Occupational Therapy - Essay Example

Introduction Occupational Therapy (OT) is a generalist field with a number of specialty areas. The core concepts of the profession bind OT practitioners together and provide a unique professional identity, regardless of practice setting. Nevertheless, within practice settings and specialty areas there are varying representations of occupational therapy practice and different aspects of the OT process may take priority Insights on Occupational Therapy Occupational therapy aims to improve a person’s productivity and usefulness in spite of any physical dysfunction of psychosocial disorder. On a personal note, occupational therapy is beneficial for people who underwent surgery, stroke or any other medical disorders and would want to be able to do their activities of daily living with minimal supervision and maximum adaptation to their current condition. The Philosophy of Occupational Therapy As with other health professionals, occupational therapists adhere to different schools of thought for the planning of treatment. There are, however, basic philosophical premises underlying occupational therapy, which foster a sense of professional identity and guide practice. In order to understand the occupational therapy process, it is important to have some consensus on the underlying philosophy of occupational therapy, which is the unifying force of the profession. The concept of occupation is central to occupational therapy. Nevertheless, the term itself has been used in the literature in various, sometimes ambiguous ways. It is best to stand with the position of AOTA (Assembly of the American Occupational Therapy Association) that occupations involve mental abilities and skills but do not always include an associated observable or physical behavior. In the OT process, one of the ultimate goals of treatment is the developing, nurturing and restoring of occupations. It is the performance aspects of occupation that have most often been discussed in OT literature, but these are most accurately described as “activities”. Three major, closely related themes are prevalent in occupational therapy literature. The first is the use of purposeful activity that includes activities that have personal and cultural meaning and provide a basis for “exploration and learning, practicing and achieving mastery” (Hopkins & Tiffany, 1988, p. 94) Yerxa, following the humanistic-phenomenologic perspective stated, “Occupational Therapy’s use of ‘meaningful and purposeful’ activity places upon the patient’s view of meaning” (Bing, 1987, p.27) A second theme in occupational therapy is the premise of occupational performance, which is the “accomplishment of tasks related to self-care/self-maintenance, work/education, play/leisure, and rest/relaxation (Christiansen & Baum, 1991, p. 855). The relationship between purposeful activity and occupational performance is both practical and philosophical. On a practical level, occupational therapists use purposeful activities as treatment methods to improve patient’s performance of self-care, work and leisure skills. On a philosophical level, there is a belief that purposeful activities positively influence an individual’s occupational performance. This was expressed by Reilly, who stated that “man, through the use of his hands as they are energized by the mind and will can influence the state of his own health” (Acquaviva, 1992, p. 2), an rephrased by Barris, Kielhofner and Watts: “The fundamental occupational therapy hypothesis is that people can become competent and confident through what they do” (Mocellin, 1988, p.7). Central to both purposeful activity and occupational performance is the concept of “doing”. The third theme in occupational therapy is the interaction with the environment. The conceptualization of the environment as significant in the OT process can be found in the historical writings of the profession and in every major frame of reference used in occupational therapy. Based on systems thinking and the extensive influence of the model of human occupation, the term environment is usually described as everything external to the individual. Although systems theory specifically dictates that all aspects of a system are connected and related, the main preference is to highlight and focus the interrelationships of the occupational therapy process by differentiating relationships from environment. The Occupational Therapy Process The initiation of the OT process has traditionally been considered to be the referral to occupational therapy. In the professions’ early history, occupational therapy was initiated by a medical prescription and referrals by physicians are still considered necessary for third-party reimbursement. However, occupational therapists have achieved some level autonomy from medicine and often actively seek cases rather than depending on the passive process of referrals. This trend, coupled with increasing consumer involvement and patient activism, has opened many avenues for the initiation of the OT process. Moreover, clients who self-initiate the process often have higher level of investment in its success. After referral, it is still necessary for the occupational therapist to determine if the individual is a candidate for occupational therapy. The determination of the needed services will vary depending on the setting, but it is accomplished through a combination of data-gathering techniques. The result of this determination must show the specific need for occupational therapy by identifying real or potential deficits in occupational performance and not merely provide information on diagnosis and symptoms. Goal setting is then undertaken in conjunction with the client and the accomplished part of the treatment planning process. Occupational Therapy is similar to any other profession which makes use of different frames of references or schools of thought as their framework and guide for a patient’s treatment. The OT process helps these professionals to conduct series of chronological treatments and evaluations depending on the desired goal agreed upon by the patient and the OT. Continuing Professional Development The efficacy of occupational therapy (OT) has not been fully explored. Occupational therapy is a relatively young profession and, therefore, needs all members of the field to contribute to its development. The philosophy of occupational therapy is, on the surface, so simple that it tends to be taken for granted. However, the relationship between occupation and health has profound significance, and it is our responsibility to fully explore all facets of occupational therapy. Ways in which the demonstration of efficacy may occur are: articulation, documentation, research, promotion and presentation and publication – these are all interrelated. All avenues of efficacy demonstration begin with the ability to articulate the philosophical principles and professional identity of occupational therapy. In other words, in order to show the effectiveness of OT, occupational therapists must be able to clearly express their beliefs and values both in oral and written communications. In their day-to-day lives, occupational therapists have many opportunities so share these principles. In a patient care setting, the occupational therapist will routinely represent the profession to patients, other health care professionals, administrators, and family members. These representations may be an informal conversation in a hallway or a presentation at a team or family meeting or case conference. However, in order for that sharing to be effective, the occupational therapist must have strong, confident communication skills and the ability to adapt the communication to the needs and level of understanding of others. Descriptions of occupational therapy will vary depending on who is receiving the information and for what purpose. However, all descriptions should show a clear professional identity with identifiable goals. The recipient of the information should be able to identify the uniqueness of occupational therapy and what the occupational therapist has to offer. CPD is necessary to ensure that Occupational Therapists are performing at a par with the constantly developing standards of their chosen profession. Commission of Continuing Competence and Professional Development (CCCPD) including AOTA board provides seminars and training to provide OT’s with updates with the trends in OT as well as specialty certification. Research is considered as one way to enhance an OT’s understanding and skills in treatment. Research is absolutely essential in the field of occupational therapy for several reasons. For one, all health care professionals, including occupational therapists, are currently being pressured by the economic market to “prove” the effectiveness of their techniques and interventions. While the need for outcome or efficacy studies is indisputable, occupational therapy also needs to continue developing its philosophical and theoretical basis, which usually implies a need for more exploratory methodologies. Both kinds of research should be encouraged in the field, and both have relevance to clinicians. Payton concurred: In all professions, and most especially in new and developing professions such as physical and occupational therapy, there is a continuous and urgent need to substantiate and further solidify the principles upon which clinical practice is built. There is an equally pressing need to organize those principles so that they assist the clinician in developing new principles that will improve practice. (Polkinghorne, 1988, p. 2070) There appears to be a general consensus that occupational therapists should engage in clinically oriented research, especially outcome studies, and that the overall level of productivity in research must be increased (Baum, Boyle & Edwards, 1984: Foto 1996: Llorens & Gillete, 1985; Mann, 1985). However, occupational therapists receive advanced degrees, sophistication of the research and the willingness to engage in it are increasing, but it is still necessary to increase productivity in all occupational therapy clinicians. In a study conducted by Colborn, she concluded that “practitioners can be successfully involved in research given favorable conditions in the clinical work environment, as well as through a variety of educational and learning experiences” (Cottrell, 1993, p. 699). It is important to remember that the basis of most clinical research is composed of the interview, treatment interventions, and observation, which are skill already incorporated into clinical practice. However, new technological trend may assist researchers. The most significant change in the production of research and collection of data is the advent of the computer. New technology can be tremendously useful in accessing literature and other resources, and it can be used to create a database for multipurpose analysis. However, the technology also requires that the researcher develop a whole new set of skills, including knowledge of hardware and software, to manage the technology. As Renwick stated: “Computerized databases can facilitate several types of occupation therapy research. The value and usefulness of any database, however, is dependent on how well it has been designed” (Yerxa, 1993, p. 827) Another important tool for clinical research is the analysis of already existing literature. According to Bailey: “Research is any activity undertaken to increase our knowledge: it is the systematic investigation of a problem, issued, or question. This may mean reviewing all of the literature on a given topic and drawing new conclusions about that topic” (1997, p. xxi). An example of this technique is a study conducted by Henry and Coster (1996) in which the authors reviewed outcome studies in the psychiatric literature. Their purpose was to determine predictors of functional outcome among adolescents and young adults with psychiatric disorders. The findings showed that pre-morbid functioning is the most consistent indicator of functional outcome. They therefore concluded that occupational therapists have a definitive role with this population especially in programs designed to ‘strengthen competence, coping skills, and social supports” (Henry and Coster, 1996, p. 177) In May 2004, the CCCPD was charged by the AOTA Representative Assembly (RA) to develop new Board Certifications in Gerontology, Mental Health, Pediatrics, and Physical Rehabilitation; and Specialty Certifications in Driving and Community Mobility; Environmental Modification; Feeding, Eating, and Swallowing; and Low Vision. Panels made up of volunteers with expertise in each of the areas were established to work on the development of the certifications.   A state license grants an occupational therapy practitioner permission to practice in that jurisdiction. State regulations vary. In at least one state, re-licensure involves simply paying a fee and attesting that alimony payments are up-to-date. NBCOT certification is nationwide recognition that an occupational therapy practitioner has met certain professional requirements. For US-educated occupational therapy practitioners, this means graduating from an Accreditation Council for Occupational Therapy Education (ACOTE) accredited education program, completing required Level II fieldwork experience, and passing the NBCOT certification examination. Every third year, practitioners must complete certification renewal requirements in order to maintain use of the OTR® or COTA® credential. Certification requirements for internationally-educated occupational therapists include graduation from a post-baccalaureate occupational therapy program recognized by the World Federation of Occupational Therapy (WFOT) at the time of graduation, or a baccalaureate degree in occupational therapy from a WFOT-approved program, plus additional education reviewed by NBCOT and approved as being equivalent to a US post-baccalaureate degree in occupational therapy. Candidates educated outside the US also must have completed at least 1,000 hours of fieldwork and passed the English language competency examinations. (Graduates of occupational therapy programs in Australia, Canada (except Quebec), Ireland, New Zealand, and the United Kingdom are currently exempt from the English test requirements.) Finally, internationally-educated occupational therapists must pass the NBCOT® certification examination, and every third year, complete certification renewal requirements in order to maintain use of the OTR® credential. Literature review, interviews, surveys, focus groups, expert consultation, and observation were used to develop the final competencies and indicators that make up the requirements for each certification. Some OT’s are asking "why should I become board or specialty certified?" As they know, the practice of occupational therapy is changing on a daily basis. The current practice environment requires more and more that practitioners be able to communicate the immediate effectiveness of their interventions and demonstrate continuous professional growth. Through its Board and Specialty Certification programs,  AOTA provides formal recognition for practitioners who have engaged in a voluntary process of ongoing professional development and who are able to translate that development into improved client outcomes. Board and specialty certification provides you with an advantage in marketing yourself to employers and marketing your services to clients. Moreover this program allows you to show payers that you possess the specialized and advanced knowledge and skills they want provided to their clients. Board certification recognizes advanced achievement by occupational therapists in the broad areas of practice (Gerontology, Physical Rehabilitation, Pediatrics & Mental Health). This certification aims to create a community of occupational therapists who share a commitment to ongoing continuing competence and the development of the profession. Further, board certification can assist occupational therapists in ongoing professional development in the areas of best practice, education, and research in occupational therapy. Specialty certification, available to occupational therapists and occupational therapy assistants was developed to acknowledge the specific skills in specialized areas of practice (Driving & Community Mobility, Feeding, Eating & Swallowing, Low Vision, & Environmental Modification). These specialized credentials assist practitioners in competing in the ever changing healthcare marketplace. The board and specialty certification process were developed based upon the AOTA standards of continuing competence (knowledge, critical reasoning, interpersonal skills, performance skills & ethical reasoning). The certification programs are based upon continuing competence, or the building of capacity to meet identified competencies. Applying for board/specialty certification is a process. It is something that will take time, but it is time well spent on their professional development as well as the ongoing development of their profession. To apply, practitioners develop a reflective portfolio based on competencies and indicators specified in the application handbook. Honestly, many practitioners will be surprised to note that much of their work day to day will meet the competencies and indicators required for the application process. There are currently upcoming seminars on board/specialty certification on at the AOTA Conference in some states. OT’s must register for this seminar but there is no charge. The registration form can be found online or in the AOTA conference program which was mailed to members. At the free seminar sponsored by CCCPD, participants will learn about the board and specialty certification process, be able to ask questions about the process, hear and exchange tips to earning certification, and participants can even bring their professional development materials to see how what theyve completed to date can be used to meet the required documentation for the board/specialty certification application process. REFERENCES: Acquaviva, J. 1992, Effective documentation for occupational therapy, Rockville, MD: American Occupational Therapy Association (AOTA) C. Christiansen & C. Baum (Eds.), Occupational Therapy: Enabling Function and Well Being. p. 36. Thorofare, NJ: SLACK Bing, R.K. 1981, ‘Occupational therapy revisited: A paraphrastic journey’. American Journal of Occupational Therapy, vol. 35 no. 8):pp. 499-518. Breines, E. 1990, ‘Genesis of occupation: A philosophical model for therapy and theory’. Australian Occupational Therapy Journal, vol. 37 no. 1, pp. 45-49. 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