treating incontinence & pelvic floor disorders · pdf filetreating incontinence &...

CE ARTICLE

Using Theory and the Therapeutic Reasoning Process To Guide the Occupational Therapy Process for Older Adults With Mental Illness

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An AT Option: Assistance DogsDesigning a CareerNews, Capital Briefi ng, & More!

Expanding an underdeveloped area of rehabilitation that helps clients resume valued roles and occupations

Treating Incontinence& Pelvic Floor Disorders

AOTA T H E A M E R I C A N O C C U P A T I O N A L T H E R A P Y A S S O C I A T I O N

MARCH 23, 2009

ENERGY!For your career, your professional community, and your clients

The American Occupational Therapy Association

2009 ANNUAL CONFERENCE & EXPOAPRIL 23--26, HOUSTON

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1

DEPARTMENTSNews 3

Capital Briefi ng 6State Scope of Practice Challenges

Careers 7• Designing a Career• Practice Perks: Nondiscrimination

and Inclusion

Perspectives 17Can This Marriage Be Saved?

Occupation in Action 19Working With Homeless Families

Fieldwork 21Call for Research on Fieldwork Education

Calendar 23Continuing Education Opportunities

Employment Opportunities 27

Molly Asks 32Jennifer Coyne

AOTA • THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATIONV O L U M E 1 4 • I S S U E 5 • M A R C H 2 3 , 2 0 0 9

CE ArticleUsing Theory and the Therapeutic Reasoning Process To Guide the Occupational Therapy Process for Older Adults With Mental IllnessEarn .1 AOTA CEU (1 contact hour or NBCOT professional development unit) with this creative approach to independent learning.

Discuss OT Practice articles at www.OTConnections.org in the OT Practice Discussions Forum.Send e-mails regarding editorial content to [email protected].

Visit our Web site at www.aota.org for OT Practice online, contributor guidelines, and additional news and information.

OT PRACTICE • MARCH 23, 2009

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.

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Members who prefer to access this publication electronically may view it as a PDF at www.aota.org. To request each issue in Word format (without graphics or other design elements), send an e-mail to [email protected].

FEATURESThe Role of OT in the Treatment of Incontinence 10and Pelvic Floor DisordersBrenda Neumann, Jeannette Tries, and Mary Plummer describe both

basic and advanced OT intervention in this emerging practice area.

COVER PHOTOGRAPH © PATRICK SHEANDELL O’CARROLL / GETTY IMAGES

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OT Practice External Advisory Board

Asha Asher, Chairperson, Developmental Disabilities Special Interest Section

Salvador Bondoc, Chairperson, Physical Disabilities Special Interest Section

Barbara E. Chandler, Chairperson, Early Intervention & School Special Interest Section

Sharon J. Elliott, Chairperson, Gerontology Special Interest Section

Jyothi Gupta, Chairperson, Education Special Interest Section

Kimberly Hartmann, Chairperson, Technology Special Interest Section

Christine Kroll, Chairperson, Administration & Management Special Interest Section

Lisa Mahaffey, Chairperson, Mental Health Special Interest Section

Kathy Maltchev, Chairperson, Work and Industry Special Interest Section

Pamela Toto, Chairperson, Special Interest Sections Council

Karen Vance, Chairperson, Home & Community Health Special Interest Section

Renee Watling, Chairperson, Sensory Integration Special Interest Section

AOTA President: Penelope Moyers Cleveland

Executive Director: Frederick P. Somers

Chief Public Affairs Offi cer: Christina Metzler

Chief Financial Offi cer: Chuck Partridge

Chief Professional Affairs Offi cer: Maureen Peterson

© 2009 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, Bethesda, MD 20814-3425; 301-652-2682. Periodical postage is paid at Bethesda, MD, and at additional mailing offi ces.

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Mission statement: The American Occupational Therapy Asso-ciation advances the quality, availability, use, and support of occupational therapy through standard-setting, advocacy, edu-cation, and research on behalf of its members and the public.

Annual membership dues are $225 for OTs, $131 for OTAs, and $75 for Student-Plus members, of which $14 is allocated to the subscription to this publication. Standard Student membership dues are $53 and do not include OT Practice. 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 fi rst issue.

Copyright of OT Practice is held by The American Occupational Therapy Association, Inc. Written permission must be obtained from AOTA to reproduce or photocopy material appearing in OT Practice. A fee of $15 per page, or per table or illustration, including photographs, will be charged and must be paid before written permission is granted. Direct requests to Permissions, Publications Department, AOTA, or through the Publications area of our Web site. Allow 2 weeks for a response.

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N E W SAssociation updates...profession and industry news

AOTA Updates

Conference Update

Recharge your career! Register now for the 2009 Annual Conference &

Expo! Join us in Houston from April 23 to 26, and get in on the best opportunity of the year to learn, advance your skills, and more. In addition to more than 600 educational sessions, hun-dreds of leaders and potential employers, and thousands of colleagues will provide news, information, and discussion about the serious challenges OT faces. Be sure to visit the Expo Center, where over 300 exhibi-tors will be on hand to dem-onstrate and discuss products and services that are important to you and your practice. And while in the Expo, don’t miss the AOTA Member Resource Center and the AOTA Mar-ketplace, where you can have member questions answered, visit the cyber café, buy the latest books on occupational therapy, and more! If ever there was a time to take advantage of top-notch learning that keeps your skills sharp, infl uential connections that open doors for career advancement, and peer interaction that inspires energy and creativity for your practice, it is now! Register online at www.aota.org/conference.

Conference Session Targets Ethical Issues in School-Based Practice

How do you maintain a child-centered focus while work-ing collaboratively with

parents and school personnel,

especially when there may be administrative directives around allocation of resources, productivity, etc. that present ethical dilemmas? “Everyday Ethics: Linking Research, Prac-tice, and Ethical Decision-Mak-ing in School-Based Practice,” sponsored by the Ethics Com-mission (EC) of the American Occupational Therapy Asso-ciation (AOTA), will identify ethical issues arising from both internal and external forces and the resources to assist you with decision-making challenges in the public schools. This short course will be held on Friday, April 24, from 8:00 a.m.–9:30 a.m. during the AOTA Annual Conference in Houston. The EC invites you to join in what is sure to be an informative and lively discussion.

RA Online Meeting

The Representative Assem-bly (RA), AOTA’s Congress for the profession, is

currently meeting online via OT Connections (http://otconnections.aota.org/groups/ra_special_e-meeting/forum/default.aspx) to discuss and vote on six motions submit-ted by the membership. The motions are: Defi nition of OT/OTA Roles within the Model Practice Act and All Other Relevant Documents; Special-ized Knowledge and Skills Paper for Occupational Therapists in Oncology; Title Change for Occupational Therapy Assistants; Develop Model Requirements for Re-Entry/Re-Licensure; Ensure Broad Prac-tice Area Representation Within the AOTA Board of Directors; and Building Diversity in Occu-pational Therapy Now To Meet the Centennial Vision.

To access all the reports and these motions, go to the AOTA Web site (www.aota.org) Lead-ership & Governance, Represen-tative Assembly, Online. The meeting ends April 10.

Results of the 2009 AOTA Elections

The Nominating Committee is pleased to announce the results of the 2009 AOTA

elections, which concluded on February 18. A special thanks to all the candidates who were so willing to serve the Asso-ciation and to all the members who took the time to vote.

GENERAL ELECTIONFlorence Clark

President-ElectVirginia “Ginny” Stoffel

Vice PresidentThomas Fisher

Board DirectorCoralie “Corky” Glantz

Board DirectorJyothi Gupta

Commission on Education Chairperson-Elect

Barbara HemphillEthics Commission Chairperson-Elect

Michele Luther-KrugOTA Representative to the RA

SPECIAL INTEREST SECTIONSTara Glennon, AMSIS ChairLeslie Jackson, EISSIS ChairMissi Zahoransky, HCHSIS ChairTina Champagne, MHSIS Chair

ASSEMBLY OF STUDENT DELEGATESRyan Morgan

ChairpersonKayla Chambers

OTA Vice Chairperson

Janelle Murray OT Vice Chairperson

Stephen BarbourSecretary

Elizabeth Hayes Communications & Advocacy Chairperson

Jennifer CruzRepresentation to the Commission on Practice

OT Practice Thanks Reviewers

The staff members of OT

Practice thank the follow-ing persons for sharing

their expertise by providing content reviews of manuscripts and articles for the issues from January 19 through March 23: Salvador Bondoc, Jyothi Gupta, Neil Harvison, Valerie Hermann, Donna Latella, Deborah Lieber-man, Maria Elena Louch, Stacy Nelson, Maureen Peterson, Deborah Pitts, Laurel Radley, Linda Riccio, Denise Rotert, and Tracy Van Oss.

OT Month 2009 Catalog Available Now!

AOTA members received the 2009 Occupational Therapy Month catalog

in January. It is also available online at www.promoteot.com and is fi lled with great ideas and fun products to show your pride in being an occupational therapy practitioner. AOTA members know better than any-one that occupational therapy helps people of all ages live life to its fullest. Take advantage of your knowledge, network, and 2009 OT Month resources to help educate others!

continued on page 4

3OT PRACTICE • MARCH 23, 2009

AOTA Secures Voting Rights on AMA Body Responsible for Quality Measure Development

A fter nearly 2 years of advocacy with the Ameri-can Medical Association’s

Physician Consortium for Per-formance Improvement (AMA-PCPI), AOTA and other health care professional organizations now have the opportunity to vote on specifi c fi nal draft qual-ity measures. Previously, only physicians had the right to vote on measures. As a non-voting member, AOTA had been able to participate in measure devel-opment workgroups, propose topics for measure develop-ment relevant to occupational therapy, and review and com-ment on all measures. AOTA’s right to cast a vote through a representative at AMA-PCPI meetings will enhance our infl u-ence in measure development and provide a critical voice in future thinking about what qualifi es as quality health care. To learn more about AMA-PCPI, visit www.ama-assn.org.

Change in Registration Process

As of March 1, 2009, purchasers of AOTA Self-Paced Clinical Courses

who want to obtain nondegree graduate credit from Colorado State University (CSU) must register directly with CSU when submitting the exam to AOTA for scoring. To obtain nondegree credit from CSU, the following is required: contact CSU to obtain the most cur-rent registration form; send CSU a completed registration form and make a copy of the form to submit to AOTA with your exam; and submit your

completed exam and a copy of your completed CSU registra-tion from to AOTA for scoring. AOTA will notify you and CSU of your completion status. Terms and conditions apply. Visit www.aota.org, and click on CE, then Self-Paced Clinical Courses, for more information.

Research Highlights

Final Guidelines for CIMT in Pediatrics

In the October 8, 2007, issue of OT Practice, therapists Pamela Little-Hayes, OTR/L,

Allison Allgier, OTR/L, Amy Klein, OTR/L, Rebecca Reder, OTR/L, and Carol Burch, PT, PTD, from Cincinnati Children’s Hospital, published the article “Embracing the Spirit of Iniq-uity,” which discussed their process of developing evidence-based guidelines for using constraint-induced movement therapy (CIMT) in pediatrics. They have fi nalized the guide-lines, and Cincinnati Children’s Hospital has posted them at www.cincinnatichildrens.org. Type “evidence-based pediatric care guidelines” into the search box, and click on the fi rst link under the “Services” subhead.

Grant for CarFit Project

The University of Minne-sota’s (UM’S) master’s of occupational therapy

students Lauren Belinkoff and Theresa Olmstead have received funding from the National Center on Senior Transportation (NCST) for their project “Creating and vali-dating an online CarFit training program for occupational therapists.” The project con-tinues work done last year by occupational therapy students Cristina Curtis and Lindsey

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BRAND NEW CEONCD™Hand RehabilitationA Client-Centered and Occupation-Based ApproachPresenter: Debbie Amini, MEd, OTR/L, CHTEarn .2 AOTA CEUs (2 NBCOT PDUs/2 contact hours).

AOTA’s new course familiarizes occupational therapy practi-

tioners with a client-centered and occupation-based approach to intervention that is easily incorporated into

the hand rehabilitation setting. Course content highlights the rationale for the use of the occupa-tion-based approach and illustrates clinical application through client intervention cases. You can view this portable CEonCD on your computer; listen to it on your MP3 player, iPhone, or iPod; or burn it to a CD and listen while you drive. $68 for Members, $97 for Nonmembers. Order #4832-BB

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The following products are avail-able from AOTA Continuing

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NEW FROM AOTA PRESSScreening Adult Neurologic PopulationsA Step-by-Step Instruction Manual, 2nd EditionBy Sharon A. Gutman, PhD, OTR/L, and Alison B. Schonfeld, OTR/L

This updated manual guides occupational therapists through

the entire screening process in an easy-to-use format. It provides de-tailed steps for cognitive, functional visual, percep-tual, sensory, motor, cerebellar function, cranial nerve function, neuropathy, peripheral nerve function, and dysphagia screening, in addition to a new section on mental status. Contains forms and case study on CD-ROM. $59 for Members, $84 for Nonmembers. Order #1226A-BB

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4 MARCH 23, 2009 • WWW.AOTA.ORG

Wegner. “Tina and Lindsey really broke the ground with their pilot showing what this online program could look like,” notes Erica Stern, PhD, OTR/L, a faculty member who mentors all four students.

Sponsored by AAA, AARP, and AOTA, CarFit is a national program that works to help older adults drive longer, safely. Says Stern, “AAA and AARP were initially hesitant about using online education. The fi rst two students’ pilot let them appreciate what this technol-ogy can provide and brought them enthusiastically on board. Now, with the NCST’s support, Lauren and Theresa will bring this idea to full realization and validate its effi cacy.”

“If successful, this project will help reduce the barriers associated with occupational therapists’ CarFit training, by allowing them to learn on their

own timeline and from their own homes, and reducing the time that they need to be at a CarFit event from 2 days to 1,” says Elin Schold Davis, OTR/L, CDRS, a collaborator on the project and the coordinator of AOTA’s Older Driver Initiative. The validation phase of the project will determine whether the project can reduce the geographic barriers of current CarFit training while retaining the skill levels needed for effec-tive events.

In Memoriam

Beverly Mae Konugres Bain, a renowned occupational thera-pist, passed away in February. Bain was an internationally known pioneer in the fi eld of occupational therapy and reha-bilitation. She graduated from Colorado College, earned a master’s degree in occupational

therapy from the University of Southern California, an MS in learning disabilities from Montclair State University, an EdD from Fairleigh Dickinson University, and was a Fellow of the American Occupational Therapy Association. She completed a postgraduate fellowship at the Rehabilita-tion Institute in Warm Springs, Georgia, during the last polio epidemic; was personally recruited by Dr. Henry Kessler and directed the OT depart-ment in the Kessler Institute in West Orange; and created the AMA-accredited 4-year OT program at Kean College and a 2-year assistant OT program at Union County Technical Insti-tute. Bain was also an assistant professor in the graduate OT program at NYU for 18 years, and was appointed by President Nixon to the Defense Advi-sory Committee on Women

in the Armed Services, which integrated women in the military and academies. She also authored numerous papers on rehabilitation, including 18 chapters in medical textbooks. Bain lectured on rehabilita-tion throughout the U.S. and abroad, was invited by the government of Iceland to con-sult and lecture on rehabilita-tion, and was a member of the Rehabilitation Engineering and Assistive Technology Society.

Molly V. Strzelecki is the associate

editor of OT Practice.


Share your feedback in the OT Practice Discussion forum! Go to www.otconnections.org and

click on Forums, Public Forums, then OT Practice Discussion

P-3983

CState Scope of Practice Challenges

Chuck Willmarth

hallenges to the occupational therapy scope of practice continued during the 2009 state legislative sessions. At the same time, state legislatures are moving forward with bills to strengthen the occupational therapy scope of practice.

STATE REGULATION OF OTMichigan Governor Jennifer M. Gran-holm signed Senate Bill 921 to license occupational therapists and occupa-tional therapy assistants on January 12. The bill also revises the state’s defi nition of “practice of occupational therapy” based on the AOTA Model Practice Act and establishes continuing education requirements for licensure renewal. OTs are now licensed in 48 states, and OTAs are licensed in 45 states. Congratulations to the Michigan Occupational Therapy Association.

Bills in Idaho and West Virginia propose revising the defi nition of occupational therapy practice based on language from AOTA’s Model Practice Act defi nition, while legislation pending in Washington State would specifi cally authorize OTs to use medications in their practice. Idaho House Bill 171 is pending in the House Business Com-mittee. West Virginia House Bill 2309 passed on February 23 and is pending in the Senate. Washington House Bill 1041 passed on February 13 and is pending in the Senate.

PHYSICAL THERAPYIn Utah, legislation to revise the physi-cal therapy practice act has passed the Senate and is pending in the House. Senate Bill 137 would revise the defi ni-tion of physical therapy to include “functional training in self-care.” The limited context in which PTs address functional training is not clearly

defi ned, which may mislead consumers and encroach on the traditional domain of OT. The Oregon Physical Therapy Licensing Board proposed regulations to adopt similar language. The Occupa-tional Therapy Association of Oregon (OTAO), with assistance from AOTA, persuaded the Board to clarify that PT intervention includes “functional train-ing related to physical movement

and mobility in self-care.”

ORTHOTICS AND PROSTHETICSLegislation to license orthotists and prosthetists was recently introduced in Oregon, Kentucky, and New York. The Kentucky bill exempts licensed OTs due to advocacy by the Ken-tucky Occupational Therapy (KOTA) association. The New York Occupa-tional Therapy Association will press for exemption language. The Oregon bill was withdrawn soon after it was introduced, but OTAO expects it to be reintroduced in 2010. All existing O&P licensure laws exempt OTs.

As reported in the February 2nd Capital Briefi ng article, the American Orthotics and Prosthetics Association considers exemption language for OTs to be “inappropriate” and “may defeat the purpose of licensure.” This is espe-cially interesting given AOPA’s strategic plan to expand the role of O&Ps. In a document provided to AOPA members (“Strategic Planning Initiatives of the American Orthotic & Prosthetic Asso-ciation as Presented to the Membership September 11, 2008”) and posted to its Web site, the association plans to pursue “alternative revenue generating business models” including “offering expanded services to include physical therapy and/or occupational therapy services including: gait training, mas-sage therapy, stretching and strength-ening therapy, therapy to improve

activities of daily living, developing the necessary skills needed in returning to the workplace, etc.”

ART THERAPYLegislation to license art therapists has passed the House in Kentucky. The bill defi nes “the practice of professional art therapy” as the “integrated use of psychotherapeutic principles, visual art media, and the creative process in the assessment, treatment, and remediation of psychosocial, emotional, cognitive, physical, and developmen-tal disorders in children, adolescents, adults, families, and groups.” KOTA lobbied to secure exemption language for OTs.

AOTA AND STATE ASSOCIATIONS ADVOCACY INITIATIVESAOTA’s State Affairs Group electroni-cally monitors state legislative and regu-latory issues in all 50 states, the District of Columbia, and Puerto Rico to identify proposals when they are introduced. We work with state associations to be proactive on these issues. Your mem-bership in AOTA and your state associa-tion provides the resources to assert and protect occupational therapy’s domain in state licensure laws.

An update on state policy issues will be provided at the State Legislative and Regulatory Affairs Forum during AOTA’s Annual Conference and Expo in Houston. The Forum (SC 400) will be held on Sunday, April 26, from 9:00 to 10:30 a.m. AOTA staff and guest speakers from state associations will discuss OT legislation and state initia-tives to address a variety of scope of practice challenges from other health professions. ■

Chuck Willmarth is the director, state affairs, at

AOTA. He can be reached at [email protected].


C A P I T A L B R I E F I N G


C A R E E R S

s a self-employed occupational therapist, Twilla Parr, MS, OTR/L, knows how to keep her career interesting. As of late, her practice focuses predominantly on her role as a First-Steps early intervention provider for the state of Kentucky. She also performs vocational assessments for a local career

service that contracts with vocational rehab. And if that weren’t enough to keep Parr on her toes, she is also a cer-tifi ed aging in place specialist (CAPS), adding this consultant service to her private practice.

Oh, and she’s also pursuing a PhD in rehabilitation science at the Univer-sity of Kentucky. And occupational therapy? Not her fi rst career, either. Like many practitioners, Parr came to the profession after a career in another fi eld; in her case, it was interior design.

“I’ve always been very function oriented,” Parr says. However, the pretentious nature of design eventu-ally soured her to the industry, she explains.

“I wanted to work with people and help them with their design no matter what kind of money they wanted to spend,” she notes. “It didn’t matter to me. But I ended up working very hard for less money [than other designers], because everything is commission driven.”

Thankfully, Parr had a friend who was an occupational therapist and the way she described her work intrigued Parr. “The creative aspect of occupa-tional therapy really interested me in a journey toward the profession,” Parr notes, and it pushed her into looking into occupational therapy programs. She eventually earned a postbaccalau-reate certifi cate in occupational ther-apy at Eastern Kentucky University. When working on this certifi cate her ideas of combining the knowledge of

both interior design and occupational therapy were not well received by the faculty, given the limited educational offerings at the time. Some 13 years later she returned to Eastern Ken-tucky University to obtain her master’s degree in occupational therapy. Because home modifi cations was an emerging practice area, and there was a renewed focus on more client-centered, occupation-based practice, her desire to study occupation and the environment was now welcomed.

Now working on her PhD, Parr notes that the multidisciplinary program—which includes speech-language pathologists, physical thera-pists, athletic trainers, and of course other occupational therapists—is ideal for her background.

“It’s exciting to see so much interest in what occupational therapy has to bring to the program,” Parr notes. “It’s enlightening to the students from other fi elds how we view function, and the other professions have tremendous knowledge to contribute to rehabilita-tion science as well. The great thing about occupational therapy is that

we’re willing to look at the multiple fac-ets of an individual to gain an increased understanding of participation and health.”

For her research, Parr is combining her experience in occupational therapy with her experience in interior design, focusing on and emphasizing the envi-ronmental impact on function. With this idea, Parr approached the design department at the University of Ken-tucky, which included some professors who were still there from when she was a student obtaining a bachelor’s degree in design.

“We started a collaboration that involves lectures and getting involved with the design projects that the stu-dents are completing, trying to make them more sensitive to the needs of diverse populations, and introducing global perspectives of occupation/par-ticipation and how it relates to health.” Parr explains. “It’s exciting, coming back to the department in this capac-ity, and it was serendipitous because the design faculty had just been chal-lenged with expanding beyond their department and working with other

ADesigning a Career

Molly V. Strzelecki

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departments of the university.” In addi-tion, Parr says, the collaboration includes a research project to fi nd out about the young designers’ attitudes on disability and whether they are open to collabora-tion with the occupational therapists.

“We want to see what [students’] attitudes are, as these are the attitudes of professionals of the future. Many occupa-tional therapists are becoming certifi ed aging in place specialists, assuming that the design profession will accept our

assistance to meet clients’ needs, when in fact designers are most likely unaware of the contribution we could make to understanding and addressing the needs of their clients. The entire point of this early investigation is to increase aware-ness of new designers and to improve the possibility of collaboration with occupa-tional therapy when they are working professionals.” Parr feels this preservice educational collaboration is important because occupational therapists are not designers.

“Occupational therapists must approach the design profession with the same sensitivity that we offer our clients or other professionals. We should think of [designers] as ‘environmental therapists,’” she explains. “Creating interiors that support function requires the input from various professions. We cannot claim to know it all, but our profession does have a unique contribution toward the success of the project.”

From her research, Parr hopes to develop a model of practice for thera-pists when they are participating in the creation of new or modifi ed interiors. She believes that occupational therapy inter-vention in home modifi cation needs to be considered beyond the individual, to the community and population levels. “There is the potential for a larger application of these services to impact occupation and health. I hope my research will demon-strate the effectiveness of these services to impact policy so that resources will be available to permit people to age in place,” she says.

“Having the evidence that supports occupational therapy’s involvement in this area and collaboration with other professionals to assure function on a community scale is the future of the profession,” Parr says.

All of which makes for one well-designed career. ■

Twilla Parr, MS, OTR/L, CAPS, is an occupational therapist working in private practice in Lexington, Kentucky. She has worked for many years providing services in the community, school, and clinical settings. She is also a doctoral student in rehabilitation science at the University of Kentucky.

Molly V. Strzelecki is the associate edtior of

OT Practice.

P R A C T I C E P E R K S

Nondiscrimination and InclusionJames Marc-Aurele

The position paper “Occupational Thera-py’s Commitment to Nondiscrimination and Inclusion”1 articulates not only

the philosophical basis for nondiscrimination and inclusion, but also operationalizes these concepts. By embracing nondiscrimination and inclusion we benefi t from the richness of diversity both as a profession and as members of society.1

Vital to the foundation of nondiscrimina-tion is the principle of equality; when we treat individuals equally we are avoiding bias and prejudice. Equality, which is also a core value of the profession,2 is the belief that all individuals possess the same fun-damental human rights and opportunities, reaching well beyond legal mandates.

A position paper describing the profes-sion’s stance on nondiscrimination and inclu-sion should not surprise us. As occupational therapy practitioners, educators, and Associa-tion members, we embrace the value of the individual while affi rming the right of everyone to access and fully participate in society. At the surface, few would argue the philosophi-cal merit of nondiscrimination and inclusion as vital to our profession. However, as with any position paper, only our actions can move the profession beyond intent and ideology to affi rmation.

In order to accomplish this we must refl ect on our own practice. Do we value our clients, respecting their culture, ethnicity, race, age, religion, gender, sexual orienta-tion, and capacities, as defi ned and described in the Occupational Therapy Code of Ethics (2005)3? From a practical standpoint, this involves choosing evaluation methodology and intervention strategies that are age appropriate and culturally sensitive and do not subject the individual to bias. At the same time, we must consider the multitude of contexts that affect

our clients’ abilities to engage in daily occupa-tions as described in the Occupational Therapy Practice Framework: Domain and Process.4 Do we actively engage clients, their families, and signifi cant others as part of the occupational therapy process? Our intervention strategies must take into account the contexts that are valued by the individual, while working toward client goals.

These same challenges exist for us as edu-cators. Do we consider the unique individual characteristics of our students in fostering their development as occupational therapy practitioners? Our teaching methodologies must take into account not only diversity in learning style, but also social, cultural, ethnic, and personal diversity as well.

The answers to these critical questions can be neither scripted nor prescribed. Each situ-ation calls us to critically evaluate a multitude of contextual factors. The position paper serves as a valuable tool for describing the principles that should guide our actions. We must refl ect on our own values, beliefs, and actions to determine how we can, in our daily practice, exemplify and affi rm the profession’s commit-ment to nondiscrimination and inclusion. ■

References1. American Occupational Therapy Association.

(2004). Occupational therapy’s commitment to nondiscrimination and inclusion. American Journal of Occupational Therapy, 58, 668.

2. American Occupational Therapy Association. (1993). Core values and attitudes of occupational therapy practice. American Journal of Occupational Therapy, 47, 1085–1086.

3. American Occupational Therapy Association. (2005). Occupational therapy code of ethics (2005). American Journal of Occupational Therapy, 59, 639–642.

4. American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy, 62, 625–683.

James Marc-Aurele, MBA, OTR/L, is the clinical

supervisor of occupational therapy for Mid Coast

Hospital in Brunswick, Maine, and is a member of

AOTA’s Commission on Practice.

AOTA Commission on Practice

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“ I don’t like to go anywhere because

I am constantly looking for a

bathroom, so I just stay home.”

“ This isn’t something you usually

talk to anyone about. It was

psychologically affecting me.

It made me want to become a

hermit. I felt trapped.”

onservative estimates indicate that in the United States 16% of the female population suffer from urinary incontinence (UI)

and 9% suffer from fecal incontinence.1

About 33% of the U.S. population report symptoms of overactive bladder, a condition characterized by urinary urgency, frequency, and night-time voiding.2 Many others experience pel-vic fl oor disorders such as pelvic pain.

COSTS AND PERSONAL IMPACTThe direct medical costs related to urinary incontinence and overactive bladder are estimated at more than $23 billion annually in the U.S. Indi-rect costs, including lost productivity, increase this estimate to more than $32 billion.3 What can’t be measured in terms of dollars is the profound impact of incontinence and pelvic fl oor disor-ders on occupation, the daily activities that give life meaning. Impairments in bowel, bladder, and urogenital func-tion can result in depression, loss of self-esteem, and diffi culty maintaining a healthy and independent lifestyle and fulfi lling relationships.4–6 Activities out-

side the home, social interactions with friends and family, and sexual activity may be restricted or avoided entirely.7–9

UI is recognized as one of the leading conditions associated with functional decline and institutionalization of the elderly.10–12

Treatment for incontinence and pelvic fl oor disorders generally falls into three major categories: surgical, pharmacological, and behavioral. Surgi-cal and pharmacological treatments are the options most familiar to clients and physicians. Recently however, pub-lished medical practice guidelines have advised using conservative treatments before surgery.10,13–15 Conservative treatments refer to behavioral tech-niques alone or in conjunction with pharmacological treatments. Behavioral techniques for incontinence include routine or scheduled toileting, habit training, prompted voiding, bowel and bladder retraining, dietary and fl uid modifi cation, and pelvic muscle reha-bilitation. Over the past 5 to 10 years, the attention given to the usefulness of behavioral techniques has given rise to an increased market for rehabilitation services aimed to improve bowel, blad-der, and pelvic fl oor disorders.

THE ROLE OF OCCUPATIONAL THERAPYRehabilitation for bowel, bladder, and pelvic fl oor disorders requires a com-prehensive approach that addresses their complexity. According to AOTA’s Scope of Practice position paper16 and the Occupational Therapy Practice

Framework: Domain and Process (Framework),17 conservative treat-ment of incontinence and pelvic fl oor disorders is within the domain of occupational therapy “as it is related to supporting performance and engage-ment in occupations and activities

targeted for intervention” (p. 636).17 Occupational therapists provide a comprehensive approach that looks beyond musculoskeletal skills defi cits and recognizes the need for changes in performance patterns, such as habits and routines, while also considering the context and activity demands related to the problem. Additionally, occupational therapy practitioners have the back-ground and training to understand the related distress and provide support for the psychosocial aspects of these disor-ders. Depending on their level of train-ing, occupational therapy practitioners may provide either basic or advanced intervention for incontinence and pelvic fl oor disorders.

BASIC OCCUPATIONAL THERAPY INTERVENTIONAll occupational therapy practitioners have the education and clinical skills to provide basic intervention for incon-tinence. Basic intervention includes assessing and training for defi cits in functional self-care skills that may be contributing to the incontinence. These defi cits can include physical problems such as managing clothing, performing hygiene, and transferring to the toilet, as well as cognitive defi cits such as remembering to void or locating the toilet. Occupational therapy practition-ers address the component skills that contribute to these functions, such as upper-extremity range of motion, fi ne motor coordination, grip-and-pinch strength, cognitive and sequencing skills, trunk mobility and balance, and functional mobility as they relate to toi-leting. Therapists also assess the need for adaptive equipment or techniques (e.g., raised toilet seats, adapted cloth-ing fasteners, urine collection devices, protective pads or garments) and pro-vide training in adapted techniques for

The Role of OT in the Treatment of Incontinence and

Pelvic Floor Disorders

BRENDA NEUMANN

JEANNETTE TRIES

MARY PLUMMER

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intermittent self-catherization, adapted handles or methods for suppository insertion, digital stimulation, and toileting hygiene. When appropriate, they train caregivers in the use of the adaptive devices and methods, or the use of scheduled or prompted toilet-ing interventions. These interventions are often helpful for persons who have cognitive defi cits or who reside in insti-tutions18 (e.g., a nursing home resident with mid-stage dementia who cannot remember to void or cannot locate the bathroom independently).

ADVANCED OCCUPATIONAL THERAPY INTERVENTIONThe Framework states, “Some thera-pists may specialize in evaluating and intervening with a specifi c function, such as incontinence and pelvic fl oor disorders, as it is related to support-ing performance and engagement in occupations and activities targeted for intervention” (p. 636).17 Specialized or advanced occupational therapy inter-vention requires the therapist to under-stand body functions such as urinary, digestive system, and reproductive functions and involves administering

specifi c assessments and treatment for pelvic fl oor muscle dysfunction. This level of intervention requires a motivated client who has the cognitive function to take an active role in the process and is commonly provided in an outpatient setting.

Occupational therapists must demonstrate competency before the delivery of advanced intervention. Competency can be obtained through continuing education, comprehensive clinical training with a qualifi ed mentor, or certifi cation through an accredited training program such as the Biofeed-back Certifi cation Institute of America (www.bcia.org). Occupational therapy practitioners are required to abide by state laws (occupational therapy prac-tice act) and other regulatory require-ments to determine scope of practice related to incontinence.

AssessmentsFunctional AssessmentSpecialized or advanced occupational therapy intervention begins with a functional assessment of bowel, blad-der, and sexual function. This informa-tion is obtained through client voiding

diaries, interview or self-report, and a review of pertinent medical and diagnostic tests. During the functional assessment, the therapist specifi cally evaluates how the client’s impairments are affecting occupational performance and engagement in everyday activities, such as attending church or commu-nity activities, gardening or exercising, or engaging in sexual activity. During the assessment, clients disclose very personal information, so it is important to promote rapport by providing ample time and an environment that ensures privacy and promotes trust.

The functional assessment includes an analysis of habits, routines, and behaviors that may be contributing to the problem. For example, consuming too much caffeine, a bladder irritant, may contribute to bladder urgency and incontinence. It is important to identify this habit during the assess-ment because it may need to be altered for a successful outcome. Identifying maladaptive behaviors associated with bladder urgency and incontinence such as voiding “just in case” or too fre-quently to preempt urgency or incon-tinence is also important because they can create further dysfunction and a lack of response to treatment.

Context is also evaluated to help identify specifi c situations in which the problem occurs. An example is the so-called “key-in-the-lock urgency” when entering one’s home. Common activity demands that contribute to inconti-nence include sit-to-stand movements, bending, lifting, coughing, and laugh-ing. Evaluating the behaviors, habits, context, and activities associated with incontinence can help facilitate a com-prehensive, client-centered approach.

Pelvic Floor Muscle (PFM) AssessmentAfter the functional assessment, occupational therapists with advanced training may provide a comprehensive pelvic fl oor muscle (PFM) assess-ment. This evaluation is useful because PFM dysfunction is often an underly-ing cause of incontinence and pelvic fl oor disorders. Neuromusculoskeletal assessment includes PFM strength, tone, isolation, and coordination as

Helping clients resume valued roles and occupations


they relate to bowel, bladder, and sex-ual function. Assessment may involve a standardized digital exam of the vagina and/or anal canal using a 0 to 5 grading scale (0 = no contraction; 5 = strong squeeze, good lift, repeatable) and/or PFM surface electromyography (biofeedback) using vaginal and/or anal sensors.19,20 Palpation to assess for soft tissue mobility and/or pain in the pelvic fl oor and surrounding tissues may also be performed.

INTERVENTIONPelvic Floor Muscle Re-educationPFM Re-education is used to improve PFM strength and endurance, train functional PFM relaxation and coor-dination, and teach inhibition of maladaptive motor responses. PFM re-education often involves electro-myography (EMG) or biofeedback and includes a progressive home exercise program. Biofeedback is a valuable tool for PFM re-education, in some cases reducing UI by as much as 80%.21,24,25 In cases of profound PFM weakness, or as a method to inhibit persistent symptoms of overactive bladder, PFM stimulation may be used in conjunc-tion with PFM re-education. Though research outcomes vary, some stud-ies support the value of pelvic fl oor muscle electrical stimulation to reduce incontinence.26–28

As the PFM re-education progresses over a series of treatments, clients are taught to integrate their skills into daily activities. For example, they may learn how to inhibit an overwhelming urge to urinate or evacuate that may precede incontinence (see Table 1)29 and reduce maladaptive and potentially harmful behaviors, such as rushing to the toilet. Successfully applying this skill can give clients the confi dence to participate in activities outside of their home.

Bladder and Bowl RetrainingBladder and bowel retraining is used to restore normal daily function. Bladder training aims to increase the bladder’s storage capacity by changing voiding habits or behaviors and progressively delaying the urge to void. In contrast, for persons with abnormally large bladders, bladder training may involve using a more frequent or scheduled voiding pattern. Bladder training has

been shown to reduce episodes of UI by at least 50%.30

Bowel retraining involves teaching strategies to improve the consistency of stool; establish a regular, predict-able time for elimination; and stimu-late emptying on a routine basis. As elimination becomes more regular and predictable, and stools become more formed and easier to control, individu-als become less fearful of having an incontinent episode in public and are more confi dent leaving home. This reduces their tendency to become isolated or homebound.31

Diet and Fluid InstructionSome foods and beverages irritate the bladder or bowel, creating the sensation of urgency and causing frequency or leakage. The amount and timing of fl uid intake also has an infl uence on func-tion. During intervention for inconti-nence, practitioners educate clients in applicable dietary and fl uid infl uences and address behavioral changes. These simple changes can have a profound effect on bowel and bladder control, yet if overlooked they can preclude a suc-cessful outcome. Common dietary irri-tants include caffeine, citrus juice and fruit, alcohol, tomato-based products, artifi cial sweeteners, and spices.32,33

Pain DesensitizationWhen pain or soft tissue restriction impairs bowel, bladder, and sexual func-

tion, occupational therapy intervention may include desensitization techniques and soft tissue mobilization. Clients may be taught to use vaginal dilators, soft tissue massage, and relaxation strategies as part of their home program.

CASE EXAMPLE The following example demonstrates an occupational therapy approach to urinary continence/overactive bladder.

Irene is a 72-year-old woman who was referred to occupational therapy for bladder urgency, frequency, and incontinence. In the months prior to her referral her problem had gradu-ally worsened, and her fear of having an incontinent episode in public had caused her to become homebound. Irene also had constipation, which affected her quality of life and con-tributed to her UI. The occupational therapist educated Irene on the role of diet and suggested that she reduce her caffeine intake and increase her dietary fi ber. PFM re-education was provided. As Irene gained better control of her pelvic fl oor muscles, she was taught how to inhibit bladder urges, particu-larly when she was out in the commu-nity. She was also taught how to relax her PFMs during a bowel movement. Over the course of therapy, Irene’s bowel patterns became more regular and she was able to control her bladder urges, signifi cantly reducing her uri-nary frequency and incontinence. As Irene’s bladder control improved, she had the confi dence to attend church services and engage in community activities. She was also able to resume her twice-weekly exercise group.

OPPORTUNITY FOR OCCUPATIONAL THERAPYIncontinence and pelvic fl oor disorders are common problems that profoundly affect one’s ability to function in daily life. Due to the personal nature of these problems and their embarrassing symp-toms, many people fail to seek help from their health care provider.34 As occupa-tional therapy practitioners, we address intimate self-care skills. We are there-fore well suited to identify and assist clients with incontinence problems. The words of a client describe the potential impact of our intervention: “This has been a lifesaver. I didn’t know what to

Table 1. Instructions for Controlling Urinary Urge■ Stop what you are doing and stand

still. Sit down if you can. Remain very still.

■ Relax your body and take a few deep breaths.

■ Squeeze your pelvic fl oor muscles gently and repeat as necessary to help quiet your bladder or bowel.

■ Keep the rest of your body relaxed.

■ Stay calm and concentrate on sup-pressing the urge feeling.

■ When the urge feeling subsides, walk slowly to the bathroom.

■ Stop and repeat the previous steps along the way as needed to stay in control.


do or where to turn...I couldn’t go on with my normal life the way it was.”

The conservative treatment of incon-tinence and pelvic fl oor disorders is an effective and underdeveloped area of rehabilitation that occupational therapy practitioners are qualifi ed to expand. This area of practice holds great poten-tial and reward for professional growth. More importantly, developing this area of practice has the potential to affect many persons with these problems. ■

Brenda Neumann, OTR, BCIAC-PMDB; Jeannette

Tries, PhD, OTR, BCIAC-PMDB; and Mary Plummer,

OTR, BCIAC-PMDB, practice at the Center for

Continence and Pelvic Floor Disorders at Aurora

West Allis Medical Center in Milwaukee, Wisconsin,

treating both women and men with incontinence

and pelvic fl oor disorders. They share more than

50 years of experience in this treatment area and

provide training and mentoring to health care

professionals interested in this topic. Please direct

correspondence to Brenda Neumann at bneumann@

wi.rr.com.

Brenda Neumann and Tiffany Lee will be presenting

a workshop at AOTA’s Annual Conference & Expo in

Houston titled “An Introduction to the Treatment of

Incontinence” on Sunday, April 26.

References 1. Nygaard, I., Barber, M. D., Burgio, K. L., Kenton,

K., Meikle, S., Schaffer, J., et al. (2008). Preva-lence of symptomatic pelvic fl oor disorders in women. JAMA, 300, 1311–1316.

2. Stewart, W. F., Van Rooyen, J., Cundiff, G., Abrams, P., Herzog, A. R., Corey, R., et al. (2003). Prevalence and burden of overactive bladder in the United States. World Journal of Urology, 20, 327–336.

3. Hu, T.W., Wagner, T. H., Bentkover, J., LeBlanc, K., Zhou, S. Z., & Hunt, T. (2004). Costs of uri-

nary incontinence and overactive bladder in the United States: A comparative study. Urology, 63, 461–465.

4. Hajjar, R. R. (2004). Psychosocial impact of urinary incontinence in the elderly population. Clinics in Geriatric Medicine, 20, 553–564.

5. Nygaard, I., Turvey, C., Burns, T., Crischilles, E., & Wallace, R. (2003). Urinary incontinence and depression in middle-aged United States women. American College of Obstetrics and Gynecolo-

gists, 101(1), 149–156. 6. Bharucha, A. E., Zinsmeister, A. R., & Locke, R.

G. (2005). Prevalence and burden of fecal incon-tinence: A population-based study in women. Gastroenterology, 129, 42–49.

7. Fultz, N. H., Fischer, G. G., & Jenkins, K. R. (2004). Does urinary incontinence affect middle-aged and older women’s time use and activity patterns? American College of Obstetrics and

Gynecologists, 104, 1327–1334. 8. Handa, V. L., Harvey, L., Cundiff, G. W., Siddique,

S. A., & Kjerulff, K. H. (2004). Sexual function among women with urinary incontinence and pelvic organ prolapse. American Journal of

Obstetrics and Gynecology, 191, 751–756.

F O R M O R E I N F O R M A T I O N

PUBLICATIONSBiofeedback: A Practitioner’s GuideEdited by M. S. Schwartz & F. Andraski, 2003. New York: Guilford. (Chapters 26: Urinary Incontinence, 27: Fecal Incontinence, and 28: Pelvic Floor Disorders).

Disorders Related to Excessive Pelvic Floor Muscle TensionBy J. Tries, n.d. International Foundation for Functional Gastrointestinal Disorders, Fact Sheet 109 ($4)www.iffgd.org/store/viewproduct/109

Strategies for Establishing Bowel ControlBy M. K. Plummer, 2006. International Founda-tion for Functional Gastrointestinal Disorders, Fact Sheet 302 (free). www.iffgd.org/store/viewproduct/302

TRAINING/COMPETENCYBiofeedback Certifi cation Institute of America (BCIA)Offers certifi cation in pelvic fl oor muscle dysfunction biofeedbackhttp://www.bcia.org or 866-908-8713

Treatment of Bowel, Bladder, and Pelvic Floor Disorders Marquette University, June 17–20, 2009An annual course with occupational therapy faculty that meets didactic and practicum requirements for certifi cation through BCIA. www.marquette.edu/chs/cont-ed/pelvic.shtml

ORGANIZATIONSInternational Foundation for Functional Gastrointestinal Disorders www.iffgd.org or 888-964-2001

National Association for Continencewww.nafc.org or 1-800-bladder

Society of Urologic Nurses and Associates www.suna.org or 888-827-7862

Continued on page 18

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The benefi ts of animal assisted therapy as an occupational therapy modality are sup-ported in the literature.1–3

However, many practitioners are not aware of the professional role of assistance dogs as an assistive technol-ogy (AT) option.4 The services offered by assistance dogs are not the same as those offered during animal assisted therapy. Although both have therapeutic value, animal assisted therapy involves a health or human services professional and a qualifi ed animal working as a team to meet specifi c measurable goals.5

Assistance dogs are formally trained for and permanently placed with individuals who have physical disabilities, seizures, diabetes, visual or hearing impairments, autism, or psychiatric disabilities.

AT USE AND ABANDONMENTThe AT abandonment rate is approxi-mately 33% and frequently occurs within the fi rst 3 months of procure-

ment.6,7 Abandonment results from pro-viders not fully considering the client’s opinion and preferences, changes in functional ability, ineffectiveness of the device, decreased motivation, lack of training, device stigma, accessibility issues, and/or insuffi cient maintenance and repair information.6–8 Proper AT placement should focus on improved physical functioning and well-being, quality of life, social participation within meaningful contexts, and a decreased need for assistance from others.7,9 For some people, assistance dogs can facili-tate these outcomes.10,11

TYPES OF ASSISTANCE DOGSEven if you aren’t involved in training or placing an assistance dog, you can help facilitate the process for a client by understanding the different jobs that dogs can do and the standards that both the dogs and clients must meet to be considered for placement. According to Assistance Dogs International (ADI),

assistance dog is a general term that refers to three specifi c subcategories: guide dogs, hearing dogs, and service

dogs.12

Guide dogs serve individuals with visual impairments or blindness. They are trained for basic obedience and skilled tasks, including guiding around obstacles or overhangs, crossing streets, and accessing public transportation. The recipient must be able to give direc-tional cues. The dog must respond to voice commands or hand signals in all environments, and walk in a controlled position next to the handler. The dog’s role includes ensuring the team’s safety by disobeying unsafe commands, such as refusing to walk into traffi c.12

Hearing dogs assist people who have hearing impairments or are deaf. Dogs alert their owners to common house-hold or work sounds, including alarms, doorbells, the person’s name being called, timers, and even crying children. The dogs are trained to respond to basic

MELISSA WINKLE

BROOKE ZIMMERMAN

Using assistance dogs may help overcome many of the barriers associated with traditional assistive technology.

Assistance DogsAn Assistive Technology Option


obedience via voice or hand signals, alert to at least three sounds (each within 15 seconds from the start), and demonstrate physical contact or some other behavior to indicate the sound’s source.12

Service dogs may be trained to per-form a broad scope of tasks for people with conditions other than visual or hearing disabilities.12 In one study, own-ers reported that service dogs assisted them in 28 functional tasks, which resulted in a decreased need for paid assistance by 2 hours per week and a decreased need for unpaid assistance by 6 hours per week, allowing for increased privacy and autonomy.13 Individuals with neuromusculoskeletal dysfunc-tion may ask service dogs to operate an out-of-reach automatic door opener, immediately retrieve dropped items, provide balance and counter-balance for transitional movements, and open doors and drawers to help conserve energy for more meaningful activities. Service dogs are capable of gathering activities of daily living (ADL) supplies and can offer assistance with dressing and undressing activities.

Some dogs have the gift of detect-ing a seizure or a diabetic emergency before or during the occurrence and can be trained to alert the handler or a caregiver. They may also be trained to prevent and respond to a crisis by carrying medical supplies in a backpack, incessantly barking to draw attention, retrieving a phone or using a call switch to activate emergency services, or stay-ing by the handler’s side as he or she becomes reoriented after an episode.14 Some dogs also are trained for individu-als with autism, as they are capable of decreasing wandering and fl ight responses, and can perform search-and-rescue tasks.15 Other dogs are trained to assist individuals with psychiatric disabilities by carrying medications, alerting to over sedation, decreasing panic and anxiety, and providing reality orientation.16

Additional documented benefi ts of assistance dogs as a group include improved social interaction and social competence (by increasing the dura-tion, frequency, and comfort level of interactions); psychosocial function (by decreasing depression, anxiety, and loneliness); life satisfaction (by increas-

A Client PerspectiveIngrid C. Hendrix

My journey to obtaining a service dog began after I took a particularly nasty fall in my home. I have limb girdle muscular dystrophy, which causes limited mobility and poor balance. I had to painstakingly crawl from the living room to the sunroom, at the opposite end of the house, to reach

the telephone. After calling for help, I had to crawl back to the front door to unlock it and let my neighbors in. Lying on the fl oor in an exhausted heap, I thought, “There must be a better way.”

Some might recommend a lock box or a medical alert button. Although I did get a lock box, the medical alert system seemed like something for old people, and I wasn’t crazy about having strangers come to my aid. Besides, I love animals and I thought an assis-tance dog would be a wonderful way to have the best of both worlds—a furry companion and a helper.

I began researching assistance dog programs and found that many required long distance travel, extended training time, or a lot of money. With a full-time job and a disability, it seemed out of the question. Further investigation led me to Assistance Dogs of the West (ADW), only an hour from my home. The program felt smaller and seemed to offer more individualized service. There was even a functional evaluation and needs assessment by an occupational therapist, which was a required part of my application.

I periodically traveled to ADW for the interview process, which involved meeting with the trainer and a series of dogs in effort to make a good “match.” That is when Fenn, a handsome and very social Labrador retriever, selected me. I took 2 weeks off of work and went to the placement training to learn about dog behavior, grooming, health, and the language Fenn was trained with. These 2 intensive weeks were both physically and mentally draining, but this is also when our human–animal bond (personal and professional) began. This type of placement training is typical of many programs, and I needed to enlist the aid of a family member during this time to help me with personal care needs—a factor to consider when one is applying for a dog.

It has been almost 4 years since I was placed with Fenn. The fi rst 6 months or so were very tiring because I was constantly on high alert, making sure he was under my control 24/7. Now I can better anticipate his needs and behavior, and it’s a more relaxed relationship. Having a service dog is a huge adjustment because unlike with a pet dog it is with you constantly, including public places like restaurants, movie theaters, and stores. Although service dogs provide a lot of assistance (opening doors, picking things up, bracing, companionship) they also require a lot of work. Regardless of my energy level or the weather conditions, Fenn requires feeding, grooming, vet visits, walks, and bathroom breaks at work or social gatherings.

Although a caregiver or typical AT equipment could get the job done, Fenn provides the added benefi t of constant companionship, eager assistance, and the social lubrica-tion required for others to approach and converse with me. An assistance dog can be a rewarding experience; however, it is not a relationship to be approached lightly. ■

Ingrid C. Hendrix, MILS, AHIP, is the nursing services librarian at the University of New Mexico (UNM) Health Sciences Library and Informatics Center. She is also the library liaison to the UNM Occupational and Physical Therapy departments, where she teaches literature searching skills to students. She is working with Melissa Winkle and Dr. Terry Crowe at the University of New Mexico on an evidence-based review of the assistance dog literature and a research study examining functional outcomes for assistance dog owners.

Ingrid and Fern working together


ing engagement and independence); and mental function (by facilitating skill development), among others.11,13,17–19

IDENTIFYING REPUTABLE ASSISTANCE DOG TRAINING ORGANIZATIONSLocating a reputable individual trainer or training organization can be a daunt-ing task. Practitioners who are unfa-miliar with the referral and placement process can look to ADI to get started. There are reputable organizations that are not members of ADI; however, we recommend looking at ADI standards as a comparison when making a selection. ADI is a coalition of many international, independent, nonprofi t organizations that train and place assistance dogs; they have assembled minimum stan-dards to protect the dog to ensure humane training techniques; to educate human recipients; to evaluate the dog’s temperament, health, and ability to perform the tasks the client needs; and to consider the lifestyle within which the dog will live and work.20 Although the member organizations share standards, there may be differences in program procedures and operations.

ADI estimates that it takes 1 to 2 hours of training per day, totaling 180 to 360 hours, to produce a well-trained service dog.20 The dogs are not placed until they are 1 1/2 to 2 years old so they have time to mature and experi-ence a variety of situations. Because the demand is greater than the supply, the national average waiting period for a trained dog is 5 years, and the average cost for an organization to train one dog is approximately $25,000 to $30,000.21 The amount paid by clients can range from nothing to the actual cost, depending on the funding to individual organizations.

Organizations vary in the quantity and types of skills and cues the dogs are taught, just as the needs of individuals with disabilities vary. When researching information about an organization, prac-titioners should inquire about trainer education, methods and experience in dog training relative to the complexities of disabilities, regular skill sets (cues taught) and specialized training criteria, number and percentage of successful placements, total costs for procurement, funding options, placement training

expectations, public access training, ownership of dog, follow-ups, plans if a placement fails, ages and abilities for whom dogs are trained, wait list time, and geographical area served.

IDENTIFYING AND REFERRING CLIENTS FOR ASSISTANCE DOGSEvidence-based data is scarce regarding variables that affect successful place-ments. Although identifying appro-priate human referrals is not yet an exact science, potential dog recipients should be evaluated regarding current abilities and needs; living and working environments that are conducive to a dog performing required tasks; and the demonstrated ability to care for, manage, and direct the dog. Working an assistance dog requires short- and long-term memory; skills with problem solving, sequencing, and generalization; a way to communicate to cue the dog; patience to develop a relationship with the dog; and the ability to both accept and respond to feedback. Other areas include fi nancial ability for procurement costs and routine care for a dog if not provided by the organization; family and friends who understand and support the role of the dog; and the ability to attend the required placement training, which may involve traveling away from home for weeks at a time. Research has found that assistance dogs can exceeded expectations in helping people to feel better, providing companionship, and meeting their needs; however, dog care, training, and traveling can be more diffi cult than anticipated.22 Lastly, for better or worse, clients should realize that having an assistance dog might call attention to their disability.

OTHER OT ROLESClients should be made aware of a variety of AT options so they can make informed decisions. If an assistance dog is the best option, practitioners can take

an active role in preparing clients; help-ing to fi nd funding; and making modi-fi cations to items such as gate latches, dog doors, feeding apparatus, commonly used tools (leashes, brushes, etc.), pegs on wheelchairs to hold a leash, and communication devices. They also can assist with establishing hand signals or establishing routines related to dog maintenance so that the person–dog team can meet the goal of indepen-dence. Practitioners also can become valuable team members for assistance dog training organizations because our services complement theirs.

CONCLUSIONEach type of assistance dog must meet specifi c training criteria to assist with tasks unique to their role, in addition to meeting the criteria established by each training organization. Therefore, the process of making referrals and offer-ing assistance with placement should be an extremely client-centered, team approach. Dogs can offer assistance in many areas of occupation and across many environments, but they are not appropriate for everyone. ■

Melissa Y. Winkle, OTR/L, provides intervention

services, national workshops, program develop-

ment, and consulting through her private practice,

Dogwood Therapy Services Inc., in Albuquerque,

New Mexico. Her special interests include develop-

mental disabilities, nature therapy, animal assisted

therapy, and assistance dogs as assistive technol-

ogy options. Under the guidance of Terry Crowe,

PhD, OTR/L, FAOTA, at the University of New

Mexico, she and Sue Zapf, MA, OTR, ATP, CTRS,

are co-authoring the revisions to the Service Animal

Adaptive Intervention Assessment, to help health

care providers improve their ability to refer clients

for assistance dogs as AT options. She is presenting

at the Institute “Animal-Assisted Interventions: The

Guiding Principles and Research” at AOTA’s Annual

Conference & Expo.

Brooke D. Zimmerman, MOT, OTR/L, is an occupation-

al therapist employed by Dogwood Therapy Services

Inc. and Amedisys Home Health Care in Albuquerque,

New Mexico, working with children, adults, and geri-

atric clients with a variety of cognitive and physical

disabilities. She has co-developed and implemented

animal assisted therapy programs within a skilled

nursing/long-term-care facility and an acute psychiat-

ric hospital, and has integrated programming at Dog-

wood Therapy Services Inc. Her special interest is

intervention for people with cognitive and psychiatric

disabilities through animal assisted therapy.

F O R M O R E I N F O R M A T I O N

Assistance Dogs Internationalwww.assistancedogsinternational.org/

International Association of Assistance Dog Partners www.iaadp.org

Continued on page 22


P E R S P E C T I V E S

TCan This Marriage Be Saved?

Nancy Mattei

his is my 25th anniversary as an occupational therapist. To take the analogy in the title further, I had had enough of my career as a modern dancer and fell in love with occupational therapy. And then, after 25 years of practic-ing, I found myself—as happens in many relationships—out of touch with my profession. What follows is an account of a way lost and then found.

Occupational therapy appealed to me instantly: its start in the Progressive Era, the philosophy of the “whole person,” recovery through activity, the history of service. The women founders were a source of pride. At the University of Illinois I became totally engaged with the sci-ence of occupational therapy and its human expression.

I was thrilled with my fi rst job, at Mercy Hospital on the south side of Chicago, in the general medicine and surgery unit. The department had a strong foundation in occupa-tional therapy philosophy. My fellow occupational therapists and director surrounded me with their sophistica-tion and professionalism and further grounded me. (I’ve consciously withheld names—no one wants to be identifi ed as participating in a messy marriage!) And then there were all the generous patients who trusted me.

Thus my new life and work regime began. I identifi ed hand therapy as a special interest and continued to develop skills and a certifi cation. It was a fascinatingly technical fi eld that I enjoyed immensely. I returned to the well many times over the years to learn new techniques and expand my knowledge. In time, I moved into more

manual treatment with myofascial techniques and Travell’s trigger point treatment.

But looking back, I never took time to revisit the roots and the fundamen-tal ideas of occupational therapy. I could still explain to patients the basic defi nition of occupational therapy, but I was out of touch with its deeper spirit. In becoming very technically profi cient, I lost sight of the patient’s intrinsic ability to lead the way, direct the treatment, and heal. I was “fi xing” patients.

Last summer I continued my studies with a craniosacral treatment class—seemingly very far from occu-pational therapy. As I was listening to the teacher talking about the patient–client relationship, the wholeness of the client, the inherent health of the client, and the balance between an active client and a listening therapist, I began to think back on my occupa-tional therapy beginnings. I had heard all of this before.

This sent me back to a brief read-ing of the history of occupational therapy. During that reading, I came

upon a Wilma West citation that intrigued me. I sourced the quote back to her 1967 Eleanor Clarke Slagle lecture, “Responsibility in Times of Change.”1 (I recommend you read the lecture in its entirety for its imaginative power in considering the future, as well as its challenge for action.) The following are her fi ve main principles from the lecture: 1. Identify with the fi eld of health, thus broadening our traditional identifi cation with medicine. 2. Enlarge our concept of therapist to that of being a

health agent responsible for normal growth and development.

3. Think more about roles in preven-tion as well as those in treatment and rehabilitation.

4. Think more about socioeconomic, cultural, and biologic causes of disease and dysfunction.

5. Think more about serving health needs of people in many settings other than the hospital.

West was no “New Ager.” She retired from the armed services as a major in 1968 after 20 years. She believed in the integrity of the whole person and the power of that integrity to achieve normal development and to heal. Our patients are larger than their pathology. They have all the resources and riches that come with being human beings. I knew this in my core 25 years ago but had lost touch.

Looking back, I have to admit I wavered in establishing the proper relationship “energy” with my patients. I was too intent on them getting better in a specifi c way that I valued. I had

A love letter to our history and profession


the information. I knew the research. I knew the anatomy. And although I did listen to them and I understood their goals, I didn’t inherently trust the natural process. I appointed myself the “fi xer.” That role becomes an over-consuming task that can never be achieved.

My patients may have believed that I fi xed them. Yet when I fell into that thought pattern, it didn’t serve them or me. (With all the exquisite techniques of the hand surgeons and hand therapists, it is understandable how we get into this.) When one “fi xes,” the experience is framed in a very limited way. It gives too much of the authority to the “fi xer.” It doesn’t allow an equal relationship based on trust in the ability of the patient to heal.

The patients with orthopedic condi-tions whom I have seen for the past 25 years haven’t come to me for some philosophical, intellectual, spiritual, or alternative experience. They have specifi c problems they want addressed.

The healing of a bone is a very precise, intrinsic process. One offers each patient a very precise treatment to support the healing. How a therapist engages with the patient—the matrix of the experi-ence; that is, the relationship—is just as precise as the cellular bone healing. That engagement has to be fi ne tuned to fi t that particular relationship, on that par-ticular day (I learned this as “therapeutic use of self”). Indeed one cannot separate the treatment and the matrix. This is the art of occupational therapy. As a for-mer teacher said, “What is occupational therapy without that?” This explanation won’t fi t into a code, it can’t be billed, but it is the spirit behind everything we do.

In her Slagle lecture, West cites the famous quote from Santayana: “He who neglects history will be condemned to repeat it.” May I amend this to say, “He who neglects history will not be able to repeat it.” We want to be able to repeat what we learned as young occupational therapists.

I feel I’ve come back to the source that originally sustained me. I am grateful to a profession whose illustrious history and body of philosophy really explains the human condition. Grateful to all the men and women who made an invaluable pro-fession out of ideas and dreams. (I can’t imagine health care without the profes-sion of occupational therapy.) Grateful to the thousands of patients who have allowed me the privilege of being part of their lives in a meaningful way.

This is my love letter to our history and profession. I think this marriage can be saved. ■

Reference1. West, W. L. (1967). 1967 Eleanor Clarke Slagle

Lecture: Professional responsibility in times of

change. In A Professional Legacy: The Eleanor

Clarke Slagle Lectures in Occupational Thera-

py, 1955–2004 (2nd ed., pp. 141–151). Bethesda,

MD: AOTA Press.

Nancy Mattei, OTR/L, CHT, has been practicing the

art and science of occupational therapy for 25 years

in the Chicagoland area.

Treating Incontinence and Pelvic Floor Disorders Continued from page 13

9. Salonia, A., Zanni, G., Nappi, R. E., Briganti, A., Deho, F., Fabbri, F., et al. (2004). Sexual dysfunc-tion is common in women with lower urinary tract symptoms and urinary incontinence: Results of a cross-sectional study. European

Urology, 45, 642–648. 10. Agency for Healthcare Policy and Research.

(1996). Urinary incontinence in adults: Acute

and chronic management: Clinical Practice

Guideline Number 2 (AHCPR Publication No. 96-0682). Washington, DC: U.S. Government Printing Offi ce.

11. Cho, C. Y., Alessi, C. A., Cho, M., Aronow, H. U., Stuck, A. E., Rubenstein, L. Z., et al. (1998). The association between chronic illness and func-tional change among participants in a comprehen-sive geriatric assessment program. Journal of the

American Geriatrics Society, 46, 677–682.12. Holroyd-Leduc, J. M., Mehta, K. M., & Covin-

sky, K. E. (2004). Urinary incontinence and its association with death, nursing home admission, and functional decline. Journal of the American

Geriatrics Society, 52, 712–718.13. Norton, C., Whitehead, W. W., Blis, D. Z., Metsola,

P., & Tries, J. (2005) Conservative and pharma-cological management of faecal incontinence in adults. In P. Abrams, L. Cardozo, S. Khoury, & A. Wein (Eds.), Incontinence management, 3rd

international consultation on incontinence (Vol. 2, pp. 1521–1563). Halifax, United King-dom: Health Publications Limited.

14. Wilson, P.D., Berghmans, B., Hagen, S. Hay-Smith, J., Moore, K., Nygaard, I., et al. (2005). Adult conservative management. In P. Abrams, L. Cardozo, S. Khoury, & A. Wein (Eds.), Inconti-

nence management, 3rd international consul-

tation on incontinence (pp. 855–964). Halifax, United Kingdom: Health Publications Limited.

15. Hanno, P., Barnanowski, A., Fall, M., Gajewski, J., Nordling, J., Nyberg, L., et al. Painful bladder

syndrome. (2005) In P. Abrams, L. Cardozo, S. Khoury, & A. Wein (Eds.). Incontinence man-

agement, 3rd international consultation on

incontinence (pp. 1455–1520). Halifax, United Kingdom: Health Publications Limited.

16. American Occupational Therapy Association. (2004). Scope of practice. American Journal of

Occupational Therapy, 58, 673–677.17. American Occupational Therapy Association.

(2008). Occupational therapy practice framework: Domain and process (2nd ed.). American Journal of Occupational Therapy,

62, 625–683.18. O’Donnell, P. D. (1998). Behavioral modifi cation

for institutionalized individuals with urinary incontinence. Urology, 51(Suppl 2A), 40–42.

19. Tries, J., & Eisman, E. (1995). Biofeedback for the treatment of urinary incontinence. In M. E. Schwartz (Ed.), Biofeedback: A practitioners

guide (2nd ed.; pp. 597–631). New York: Guilford.20. Chirarelli, P. (1997). Manual muscle test for

the pelvic fl oor muscles. In The gynecological

manual. Alexandria, VA: American Physical Therapy Association.

21. Bump, R. C., Hurt, W. G., Fantl, J. A., & Wyman, J. F. (1991). Assessment of Kegel pelvic muscle exercise performance after brief verbal instruc-tion. American Journal of Obstetrics and

Gynecology, 165, 322–327.22. Tries, J. (1990). Kegel exercises enhanced by

biofeedback. Journal of Enterostomal Therapy,

17(2), 67–76. 23. Burgio, K. L., Robinson, J. C., & Engel, B. T.

(1986). The role of biofeedback in Kegel exer-cise training for stress urinary incontinence. American Journal of Obstetrics and Gynecol-

ogy, 154, 58–64.24. Tries, J., & Brubaker, L. (1996). Application of

biofeedback in the treatment of urinary inconti-nence. Professional Psychology: Research and

Practice, 27, 554–560.25. Burgio, K. L., Locher, J. L., Goode, P. S., Hardin,

J. M., MacDowell, B. J., Dombrowski, M., et al. (1998). Behavioral vs. drug treatment for urge

urinary incontinence in older women: A random-ized controlled trial. JAMA, 280, 1995–2000.

26. Siegel, S. W., Richardson, D. A., Miller, K. L., Karram, M. M., Blackwood, N. B., Sand, P. K., et al. (1997). Pelvic fl oor electrical stimulation for the treatment of urge and mixed urinary incontinence in women. Journal of Urology, 50, 934–940.

27. Yamanishi, T., Yasuda, K., Sakakibara, R., Hat-tori, T., Ito, H., & Murakami, S. (1997). Pelvic fl oor electrical stimulation in the treatment of stress incontinence: An investigational study and a placebo controlled double-blind trial. Journal of Urology 158, 2127–2131.

28. Moore, K. (2000). Treatment of urinary incon-tinence in men with electrical stimulation: Is Practice Evidence-Based? Journal of Wound,

Ostomy, and Continence Nursing, 27, 20–31. 29. Burgio, K. L. Pearce, L., & Lucco, A. J. (1989).

Staying dry: A practical guide to bladder con-

trol. Baltimore: Johns Hopkins. 30. Fantl, J. A., Wyman, J. F., McClish, D. K.,

Harkins, S. W., Elswick, R. K., Taylor, J. R., et al. (1991). Effi cacy of bladder training in older women with urinary incontinence. JAMA, 265, 609–613.

31. Plummer, M. (2002). Strategies for establishing

bowel control (IFFGD Fact Sheet 302). Milwau-kee, WI: International Foundation for Functional Gastrointestinal Disorders.

32. Jeter, K.F., & Faller, N. (1996). Diet and daily

habits: Can this affect your bladder control?

Spartanburg, SC: National Association for Continence.

33. Thompson, W. G. (2003). Chronic diarrhea:

Could it have an every day cause? (IFFGD Fact Sheet 150). Milwaukee, WI: International Foundation for Functional Gastrointestinal Disorders.

34. Morril, M., Lukacz, E. S., Lawrence, J. M., Nager, C. W., Contreras, R., & Luber, K. M. (2007). Seeking healthcare for pelvic fl oor disorders: A population-based study. American Journal of

Obstetrics and Gynecology, 197, 86.e1–86.e6.


O C C U P A T I O N I N A C T I O N

At its 2007 spring meeting, AOTA’s Representative Assembly (RA) passed a motion to begin a series of articles in OT Practice highlighting occupational therapists and occupational therapy assistants using engagement in occupation to support participation across the continuum of rehabilitation and disability. The RA Coordinating Council (RACC) will be working closely with AOTA’s president to provide leadership and oversight with these articles. If you are interested in sharing your own “occupa-tion in action” please send an e-mail to [email protected] for the guidelines.

FWorking With Homeless Families

Winifred Schultz-Krohn

amilies who are homeless and seek shelter at the Family Supportive Housing Program are referred to occupational therapy for a variety of reasons, including stress man-agement, diffi culties with prob-

lem-solving skills, and lack of family leisure pursuits. The shelter, located in Northern California, serves homeless families in which there is at least one adult over the age of 18 who is respon-sible for at least one child under the age of 18. This can include a mother and her children, two-parent families, grandparents and grandchildren, or aunts and uncles who are responsible for nieces and nephews. People who are homeless represent an under-served population that could benefi t from occupational therapy services.1

Individuals within the family are sometimes referred for the following reasons:■ Parents: Services are provided to

enhance and support parenting skills, fi nancial management, work readiness, and home management to include the previously men-tioned broader reason for referrals.

■ Children and teens: To assess and foster appropriate developmen-tal skills, decision-making skills, activities of daily living (ADL)

skills, educational skills, and stress management.

■ Infants and parents: To address par-enting skills and enhance bonding, along with providing developmental screening and services to foster developmental skills.

As families enter the shelter, which can house up to 36 families at a time, they are provided with their own bedroom, access to shared bathrooms, and a dining area. All meals are provided by the shelter. The families are allowed to stay at the shelter for 3 months while the adults search for work, housing, and sup-port services. Each family is assigned a case manager, who typically refers them to occupational therapy services, but self-initiated referrals also occur. The majority of occupational therapy services are provided at the shelter, but services are also offered to families through two programs after they leave the shelter (not all families participat-ing in these two programs receive occupational therapy services). These two programs are directed by the Family Supportive Housing Program.

One program is Transitional Housing, in which fi nancial support is provided on a decreasing basis over 2 years as families become more fi nancially capable. The other program is Aftercare, in which families are followed for 1 year to support their ability to manage their fi nances in the community. The case managers evaluate each family’s needs and make recommendations for participation in one of the two programs. The manag-ers of each program refer families to occupational therapy for several reasons, including diffi culties with time and fi nancial management, stress management, and decision-making skills. Services are typically provided

on a consultative basis, either two or three times a month.

Most homeless parents experience depression and stress,2,3 which com-promises their performance of ADL and instrumental ADL. Many of the parents have limited problem-solving and budgeting skills. With the loss of their home, many experience disen-franchisement from the general com-munity, diminished social supports, and limited control over their environ-ment. Homeless parents often have limited work experience, have lived in tenuous situations before becoming homeless, and have a history of mental health problems or substance abuse.4,5 Many do not have a high school diploma or equivalent, further limiting their access to well-paying jobs.

All of these factors compromise the ability of homeless persons to construct and engage in productive activities. Most experience a lack of energy and have diffi culties prioritiz-ing tasks. They often report feeling overwhelmed and unable to meet the demands needed to extricate themselves from being homeless. School-age children and teens have a high incidence of school absences, and frequent school changes during an academic year compromise their educational pursuits.

At this shelter, the most fre-quently used occupational therapy assessments are the Occupational Self Assessment (OSA)6 and the Child Occupational Self Assessment (COSA)7 because they facilitate the development of client-centered goals. Additional instruments, such as the Beck Depression Inventory8 and the Sensory Profi le,9 or developmental screening tools such as the Denver Developmental Screening Test—II10 are also used as needed. Nonstandard-ized assessments, such as interviews,


are used for each client to further evalu-ate individual occupational needs.

To determine client goals, we explain the process of occupational therapy services, including the standardized assessments or interviews. The OSA and COSA allow clients to identify important occupational pursuits, then we estab-lish specifi c outcome goals through the interview process. For example, an item from the OSA such as “accomplishing my goals” would be operationally written to refl ect a specifi c outcome, such as complete three job applications to secure employment. This process provides a common agreement between the client and therapist about what needs to be addressed during the session and rea-sonable time frames to meet each goal. Evaluation reports are generated for the initial session, and notes are written using a SOAP (subjective, objective, assess-ment, plan) format. The most typical challenge is scheduling and addressing all the needs of clients. We address this chal-lenge by helping clients prioritize their concerns and by focusing on what issues are most important for them while they are living at the shelter.

After the goals are determined, inter-vention includes evaluating the status of the goals and working on the systematic skills needed to accomplish them. The cli-ent and therapist work together on a task, then the therapist provides exercises or activities to be accomplished before the next session. For example, securing employment often requires developing interviewing skills and anticipating ques-tions from a potential employer. During a session the client and therapist may review basic interviewing skills and how to anticipate questions from a potential employer. The client will bring employ-ment ads to the next session, and the interview practice will be tailored to these jobs. Reevaluation occurs periodically during the occupational therapy interven-tion, and a formal reevaluation occurs at the end of the family’s stay at the shelter.

A common goal among our clients is to improve their fi nancial management skills. One client would keep all her receipts but did not record the amount of money she spent each day. She would overspend on incidentals and not have suffi cient savings for a fi rst and last month’s rent deposit, so she was unable to get an apartment. In her occupational

therapy sessions we established a system for her to record her expenditures for 1 week, which helped her develop a sense of what she spent during this period. We then helped her create and use a monthly budgeting form so she could track her expenditures during the month. We often provide instruction on very basic math skills before working on money manage-ment and budgeting skills.

We sequence our interventions to be sure the client has the basic skills needed for the occupational performance skill being targeted, such as helping children with the words they can use to ask for assistance or to engage in play with peers, or working with parents on basic sequencing skills before they begin searching for a job. Many parents have identifi ed a need to express themselves more clearly. During the occupational therapy sessions we practice using basic vocabulary words that will clearly express their concerns and interests and then apply those skills during practice job interviews. Parents have reported that engaging in these practice opportunities has been very helpful during the actual job interview.

The clients we serve have demon-strated improved performance related to desired occupational areas. For example, children display better frustration toler-ance and have increased opportunity to play with peers during group occupational therapy sessions, teens have increased opportunity for inexpensive leisure pur-suits to mitigate the deleterious effects of being homeless, and parents learn positive parenting techniques and engage in leisure activities with their families.

One of the biggest problems of serving homeless families is that they are very transient and frequently leave the shelter before completing the program. Although most of the families stay at the shelter for the 3-month period, the need to secure housing and employment takes a priority over occupational therapy appointments, which are often cancelled or missed. Therefore we run several groups each day to provide services for children, teens, and parents, to give them multiple opportunities to participate.

We face signifi cant funding issues and are investigating alternative ways to sup-port occupational therapy services with this population. Currently, these occupa-tional therapy services are provided by

graduate fi eldwork students. I train and supervise the interns and provide my ser-vices on a pro bono basis. The population of homeless families is underserved, and occupational therapy provides a much-needed support. Occupational therapy service should not be driven only by a diagnosis, but should be provided to meet an occupational need. The engagement in occupation, the cornerstone of the profession, is important for all persons, including those who are homeless. ■

References 1. Petrenchik, T. (2006). Homelessness: Perspec-

tives, misconceptions, and considerations for occupational therapy. Occupational Therapy in

Health Care, 20(3/4), 9–30. 2. Cosgrove, L., & Flynn, C. (2005). Marginalized

mothers: Parenting without a home. Analysis of

Social Issues and Public Policy, 5(1), 127–143. 3. VanLeit, B., Starrett, R., & Crowe, T. K. (2006).

Occupational concerns of women who are homeless and have children: An occupational justice critique. Occupational Therapy in

Health Care, 20(3/4), 47–62. 4. Bassuk, E. L., Dawson, R., & Huntington, N.

(2006). Intimate partner violence in extremely poor women: Longitudinal patterns and risk markers. Journal of Family Violence, 21, 387–399.

5. Helfrich, C. A., Aviles, A. M., Badiani, C., Walens, D., & Sabol, P. (2006). Life skill interventions with homeless youth, domestic violence victims and adults with mental illness. Occupational

Therapy in Health Care, 20(3/4), 189–207. 6. Baron, K., Kielhofner, G., Iyengar, A., Goldham-

mer, V., & Wolenski, J. (2006). Occupational Self

Assessment. Chicago: Model of Human Occupa-tion Clearinghouse.

7. Baron, K., Kielhofner, G., Iyengar, A., Goldham-mer, V., & Wolenski, J. (2005). Child Occupa-

tional Self Assessment. Chicago: Model of Human Occupation Clearinghouse.

8. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory (2nd ed.). San Anto-nio, TX: Psychological Corporation.

9. Dunn, W. P., McIntosh, D. N., Miller, L. J., & Shyu, V. (1999). Sensory Profi le. San Antonio, TX: PsychCorp.

10. Frankenburg, W. K., Dodds, J., Archer, P., Bresn-ick, B., Maschka, P., Edelman, N., & Shapiro, H. (1989). Denver II. Denver, CO: Denver Develop-mental Materials.

Winifred Schultz-Krohn, PhD, OTR/L, BCP, SWC,

FAOTA, is a professor of occupational therapy at

San Jose State University. Her scholarly interests

include pediatric occupational therapy with exper-

tise in school-based practice and family centered

intervention, the needs of children and families in

homeless shelters, multicultural health care issues,

feeding problems, and neurological rehabilitation.

She is the co-editor of the 6th edition of Pedretti’s

Occupational Therapy: Practice Skills for Physical

Dysfunction textbook. She serves on the editorial

board of the Occupational Therapy Journal of

Research and the Journal of Occupational Therapy,

Schools & Early Intervention.

Call for Research on Fieldwork EducationDonna M. Costa

recent article reported the results of an exploratory study that examined the experiences of occupational therapists being in a supervisory role during students’ fi eldwork experiences.1 The author made a point of stating that there is little published evidence in the occupational

therapy literature that addresses fi eldwork education. I could not agree more; there is an abysmal lack of research being published related to occupational therapy fi eldwork educa-tion at a time when our profession is emphasizing the need to produce more evidence for what we do. Why is investigational research in this area so important? Because supervision in fi eldwork is as much an intervention as are treatment interventions being provided in the clinic. And, as stated in the study, “A theoretical perspective about supervision helps make sense of the experience, attempts to account for changes in student learning, and can help validate and direct effective clinical practices within the profession” (p. 156).1

Not since 1998 has there been a publication that focused on fi eldwork and examining outcomes. The Field-

work Anthology: A Classic Research

and Practice Collection2 devoted three of the seven sections to research on fi eldwork education. A literature search using the bibliographic tool OT Search yielded a listing of 734 articles published on “fi eldwork education,” but only 36 articles were found when the search was changed to “research on fi eldwork education,” and only 19 of these were published in the 11 years since the fi eldwork anthology2 was published. Of the few articles published on fi eldwork research, many were written by our colleagues in Canada,

Australia, New Zealand, and the United Kingdom. Occupational therapy fi eld-work educators and academic fi eldwork coordinators in this country have the broad-based knowledge and skills to produce this kind of research and could partner with academic faculty and stu-dents to design and implement these kind of studies. There are several fi eld-work consortia in the U.S. that could collaborate on some identifi ed research questions on fi eldwork outcomes. In the absence of an established consortia, educational programs and fi eldwork sites could collaborate to produce a broader database of fi eldwork informa-tion, since there are probably regional variations across the country. I am listing some ideas for research ques-tions that can be explored below and I encourage the readers of this column to identify others:■ Are there differences in outcomes

in fi eldwork when supervisors use different supervision models (i.e., one supervisor to one student, versus one supervisor to a group of students)?

■ When a program revamps its cur-riculum, or institutes other changes, are there differences in the learn-ing outcomes of students during fi eldwork?

■ What are the differences in learning during fi eldwork in those students who come from a school that uses a problem-based learning model, versus a program that has a more reductionist model?

■ What characteristics do students value in fi eldwork educators? Not since 1985 has this question been examined,3 and we know that we have a new generation of learners in our educational programs whose values and learning styles differ from those of over 2 decades ago.

■ What are the outcomes related to the sequencing of fi eldwork in educational programs curriculum design? Some programs schedule all Level II fi eldwork experiences after coursework has been com-pleted, whereas others schedule Level II fi eldwork experiences throughout the curriculum—is there a difference?

■ The American Occupational Ther-apy Association recently launched a Certifi cation Program for Fieldwork Educators. How do outcomes relate to the training that fi eldwork educa-tors receive?

These and many other topics could be identifi ed and pursued in occu-pational therapy and occupational therapy assistant programs across the country. Many of these topics would be ideal for master’s theses and doc-toral dissertations. Reviewing articles in other countries’ occupational therapy journals can give us ideas about research studies that could be replicated. Let 2009 be the beginning of our response to a Call for Research

on Fieldwork Education. ■

References1. Richard, L. (2008). Exploring connec-

tions between theory and practice: stories from fi eldwork supervisors. Occupational

Therapy in Mental Health, 24(2), 154-175.2. Privott, C. (Editor) (2008). The fi eldwork

anthology: A classic research and practice

collection. AOTA Press: Bethesda.3. Christie, B., Joyce, P., & Moeller, P.

(1985). Fieldwork experience, part II: The supervisor’s dilemma. American Journal of

Occupational Therapy, 39(10), 675-681.

Donna M. Costa, DHS, OTR/L, FAOTA, is a clinical

professor in the Occupational Therapy Program

at the University of Utah in Salt Lake City. She

is the author of Clinical Supervision in Occu-

pational Therapy: A Guide for Fieldwork and

Practice published by AOTA Press.

A


F I E L D W O R K I S S U E S


BK-105

Essential Resource from AOTA Press

Call 877-404-AOTAShop online store.aota.org

ISBN-13: 978-1-56900-232-2ISBN-10: 1-56900-232-0303 pages, 2007

Enhancing Human Occupation Through Hippotherapy A Guide for Occupational TherapyEdited by Barbara T. Engel, MEd, OTR, and Joyce R. MacKinnon, PhD, OT(C), OTR

Hippotherapy—using a horse as a partner in treating a variety of disabilities—is a strategy used throughout the world, fi rst developed in Germany and

Austria as a physical therapy modality. This book introduces hippotherapy to a wider occupational therapy audience and focuses on the differences in the use of the horse in the two professions. It covers a wide range of topics, including why this strategy is used, why it is effective, and how therapists can become involved in this dynamic community-based treatment. This evidence-based text is intended for educators, students, researchers, and practitioners.

Order #1106$55 AOTA Members$79 Nonmembers

Assistance DogsContinued from page 16

References 1. Sams, M. J., Fortney, E. V., & Willenbring, S.

(2006). Occupational therapy incorporating animals for children with autism: A pilot inves-tigation. American Journal of Occupational

Therapy, 60, 268–274. 2. Velde, B. P., Cipriani, J., & Fisher, G. (2005).

Resident and therapist views of animal-assisted therapy: Implications for occupational therapy practice. Australian Occupational Therapy

Journal, 52, 43–50. 3. Winkle, M., & Canfi eld, K. (2008). Considerations

for using animals in practice. OT Practice 13(5), 33–34.

4. Dapice, J. L. (2005). Occupational therapists

and the service dog community: Beliefs and

practice. Unpublished master’s thesis, Tufts University, Massachusetts.

5. Delta Society. (1996). Standards of practice for

animal-assisted activities and animal-assisted

therapy. Bellevue, WA: Delta Society. 6. Riemer-Reiss, M. L., & Wacker, R. R. (2000, July/

September). Factors associated with assistive technology discontinuance among individuals with disabilities [Electronic version]. Journal of

Rehabilitation.

7. Scherer, M. J., & Galvin, J. C. (1994, February/March). Matching people and technology—A systematic consumer-directed approach can help ensure quality assistive technology services. Rehab Management: Rehab Engineer-

ing, 128–130.

8. Agree, E. A., & Freedman, V. A. (2003). A comparison of assistive technology and personal care in alleviating disability and unmet need. The Gerontologist, 43, 335–344.

9. Fuhrer, M. .J., Jutai, J. W., Scherer, M. J., & Deruyter, F. (2003). A framework for the con-ceptual modelling of assistive technology device outcomes. Disability and Rehabilitation, 25, 1243–1251.

10. Allen, K., & Blascovich, J. (1996). The value of service dogs for people with severe ambulatory disabilities. JAMA, 275, 1001–1006.

11. Camp, M. M. (2001). The use of service dogs as an adaptive strategy: A qualitative study. American Journal of Occupational Therapy,

55, 509–517.12. Assistance Dogs International. (2008). Assis-

tance dogs. Retrieved December 1, 2008, from http://www.assistancedogsinternational.org/

13. Fairman, S. K., & Huber, R. A. (2000). Service dogs: A compensatory resource to improve func-tion. Occupational Therapy in Health Care,

13(2), 41–52.14. Dalziel, D. J., Uthman, B. M., McGorray, S. P., &

Reep, R. L. (2003). Seizure-alert dogs: A review and preliminary study. Seizure, 12, 115–120.

15. Pavlides, M. (2008, July/August). Autism service dogs. ADPT Chronicle of the Dog, 46–47.

16. Froling, J. (2003). Service dog tasks for psychi-

atric disabilities: Tasks to mitigate certain

disabling illnesses classifi ed as mental impair-

ments under the Americans with Disabilities

Act. Retrieved November 29, 2008, from http://www.iaadp.org/psd_tasks.html

17. Collins, D., Fitzgerald, S. G., Sachs-Ericsson, N., Scherer, M., Couper, R. A., & Boninger, M. L. (2006). Psychosocial well-being and community participation of service dog partners. Disabil-

ity and Rehabilitation: Assistive Technology,

1(1–2), 41–48.18. Lane, D. R., McNicholas, J., & Collis, G. M.

(1998). Dogs for the disabled: Benefi ts to the recipients and welfare of the dog. Applied Ani-

mal Behavior Science, 59, 49–60.19. Valentine, D. P., Kidoo, M., Lafl eur, B. (1993).

Psychosocial implications of service dog owner-ship for people who have mobility or hearing impairments. Social Work in Health Care,

19(1), 109–124.20. Assistance Dogs International. (2008). Real-

istic answers to frequently asked questions.

Retrieved January 26, 2009, from http://www.assistancedogsinternational.org/FAQ.php

21. Assistance Dogs of the West. (2008). About ADW: Frequently asked questions. Retrieved January 25, 2009, from http://www.assistancedogsofthewest.org/about-adw/faqs

22. Hart, L. A., Hart, B. L., & Bergin, B. (1987). Socializing effects of service dogs for people with disabilities. Anthrozoos, 1(1), 41–44.


C A L E N D A R

April

Chicago Suburbs Apr. 3–4Bladder, Bowel, & Standing Balance Issues for Kids. For pediatric occupational and physical thera-pists who wish to learn how to manage the bowel and bladder issues affecting 20% of children aged 4–12 years, affecting both ADLs and standing balance. The causes, medical diagnostic tests, and therapeu-tic interventions needed to treat twelve diagnoses of bladder and bowel dysfunction will be reviewed. Developmental anatomy and physiology of the uro-genital, gastrointestinal, and pelvic rotator cuff sys-tems will be explained. Participants can look forward to experiencing therapeutic exercise approaches in lab. Instructor: Janet A. Hulme, MA, PT. Contact Kids In Motion, Inc., 708-371-7007, [email protected].

Ft. Lauderdale, FL Apr. 18–28Lymphedema Management. Certifi cation courses in Complete Decongestive Therapy (135 hours), Lymphedema Management Seminars (31 hours). Coursework includes anatomy, physiology, and pathology of the lymphatic system, basic and ad-vanced techniques of MLD, and bandaging for primary/secondary UE and LE lymphedema (incl. pediatric care) and other conditions. Insurance and billing issues, certifi cation for compression-garment fi tting included. Certifi cation course meets LANA requirements. Also in Chattanooga, TN and New York, NY, May 2–12. AOTA Approved Provider. For more information and additional class dates/loca-tions or to order a free brochure, please call 800-863-5935 or log on to www.acols.com

Ogden, UT Apr. 23–25 The Listening Program® Provider Training. Learn to apply The Listening Program® (TLP) method while you network with other professionals. Discover how you can integrate this safe, practical and effective approach of music-based auditory stimulation into your everyday practice. TLP is easy to use in the home, school or clinical setting. It offers the choice of CDs or iListen® (iPod system), and the option of portable bone conduction technology. The path to becoming a TLP Certifi ed Provider starts here. Earn 1.2–3.2 AOTA CEUs. Also in Long Island, NY, May 15–16 and Minneapolis, MN, June 5–6. Contact: Advanced Brain Technologies 888-228-1798. Visit www.thelisteningprogram.com.

May

Tempe, AZ May 20–23 Association of Children’s Prosthetic-Orthotic Clinics 2009 Annual Meeting (30th Anniversary). Fiesta Resort Conference Center. Highlights in-clude: New Investigative Research Award, Physi-cian Guided Case Study Form, Hector Kay Lecturer,

Presidential Guest Speaker. Preliminary program & registration at www.acpoc.org. CME & ABC ac-credited.Contact: [email protected] / 847-698-1637, FAX: 847-823-0536.

Chicago Suburbs May 30–31Electrotherapeutic Intervention in the Manage-ment of Pediatric CNS Impairments/Dysfunction. An examination of the use of state-of-the-art elec-trotherapy techniques for pediatric occupational and physical therapists in the treatment of children with cerebral palsy, brachial plexopathy, muscular dystrophy, impaired sensory-motor development, spinal atrophy, and spina bifi da. The course com-mences with a comparison of TENS, NMES, EMS, and TES, followed by principles of use to treat chil-dren. Therapists will be able to practice newly ac-quired techniques in lab using electro-stimulation units. Instructor: Gad Alon, PhD, PT. Contact Kids In Motion, Inc., 708-371-7007, [email protected].

Ongoing

Internet/Home Study OngoingBecome an Accessibility Consultant. Incorporate home safety, environmental modifi cations, assistive technology, and ADA consulting in your present career, or begin a private practice. Extensive manual included. Instructor: Shoshana Shamberg, OTR/L, MS. Cost: 2-Day $350–$400; COMBO+Internet $625–$675; Inter-net-Home Study $300–$400. Also in Atlanta, GA, March 29–30; and Baltimore, MD, June 7–8 and Au-gust 23–24, 2009. Earn CEUs OT/OTA/PT/PTA; college credits; AOTA Approved Provider. Member NBCOT PP Registry. Contact Abilities OT Services, 410-358-7269. Brochure/free info: www.aotss.com; e-mail: [email protected]

NEW AOTA CE on CDTM OngoingCreating Successful Transitions to Community Mobility Independence for Adolescents: Address-ing the Needs of Students With Cognitive, Social and Behavioral Limitations. Miriam Monahan, MS OTR, CDRS, CDI, and Kimberly Patten, OTL, AMPS certifi ed. Addresses the critical issue of community mobility skill development for youth with diagno-ses that challenge cognitive and social skills, such as autism spectrum and attention defi cit disorder. Community mobility is vast in that it includes mass transportation, pedestrian travel, and driving, and is essential for engaging in vocational, social, and educational opportunities. The course is appropri-ate for occupational therapy practitioners practic-

ing in educational settings and in driver rehabilita-tion. Earn .7 AOTA CEU (7 NBCOT PDUs/7 contact hours). Order #4833-CR. $175 AOTA Members, $250 Nonmembers.

NEW AOTA CE on CDTM OngoingHand Rehabilitation: A Client-Centered and Oc-cupation-Based Approach. Presented by Debbie Amini, MEd, OTR/L, CHT. Describes how to use the occupation-based intervention to enhance hand rehabilitation protocols without sacrifi cing produc-tivity or detracting from the concurrent client factor focus. CD-ROM includes MP3 audio fi le of the entire course. Earn .2 AOTA CEUs (2 NBCOT PDUs/2 con-tact hours). Order #4832-CR, $68 AOTA Members, $97 Nonmembers.

AVAILABLE NOW FROM AOTA OngoingBasics and Beyond: A Comprehensive Study of Hand and Upper Extremity Rehabilitation. Avail-able from AOTA Continuing Education by special arrangement with Treatment2Go in St. Petersburg, Florida. Presented by Nancy Falkenstein, OTR/L, CHT, and Susan Weiss, OTR/L, CHT. Expand your learning about hand and upper extremity therapy. This is a CHT Prep Course. Earn 4 AOTA CEUs (40 NBCOT PDUs/40 contact hours). Order #4858-CR, $559 AOTA Members and Nonmembers.

AVAILABLE NOW FROM AOTA OngoingStatic Progressive Splinting: Up Close & Per-sonal. Available from AOTA Continuing Education by special arrangement with Treatment2Go in St. Petersburg, Florida. Presented by Nelson Vazquez, OTR/L, CHT; Nancy Falkenstein, OTR/L, CHT; and Susan Weiss, OTR/L, CHT. Advance your splint-ing skills with this video-format course that dem-onstrates splints being fabricated at a deliberate pace and an “up close” perspective that facilitates detailed learning from experts. Earn .3 AOTA CEUs (3 NBCOT PDUs/3 contact hours). Order #4857-CR, $179.30 AOTA Members and Nonmembers.

To advertise your upcoming event, contact

the OT Practice advertising department at

800-877-1383, 301-652-6611, or otpracads

@aota.org. Listings are $95 each for 1–10

lines, $150 for 11–15 lines, per event. Mul-

tiple listings may be eligible for discount.

Please call for details. Listings in the Cal-

endar section do not signify AOTA endorse-

ment of content, unless otherwise specifi ed.

Look for the AOTA CE logo on con-

tinuing education promotional ma-

terials. The AOTA CE logo indicates

the organization has met the AOTA APP

requirements and offers continuing educa-

tion that meets quality standards..

www.otceus.orgThis is the place to expand your knowledge and expertise with our dynamic continuing education courses. The IWA specializes in fi tness related topics which give you practical information for both yourself and your patients.

Topics include:❚ Functional Training❚ Senior Programs❚ Weight Training❚ Therapy Ball❚ Pilates / Yoga❚ Program Design

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Since 1989

Continuing Education

Cincinnati, OH Starting May 14, 2009USC/WPS Comprehensive Program in Sensory Integration Course 1: May 14–18 Course 2: Jul 23–27 Course 3: Oct 1–5 Course 4: Dec 4–8 For additional sites and dates, or to register, visit www.wpspublish.com or call 800-648-8857

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Complete your degree part-time in this graduate program taught by the San José State University faculty, who are recognized teachers, clinicians, and scholars. This program is accredited by the Western Association of Schools and Colleges (WASC).

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practice, leadership, and research in your area of clinical interest

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AVAILABLE NOW FROM AOTA OngoingStatic Splinting Made Simple. Available from AOTA Continuing Education by special arrange-ment with Treatment2Go in St. Petersburg, Florida. Presented by Nancy Falkenstein, OTR/L, CHT and Susan Weiss, OTR/L, CHT. Learn how to use basic low temperature splint fabrication skills in any clini-cal setting through the Static Splinting Made Simple continuing education course. Earn .3 AOTA CEUs (3 NBCOT PDUs/3 contact hours). Order #4856-CR, $130.90 AOTA Members and Nonmembers.

NEW AOTA CE on CDTM OngoingAutism: Evidence for the AOTA Practice Guide-lines. Presented by Jane Case-Smith, EdD, OTR/L, FAOTA, BCP. This course identifi es the primary issues in children with ASD that limit daily occupa-tions and participation in school, home, and com-munity settings. Based on an extensive review of the research literature, the evidence-based interven-tions provided by the occupational therapy practi-tioners for children with ASD will be identifi ed and described. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4830-CR, $68 AOTA Mem-bers, $97 Nonmembers.

AOTA/Genesis CE on CDTM OngoingSeating and Positioning for Productive Aging: An Occupation-Based Approach. Presented by Fe-licia Chew, MS, OTR, and Vickie Pierman, MSHA, OTR/L. This course reviews seating and positioning from evaluation to outcome, with a concentration on interventions. The seating and positioning infor-mation reviewed will be applicable to a variety of settings, including skilled nursing facilities, home health, rehab centers, assisted living communities, and others. The content primarily addresses manual wheelchair mobility. Earn .4 AOTA CEU (4 NBCOT PDUs/4 contact hours). Order #4831-CR, $97 AOTA Members, $138 Nonmembers.

AVAILABLE NOW FROM AOTA OngoingASHT Test Preparation. This intermediate-level course provides a comprehensive overview of all topics related to upper extremity rehabilitation. There are twenty-fi ve PowerPoint chapters with over 2,000 slides and sample multiple-choice test questions accompany each chapter. Earn 30 AOTA approved contact hours (3 AOTA CEUs/30 NBCOT PDUs). Order #4850-CR, $300 AOTA Members, $450 Nonmembers.

AOTA CE on CDTM OngoingExploring the Domain and Process of Occupa-tional Therapy Using the Occupational Therapy Practice Framework, 2nd Edition. Presented by Susanne Smith Roley, MS, OTR/L, FAOTA; Janet V. DeLany, DEd, OTR/L, FAOTA; Carolyn M. Baum, PhD, OTR/L, FAOTA; Ellen S. Cohn, ScD, OTR/L, FAOTA; and Mary Jane Youngstrom, MS, OTR, FAO-TA. Explore ways in which the document supports occupational therapy practitioners by providing a holistic view of the profession. Earn .3 AOTA CEU (3 NBCOT PDUs/3 contact hours). Order #4829-CR, $73 AOTA Members, $103.00 Nonmembers.

AOTA CE on CDTM OngoingThe New IDEA Regulations: What Do They Mean to Your School-Based and EI Practice? Presented by Leslie L. Jackson, MEd, OT, and Tim Nanof, MSW. Understand what the 2004 reauthorization of IDEA and the new Part B regulations, released in August 2006, mean and what impact they have on your work as a school-based and early intervention prac-titioner. This CE course is an excellent opportunity to update your knowledge on IDEA. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4825-CR, $68 AOTA Members, $97 Nonmembers.

AOTA CE on CDTM OngoingResponse to Intervention: A Role for Occupational Therapy Practitioners. Presented by Gloria Frolek Clark, MS, OTR/L, BCP, FAOTA. Response to Inter-vention (RtI) is a process for educational decision-

making promoted by the U.S. Department of Educa-tion. High-quality instruction and interventions are matched to the student’s needs, and progress is monitored frequently. Occupational therapy practi-tioners need to understand how federal statute and data-based decision-making have changed how we address the needs of students. This CE on CD™ addresses the evolving role of occupational thera-pists and occupational therapy assistants who work with students in grades K–12. The information con-tained on this CD is from the AudioInsight™ Semi-nar originally presented on March 7, 2007. Earn .2 AOTA CEU (2 NBCOT PDUs/2 contact hours). Order #4826-CR, $68 AOTA Members, $97 Nonmembers.

AOTA CE on CDTM OngoingOccupational Therapy and Transition Services. Presented by Kristin S. Conaboy, OTR/L; Susan M. Nochajski, PhD, OTR/L; Sandra Schefkind, MS, OTR/L; and Judith Schoonover, MEd, OTR/L, ATP. This course will present an overview of the impor-tance of 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. It is an excellent op-portunity to update your knowledge about Transition Services and practice opportunities related to this area of school-based practice. Earn .1 AOTA CEU (1 NBCOT PDU/1 contact hour). Order #4828, $34 AOTA Members, $48.50 Nonmembers. Set of 3 CE on CDTM’s: The New IDEA Regulations, Response to Intervention, and Occupational Therapy and Transi-tion Services. Order #4828K-CR, $136 AOTA Mem-bers, $194 Nonmembers.

AOTA CE on CDTM OngoingEveryday Ethics: Core Knowledge for Occupa-tional Therapy Practitioners and Educators. De-veloped by the AOTA Ethics Commission, this CE on CDTM helps practitioners and educators identify and analyze ethical dilemmas, provide a framework for making ethical decisions, identify the different agencies involved in regulating the profession of occupational therapy and their roles, and identify a process for fi ling and handling complaints related to ethical violations. The AOTA Press publication Reference Guide to the Occupational Therapy Code of Ethics, 2006 Edition is a required text for successfully completing this course. Earn .3 AOTA CEU (3 NBCOT PDUs/3 contact hours). CE on CDTM only: Order #4827-CR, $73 AOTA Members, $103.50 Nonmembers. CE on CDTM and text: Or-der #1139K-CR, $85.60 AOTA Members, $121.40 Nonmembers.

NEW AOTA Online Course OngoingUnderstanding the Assistive Technology Process to Promote School-Based Occupation. Presented by Beth Goodrich, MS, MEd, OTR, ATP; Lynn Gitlow, PhD, OTR/L, ATP; and Judith Schooner, MEd, OTR/L, ATP. The purpose of this course is to provide occupa-tional therapy practitioners with knowledge of the AT process as it is delivered in schools, and how it can assist practitioners in considering the use of technol-ogy to increase student participation in meaningful school-based occupations. Earn 1 AOTA CEU (10 NBCOT PDUs/10 contact hours). Order #OL31-CR, $112.50 AOTA Members, $159.75 Nonmembers.

AOTA Online Course OngoingFundamentals of Occupational Therapy for Indi-viduals with Dementia. By Mary A. Corcoran, PhD, OTR/L, FAOTA. Learn to evaluate occupational per-formance and establish goals to reduce disability, simplify objects and tasks, and communicate ef-fectively. Assessment tools and intervention proto-cols are provided. Earn 1 AOTA CEU (10 NBCOT PDUs/10 contact hours). Order #OLD07-CR, $198 AOTA Members, $280 Nonmembers.

AOTA Online Course OngoingAdvanced Occupational Therapy for Individuals with Dementia. Presented by Mary A. Corcoran, PhD, OTR/L, FAOTA. Learn how to develop and


C A L E N D A Rmonitor interventions that address common but complex problems, such as wandering, agitation, driving diffi culties, and resistance to self-care. As-sessments and intervention protocols for standard-ized approaches are provided; strategies for reim-bursement are discussed. Earn 1 AOTA CEU (10 NBCOT PDUs/10 contact hours). Order #OLD06-CR, $198 AOTA Members, $280 Nonmembers.

AOTA Online Course OngoingOccupational Therapy for Family, Professional, and Paraprofessional Caregivers of Individu-als With Dementia. Presented by Mary A. Corco-ran, PhD, OTR/L, FAOTA. Learn how to help fam-ily and paid caregivers manage dementia-related symptoms on a daily basis. A library of caregiver assessments is provided, as are research-tested in-tervention protocols. Earn 1 AOTA CEU (10 NBCOT PDUs/10 contact hours). Order #OLD05-CR, $198 AOTA Members, $280 Nonmembers.

AOTA Online Course OngoingUsing the Fieldwork Performance Evaluation Forms: An Interactive Approach. Presented by Karen Atler, MS, OTR, and Roberta Wimmer, OTR/L. Five lessons address how to use the Fieldwork Performance Evaluation Forms for OT and OTA fi eldwork students. Learn how to identify and write site-specifi c objectives, rate and score student per-formance, and much more. The AOTA Press publi-cation, Using the Fieldwork Performance Evaluation Forms: The Complete Guide, is necessary for taking the course. Earn .6 AOTA CEU (6 NBCOT PDUs/6 contact hours). Course only: Order #OL23-CR, $135 AOTA Members, $195 Nonmembers. Course and text: Order #OL23K-CR, $143.10 AOTA Members, $206.10 Nonmembers.

AOTA Online Course OngoingOccupational Therapy in School-Based Prac-tice: Contemporary Issues and Trends. Edited by

Yvonne Swinth, PhD, OTR/L. Gain an understand-ing of and suggestions for service delivery and intervention strategies in school-based settings based on IDEA, the No Child Left Behind initiative, the philosophy of education, and the Occupational Therapy Practice Framework. The content of the Core Session has been updated to refl ect the changes in the 2004 IDEA amendments. Core session: Service Delivery in School-Based Practice: Occupational Therapy Domain and Process. Earn: 1 AOTA CEU (10 NBCOT PDUs/10 contact hours). Order #OLSBC-CR, $225 AOTA Members, $320 Nonmembers. Elective sessions: After completing the Core session, choose supplemental sessions to further enhance your knowledge for specifi c school-based populations, types of settings, and service delivery issues. Each provides .1 AOTA CEU (1 NB-COT PDU/1 contact hour), $22.50 AOTA Members, $32 Nonmembers.

AOTA Online Course OngoingLow Vision in Older Adults: Foundations for Re-habilitation. Presented by Roy Gordon Cole, OD, FAAO; Gordon Rovins, MS, CEAC; and Alison Schonfeld, OTR/L. This course is an overview of low-vision causes, effects, and interventions, with emphasis on optical considerations and strategies for environmental adaptation. Examines the clinical defi cits associated with low vision, and addresses the rehabilitation process. Includes a review of the eye, an overview of the types of optical prescrip-tions, and the use of specifi c intervention approach-es. Case study format enhances clinical reasoning skills. From AOTA and SightCare, a program of The Jewish Guild for the Blind. Earn .8 AOTA CEU (8 NBCOT PDUs/8 contact hours). Order #OL28-CR, $158 AOTA Members, $225 Nonmembers.

AOTA Online Course OngoingDriving and Community Mobility for Older Adults: Occupational Therapy Roles. Presented by Susan

• Enhance your career and become a professional leader• Apply principles of evidence-based practice as a basis for clinical

decision making• Gain advanced knowledge of occupational therapy practice through

the study and application of occupational science literature and occupation-based intervention

• Design, implement, and evaluate the effectiveness of innovative occupation-based programs in your chosen area of interest

• 24/7 online experience is convenient and flexible• Taught by clinical educators distinguished nationally and regionally in

specific areas of expertise• Your professional interest determines your specialization in the program• Content from each course can be directly applied to your practice setting• Program can be completed in 16 months• No GRE scores are required for admission

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Assessment & Intervention SeminarsTwo Days of Hands-On Learning (1.6 CEU)

2009 Upcoming Locations & Dates:

St. Cloud, MN Apr 24–25Abingdon, VA Jun 5–6Everett, WA Jun 11–12

Colorado Springs, CO Jun 25–26Tyler, TX Aug 7–8

Wheeling, WV Aug 13–14Morgantown, NC Sept 24–25

Roosevelt, NY Oct 22–23Grand Rapids, MI Oct 16–17

For additional information visitwww.beckmanoralmotor.com

Host a Beckman Oral Motor Seminar!Host info (407) 590-4852, or

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C A L E N D A R

Pierce, OTR, CDRS, and Linda Hunt, PhD, OTR/L. Provides an understanding of the key issues relat-ed to community mobility, including driving. Helps therapists working with older adults in all settings identify the desired community mobility outcomes of clients and fi nd resources for specialized driving re-habilitation. Offers professional development guide-lines for those who wish to become occupational therapy driver rehabilitation specialists. Develop-ment sponsored by the National Highway Traffi c Safety Administration. Earn .5 AOTA CEU (5 NBCOT PDUs/5 contact hours). Order #OL25-CR, $112.50 AOTA Members, $160 Nonmembers.

AOTA Self-Paced Clinical Course OngoingCollaborating for Student Success: A Guide for School-Based Occupational Therapy. Edited by Barbara Hanft, MA, OTR, FAOTA, and Jayne Shep-herd, MS, OTR, FAOTA. Engages school-based oc-cupational therapists in collaborative practice with education teams. Identifi es the process of initiating and sustaining changes in practice and infl uenc-ing families/education personnel to engage in col-laboration with occupational therapists. Perfect for learning to use professional knowledge and inter-personal skills to blend hands-on services for stu-dents with team and system supports for families, educators, and the school system at large. Earn 2 AOTA CEUs (20 NBCOT PDUs/20 contact hours). Order #3023-CR, $370 AOTA Members, $470 Nonmembers.

AOTA Self-Paced Clinical Course OngoingStrategies to Advance Gerontology Excellence: Promoting Best Practice in Occupational Ther-apy. Edited by Susan Coppola, MS, OTR/L, BCG, FAOTA; Sharon J. Elliott, MS, OTR/L, BCG, FAOTA; and Pamela E. Toto, MS, OTR/L, BCG, FAOTA. Fore-word by: Wendy Wood, PhD, OTR/L, FAOTA. Excel-lent resource for gerontology practitioners today to help sharpen skills and prepare for the spiraling de-

mand among older adults for occupational therapy services. Special features include core best practice methodology with older adults, approaches to and prevention of occupational problems, health condi-tions that affect participation, and practice in cross-cutting and emerging areas. Earn 3 AOTA CEUs (30 NBCOT PDUs/30 contact hours). Order #3024-CR, $490 AOTA Members, $590 Nonmembers.

AOTA Self-Paced Clinical Course OngoingLow Vision: Occupational Therapy Evaluation and Intervention With Older Adults, Revised Edition. 2008. Edited by Mary Warren, MS, OTR/L, SCLV, FAOTA. Occupational therapy practice in low vision rehabilitation services has changed signifi cantly since the fi rst edition of Low Vision. The Revised Edition helps practitioners maintain professional competency by supporting the AOTA Specialty Certifi cation in Low Vision Rehabilitation (SCLV) cre-dentialing process. Special features include fi rst-edition updates and revisions, new information on evaluation, lessons related to psychosocial issues and low vision, eye conditions that cause low vi-sion in adults, and basic optics and optical devices. Earn 2 AOTA CEUs (20 NBCOT PDUs/20 contact hours). Order #3025-CR, $370 AOTA Members, $470 Nonmembers.

AOTA Self-Paced Clinical Course OngoingNeurorehabilitation Self-Paced Clinical Course Series. Series Senior Editor: Gordon Muir Giles, PhD, DipCOT, OTR/L, FAOTA. This Series includes 4 components—the Core SPCC and 3 Diagnosis-Specifi c SPCCs. The Core SPCC is highly recom-mended as a prerequisite for the Diagnosis-Specifi c courses. Each of the Diagnosis-Specifi c SPCCs is based on a case study model supported by key concepts presented in the Core. Core SPCC: Core Concepts in Neurorehabilitation: Earn .7 AOTA CEU (7 NBCOT PDUs/ 7 contact hours). Order #3019-CR, $130 AOTA Members, $184 Nonmembers. Diagnosis-Specifi c SPCCs: Neurorehabilitation for Dementia-Related Diseases (Order #3022-CR), Neurorehabilitation for Stroke (Order #3021-CR), and Neurorehabilitation for Traumatic Brain Injury (Order #3020-CR). Each: 1 AOTA CEU (10 NBCOT PDUs/10 contact hours), $185 AOTA Members, $263 Nonmembers. Call or shop online to pur-chase the Core and/or 1 or more Diagnosis-Specifi c SPCCs together for signifi cant savings!

AOTA Self-Paced Clinical Course OngoingThe Hand: An Interactive Study for Therapists. By Judy C. Colditz, OTR/L, CHT, FAOTA. Combines written coursework with interactive, computer-based learning to present the anatomical basis and clinical presentation of problems in the hand and forearm. Using the CD-ROM The Interactive Hand: Therapy Edition, explore the multiple layers of complex anatomy while learning about palpation, examination, and common disorders. An excellent preparation tool for the Hand Therapy Certifi cation Exam. Earn 1.6 CEUs (16 NBCOT PDUs/16 contact hours). Order #3017-CR, $260 AOTA Members, $360 Nonmembers.

AOTA Self-Paced Clinical Course OngoingDysphagia Care for Adults. Edited by Wendy Av-ery-Smith, MS, OTR/L. Advance your evaluation and intervention skills in dysphagia care for adult clients in settings such as acute-care hospitals, home health, rehabilitation settings, long-term-care facilities, school settings, nursing homes, residen-tial settings, and outpatient-care environments. Topics include physiology and manifestations of abnormal swallowing; clinical evaluations of swal-lowing; identifying commonly used instrumental evaluation procedures and when to recommend them; interpreting dysphagia evaluation results and providing appropriate treatment; and more. Earn 1.4 AOTA CEUs (14 NBCOT PDUs/14 contact hours). Order #3018-CR, $259 AOTA Members, $374 Nonmembers.


Register Online!Go to www.hwtears.com

or call 402.492.2766 to register.

2009 Workshops

Use Promo CodeOTP0409

Pre-K* and Kindergarten-5th Grade Workshops

Hartford, CT Apr 3*–4Jacksonville, FL Apr 3*–4San Antonio, TX Apr 3*–4Peoria, IL Apr 17*–18Oklahoma City, OK Apr 17*–18King of Prussia, PA Apr 17*–18San Jose, CA Apr 24*–25Syracuse, NY Apr 24*–25Madison, WI Apr 24*–25Boston, MA May 1*–2Lansing, MI May 1*–2Jackson, MS May 1*–2Tucson, AZ May 15*–16Des Moines, IA May 15*–16New York City, NY May 15*–16

The Print Tool™ WorkshopsKansas City, MO Apr 3Atlanta, GA Apr 17Orlando, FL Apr 24San Diego, CA May 1

*Indicates the first day is the Pre-K Workshop

Cost: $195-$385Up to 10.25 contact hours

D-3992


D-3932


Transformative Learning:Theory, Research, Implementation, and Assessment

D-3988


E M P L O Y M E N T O P P O R T U N I T I E S

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

AD REGION COLOR KEY

E M P L O Y M E N T O P P O R T U N I T I E SFaculty

Department of Occupational TherapyCollege of Health and Human Services

Chair—Position #0227Qualifi cations: Earned doctorate, certifi ed as an Occupational Therapist, creden-tialed, or eligible for credentialing, as an occupational therapist in the state of Michi-gan; a minimum of six years’ experience in the fi eld of occupational therapy, includ-ing practice as an occupational therapist; administrative or supervisory experience; at least two years of experience in a full-time academic appointment with teaching responsibilities; evidence of excellence in teaching, academic or clinical publications, and professional/clinical service to meet university standards for the faculty rank of Associate or Full Professor

Responsibilities: Tenure track, FY appointment as chief academic and executive of-fi cer, reporting to and advising the dean regarding the department. The chair engages in teaching, research, or clinical activities; promotes shared governance; is respon-sible for effective administration of the department; and provides leadership and di-rection regarding:

• Planning, developing, delivering, and assessing academic programs• Maintaining excellence in faculty teaching and supporting a student-

centered culture• Fostering scholarship and externally funded research• Hiring, developing, and reviewing faculty and staff• Planning and managing the department budget and other resources• Managing student enrollment and retention with emphasis on academic

excellence and diversity• Developing and maintaining community partnerships• Fundraising and developing pertinent external constituencies• Representing the accomplishments and needs of the department• Fostering collegiality and good morale

Department: The Occupational Therapy Department was founded in 1922 and has the distinction of being the fi rst non-teacher education academic program at WMU. The program has been ranked as the best occupational therapy program in Michigan by US News and World Report, 2008. The department admits 60 students into the Kalamazoo campus, and is in the process of implementing a satellite program at the University’s Grand Rapids campus. The department has 10 faculty members with 8 holding a doctorate degree. The faculty has an outstanding record of research, publi-cation, and receiving external funding.

Western Michigan University: Western Michigan University (WMU), located in Southwest Michigan, is a vibrant, nationally recognized student-centered research institution with an enrollment of nearly 25,000. WMU delivers high-quality under-graduate instruction, has a strong graduate division, and fosters signifi cant research activities. The Carnegie Foundation for the Advancement of Teaching has placed WMU among the 76 public institutions in the nation designated as research universi-ties with high research activities.

Salary: Competitive and commensurate with qualifi cations and experience, with an excellent benefi ts package.

Expected Start Date: July 1, 2009

Application Deadline: Review of applications will begin March 15 and continue until position is fi lled.

Please visit http://www.wmich.edu/hr/careers-at-wmu.html for information and ap-plication procedures.

Western Michigan University is an affi rmative action/equal opportunity employer consistent with applicable federal and state law.

All qualifi ed applicants are encouraged to apply.F-3960

Faculty

Help Educate Occupational Therapy AssistantsPima Medical Institute (PMI) is starting an Associate Degree Occupational Therapy Assistant program and is looking for Occu-pational Therapy Assistants, Clinical Direc-tors, in the following states: Arizona, Den-ver, Washington, and a Program Director in New Mexico. The Tucson campus is seeking a full-time OTA faculty member with fi ve (5) years of management experience.

In keeping with PMI’s philosophy, appli-cants should have the desire and passion to help build a successful Associate Degree program and be strongly motivated to help students become well-prepared for a successful career in occupational therapy. Pima Medical Institute is a progressive pri-vate school that offers Certifi cates and As-sociate Degrees in numerous Allied Health professions.

Bachelor’s degree—fi ve (5) years experi-ence as an occupational therapist or certi-fi ed occupational therapy assistant. Gradu-ate of an accredited occupational therapy or occupational therapy assistant program. One year of documented experience as an instructor in an ACOTE® accredited occu-pational therapy or occupational therapy assistant program.

Pima Medical Institute’s benefi ts package includes medical, dental, vision, prescrip-tions, life insurance, and short-term dis-ability. We offer Paid Time Off (PTO), an educational reimbursement plan, a 401(k) plan with a 20% employer match, and an Employee Stock Option Plan (ESOP), which is a deferred compensation plan fully funded by PMI.

Interested applicants may submit resume and cover letter to Diana Negrete, [email protected] or fax to 520-323-5983.

F-3927



Faculty

Brown Mackie College–Ft. Wayne is currently recruiting a Site Coordinator for our growing

Occupational Therapy Assistant Program!

Occupational Therapy Assistant ProgramPosition Requirements:

• Applicants must be a registered occupational therapist.

• Must have a minimum of three years’ clinical experience.

• Must have (or be eligible for) Indiana licensure.

To learn more about us you can visit our website at: www.brownmackie.edu

Interested candidates please submit resume and cover letter to: Michelle Sheperd

[email protected] East Coliseum Blvd.

Fort Wayne, IN 46805F-3974

Faculty

Tenure-Track Faculty PositionsRadford University (RU) invites applications for full-time, nine-month, tenure-track fac-ulty positions in the new Department of Occupational Therapy. Faculty will work with the Founding Chair and Founding Director of Clinical Education, to build a distinctive master’s entry-level program. The program’s mission is to prepare students to provide oc-cupation-based services in rural communities.

RU is a public comprehensive institution with an enrollment of 9,300 and a commitment to rigorous graduate education with a balanced approach towards teaching and scholarship. It is located in the New River Valley of Southwest Virginia, a region in the foothills of the Blue Ridge Mountains, which has received numerous accolades for its quality of life, outdoor recreation opportunities, and excellent schools and colleges. The local health-care community enthusiastically supports development of the occupational therapy program.The Department of Occupational Therapy is housed in the Waldron College of Health and Human Services, comprised of the School of Nursing; the School of Social Work; and the Department of Communication Sci-ences and Disorders. A Department of Physical Therapy is also in development, and a new Doctor of Nursing Practice degree was recently approved. Newly remodeled space for occupational therapy education will be in place by the spring of 2009.Successful candidates for the faculty positions will have an interest in developing clinical sites in underserved communities, in order to provide active learning opportunities for students. NBCOT certifi cation, eligibility for licensure in the Commonwealth of Virginia, a master’s degree and a strong clinical background are required. A doctoral degree or substantial progress toward the doctorate, and teaching experience are preferred. Ex-pertise in pediatrics or upper extremity rehabilitation/hand therapy is desirable, but experience and research interests in a variety of areas of practice will be considered. Rank, salary, and benefi ts are competitive and commensurate with professional and academic experiences. RU is in the fi rst step of the three-step process of seeking initial accreditation for the MOT program from the Accreditation Council for Occupational Therapy Education. Review of applications for faculty positions will begin immediately, and continue until the positions are fi lled. Anticipated start date for new faculty will be August 10, 2009. Applicants should submit a curriculum vita, a cover letter summarizing their qualifi cations and interests, offi -cial transcripts, and names and contact information for three professional references. Electronic applications are preferred and should be directed to Dr. Douglas M. Mitchell, Occupational Therapy Search Committee Chair, at [email protected]. Paper copies should be addressed to Dr. Mitchell, Department of Occupa-tional Therapy, Box 6985, Radford University, Radford, VA 24142. Radford University is an Equal Opportunity/Affi rmative Action Employer committed to diversity.

F-3886

Northeast

OCCUPATIONAL THERAPISTS/COTASFull time, part time and per diem

HAND THERAPY & UPPER EXTREMITY REHABILITATION

BRAIN & SPINAL CORD INJURY, STROKE, ORTHOPEDICS, AMPUTATION, AND

NEUROMUSCULAR DISORDERS

Flexible scheduling, mentorship opportunities and model treatment programs. Seeking staff, senior level and clinical specialists. Inpatient/

Outpatient

To learn more or to submit your resume, please contact Karen Dresher,

TEL: 973-243-6855 FAX: 973-243-6846 EMAIL: [email protected]

Please visit our website www.kessler-rehab.com

West Orange, Saddle Brook & Chester, New Jersey

THEKESSLERDIFFERENCE.

a Select Medical company

EOE.N-3998

South

Occupational Therapist

Variety of practice areas—Seating, Physical Disability, Sensory, and ADLs. $5,596/month.

Benefi ts:• 8+ hours vacation monthly• 8 hours sick leave monthly•12+ paid holidays each year, M-F• Excellent health and retirement

Call Bobbie Holden at 325-795-3611

S-3911



The nature of

Caring

be treasured

With a team committed to innovative, ethical and superlative care, Hallmark Rehabilitation strives to enhance the quality of our patients’ lives and serve the community with exceptional rehabilitation services. Our programs and supportive systems give our therapists the clinical resources needed to make every day truly extraordinary.

We currently have rewarding career opportunities available for management and staff OT and COTA positions. For information on sign-on bonuses and relocation packages, please contact our recruiting team member in your area of interest:

Paul Medvene

Los Angeles, Orange County

Phone: (800) 308-4014

Lana Moss

Central California,

Sacramento area

Phone: (800) 979-0891

Kristi Carter

San Diego, Inland Empire

Phone: (800) 886-9941

Angela Lindhorst

Santa Barbara, Lompoc,

Santa Maria,

Phone: (888) 873-3416

Alison Sabino

Los Angeles, Long Beach

Phone: (877) 778-1116

Sandy Boyer

East Bay, Northern California

Phone: (800) 464-7104

To support our employees, we offer:

New graduates are always welcome!

(877) 777-4584www.hallmarkrehabinc.com

W-3977

West

People. Strength. Commitment.

Occupational TherapistsCurrently Hiring Full-Time!

Four amazing locations to choose from! Each with their own unique attributes!

That’s why I chose HCR ManorCare. I owe it to my patients, and myself, to keep my skills on the leading edge. Here, my professional development is supported through on-site CE courses. Not only are they convenient, but as an AOTA Continuing Education Provider, I can be assured that the courses are approved. See how our focus on clinical excellence can make your career more rewarding.

Heartland of Sarasota, 5401 Sawyer Road, Sarasota, FL 34233 Unique Strengths: In-Patient and Out-Patient Opportunities,

Pain Management Approaches with Advanced Modalities

Kensington Manor, 3250 12th Street, Sarasota, FL 34237 Unique Strengths: Great for Neurological Rehab Focus, VitalStim Therapy,

Falls Management, Extensive Training and Staff Education on Neurological Rehab

Join the team providing leading-edge rehabilitation and post-acute care at our nationwide network of clinics, skilled nursing facilities, and home health and hospice agencies. Call for more information or send your resume to: Lisa Ulinski, Associate Recruiter, 866-427-2004 ext. 114, fax: 877-479-2652, email: [email protected]. To learn more, and to apply online, visit www.hcr-manorcare.com. EEO/Drug-Free Employer

ManorCare of Venice, 1450 E. Venice, Venice, FL 34292 Unique Strengths: Orthopedic Focus, Inpatient Services with

Assisted Living Treatment Opportunities

ManorCare of Sarasota, 5511 Swift Road, Sarasota, FL 34231 Unique Strengths: Comprehensive Rehabilitation, Ranked #5 Among

All of our SNF’s for Best Customer Service, Wound Care

S-3985

South



South

DIRECTOR OF REHABILITATIONAdminister Health Rehabilitation Dept., includ-ing physical, occupational, & speech therapies, at assisted living/skilled nursing facility. MS in OT, PT, or SLP, 3 yrs. exp. or 5 yrs. of progressively re-sponsible exp. in fi eld, FL OT, PT, or SLP license. Resume to: Philip Castleberg, Leesburg Health & Rehab, 715 East Dixie Ave., Leesburg, FL 34748.

S-3973

West

ARIZONA—OTs $65K Phoenix, Tucson, & Burbs

480-294-3678/602-478-5850 Schools, 16 wks off, 100% Paid: Health, Dental, Lic, Dues, Ed$, 401K, Hawaii/Spanish I trips… [email protected]

StudentTherapy.comW-3871

Northeast

Pediatric Therapeutics, Inc. has a preschool OT position working as an in-dependent contractor in community pro-grams within Bucks County, PA. Position is 3–5 days per week. This position is easily accessible to commutes from Montgomery and Philadelphia counties.Please contact us at [email protected] or our offi ce at 215-497-0894. N-3997

Activity Card Sort, 2nd Edition By Carolyn M. Baum, PhD, OTR/L, FAOTA, and Dorothy Edwards, PhDPhotography by Madelaine Gray, MA, MPA, OT, and Stephanie Cordel

The Activity Card Sort, 2nd Edition (ACS) is a fl exible and useful measure of occupation that enables occupational therapy practitioners to help clients describe their instrumental, leisure, and social activities. Eighty-nine photographs of individuals performing activities and 3 versions of the instrument (Institutional, Recovering, and Community Living) are easily understood by clients and administered by clinicians. Using the ACS will give clinicians the occupational therapy history and information they need to help clients build routines of meaningful and healthy activities.

The set includes 20 instrumental activities, 35 low-physical-demand leisure activities, 17 high-physical-demand leisure activities, and 17 social activities.

ACS Highlights• Test description and methodology• Administration and scoring directions• Test development, validation, and reliability• Examples of test utility• References• Easy-to-use sample forms (available on CD-ROM)

Order #1247-P AOTA Members: $99, Nonmembers: $140.50

AOTA BESTSELLER!

ISBN: 978-1-56900-266-7

Call 877-404-AOTA or Shop online store.aota.org

BK-733

West

Where San Diego goes for pediatric care. With plans for a new state-of-the-art Patient Care Pavilion, Rady Children’s Hospital-San Diego is creating a stronger future for children in San Diego and around the world. As our expansion continues, we remain the region’s only hospital dedicated solely to pediatric care.

In 2009, Parents Magazine honored Rady Children’s Hospital-San Diego as one of the top 25 children’s hospitals in the nation.

Occupational Therapist

We are seeking a motivated team player and creative problem solver. You will have the opportunity to collaborate with our multidisciplinary team of allied health professionals to meet the needs of our pediatric outpatients and their families.

Use your critical thinking skills to arrive at objective, results-oriented decisions regarding patient care, with due consideration for departmental, divisional and organizational priorities. Requires the ability and experience to work independently; a Master’s degree in Occupational Therapy from an AOTA accredited program (Bachelor’s degree if graduated prior to 2004); CPR certifi ed, and both California license in Occupational Therapy and NBCOT certifi cation eligibility. We also have openings for Bilingual English/Spanish OTs.

Your desire to grow professionally and fl exibility are your keys to success at Rady Children’s Hospital. We offer a competitive salary and benefi ts package. To apply visit us on-line at: www.rchsd.org or forward your resume via email to: [email protected] Phone: (858) 966-7790.

Rady Children’s Hospital is an equal opportunity employer that values diversity in the workplace.

www.rchsd.orgW-4000


Northeast

Clinical Supervisor of Rehabilitation Services/CVPH Medical Center

This is a great opportunity for a candidate with exceptional clinical and leadership skills and a strong commitment to service excellence desiring to work in a highly chal-lenging environment.

The ideal candidate for this position must have excellent communication, confl ict res-olution, and interpersonal skills, be a good problem solver, out-come oriented, and work effectively within a complex and busy rehabilitation services department.

To be considered, the candidate must be a graduate of an accredited rehab discipline, licensed in New York State, possess 5 years of rehab experience and at least 3 years of management experience with program de-velopment.

CVPH Medical Center, with 2,200 employ-ees, is a regional referral center, fi nancially stable, and growing! We recently received a 2009 “5-Star” rating from HealthGrades for our Interventional Cardiology program. Plattsburgh is located on Lake Champlain, at the foothills of the Adirondack Mountains and within an hour’s drive of Montreal, Lake Placid Olympic region, and Vermont.

Human Resources

CVPH Medical Center75 Beekman Street

Plattsburgh, New York 12901800-562-7301

Fax: 518-562-7302E-mail: [email protected]

Visit our Web site at www.cvph.orgEOE N-3995

Michigan

Summer Employment

OTs needed at a unique summer therapy camp for children, ages 3 to 17, with physical disabilities. Located on Lake Superior. June 14 to August 9. Salary plus room and board provided.

Bay CliffHealth CampPO Box 310Big Bay, MI 49808ph.: (906) 345-9314fax: (906) [email protected]

Midwest

The

Expe

rien

ce o

f a L

ifetim

e

M-3913

West

OCCUPATIONAL THERAPISTSAnchorage School District • Anchorage Alaska

Join a dynamic team of 30 OT’s!Full- and part-time opportunities in large, progressive district. Competitive sal-ary, great benefi ts. 6% salary increase and $3,000 signing bonus for 2009–2010 school year. $2,000 salary supplement for SI or NDT.

Contact Kate Konopasek at907-742-6121

([email protected])or apply online at www.asdk12.org

W-3993

Midwest

Work Can Be Exciting!Pediatric OT position at multidisciplinary therapy clinic, specializing in speech/feeding, in Niles, IL.

For more information, visit www.atmfc.com or fax resume to (847) 699-5037.

M-3980

South

Occupational Therapist—Lake County School District is seeking to direct hire a licensed therapist to work a 196-day cal-endar year. Pediatric experience preferred. Please contact Judy Miller, Exceptional Student Education Director at 352-253-6610 for details. Applicants may apply on line at www.lake.k12.fl .us. S-3961

West

OT/COTA—Multiple openings at Olympic Sports and Spine Rehabilitation in an outpatient orthopedic and industrial rehab/hand therapy environment. Excellent bene-fi ts package and competitive compensation. FT and PT available in the surrounding city of Tacoma, Washington. Send resume to Attn: Human Resources, Fax: (253) 581-5203 or e-mail: [email protected]. W-3923

Culture & Occupation

A Model of Empowerment in Occupational Therapy

By Roxie M. Black, PhD, OTR/L, FAOTA, and Shirley A. Wells,

MPH, OTR, FAOTA

This follow-up to the best-seller Cultural Competency for

Health Professionals emphasizes the role that culture and cultural competence play in occupational therapy. The Cultural Competency Model introduced in this book helps practitioners, educators, researchers, and students develop self-awareness and the concept of power, attain cultural knowledge, and improve cross-cultural skills. Two chapters detail the use of this model in working with an ethnic population and community, and evidence is featured throughout the discussion.

Order #1241-PAOTA Members: $55Nonmembers: $79

AOTA Best-Seller!

ISBN 13: 978-1-56900-243-8, ISBN 10: 1-56900-243-6, 443 pages, 2007

Call 877-404-AOTA Shop online store.aota.org

BK-687



How did you become the OTA program director at Greenville Technical College?I started out teaching kinesiology

as an adjunct instructor in 2004. After teaching at Greenville Technical College for one semester, they offered me a full-time position as the academic fi eldwork coordinator. I loved that job, marketing and placing students in fi eldwork rota-tions. After I had been a full-time faculty member for 1 year, the program director resigned. While the college interviewed candidates for the position, I was named interim program director. I was respon-sible for the all encompassing duties involved with the daily operation of an OTA program. It was overwhelming at fi rst, but I soon found myself enjoying, and even loving, each and every challenge that surfaced. When the new ACOTE standards were put into place, it made it possible for an occupational therapy assistant to be a program director. Due to the new standards, my role as interim program director has evolved into the program director.

It never occurred to me that I might be one of the fi rst occupational therapy assistant program directors. Upon this realization, I became extremely excited about the future and what this new role may bring for me as well as all OTAs. I am thrilled that the new standards allow OTAs the opportunity to become involved in management positions in the academic arena.

Why is it important for OTAs to be program directors?I think it is important that ACOTE now allows occupational therapy assistants

to be program directors, because we know exactly what occupational therapy assistants should do. I have been an occupational therapy assistant student and clinician, and feel like my experi-ence benefi ts the occupational therapy assistant program greatly. When you have an occupational therapy assistant in the program director role, you understand what entry-level practice is for an occu-pational therapy assistant. That is not to say that an occupational therapist does not understand entry-level practice for an occupational therapy assistant. I just think that sometimes the understanding of entry-level expectations for the OTA can be skewed due to the fact that they are different from entry-level expecta-tions for an OT.

I think it is also important for AOTA, and other organizations that support occupational therapy assistants, to encourage OTAs to take on leadership positions. The new ACOTE standards opened the door for this to happen. To meet the Centennial Vision of AOTA, it is imperative that occupational therapists, as well as occupational therapy assistants, are active in state and national profes-sional associations.

How did you get involved with COE?I attended the OTA Forum at AOTA’s Annual Conference, and heard there were only a very small number of occupational therapy assistant members of AOTA. I was really shocked and disappointed. I decided to get more information about AOTA out to my students, in hopes that it would spark greater interest in them. During this time, I began paying closer attention to the 1-Minute Update from

AOTA, and happened to see an open-ing on COE [Commission on Education]. They were looking to fi ll several positions, one being the occupational therapy assis-tant educator position. Honestly, I never considered taking on a leadership role in AOTA prior to learning of this opening, but I decided that my involvement was necessary. If I am expecting my students to become AOTA members and take on leadership roles, then I should not just talk the talk, but also walk the walk. It was a very exciting day in 2007 when I was appointed. It is a 3-year appointment, and I am the only educator on the com-mission who is an occupational therapy assistant.

What advice do you have for other OTAs who want to get involved in leadership?My suggestion is to make sure you are a member of AOTA! If you are not a member of AOTA, then you really do not know where the heart of things are for occupational therapy practitioners. I am constantly encouraging my students and practitioners in the community to get involved with AOTA and the state occupational therapy association. I think people wait for opportunities to come to them rather than taking the step forward themselves. I encourage OTAs to step for-ward, and take the initiative to see what they can offer. ■

Jennifer Coyne can be reached at Jennifer.Coyne@

gvltec.edu

Molly AsksA monthly column in which Associate Editor Molly Strzelecki profi les your peers.

Jennifer Coyne, BHS, COTA/L, is the program director for the occupational therapy assistant program at Greenville Technical College in Greenville, South Carolina. Here, she talks about being one of the fi rst occupational therapy assistants to become a program director in the country, and her participation on the Commission on Education (COE) for the American Occupational Therapy Association (AOTA).

Q

Low VisionOccupational Therapy Evaluation and Intervention With Older Adults, Revised EditionEdited by Mary Warren, MS, OTR/L, SCLV, FAOTA

Earn 2 AOTA CEUs (20 NBCOT PDUs/20 contact hours)

Occupational therapy practice in low vision rehabilitation services has changed signifi cantly since the Low Vision fi rst edition. Low Vision, Revised Edition helps practitioners maintain professional competency by supporting the AOTA Specialty Certifi cation in Low Vision Rehabilitation (SCLV) credentialing process.

Special features include fi rst edition updates and revisions, new information on evaluation, lessons related to psychosocial issues and low vision, eye conditions that cause low vision in adults, and basic optics and optical devices.

Order #3025-P • Member Price: $370 • Non-Member Price: $470

AOTA Continuing Education Opportunities

AOTA Self-Paced Clinical Courses • Build your practice skills! • Learn at your own pace! • Earn CE contact hours!

CE-105

Self-Paced Clinical Courses From AOTA

Strategies to Advance Gerontology ExcellencePromoting Best Practice in Occupational TherapyEdited by Susan Coppola, MS, OTR/L, BCG, FAOTA; Sharon J. Elliott, MS, OTR/L, BCG, FAOTA; and Pamela E. Toto, MS, OTR/L, BCG, FAOTAForeword by Wendy Wood, PhD, OTR/L, FAOTA

Earn 3 AOTA CEUs (30 NBCOT PDUs/30 contact hours)

Strategies to Advance Gerontology Excellence is among the best continuing education resources available to gerontology practitioners today to help sharpen skills and prepare for the spiraling demand among older adults for occupational therapy services.

Special features include core best practice methodology with older adults, approaches to and prevention of occupational problems, health conditions that affect participation, and practice in cross-cutting and emerging areas.

Order #3024-P • Member Price: $490 • Non-Member Price: $590

To order, go to store.aota.org (Self-Paced Clinical Courses) or call toll free 877-404-AOTA and refer to the course’s code.

Get Ready for Occupational Therapy MonthApril 2009

Visit Us Online!

www.promoteOT.comView all of the Occupational Therapy Month products and order online, request or download the entire 16 page catalog.

OT3

OT16

OT15

OT11

PR-219

OT9

OT20OT32

OT39

OT28

OT24 OT26

OT1

Occupational Therapy Month is the time each year when you can demonstrate the importance of Occupational Therapy in health care. Show your enthusiasm for your profession, staff, colleagues, and friends with specially designed items from AOTA. Our new collection is sure to make this year’s celebration the best ever!

Sponsored by

OT6 OT30

OT47

OT36

CE-1MARCH 2009 ■ OT PRACTICE, 14(5) ARTICLE CODE CEA0309

AOTA Continuing Education ArticleEarn .1 AOTA CEU (one NBCOT PDU/one contact hour). See page CE-7 for details.

LISA MAHAFFEY, MS, OTR/LOccupational Therapist, Linden Oaks At Edward, Naperville, Il

This Continuing Education Article was developed in collaboration with AOTA’s Mental Health Special Interest Section.

ABSTRACTStudies have shown the importance of engaging in meaning-ful occupation to achieve and maintain good mental and physical health (Clark et al., 1997; Rowe & Kahn, 1997). This article lays out a six-step reasoning process that is compat-ible with any occupational therapy theory. Using this process, the practitioner makes decisions throughout the occupational therapy process that incorporate the concepts of the chosen theory. The result is intervention that is occupation-based, client-driven, and meaningful to older adults who are hoping to gain satisfaction in their lives in spite of physical or mental challenges.

LEARNING OBJECTIVES After reading this article, you should be able to:1. Recognize the transactional relationship between participa-

tion in occupation(s) and the mental health status of older adults.

2. Recognize a therapeutic reasoning process that structures decision making during occupational therapy intervention when using a theoretical framework.

3. Recognize how applying a therapeutic reasoning process using a theoretical model like the Model of Human Occupa-tion (MOHO) can direct intervention toward meaningful and fulfi lling occupations for older adults.

4. Recognize how the therapeutic reasoning process is com-patible with many theories that are appropriate for working with older adults.

INTRODUCTION TO MARIAN Marian is admitted into the geriatric mental health unit for the third time this year. During the last two hospitalizations she was suicidal and diffi cult to motivate. This time, she has too much energy and had been staying up most of the night cleaning. Marian is 78 years old. She was diagnosed with bipolar disorder in her 20s. She was put on medication and had a long period of stability during which she was able to raise her kids, complete a degree in business management, and run her own gift shop. Three years ago her husband became ill. Marian cared for him until his death last year, then fell into a deep depression from which she has not been able to recover.

Mental Health and the Older AdultOccupational therapy practitioners work with seniors in many different settings, thus we need to be prepared to address mental health issues among this population. The latest report on mental health prepared by the Surgeon General (U.S. Department of Health and Human Services [DHHS], 1999) estimated that 20% of older adults are diagnosed with a men-tal illness. Many people go without interventions that would allow them to live an occupationally rich life. Between 2018 and 2032, the population of older adults will double (CDC, 2007), and if trends continue, so will the number of those needing mental health support.

Because of the stigma of mental illness, and the fragmented and disconnected U.S. health care system, many older adults with mental illness fall by the wayside. Many do not seek help from a psychiatrist, opting instead to see their primary care physician (National Institute of Mental Health [NIMH], 2007). Sixteen percent of all suicides are among adults over age 65, although people in this age group comprise only 12% of the total population (NIMH, 2007). Seventy fi ve percent of these older adults visited their primary care physician within a month of their suicide (NIMH, 2007). On the positive side, more mental health facilities are working to cater to the needs of older adults. There has been a recent push for more com-munity-based mental health services, starting with educating primary care physicians to recognize and treat the symptoms of mental illness (Krahn, 2006). The Substance Abuse and Mental Health Services Administration (SAMHSA, 2007) and geriatric psychiatric units are developing programs that can address more severe situations. Occupational therapists are in a position to identify the need for mental health support in home health, rehabilitation settings, and long-term-care facilities.

Statistically, only 5% of community-dwelling older adults have depression. However, that percentage rises to 13.5% among those requiring long-term health care. And depression is not the only mental health concern. Two thirds of people living in extended care facilities meet the criteria for a psy-chiatric diagnosis (NIMH, 2007). Overall, 10% to 12% of older adults are at risk for alcohol dependence, 1% are diagnosed with bipolar disorder, 11% are diagnosed with anxiety disor-ders, and 1% are diagnosed with schizophrenia (DHHS, 1999).

The prevalence of depression increases when people have other illness or injury (Miller, Paschall, & Svendsen, 2006), and the reverse can also be true. Incidences of dementia, heart dis-ease, diabetes, and possibly cancer increase when depression

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Using Theory and the Therapeutic Reasoning Process To Guide the Occupational Therapy Process for Older Adults With Mental Illness

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in older adults is left untreated (Miller, Paschall, & Svendsen, 2006). For example, when an older adult has a serious fall, fear of another fall can keep the person from going out and engag-ing in meaningful occupations. This lack of activity often leads to catastrophic loss of roles, social connection, and physical conditioning, resulting in isolation, depression, and an increase in the chances of having another, potentially more devastating fall (Centers for Disease Control & Prevention, 2008; How-land, Peterson, Levin, Ried, Pordon, & Bak, 1993). In addition, people who struggle with recovery from injury or illness often take multiple medications. “Do The Right Dose” is a new initia-tive from SAMHSA in response to increasing numbers of older adults who are misusing medications, using alcohol with their medications, or seeking help for new addictions. SAMHSA also is addressing the growing incidences of accidental overdose due to confusion (SAMHSA, 2006).

Faced with these statistics, it is hard to remember that mental illness is not a normal part of aging. The majority of older adults cope successfully with the changes in their bodies and the losses that come with getting older. Researchers have attempted to determine what factors contribute to these per-sons’ ability to successfully cope with aging. Rowe and Kahn (1997) identifi ed several factors, including level of education and continuing education, as strong indicators of the ability to cope with aging. Other factors include having a support network, being engaged in daily life (particularly in productive activity), and having a sense of control over one’s life and a say in major life decisions.

The Well Elderly Study completed by researchers at the University of Southern California is a defi ning study for the power of occupation and occupational therapy intervention (Clark et al., 1997). Participants from several independent living situations were divided into three groups. One group received no intervention, one group was encouraged to attend social activities, and one group received both group and individual occupational therapy sessions. The subjects in the occupational therapy intervention group were taught the importance of continued participation and were given skills to stay active in occupations, such as managing changes in nutritional needs and avoiding falls. Individual sessions helped them apply the lessons to their own situations. All participants were administered a battery of fi ve assessments that measured physical and social function, self-rated health, life satisfaction, and symptoms of depression, before and after the interven-tion. Both control groups showed a decline in all indicators. The intervention group showed improvement in all indica-tors except three, and declined signifi cantly less in those. The results provide strong support for making participation in occupation the desired outcome of occupational therapy intervention.

THE ROLE OF THEORY IN PRACTICE It is occupation-based theory that sets occupational therapy intervention apart from interventions used by counselors,

physical therapists, and others who provide care to geriatric clients. As a clinical supervisor for students from schools all over the country, I have noticed that theory remains an after-thought and is not a guide in determining the course of inter-vention. Occupational therapy theory must be used to guide intervention, from the moment the person enters our care. By using theoretical concepts to guide information gathering and intervention, not only do we focus on participation through engagement in occupation (AOTA, 2008), but we also have the words and language to help others understand and value our unique contribution to a person’s recovery.

Theory and the Reasoning ProcessMattingly (1991) used an anthropologic approach to study and describe the way occupational therapy practitioners think when engaged in the process of intervention. Kielhofner and Forsyth (2008), building off of Mattingly’s approach, proposed a six-step process that helps the practitioner “think with theory.” This reasoning process can be used with all theories, including those that are not traditionally used in occupational therapy practice. The six steps of the therapeutic reasoning process structure practitioners’ choices from the moment they are introduced to their client until discharge. Kielhofner and Forsyth used the Model of Human Occupation (MOHO) to illustrate this process. The remainder of this article will use the MOHO as the framework to demonstrate how to integrate theory as a guide to intervention.

The six steps are as follows: Step One: Generating clinical questions based on the

concepts of the theoretical model.Step Two: Collecting information from the person,

through formal and informal means.Step Three: Creating a picture of that person’s experience.Step Four: Working with the person to generate the inter-

vention plan, including goals and strategies.Step Five. Implementing the plan.Step Six: Evaluating the outcomes.

It is important to remember that the steps are not neces-sarily followed in this order. Practitioners often complete the steps concurrently as they move through the process. The choice of which theory to use in the process may be a refl ec-tion of the treatment setting, the age of the client, the present-ing problem, or the therapist’s preference. It is also important to keep in mind that the process is taught to clients when pos-sible, so they gain competence in making changes in their own lives after being discharged from therapy (Kielhofner, 2008).

In Marian’s case, the MOHO (Kielhofner, 2008) will be used to develop the clinical questions and drive the therapeutic rea-soning process. The MOHO begins with the understanding that people are occupational beings and that our identity and sense of effectiveness in the world are established through success-fully participating in our roles, identifying what motivates us, and developing our competence in occupations. Performance

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factors such as our neurological and mental capacity, our natural and learned functional skills, and our developed inter-personal skills, are key to successful participation. MOHO also considers the transactional relationship between the person and the contexts in which he or she lives, learns, and works (Kielhofner, 2008).

MARIAN AND THE THERAPEUTIC REASONING PROCESS When Marian was admitted into the mental health facility, the information in her chart focused on her symptoms, her recent history of frequent hospital-ization, her children’s concerns, and her advancing age. Her children were worried that Marian’s mental status meant they could no longer care for her, and they sought options. Further discussion with two of Marian’s children revealed anxiety about her memory. She was calling them more frequently and not remembering the previous calls. She was losing things more often, and she was not able to remember how to get to her daughter’s new home. As part of her inpatient treatment, Marian was referred to occupational therapy.

Step One: Generating Clinical QuestionsThe fi rst step in the therapeutic reasoning process is to gener-ate a list of clinical questions, The clinical questions are based on the tenets of the theory, which helps to focus and guide the method of information gathering, the choice of instruments, and the quality and focus of the information. A list of clinical questions can be found in the fourth edition of A Model of

Human Occupation: Theory and Application (Kielhofner, 2008 144). I considered the following questions to be most important in guiding Marian’s treatment when I fi rst made contact with her.■ Occupational Identity: How does Marian describe herself

occupationally? What factors have infl uenced her view of herself and her lifetime of participation? What has been most motivating for her throughout her life?

■ Occupational Competence: Does Marian feel she has been able to meet her past responsibilities and accomplish her goals? Does she feel she has the ability to accomplish the tasks she needs and wants to do now?

■ Habituation: What is Marian’s daily routine? Does it refl ect those things that motivate her? What roles does she identify with, and does she feel that she meets the expectations of these roles? Is she routinely engaging in productive, leisure, social, and self-care activities?

■ Performance and Skill: Are there factors that are interfering with Marian’s ability to participate in self-care and produc-tive, leisure, and social activities? Does she have the motor, process, sensory modulation, and communication and interaction skills to participate in her occupations?

■ Volition: Is Marian able to express confi dence in her ability to engage occupationally? Does she feel that she has con-trol in her day? What does she identify as most meaningful, and is she incorporating activity with meaning into her daily routine? Is she able to identify direction for her life given the changes she has experienced?

■ Environment: What sort of support will Marian need to remain at home? Are those supports available in her community? Does she have the transportation and monetary supports to stay active and meet her role expectations? Are the supports in place if she shows increased signs of cognitive decline? Do Marian and her family understand her bipolar disorder and dementia so as to be able to monitor changes and react in her best interest? Are she and her family aware of the care options, and can they access that system?

Although additional questions may surface during the evaluation and intervention stages of care, starting with these allows me to create a narrative of Marian as an occupational being who interacts within the context of her home, commu-nity, and social relationships.

Step Two: Collecting InformationStep two of the therapeutic reasoning process is gathering information. Decisions about what assessments to use are based not only on the questions I have posed, but on Marian’s age and developmental life stage. Interview is always a source of information, and I fi nd the Occupational Performance His-tory Interview (OPHI) (Kielhofner, et al., 2004) to be a good choice for older adults. The OPHI is semi-structured and designed to capture a person’s life story, focusing on engage-ment in occupations throughout the life span. The OPHI covers many of the clinical questions and can pinpoint changes in occupation that are characteristic of changes in physical or mental status, many of which lead to admission to a mental health facility. In addition to interview, I will use self-report forms, observation, and, if needed, a more formal cognitive assessment such as the Allen Cognitive Level Test (Allen, 1990).

In my experience, older adults enjoy having someone to talk with, but asking a lot of questions at once can be over-whelming and uncomfortable. Keeping the clinical questions in the back of my mind allows me to gather information every time Marian and I are together.

Initially, Marian expresses anxiety at being in the hospital and talking about herself. She does better with a series of short question-and-answer sessions over several days. She is also more willing to share in groups when she experiences others sharing. The evaluation process continues as I spend time on the unit, during morning activities of daily living time and meals. By helping Marian and others complete these tasks, I have the opportunity to unobtrusively observe them. She is also observed interacting with her peers and staff, during groups and in the milieu. The observations are meant to identify her motor and process skills, such as her ability to manage her utensils and tray, adapt to changes, learn from her mistakes, etc. (Pan & Fisher, 1994). Eventually, she becomes more active and interested in the assessment process and in setting goals for herself. I ask her to complete a Role Checklist (Oakley, Kielhofner, Barris, & Reichler, 1986). This simple



self-report form helps her identify past and present roles and those she wishes to continue in the future. Knowing what roles she values helps me determine whether she incorporates the activities associated with those roles into her routine. Marian completes an Occupational Self-Assessment (Baron, Kielhof-ner, Iyengar, Goldhammer, & Wolenski, 2006) to help her iden-tify the three goals she believes are most crucial for her right now. Lastly, Marian and her family give me a clear picture of her home, neighborhood, and support network through their responses to the environment questions on the OPHI. I use the Internet to search for community support services, such as senior services and adult day care, in her area.

To summarize the information, I use the Model of Human Occupation Screening Tool (Parkinson, Forsyth, & Kielhofner, 2006). This tool covers all areas of MOHO, allowing for a rat-ing and brief summary in each area. Because evaluation and intervention are ongoing in acute care, additional information is added daily to the record, summarized in weekly progress notes, and reported to the staff in biweekly meetings.

STEP 3: CREATING A PICTUREIn step three of the therapeutic reasoning process, a picture of the person is created, including his or her strengths and challenges. I return to the clinical questions noted earlier to develop Marian’s story.

Occupational Identity: Marian struggles with describing herself occupationally. She is quick to mention being a parent and grandparent, but her children are busy and she knows that these roles are not enough to occupy her time. She also identi-fi es owning her own home, but feels that is in jeopardy due to her struggles to keep it up. She falls back on her long history of participating in her life roles to characterize herself. Diffi culty staying on task and constant feelings of self-doubt affected her school years. Shortly after turning 20 she had her fi rst manic episode and left college to open a business on the West Coast, spending all of her money and borrowing from questionable sources. In her late 20s she was placed on lithium and began to experience a period of stability that allowed her to complete a business degree and open her own gift shop. She met her husband at this time and credits him for much of her stability. “He was always supportive, and if he saw my moods shift, he would encourage me to take care of myself,” she says. They raised fi ve children. One daughter is diagnosed with bipolar disorder and remains stable. Her son lives in California and has an addiction to alcohol. Although he was never diagnosed, Marian is convinced that he too has bipolar disorder. They have remained estranged, and this is a constant source of sadness for Marian. The four children in the Chicago area have been supportive and available to Marian. Marian describes her grandchildren as her “greatest joy.” She gave up the role she took most pride in, owning and managing the gift shop, when her husband became ill. For the 2 years that she took care of him she rarely got out. Although the kids offered to help and regularly relieved her so that she could shop and run errands,

she felt it was her responsibility to care for her husband and she didn’t want to bother them. Because of this, she lost touch with her friends and gave up most of her interests. She has not had the motivation to reconnect since her husband died.

Occupational Competence: Marian talks with pride about her life. She sees herself as overcoming her bipolar disorder to accomplish her goals. Several times she refl ects on her rela-tionship with her son, or her “episode” in California, but for the most part, she is able to focus on the things she is proud of. When the conversation turns to the present, she becomes much sadder. She worries about her memory and struggles with how she will ever get the motivation to re-engage. Her recent “burst of energy” was encouraging to her until her children brought her to the hospital. Although she is able to see that there were unhealthy patterns, such as spending too much money, she remains unsure that this behavior was a symptom of mania and wonders if the children are just try-ing to take control of her. Marian identifi es exercising more and cleaning the basement as her goals. When asked about how she would fi ll the remainder of her time, she is unable to identify anything, stating that she is too old and too tired to do anything else.

Habituation: After Marian’s husband died, her days were characterized by watching TV. She would get microwaveable meals for herself, but there were long periods when she didn’t eat anything. She would shower and dress on days her family was coming; otherwise, she would put on clean pajamas and spend much of the day on the couch. She did clean when she had the energy, but it didn’t take long. She was sure the house needed repair but was content to leave that to her children. The week before she was admitted, she was averaging 3 hours of sleep per night and was spending hours cleaning the attic and the basement. She could not focus on anything, and as a result she left the house in chaos, which was weighing on her mind. Marian conceded that the greatest period of stability in her life was when she owned the gift shop and had to get there each day. She realized how much she missed the interaction with customers and the creative process of arranging the store displays and windows. A friend had always been understand-ing of her mental illness and had provided her with support at some of the more trying times. Marian realizes that this friend would help her reconnect with her social network so that she won’t need to rely so heavily on her children.

Performance and Skills: Marian’s loss of major roles—owning a gift shop and providing care for her husband—has been a powerful factor in her sense of identity and her participation. Her grief encompasses these losses, along with her husband’s death. She appears to have had good communication and social interaction throughout her life. Of concern now is her memory. Marian shows minor diffi culty with task management. The fi rst few days she took the wrong meal tray and when it was pointed out, expressed frustration with the system. Dur-ing activities of daily living (ADL) she struggled with fi nding her things. By day 3, Marian is able to remember where her

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things are and to manage all of her self-care tasks indepen-dently. She continues to need help fi nding her way outside of the unit. Her fi rst visit to the cafeteria proved to be very anxiety provoking, but that anxiety subsided with subsequent visits.

Marian completed neuropsychological testing while at the hospital. Results indicate that she has Alzheimer’s-type dementia. Her ability to use visual cues for memory recall to use judgment indicate that she is in the early stages. She is placed on medication to slow the progression of the disease. This development will need to be considered in all discharge decisions, client and family education, and the occupational therapy intervention and discharge plan.

Volition: Marian completed the OSA with great interest. She identifi ed several problems, but the areas that are most impor-tant to her are reconnecting with her social supports and fi nd-ing things to do that give her a sense of purpose. She uses the results of the OSA to identify three goals: (1) to fi nd part-time work or volunteer somewhere so she can feel productive. (2) to reconnect with her friends and re-engage in the activities they once did, and (3) to improve her health and fi tness by eating healthier, managing her medications better, and adding activities, including exercise at the YMCA. She expresses some fear over returning to the gift shop as an employee and not the owner. She identifi es being with children as a joy and is sad that she has so little time with her grandchildren. Marian decides she would like to explore opportunities where she could work with children. Her diagnosis of Alzheimer’s-type dementia and the implications of the disease process anger her because she has managed her bipolar disorder, and now she has to contend with this. She agrees that she will need to put things into place to accommodate the inevitable changes in her mental status.

Environment: By the end of Marian’s hospitalization, it is determined that she will be able to return home for the time being. Her memory problems remain, but her judgment is intact and her function clearly improved as she became familiar with her surroundings. She will be allowed to drive in her local and familiar community but agrees to ask for help to go somewhere outside of her community. The family is made aware of a driving assessment program they may use if the need arises. The gift shop and several volunteer options are available near her home. In fact, she could walk to the gift shop and the local elementary school, where there is an oppor-tunity to read to children. One daughter lives in her town with her two teen girls, and the three of them agree to check in on Marian every day and to fi ll her pillbox on Sundays. The other children agree to take on other roles, such as home mainte-nance. Marian is hesitant to give up control of her money, so a system is established to include one daughter on the account. Marian will be given cash for the week, but the bank or her daughter will handle all other monetary responsibilities. They have discovered that Marian can use her cell phone to record appointments and her medication schedule, and it will beep to

remind her of these things. Marian got in the habit of carry-ing her phone when her husband was sick, so this will serve as her lifeline. A neighboring community has a support group for people with bipolar disorder, and a local assisted living facility has a support group for people dealing with Alzheimer’s disease. The family is given this information and encouraged to tap into these resources. Lastly, Marian is introduced to the idea of moving into assisted living. She and her family agree to explore the assisted living facilities near them.

Steps Four and Five: Generating Goals and Implementing a PlanStep four in the therapeutic reasoning process is identifying goals, and step fi ve is implementing them. Because of the cli-ent-centered nature of the MOHO, Marian is able to identify her own goals, which will guide mine. The evaluation process gives her the opportunity to explore her occupational his-tory and identify the things that have supported her success. The results provide her with direction for the future. Marian’s occupational therapy goals are to arrange to return to the gift shop and to volunteer in order to regain a sense of control and to explore and understand the changes in her cognitive status, which will require modifi cation for future occupations. Imple-mentation for Marian is simply a matter of providing her with the resources she needs to explore her community, setting up opportunities for her to discuss her goals with her family and friends, and keeping her discharge plans achievable. Marian also appreciates the frank discussion about her Alzheimer’s diagnosis and the need to have a plan for her future. Although her situation is distressing at times, she likes the idea of being proactive and having a level of control in future decisions.

Step Six: Evaluating Outcomes The last step in the process is evaluating outcomes. In a short-term, acute hospital stay, this process can only focus on the person’s function within the hospital. However, many of Marian’s goals are achievable only after discharge, and I will not be able to follow up with her after she is gone. Marian expresses a greater sense of self-control and comfort now that she has direction and some things to look forward to. She feels much more hopeful, and her fear is under control. Her family states that they also have a better idea of how to help her.

CALEB AND THE THERAPEUTIC REASONING PROCESS Using an approach focused on participation creates oppor-tunities for setting meaningful and functional intervention goals with someone who has more advanced dementia. Using the MOHO, the practitioner focuses on participation in valued roles as the end goal, with adaptation for cognitive challenges as needed. Caleb came to the hospital diagnosed with Alzheimer’s disease. He was living at home with his wife and one daughter who had recently moved home to help her mother care for him. Caleb had recently taken to wander-ing off. When his exit is blocked, he becomes aggressive, and he has threatened to hit his daughter several times. He was



brought to the hospital to help decrease his aggression and to be evaluated for placement. Caleb proves to be challenging to the staff and other patients on the unit. He wanders from door to door asking to be let out. He becomes frustrated and angry, banging the doors and shouting.

The occupational therapy evaluation is developed around a similar set of clinical questions as Marian’s, although with Caleb the focus shifts to his past participation and what made up his occupational identity throughout his life. The evalua-tion with Caleb is ongoing because each conversation presents new information. Caleb’s wife and daughter are very helpful, providing me with information about his past occupations.

Caleb’s EvaluationCaleb spent much of his adult life working at a factory that built electronic parts for radios and television sets. Eventually he worked his way up from the fl oor to plant manager, where he was in charge of production and labor. The company was relatively small and he took pride in knowing everyone who worked for him, taking great responsibility for their well-being. Before working at this company, he spent 2 years in the army and saw action in Korea. He never talked about this with his family but alluded to something terrible happening there. He met his wife after he got out of the army, and they have been married for 53 years. They had two daughters and a son. About 11 years ago, their son died of cancer. Caleb rarely talks about his son despite their having been close when he was alive.

Using Other Theoretical Models in the Therapeutic Reasoning ProcessWhen working with clients like Caleb who have dementia, I like to incorporate other theories and models into the therapeutic reasoning process. In addition to MOHO, I draw on two other theories related to dementia that work well with occupational therapy. The fi rst, by Barry Reisberg and colleagues, is called Retrogenesis (Reisberg et al., 1999). Retrogenesis states that people with Alzheimer’s disease will regress cognitively in the same pattern and time frame as infants and children develop. One of my clinical questions is, “How does Caleb manage self-care tasks such as getting dressed and eating?” I can compare the results of my observation to the stages of child develop-ment, and by doing so I am able to consider interventions that help him feel more in control. Caleb no longer effectively uses utensils when eating, often trying to use his knife to eat soup or to stab a piece of meat. After many battles the family opted to feed him, which he tolerates poorly. During his stay, Caleb and his family are introduced to the idea of fi nger foods. By using his fi ngers to put food in his mouth, Caleb is able to feed himself independently. As a result, he is calmer at meals and his intake has improved signifi cantly. Caleb also has diffi culty with continence and tends to relieve himself in a corner. At fi rst the staff puts briefs on him, but changing them proves challenging because Caleb becomes aggressive. Although he

keeps the briefs on at night, he is eventually put on a toileting schedule and taken to the bathroom every 2 hours, where he manages with moderate assist and little aggression.

Another theory I draw from is Validation Therapy (Feil, 2002). Naomi Feil, MSW, developed this theory after observing how her interaction with older adults affected their happiness and acceptance of the disease process. There are two key principles to validation. First, participation in present real-ity requires fair function of eyesight, hearing, and memory. Without these, people will retreat to their memories, often those that are tinged by emotion. The second is that older adults must go through a process of resolution and will do so regardless of their stage of dementia (Feil, 2002). As care providers, it is often our job to understand the purpose behind a person’s actions. When using Validation Therapy, clinical questions are created to explore the relationship between past occupational participation and current emotional response to daily situations.

Caleb struggles with self-care on the unit. In my attempt to solve this problem, I implement a validation process with him. At one point Caleb decides that I am a reporter doing an exposé of the war, and he begins to share what happened. Although he never gives details, he alludes to being awakened early in the morning, stripped, and made to do humiliating things. The staff decide that this memory may be why he is so resistant to self-care. After changing his bath time to early evening, they fi nd that he is much less distressed. Validation therapy reveals that Caleb experiences time as nonlinear, mov-ing back and forth in his memory. Two recurring events sur-face when Caleb insists that he be allowed to leave: (1) a time when he had been accused of stealing from his company, and (2) his son’s funeral. At least once a day, Caleb wants to leave to “take care of” the situation. He is encouraged to express his distress and unresolved grief to the staff, and over time these memories become less emotionally charged. Treatment includes exploring ways to engage Caleb in tasks associated with successful past roles. His family is included in this process and eventually they take over. Engaging Caleb in activities that once brought him a sense of identity and competence prove very successful. Caleb begins to laugh and talk with his family, his ADL improve, and his aggression is eliminated.

CONCLUSION Throughout both Marian’s and Caleb’s occupational therapy intervention, my focus remains the promotion of both mental and physical health through engagement in occupation. This is the result of my use of a therapeutic reasoning process that incorporates occupation-related theories. The tenets of the theories help guide me as I work with my clients to identify goals that are meaningful and relevant to them. Helping clients and their families create routines that incorporate occupa-tion allows them to feel engaged in meaningful life roles and provides them with a sense of control and satisfaction. Provid-ing the family with an understanding of the importance of


occupation gives them the knowledge to make decisions about long-term care that take into account their family member’s optimal engagement in desired occupations. Lastly, because the therapeutic reasoning process can help direct theory, I have the structure and language to explain to my teammates the benefi ts of helping someone engage in meaningful occupa-tion, thus creating a unique and valued place for occupational therapy on the treatment team. ■

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CE-7

Earn .1 AOTA CEU (one NBCOT PDU/one contact hour). See below for details.

Electronic Exam:Immediate Results and Certifi cate

How To Apply for Continuing Education Credit:1. After reading the article Using Theory and Therapeutic Reasoning

To Guide the Occupational Therapy Process for the Older Adult With Mental Illness, answer the questions to the fi nal exam (begin-ning below) by registering to take the exam online and receive your certifi cate immediately upon successful completion of the exam. Alternatively, you can complete the exam by using the Registration and Answer Card bound into this issue of OT

Practice following the test page. In either case, each question has only one answer.

2. To register, go to www.aota.org/cea or call toll-free 877-404-2682. Once you are registered you will receive your personal ac-cess information. Then log on to www.aota-learning.org to take the exam online. If you are using the Registration and Answer Card, complete Sections A through F and return the card with the appropriate payment to the address indicated.

3. There is a nonrefundable processing fee to score the exam, and continuing education credit will be issued only for a passing score of at least 75%. Use the electronic exam and you can print off your offi cial certifi cate immediately if you achieve a passing score. If you are submitting a Registration and Answer Card, you will receive a certifi cate within 4 to 6 weeks of receipt of the processed card.

4. The electronic exam must be completed by March 31, 2011. The Registration and Answer Card must be received by March 31, 2011, in order to receive credit for Using Theory and Therapeutic Reasoning To Guide the Occupational Therapy Process for the Older Adult With Mental Illness.

Final Exam ARTICLE CODE CEA 0309Using Theory and Therapeutic Reasoning To Guide the Occupational Therapy Process for the Older Adult With Mental Illness

March 23, 2009

Learning Level: Intermediate

Target Audience: Occupational therapists and occupational therapy assistants

Content Focus: Domain of Occupational Therapy, Areas of Occupation, Occupational Therapy Process, Evaluation and Intervention

1. Which of the following does not contribute to mental health issues for older adults?

A. Fear of falling B. Getting older C. Medication overdose D. Serious physical illness, such as heart failure or cancer.

Exam continued on page CE-8



2. Level of education, as well as continuing education, are two indicators for successful aging. Which of the follow-ing is also a factor?

A. Being able to remain in one’s own home B. Absence of serious illness C. Remaining actively engaged in productive activity D. Having fi nancial security

3. The landmark Well Elderly Study indicates that occupa-tional therapy intervention can help older adults avoid a decline in health and daily function. Which of the following key concepts in the study results support this assumption?

A. The subjects in group two, who were provided with structured social activities, showed the same decline as the control group.

B. Individual attention for subjects in the study group did not affect the end results.

C. All subjects benefi tted from being in the study, regard-less of which group they were assigned to.

D. Subjects in the social activity group showed the same benefi ts as those in the study group that received indi-vidual occupational therapy.

4. Which of the following is not considered a step in the therapeutic reasoning process?

A. Creating the person’s story from the assessment results B. Generating clinical questions and collecting information C. Creating an intervention plan with the person D. Developing a standard form to be used with all clients

5. Step one of the therapeutic reasoning process is to choose a guiding practice theory and create which of the following?

A. A description of the problem the person is presenting with

B. A list of clinical questions that will form the basis for all future steps

C. An evaluation to start with D. Ways to help the person determine what he or she

wants out of the treatment process

6. Assessments are chosen by considering the clinical ques-tions as well as the person’s age, cognitive capability, and developmental stage in life.

A. True B. False

7. Which of the following questions best determines occupa-tional competence when using the therapeutic reasoning process with the Model of Human Occupation?

A. What roles does Marian see herself as holding in society?

B. Does Marian feel she has been able to meet her past role responsibilities and accomplish her goals?

C. What is Marian’s daily routine? D. What sort of support will Marian need to remain at

home?

8. After collecting data, the therapist organizes this informa-tion by answering the clinical questions created in step one. This step is meant to do what?

A. Generate the treatment plan B. Gather information through formal or informal means C. Create a picture of the client’s situation D. Assess outcomes

9. All steps in the therapeutic reasoning process are com-pleted individually and in the order in which they are presented.

A. True B. False

10. Which of the following is not one of the interrelated con-cepts in the Model of Human Occupation?

A. The infl uence of the environment on occupation B. The development of identity through competence in

occupations C. Cognitive levels that infl uence decisions about function D. Identifi cation of the factors that motivate people to

participate in occupations.

11. The idea of looking to past occupations to understand and interpret Caleb’s behavior is drawn from which theory about communicating with confused older adults?

A. Validation Therapy B. The Model of Human Occupation C. Cognitive Behavioral Therapy D. The therapeutic reasoning process

12. Caleb is no longer able to manage his utensils dur-ing meals. Using retrogenesis to guide the therapeutic reasoning process, what clinical questions might the therapist ask to begin creating Caleb’s intervention?

A. What cognitive and perceptual motor skills does Caleb have relative to managing toileting and dressing?

B. What tasks related to ADL can Caleb complete using cueing and set up?

C. What activities and occupations does Caleb engage in and enjoy, and what modifi cations can be made to allow participation?

D. All of the above