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AUGUST 20, 2012

Setting One Goal at a Time
A Story of Complex Neurological Recovery

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Organizing a Backpack Awareness Event Helping People With Addictions Working With Veterans Proposed 2013 Amendments to AOTA Articles of Incorporation and Bylaws
CE ARTICLE

Home Modifications: An Introduction to Practice Considerations

THANK YOU!
AOTA wants to specially thank our sponsors and exhibitors for the 2012 AOTA Specialty Conference—Advanced Practice in Traumatic injuries & PTSD. We could not have done this without their support.
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Practice Guideline From AOTA Press!
Occupational Therapy Practice Guidelines for Adults With Traumatic Brain Injury
By Kathleen Golisz, OTR, OTD
Using an evidence-based perspective and key concepts from the Occupational Therapy Practice Framework, this guideline provides an overview of the occupational therapy process for adults with traumatic brain injury (TBI), including definition, epidemiology, stages of recovery, referral, evaluation, and interventions throughout the various recover phases. This publication is designed to help occupational therapists and ISBN-13: 978-1-56900-258-2 occupational therapy assistants, as well as individuals who manage, reimburse, or set policy for occupational therapy services, understand the contribution of occupational therapy in treating adults with TBI. This guideline also can serve as a reference for parents, school administrators, educators, and other school staff; health care facility managers; education and health care regulators; third-party payers; and managed care organizations.

Order #2214 • AOTA Members: $59 • Nonmembers: $84
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To Order, call 877-404-AOTA, or visit http://store.aota.org/view/?SKU=2214

Chief Operating Officer: Christopher Bluhm Director of Communications: Laura Collins Director of Marketing: Beth Ledford Editor: Ted McKenna Associate Editor: Andrew Waite CE Articles Editor: Maria Elena E. Louch Art Director: Carol Strauch Production Manager: Sarah Ely Director of Sales & Corporate Relations: Jeffrey A. Casper Sales Manager: Tracy Hammond Advertising Assistant: Clark Collins

AOTA • THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION
VOLUME 17 • ISSUE 15 • AUGUST 20, 2012

FEATURE
Setting One Goal at a Time

Ad inquiries: 800-877-1383, ext. 2715, or e-mail sales@aota.org
OT Practice External Advisory Board

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Donna Costa: Chairperson, Education Special Interest Section Michael J. Gerg: Chairperson, Work & Industry Special Interest Section Dottie Handley-More: Chairperson, Early Intervention & School Special Interest Section Kim Hartmann: Chairperson, Special Interest Sections Council Gavin Jenkins: Chairperson, Technology Special Interest Section Tracy Lynn Jirikowic: Chairperson, Developmental Disabilities Special Interest Section Teresa A. May-Benson: Chairperson, Sensory Integration Special Interest Section Lauro A. Munoz: Chairperson, Physical Disabilities Special Interest Section Linda M. Olson: Chairperson, Mental Health Special Interest Section Regula Robnett: Chairperson, Gerontology Special Interest Section Tracy Van Oss: Chairperson, Home & Community Health Special Interest Section Jane Richardson Yousey: Chairperson, Administration & Management Special Interest Section
AOTA President: Florence Clark Executive Director: Frederick P. Somers Chief Public Affairs Officer: Christina Metzler Chief Financial Officer: Chuck Partridge Chief Professional Affairs Officer: Maureen Peterson
© 2012 by The American Occupational Therapy Association, Inc. OT Practice (ISSN 1084-4902) is published 22 times a year, semimonthly except only once in January and December, by The American Occupational Therapy Association, Inc., 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449; 301-652-2682. Periodical postage is paid at Bethesda, MD, and at additional mailing offices. U.S. Postmaster: Send address changes to OT Practice, AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449. Canadian Publications Mail Agreement No. 41071009. Return Undeliverable Canadian Addresses to PO Box 503, RPO West Beaver Creek, Richmond Hill ON L4B 4R6. Mission statement: The American Occupational Therapy Association advances the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, education, and research on behalf of its members and the public. Annual membership dues are $225 for OTs, $131 for OTAs, and $75 for student members, of which $14 is allocated to the subscription to this publication. Subscriptions in the U.S. are $142.50 for individuals and $216.50 for institutions. Subscriptions in Canada are $205.25 for individuals and $262.50 for institutions. Subscriptions outside the U.S. and Canada are $310 for individuals and $365 for institutions. Allow 4 to 6 weeks for delivery of the first issue. Copyright of OT Practice is held by The American Occupational Therapy Association, Inc. Written permission must be obtained from the Copyright Clearance Center to reproduce or photocopy material appearing in this magazine. Direct all requests and inquiries regarding reprinting or photocopying material from OT Practice to www.copyright.com.
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A Story of Complex Neurological Recovery
Andrew Waite tells the story of how occupational therapy helped one client in Maine re-learn skills and rebuild her life, step by step.
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DEPARTMENTS
News Capital Briefing

Congressional Storm Ahead: Navigating the Upcoming Year-End Budget Disaster

Practice Perks

Housing First Meets Harm Reduction: Adapting Existing Social Services Models to Help People With Addictions

Evidence Perks

Conflict of Interest: Policies for Creating a Culture of Accountability

Perspectives Careers

Working With Veterans

Breast Cancer and Occupational Therapy: Developing an Oncology Occupational Therapy Program

Social Media Spotlight

Updates From Facebook, Twitter, YouTube, and OT Connections

• Discuss OT Practice articles at www.OTConnections.org in the OT Practice Magazine Public Forum. • Send e-mail regarding editorial content to otpractice@aota.org. • Go to www.aota.org/otpractice to read OT Practice online. • Visit our Web site at www.aota.org for contributor guidelines, and additional news and information.
OT Practice serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants to succeed professionally. OT Practice encourages a dialogue among members on professional concerns and views. The opinions and positions expressed by contributors are their own and not necessarily those of OT Practice’s editors or AOTA. Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor does acceptance of advertising imply endorsement, official attitude, or position of OT Practice’s editors, Advisory Board, or The American Occupational Therapy Association, Inc. For inquiries, contact the advertising department at 800-877-1383, ext. 2715. Changes of address need to be reported to AOTA at least 6 weeks in advance. Members and subscribers should notify the Membership department. Copies not delivered because of address changes will not be replaced. Replacements for copies that were damaged in the mail must be requested within 2 months of the date of issue for domestic subscribers and within 4 months of the date of issue for foreign subscribers. Send notice of address change to AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449, e-mail to members@aota.org, or make the change at our Web site at www.aota.org. Back issues are available prepaid from AOTA’s Membership department for $16 each for AOTA members and $24.75 each for nonmembers (U.S. and Canada) while supplies last.

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SPECIAL Proposed 2013 Amendments 16 to AOTA Articles of Incorporation and Bylaws Organize a Backpack Awareness Event CE Article
Home Modifications: An Introduction to Practice Considerations
Earn .1 AOTA CEU (1 contact hour or 1.25 NBCOT professional development units) with this creative approach to independent learning.

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Calendar

Continuing Education Opportunities

20 27 32

Employment Opportunities Research Update
Depression, Health Interventions, and Play

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OT PRACTICE • AUGUST 20, 2012

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News
AOTA News

Association updates...profession and industry news
Hill Day Coming Soon
e part of the contingent of occupational therapy practitioners converging on Washington, DC, as part of AOTA Capitol Hill Day 2012 on September 24. If you’re passionate about your profession, don’t miss your chance to meet with elected officials to discuss key legislative issues affecting occupational therapy practice. By participating, you can help make a difference in the lives of your clients and for the profession. For more, visit www.aota. org/practitioners/advocacy/ hill-day-12. Name: Shana Elyse Novegrod, MA, OTR/L. Sanction: Censure: Effective July 31, 2012. Violation of Principles 2E and 5E, Occupational Therapy Code of Ethics and Ethics Standards (2010) Please contact Deborah Slater, AOTA liaison to the EC, at dslater@aota.org if there are questions concerning this information. tion and Neuropsychology, Department of Rehabilitation, Cedars-Sinai Medical Center in Los Angeles, California. Roberts has been a member of ACOTE since August 2008. The following three new ACOTE members began their terms at the August meeting: Tia Hughes, DrOT, MBA, OTR/L, department chair of the Occupational Therapy Program at the Florida Hospital College of Health Sciences in Orlando; Heather M. Stagliano, MHS, OTR/L, an occupational therapist with the Department of Veterans Affairs at the VA Palo Alto Health Care System in Palo Alto, California; and Donald E. Walkovich, DHSc, MS, OTR/L, associate dean at the School of Health Sciences and chair of and professor at the Department of Occupational Therapy at Saint Francis University in Loretto, Pennsylvania. They replaced the positions held by Dorothy Bethea, EdD, OTR/L; Dahlia Castillo, MS, OTR; and Letha Mosley, who fulfilled their terms after several dedicated years of service. More information on the leadership changes and a complete list of ACOTE members may be found on the ACOTE Web site at www.aota.org/educate/ accredit/overview.

Specialty Conference on Adults With Stroke

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ore than 700,000 people in the United States experience a new or recurrent stroke each year, resulting in cognitive disorders, muscle weakness, vision loss, and other effects on their ability to live independently. The AOTA Adults with Stroke Specialty Conference—November 30 to December 1 in Baltimore, Maryland—is a special opportunity for occupational therapy practitioners to advance their stroke rehabilitation knowledge and skills from top-level speakers and earn up to 13 contact hours. Registration opens September 5 at www.aota.org/ confandevents/stroke.

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New ACOTE Officers and Members
t the Accreditation Council for Occupational Therapy Education (ACOTE®) summer meeting in August, Letha Mosley completed her term as ACOTE Chairperson. Following a 1-year term as ACOTE Chairperson-Elect in 2008, Mosley served as the ACOTE chairperson for the past 3 years. During her tenure as chairperson, Mosley has overseen a standards review process; a petition for recognition to the U.S. Department of Education; development of the e-accreditation system; and unprecedented growth in program applications and reviews. Ellen McLaughlin, EdD, OTR/L, who has served in the chairperson-elect position for the past year, became the new chairperson of ACOTE on August 5. McLaughlin has been a member of ACOTE since August 2007 and served as chairperson of ACOTE’s Educational Standards Review Committee. Current ACOTE member Pam Roberts, PhD, OTR/L, SCFES, CPHQ, FAOTA, was selected to serve as ACOTE’s new vice chairperson. Roberts is manager of Rehabilita-

Public Disciplinary Actions
he Ethics Commission (EC) has taken the following recent disciplinary actions. According to Section 1.3 of the Enforcement Procedures for the Occupational Therapy Code of Ethics, with the exception of those cases involving only reprimand, the American Occupational Therapy Association (AOTA) “will report the conclusions and sanctions in its official publications and will also communicate to any appropriate persons or entities.” Name: Sandra M. IngramWatson, OTR/L. Sanction: Censure: Effective June 11, 2012. Violation of Principles 5E, 5F, 5H, 6A, 6C, and 6D, Occupational Therapy Code of Ethics and Ethics Standards (2010) Name: Robin Lea Branine, OT. Sanction: Censure: Effective June 11, 2012. Violation of Principle 5E, Occupational Therapy Code of Ethics and Ethics Standards (2010)

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AOTA Responds to Research in Autism Spectrum Disorders Article
s part of multiple ongoing activities underway in support of occupational therapy’s important role in addressing autism spectrum disorders, AOTA responded to a negative article about occupational therapy and sensory integration therapy. The article was published in the July–September 2012 issue of Research in Autism Spectrum Disorders and analyzed 25 studies involving sensory integration. AOTA’s response challenges the researchers’ questionable conclusions about sensory integration therapy. For more as well as a link to AOTA’s response, visit www.aota.org/ news/consumer/response-on-si.
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AOTF Scholarship Opportunities Abound

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he American Occupational Therapy Foundation (AOTF) will offer more than 40 Scholarships in the 2012–2013 academic year. AOTF will be accepting online applications from students currently enrolled full time in either a profesAUGUST 20, 2012 • WWW.AOTA.ORG

sional occupational therapy educational program or an occupational therapy assistant program. You must be a member of AOTA to be eligible to receive a scholarship. Additional eligibility requirements can be found at www.aotf.org. Online applications must be submitted by November 15, 2012. Please direct questions to Jeanne Cooper at jcooper@ aotf.org. Scholarships will be awarded based on academic merit and leadership potential.

Recognize a Colleague for an AOTA Award

the SIS Quarterly publication. The chairperson represents the SIS with all bodies of AOTA and is a member of the SIS Council. Each nominee will submit the information outlined in the SIS Chairperson Nomination Form (Attachment E of the SIS SOPs) to the Nominating Chairperson via e-mail. This form is available on the AOTA Web site in the Nominations and Election Areas area of the SIS section. Nominees may also request this form by contacting the SIS administrative assistant, Barbara Mendoza, at bmendoza@aota.org or 800-SAY-AOTA, ext. 2042. Selfnominations are welcome.

A O TA B u l l e T i N B O A r D
OUTSTANDING RESOURCES FROM

Occupational Therapy in Acute Care
H. Smith Gabai his text lays the foundation for occupation-based practice and addresses the contextual issues of working within the acute care setting. The research covers occupational therapy practitioners’ knowledge of how diseases affect the human body, including the cardiovascular, nervous, and endocrine systems. Color illustrations of the human body’s systems and functions, as well as tables delineating the signs and symptoms for various diseases, help clarify important concepts. $109 for members, $154 for nonmembers. Order #1258. http://store.aota.org/ view/?SKU=1258

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Pain, Fear, and Avoidance: Therapeutic Use of Self With Difficult Occupational Therapy Populations
(CEonCD™) R. Taylor Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). iscover strategies for managing three of the most common and difficult client reactions in occupational therapy practice—pain, fear, and avoidance. Learn how to best manage these emotions and behaviors so that treatment goals can be accomplished. $68 for members, $97 for nonmembers. Order #4836. http://store. aota.org/view/?SKU=4836

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he AOTA Recognitions Committee encourages you to recognize colleagues who have made significant contributions to the profession by nominating them for one of the awards offered by the Association each year. Descriptions of the awards, nominations forms, FAQs, and the general point system can be found on the AOTA Web site at www. aota.org/practitioners/profdev/ awards. Questions can be directed to awards@aota.org.

New Resources

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SIS Call for Nominations (Chairperson Positions)

o you work with older adults? If so, you might find a new OT in Productive Aging PowerPoint to be helpful. Look for it in the Resources on the AOTA Web site at www. aota.org/Practitioners/Presenta tion-Resources.aspx. A new AOTA information sheet on grief and loss is being offered as part of the online School Mental Health Toolkit. Find it at www.aota.org/ Practitioners-Section/Childrenand-Youth/New/Grief-and-Loss. aspx?FT=.pdf.

Ways of Living: Intervention Strategies to Enable Participation, 4th Edition
C. H. Christiansen and K.M. Matuska his edition reflects the terminology and content of the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition in light of the new realities of health care, including intervention strategies beyond adaption to activities of daily living (ADL) and instrumental ADL challenges. The 20 chapters include nearly 300 tables, figures, and case examples to illustrate key points. This book will be valuable to students, practitioners, and researchers. $79 for Members, $112 for Non-members. Order #1970B. http://store.aota.org/ view/?SKU=1970B

Let’s Think BIG About Wellness
(CEONCD™) W. Dunn Earn .25 AOTA CEU (3.13 NBCOT PDUs/2.5 contact hours). his product reviews the official documents and materials that support our concept of wellness, reviews examples of interdisciplinary literature on wellness, and explores strengths models from other disciplines as a way to inform our bigger thinking. It examines our own practices, designs an action plan for embedding health and wellness perspectives into our current work, and considers how we can expand our influence to the public. $68 for members, $97 for nonmembers. Order #4879. http://store. aota.org/view/?SKU=4879

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Industry News

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ominations are being accepted until September 15 for the next chairperson of four Special Interest Sections (SISs): Education, Gerontology, Physical Disabilities, and Technology. The term of office is 3 years, beginning July 1, 2013. The chairperson coordinates the projects and activities of the Standing Committee, including the section’s program(s) at AOTA’s Annual Conference & Expo, SIS Internet activities, and the topics for
OT PRACTICE • AUGUST 20, 2012

Help Promote Falls Prevention Awareness Day

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on’t let Falls Prevention Awareness Day slip your mind. It’s coming up on September 22, 2012. National Falls Prevention Awareness Day is observed the first day of fall to promote and increase public awareness about how to prevent and reduce falls among older continued on page 4

Bulletin Board is written by Amanda Fogle, AOTA marketing specialist.

Ready to order? Call 877-404-AOTA or go to http://store.aota.org Enter Promo Code BB

Questions? Call 800-SAY-AOTA (members); 301-652-AOTA (nonmembers and local callers); TDD: 800-377-8555

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c a p i ta l b r i e f i n g

Congressional Storm Ahead

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Navigating the Upcoming Year-End Budget Disaster
Tim Nanof

lection years always pose unique challenges for addressing business before Congress. Extended campaigning and a hypersensitive focus on politics and political ramifications tend to make Congress tentative when it comes to addressing difficult and complicated issues. 2012 is no exception and may be worse than usual. The 112th Congress has developed a record for inactivity and futility that is historic. In addition, that inactivity has led to a laundry list of critical tax, spending, and health care issues that must all be addressed within the last month of the year. The perfect storm of critical issues facing Congress will continue to grow larger and more complex, making solutions at the end of the year extremely difficult to find. As members of Congress are on recess for the month, they are trying to meet with constituents all over their districts in anticipation of the November elections and their hoped-for return to office next year. Recess and the remainder of the electioneering yet to come present occupational therapy with an opportunity to educate these policymakers about the challenges occupational therapy faces as a profession. Although occupational therapy has significant issues hanging in the balance—such as the Medicare therapy caps, Medicare provider payments in general, and a scheduled 8.4% cut to federal funding for general and special education through the sequestration process—the larger issues facing Congress portend even more dire circumstances for the entire country unless Congress can work together to determine a moderate and thoughtful path ahead. In the last month and a

AOTA continues to work for you, but your individual voice is critically important. [Members of Congress] are home this month and off and on through the elections in November. This is your time to talk with them and educate them.
half of 2012, Congress must address a whole range of budget busters, from the expiration of the George W. Bush administration–era tax cuts, which cost $3.3 trillion over 10 years; to the Social Security tax holiday, which reduces middle class tax cuts 2% and will cost $33 billion in 2013; to passage of the National Defense Authorization Act, which will cost $554.2 billion in 2013; and much more. One key issue for occupational therapy is sequestration, a process for engaging in mandatory across-theboard cuts to achieve $1.2 trillion in federal spending reductions. Sequestration was created as a blunt instrument to cut federal spending in the event that members could not come to an agreement on targeted cuts to achieve deficit reduction goals passed in the Budget Control Act of 2011. They did not. As a result, on January 1, 2013, we will be faced with uniform 8.4% cuts (with just a few exceptions) that may cripple the nation’s economic recovery and its programs and services, including education, special education, and the military—all the things that are so critical to the country’s safety and future. For occupational therapy, the challenge to special education is most significant. Federal funding is already inadequate, with most of the burden on local school districts. The 8.4% cut in federal funding could have devastating consequences for jobs and certainly the quality of education. Medicare is exposed to a maximum of 2% cuts and Medicaid is barred by statute from any cuts at all under sequestration. How do we get back on track? We talk to each other. The political differences that separate us are far less significant than the principles that unite us. Political leadership is the art of the possible and stems from thoughtful consideration and compromise. Tell Congress that the time for action on issues important to you is now. Members are home this month and off and on through the elections in November. This is your time to talk with them and educate them about your beliefs and your frustrations. Do it politely, do it civilly, but be clear and be assertive. AOTA’s Legislative Action Center has a Web page (http://capwiz. com/aota/home) with information about how to reach your members of Congress, and we are sharing information about town hall meetings that members traditionally hold during recess to hear from constituents. Use the resources AOTA provides to educate yourself, and then educate your elected officials. AOTA continues to work for you, but your individual voice is critically important. n
Tim Nanof is AOTA’s director of Federal Affairs.

OT PRACTICE • AUGUST 20, 2012

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PrACTiCe PerKs

Housing First Meets Harm Reduction
Adapting Existing Social Services Models to Help People With Addictions

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Andrea McElroy
I am pursuing my master’s degree in occupational therapy and am interested in Level II fieldwork opportunities in the area of mental health, particularly related to people with drug and alcohol addictions. In what ways can the profession support these types of clients and provide related fieldwork opportunities?
As the occupational therapy profession moves toward 2017 and AOTA’s Centennial Vision, it is evident that the mental health area of practice is becoming revitalized and embraced by the new generation of occupational therapy practitioners. Level II fieldwork students in particular have the opportunity to experience a wide range of interesting and challenging settings within mental health, some of which are considered emerging or nontraditional. Community-based facilities that provide services to people who are homeless or at risk for homelessness and have drug and alcohol addictions are being seen more and more as grassroots efforts to aid people in this population. These facilities often combine models used by other social services such as social work or psychiatric services, to support consumers in their goals to maintain sobriety and housing. One such combination is the Housing First/Harm Reduction Model.1 Housing First provides clients who are homeless or at risk for homelessness with supportive housing as a way to reduce overall stress and anxiety and support individuals in eventually maintaining their own housing.1,2,3,4 The Harm Reduction model provides for practical intervention aimed at minimizing negative consequences associated with drug use.1,5,6 Improving quality of life and not necessarily abstinence from drug use is the goal under harm reduction.1,6 Per the tenets of this Housing First/ Harm Reduction model, some facilities now in operation provide supportive housing and utilities, case management, and occupational therapy services to people who are experiencing homelessness and addiction to heroin. Additional support often includes peer mentors, basic furniture, clothing, liaisons for educational opportunities, and employment and legal services. According to this combined model, individuals being accepted to the program are overwhelmed with attempts at navigating homelessness and managing addictions and are not able to participate in activities that lead to secure employOccupational therapy has a specific skill set to bring to the table under this combined model. Occupational therapy practitioners are able to focus on client interest in meaningful occupations, provide experiences that lead to selfworth and self-efficacy, and address all the other barriers faced by individuals in this population through a variety of frames of reference. Occupational therapy complements the Housing First/Harm Reduction model by meeting clients “where they are,” not “where we would like them to be.” To a Level II fieldwork student, assisting a client who is homeless to develop self-worth and self-efficacy

Occupational therapy complements the Housing First/Harm Reduction model by meeting clients “where they are,” not “where we would like them to be.”
ment or keeping and maintaining a home. These individuals are not only homeless but have many additional barriers to recovery such as a lack of employment history, lack of education, lack of basic employment skills such as computer use, past criminal history, co-morbid mental health diagnoses, and poor overall health. In addition, these individuals also have a loss of self-worth and self-efficacy that can affect their desire to pursue a more healthful lifestyle. Housing provided through the Housing First focus of the model allows clients to experience life without the stress of homelessness. The Harm Reduction focus provides for an open agreement with the client in which they do not have to utilize services that do not interest them, and the focus of treatment is not on disciplinary action for noncompliance. may seem overwhelming. However, the skills needed to successfully work with this population, according to the Housing First/Harm Reduction model, are in keeping with the skill set of an entry-level practitioner and Level II Fieldwork student. The knowledge and skills needed for this area of practice are described in the AOTA paper Specialized Knowledge and Skills in Mental Health Promotion, Prevention, and Intervention in Occupational Therapy Practice,7 which includes an appendix that identifies entry-level knowledge and entry-level performance skills for occupational therapists and occupational therapy assistants. The official document also lists a sampling of approaches for group and individual interventions that are commonly used in mental health. Another official AOTA paper, continued on page 8
AUGUST 20, 2012 • WWW.AOTA.ORG

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Setting One Goal at a Time

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n 2005, Janie Lucas stared down from the bleachers at her second grader’s baseball coach. She noticed how patient Mark Fox was with his young players. “Do you think he would be interested?” Janie whispered to her sister, Trudy Newton. Janie was not involved with her son’s father. Trudy and Janie were close. They even worked together at the same home care agency—Trudy as a care provider and Janie in the intake department handling referrals. So when Janie asked Trudy what she thought about the coach, Trudy told her sister to go for it. That proved to be good advice. As a couple, Mark and Janie enjoyed simply spending time with each other. They liked to stay home and work in the garden. They lounged around the pool and read, basking in beautiful Maine summers. In the winter, they revved snowmobiles through the state’s untapped wilderness. “She is a very kind person. Always worried about other people more than herself,” Mark says of Janie. But soon, Janie would need other people to care for her, and occupational therapy would become the service to help her regain life’s meaning.

A Story of Complex Neurological Recovery
ANDREW WAITE

Janie, Mark, and sons.

How occupational therapy helped a client and her loved ones rebuild their lives, one step at a time.
Janie underwent chemotherapy successfully. But while she beat cancer, the treatment beat her up in other ways. In April 2011, Janie caught a cold. “With a weakened immune system, the cold caused her to have double pneumonia, and it set in really fast,” Mark says. “I let her sleep for a while, then I couldn’t wake her up.” Mark called Trudy, who was in Florida at the time, and she told Mark he needed to call 9-1-1. Doctors in Maine weren’t certain what happened to Janie. “They said she had developed an infection that had gone septic, and her heart stopped because of that and she went into septic shock,” Trudy says. “They basically were telling us that she wasn’t going to live.” During this time, Trudy got to know Mark on a deeper level. “I don’t think I knew his character as well before,” Trudy says. “We ended up staying at the hospital and just sort of having those quiet times when you don’t know what else to do but sort of sit there and stare. I remember having conversations in the hospital about more philosophical type things, like how did this happen and why.” Trudy saw Mark’s optimistic spirit and began to more completely understand the man her sister had fallen in love with.
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PHOTOGRAPH COURTESY OF TRUDY NEWTON

CAN’T WAkE UP
On July 31, 2008, Janie called Trudy. And it wasn’t to chat. Janie had been diagnosed with breast cancer at the age of 45. “She was very frightened. She had a young son, a steady relationship [with Mark] and two other kids in her life [Mark’s from a previous marriage]. It was scary for everyone,” Trudy recalls.
OT PRACTICE • AUGUST 20, 2012

Miraculously, Janie’s health improved quickly. She was back home and back to almost normal in less than a month. Sensing there was no longer a need to put life on hold, Mark proposed to Janie, and she said yes in May 2011. “We seemed to be more in love with each other after that time in the hospital,” Mark recalls.

AOTA Platinum Partner Genesis Rehab
Services (GRS), which provides educational and professional-clinical opportunities for AOTA members while serving to advance occupational therapy practice in line with AOTA’s Centennial Vision, is a national provider of occupational therapy, physical therapy, speech therapy, respiratory therapy, and wellness services, primarily for older adults. GRS provides comprehensive therapy services in partnership with skilled nursing centers, assisted living facilities, independent living facilities, hospitals, home health companies, adult day care programs, and outpatient clinics in more than 1,100 sites in 36 states and Washington, DC.

SLIPPING AWAy
But before she and Mark could begin planning their wedding, Janie began to slip away. “The first thing that we noticed was her laugh, which sounded really bizarre—her personality had started to change,” Trudy says. “She used to have a great laugh, but this was almost hysterical.” Mark and Trudy thought maybe Janie was overextending herself. They decided the change was something to monitor but not something over which to fret. But then Janie’s walking altered, too. It became more of a shuffle, almost a stumble, Trudy says. And Janie would forget things. Mark and Trudy talked again. Finally, they admitted to each other that something wasn’t right. Mark, once again, took Janie to the hospital. “They did an MRI and didn’t really see anything,” Trudy says. But Trudy and Mark knew better. They were watching their loved one lose little parts of her personality, piece by piece, until she steadily sank into a coma less than a month after getting engaged. “That was the scariest moment for sure,” Mark says. “Because you just saw somebody that you love slipping away. And somebody was showing up that you didn’t recognize––someone that wasn’t her.” After about a week, the doctors in Maine referred Janie to Massachusetts General Hospital in Boston. Janie had another MRI, and this time, the doctors had an answer—sort of. Janie’s myelin sheath, which essentially allows the nervous system to function properly, had frayed. Her brain matter was intact, but the white matter of her nerves was not able to transmit signals. “Doctors said it was very rare to see because it was such a delay in the
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onset—usually it wasn’t delayed like that. I said, well, that’s my sister, one in a million. And they said, more like one in 2 million,” Trudy recalls. “They didn’t have any treatment for it. So, we finally had a name for it, but we didn’t know what it meant. The doctors said sometimes, on rare occasions, people will get a little bit better. But often they get worse and sometimes they die.”

SHARED CONNECTIONS
While Janie was in a coma, Mark and Trudy spent more time in the hospital, staring at vending machines and flipping through magazines. Trudy was worried about her sister, but Mark hung onto hope. “He has a very positive outlook on things, so he had the belief that she was going to get better. I tend to be a little more cynical. Or maybe just a little more realistic,” she says. Janie came out of the coma after a few days, but she was minimally responsive. Mark went into the hospital room to spend some alone time with his fiancé. She still needed a feeding tube and could hardly keep her eyes open. But it was there that Mark realized the strength of the connection he and Janie shared. “She could look at me; she could see me. Just with her eyes she would try to follow me around the room,” Mark remembers. “I was the only one who could get her attention, and she would try to keep her eyes open for me.” Mark believed then that he wasn’t going to lose Janie. Despite the doctors’ grim prognosis, Janie improved. Very slightly, but

still. And it was enough for them to move her to a nursing home in Maine and eventually to RiverRidge Center, a Genesis HealthCare inpatient clinic in Kennebunk, Maine, about an hour and a half from Janie and Mark’s home. Janie had been diagnosed with anoxic brain damage, encephalitis, contracture of multiple joints, and dysphagia. “Medically complex patients require an occupational therapist to assess cognitive abilities, physical performance, and psychosocial drives in order to provide them the opportunity to reach minute incremental goals during the recovery process,” says Tracey Samela, OTR/L, Rehabilitation Program director at Genesis HealthCare’s Skyview Center in Wallingford, Connecticut. “Due to the significance of Janie’s impairments at the onset of her illness, her occupational therapist needed to establish goals that required a passive treatment approach.”

REHAB AT RIvERRIDGE
When Janie arrived at RiverRidge in July 2011, she had almost no function. During Janie’s initial evaluation, Melinda Morgrage, MS, OTR/L, set goals of tolerating activities of daily living (ADLs) for 10 minutes and improving passive range of motion in her upper and lower extremities. In addition, Morgrage wanted Janie to visually scan her environment with moderate assistance. “Another goal, and this seems so primitive, was to maintain eyes open during a treatment session for 5 minutes,” Morgrage says. Christine Rosa, MS, OTR/L, Inpatient Program manager at RiverRidge,
AUGUST 20, 2012 • WWW.AOTA.ORG

says setting such small goals is imperative in the recovery process. “We knew that she could use visual scanning for an actual purpose. She could use it to identify what she needed. Like if you held up two different colored shirts, she would be able to pick what shirt she wanted,” Rosa says. “Patients tend to respond so well to occupational therapy because it’s in a real-world environment. We do our best

isn’t going to be functional for them at a different point in their recovery.” The therapists at RiverRidge began looking at activities like upper-body bathing and hygiene and grooming tasks with a goal of moving from moderate to minimal assistance. And Janie’s transfers were upgraded from mechanical lift to stand lift, Morgrage says. Janie’s loved ones saw her come back, too.

meaning she likes to do tasks she sees that are meaningful. And the family has been able to communicate with the therapists to say ‘these activities she might not connect with, but doing things that she sees are getting her closer to things she might have to do for herself at home are really important to her.’”

“[Janie] is very practically based,

to imitate home life. If the issue is she wants to be able to pick out her own clothes, then we are helping her reorganize her closet, we’re not bringing her to the gym. We are actually working in her closet. Relatively quickly, the therapy team at Genesis’s RiverRidge moved Janie into a wheelchair. “Once we were able to get her up into a wheelchair, we started progressing the length of time and started doing more of the edge-of-mat sitting activities,” Morgrage recalls. But more importantly, occupational therapy helped Janie re-learn practical skills that once seemed rote. “OTs have a unique ability to know that something as simple as brushing your teeth is a 12-step task by the time you reach up, turn on the faucet, bend your elbow, twist the cap, squeeze the tube, and so on. So with our ability to look at nothing but function, function, function helps to keep it more real for the patient and brings the pieces together,” Rosa says. “The whole purpose is that [occupational therapy] is unique, and it’s individualized. So what’s functional for one person isn’t going to be functional for another. Not only that, what’s functional for one person at a certain point in their recovery
OT PRACTICE • AUGUST 20, 2012

“I think I was the most hopeful when we started to get her personality back. I would say it took months to get her personality to come through,” Trudy says. “Her laugh came back, her smile came back. She’s a very gentle person, and that came back. Her calm personality came right through. She started to get her vocalization, her memory. And that’s the soul of a person.”

NExT STEPS
Around that time, Janie told her therapists that she would soon be leaving RiverRidge to marry Mark. “We had a meeting toward the beginning of October, and she was convinced that on October 31 she was going to be getting married. She said, ‘I am walking down the aisle no matter what.’ She still had a ways to go, but she was confident,” recalls Heidi Fullerton, MSPT, Janie’s physical therapist at RiverRidge. But Janie remained at RiverRidge, undergoing a therapy regimen 6 days a week. “She started to be able to move the wheelchair herself. She was working so hard to push that chair, but she could

do it herself. She could get herself to the dining room, she could get herself up at 7 am every day to watch her morning shows,” Rosa says. “She wasn’t just wandering the hall. She was saying, ‘I want to watch TV,’ and she was going to the TV room. She was not only able to have that thought, but she recognized, ‘this is how I am going to do it’ and then she did it.” Meanwhile, Mark and Trudy would visit the clinic as often as possible. “I do whatever I have to for her,” Mark says. “I always tell her that if she can get through what she has to, then I won’t have trouble getting through what I have to.” Mark and Janie found ways to make their relationship work, even though their nuptials remained on hold. Two nights a week after work, Mark would commute the 1.5 hours to the clinic to be with her. And on Christmas and Thanksgiving, Mark took Janie to her brother’s house in Kennebunk. “Many patients with catastrophic medical complexities set milestone goals such as a visit home for the holidays, a trip to a child’s ball game, or even to plan a wedding,” Samela says. “These out trips require extensive planning and training by the patient, therapist, and their families, including such tasks as car transfers, stair performance, wheelchair mobility and accessibility, assistive device use, ADL performance in the home or public environment, and medication management in order to be successful. These milestone goals created by the patient and facilitated by the family and occupational therapist create the motivation the patient needs to progress their functional abilities to a level needed for a successful transition to home.” Around the time Janie resolved to be married to Mark, she also began believing in her ability to regain her life. As with Mark, Janie’s positivity triumphed. Trudy thinks occupational therapy was especially beneficial for her sister. “She is very practically based, meaning she likes to do tasks she sees that are meaningful,” Trudy says. “And the family has been able to communicate with the therapists to say ‘these activities she
11

FOr MOre iNFOrMATiON
Living Life To Its Fullest™: Stories of Occupational Therapy Edited by A. Hofmann & M. Strzelecki, 2010. Bethesda, MD: AOTA Press. ($19 for members, $27 for nonmembers. To order, call toll free 877404-AOTA or shop online at http://store.aota.org/ view/?SKU=1254. Order #1254. Promo code MI) Living With Illness or Disability: 10 Lessons of Acceptance, Understanding, and Perseverance By S. Gutman, 2005. Bethesda, MD: AOTA Press. ($14.95 for members/nonmembers. To order, call toll free 877-404-AOTA or shop online at http:// store.aota.org/view/?SKU=1235. Order #1235. Promo code MI) Occupational Therapy in Acute Care By H. Smith Gabai, 2011. Bethesda, MD: AOTA Press. ($109 for members, $154 for nonmembers. To order, call toll free 877-404-AOTA or shop online at http://store.aota.org/view/?SKU=1258. Order #1258. Promo code MI) AOTA CEonCD™ Pain, Fear, and Avoidance: Therapeutic Use of Self With Difficult Occupational Therapy Populations By R. Taylor, 2011. Bethesda, MD: American Occupational Therapy Association. (Earn .2 AOTA CEU [2.5 NBCOT PDUs, 2 contact hours]. $68 for members, $97 for nonmembers. To order, call toll free 877404-AOTA or shop online at http://store.aota.org/ view/?SKU=4836. Order #4836. Promo code MI)

might not connect with, but doing things that she sees are getting her closer to things she might have to do for herself at home are really important to her.’ “Instead of doing some sort of matching activity, putting [the activity] into a kitchen setting and making it practical works better for Janie,” Trudy continues. Samela says the skill of an occupational therapist is to continually evaluate the patient’s functional abilities and progress while staying mindful of what the client wants to be able to do. “We provide therapeutic interventions that are patient specific and relate to their lives prior to the onset of illness. In this case, Janie preferred kitchen tasks as a means to improve her cognition, balance, coordination, and problem solving, where another patient with similar deficits might prefer computer use.”

‘I’D COME A LONG WAy’
As Janie spent more time in the clinic, therapists continued advancing her goals. At one point, everyone was going to be satisfied with having Janie be independent in her wheelchair so she could get around and resume
12

ment. But she is at a point where she can function on her own. At the time Janie and her therapists were interviewed for this article, they were preparing for Janie’s discharge. She would still have to follow a discharge plan, but she would be able to Ways of Living: Intervention Strategies to Enable do it at home, where she could live with Participation, 4th Edition Mark, her now 14-year-old son, and Edited by C. Christiansen & K. Matuska, 2011. Mark’s sons. Bethesda, MD: AOTA Press. ($79 for members, $112 for nonmembers. To order, call toll free 877The first thing Janie planned to do 404-AOTA or shop online at http://store.aota.org/ after arriving home was “Kiss the boys, view/?SKU=1970B. Order #1970B. Promo code MI) tell them how much I love them, and tell Mark how much I love him. I know CONNECTIONS it’s been hard on him, but he’s been Discuss this and other articles on here for me the whole time,” she says. the OT Practice Magazine public forum Mark admits that the entire situation at http://www.OTConnections.org. with Janie has been trying. But even when discussing how hard it’s been, his hopefulness persists. “There are times that I’m upset that we probably won’t ever have the “It really just confirms life we used to have, but then I look at it and I say, ‘At least our ability to teach the body we still have her. Things may to adapt and learn new strategies, never be what they used to and it proves that hard work be, but we’ll just be happy with what we have and not pays off.” worry about what we don’t have.” Morgrage says Janie’s story is a testament to the value of therapy, particularly occupational therapy services. “It’s not always butterflies and roses, doing things like attend her son’s but with Janie’s story it sort of is. We baseball games. But in May 2012, after can be proud that we have done every10 months in rehabilitation, it was time thing we can to make her as indepenfor the next step. Janie’s therapists dent as possible,” she says. “It really told her she was ready to ditch the just confirms our ability to teach the wheelchair. body to adapt and learn new strategies, “They told me that I was going to and it proves that hard work pays off.” have it for the weekend, and then after Trudy says she and Mark were the weekend was over I was going to recently discussing what to do for be without it. Then I got nervous,” Janie’s discharge. Janie says. “I didn’t want to be without “We talked about this huge welcome it because I really got good at moving home party and making it a crazy day,” around with it.” she says. “But the closer it gets and Janie vividly remembers the moment the more I think about it, I think that she finally stood on her own. can be off in the future someday, too,” “I had to get to the edge of the Trudy explains. chair and position my feet correctly, That big party can be Mark and and I had to say, ‘Push, push, push.’ It Janie’s wedding, which Janie says is worked. I could get up that way. So I coming “sooner, not later.” n did it. I felt independent again. I’d come a long way,” she says. Janie, her therapists, and loved ones Andrew Waite is the associate editor of OT Practice. say Janie is about 80% back mentally He can be reached at awaite@aota.org. and about 60% back physically. She still has trouble with her memory, and her muscle tone still needs major improveThe Texture of Life: Purposeful Activities in the Context of Occupation, 3rd Edition Edited by J. Hinojosa & M. Blount, 2009. Bethesda, MD: AOTA Press. ($59 for members, $84 for nonmembers. To order, call toll free 877-404AOTA or shop online at http://store.aota.org/ view/?SKU=1209B. Order #1209B. Promo code MI)
AUGUST 20, 2012 • WWW.AOTA.ORG

PersPeCTives

Working With Veterans
William Croninger

i
PHOTOGRAPHS © LEFT: COURTESY U.S. AIRFORCE / U.S. ARMY. CENTER: PHIL SCHERMEISTER/CORBIS. RIGHT: COURTESY OF U.S. ARMY.

felt an almost overwhelming wave of anger as I stood in front of the Vietnam Veterans Memorial one morning in 1996. My colleague and I were in Washington, DC, presenters for a workshop on integrating technology into small colleges. She had coaxed me into accompanying her on her daily runs and suggested we visit the memorial one morning. It would be my first visit, one I had put off for 14 years, since the Memorial’s dedication in 1982. We searched for and found the name of one of my friends. Of the three of us who went to war, he was the one who did not return. Now I stood there feeling abandoned and absolutely alone as my colleague no longer stood beside me. “How could she do this?” I wondered. Then, in the mirror-like surface of the wall, I saw her. She had taken a step back, giving me personal space but remaining close by if I needed her support. For occupational therapy practitioners working with veterans, I would suggest following my friend’s lead: Stay close by but be respectful of each veteran’s need to deal with emotions in his or her own way. War, experienced at any level, changes the warrior forever. I would argue, however, that time spent as a warrior should be regarded as only one of many occupations a servicewoman or man will experience in his or her

life. To effectively work with veterans, we as practitioners must not lose our historical focus on treating the whole person. Each veteran will bring his or her own personal story, coping mechanisms, and needs. Occupational therapy practitioners are well trained in dealing with both the physical and psychosocial aspects of a wide variety of clients. However, dealing with veterans presents some unique challenges: 1. There may be a “latency” period in which we cannot or do not want to talk to anyone. Many veterans want to “focus forward,” to reintegrate with families, occupations, education, etc. We do not want to “waste” time talking about events that we are more comfortable forgetting. When I left active duty services after 4 years, I was acutely aware that many of my cohort group had already completed college and begun their professional lives. Talking about wartime experiences was absolutely the last of my priorities. I would not likely have spoken to anyone even if the opportunity presented itself. It would be 12 years after my tour in Viet Nam before I began to question how that experience might have changed me. 2. We may not want to talk to you. It’s not that we do not appreciate your concerns, but veterans will often feel that because you are a nonvet, an outsider,

you cannot understand what we experienced or what we feel. That is not so very uncommon—think of experiences you would feel most comfortable speaking about with those whom you know will understand you. Add to this memories that evoke guilt or extreme sadness. Thus, veterans often prefer to talk to other veterans. 3. Returning to civilian life often feels “hollow” and with little meaning. Warriors are engaged in possibly the most intense activity in which humans can participate. Wartime service demands absolute dedication to the mission and one’s fellows. My father was a WWII veteran and for years we used to travel to New Hampshire to spend time with one of his wartime friends and his family. These two men would often retire to a local restaurant to talk about their experiences and lives. Years later, I found myself in the same restaurant, talking with that man’s son about our respective time in Vietnam. At one point he looked at me and said, “Bill, I am going to say the stupidest thing you have ever heard. But those times were the only time in my life when I felt like I was doing something important for the world.” His comment mirrored another point: many warriors return to civilian or even peacetime military life struggling to find a focus. War, for many
13

OT PRACTICE • AUGUST 20, 2012

Careers

Breast Cancer and Occupational Therapy

Y
PHOTOGRAH © MICHAEL COURTNEY / ISTOCK

Developing an Oncology Occupational Therapy Program
Lauren Robins

ou have breast cancer. An estimated 226,487 women and 2,190 men in the United States will hear these words in 2012.1 These words strike feelings of disbelief, fear, anger, and even despair. Many people report feeling overwhelmed with the myriad treatment options, or lost when they complete their treatment. Many are left with challenges following surgery, such as decreased range of motion, tightness, or pain and discomfort with movement. Still others battle potentially devastating lymphedema, which is a swelling in a body part resulting from damage done to the lymphatic system through surgery, radiation, or other cancer-related treatments. Cancer also involves a number of psychosocial issues that may impact women and men before, during, and after treatment. Cancer or treatments related to cancer may lead to changes in an individual’s physical, cognitive, or emotional identity, leading to decreased participation in desired daily occupations.2 Penfold noted that the role of an occupational therapist in oncology and/or cancer care is “to facilitate and enable an individual patient to achieve maximum functional performance, both physically and psychologically, in everyday living skills regardless of his or her life expectancy” (p. 75).3 Human occupation is varied and complex. Thus, each individual diagnosed with breast cancer can experience a number of challenges in his or her various occupations and/or roles. In addition, these may fluctuate throughout the course of the disease. A person’s abilities and desires to participate may change dramatically from initial diagnosis, through chemotherapy and/or radiation treatment, to end-of-life care.3 Occupational therapy is an effective, nonpharmacological option to enable an individual with breast cancer to partici-

pate in the activities he or she deems meaningful.

INITIAL INTEREST
My affinity for oncology began with my first Level II fieldwork experience. I was 6 weeks into a 12-week mental health rotation in urban Kansas City, Missouri, when one of my clients was diagnosed with cancer. She was devastated. Our sessions focused on using positive coping strategies and stress management in order for her to participate in her desired daily occupations. It was then that I began to research oncology, treatment side effects, survivorship, and other issues, and I discovered the vital role for occupational therapy. Oncology has now grown into both my career specialty focus and passion. When searching for employment opportunities following graduation, I was having difficulty finding oncology-specific occupational therapy positions, so I created my own. In January 2011, I began working at Methodist Hospital and Methodist Estabrook Cancer Center in Omaha, Nebraska. I was employed as an occupational therapist with the intent of developing an outpatient oncology occupational therapy and lymphedema program as well as inpatient oncology

therapy services. Although Methodist has had a longstanding reputation in the Omaha and rural Nebraska communities for excellence in cancer care, therapy services onsite at the Estabrook Cancer Center and an occupational therapist dedicated to oncology rehabilitation had not existed prior to my being hired. I quickly learned I needed to acquire new skills and knowledge in order to best serve this unique population. I was a generalist practitioner on the acute side, but I strived for a specialist role in oncology. In April 2011, I attended a certified lymphedema therapy course to gain additional knowledge specific to lymphedema. To compensate for a lack of therapy-focused courses specifically geared toward oncology, I began reading medical journals from a broad range of specialties to familiarize myself with cancer and its effects on an individual’s performance, and I began attending tumor board meetings at least once each month to learn about the latest developments in breast cancer–related surgery, staging, pathology, and treatment options. To educate our in-house staff about the benefits of occupational therapy, continued on page 17
15

OT PRACTICE • AUGUST 20, 2012

sOCiAl MeDiA sPOTlighT

Recreation Therapy Scope of Practice
http://otconnections.aota.org/forums/t/14933.aspx

AOTA Poll Results:

Survey Says: Staying Connected With Work
Do you use today’s technology to stay connected with your job, even when it’s not work hours? Yes. I like knowing what’s going on ..................................... 28% Yes, but it encroaches on my downtime.............................. 28% Sometimes. For something important ................................. 24% No. I go completely offline.................................................. .20% For more, visit http://otconnections.aota.org/blogs/pulsecheck/ archive/2012/07/17/poll-results-work-email.aspx

Kristy Posted: Sun, Jul 15 2012 7:28 PM
I am 3 weeks into my first Level II placement in mental health at a medical center. At a recent team meeting, the recreation therapist mentioned that he was doing the same purposeful activities that my supervisor was planning to do with the same group! She asked me to look up the recreation therapy scope of practice so she can, in fact, prove that OTs are more competent in this specific area.

OTshira replied Wed, Jul 18 2012 5:36 PM
I have to say I struggled with a similar question on my mental health fieldwork. It kind of depends on how the hospital/setting divides the responsibilities, in the same way that both PT and OT could do car transfers in a physical dysfunction setting. In my setting, the rec therapists did more leisure skills groups, etc., and the OTs did more “advanced” skills groups such as anger management, coping skills, discharge readiness, and home management. Another comment: One of my classmates in OT school had been a rec therapist for 3 years prior to getting her OT degree. In her opinion, the major difference was that OTs do ADLs while rec therapists don’t. It is one of the challenges of OT mental health practice to differentiate what we do and prove that we are worth the extra money in helping clients improve occupational performance!

Find us on Facebook www.aota.org/facebook
American Occupational Therapy Association shared a link. July 17

Occupational Therapists (#13) in Forbes Top 20 BestPaying Jobs For Women In 2012! http://ow.ly/ciH6p
446 people like this. Sheila Ann Olis: Oh heck yeah!! That’s what’s up ppl!!!
July 17 at 1:29pm

Joe Patrick: Also a great profession for men :) July 17 at 1:44pm Christina Ross Hint hint Stepahie Stephanie Zangroniz, Hannah Jewel Conner July 17 at 7:11pm Kris Kagawa: I wish. I work as an OTR for pennies and love. But it’s all good because I love being an OT! July 17 at 10:11pm

Jaclyn Tarloff Schwartz replied Thu, Jul 19 2012 3:30 AM
Sometime groups might look the same but different professions will approach it with different reasons and techniques. Take a cooking group for example. A rec therapist may engage clients in a cooking activity for the benefits of diversion and leisure and therefore grade the activity to an easier level. An OT can do the same cooking group with a different focus. Maybe it is following complex directions such as a recipe. Maybe the focus is on memory and attention by working on remembering the needed ingredients and scanning the shelves to find them. Perhaps the focus is on learning new cooking techniques to help clients develop healthy nutritional habits. For more of this discussion and to view other posts, go to www.OTConnections.org. New user? Click on “User’s Guide” in the upper right hand corner of the Web page.

www.aota.org/twitter
Amy Jo Lamb@ajlamb1216 : Students, join me in Columbus OH for the National Student Conclave Nov 9–10, 2012. A conf tailored for you...our next gen leader @frankaota 7 Jul 12 Cindi Petito@CindiPetito: See our latest blog post regarding AOTA’s Policy Statement on Complex Rehab Technology and H.R. 4378.... http:// fb.me/1qZJsR5UO 21 June 12
BACKGROUND ILLUSTRATION © WILLIAM CRAIG / ISTOCKPHOTO.COM

Erik Johnson@armyOTguy I uploaded a @YouTube video http://youtu.be/kIN7tvcKWYs?a Garrett

Carnes.....kinda a big deal 27 July 12

you’ll also find AOTA on
and
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www.aota.org/youtube

PutMeBackTogether @pmbtogether An OT guide for assessing children ages 3 and up #pediOT #OTpeeps #OccupationalTherapy http://ht.ly/cvpkH
26 July 12

http://pinterest.com/aotainc

AUGUST 20, 2012 • WWW.AOTA.ORG

lS

o ch

a c kp a c k A ol B wa r
en

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Organize a
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Backpack Awareness Day

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or this year’s AOTA National School Backpack Awareness Day, to be held on September 19, AOTA is encouraging members to start planning their own event now. Occupational therapy practitioners and students can help educate the public about how to avoid pain and injury by holding a weigh-in targeting backpacks, purses, briefcases, purses, or other heavy bags.
n

PLAN yOUR WEIGH-IN
The first step is to secure a venue. Talk with the principal and/or administrator in charge of scheduling (in a school) or the manager of other facilities to request permission to hold the event. Be sure to share the date, times, desired room or area, anticipated number of attendees, number of adults volunteering at the event, and so forth. Well before the event, consider what you will need: n At least one scale n Handouts n Stickers or other artwork n Enough occupational therapy practitioners or adults to assist (be sure to provide them with training) n Charts showing the maximum suggested backpack or bag weight for different body weights (no more than 10%) for those who prefer not to be weighed. n Signed permission slips for minors n A display table for materials
PHOTOGRAPHS: LEFT, COURTESY OF SUNY DOWNSTATE. RIGHT, © PICTROUGH / BIGSTOCKPHOTO

TARGET yOUR EvENT
The following are examples of what to focus on during a weigh-in: Backpacks n Weigh-in events have been very successful in demonstrating to students, teachers, and parents just how heavy some of those backpacks can get. And events can be fun—the children and young adults enjoy it, which makes learning easier.
OT PRACTICE • AUGUST 20, 2012

Oc

cu

Pack It Light, Wear It Right

an

pat

i o n a l Th e r a

py

A

o ss

Schools and universities are the natural choices for venues, but you can also target locations wherever individuals with backpacks can be found.

n

avoid the aches and pains associated with heavy suitcases. Airports and commuter stations are natural choices for venues, or wherever individuals who buy, sell, and use suitcases can be found.

Purses Over the years, purses have grown larger to accommodate the daily load that women carry every day. Although these large purses seem convenient, they’re also potentially causing future neck, shoulder, and back problems. n Shopping malls are the natural choice for venues, or wherever individuals who buy and sell purses can be found.
n

PROMOTE yOUR EvENT
A weigh-in has all the elements of a great news story. Don’t miss out on a chance to introduce your local media to occupational therapy and how it can help individuals of all ages live life to its fullest. Don’t limit yourself to coverage by traditional media, however. Promote your event on Facebook, Twitter, the venue’s Web site, blogs, and so forth. But be sure to err on the side of caution, however: Don’t share photos of attendees unless you have their permission to do so, particularly those who are less than 18 years of age. n

Briefcases Many men and women haul documents, laptops, and notebook computers back and forth to work each day. If improperly packed and carried, these briefcases can cause serious neck, shoulder, and back problems. n Corporate parks and commuter stations are natural choices of venue, or wherever individuals who buy, sell, and use briefcases can be found.
n

To learn more about AOTA’S National School Backpack Awareness Day, and to download tip sheets,
artwork, event strategies, media tips, and more, visit www.aota.org/backpack. For more suggestions on organizing events, and to share outcomes of events for possible future promotion by AOTA, contact AOTA Media Relations Manager Katie Riley at 301-652-6611, ext. 2963, or kriley@aota.org.
19

n

Suitcases Suitcases can be a burden to the already stressful task of traveling. If properly packed and carried, consumers can travel stress free and

CALENDAR
To advertise your upcoming event, contact the OT Practice advertising department at 800-877-1383, 301-652-6611, or otpracads@aota.org. Listings are $99 per insertion and may be up to 15 lines long. Multiple listings may be eligible for discount. Please call for details. Listings in the Calendar section do not signify AOTA endorsement of content, unless otherwise specified. Look for the AOTA Approved Provider Program (APP) logos on continuing education promotional materials. The APP logo indicates the organization has met the requirements of the full AOTA APP and can award AOTA CEUs to OT relevant courses. The APP-C logo indicates that an individual course has met the APP requirements and has been awarded AOTA CEUs. September
visABILITIES Rehab Services: www.visabilities.com or (888) 752-4364, Fax: (205) 823-6657. exploration of critical elements of neuroanatomy and nerve physiology, evaluation of peripheral nerve involvement, treatment of nerve injuries, surgical intervention for peripheral nerve injuries and the therapist’s role in post operative care, management of the painful UE, corrective orthosis fabrication, and future trends in enhancing nerve function. Contact University of Wisconsin-Milwaukee, 414-227-3123; visit our Web site at www.chs-ce.uwm.edu.

ACROSS PRACTICE AREAS

CEonCD™

St. Louis, MO

Envision Conference 2012. Learn from leaders in

Sept. 12–15

NEW! OT Manager Topics, by Denise Chisholm, Penelope Moyers Cleveland, Steven Eyler, Jim Hinojosa, Kristie Kapusta, Shawn Phipps, and Pat Precin. Supplementary content from chapters

the field of low vision rehabilitation and research while earning valuable continuing education credits. Attend the multi-disciplinary low vision rehabilitation and research conference dedicated to improving the quality of low vision care through excellence in professional collaboration, advocacy, research, and education. Envision Conference, September 12–15, 2012, Hilton St. Louis at the Ballpark. Learn more at www.envisionconference.org.

November

Chattanooga, TN

Nov. 3–13

On-Line Course

and PT practitioners with the Individual with Disabilities Act (IDEA), Wis Administration Rules for special education and related services, school-based assessment and intervention including paperwork requirements and evidence-based best practice standards for school therapists. The educational model of service delivery will be distinguished from the medical model. Contact University of Wisconsin-Milwaukee, 414-227-3123; visit our Web site at www.chs-ce.uwm.edu.

Orientation for OTs and PTs New to School-Based Practice. This course is designed to familiarize OT

Sept. 17–28

in Complete Decongestive Therapy (135 hours), Lymphedema Management Seminars (31 hours). Coursework includes anatomy, physiology, and pathology of the lymphatic system, basic and advanced techniques of MLD, and bandaging for primary/secondary UE and LE lymphedema (incl. pediatric care) and other conditions. Insurance and billing issues, certification for compression-garment fitting included. Certification course meets LANA requirements. Also in Dallas, TX, November 3–13. AOTA Approved Provider. For more information and additional class dates/ locations or to order a free brochure, please call 800863-5935 or log on to www.acols.com.

Lymphedema Management. Certification courses

in The Occupational Therapy Manager, 5th Edition with additional applications relevant to selected issues on management. Earn .7 CEU (8.75 NBCOT PDUs/7 contact hours). Order #4880, AOTA Members: $194, Nonmembers: $277. http://store.aota. org/view/?SKU=4880

CEonCD™

basic ethics information that gives context and assistance with application to daily practice and rationale for changes in the Occupational Therapy Code of Ethics and Ethics Standards 2010. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4846, AOTA Members: $105, Nonmembers: $150. http://store.aota.org/view/?SKU=4846

NEW! Everyday Ethics: Core Knowledge for Occupational Therapy Practitioners and Educators, 2nd Edition, by AOTA Ethics Commission and presented by Deborah Yarett Slater. Foundation in

Carmel, IN

Driver Rehabilitation for Drivers Using Bioptics by Occupational Therapy Process and Intervention.

Nov. 8–11

CEonCD™

Syracuse, NY

Eval & Intervention for Visual Processing Impairment in Adult Acquired Brain Injury Part I. This

Sept. 29–30

intensive updated course has the latest evidence based research. Participants learn to identify visual processing deficits, interpret evaluations, develop interventions and document. Topics include: visual inattention and neglect, eye movement disorders, hemianopsia and reduced acuity. Faculty: Mary Warren PhD, OTR/L, SCLV, FAOTA. Also New Orleans, LA, March 9 to 10, 2013. Contact: www.visabilities. com or (888) 752-4364, Fax (205) 823-6657.

A focused workshop sponsored by Adaptive Mobility Services, Inc. for the OT practitioner who is interested in evaluation and in-vehicle interventions with persons who are visually impaired and/or use bioptic lens. Our instructors are master clinicians with this specialty group, knowledgeable in state licensing requirements, and skilled in focused interventions in this sub-specialty practice area. Teaching strategies include classroom instruction, working in the car with the instructors, and observing real clients in the car. Instructors: Mary Ellen Keith, COTA, CDRS; and Carmen Palanca, OTR, CDRS. To register, call 407-4268020 or click on educational workshops for therapists at www.adaptivemobility.com.

NEW! Ethics Topic—Duty to Warn: An Ethical Responsibility for All Practitioners, by Deborah Yarett Slater, Staff Liaison to the Ethics Commission. Professional, ethical, and legal responsi-

bilities in the identification of safety issues in ADLs and IADLs as they evaluate and provide intervention to clients. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4882, AOTA Members: $45, Nonmembers: $65. http://store.aota.org/ view/?SKU=4882

CEonCD™

Ethics Topics—Organizational Ethics: Occupational Therapy Practice In a Complex Health Environment, by Lea Cheyney Brandt. Issues that can

October

Ongoing

Webcast

other soft tissue conditions of the upper extremity. Differential diagnoses of various conditions are explored. Evidence to support surgical, non surgical, and therapeutic approaches to treatment of these conditions including new and future trends are presented. Contact the University of Wisconsin-Milwaukee, 414-227-3123; visit our Web site at www. chs-ce.uwm.edu.

Encore Presentation of WI Hand Experience 2012: Treatment of Soft Tissue Conditions of the Upper Extremity. Course focuses on tendinopathy and

Oct. 1–31

Clinician’s View Offers Unlimited CEUs

influence ethical decision making and strategies for addressing pressure from administration on services in conflict with code of ethics. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4841, AOTA Members: $45, Nonmembers: $65. http://store .aota.org/view/?SKU=4841

Two great options: $177 for 7 months or $199 for 1-Full Year of unlimited access to over 640 contact hours and over 90 courses. Take as many

CEonCD™

courses as you want. Approved for AOTA and BOC CEUs and NBCOT for PDUs. www.clinicians-view. com 575-526-0012.

Ethics Topics—Moral Distress: Surviving Clinical Chaos, by Lea Cheyney Brandt. Complex nature

Internet & 2-Day On-Site Training

Become an Accessibility and Home Modifications Consultant. Instructor: Shoshana Shamberg,

of today’s health care environment and results in increased moral distress for occupational therapy practitioners. Earn .1 AOTA CEU (1.25 NBCOT PDUs/1 contact hour). Order #4840, AOTA Members: $45, Nonmembers: $65. http://store.aota.org/ view/?SKU=4840

San Diego, CA

tion of Part I course, this intense practicum provides hands-on experience in administering, interpreting, and using evaluation results to develop intervention for visual processing deficits including eye movement disorders, hemianopsia, reduced visual acuity, and visual neglect. Offered only once a year. Faculty: Mary Warren PhD, OTR/L, SCLV, FAOTA. Also Boston, MA, November 8–10, 2013. Contact

Eval & Intervention for Visual Processing Deficits in Adult Acquired Brain Injury Part II. Continua-

Oct. 12–14

OTR/L, MS, FAOTA. Over 22 years specializing in design/build services, technologies, injury prevention, and ADA/504 consulting for homes/jobsites. Start a private practice or add to existing services. Extensive manual. AOTA APP+NBCOT CE Registry. Contact: Abilities OT Services, Inc. 410-358-7269 or info@aotss.com. Group, COMBO, personal mentoring, and 2 for 1 discounts. Calendar/info at www.AOTSS.com. Seminar sponsorships available nationally.

CEonCD™

Let’s Think Big About Wellness, by Winnie Dunn.

Official documents and materials that support OT concept of wellness, interdisciplinary literature, and models from other disciplines. Earn .25 CEU (3.13 NBCOT PDUs/2.5 contact hours). Order #4879, AOTA Members: $68, Nonmembers: $97. http://store .aota.org/view/?SKU=4879

CEonCD™

DVD Course

Exploring Injuries and the Recovery of Peripheral Nerves in the Upper Extremity. A comprehensive

Open enrollment

Exploring the Domain and Process of Occupational Therapy Using the Occupational Therapy Practice Framework, 2nd Edition, by Susanne Smith Roley and Janet V. DeLany. Ways in which
AUGUST 20, 2012 • WWW.AOTA.ORG

20

CALENDAR
Framework supports practitioners by providing a holistic view of the profession. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 contact hours). Order #4829, AOTA Members: $73, Nonmembers: $103.00. http:// store.aota.org/view/?SKU=4829 NBCOT PDUs/10 contact hours), AOTA Members: $129.50, Nonmembers: $184.10.

CEonCD™

tact hours). Order #4878, AOTA Members: $105, Nonmembers: $150. http://store.aota.org/view/?SKU =4878

Online Course

Occupational Therapy in Action: Using the Lens of the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition, by Susanne Smith Roley and Janet DeLany. Oc-

NEW! Using the Occupational Therapy Practice Guidelines for Adults with Alzheimer’s Disease and Related Disorders (ADRD) To Enhance Your Practice, by Patricia Schaber. Evidence-based

ADED Approved CEonCD™

cupational therapy and the occupational therapy process as described in the 2008 second edition of Framework. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #OL32, AOTA Members: $180, Nonmembers: $255. http://store.aota.org/ view/?SKU=OL32

perspective in defining the process and nature, frequency, and duration of interventions and case studies of adults at different stages of Alzheimer’s disease. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4883, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/ ?SKU=4883

ADED Approved CEonCD™

velopment for youth with diagnoses that challenge cognitive and social skills, such as autism spectrum and attention deficit disorder. Earn .7 AOTA CEU (8.75 NBCOT PDUs/7 contact hours). Order #4833, AOTA Members: $175, Nonmembers: $250. http:// store.aota.org/view/?SKU=4833

Creating Successful Transitions to Community Mobility Independence for Adolescents: Addressing the Needs of Students With Cognitive, Social and Behavioral Limitations, by Miriam Monahan and Kimberly Patten. Community mobility skill de-

ASSESSMENT & EvAlUATION

Self-Paced Clinical Course

Occupational Therapy and Home Modification: Promoting Safety and Supporting Participation, edited by Margaret Christenson and Carla Chase. Education on home modification for OT

professionals and an overview of evaluation and intervention and detailed descriptions of assessment tools. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3029, AOTA Members: $259, Nonmembers: $359. http://store.aota.org/ view/?SKU=3029

quired professional reasoning and ethics for making final recommendations about the capacity for older adults with dementia to drive or not. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4842, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4842

Determining Capacity to Drive for Drivers with Dementia Using Research, Ethics, and Professional Reasoning: The Responsibility of All Occupational Therapists, by Linda A. Hunt. Re-

ADED Approved CEonCD™

ChIlDREN & YOUTh

ment and training with highlights of skills deficits, methods and tools that address driving skills, assessment techniques, and intervention techniques. Earn 1 AOTA CEU (12.5 NBCOT PDUs/10 contact hours). Order #4837, AOTA Members: $249, Nonmembers: $355. http://store.aota.org/view/?SKU=4837

Driving Assessment and Training Techniques: Addressing the Needs of Students With Cognitive and Social Limitations Behind the Wheel, by Miriam Monahan. Critical issues related to driving assess-

Self-Paced Clinical Course

CEonCD™

CEonCD™

The Short Child Occupational Profile (SCOPE), by Patricia Bowyer, Hany Ngo, and Jessica Kramer.

Introduction of SCOPE assessment tool and description of documenting child motivation for occupations, habits and roles, skills, and environmental supports and barriers. Earn .6 AOTA CEU (7.5 NBCOT PDUs/6 contact hours). Order #4847, AOTA Members: $210, Nonmembers: $299. http://store. aota.org/view/?SKU=4847

public awareness strategies on expertise in transitioning early childhood development into occupational engagement in natural environments. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3026, AOTA Members: $259, Nonmembers: $359. http://store.aota.org/view/?SKU=3026

Early Childhood: Occupational Therapy Services for Children Birth to Five, edited by Barbara E. Chandler. Federal legislation in OT practice and

sensory processing based on Dunn’s Model of Sensory Processing and comparison with other sensory based approaches with evidence reviews for best practice assessment and intervention methods. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4834, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4834

Sensory Processing Concepts and Applications in Practice, by Winnie Dunn. Core concepts of

Self-Paced Clinical Course

CEonCD™

CEonCD™

Strategic Evidence-Based Interviewing in Occupational Therapy, presented by Renée R. Taylor.

Collaborating for Student Success: A Guide for School-Based Occupational Therapy, edited by Barbara Hanft and Jayne Shepherd. OT collab-

Structured, semi-structured, and general clinical interviewing and set of norms and communication strategies that can maximize accurate, relevant, and detailed information. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4844, AOTA Members: $68, Nonmembers: $97. http://store.aota. org/view/?SKU=4844

orative practice with education teams using professional knowledge and interpersonal skills to blend hands-on services for students and system supports for families and educators. Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Order #3023, AOTA Members: $259, Nonmembers: $359. http:// store.aota.org/view/?SKU=3023

of occupational therapists at each tier, case studies, and highlighted opportunities for OT within RtI frameworks in public education. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4876, AOTA Members: $68, Nonmembers: $97. http:// store.aota.org/view/?SKU=4876

Response to Intervention (RtI) for At Risk Learners: Advocating for Occupational Therapy’s Role in General Education, by Gloria Frolek Clark and Jean Polichino. Core components of RtI, the role

CEonCD™

CEonCD™

CEonCD™

Model of Human Occupation Screening Tool (MOHOST): Theory, Content, and Purpose, by Gary Kielhofner, Lisa Castle, Supriya Sen, and Sarah Skinner. Information from observation, interview,

Autism Topics Part I: Relationship Building, Evaluation Strategies, and Sensory Integration and Praxis, edited by Renee Watling. Content from Au-

Staying Updated in School-Based Practice, by Yvonne Swinth and Mary Muhlenhaupt. Informa-

chart review, and proxy reports to complete the MOHOST occupation-focused assessment tool. Earn .4 AOTA CEU (5 NBCOT PDUs/4 contact hours). Order # 4838, AOTA Members: $125, Nonmembers: $180. http://store.aota.org/view/?SKU=4838

tism, 3rd Edition to expand OT practice with children through building the intentional relationship, using evaluation strategies, addressing sensory integration challenges, and planning intervention for praxis. Earn .6 CEU (7.5 NBCOT PDUs/6 contact hours). Order #4848, AOTA Members: $210, Nonmembers: $299. http://store.aota.org/view/?SKU=4848

tion and strategies on issues, trends and knowledge related to services for children and youth in public schools with topics on IDEA 2004, NCLB, and Section 504 of the Rehabilitation Act. Earn .15 AOTA CEU (1.88 NBCOT PDUs/1.5 contact hours). Order #4835, AOTA Members: $51, Nonmembers: $73. http://store.aota.org/view/?SKU=4835

CEonCD™

BRAIN & COGNITION

CEonCD™

Self-Paced Clinical Course

3 Diagnosis-Specific SPCCs. Core SPCC: Core Concepts in Neurorehabilitation: Earn .7 AOTA CEU (8.75 NBCOT PDUs/ 7 contact hours). Order #3019, AOTA Members: $91, Nonmembers: $128.80. http://store.aota.org/view/?SKU=3019. Diagnosis-Specific SPCCs: Neurorehabilitation for Dementia-Related Diseases (Order #3022 http:// store.aota.org/view/?SKU=3022), Neurorehabilitation for Stroke (Order #3021 http://store.aota.org/ view/?SKU=3021), and Neurorehabilitation for Traumatic Brain Injury (Order #3020 http://store.aota. org/view/?SKU=3020). Each: 1 AOTA CEU (12.5

Neurorehabilitation Self-Paced Clinical Course Series, by Gordon Muir Giles, Kathleen Golisz, Margaret Newsham Beckley, and Mary A. Corcoran. Includes 4 components—the Core SPCC, and

NEW! Autism Topics Part II: Occupational Therapy Service Provision in an Educational Context, edited by Renee Watling. Second in 3-part CE

The New IDEA Regulations: What Do They Mean to Your School-Based and EI Practice?, by Leslie L. Jackson and Tim Nanof. Purpose and impact of

series with content from Autism, 3rd Edition addressing OT practice within public school systems and early intervention through elementary years and transition process. Earn .6 CEU (7.5 NBCOT PDUs/6 contact hours). Order #4881, AOTA Members: $210, Nonmembers: $299. http://store.aota. org/view/?SKU=4881

2004 reauthorization of IDEA and Part B regulations on school-based and early intervention practice. Earn .2 AOTA CEU (2.5 NBCOT PDUs/2 contact hours). Order #4825, AOTA Members: $68, Nonmembers: $97. http://store.aota.org/view/?SKU=4825

CEonCD™

CEonCD™

issues of autism in adulthood and knowledge and tools to advocate health and community participation of young adults and adults on the autism spectrum. Earn .3 AOTA CEU (3.75 NBCOT PDUs/3 con-

Young Adults on the Autism Spectrum: Life After IDEA, by Lisa Crabtree and Janet DeLany. Critical

addressing transition needs as part of a student’s IEP and the key role of the occupational therapy practitioner as a potential collaborative member of the transition team. Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour). Order #4828, AOTA Members: $34, Nonmembers: $48.50. http://store.aota.org/ view/?SKU=4828
AUGUST 20, 2012 • WWW.AOTA.ORG

Occupational Therapy and Transition Services, by Kristin S. Conaboy, Susan M. Nochajski, Sandra Schefkind, and Judith Schoonover. Importance of

22

Stand from the ordinary.
Ready to find the career you’ve been waiting for? Highlight your extraordinary at

apart

www.OTJobLink.org
PR-207

EMPLOYMENT OPPORTUNITIES
Faculty Northeast South

Fall 2013 • CHP-N-2601 The Department of Occupational Therapy and Occupational Science at Towson University, established in 1975, is currently recruiting a tenuretrack faculty member with experience in teaching research and with graduate programs. Current programs include a combined BS/MS degree, professional and post-professional master’s degree programs, and a doctoral degree program in occupational science. Position Responsibilities: • Teaching and advising • Conducting scholarship in a research line consistent with the mission of the department, college, and university • Developing and obtaining external grant funding to support research line • Contributing to service mission of the department, college, and university Qualifications: Applicant must be licensed or eligible for licensure as an occupational therapist in the state of Maryland, have a minimum of 3 years of occupational therapy practice experience, have an earned doctoral degree with a research component (i.e., PhD, ScD, EdD), and a commitment to excellence in teaching, scholarship, and service. Prior academic teaching experience is required. Ongoing involvement in professional activities and evidence of scholarship outcomes with external funding are preferred. Candidates for the rank of associate professor must have 6 years at the rank of assistant professor and a well-established line of research. Application Process: Applications will be reviewed beginning on October 29, 2012, and should include a letter of application; curriculum vitae; transcript(s) from degree granting institutions; evidence of initial certification as an OTR; and names, addresses, and telephone numbers of four references to: Sonia Lawson, PhD, OTR/L, Search Committee Chair, Department of Occupational Therapy & Occupational Science, Towson University, 8000 York Road, Towson, MD 21252-0001 slawson@towson.edu Upon submitting your curriculum vitae to indicate that you are an applicant for this position, please be sure to visit http://www.towson. edu/odeo/applicantdata.asp to complete a voluntary online applicant date form. The information you provide will inform the university’s affirmative action plan and is for statistical purposes only and shall not be used to illegally discriminate for or against anyone. F-6114

Assistant/Associate Professor Occupational Therapy and Occupational Science College of Health Professions, Towson University

You can have it all.
Life balance. Competitive salary. Bar-setting benefits.

Amedisys Home Health is now hiring Occupational Therapists in the Chautauqua County area: • Occupational Therapists (Full-time) $5,000 Sign-on Bonus!!! Relocation package offered • Occupational Therapists (Part-time, Per Diem)

Have you checked out RehabCare lately?
Program Director Occupational Therapist
At RehabCare, we revere both our patients and our work force, with a combination of Fun, Integrity, Respect, Support and Teamwork. We are currently seeking a Program Director Occupational Therapist for our busy sub acute rehab facilities in Roberta, GA. Must possess or be eligible for a GA OT license. For more information, please contact: Devin Roos at 502-596-6822 Email: Devin.Roos@kindredhealthcare.com.

Apply online at amedisys.com/careers. For additional information, please contact Mary Ann Pereira at (877) 263-9613 or maryann.pereira@amedisys.com.

Amedisys is an equal opportunity employer committed to diversity in the workplace. N-6115

S-6105

EOE

Faculty

Open Faculty Positions
The Department of Occupational Therapy at Colorado State University is seeking exceptional applicants for two (2) tenure-track, 9-month appointment, positions at any academic rank, assistant through full professor. The successful candidate will be responsible for: • onducting and disseminating research related to human performance and participation in c everyday occupations and contexts; • teaching and mentoring graduate students pursuing masters and PhD degree options; • providing service at departmental, university, community and professional levels; and • eveloping and maintaining collegial relationships in the department, university and with d external professional and scientific communities. Candidates must have rank-appropriate records of scholarship, teaching, and service. Full position qualifications and application procedures are posted at www.cahs.colostate.edu/otsearch. Electronic applications must be submitted to this same URL address by September 17 at 5 pm. Confidential inquires may be directed to Robert Gotshall, PhD, Search Chair, at robert.gotshall@ colostate.edu or 970-491-6374.
Colorado State University is an EO/EA/AA employer. CSU conducts background checks on all final candidates.
F-6081

OT PRACTICE • AUGUST 20, 2012

27

NEW EDITION OF BESTSELLER!
Cognition, Occupation, and Participation Across the Life Span: Neuroscience, Neurorehabilitation, and Models of Intervention in Occupational Therapy, 3rd Edition
Edited by Noomi Katz, PhD, OTR
Foreword by Beatriz Colon Abreu, PhD, OTR/L, FAOTA The translation of cognitive neuroscience into occupational therapy practice is a required competence that helps practitioners understand human performance and provides best practice in the profession. This comprehensive new edition represents a significant advancement in the knowledge translation of cognition and its theoretical and practical application to occupational therapy practice with children and adults. Chapters, written by leaders in an international field, focus on cognition that is essential to everyday life. GENERAL TOPICS • Cognitive Intervention and Cognitive Functional Evaluation • Higher-Level Cognitive Functions Enabling Participation • Impact of Mild Cognitive Impairments on Participation • Transition to Community Integration for Persons With Acquired Brain Injury • Family Caregivers’ Participation in Recovery • Cognitive Information Processing • Cognitive Aging • Virtual Reality for Cognitive Rehabilitation MODELS FOR INTERVENTION • Dynamic Interactional Model of Cognition in Cognitive Rehabilitation • Dynamic Interactional Model in Schizophrenia • Metacognitive Model for Children With Atypical Brain Development • Cognitive Rehabilitation of Children and Adults With Attention Deficit Hyperactivity Disorder • Retraining Model for Clients With Neurological Disabilities • Cognitive Orientation to Daily Occupational Performance (CO-OP) • Dynamic Cognitive Intervention: Application in Occupational Therapy • A Neurofunctional Approach to Rehabilitation After Brain Injury • The Cognitive Disabilities Model in 2011 • The Cognitive Disabilities Reconsidered Model: Rehabilitation of Adults With Dementia

A must-read book for occupational therapy professionals and students to consider cognitive intervention strategies as critical to promote occupation-based, client-centered care and everyday participation in a fuller life!

Each model includes (1) a theoretical base; (2) intervention, including evaluation procedures, assessments, and treatment methods; (3) individual and group treatment case studies that illustrate the intervention process; and (4) research supporting the evidence base of the model or parts of it. Chapters feature learning objectives and review questions.
ISBN: 978-1-56900-322-0

Order #1173B. AOTA Members: $89, Nonmembers: $126

BK-244

Shop online at http://store.aota.org/view/?SKU=1173B, or call 877-404-AOTA!

EMPLOYMENT OPPORTUNITIES
Faculty Faculty

C

ASSISTANT PROFESSOR OCCUPATIONAL THERAPy

Occupational Therapy Graduate Program

hatham University, a thriving dynamic institution with three colleges and one school—Chatham College for Women and the co-educational College for Graduate Studies, College for Continuing and Professional Studies, and School of Sustainability and the Environment—invites applications for the position of assistant professor to teach in our Master of Occupational Therapy Program. This is a 9-month, renewable term position. We are seeking candidates with clinical experience in mental health and evidence-based practice who value a collaborative, collegial environment in which to further the program’s excellent reputation for entry-level education. The successful candidate will hold an earned doctorate, a minimum of 5 years of clinical experience, and eligibility for occupational therapy licensure in Pennsylvania. Responsibilities include teaching, student advisement, scholarship, and service to the university and community. Chatham University offers a competitive salary; an excellent benefits package, including tuition remission for qualified personnel; and a generous retirement plan. Applicants should send a cover letter with salary requirements, resume, and the names of three professional references to: CHATHAM UNIVERSITY ATTN: H.R. Dept. Pos. #1463 Woodland Road Pittsburgh, PA 15232 E-mail: chathr@chatham.edu Visit: www.chatham.edu
Chatham University is an Equal Opportunity Employer
F-6096

New Full-time Faculty Position
Applications are invited for a 12-month, full-time assistant/associate professor position to join our innovative entry-level Occupational Therapy Graduate Program at the University of New Mexico, a research-intensive university in a culturally rich and unique location. Occupation is the foundation of the curriculum, which includes a strong problem-based learning component. Although the occupational therapy program is housed in the Department of Pediatrics within the School of Medicine, we seek faculty with clinical and research expertise in diverse areas such as pediatrics, gerontology, physical disabilities, and curriculum development incorporating distance/blended learning. Opportunities are available to develop and teach in the post-professional OTD Program. Responsibilities will include collaborating with faculty in teaching and administering the master’s program, developing courses, engaging in scholarly activity, writing grants, mentoring graduate student research, and serving on program and university committees. Rank and tenure status will be commensurate with educational background and experience. Minimum Qualifications: Applicant must have a doctoral degree or verified completion of doctoral degree by start date, at least 2 years of teaching and 3 years of practice experience, and eligibility for an occupational therapist license in New Mexico. Preferred Qualifications: Record of scholarly activity, experience in advising research projects and theses, and experience in grant writing and obtaining research funding. The position will remain open until filled. For complete details of this position or to apply, please visit this Web site: https://unmjobs.unm.edu/. Please reference Posting Number: #0811161. For assistance with UNMJobs or technical questions please contact Cynthia Layton, Search Coordinator, at clayton@salud.unm.edu. For Program information you may contact: Dr. Betsy VanLeit, Program Director Occupational Therapy Graduate Program MSC09 5240 1 University of New Mexico Albuquerque, NM 87131-0001 (505) 272-9435 bvanleit@salud.unm.edu
UNM offers a competitive salary with excellent benefits and continuing education opportunities. UNM is an Equal Opportunity / Affirmative Action Employer and Educator. This position may be subject to criminal screening in accordance with New Mexico Law. F-6092

UNIVERSITY OF NEW MEXICO (UNM)

Faculty

Northeast

New England Institute of Technology
seeks full-time faculty for the occupational therapy programs. Doctoral degree; Rhode Island license; NBCOT registration; and 1 year teaching experience required. Experience in pediatric and adult disabilities preferred. Position requires teaching in the MSOT weekend program and in the AS OTA program. Send cover letter and resume to: Donna Daigle, office manager, at ddaigle@neit.edu.
Equal Opportunity Employer
OT PRACTICE • AUGUST 20, 2012
F-6116

Outpatient Adult Neuro Specialty Clinic Community Rehab Care (CRC) is looking for FT and PT occupational therapists/COTAs for our Quincy, MA, outpatient rehabilitation clinic. The position is Monday–Friday––no nights, weekends, or holidays. We are a great small team still providing “old fashioned rehab values” like communication amongst the team and with families and potential to be creative in the clinic and in the community! Send resumes to quincrc@brain-injury-rehab.com

Occupational Therapists

Avante Skilled Nursing and Rehab facilities South in FL, NC, & VA are seeking Occupational Therapists to add to our in-house therapy Avante Skilled departments forNursing and rehab Centers the following locations: in FL & VA are seeking Occupational • Inverness, FL • Ocala, FL Therapists for our in-house therapy • Reidsville, NC • Harrisonburg, VA departments at the following locations: • Lynchburg, VA • Waynesboro, VA • Inverness, FL • Leesburg, FL Responsible for evaluations,Lynchburg, VA • Harrisonburg, VA • direct patient treatment, and discharge planning. Will communicate • Waynesboro, VA with families, physicians, and other health care Responsible for evaluations, direct patient treatteam and discharge planning. Will communiment, members; and maintain documentation of services in the medical records. cate with families, physicians, and other health care team members; and maintain documentaJob Requirements: Must be licensed in the tion of services in the medical records. appropriate state as an Occupational Therapist Job Requirements: Must be licensed in the with a Bachelor’s as an occupational therapist. appropriate statedegree. New Grads welcome to apply! Avante offers to apply! Avante offers an New grads welcome an excellent starting salary excellent starting salary package. and a premium benefits and a premium benefits
package. Sign-on bonus or relocation assistance is available! Please contact: Gretchen Nolte Please apply at Inc. website: Avante Group our 954-790-9589 www.avantecenters.com Fax: 800-611-7457 For information: gnolte@avantegroup.com gnolte@avantegroup.com

Manager of Talent Acquisition

S-6117

N-6113

www.avantegroup.com

29

AOTA Self-pAced clinicAl cOurSe
Occupational Therapy and Home Modification: Promoting Safety and Supporting Participation
Edited by Margaret Christenson, MPH, OTR/L , FAOTA, and Carla Chase, EdD, OTR/L, CAPS

Earn 2 AOTA CEUs (25 NBCOT PDUs/20 contact hours). Participation in meaningful activities in the home and community contributes to health, wellness, and good quality of life. Occupational therapy fills a unique role in environmental modification and facilitating the creation of a safe, accessible home through evaluation, intervention, and outcomes measurement. This Self-Paced Clinical Course consists of in-depth text, an exam packet, and a CD-ROM with hundreds of photographic and video resources, all of which provide education on home modification for both occupational therapy professionals new to the practice area and to practitioners experienced in environmental modification. Professionals who work with either adults or children will find an overview of evaluation and intervention, detailed descriptions of assessments, and guidelines for client-centered practice and occupation-based outcomes. Course Highlights • Section 1: Evaluating the Client and Environment • Section 2: Developing and Implementing the Plan • Section 3: Moving the Profession Forward

Specialty
The American Occupational Therapy Association

Certification

Order #3029 AOTA members: $259 | Nonmembers: $359

To order, call 877-404-AOTA, or shop online at http://store.aota.org/view/?SKU=3029

AOTA Specialty Certification in Environmental Modification (SCEM or SCAEM) is a major achievement for occupational therapy professionals in the field of environmental modification. This SPCC supports those efforts by offering a broad range of topics that may assist occupational therapists and occupational therapy assistants to become SCEM certified. To learn more, go to www.aota.org/certification.
CE-192

NEW PRACTICE GUIDElINES FROM AOTA PRESS

eMPlOYMeNT
West

Occupational Therapy Practice Guidelines for Productive Aging Community-Dwelling Older Adults
By Natalie Leland, PhD, OTR/L, BCG; Sharon J. Elliott, DHS, GCG, OTR/L, BCG, FAOTA; and Kimberly Johnson, MS, MSW

Phoenix, Tucson, & Burbs 602-478-5850/480-221-2573 Schools, 16 wks off, 100% Paid: Health, Dental, Lic, Dues, CEU-$1,000,401K, Hawaii/Spanish I trips… Jobs@StudentTherapy.com

ARIZONA OTs—$65,000

*STARS* StudentTherapy.com W-6037
Midwest

HEALTHCARE FACILITY, INC.

CERTIFIED OCCUPATIONAL THERAPY ASSISTANT
Part-Time: Monday–Friday Excellent Working Environment FAX Resume to Human Resources (630) 778-9826 1347 Crystal Ave., Naperville, IL 60563 M-6112

By 2030, nearly 20% of the U.S. population will be ages 65 or older, and the fastest growing segment among them will be people ages 85 or older. Individuals in this oldest age group have the highest rates of health care utilization, morbidity, and disability. To support productive aging and continued participation despite occupational shifts in habits, roles, and routines, preventive care models that include self-management programs and strategies to support participation are needed that will support older adults in the management of their chronic conditions and prevention of illness and injury. This Practice Guideline will help occupational therapists and occupational therapy assistants, as well as the individuals who manage, reimburse, or set policy regarding occupational therapy services, understand the contribution of occupational therapy in treating community-living older adults to facilitate productive aging.
ISBN: 978-1-56900-332-9

Midwest

T

he Comprehensive Group, A HealthPRO Rehabilitation Company, is Illinois’ leading provider of rehabilitation services. We offer a ‘Career for Life’ with opportunities that fit your lifestyle as well as your career goals. The Comprehensive Group provides Occupational Therapy services in a wide variety of placement settings including: –Skilled Nursing Facilities –Hospitals –Senior Living Communities –Schools –Private outpatient clinics Visit us online at www.comprehensiveonline.com or contact Robin Luman, VP of Staffing, at robinl@ comprehensiveonline.com or call 847-904-5057

M-6118

AD REGION COLOR KEY
Faculty opportunities in education Northeast Connecticut, Washington, D.C., Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Ohio, Pennsylvania, Rhode Island, Vermont South Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, Oklahoma, S. Carolina, Tennessee, Texas, Virginia, West Virginia Midwest Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, Wisconsin West Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming National Multiple locations within the U.S. International All countries outside the United States

Order #2220 AOTA Members: $69, Nonmembers: $98

To order, call 877-404-AOTA, or visit http://store.aota.org/view/?SKU=2220
BK-278

OT PRACTICE • AUGUST 20, 2012

31

RESEARCH updAtE

Depression, Health Interventions, and Play
Susan H. Lin

Depression Is Related to Social Functioning After Stroke

s

Occupation- and ActivityBased Health Interventions for Older Adults
he May/June 2012 issue of the American Journal of Occupational Therapy includes a systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling adults by Arbesman and Mosley.2 The authors reported moderate to strong evidence for client-centered occupational therapy improving physical functioning and occupational performance related to health management in communitydwelling older adults. The evidence for health education programs to reduce pain and increase physical activity, and for individualized health action plans to improve activities of daily living function and participation in physical activities was moderate. Similarly, there was moderate evidence for (1) self-management programs that result in decreased pain and disability, and (2) incorporating cognitive-behavioral principles into physical activity to improve long-term participation in exercise. Despite the limited evidence for skill-specific training in isolation, skill-specific training’s effectiveness increases when it is combined with health management programs. In summary, occupational therapy practitioners working with older adults play an important role in educating, facilitating, and supporting their health routines and health management.

chmid and colleagues1 investigated the relationships between demographic, clinical, and psychological characteristics and social role functioning (SRF) at 4 months after stroke, and the association between depression improvement and 4-month SRF. Performing a secondary data analysis of the Activate-Initiate-Monitor Study, researchers used the data from a randomized clinical intervention trial that included 371 adult survivors of ischemic stroke, with and without depression (depressed only n=176). Depression was measured with the Patient Health Questionnaire (PHQ-9), and depression improvement was defined by a 50% decrease in PHQ-9 scores. SRF was measured with the social domain of the Stroke-Specific Quality of Life Scale. After performing a multiple linear regression, researchers found that out of the potential variables (depression, stroke severity, functional status, social support, and personal factors), depression and comorbidities were independently associated with SRF at 4 months after stroke. Moreover, depression improvement emerged as the only variable to independently predict SRF in the depressed-only group. This finding underscores the importance of rehabilitation providers screening and treating poststroke depression because a satisfactory return to SRF is associated with improved quality of life.

T

Play Behaviors of Children With Sensory Processing Disorders
n a study comparing the playground play behaviors of children with sensory processing disorders (SPD) and typically developing peers, Cosbey and colleagues3 observed two groups of children (12 per group) during unstructured recess activity over multiple sessions. Although the play patterns of the two groups did not show statistically significant differences, there were qualitative differences in play behaviors in the areas of conflict, social play, access to play opportunities, and awareness of social cues. The findings suggest that children with SPD engage in less complex and more solitary play than their peers, and that conflict is more often observed in their play.

i

References
1. Schmid, A. A., Damush, T., Tu, W., Bakas, T., Kroenke, K., Hendrie, H. C., & Williams, L. S. (2012). Depression improvement is related to social role functioning after stroke. Archives of Physical Medicine and Rehabilitation, 93, 978–982. 2. Arbesman, M., & Mosley, L. J. (2012). Systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling older adults. American Journal of Occupational Therapy, 66, 277–283. doi:10.5014/ajot.2012.003327 3. Cosbey, J., Johnston, S. S., Dunn, M. L., & Bauman, M. (2012). Playground behaviors of children with and without sensory processing disorders. OTJR: Occupation, Participation and Health, 32(2), 39–47. Susan H. Lin, ScD, OTR/L, is AOTA’s director of research.

Note: To view the abstracts of these articles, visit Google Scholar http://scholar.google. com/schhp?hl=en&tab=ws or go to PubMed at www.ncbi.nlm.nih.gov/sites/pubmed and type the article title in the search box, then click on Search. If you would like your in-press or recently published research featured in this column, please contact Susan Lin at slin@ aota.org or 301-652-6611, ext. 2091.
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Follow Susan Lin on @SusanAOTA www.twitter.com/susanaota
AUGUST 20, 2012 • WWW.AOTA.ORG

AOTA
 in 

93rd annual conference & expo

San diego cAlifOrniA
april 25–28, 2013
plAn TOdAy fOr 2013!
Bring your family and visit ocean life at Sea World, stroll the beautiful Pacific Coast, and see pandas at the zoo. Shopping and dining are all within walking distance from the convention center and hotels.

BEFORE
you drive to work tomorrow …

BEFORE
you run errands over lunch …

BEFORE
you kiss your kids good night …

Set Up a Solid Safety Net to Help Protect Your Family’s Tomorrow with AOTA’s Term Life Insurance Plan
As an occupational therapist, you see the real-life stories: • A sudden car accident caused by a rain-slicked highway leaves a family without a mother. • Chest pain—overlooked as indigestion—develops into a full-fledged heart attack and a “healthy” man never makes it home. What if tomorrow your loved ones became one of those families in the waiting room? Hearing the devastating news that they’d need to move on without you. How would your family continue the life they’ve built without your paycheck to help make ends meet? What about your family’s dreams of the future? College for your children? Who would help out your parents as they got older or take care of other family members who already rely on you? A Safety Net to Reinforce Any Coverage You Have Through Work Think of your own family. Would one or two times your salary take care of the bills over the long haul? Would it pay off the mortgage? What about credit cards, car loans or student loans? To help you bridge the gap between the life insurance you have through work (or may have bought on your own) and the level of coverage your loved ones may need, AOTA set up the Occupational Therapists’ Term Life Plan. AOTA Program Delivers Solid Coverage Without Application Hassles Dependable benefits up to $250,000. Applying extended on an easy-access, “buy it directly through the mail” basis. It all adds up to one of the most hassle-free ways to help protect your loved ones against the financial impact of facing tomorrow without you.

A Financial Cushion That Follows You Wherever Your Career May Go

I

f you rely strictly on life benefits from your employer, you face the real risk of watching those same benefits disappear if you switch jobs or if your employer cuts benefits because of tough economic times. But with the Occupational Therapists’ Term Life Plan for AOTA members, you can rest assured your financial safety net will be there when your loved ones need it—no matter what changes your career brings.

Many occupational therapists have “some” life insurance through work. But for many families, coverage equal to just one or two times your salary simply isn’t enough.

Plus, AOTA’s Occupational Therapists’ Term Life Plan automatically comes with group rates designed to fit in almost any budget.

Please don’t put this off. Reinforce your family safety net with special AOTA-sponsored benefits today: Call 1-800-503-9230 or visit www.aotainsurance.com
Underwritten by: Hartford Life Insurance Company, Simsbury, CT 06089 The Hartford® is The Hartford FInancial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life Insurance Company.
P-6087

AR Ins. Lic. #245544 • CA Ins. Lic. #0633005 d/b/a in CA Seabury & Smith Insurance Program Management
All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life Insurance Company detailed exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.
55512, 55823, 55824, 55825 (8/12) ©Seabury & Smith, Inc. 2012

AGL-1550

Education Article

(one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.

Earn .1 AOTA CEU

Home Modifications
MARNIE RENDA, MED, OTR/L, CAPS, ECHM
Private Practice, Destination Home LLC; Adjunct Professor, Xavier University; Adjunct Professor, Cincinnati State Technical and Community College Cincinnati, OH This CE Article was developed in collaboration with AOTA’s Home & Community Health Special Interest Section.

An Introduction to Practice Considerations
The goals of home modifications go beyond increasing independence, performance, or participation of a particular functional activity or occupation. They include increasing the ease of use of a home for both caregivers and consumers, decreasing environmental demands by removing environmental barriers, improving safety, and planning for future needs due to progressive conditions. Some home modifications are designed to increase function of consumers, while others may be designed solely to decrease the activity demands of caregivers to reduce caregiver burden. Likewise, home modifications may accomplish both increased performance and decreased caregiver burden. It is the role of occupational therapists to evaluate the client and caregiver needs to determine the most optimal interventions. There are many societal and health care trends that are influencing the expansion of occupational therapy services in the area of home modifications. First, the number of older persons in the United States is drastically increasing as the baby boomers turn 65. The U.S. Census Bureau estimated that the percentage of persons aged 65 years and older will increase from 12% of the total population in 2020 to more than 19% in 2030 (U.S. Census Bureau, 2006). With this rise in the number of older Americans, an increased need for occupational therapy services is expected. Research on the boomer population indicated that these individuals plan to live long, active lives in their homes (Chattanooga Times Free Press, 2008). A study by AARP found that as people age, they increasingly desire to remain in their current homes. Specifically, more than 89% of respondents 75 years and older said they plan to live in their current homes as they age, and 96% of people 85 years and older reportedly plan to remain in their homes. Unfortunately, homes constructed before 1970, which account for the majority of housing in the country, typically have limited accessibility features (AARP Research & Strategic Analysis, 2011). For example, the majority of such homes are entered through steps and feature narrow hallways and even narrower bathroom doors. These characteristics require many older adults and persons with disabilities to physically alter their homes or to modify their occupations to meet the demands of the home to maintain performance over time. These requirements create a tremendous opportunity for occupational therapy practitioners to provide home modification services.

ABSTRACT
Occupational therapy has included home modifications for many years, but because both the scope of the services we provide as well as the practice settings for these services has expanded, it is considered an emerging area of practice. As with all areas of practice, occupational therapy practitioners must remain vigilant of the ethical, legal, and practice considerations shaping this area, and use our official documents to help guide current and future practice. This article defines the ethical, legal, and practice issues related to home modifications, and it explores their impact on occupational therapy practice across settings, including the need to use home modifications in all settings to meet consumer needs.

LEARNING OBJECTIvES
After reading this article, you should be able to: 1. Identify the ethical and legal considerations for home modification services across practice settings. 2. Identify the American Occupational Therapy Association official documents used to provide guidance for home modifications practice across settings. 3. Recognize the knowledge, skills, and experience necessary for competent practice in home modifications in emerging areas of practice.

INTRODUCTION
Home modifications are defined as “adaptations to living environments intended to increase usage, safety, security, and independence for the user” (Siebert, 2005, p. 28). Home modifications are defined as both a process and a product. The product is the alteration, adjustment, or addition to the home environment (Siebert, 2005, p. 3). The process is the combination of services to deliver the product. This includes evaluating clients, identifying and selecting solutions (assistive technology or alteration to the structure of the home), acquiring and installing products or solutions, training end users and caregivers, and assessing associated outcomes (Siebert, 2005, p. 4).
AUGUST 2012
n

continued
CE-1

OT PRACTICE, 17(15)

ARTICLE CODE CEA0812

AOTA Continuing Education Article
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).

HOME MODIFCATION SERvICES IN DIFFERENT PRACTICE SETTINGS
Acute Care In acute care, home modification services often are limited by time and the acuity of the client’s condition. Short lengths of stay and frequent inability to conduct home site visits can make providing home modification interventions difficult. Practitioners in these settings need to evaluate their own competency in home modifications and rely on their knowledge of additional resources to provide these services, including traditional home health, outpatient, and nontraditional private practice services. Skilled Nursing Facilities Practitioners providing home modification services in skilled nursing facilities (SNFs) may or may not have the ability to conduct home visits and make home modification recommendations. Often, services depend on facility or agency policies. For example, some facilities promote home visits, while others prohibit them. Additionally, some practitioners have reported that they are able to conduct home visits within a limited geographic area—for example, within 10 miles of the facility. In SNFs, practitioners’ interventions are generally restorative. This means that they are focused on increasing skills to reestablish function. Practitioners in this setting are well versed in treatment techniques but not necessarily on the emerging products and building techniques to manage chronic or progressive conditions. Skilled Home Care Practitioners in home health provide all services within the home environment. Similar to the SNF goals, interventions are often focused on restoring function through acquiring skills versus focusing on managing chronic illness and planning for declining function related to specific medical conditions. Practitioners in this practice area must be aware of the local funding available for assistive technology and construction needed for home modifications. Qualifications for funding change frequently, especially in this economic environment. It is the responsibility of individual practitioners to seek information about these resources and refer clients as appropriate. One challenge faced in home health is that occupational therapy services often may be discontinued prior to implementation of the recommended modifications. Therefore, recipients of care may not receive the training or coordination of environmental modifications that is necessary for optimal outcomes. Outpatient Care Practitioners provide home modification services in clinics and homes under outpatient insurance benefits. The quality
CE-2

of home modifications may differ drastically, depending on the location of services. Providing services in a clinic setting can prevent practitioners from conducting home site visits, significantly impacting their ability to make informed recommendations about the client’s specific home modification needs. On the other hand, like home health practitioners, outpatient practitioners providing services in the home are able to perform comprehensive evaluations and implement home modification recommendations. However, time can also affect home modification services in this setting. Often, outpatient services are discontinued prior to acquiring assistive technologies or structural changes to a home. As with practice within SNFs, this turn of events can prevent clients from receiving any training or alterations for home modifications. Private Practice Private practice practitioners often work as consultants and do not typically provide “skilled treatment.” Practitioners in this setting generally provide consultation on general home modifications or more extensive services such as architectural changes or complex assistive technologies. When expanding into more complex services, practitioners must obtain additional skills, training, and experience to ensure competency and prevent harm to clients. Finally, private practice practitioners accepting private pay have the ability to provide the full scope of occupational therapy services and are not limited to reimbursable services identified by the various funding sources, such as insurance providers or state or federally funded agencies or waiver programs. Table 1 on p. CE-3 provides a summary of occupational therapy home modification services in different practice settings.

OCCUPATIONAL THERAPy IN HOME MODIFICATIONS
When examining the process of home modification, practitioners must understand the theoretical foundations guiding practice. Several theories can be used when working in home modifications, and a common one is the PersonEnvironment-Occupation Model (PEO; Law et al., 1996). The PEO views occupational performance as the result of the transaction between the person, the occupation, and the environment. The person is defined as an individual with specific performance skills, preferences, and experiences. The occupation is defined as the “self-directed meaningful tasks and activities engaged in throughout a lifespan” (Law et al., 1996, p. 17). Finally, the environment is defined as the “context within which occupational performance takes place, and it is categorized into cultural, socioeconomic, institutional, physical, and social” contexts (Law et al., 1996, p. 17). This model assumes that the environment is easier to change than the person and, therefore, it focuses on environmental interventions.

ARTICLE CODE CEA0812

AUGUST 2012

n

OT PRACTICE, 17(15)

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