canada:

Guidance for Occupational Therapists

Presented by:

Katelyn Bridge, OT Reg. (Ont.)

December 14, 2017


Learning Objectives

1. Identify and understand the roles of occupational therapists working for the Canadian Armed Forces (CAF).

2. Identify and understand the roles of occupational therapists working for Veterans Affairs Canada (VAC).

3. Recognize the emerging role for occupational therapists in working with military families and

children.


Disclaimer

• This presentation is based on CAOT’s reference document, “Working for the Canadian Armed Forces and Veterans Affairs Canada: A Guidance Document for Occupational Therapists”

http://www.caot.ca/site/pt/militaryguidancedocument?nav=sidebar

• I do not work for CAF or VAC.

Bridge, K. (2017, December 14). Working for the Canadian Armed Forces and Veterans Affairs Canada: Guidance for Occupational Therapists. In CAOT News & Resources Webinar series. Retrieved from https://caot.ca/site/pt/resources/odnrwebinars?nav=sidebar


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Recent Developments

• CAOT has been working closely with the CAF and VAC to promote occupational therapy as an essential service for the health and well being of military personnel, Veterans, and their families.

• At the 2017 CIMVHR Forum, the CAF announced that they will be hiring 30 new occupational therapists – an increase from their current number of 4.

– Reiterated at the 2017 Family Medicine Forum


Working with Members of the Canadian Armed Forces

Occupational therapists work with active military personnel in two different roles:

– OTs may work directly on base for the Department of National Defence (DND) as a DND Rehabilitation Occupational Therapist (DND OT). ***

– Occupational therapists can also register to be Blue Cross service providers and work in the community as Blue Cross Occupational Therapists (Blue Cross OTs).


Unique Considerations

• When working with members of the CAF, whether as a DND OT or a Blue Cross OT, there are some unique considerations:– The overarching goal of occupational therapy

interventions with CAF members is return to duty.

– Rehabilitation outcomes with CAF personnel are strongly tied to motivation, effort, and support.

– An injured CAF member is seen a recovering athlete who must be provided with an appropriate level of challenge to reach their rehabilitation goals.

(National Defence and the Canadian Armed Forces, 2011)


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DND Occupational Therapists

• DND OTs work on military bases as team members on the Canadian Forces Health Services Physical Rehabilitation Team.– Primary goal: Return injured personnel to their previous duty

as soon as medically possible.

– When return to duty cannot be accomplished through a physical rehabilitation program, the secondary goal is to prepare CAF personnel for alternative military employment.

– If this too is not a realistic goal, the tertiary goal is to prepare CAF members for an optimal transition to civilian life.

(Besemann, 2011)


DND OTs: Commonly Addressed Issues

• DND OTs commonly work with CAF members who may be experiencing the following:

• orthopedic problems• musculoskeletal

problems• sleep disorders • amputations • chronic pain • traumatic brain injury • need for mobility aids

• need for assistive devices/equipment

• needs for home adaptations

• need for vehicle adaptations

• dysregulated routines and habits


DND OTs: Commonly Used Assessment Tools

• The following list is an example of occupational therapy assessments used on one of the CAF bases:

• Beck Anxiety Inventory (BAI) • Beck Depression Inventory (BDI) • Behavioral Assessment of Dysexecutive

Syndrome (BADS) • Box and Block Test (BBT) • Brain Injury Visual Assessment Battery for

Adults (biVABA) • Canadian Occupational Performance

Measure (COPM) • Contextual Memory Test (CMT) • Headache Impact Test (HIT-6) • Insomnia Severity Index (ISI) • Jebsen Hand Function Test (JHFT)

• Montreal Cognitive Assessment (MoCA)• Motor-Free Visual Perception Test (MVPT) • Neurobehavioral Symptom Inventory (NSI) • Patient Health Questionnaire-9 (PHQ-9) • Pittsburgh Sleep Quality Index (PSQI) • Purdue Peg Board • Rivermead Behavioural Memory Test

(RBMT) • Standardized Concussion Assessment Tool

3 (SCAT3) • Tampa Scale of Kinesiophobia (TSK) • Test of Everyday Attention (TEA)


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Working for the Canadian Armed Forces

Keep an eye out for the online application process for the recently announced positions.

www.jobs.gc.ca

https://bts.calian.com/en/career_jobs/index.asp

They will also be advertised on www.caot.ca


Blue Cross Occupational Therapists

• OTs working in the community or private practice can register with Medavie Blue Cross to become Blue Cross service providers, making them eligible to provide direct service to CAF members requiring occupational therapy.

https://www.medaviebc.ca/en/health-professionals/register



“Outsourcing” is the term used when a CAF member is referred to a Blue Cross OT.

CAF members may be referred to Blue Cross OTs for a variety of reasons including: • When no on-site occupational therapy services are available on base.

• The DND OT is unable to see a client within the required priority timeline.

• The member requires specialized assessment or treatment that is not available on-site (e.g. hand therapy, functional capacity evaluation).

• The member lives/works at a distance from the primary DND OT location.


http://www.jobs.gc.ca/

https://bts.calian.com/en/career_jobs/index.asp

http://www.caot.ca/

https://www.medaviebc.ca/en/health-professionals/register

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• Services provided by Blue Cross OTs are typically provided within the military member’s home.

• The initial home assessment should be comprehensive and include:

• home safety • medication and health management • accessibility of home space • mobility (essential transfers and

movement) • cognitive screenings and/or

assessment • social support

• caregiver physical/mental health requirements

• comparisons of present versus past ability to function in everyday roles and routines

• fit between home environment and member’s current functional abilities


Blue Cross OTs – Process Overview1. DND OT/referral source speaks with Blue Cross OT to ensure that the

OT can meet the required priority timeline.

2. Appropriate information is provided to the Blue Cross OT including: client referral, reporting standards, and any other important information.

3. Blue Cross OT contacts CAF member to arrange initial assessment.

4. Blue Cross OT and CAF member meet.

5. Blue Cross OT writes an initial report.

6. Blue Cross OT submits the reports to the referral source.

7. The recommendations on the occupational therapy report are reviewed by the referring health care provider. Recommendations are addressed and funding options are considered.


Working with Veterans and Veterans Affairs Canada

• Veterans are defined as “Canadian Armed Forces members who meet the Department of National Defence’s military occupational classification requirements and have been released from the Canadian Armed Forces with an honourable discharge” (Department of National Defence, 2015, p. 130)


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The Transition to Veteran Status

• There are components of military life that may make the transition to Veteran status more difficult:

– Military life is very structured

– Loss of comradery

– Lack of experience with everyday tasks, such as:

• Applying for jobs

• Finding housing

• Managing a budget

• Registering for a health card


VAC Client Base: Commonly Addressed Issues

• Chronic pain

• Physical limitations

• Need for mobility aids

• Need for home adaptations

• Need for assistive devices and equipment

• Depression

• Anxiety

• Post-traumatic stress disorder (PTSD)

• Substance abuse

• Dysregulated routines and habits

• Social isolation

• Issues resulting from a traumatic brain injury (TBI)


Working for Veterans Affairs Canada

• VAC employs occupational therapists in four capacities:

1) Field Occupational Therapy Services Officers (FOTSO)

2) Case Managers

3) Field Occupational Therapists

4) Clinical Care Managers (CCM)


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Field Occupational Therapy Services Officers (FOTSOs)

• Work within a VAC office, where their primary roles are as a consultant who coordinates occupational therapy referrals, and as a member of an interdisciplinary team.

• Do not provide direct treatment to clients.

– Act as an intermediary between other VAC staff, Case Managers, and community therapists to help ensure VAC clients receive occupational therapy services to meet their needs.


FOTSOs - Key Duties

• Reviews the client’s concerns and functional issues, and sends a referral to a Field OT in the community.

• After assessment by the Field OT, the FOTSO reviews the report and recommendations made by Field OT.

– The FOTSO then makes their own recommendations based on the client’s needs, the Field OTs recommendations, VAC policies, and VAC benefits that the client may be eligible for.

• Reviewing financial quotes generated by Field OTs.

• Provide a comprehensive package (recommendations, funding info) to decision makers – goal is to obtain approval for recommendations.


Case Managers

• Role is not exclusive to occupational therapists.

• VAC Case Managers assist Veterans and their families with the transition from active military personnel to civilian life.

– Not all Veterans require case management; it is a service designed to assist those who may be finding it particularly difficult to navigate the transition.

– Military are personnel are screened for case management needs when they are transitioning out of active duty.


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Case Managers – Key Duties

• Work with a caseload of clients on a one-on-one basis to identify potential barriers to engagement in civilian life and to coordinate and approve services.

• Do not provide direct treatment to clients.

– Refer them to services in the community, support them through VAC Rehabilitation Program.

• Clients continue to work with a Case Manager until they have met their identified goals, which can take several years (especially in the case of vocational goals).


Interested in Working as a Case Manager?

• Knowledge and skills to have to excel in this role:– General knowledge of physical health issues and treatment

strategies

– General knowledge of mental health issues and treatment strategies

– Knowledge of assessment and intervention for chronic pain

– Knowledge of available community resources

– Experience in vocational rehabilitation (specifically interpreting Functional Capacity Evaluation results)

– Motivational interviewing skills

– Knowledge of suicide prevention intervention strategies


Field Occupational Therapists

• Occupational therapists working in the community or private practice can register with Medavie Blue Cross to become Blue Cross service providers, making them eligible to provide direct service to VAC clients.

http://www.veterans.gc.ca/eng/services/ health/treatment-benefits/info-providers


http://www.veterans.gc.ca/eng/services/ health/treatment-benefits/info-providers

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Field Occupational Therapists

• Field Occupational Therapists provide services to VAC clients in their homes and within the community.

• They work closely with the FOTSOs.

• In the Veterans Affairs context, occupational therapists are viewed as external providers.

– Decisions are made at the administrative and funding level of VAC, meaning that not all the occupational therapist’s recommendations may be funded and implemented.


Field Occupational Therapists –Process Overview

• VAC FOTSO will send a referral to the Field Occupational Therapist.

– A comprehensive assessment is completed and recommendations are generated for the client.

• The assessment report is then sent back to VAC for approval.

– VAC will approve a designated amount of time for the therapist to work with the client towards their identified goals.

• VAC requires progress reports at the halfway and end point of the allotted time.


Clinical Care Managers (CCMs)

• CCMs provide short-term, intensive case management services to VAC clients who are experiencing complex health needs.

• Clients who work with CCMs often have serious mental health symptoms, comorbid conditions, are disconnected from social and community supports, and struggle with various areas of their daily lives including housing or employment.


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Clinical Care Managers (CCMs)Duties of a CCM can include (Hutton 2010): • building supportive relationship with the client and/or family;• assisting with follow through on the case plan objectives; • being a personal link to community resources;• promoting access to necessary treatment services; • providing regular support to the client;• collaborating with the VAC Case Manager; • consulting with other health care providers• advocating for clients


Interested in Working as a CCM?

• Must be registered with Blue Cross

• Minimum of 5 years experience working in mental health

• Other assets:– knowledge of community resources including funding options and public

transportation

– flexibility; must be able to think “on the spot” as role can be unpredictable

– ability to advocate for clients

– ability to research to find needed information

– comfort in a variety of situations where client may need support (e.g. meeting with banks, professors, realtors)


Working with Military Families & Children

• Military families are most likely to access occupational therapy services within the local communities where they live through publicly funded or private systems.

– Occupational therapists work with military families in the same settings as they would with civilians, including contexts such as acute care, outpatient clinics, and school-based services (Edgelow & Cramm, 2015).


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The Impact of Mobility, Risk & Separation

• Mobility– Military families are required to geographically relocate on a

recurring basis, relocating three to four times more often than civilian families (Cramm et al., 2015).

• Separation– Canadian Armed Forces members are frequently required to be

away from their families during training missions and deployments.

• Risk– The effects of the risk associated with being a member of the CAF

extends beyond the military member themselves, and has a significant impact on their family members.


Accessing Health Care

• Frequent relocations lead to the need to repeatedly navigate access to a family physician and any required specialists.

– Many military families do not have family doctors.

• Because of this, families may miss periodic health assessments, routine screenings, immunizations, and preventive care (College of Family Physicians of Canada, 2016).

• When moving among provinces, military families must apply for new health cards, which often involves a waiting period.


Accessing Health Care• Lack of consistency in the

transfer of medical records from

location to location further

impacts quality of care.

• Civilian physicians working with military families may be unaware of the unique aspects of military life and their impact on the prevalence of certain health conditions.

– Increased physical health issues, sleep issues and stress have been identified in military children (DND/CF Ombudsman, 2013).


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Accessing Educational Supports

• With each relocation, children must adapt to new curriculums, new classroom expectations, and the challenges of socializing with new peers and classmates.

• Children with disabilities or learning needs from military families often face difficulties accessing educational accommodations at their new school.


Accessing Educational Supports


Military Families: Moving Forward

• Military families are becoming a more prevalent topic of research.

– There will likely be more information available on how to best meet their needs in the coming future.

– At present, the most important consideration when working with military families is to simply be aware that military families exist, and to consider them as their own special population, with unique needs and considerations.


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Key Points

• Occupational therapists are well-suited to support military personnel, Veterans, and their families.

• There are a wide range of roles for occupational therapists within the Canadian Armed Forces and Veterans Affairs Canada.

• We must continue to advocate for the value of occupational therapy services and the importance of hiring more occupational therapists within these organizations.


Additional Information• To download the full PDF version of Working for

Canadian Armed Forces and Veterans Affairs Canada: A Guidance Document for Occupational Therapists please visit:


(aussi disponible en français)


ReferencesBesemann, M. (2011). Physical rehabilitation following polytrauma. The Canadian Forces

Physical Rehabilitation Program 2008-2011. Canadian Journal of Surgery, S135. https://dx.doi.org/10.1503/cjs.025511

College of Family Physicians of Canada. (2016). Family physicians working with military families. Retrieved from http://cfpc.ca/uploadedFiles/Military%20Family%20Physician%20Guide_E.pdf

Cramm, H., Norris, D., Tam-Seto, L., Eichler, M., & Smith-Evans, K. (2015). Making military families in Canada a research priority. Journal of Military, Veteran and Family Health, 1(2), 8-12. https://dx.doi.org/10.3138/jmvfh.3287

Department of National Defence and Canadian Forces Ombudsman. (2013). On the homefront: Assessing the wellbeing of Canada’s military families in the new millennium. Retrieved from http://www.ombudsman.forces.gc.ca/assets/OMBUDSMAN_Internet/docs/en/mf-fm-eng.pdf



http://cfpc.ca/uploadedFiles/Military Family Physician Guide_E.pdf

http://www.ombudsman.forces.gc.ca/assets/OMBUDSMAN_Internet/docs/en/mf-fm-eng.pdf

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References Cont.Department of National Defence. (2015). Canadian Armed Forces 101 for civilians.

Retrieved from https://www.cfmws.com/en/AboutUs/MFS/ResourcesMFRCs/Documents/Military%20101%20for%20civilians/CAF%20101%20For%20Civilians,%20Aug%2016.pdf

Edgelow, M. & Cramm, H. (2015). Occupational therapy leadership in military, Veteran and family health. Occupational Therapy Now, 17(5), 23.

Hutton, M. (2010). Occupational therapists as clinical care managers with Veterans Affairs Canada. Occupational Therapy Now, 12(6), 14.

National Defence and the Canadian Armed Forces. (2011). Canadian Forces Physical Rehabilitation Program. Retrieved from http://www.forces.gc.ca/en/news/article.page?doc=the-canadian-forces-physicalrehabilitation-program/hnps1vcf


Questions?

Katelyn Bridge [email protected]

THANK YOU


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Registrants will receive a certificate of attendance by email with the feedback form, which may be completed with their name in order to attest their participation in this webinar and to keep for their records.

*Only those that have registered for this webinar should complete the certificate of attendance.


https://www.cfmws.com/en/AboutUs/MFS/ResourcesMFRCs/Documents/Military 101 for civilians/CAF 101 For Civilians, Aug 16.pdf

http://www.forces.gc.ca/en/news/article.page?doc=the-canadian-forces-physicalrehabilitation-program/hnps1vcf

mailto:[email protected]

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