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CE Article: Reducing Hospital Readmissions<br />
The American Occupational Therapy Association<br />
<strong>Practice</strong><br />
August 22, 2016<br />
®<br />
Familiar Pathways<br />
Learning From the Story of Marty<br />
Also in This Issue<br />
Planning a State OT on the Hill Day<br />
A Magical Teacher
AOTA Specialty Conference<br />
September 23–24, 2016 · Cleveland, Ohio<br />
Preconference Workshops: September 22, 2016 (separate registration required)<br />
Presented by Lucy Jane Miller, PhD, OTR/L and Susan Bazyk, PhD, OTR/L, FAOTA<br />
Register by August 24, and SAVE!<br />
www.aota.org/autismconference<br />
Autism diagnoses continue to rise, along with the greater necessity to<br />
understand life transition challenges. It is urgent for the occupational<br />
therapy profession to be fully prepared to meet the needs of children,<br />
adolescents, and young adults on the autism spectrum.<br />
A must-attend<br />
conference for advancedlevel<br />
practitioners<br />
working with kids or<br />
young adults!<br />
Occupational therapists play a key role in working with individuals on the autism spectrum to<br />
help them participate in daily routines and integrate into communities. This AOTA Specialty<br />
Conference, featuring national experts in occupational therapy, will give practitioners an<br />
exceptional opportunity to learn evidence-based practices—across the lifespan—from leaders in<br />
the autism field.<br />
Earn up to 14 CONTACT HOURS (1.4 AOTA CEUs/14 NBCOT PDUs)<br />
All Specialty Conference sessions will be held at the<br />
modern, new Hilton Cleveland Downtown—located just<br />
minutes from the city’s most popular attractions, including<br />
Cleveland’s iconic Rock & Roll Hall of Fame!<br />
SP-122
side<br />
The American Occupational Therapy Association (AOTA)<br />
Volume 21 • Issue 15 • August 22, 2016<br />
2 Editor’s Note<br />
3 News<br />
5 Capital Briefing<br />
New Occupational Therapy<br />
Evaluation Codes Released<br />
19 Evidence Perks<br />
New AOTA <strong>Practice</strong> Guidelines<br />
on Autism Spectrum<br />
Disorder and Traumatic<br />
Brain Injury<br />
21 Perspectives<br />
A Magical Teacher<br />
23 Around the World<br />
Making Global<br />
Connections in Galway,<br />
Ireland: 1st Joint Congress<br />
of COTEC-ENOTHE<br />
26 Continuing<br />
Education<br />
Opportunities<br />
29 Employment<br />
Opportunities<br />
31 AOTA for You<br />
32 Social Media<br />
Spotlight<br />
Cover Story<br />
6 Familiar Pathways<br />
Learning From the Story of Marty<br />
The story of a skilled nursing facility client reveals the value of<br />
occupational therapy in helping individuals find comfort and meaning.<br />
By Carolyn Pluta<br />
Also in This Issue<br />
12 Planning a Successful<br />
State OT on the Hill Day<br />
Lessons Learned From Legislative Experiences<br />
in Missouri<br />
By Jacquelyn M. Sample<br />
12<br />
OT PRACTICE • AUGUST 22, 2016<br />
21<br />
CE Article<br />
The Role of Occupational Therapy<br />
in Reducing Hospital Readmissions<br />
Earn .1 AOTA CEU (1 contact hour or 1.25 NBCOT professional development<br />
units) with this creative approach to independent learning.<br />
1
Chief Operating Officer: Christopher Bluhm<br />
Director of Communications: Laura Collins<br />
Director of Marketing: Rebecca Rutberg<br />
Editor: Ted McKenna<br />
CE Articles Editor: Debbie Amini<br />
Art Director: Carol Strauch<br />
Production Manager: Gary Furton<br />
Director of Sales & Corporate Relations: Jeffrey A. Casper<br />
Sales Manager: Tracy Hammond<br />
Advertising Assistant: Clark Collins<br />
Ad inquiries: 800-877-1383, ext. 2715,<br />
or e-mail sales@aota.org<br />
OT <strong>Practice</strong> External Advisory Board<br />
Donna Costa: Chairperson,<br />
Special Interest Sections Council<br />
Julie Dorsey: Chairperson,<br />
Work & Industry Special Interest Section<br />
Elena Espiritu: Chairperson,<br />
Physical Disabilities Special Interest Section<br />
Lenin Grajo: Chairperson,<br />
Education Special Interest Section<br />
Ellen Hudgins: Chairperson,<br />
Administration & Management Special Interest Section<br />
William E. Janes: Chairperson,<br />
Technology Special Interest Section<br />
Patricia Laverdure: Chairperson,<br />
Early Intervention & School Special Interest Section<br />
Wanda Jean Mahoney: Chairperson,<br />
Developmental Disabilities Special Interest Section<br />
Jenny Martinez: Chairperson,<br />
Gerontology Special Interest Section<br />
Annie Baltazar Mori: Chairperson,<br />
Sensory Integration Special Interest Section<br />
Susan Noyes: Chairperson,<br />
Mental Health Special Interest Section<br />
Marnie Renda: Chairperson,<br />
Home & Community Health Special Interest Section<br />
AOTA President: Amy Lamb<br />
Executive Director: Frederick P. Somers<br />
Chief Academic & Scientific Affairs Officer: Neil Harvison<br />
Chief Public Affairs Officer: Christina Metzler<br />
Chief Financial Officer: Chuck Partridge<br />
Chief Professional Affairs Officer: Maureen Peterson<br />
© 2016 by The American Occupational Therapy Association, Inc.<br />
OT <strong>Practice</strong> (ISSN 1084-4902) is published 22 times a year,<br />
semimonthly except only once in January and December, by<br />
The American Occupational Therapy Association, Inc., 4720<br />
Montgomery Lane, Suite #200, Bethesda, MD 20814-3449;<br />
301-652-2682. Periodical postage is paid at Bethesda, MD,<br />
and at additional mailing offices.<br />
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Mission statement: The American Occupational Therapy<br />
Association advances the quality, availability, use, and<br />
support of occupational therapy through standard-setting,<br />
advocacy, education, and research on behalf of its members<br />
and the public.<br />
Annual membership dues are $225 for OTs, $131 for OTAs,<br />
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Copyright of OT <strong>Practice</strong> is held by The American Occupational<br />
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material from OT <strong>Practice</strong> to www.copyright.com.<br />
Editor’s Note<br />
Life’s Pathways<br />
T<br />
his issue’s cover story (p. 6) conveys, I think, the full spectrum of care<br />
and compassion that occupational therapy practitioners provide for<br />
clients, however far along they are on their paths through life. In the<br />
case of older adults, the desire for meaningful occupations may well<br />
entail activities they engaged in when very young, a kind of circling<br />
back to what were the most profound events of their lives. This path through<br />
life, wherever it may take clients over their lifespan, is also described through a<br />
first-person account (p. 21) from a young adult with autism about the lessons he<br />
learned from his occupational therapist, from when he was very young to his days<br />
in high school.<br />
Turning to political matters, which have dominated the news of late, this issue<br />
also provides extensive lessons learned about planning a successful state OT on<br />
the Hill Day (p. 12). So much of occupational therapy practice is affected by state<br />
legislation, and as author Jacquelyn M. Sample notes, practitioners must not<br />
assume that someone else will do their advocating for them—they themselves<br />
can be among their profession’s own best boosters. On the federal level as well,<br />
lawmakers are returning to office following their August recess, and with national<br />
elections in full swing, they may be especially alert to advocacy efforts. Much<br />
more on Congressional, federal regulatory, and state policy affairs as they affect<br />
occupational therapy can also always be found at www.aota.org/advocacy-policy.<br />
As we here at AOTA build toward a celebration at the next Annual Conference<br />
of the profession’s 100th anniversary, we aim to share more such stories about the<br />
benefits of occupational therapy, past and present. Any lessons learned from your<br />
work with clients that you would share? Send us a note to let us know.<br />
Best regards,<br />
Ted McKenna, Editor, OT <strong>Practice</strong>, tmckenna@aota.org<br />
• Discuss OT <strong>Practice</strong> articles at www.OTConnections.org.<br />
• Send email regarding editorial content to otpractice@aota.org.<br />
• Go to www.aota.org/otpractice to read OT <strong>Practice</strong> online.<br />
• Visit our Web site at www.aota.org for contributor guidelines, and additional news and information.<br />
OT <strong>Practice</strong> serves as a comprehensive source for practical information to help occupational therapists and occupational therapy assistants<br />
to succeed professionally. OT <strong>Practice</strong> encourages a dialogue among members on professional concerns and views. The opinions<br />
and positions expressed by contributors are their own and not necessarily those of OT <strong>Practice</strong>’s editors or AOTA.<br />
Advertising is accepted on the basis of conformity with AOTA standards. AOTA is not responsible for statements made by advertisers, nor<br />
does acceptance of advertising imply endorsement, official attitude, or position of OT <strong>Practice</strong>’s editors, Advisory Board, or The American<br />
Occupational Therapy Association, Inc. For inquiries, contact the advertising department at 800-877-1383, ext. 2715.<br />
Changes of address need to be reported to AOTA at least 6 weeks in advance. Members and subscribers should notify the Membership<br />
department. Copies not delivered because of address changes will not be replaced. Replacements for copies that were damaged in<br />
the mail must be requested within 2 months of the date of issue for domestic subscribers and within 4 months of the date of issue for<br />
foreign subscribers. Send notice of address change to AOTA, 4720 Montgomery Lane, Suite #200, Bethesda, MD 20814-3449, e-mail to<br />
members@aota.org, or make the change at our Web site at www.aota.org.<br />
Back issues are available prepaid from AOTA’s Membership department for $16 each for AOTA members and $24.75 each for nonmembers<br />
(U.S. and Canada) while supplies last.<br />
2 AUGUST 22, 2016 • WWW.AOTA.ORG
News<br />
Evidence Highlights<br />
Surviving Cancer<br />
A<br />
recent systematic review reveals moderate to<br />
strong evidence that addressing psychosocial<br />
components of cancer survivorship is beneficial<br />
for survivors, regardless of age or the type or stage<br />
of cancer. To learn more and find out about key findings in<br />
other areas such as complementary and alternative medicine,<br />
exercise rehabilitation, symptom management, and<br />
multidisciplinary rehabilitation, check out the new Critically<br />
Appraised Topics on cancer at http://goo.gl/21XkUM.<br />
2016–2017 Emerging Leaders<br />
Development Program<br />
Participants Named<br />
A<br />
OTA<br />
announced the participants chosen for the<br />
2016–2017 Emerging Leaders Development Program<br />
(ELDP):<br />
Jesse Ausec, MS, OTR/L, (C)SI<br />
Moira Bushell, OTD, MEd, OTR/L<br />
Gabrielle Heckman<br />
Sabrina Hilton, OTR/L<br />
Lauren Jones, MSOT<br />
Bridgette LeCompte, MS, OTR/L<br />
Rebecca Masterjohn, MSOT<br />
Miranda Miller, MS, OTR/L<br />
Erin O’Donnell, OTD, OTR/L<br />
Hanna Paul<br />
Niccole Rowe, COTA/L<br />
Gail Stephens, MS<br />
Abigail Swidergal, COTA/L<br />
Kirsty Vannoy, MS, OTR/L<br />
Jarrett Wolske<br />
The ELDP, created for students and practitioners at the start<br />
of their careers who have demonstrated dedication and commitment<br />
through service to the profession, provides selected<br />
candidates with leadership training and ongoing mentorship<br />
while addressing volunteer service needs within AOTA. Participants<br />
receive formal face-to-face (2-day) training focusing on<br />
leadership development and other components of the program.<br />
Prior to the training, candidates are paired with a mentor who<br />
currently holds a leadership position within AOTA, and they<br />
participate in service learning activities over a 1-year period that<br />
directly support AOTA’s Strategic Priorities. For more on the<br />
ELDP, visit http://goo.gl/rcs8hb<br />
PHOTOGRAPHS © ISTOCK AND GETTY IMAGES<br />
Apply for Student<br />
Membership Circle<br />
A<br />
OTA’s<br />
Student Membership<br />
Circle is a three-tier plan that<br />
supports academic program<br />
student membership initiatives—<br />
Gold Level, Silver Level, and<br />
Bronze Level. Student Membership<br />
Circle recipients are determined based<br />
on the percentage of enrolled students<br />
who are also current active members of<br />
AOTA. AOTA is now accepting applications<br />
for the 2016–2017 academic year.<br />
To apply to Student Membership Circle,<br />
fill out the online form at www.aota.org/<br />
studentcircle no later than October 31.<br />
OT PRACTICE • AUGUST 22, 2016<br />
3
News<br />
Practitioners in the News<br />
University of North Carolina–<br />
Wilmington occupational therapy<br />
student Oyoana Allende was<br />
profiled in the News & Observer<br />
(http://goo.gl/3UMsIG) and<br />
other news outlets for her drive<br />
to become an occupational<br />
therapist after surviving a<br />
suicide-bomber attack in Iraq<br />
while serving in the U.S. Marine<br />
Corps.<br />
Karen Dobyns, OTD, MOT,<br />
OTR/L, an occupational therapist<br />
based in the San Diego<br />
AOTA for You<br />
Nancy Baker, SCD, MPH, OTR/L,<br />
an associate professor at the<br />
University of Pittsburgh, is quoted<br />
in an article in Everyday Health on<br />
tips for people with arthritis who<br />
are hosting outdoor parties.<br />
area, is quoted in an article<br />
in Everyday Health on tips<br />
for making life with multiple<br />
sclerosis easier.<br />
MarketWatch highlighted a<br />
study led by Yael Goverover,<br />
PhD, OT, an associate professor<br />
of occupational therapy<br />
at New York University, on<br />
the difficulties people with<br />
multiple sclerosis may face in<br />
managing their finances as a<br />
result of cognitive impairment<br />
(http://goo.gl/hOQuR9).<br />
Laura Vogtle, PhD, OTR/L,<br />
FAOTA, and Sarah C. Tucker,<br />
MS, OTR/L, faculty members at<br />
the University of Birmingham,<br />
in Alabama, are profiled in the<br />
Birmingham Times (http://goo.gl/<br />
dXlPev) for teaching occupational<br />
therapy students about<br />
working with kids to gain the<br />
myriad social, gross motor, and<br />
other benefits of playing.<br />
Janet Weisberg, MS, OTR/L,<br />
executive director of the<br />
nonprofit Hold Your Horses, is<br />
quoted in the Minneapolis Star-<br />
Tribune on her organization’s<br />
work providing equine-assisted<br />
therapy.<br />
Missouri Health Professions<br />
Consortium Occupational<br />
Therapy Assistant Program<br />
student Jaclyn Weydert was<br />
quoted in an article in the<br />
News-Express (http://goo.gl/<br />
cR2cS6) on helping to organize<br />
the third-annual Adaptive<br />
Anglers Fishing Derby, held<br />
near Plattsburg, Missouri.<br />
Get the latest updates<br />
at www.aota.org/alerts<br />
AOTA Awards: Nominate a<br />
colleague who has made<br />
significant contributions to the<br />
profession for an AOTA award.<br />
The deadline is September 13.<br />
New CMS Demonstration<br />
Project: Illinois, Florida, Texas,<br />
Michigan, and Massachusetts<br />
will be part of a 3-year, preclaims<br />
review of home health<br />
agency services to avoid<br />
Medicare fraud and improper<br />
payments.<br />
Participate in Capitol Hill Day:<br />
Participate in the first joint<br />
Capitol Hill Day of AOTA and<br />
the American Society of Hand<br />
Therapists (ASHT), in person<br />
or virtually, on September<br />
19. Registration to attend<br />
the Washington, DC, events<br />
is limited this year, and will<br />
close on September 4, or<br />
when full capacity is reached.<br />
Reviewers Needed: The<br />
Evidence Exchange, a central<br />
repository of quality evidence,<br />
is looking for individuals to<br />
review critically appraised<br />
summaries (CAPs) of research<br />
articles for the exchange.<br />
Applications for this round<br />
close on September 16.<br />
The Texture of Life,<br />
4th Edition<br />
J. Hinojosa & M. Blount<br />
This text presents a theoretical<br />
foundation for the<br />
idea of occupation, framed<br />
within historical and current<br />
practice and developed<br />
from within the occupational<br />
therapy profession.<br />
$89 for members,<br />
$126 for nonmembers.<br />
Order #900352.<br />
Ways of Living<br />
C.H. Christiansen<br />
& K.M. Matuska<br />
This text reflects the<br />
terminology of the Occupational<br />
Therapy <strong>Practice</strong><br />
Framework and content in<br />
light of the new realities<br />
of health care, including<br />
interventions strategies<br />
beyond adaptation to ADL<br />
and IADL challenges.<br />
$89 for members,<br />
$126 for nonmembers.<br />
Order #1970B.<br />
A Mindful Path to Leadership<br />
Series Module 1: Exploring<br />
Your Leadership Journey<br />
(Online Course)<br />
N. Blair & V. Stoffel<br />
Earn 1 AOTA CEU (1 NBCOT<br />
PDUs/1 contact hours).<br />
This course supports the<br />
exploration of leadership<br />
from the inside out through<br />
the identification of core values,<br />
purpose, and personal<br />
mission, leading to authentic<br />
and trusting relationships<br />
with others. $39.95 for<br />
members, $49.95<br />
for nonmembers.<br />
Order #OL4791.<br />
TO Order: http://store.aota.org (enter order # preferred) or call 877-404-AOTA<br />
Questions?: 800-SAY-AOTA (members); 301-652-AOTA (nonmembers and local callers); TDD: 800-377-8555.<br />
2015 Conference Presidential<br />
Address by Dr. Stoffel:<br />
Engagement, Exploration,<br />
Empowerment (Webcast)<br />
V. Stoffel<br />
Earn .75 contact hours.<br />
The course illuminates how<br />
engagement, exploration,<br />
and empowerment strategies<br />
not only enhance our<br />
effectiveness as practitioners,<br />
educators, managers,<br />
and researchers, but also<br />
meets society’s occupational<br />
needs. Free for members,<br />
$24.99 for<br />
nonmembers.<br />
Order #WA0215.<br />
PHOTOGRAPH © ALEX RATHS / GETTY IMAGES<br />
4 AUGUST 22, 2016 • WWW.AOTA.ORG
Capital Briefing<br />
New Occupational Therapy<br />
Evaluation Codes Released<br />
PHOTOGRAPH © MILOSDUCATI / GETTY IMAGES<br />
Although the new<br />
re-evaluation code presents<br />
a similar coding concept,<br />
the new evaluation codes<br />
introduce a coding paradigm<br />
for evaluations based on<br />
patient complexity.<br />
Bryan Hull<br />
O<br />
n July 7, 2016, the Centers<br />
for Medicare & Medicaid<br />
Services (CMS) issued a<br />
proposed rule that updates<br />
payment policies, payment<br />
rates, and quality provisions for services<br />
furnished under the Medicare Physician<br />
Fee Schedule (PFS), effective January 1,<br />
2017. After a multi-year collaborative effort<br />
involving AOTA, the American Medical<br />
Association (AMA), and CMS, the release<br />
of the proposed rule provided a first look<br />
at the long-awaited new evaluation and<br />
re-evaluation codes for occupational therapy.<br />
Although the new re-evaluation code, replacing<br />
CPT© code 97004, presents a similar<br />
coding concept (single, untimed code, billed<br />
once per day, per patient), the new evaluation<br />
codes, replacing CPT® code 97003,<br />
introduce a coding paradigm for evaluations<br />
based on patient complexity (low, moderate,<br />
or high). AOTA introduced complexity levels<br />
to reflect the complex clinical decision making<br />
of the occupational therapist during the<br />
evaluation process and address the needs of a<br />
significantly different health care population<br />
than that which existed when<br />
these codes were originally<br />
developed almost two decades<br />
ago.<br />
AOTA proposed and advocated<br />
for this tiered coding<br />
system, which was ultimately<br />
accepted by AMA and later<br />
presented to CMS. Although<br />
CMS accepted the new<br />
evaluation and reevaluation<br />
code descriptors, it opted for a<br />
work relative value unit (RVU)<br />
of 1.20 for each of the occupational<br />
therapy evaluation<br />
codes, rather than differentiating<br />
values per code, as AOTA<br />
advocated. CMS expressed<br />
concerns with potential abuses<br />
of the levels—for example,<br />
upcoding a moderate level evaluation to a<br />
high level. The agency proposed to maintain<br />
each level at the same value, meaning<br />
that reimbursement will be the same<br />
regardless of the complexity of the patient,<br />
as defined by the code descriptor.<br />
Same Values … So What Now?<br />
Even though the codes have been given the<br />
same values, AOTA will be working to educate<br />
occupational therapy practitioners on<br />
the importance of accurately differentiating<br />
and documenting for the levels contained in<br />
the three evaluation codes. In the proposed<br />
rule, CMS also encourages education on the<br />
factors embedded within each code descriptor<br />
to better equip therapists to correctly<br />
choose the appropriate level. AOTA is devoting<br />
significant effort to member education to<br />
define key terms, such as performance deficits,<br />
as well as the process therapists should use to<br />
identify the number of performance deficits<br />
that result in activity limitations and/or<br />
participation restrictions, and the relevance<br />
of the number of comorbidities and treatment<br />
options. Therapists have a professional<br />
responsibility to code and document accurately.<br />
In addition, CMS has indicated that<br />
it will analyze the utilization of the different<br />
levels and will make value determinations<br />
based on that data. Therefore, correct level<br />
selection and documentation will provide<br />
AOTA and CMS with accurate utilization<br />
data so we can advocate for stratified values<br />
in the future. Stay tuned to AOTA publications<br />
and the website for upcoming CE<br />
articles, webinars, in-depth coding and<br />
documentation guidelines, and AOTA presentations<br />
to state associations and specialty<br />
conferences to highlight these new codes.<br />
For more details, including a table listing the<br />
new codes and descriptors, see www.aota.<br />
org/advocacy-policy/federal-reg-affairs.<br />
Bryan Hull, JD, MPH, is AOTA’s manager of coding and payment<br />
policy.<br />
OT PRACTICE • AUGUST 22, 2016<br />
5
The story of a skilled nursing facility client<br />
reveals the value of occupational therapy in<br />
helping individuals find comfort and meaning.<br />
6 AUGUST 22, 2016 • WWW.AOTA.ORG
Familiar Pathways<br />
Learning From the Story of Marty<br />
Carolyn Pluta<br />
“ Good luck getting anything out of him;<br />
he plays possum,”<br />
the med tech told me as I curiously<br />
approached a long-term resident I was<br />
meeting for the first time. “Oh, and he<br />
has dialysis every Monday, Wednesday,<br />
and Friday.”<br />
I found him sleeping in his wheelchair,<br />
the same way he always looked,<br />
according to the nursing staff. I was told<br />
that they recently discovered he had<br />
sustained a pelvic fracture, from which<br />
the cause was unknown, thus warranting<br />
a therapy evaluation. He used to walk<br />
but had been wheelchair bound for quite<br />
some time, and they thought that the<br />
fracture was simply pathological.<br />
I ran my typical evaluation protocol.<br />
“How is he with his daily activities?<br />
Does he get himself dressed? How about<br />
showers?”<br />
“Total assist; he doesn’t do anything<br />
himself. Sometimes he’ll try to fight you.”<br />
“What about transfers?” “He can’t<br />
stand on his own. We need two people to<br />
use the sit-to-stand lift for him.”<br />
Wow. What am I going to work on<br />
with this guy, who won’t even open his<br />
eyes for me? I left the ward feeling unaccomplished<br />
and nervous. Not knowing<br />
what this guy could do, or what I could<br />
do for him, I hesitantly brought my finger<br />
to the buttons on the phone and slowly<br />
dialed the number for his power of attorney,<br />
his father.<br />
Wait—his father? I work in a skilled<br />
nursing facility/long-term-care center.<br />
Almost all of my clients for short-term<br />
rehab, in addition to our long-term<br />
residents, have received a diagnosis of<br />
dementia. Some are in the early stages<br />
and simply have trouble remembering<br />
the date or what they had for breakfast.<br />
Others have reached the tail end, where<br />
they are entirely dependent on their caregivers<br />
to get out of bed, get dressed, sit<br />
upright in their chair, and even to chew<br />
their food. Marty was only in his 60s.<br />
His parents were still alive. And he lived<br />
here, with the other long-term residents.<br />
And he was now my responsibility.<br />
“Hello??”<br />
“Oh, hi, this is Carolyn from occupational<br />
therapy. I am calling to tell<br />
you that we received an order to evaluate<br />
your ... er ... son ... after his pelvic<br />
fracture.”<br />
“You might want to speak to the<br />
physician about that. He’s in a lot of pain.<br />
I don’t want your therapy to hurt him any<br />
more than he already is hurting.”<br />
What do I even say? I don’t want him<br />
hurting either, nor do I want to put this<br />
poor father through any more trouble<br />
than he already is experiencing, given<br />
his son’s current circumstance. I thought<br />
about it.<br />
“Well, you know, we think the fracture<br />
may actually be due to prolonged sitting<br />
in that wheelchair. I understand that the<br />
nursing staff hasn’t really been encouraging<br />
him to actively stand up or participate<br />
in daily tasks. It might be good for<br />
him to off-load that weight. And I saw<br />
him today and noticed he tends to close<br />
his eyes when he wants nothing to do<br />
with someone. If he does that, I will not<br />
OT PRACTICE • AUGUST 22, 2016<br />
7
Something in<br />
Marty’s facial<br />
expression told me<br />
that he understood<br />
more than he was<br />
letting on.<br />
Marty slowly raised<br />
his hand and<br />
pinched the gel<br />
with his index finger<br />
and thumb.<br />
Marty smiled.<br />
He really smiled.<br />
push for therapy that day and take it as a<br />
sign that he is hurting. And nursing and I<br />
will work closely together to manage his<br />
pain.”<br />
“Well, Carolyn, you’re the expert.”<br />
Shoot, am I really, though?<br />
“I trust your judgment. You can try,<br />
but I don’t know what all he will do for<br />
you.”<br />
Feeling a combination of relief that<br />
the man didn’t tell me to go to hell, yet<br />
apprehension toward my clinical abilities,<br />
I hung up the phone. The next day,<br />
Marty was due for a shower. I jumped<br />
at the opportunity to use that as a time<br />
to incorporate occupational therapy. I<br />
saw how Marty grew agitated with the<br />
certified nursing assistant (CNA) as he<br />
was wheeled in his shower chair and his<br />
clothing was removed. Most of the residents<br />
who live in my facility rely on nursing<br />
staff to do these once-simple tasks for<br />
them, but I wondered about something.<br />
Something in Marty’s facial expression<br />
told me that he understood more than he<br />
was letting on.<br />
The CNA began threading Marty’s<br />
right hand through his sleeve, and he<br />
swatted at her. I had an idea. I took Marty’s<br />
shirt and placed it on his lap. Marty<br />
put his own shirt on.<br />
“I didn’t know he could do that,” the<br />
CNA muttered.<br />
I gave Marty his pants. Marty crossed<br />
one leg over the other and pulled a pant<br />
leg over his foot. Marty, I realized, closes<br />
his eyes because he is in pain. Because he<br />
doesn’t want to be bothered. Because he<br />
wants to avoid his reality. Not because he<br />
doesn’t understand.<br />
Creature Comforts<br />
The following sessions were frustrating.<br />
Marty would occasionally participate for<br />
a good 5 consecutive minutes, be it in the<br />
form of lacing up his shoes or pedaling<br />
his arms on an exercise machine, and<br />
in the drop of a hat he would close his<br />
eyes again. I felt like I was just an added<br />
nuisance in his life.<br />
Later one day, I was working with<br />
another resident in the dining room of<br />
Marty’s ward. The same CNA who had<br />
helped Marty shower saw me and flagged<br />
me over.<br />
“Please, go talk to Marty! He keeps<br />
standing up! He’s going to fall!”<br />
Talk to Marty? Dementia is an<br />
interesting condition. Some people can<br />
still have a conversation with you, but in<br />
addition to reminiscing about how they<br />
met their husband or where they grew<br />
up, they also acquire unsafe and inappropriate<br />
behaviors without much rationality<br />
involved. A lot of residents try to stand<br />
up from their wheelchairs just for the<br />
heck of it, and this is when falls occur.<br />
Once this impulsive behavior happens,<br />
the best bet is to distract the resident<br />
rather than try to talk things through.<br />
But Marty seemed different. I found<br />
Marty supporting himself with his hands<br />
on the table and leaning over with his<br />
head down. He didn’t look like he was<br />
causing trouble. He looked like he was<br />
hurting.<br />
“Marty, are you in pain?” Marty<br />
nodded. “Marty, let’s sit down. Please. It’s<br />
not safe. I’ll ask the nurse to get you some<br />
pain meds. Please sit down.”<br />
Marty slowly lowered down.<br />
“Please don’t stand up like that again.”<br />
“Yes, dear.”<br />
Dear? Marty still talks. Marty can<br />
rationalize.<br />
The next day I took a look at Marty’s<br />
wheelchair cushion. The foam was so<br />
worn out that the area his tailbone rested<br />
on was essentially a piece of paper. Marty’s<br />
fractured pelvis was not being cushioned.<br />
No wonder he was hurting. I ran<br />
down to the equipment room and was<br />
ecstatic to find a cushion with gel around<br />
the tailbone region and foam surrounding<br />
it. It was the perfect size for Marty’s<br />
chair. I found Marty seated on the couch,<br />
with his eyes closed. Playing possum.<br />
“Marty, look at this cushion I got for<br />
you. I think it will hurt less when you sit<br />
in your wheelchair.”<br />
Marty blinked his eyes open.<br />
“Feel it! Do you like it?”<br />
Marty slowly raised his hand and<br />
pinched the gel with his index finger and<br />
8 AUGUST 22, 2016 • WWW.AOTA.ORG
thumb. Marty smiled. He really smiled. I<br />
have seen Marty smile twice in the short<br />
couple of months I’ve known him. And<br />
that’s two more times than some staff<br />
members who have been working here<br />
with Marty for years have seen. From his<br />
brief smile, I can tell you that Marty has<br />
some teeth missing. He has crystal blue<br />
eyes that squint and create lines at the<br />
corners.<br />
“Thank you,” he said.<br />
I changed out his old cushion for the<br />
new one and left him in peace.<br />
The social worker in Marty’s ward<br />
sent me an email requesting that I attend<br />
a care conference with Marty’s parents<br />
to discuss his plan of care in regards to<br />
nursing, therapy, and his overall prognosis.<br />
My heart dropped. Marty’s father, the<br />
man who questioned my intentions over<br />
the phone, who so dearly loved his son,<br />
who didn’t want him to feel any more<br />
pain, would now see me in person.<br />
I gently knocked on the office door<br />
and entered to find the social worker<br />
seated with two individuals who had<br />
canes propped against their chairs. They<br />
looked elderly certainly, but alert and<br />
strong. Marty’s parents are in their 90s<br />
and have no diagnoses of dementia,<br />
unlike their son. I tried to muster up my<br />
most professional voice and shook each<br />
of their hands.<br />
“HI. NICE TO MEET YOU.<br />
I’M CAROLYN.”<br />
With a good 80% of my client<br />
population being hard of hearing, the<br />
over-exaggerated mouthing of my speech<br />
just came out automatically. I instantly<br />
regretted not suppressing that reflex.<br />
I learned quickly that Marty’s parents,<br />
though almost a century old, were still<br />
extremely coherent. The care conference<br />
began rather unpleasantly, with the social<br />
worker reviewing the documentation that<br />
Marty’s father had submitted as power<br />
of attorney, including Marty’s “Do not<br />
resuscitate “ status and the progression of<br />
Alzheimer’s disease, from the early stages<br />
to the inevitable death of the individual.<br />
In the short time I have been at this<br />
facility, I have already participated in a<br />
large number of these care conferences.<br />
For a while, I feared that I had already<br />
lost my sensitivity, my compassion, my<br />
empathy for this population because I<br />
could leave these conferences unscathed<br />
by the impact this condition clearly has<br />
on the families.<br />
But here is the thing. The familiar<br />
pattern of life typically entails children<br />
outliving their parents. Parents grow old<br />
and lose their strength, their memory<br />
fades, and they become more dependent<br />
on their caregivers. Losing a parent or<br />
grandparent is not easy, by any means,<br />
but it is more or less a natural experience.<br />
Attending Marty’s care conference<br />
just hurt. It was my turn to talk. I tried<br />
to keep my composure as I recapped my<br />
experience with Marty in therapy thus<br />
far. I told his parents how I switched<br />
out his cushion, how I learned just how<br />
much he can actually still do on his own,<br />
how he was standing and walking with<br />
physical therapy. How we have been<br />
respectful of his pain.<br />
“We really appreciate everything<br />
you’re doing. Marty has always been very<br />
independent, and we know this is hard<br />
for him. Oh, and we love the new cushion.<br />
We took turns sitting in it.”<br />
Whoa, they appreciate me? Just a few<br />
weeks ago I felt like I had to muster up all<br />
I had learned in grad school about advocating<br />
for my profession while on the<br />
phone with Marty’s father, and now they<br />
were seeing the value in the therapy sessions?<br />
From that point forward, we were<br />
a team. I gave his parents a gentle touch<br />
on the shoulder as they left smiling,<br />
walking hand in hand, each with a cane<br />
supporting their other side. Relying on an<br />
assistive device to keep their balance yet<br />
possessing more emotional strength than<br />
I could ever imagine.<br />
Client Priorities<br />
Weeks went by, and Marty’s participation<br />
in therapy continued to be spotty,<br />
depending on his pain and overall motivation.<br />
Marty’s parents popped in and out<br />
of the facility, and they always greeted me<br />
with a smile and appreciation. I began<br />
Just a few weeks ago<br />
I felt like I had to muster<br />
up all I had learned in<br />
grad school about<br />
advocating for my<br />
profession while on<br />
the phone with<br />
Marty’s father,<br />
and now [his parents]<br />
were seeing the value<br />
in the therapy sessions?<br />
From that point forward,<br />
we were a team.<br />
OT PRACTICE • AUGUST 22, 2016<br />
9
to learn that Marty was funny. I would<br />
occasionally pass by to find him wearing<br />
a straw hat.<br />
“Marty, is that your hat?”<br />
“I guess it is now.”<br />
“Marty, what are you doing waiting by<br />
the elevator?”<br />
“Trying to catch a lift!”<br />
That was the second time I saw<br />
Marty smile. I learned Marty liked rock<br />
’n roll and dogs. I learned his legs were<br />
beginning to hurt more than his pelvis. I<br />
learned he sometimes transferred himself<br />
to bed from his wheelchair on his own,<br />
an occurrence so unfathomable that the<br />
nursing staff simply assumed it was one<br />
of the CNAs who assisted him.<br />
I learned that Marty didn’t want dialysis<br />
anymore. I learned Marty now had<br />
weeks left to live.<br />
I began seeing Marty’s parents more<br />
frequently, and my guarded aura of<br />
professionalism began to dissipate. I had<br />
to discharge Marty from therapy because<br />
he was now transitioning to hospice<br />
care, but I told his parents that I would<br />
continue to look out for him.<br />
I kept that promise. While sitting in<br />
the dining room helping other residents<br />
eat, I would periodically glance out into<br />
the courtyard. I will never erase from<br />
my mind one particular image painted<br />
before me. For there in the courtyard was<br />
Marty, the same Marty who spent the<br />
majority of his days in his wheelchair,<br />
with one leg crossed over the other in<br />
a figure four, with his head bowed and<br />
his eyes closed. But now the Marty who<br />
played possum was walking with his dad.<br />
His dad had one hand on Marty’s belt<br />
loop and another grasping a cane, with<br />
Marty pushing his front-wheeled walker,<br />
and Marty’s mother trailing after them<br />
with Marty’s wheelchair. If Marty fell, his<br />
father would not be able to recover him,<br />
and his father would be in serious condition<br />
as well. But at the same time, Marty<br />
was walking with his parents for the last<br />
weeks of his life. What is to be prioritized<br />
at a time like this?<br />
Later that afternoon, my boss and I<br />
walked outside to talk to Marty’s parents.<br />
We told them of our safety concerns, and<br />
offered to provide a nursing aid to accompany<br />
them. They told us the problem was<br />
not that they didn’t want to be safe, but<br />
rather than Marty would spontaneously<br />
start walking out of nowhere, whether<br />
they had prepared for it or not. They<br />
expressed their gratitude toward receiving<br />
assistance whenever possible. As my<br />
boss and I walked back into the building,<br />
out of the corner of my eye I could<br />
already see Marty beginning to stand<br />
again. Marty knew he was dying. Marty<br />
just wanted to walk with his parents.<br />
Safety concerns were no longer of value<br />
to him.<br />
Getting glimpses of Marty walking in<br />
the courtyard with his father became a<br />
daily ritual, and there was something so<br />
beautiful and so tragic about this scene.<br />
It was mesmerizing. Then one day it<br />
stopped. I found Marty on a recliner in<br />
the TV room of his ward, playing possum,<br />
with a tray of food in front of him. Marty<br />
hadn’t eaten that day, much less opened<br />
his eyes.<br />
I asked about Marty every day. Suddenly<br />
I stopped seeing him out in the TV<br />
room. The door in his room was closed,<br />
and the nurses told me he wasn’t doing<br />
well. At the end of the week I found two<br />
chairs seated outside Marty’s room. The<br />
door was left ajar and inside the room I<br />
could see a table with a water pitcher and<br />
dinner for two. We were accommodating<br />
for his parents. It was only a matter of<br />
days. I punched out at the time clock,<br />
then went back up to Marty’s room. I<br />
crossed paths with Marty’s mom. She<br />
smiled, but I was too distracted by the<br />
redness in her eyes. I gave her a hug.<br />
Marty had been sleeping all day, she told<br />
me. She wasn’t sure whether he would<br />
last through the night. I walked into<br />
Marty’s room and was greeted by his<br />
father. There were two chairs set up at<br />
the foot of his bed. All the lights were off.<br />
I helped Marty’s parents prop their canes<br />
against the wall as they took a seat next<br />
to their sleeping son.<br />
“We should just stay here forever; look<br />
at this free food we get!”<br />
10 AUGUST 22, 2016 • WWW.AOTA.ORG
While I am forced to face the sadness of this world,<br />
I am equally exposed to its beauty.<br />
They gestured to the dinner for two<br />
I had seen through the door. Humor. A<br />
preferred defense mechanism in times<br />
of turmoil. I let out a supportive laugh,<br />
then asked whether I could hug their<br />
son. I knelt down next to Marty’s bed,<br />
announced my presence, and gave him a<br />
one-sided hug as he continued to sleep.<br />
On the other side of him I saw a stuffed<br />
dog with the tag still on it.<br />
“Did you just get this for him? It’s<br />
adorable.”<br />
They nodded. Marty’s mom stood up.<br />
“Do you want to see his childhood<br />
dog?”<br />
She reached into a drawer and pulled<br />
out the remnants of a small stuffed animal,<br />
with matted fur and a faded coat.<br />
“Did he name it?” I asked as I choked<br />
back the tears.<br />
“Poochie.”<br />
“How original,” I joked.<br />
Good old humor, saving the world<br />
from raw emotions. I tucked Poochie<br />
under Marty’s chin and stood up. I asked<br />
his parents if they needed anything and<br />
they politely declined.<br />
“You drive home safe, young lady.”<br />
I can’t remember what additional<br />
words were exchanged at that moment,<br />
only the emotions that were felt. I will<br />
forever hold in my heart the cool dimness<br />
that flooded that room. The loving wear<br />
and tear of Marty’s beloved toy. The<br />
unique combination of sadness and peace<br />
I gathered from Marty’s parents. The<br />
tears that left my eyes as I drove home<br />
that evening.<br />
I didn’t work the next day, so I texted<br />
my boss to notify me of Marty’s status. She<br />
told me she hadn’t heard anything yet.<br />
The morning after that I received the<br />
text.<br />
“I’m so sorry Carolyn. Just find peace<br />
in that it was what he wanted ... and that<br />
you helped him live out his last months<br />
with dignity and a sense of purpose …<br />
you made him smile.”<br />
Marty had told me he was waiting for<br />
the elevator to “catch a lift.” That day, his<br />
wait was over. No more pain, no more<br />
playing possum to block out the triweekly<br />
dialysis appointments, no more<br />
loss of independence. Marty was free.<br />
Marty was lifted from the confines of his<br />
wheelchair.<br />
Daily Reflections<br />
This job is not easy. I stare at death in<br />
some form on a daily basis. It is through<br />
Marty I am reminded why I work with<br />
this population. While I am forced to face<br />
the sadness of this world, I am equally<br />
exposed to its beauty. I hear tales of traveling<br />
the world, of previous careers. I witness<br />
the silliness of a food fight instigated<br />
by a confused resident. I watch the power<br />
of human connection and the emotional<br />
resilience of two parents. Marty temporarily<br />
avoided his daily woes by closing<br />
his eyes, but he also faced the hardships.<br />
He knew the control he had of his own<br />
life and made the conscious decision to<br />
cease his dialysis appointments. And on<br />
his final weeks, when he no longer had<br />
control of the situation and his timeline<br />
was unpredictable, he held onto those he<br />
loved and just kept walking. And that’s all<br />
any of us can do. We work with what we<br />
have, making informed decisions when<br />
we can. After that, we can either live in<br />
fear, or we can walk and enjoy the breeze<br />
of a courtyard in the afternoon while we<br />
wait for the unpredictable to happen.<br />
Rest in peace, Marty. And may Marty’s<br />
parents find peace now and for the<br />
remainder of their beautiful lives.<br />
Carolyn Pluta, MS, OTR/L, is an occupational therapist at a<br />
skilled nursing facility/long-term-care center.<br />
For More Information<br />
www<br />
Fact Sheet<br />
Occupational Therapy’s<br />
Role in Skilled Nursing<br />
Facilities<br />
http://goo.gl/Q5wg6O<br />
Living Life To Its Fullest:<br />
Stories of Occupational<br />
Therapy<br />
By A. Hofmann & M. Strzelecki,<br />
2010. Bethesda, MD: AOTA<br />
Press. ($19 for members, $27 for nonmembers.<br />
To order, call toll free 877-404-<br />
AOTA [2682] or shop online at http://store.<br />
aota.org, and enter order #1254).<br />
Ways of Living: Intervention<br />
Strategies to Enable<br />
Participation, 4th Edition<br />
By C. H. Christiansen & K. M.<br />
Matuska, 2011. Bethesda,<br />
MD: AOTA Press. ($89 for members, $126<br />
for nonmembers. To order, call toll free<br />
877-404-AOTA [2682] or shop online<br />
at http://store.aota.org, and enter order<br />
#1970B).<br />
OT PRACTICE • AUGUST 22, 2016<br />
11
Planning a Successful<br />
State<br />
Lessons Learned From<br />
Legislative Experiences<br />
in Missouri<br />
I<br />
was born with an advocate’s heart…<br />
or maybe I am just stubborn. Either way, I spend most days trying to<br />
follow my dad’s and grandfather’s advice: “Be part of the solution,<br />
not part of the problem.” My family instilled a value of offering and<br />
working toward solutions instead of adding to the list of complaints.<br />
Complaints, however, are usually a required first step in determining how we<br />
can impact change and where we need to start. Complaints, although a negative<br />
connotation, result in clientele for the practice of occupational therapy.<br />
Clients complain to their doctor about an illness, an injury, pain, or concerns<br />
for a loved one. The occupational therapy profession would be difficult to<br />
maintain if we did not first recognize and attend to complaints. The beauty of<br />
being an occupational therapy practitioner is that we are part of the solution.<br />
We are solution practitioners, problem solvers, and advocates for productive<br />
living.<br />
The Occupational Therapy <strong>Practice</strong><br />
Framework: Domain and Process,<br />
3rd Edition (Framework; American<br />
Occupational Therapy Association<br />
[AOTA], 2014) defines advocacy as<br />
“efforts directed toward promoting<br />
occupational justice and empowering<br />
clients to seek and obtain resources<br />
to fully participate in daily life occupations.<br />
The outcomes of advocacy<br />
and self-advocacy support health,<br />
well-being, and occupational participation<br />
at the individual or systems<br />
level” (p. S30).<br />
The Framework definition of<br />
advocacy suggests the importance of<br />
advocating for clients and teaching<br />
clients skills in self-advocacy, but we<br />
must also advocate for our profession,<br />
and that includes being aware<br />
of relevant legislation at the state and<br />
federal levels. Legislation directly<br />
affects the reimbursement rates<br />
for occupational therapy services<br />
as well as what services are available<br />
to vulnerable populations. We<br />
must advocate for our profession, to<br />
protect our scope of practice and the<br />
independent occupational functioning<br />
of our clients.<br />
What steps do we take to protect<br />
our clients and the profession? This<br />
article will provide some steps to<br />
follow based on the successes of<br />
the Missouri Occupational Therapy<br />
Association (MOTA) On the Hill Day<br />
event, held over the past 3 years at<br />
the Missouri State Capitol Building,<br />
in Jefferson City.<br />
PHOTOGRAPH © GETTY IMAGES<br />
12 AUGUST 22, 2016 • WWW.AOTA.ORG
OT on the Hill Day<br />
Jacquelyn M. Sample<br />
Action Plan<br />
Know your audience.<br />
Know who you are dealing with. Take a<br />
quick look at the structure of your state’s<br />
legislative branch. Determine:<br />
l How many members are in the state<br />
House of Representatives? How many<br />
senators are in the Senate? Knowing<br />
these numbers will allow you to<br />
adequately plan and request meetings.<br />
You will need multiple practitioners<br />
and students to cover all of the offices.<br />
l What are the term limits? Constituents<br />
can be weary of this question,<br />
especially in an election year. But<br />
turnover does occur. To effectively<br />
advocate, you need to know who has<br />
extended experience in the legislature,<br />
perhaps leading to more political<br />
influence. Missouri state representatives<br />
have a term limit of four 2-year<br />
terms. These term limits can result<br />
in large turnover rates in the House.<br />
Continuing education of and familiarity<br />
with new representatives as they<br />
take office is necessary and imperative<br />
to supporting occupational therapy<br />
practice and education.<br />
l What committees has each legislator<br />
been assigned to? No, you do not need<br />
to know every committee every legislator<br />
sits on. However, if your state<br />
association has an active bill, it will be<br />
assigned to committee(s) for hearings.<br />
As an advocate for legislation that supports<br />
occupational therapy practice,<br />
you will need to identify the assigned<br />
committee members and committee<br />
chair, specifically communicating<br />
with the committee members regarding<br />
the actual bill that has been filed.<br />
OT PRACTICE • AUGUST 22, 2016<br />
l What is the political party representation<br />
in the House and Senate, compared<br />
with the governor’s office? Is<br />
bipartisan cooperation more than just<br />
a buzzword for election platforms and<br />
promises? Again … election years can<br />
be a bit tense. Political parties view<br />
and vote for health care and funding<br />
in different ways. It is important to<br />
know which party has the majority in<br />
the House and the Senate. That information<br />
may influence whom your<br />
state association chooses as a sponsor<br />
of an occupational therapy bill. If the<br />
governor’s party is not the majority<br />
party, actually getting the bill signed<br />
could be difficult.<br />
l Identify the leaders in the House and<br />
Senate. Have your state association<br />
officers visit with them personally<br />
during Hill Day.<br />
Know your advocates.<br />
Your advocates include every occupational<br />
therapy practitioner and student in your<br />
state. Keep them involved and up to date.<br />
l Increase involvement and membership<br />
numbers in your state occupational<br />
therapy association. The goal is<br />
to have state association members in<br />
every district. If that goal is met, every<br />
state representative and senator will<br />
have a constituent active regarding<br />
occupational therapy legislation.<br />
l Have occupational therapy district<br />
meetings. Invite the elected officials<br />
of each area to the meetings to discuss<br />
their views on health care and occupational<br />
therapy.<br />
l Provide information to all state association<br />
members year round regarding<br />
legislative issues that can impact the<br />
practice of occupational therapy in<br />
your state.<br />
l Reach out to non–state association<br />
members. If your state has one, collaborate<br />
with the state board of occupational<br />
therapy to determine where the<br />
licensed practitioners are.<br />
l Invite each and every occupational<br />
therapy program faculty person and<br />
student in your state to attend your<br />
Hill Day. Attending and participating<br />
in the state Hill Day activities<br />
is a great assignment for students<br />
at all levels of occupational therapy<br />
education.<br />
Know your reasons.<br />
As private citizens, we may have many<br />
reasons why we would like to talk with an<br />
elected official. As a profession, the most<br />
effective Hill Day has one main message.<br />
It could be support of a particular bill,<br />
opposition to a bill, or information on<br />
legislation affecting occupational therapy.<br />
Have a clear and concise message, and<br />
train all Hill Day attendees to communicate<br />
that message.<br />
13
Plan Hill Day<br />
The basics.<br />
We all have to start somewhere.<br />
Your state’s Hill Day can be as<br />
large or as small as your state<br />
organization wants it to be. Missouri’s<br />
goal is to have as many<br />
occupational therapy practitioners<br />
and students as possible in<br />
the capitol building on the same<br />
day. Two hundred bodies in one<br />
hearing room or rally space is<br />
very powerful. The following<br />
steps have proven the most successful<br />
for us.<br />
Hawaii became the 50th and final state to fully<br />
license occupational therapists and one of<br />
the last remaining states to license occupational<br />
therapy assistants when then Governor<br />
Neil Abercrombie signed the practice act. (2014)<br />
Successful<br />
Advocacy<br />
1Pick your team. The Hill Day planning<br />
team will be made of volunteers. Team<br />
members do not necessarily need to<br />
be legislative experts. However, they<br />
do need to be organized and willing to<br />
dedicate the time to planning and follow<br />
through. I suggest the following four<br />
main team positions:<br />
l Appointment Master. This person is<br />
in charge of requesting and scheduling<br />
all appointments with legislators.<br />
This requires lots of emailing, phone<br />
calling, and reminding. This person<br />
will coordinate the schedule of events<br />
for the day and assist with finding<br />
rally speakers. On the actual Hill Day,<br />
this person is responsible for keeping<br />
attendees on schedule and making<br />
sure all legislators are visited.<br />
Maryland Governor Larry Hogan signed a law<br />
that strengthens the state law regarding habilitative<br />
services and brings it in line with a new<br />
federal rule. (2016)<br />
l Logistical Planner and Visual Marketer.<br />
This person is responsible for<br />
reserving space and tables, determining<br />
visual displays promoting occupational<br />
therapy, and coordinating Hill<br />
Day marketing, including invitations<br />
to all licensed occupational therapy<br />
practitioners and invitations to hand<br />
out to the legislators and legislative<br />
assistants during the Hill Day event.<br />
This person(s) will need to be creative<br />
and organized to ensure visual<br />
appeal of the displays and marketing<br />
material. Working with a marketing<br />
and/or mailing agency is highly<br />
recommended.<br />
l Legislative Summarizer. This team<br />
member writes the information<br />
regarding current legislation, or creates<br />
the “message” of OT on the Hill<br />
Day. This information should be provided<br />
prior to the event, as well as on<br />
the day of the event. This will ensure<br />
all attendees are giving a consistent<br />
message.<br />
l OT Power Player. This is everyone<br />
else. Hill Day events are not successful<br />
because of one or two people. Hill<br />
Day events are successful because of<br />
all the practitioners and students who<br />
support the event. Hill Day is a lot<br />
of fun, but it is also a lot of work. It<br />
takes a lot of people to reinforce positive<br />
messages, educate, and contact<br />
legislators.<br />
PHOTOGRAPHS: HAWAII GOVERNOR’S OFFICE (LEFT) AND<br />
© EXECUTIVE OFFICE OF THE GOVERNOR OF MARYLAND (RIGHT)<br />
PHOTOGRAPHS OF STATE CAPITOLS © GETTY IMAGES<br />
14 AUGUST 22, 2016 • WWW.AOTA.ORG
Missouri OT advocates meet with Representative Todd Richardson, Speaker of the House (back<br />
row, center).<br />
Missouri OT advocates meet with Representative Bart<br />
Korman (third from right).<br />
PHOTOGRAPHS: TOP: COURTESY OF THE AUTHOR.<br />
BOTTOM/: COURTESY OF ANDREA STAYZER AND NNAZARETH COLLEGE<br />
PHOTOGRAPHS OF STATE CAPITOLS © GETTY IMAGES<br />
2<br />
Schedule. Pick and reserve<br />
a date. Make sure it is<br />
during the time legislators<br />
are in session. End<br />
of session is very busy, so you may<br />
want to avoid that time frame, as you<br />
will be granted fewer meetings. Try<br />
to choose the same date each year.<br />
For example, in Missouri, we have<br />
Hill Day on the 4th Wednesday in<br />
February every year. Keeping the date<br />
consistent will keep it on everyone’s<br />
calendar.<br />
3<br />
Invite. Send an invitation<br />
to Hill Day to all licensed<br />
occupational therapy<br />
practitioners throughout<br />
your state. Work with your state’s<br />
occupational therapy licensure board<br />
to obtain their mailing addresses.<br />
Offer contact hours. Email or call<br />
all legislators and legislative assistants<br />
inviting them to meet with the<br />
occupational therapy experts on Hill<br />
Day. Provide personal invitations the<br />
morning of the event to each office.<br />
4<br />
Educate. Once your Hill<br />
Day message is determined,<br />
educate all attendees on<br />
that message. Provide brief,<br />
written information or have information<br />
available for mobile devices.<br />
Assist your attendees in identifying<br />
their elected officials. Make this a<br />
requirement for registration.<br />
5<br />
Organize. Match constituents<br />
with their legislators<br />
for meetings. If a practitioner<br />
or student has a<br />
personal relationship or connection<br />
with a legislator, schedule a meeting!<br />
6<br />
Hold the meetings. Meetings<br />
will usually be brief;<br />
usually around 5 minutes.<br />
Meetings with legislators<br />
should always have more than<br />
one occupational therapy practitioner<br />
and/or student present. Pair<br />
students with practitioners and<br />
educators for role modeling and<br />
creation of future occupational<br />
therapy advocates.<br />
7<br />
Say “thank you.” Make sure<br />
you recognize all occupational<br />
therapy attendees<br />
at least verbally and thank<br />
them for their participation. In<br />
addition, have volunteers write thank<br />
you notes after their meetings with<br />
legislators. During Missouri OT on<br />
the Hill Day, a “thank you” note table<br />
is set up for easy and timely completion.<br />
All thank you notes are hand<br />
delivered by occupational therapy<br />
volunteers by the end of the day.<br />
OT students from Nazareth College and Bryant and<br />
Stratton College in Rochester, New York, meet with<br />
Senator Joseph Robach.<br />
OT PRACTICE • AUGUST 22, 2016<br />
15
Plan Hill Day<br />
Hill Day events in each state in support of occupational therapy legislation are feasible,<br />
realistic, and imperative to occupational therapy practice.<br />
candy to your message. For example,<br />
when lobbying for a co-pay parity bill,<br />
MOTA had “100 Grand” candy bars on<br />
the tables. We added stickers with the<br />
bill information to the candy. Regardless<br />
of the kind, though, be sure to have<br />
good-quality candy on your tables.<br />
Create signs and banners that you<br />
can use year after year. Avoid including<br />
a specific date or bill number.<br />
Provide a registration packet to the<br />
attendees online.<br />
Have them print the packet for their<br />
use prior to Hill Day. This will cut down<br />
on printing costs.<br />
Additional Tips<br />
Several extra tasks can personalize<br />
the day, assist in helping legislators<br />
remember occupational therapy, and<br />
serve occupational therapy practitioner<br />
attendees.<br />
Social media.<br />
Create a Twitter hashtag (e.g., #MOTA-<br />
OnTheHill2016). Encourage all<br />
attendees to take pictures and post to<br />
social media outlets. All pictures with<br />
legislators should be tagged and sent to<br />
the legislators’ social media profiles and<br />
emailed to them.<br />
Consider special needs, such as accessible<br />
entrances and dietary needs if you<br />
serve lunch or snacks, as well as space<br />
for attendees to breast feed and/or pump.<br />
Have a rally!<br />
Having 200 occupational therapy practitioners<br />
and students in one place at<br />
one time sends a big message and will<br />
be remembered by all involved.<br />
Serve lunch or snacks to attendees.<br />
Have candy (chocolate!) on your display<br />
tables. If at all possible, “theme” the<br />
Check WiFi connections.<br />
Make sure you are aware of the availability<br />
of the wireless connection in<br />
the state building. Let attendees know<br />
ahead of time if the WiFi is poor.<br />
Give prizes.<br />
Have a drawing in which attendees<br />
can win a free membership in the<br />
state association. Also consider having<br />
occupational therapy–themed gift<br />
baskets available for a raffle for capitol<br />
employees. MOTA has had baskets for<br />
pediatrics, stress management and wellness,<br />
adaptive gardening, and kitchen<br />
adaptations. Each basket includes an<br />
information sheet on how occupational<br />
therapy supports occupational performance<br />
in each area.<br />
PHOTOGRAPH © GETTY IMAGES<br />
Don’t get discouraged, and stay persistent!<br />
For us, Hill Day has been a success, with the Missouri governor recently signing a bill into law that included an occupational<br />
therapy–related amendment for co-pay parity. Impacting legislation is not a quick process. Hill Day events in each state in support<br />
of occupational therapy legislation are feasible, realistic, and imperative to occupational therapy practice. As a profession and<br />
individual practitioners, it is important for us to not believe that “someone else” will take care of occupational therapy legislative<br />
efforts. That “someone else” could be someone whom we do not want speaking for us and guiding the decision-making regarding<br />
occupational therapy policy. The tired question of, “What is OT?” is best answered by us! Have an excellent Hill Day!<br />
16 AUGUST 22, 2016 • WWW.AOTA.ORG
Reference<br />
American Occupational Therapy Association. (2014).<br />
Occupational therapy practice Framework: Domain<br />
and process (3rd ed.). American Journal of Occupational<br />
Therapy, 68, S1–S48. http://dx.doi.org/10.5014/<br />
ajot.2014.682005<br />
Jacquelyn M. Sample, MEd, OTR/L, is completing a Doctorate<br />
of Occupational Therapy through Nova Southeastern University in<br />
Fort Lauderdale, Florida. Sample’s clinical specialty is pediatrics.<br />
She is currently an instructor in the Missouri Health Professions<br />
Consortium Occupational Therapy Assistant (OTA) program. For<br />
the Missouri OT Association, Sample serves as director of practice<br />
and chair of the Mid-Missouri District, and has served as co-developer<br />
of the MOTA Hill Day for the past 3 years.<br />
For More Information<br />
www<br />
www<br />
AOTA’s Guide to Advocacy &<br />
Promotion: A Special Issue<br />
of OT <strong>Practice</strong><br />
http://goo.gl/dOs6Jh<br />
State Policy News and<br />
Resources<br />
www.aota.org/advocacy-policy/state-policy<br />
Webcast<br />
2015 Conference Presidential<br />
Address by Dr. Stoffel:<br />
Engagement, Exploration,<br />
Empowerment<br />
By V. Stoffel, 2015. Bethesda,<br />
MD: American Occupational Therapy Association.<br />
(Earn .75 contact hour. Free for members,<br />
$24.99 for nonmembers. To order, call toll free<br />
877-404-AOTA [2682] or shop online at http://<br />
store.aota.org, and enter order #WA0215).<br />
Jacquelyn M. Sample (left) and MOTA Legislative<br />
Representative Diana Baldwin at MOTA on the<br />
Hill Day<br />
PHOTOGRAPH COURTESY OF THE AUTHOR.<br />
Joint Capitol Hill Day of<br />
AOTA and the American<br />
Society of Hand Therapists,<br />
on September 19,<br />
in Washington, DC—<br />
Join with more than 500<br />
practitioners and students from around the<br />
country to advocate for issues important<br />
to both professions, www.aota.org/Conference-Events/Hill-Day<br />
Mentoring Leaders: The<br />
Power of Storytelling for<br />
Building Leadership in Health<br />
Care and Education<br />
By E. Gilfoyle, A. Grady, & C.<br />
Nielson, 2011. Bethesda, MD:<br />
AOTA Press. ($44 for members, $62.50 for<br />
nonmembers. To order, call toll free 877-404-<br />
AOTA [2682] or shop online at http://store.<br />
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OT PRACTICE • AUGUST 22, 2016<br />
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In addition to the 3rd edition of the Occupational Therapy<br />
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BK-439<br />
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The program is primarily online with two visits to the Galveston,<br />
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For more information please contact: Sharon McEachern,<br />
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17
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PR-297
Evidence Perks<br />
New AOTA <strong>Practice</strong> Guidelines<br />
on Autism Spectrum Disorder<br />
and Traumatic Brain Injury<br />
OT PRACTICE • AUGUST 22, 2016<br />
Marian Arbesman<br />
Melissa Stutzbach<br />
Deborah Lieberman<br />
Through outlining key<br />
evidence-based findings<br />
on the effectiveness of<br />
occupational therapy<br />
interventions in these topic<br />
areas, the guidelines are a<br />
useful tool for improving<br />
the quality of health care<br />
and education,<br />
enhancing consumer and<br />
family satisfaction,<br />
promoting appropriate use<br />
of services, and reducing<br />
health care costs.<br />
In conjunction with the American<br />
Occupational Therapy Association<br />
(AOTA) Evidence-Based <strong>Practice</strong><br />
Initiative, AOTA Press recently published<br />
two new <strong>Practice</strong> Guidelines:<br />
Occupational Therapy <strong>Practice</strong> Guidelines for<br />
Individuals With Autism Spectrum Disorder<br />
(Tomchek & Koenig, 2016) and Occupational<br />
Therapy <strong>Practice</strong> Guidelines for Adults<br />
With Traumatic Brain Injury (Wheeler &<br />
Acord-Vira, 2016). Both guidelines combine<br />
an evidence-based perspective with<br />
key concepts from the Occupational Therapy<br />
Framework: Domain and Process, 3rd<br />
Edition (AOTA, 2014) to provide an overview<br />
of the occupational therapy domain,<br />
process, and interventions for individuals<br />
with autism spectrum disorder (ASD) as<br />
well as adults with traumatic brain injury<br />
(TBI), respectively. Through outlining key<br />
evidence-based findings on the effectiveness<br />
of occupational therapy interventions<br />
in these topic areas, the guidelines are a<br />
useful tool for improving the quality of<br />
health care and education, enhancing consumer<br />
and family satisfaction, promoting<br />
appropriate use of services, and reducing<br />
health care costs.<br />
Current evidence for the <strong>Practice</strong><br />
Guidelines is based on findings from<br />
systematic reviews that cover key concepts<br />
of interventions within the scope<br />
of occupational therapy practice. The<br />
systematic reviews were conducted by content<br />
experts with experience in critically<br />
appraising, synthesizing, and summarizing<br />
the research literature. For the guidelines<br />
on individuals with ASD, four systematic<br />
reviews were completed. The systematic<br />
reviews focused on the effectiveness<br />
of interventions in the areas of social<br />
participation, play, leisure, and social and<br />
restricted behaviors; work, activities of<br />
daily living, education, and sleep; improving<br />
family outcomes in areas such as stress<br />
and coping; and the effectiveness of Ayres<br />
Sensory Integration ® and sensory-based<br />
interventions. Six systematic reviews were<br />
completed for the <strong>Practice</strong> Guidelines on<br />
Adults With Traumatic Brain Injury. Five<br />
systematic reviews were on interventions<br />
to address motor impairments; cognitive<br />
impairments; arousal and alertness; vision<br />
and visual-perceptual impairments; and<br />
psychosocial, behavioral, or emotional<br />
impairments. The sixth systematic review<br />
examined the evidence for interventions<br />
that address everyday activities and areas<br />
of occupation and social participation.<br />
Understanding<br />
the Evidence Base<br />
Providing quality services to individuals<br />
with ASD or TBI requires a comprehensive<br />
understanding of evidence-based best<br />
practices. Coauthor Stephen Wheeler of<br />
the <strong>Practice</strong> Guidelines for Adults With<br />
Traumatic Brain Injury notes that although<br />
“the complexity and unique presentation<br />
of impairments that may result from<br />
traumatic brain injury can challenge<br />
the skills of even the most experienced<br />
occupational therapy practitioner,” there<br />
is strong evidence to support occupational<br />
therapy services in TBI recovery, including<br />
“the impact of aerobic activity and exercise<br />
on psychosocial well-being, the value of<br />
client-centered goal setting and goal-directed<br />
interventions to facilitate participation,<br />
and the value of cognitive behavioral<br />
approaches at the later stages of recovery.”<br />
The <strong>Practice</strong> Guidelines can help<br />
occupational therapy practitioners better<br />
understand and apply these findings to<br />
practice.<br />
“Through its coverage of motor, cognitive,<br />
psychosocial, behavioral, and visual<br />
interventions, the <strong>Practice</strong> Guidelines put<br />
evidence-based decisions at the clinician’s<br />
fingertips. The assessment tables are an<br />
important bonus that facilitates the collection<br />
of baseline information and outcomes<br />
19
Learn More About What You Read in OT <strong>Practice</strong>!<br />
New! 2015 AOTA Salary and Workforce Survey<br />
By American Occupational Therapy Association<br />
With over 13,000 valid responses collected, the largest sample of any AOTA Salary<br />
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Occupational Therapy <strong>Practice</strong> Guidelines Series<br />
Using an evidence-based perspective developed by the AOTA Evidence-Based<br />
<strong>Practice</strong> Project and key concepts from the Occupational<br />
Therapy <strong>Practice</strong> Framework, these guidelines provide an overview<br />
of the occupational therapy process for each respective topic. They<br />
define the process and the nature, frequency, and duration of the<br />
intervention that occurs within the boundaries of the illness or<br />
physical disability being addressed.<br />
Visit www.aota.org/pg for a complete list of <strong>Practice</strong> Guidelines.<br />
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BK-424<br />
data to support client progress at all<br />
stages of the rehabilitation process,”<br />
according to Wheeler.<br />
Each <strong>Practice</strong> Guideline also includes<br />
an Executive Summary—a brief, digestible<br />
synopsis of key findings as well as<br />
recommendations and implications for<br />
occupational therapy practice. The summaries<br />
can be used as a quick reference<br />
for occupational therapy practitioners to<br />
provide quality, evidence-based services.<br />
Appendices, provided on a flash drive for<br />
ease of use, include searchable evidence<br />
and risk-of-bias tables.<br />
Supporting Decision Making<br />
AOTA is committed to developing new<br />
<strong>Practice</strong> Guidelines and revising those<br />
already published on a regular basis to<br />
ensure that occupational therapy practitioners<br />
and external audiences have the<br />
best available scientific evidence and recommendations<br />
to support decision making<br />
that promotes a high-quality health<br />
care and education system. All <strong>Practice</strong><br />
Guidelines are available at AOTA’s store.<br />
To learn more, visit www.aota.org/<br />
practice/researchers/practice-guidelines.<br />
References<br />
American Occupational Therapy Association.<br />
(2014). Occupational therapy practice framework:<br />
Domain and process (3rd ed.). American<br />
Journal of Occupational Therapy, 68, S1–S48.<br />
http://dx.doi.org/10.5014/ajot.2014.682006<br />
Tomchek, S. D., & Koenig, K. P. (2016). Occupational<br />
therapy practice guidelines for individuals<br />
with autism spectrum disorder. Bethesda, MD:<br />
AOTA Press.<br />
Wheeler, S., & Acord-Vira, A. (2016). Occupational<br />
therapy practice guidelines for adults with traumatic<br />
brain injury. Bethesda, MD: AOTA Press.<br />
Marian Arbesman, PhD, OTR/L, FAOTA, is president of<br />
ArbesIdeas, Inc., and an adjunct assistant professor in the<br />
Department of Rehabilitation Science at the State University<br />
of New York at Buffalo. She has served as a consultant with<br />
AOTA’s Evidence-Based <strong>Practice</strong> Project since 1999.<br />
Melissa Stutzbach, MS, OTR, is the project coordinator<br />
for AOTA’s Business Operations Division, staff liaison to the<br />
Assembly of Student Delegates, and a contributor to the<br />
Evidence-Based <strong>Practice</strong> Project.<br />
Deborah Lieberman, MHSA, OTR/L, FAOTA, is the program<br />
director of AOTA’s Evidence-Based <strong>Practice</strong> Project and staff<br />
liaison to the Commission on <strong>Practice</strong>. She can be reached at<br />
dlieberman@aota.org.<br />
Write for<br />
OT <strong>Practice</strong>!<br />
See author<br />
guidelines at<br />
otpractice.org<br />
20 AUGUST 22, 2016 • WWW.AOTA.ORG
Perspectives<br />
A Magical Teacher<br />
Kirby Scott<br />
Kirby Scott is a 19-year-old man who<br />
was diagnosed with autism spectrum<br />
disorder (ASD) at age 3 years. Scott is<br />
a currently a student at Northern Oklahoma<br />
College, pursuing an associate<br />
of science degree in engineering. He<br />
graduated from Enid High School in<br />
2014 and completed a 2-year program<br />
in drafting and design at Autry<br />
Technology Center in 2016. Scott is<br />
the third of four sons born to Jon and<br />
Sue Scott. His younger brother, Luke,<br />
also has high-functioning ASD (the<br />
type previously identified as Asperger’s<br />
syndrome). Scott’s future plans are to<br />
pursue a bachelor’s degree in animation<br />
and filmmaking. This essay, about his<br />
occupational therapist Diane Fosmire,<br />
was part of an assignment for a college<br />
composition course identifying someone<br />
who made a difference in his life. Fosmire<br />
was Scott’s school-based therapist<br />
at Enid High School and is now in<br />
private practice, as owner and operator<br />
of Acres of Joy, in Enid.<br />
A<br />
teacher is someone who<br />
instructs, but a teacher takes<br />
many different forms. Not all<br />
kids grow up knowing what<br />
occupational therapy means.<br />
For some, they might think it’s about<br />
getting a job, because of the root word<br />
occupation. For me, I learned quickly that<br />
an occupational therapist was my friend,<br />
my teacher, my mentor; Diane Fosmire was<br />
just that. I was King Arthur, and she was<br />
my Merlin.<br />
When I first met Diane Fosmire, I was 3<br />
years old and I kept mostly to myself. Diane<br />
was a sweet lady. She had short, straight<br />
blonde hair with subtle hints of grey. Her<br />
smile was as beautiful as her voice. She<br />
always spoke calmly and firmly. She always<br />
dressed in business casual, comfortable<br />
clothing that suited her personality perfectly.<br />
Diane had a great sense of humor<br />
along with a heartwarming laugh. She<br />
was physically fit, which was most likely a<br />
result of her daily work.<br />
During my toddler years, I didn’t speak<br />
to many people, but Diane was different.<br />
Diane had many tools and games that<br />
sparked my interest. She helped me learn<br />
how to get my needs and wants met. The<br />
first step she taught me was to say, “I<br />
want.” Then, she had all kinds of activities<br />
for me to choose from. I listened as the<br />
computer spoke the words for my choices,<br />
and soon I was speaking along with the<br />
computer voice. She taught me the power<br />
of communication. She made my life less<br />
complicated and confusing because I could<br />
speak to the people who I cared about and<br />
understand the world around me. I was<br />
finally able to make choices instead of<br />
melting down because nobody understood<br />
what I wanted.<br />
Diane had a keen understanding of kids<br />
with disabilities. There are many people<br />
who choose a job based on the amount of<br />
money they might earn. However, there<br />
are others, like Diane, who choose a career<br />
because it lets them help people and not<br />
because of what it pays. Diane knew me<br />
so well, and she pushed me very hard to<br />
do things that I wouldn’t do on my own.<br />
She always had a reward for me when I<br />
PHOTOGRAPHS COURTESY OF THE SCOTT FAMILY<br />
OT PRACTICE • AUGUST 22, 2016<br />
21
Because of [Diane’s] teaching, wisdom and guidance,<br />
I was able to pull the “sword from the stone”<br />
and become the ruler of my world.<br />
NEW AOTA<br />
ONLINE COURSE!<br />
completed those tough tasks. She knew<br />
how to use all the activities I enjoyed<br />
as part of my therapy. I remember<br />
bringing my stuffed toys—Woody from<br />
Toy Story, a dog named Blue from the<br />
show Blue’s Clues, and the Road Runner<br />
and Wile E. Coyote from the Looney<br />
Tunes cartoons—to my sessions with<br />
Diane. Everything I did, my toys did<br />
as well. When I chose the ball bath<br />
and I jumped in, I did it with toys in<br />
hand. Diane could make a game out<br />
of almost anything. In the beginning, I<br />
was hesitant to leave my mom and go to<br />
occupational therapy, but it wasn’t long<br />
before my mom had to “make” me leave<br />
my sessions with Diane.<br />
Diane taught me lifelong skills.<br />
She showed me tricks for tying my<br />
own shoelaces, such as the bunny ears<br />
technique. She showed me a handwriting<br />
system called Handwriting Without<br />
Tears, through which I learned to write<br />
in cursive. My classroom teachers<br />
throughout the years were always<br />
impressed with my handwriting. Diane<br />
helped me to better understand the<br />
facial expressions of the people around<br />
me. We worked on making eye contact<br />
with the people I was talking to, and<br />
she taught me how to introduce myself<br />
to new people. One very important<br />
skill she taught me was correct hand<br />
positioning on a keyboard. I learned to<br />
avoid the “hunt-and-peck” trend.<br />
As a result, I am a very skilled typist.<br />
A vitally important strategy I learned<br />
from Diane was how to identify when<br />
I was becoming stressed out or overwhelmed.<br />
She showed me how to use<br />
a color-coded chart with an “engine<br />
speed meter” on it. It helped me realize<br />
how important pacing is to my daily<br />
life. I could successfully identify when I<br />
was becoming too worked up, and then<br />
I would use some of the procedures<br />
we worked on in therapy: Breathing<br />
through the nose and out of the mouth,<br />
removing myself and taking a walk, or<br />
spending some time on the swing or<br />
rocking chair. All of these things helped<br />
calm me down and kept me focused.<br />
During therapy, we worked on<br />
my fine and gross motor skills. Diane<br />
showed me how I could feel better so I<br />
fit into the world by wearing a weighted<br />
vest, crawling through a tunnel, being<br />
squashed by a “big cheese” (a large<br />
triangular foam/sponge pillow), and<br />
rolling on a walrus (a large, rounded,<br />
inflated pillow-shaped mattress). She<br />
helped me develop my fine motor<br />
skills by hiding objects in Play-Doh.<br />
Oftentimes, I would search through the<br />
dough and find coins. Diane taught me<br />
the value of the coins, and I learned to<br />
count money. But the most memorable<br />
of these comforting activities was the<br />
cocoon swing. This swing was made<br />
from a nylon Spandex type material,<br />
and it shaped to my body. Diane would<br />
swing me while she sang a song, “Caterpillar,<br />
caterpillar in a cocoon, I want to<br />
be a butterfly soon.” I loved that song.<br />
Diane Fosmire was more than<br />
a teacher to me. She helped me to<br />
develop so many valuable attributes.<br />
I will never forget her sweet personality,<br />
the songs she sang, the games we<br />
played, the techniques she introduced,<br />
or the many important life lessons she<br />
taught me. Because of her teaching,<br />
wisdom, and guidance, I was able to<br />
pull the “sword from the stone” and<br />
become the ruler of my world.<br />
PHOTOGRAPH COURTESY OF THE SCOTT FAMILY<br />
Organizational Ethics:<br />
Occupational Therapy<br />
<strong>Practice</strong> in a Complex Health<br />
Environment, 2nd Edition<br />
Presented by<br />
Lea Cheyney Brandt, OTD, MA, OTR/L<br />
Earn .1 AOTA CEU (1.25 NBCOT<br />
PDU/1 contact hour)<br />
This newly updated course will explore<br />
organizational ethics issues that may<br />
influen e the ethical decision making<br />
of occupational therapy practitioners.<br />
Course material will explore ethical<br />
confli ts that may arise between<br />
the practitioner as an organizational<br />
employee and as an autonomous<br />
health care provider.<br />
Participants will be introduced to<br />
strategies that will assist in addressing<br />
situations in which occupational<br />
therapy practitioners may be pressured<br />
by an organization’s administration<br />
to provide services that are in confli t<br />
with their personal or professional<br />
code of ethics.<br />
Order #OL4950<br />
AOTA Members: $24.99<br />
Nonmembers: $39.99<br />
To order, call 877-404-AOTA,<br />
or visit http://store.aota.org<br />
CE-366<br />
22 AUGUST 22, 2016 • WWW.AOTA.ORG
Around the World<br />
Making Global Connections in Galway, Ireland<br />
1st Joint Congress of COTEC-ENOTHE<br />
Thomas Hawksworth<br />
Susan Burwash<br />
Shannon Brawley<br />
Center: Author Thomas Hawksworth<br />
makes a presentation.<br />
Right: Boston University’s Karen<br />
Jacobs (left) meets up with Eastern<br />
Washington University’s Diane Norell<br />
T<br />
he 1st Joint Congress of the<br />
Council of Occupational<br />
Therapists for European<br />
Countries (COTEC) and<br />
the European Network of<br />
Occupational Therapy in Higher Education<br />
(ENOTHE) provided a recent opportunity<br />
for making global connections. The Congress<br />
took place in Galway, Ireland, from<br />
June 15 to 19. For occupational therapy<br />
practitioners unfamiliar with COTEC and<br />
ENOTHE, here is a bit of background.<br />
COTEC was founded in 1986 with the<br />
intent of bringing European national occupational<br />
therapy associations together to<br />
address issues of education, practice standards,<br />
and advancing occupational therapy<br />
theory to serve the social and health<br />
needs of European citizens. It represents<br />
30 occupational therapy associations and<br />
more than 120,000 therapists. ENOTHE,<br />
founded in 1995, focuses on helping to set<br />
educational standards for occupational<br />
therapy, supporting new programs, and<br />
working with COTEC to promote education.<br />
It was initially funded through the<br />
European Council’s Erasmus/Socrates<br />
program, which was established as a means<br />
of enabling students to complete a portion<br />
of their studies as exchange students<br />
outside their home country. ENOTHE has<br />
both institutional and individual members.<br />
The headquarters has been in the Netherlands<br />
and Denmark, and is currently in<br />
the United Kingdom. In addition to the<br />
joint Congress, COTEC-ENOTHE worked<br />
together recently to launch a joint website,<br />
at www.oteurope.eu.<br />
The Congress had more than 900<br />
attendees from 50 countries, including<br />
all of the European Union countries, the<br />
United States, Canada, Australia, and<br />
Japan. It took place at the National University<br />
of Ireland Galway, located along the<br />
banks of the River Corrib. The Congress<br />
theme was, “Connecting: Education/<strong>Practice</strong>/Research/Policy.”<br />
Keynote speakers<br />
came from England, Spain, Belgium, the<br />
PHOTOGRAPH ©<br />
OT PRACTICE • AUGUST 22, 2016<br />
23
University of Scranton<br />
graduate students<br />
Kathleen Phelan<br />
and Courtney Ruch<br />
(pictured left to right)<br />
and faculty mentors<br />
Verna Eschenfelder,<br />
and Marlene Morgan,<br />
EdD, OTRL presented<br />
a poster on A Relational<br />
Content Analysis<br />
of Current and<br />
Future Pedagogical<br />
Instruction of Motor<br />
Control Approaches.<br />
Being a global profession means continuously developing the<br />
means by which expertise and knowledge are shared to address<br />
challenges that our clients face, taking into account the many<br />
varying regions, countries, conditions, and settings. It is both our<br />
diversity as a profession and our ability to draw on the pool<br />
of our diversity that makes us effective.<br />
United States, Canada, and Ireland, and<br />
attendees presented 404 oral papers, 303<br />
posters, 13 symposia, and 87 workshops.<br />
Highlights included an opening ceremony<br />
featuring harp, whistle, and fiddle<br />
music as well as a greeting in Gaelic from<br />
the president of the university.<br />
Although this was a European<br />
Congress, there were many attendees<br />
from the United States. Some of the<br />
presenters included Karen Jacobs, EdD,<br />
CPE, OTR/L, FAOTA, from Boston<br />
University; George Tomlin, PhD, OTR/L,<br />
from the University of Puget Sound;<br />
Nancy Krusen, PhD, OTR/L, from Pacific<br />
University; Katherine Phelan, Courtney<br />
Ruch, Verna Eschenfelder, PhD, OTR/L,<br />
Marlene Morgan, EdD, OTRL, and Rita<br />
Fleming-Castaldy, PhD, OTR/L, FAOTA,<br />
from the University of Scranton; Kristine<br />
Haertl, PhD, ACE, OTR/L, FAOTA, from<br />
St. Catherine University; Donna Costa,<br />
DHS, OTR/L, FAOTA, from Touro University;<br />
Peggy Martin, PhD, OTR/L (OT),<br />
from the University of Minnesota; Susan<br />
Burwash, PhD, OTR/L, and Diane Norell,<br />
MSW, OTR/L, CPRP, from Eastern Washington<br />
University; and Pollie Price, PhD,<br />
OTR/L, from the University of Utah. Bill<br />
Wong, OTD, OTR/L, both presented and<br />
contributed to the Twitter feed from the<br />
Congress. Shannon Brawley, a new OTR<br />
from Wenatchee, Washington, presented<br />
narrative inquiry research into homeless<br />
women’s experiences at a drop-in center.<br />
Also attending were then AOTA President<br />
Virginia Stoffel, PhD, OT, BCMH,<br />
FAOTA, and then AOTA President-Elect<br />
Amy Lamb, OTD, OT/L, FAOTA, AOTA.<br />
One of the aims of the joint Congress<br />
was to launch the public face of occupational<br />
therapy in Europe through the shared<br />
visual identity of the website, but also as a<br />
shared voice, demonstrating the collaborative<br />
power of both COTEC and ENOTHE.<br />
As such, the executives of the Congress<br />
identified eight areas of significant interest<br />
for the profession to be considered and<br />
addressed at a European level and created<br />
workshops for delegates to contribute to<br />
the discussions and direction of the conversation.<br />
Congress delegates were asked to<br />
choose one of the following workshops in<br />
which to consider these key topics:<br />
l The importance of evidence-based<br />
practice<br />
l The accessibility of occupational therapists<br />
in primary care across Europe<br />
l The increasing number of occupational<br />
therapists working with<br />
refugees<br />
l The struggle in many countries to provide<br />
sufficient fieldwork opportunities<br />
l The successes and challenges of curriculum<br />
development for occupational<br />
therapy in emerging areas<br />
l The role of practitioners in social and<br />
political changes<br />
l E-health as a developing area in medical<br />
practice<br />
l Creating and developing a self-sustaining<br />
research branch of ENOTHE<br />
The Brexit vote, which followed hard<br />
on the heels of the COTEC-ENOTHE<br />
Congress, highlights recent European<br />
sociopolitical discourse in which the<br />
specters of disunity, separation, and<br />
nationalism reared their heads. This<br />
discourse is, of course, not limited to<br />
the Eurozone. The conference theme of<br />
connecting seems especially relevant in<br />
this context. It remains more important<br />
than ever that the profession is outward<br />
looking, collaborative, and “without<br />
borders.” Being a global profession means<br />
continuously developing the means<br />
by which expertise and knowledge are<br />
shared to address challenges that our<br />
clients face, taking into account the many<br />
varying regions, countries, conditions,<br />
and settings. It is both our diversity as<br />
a profession and our ability to draw on<br />
the pool of our diversity that makes us<br />
effective.<br />
The next COTEC-ENOTHE joint Congress<br />
is scheduled for Prague in 2020.<br />
Perhaps we’ll see you there? In the meanwhile,<br />
slán go fóill (goodbye for now).<br />
Thomas Hawksworth is recent graduate of the bachelor<br />
of science Occupational Therapy Program at the University<br />
of Derby, United Kingdom, and is now working for the U.K.<br />
National Health Service’s Priory Group with Eating Disorders<br />
in Child and Adolescent Mental Health Services.<br />
Susan Burwash, PhD, MSc(OT), OTR/L, OT(C), is an associate<br />
professor at Eastern Washington University.<br />
Shannon Brawley, MOT, OTR/L, is a recent graduate of<br />
the Occupational Therapy Program at Eastern Washington<br />
University.<br />
24 AUGUST 22, 2016 • WWW.AOTA.ORG
Save the dates!<br />
AOTA Specialty Conferences and Student Conclave<br />
www.aota.org/conferences<br />
Autism<br />
September 23–24, 2016<br />
Cleveland, Ohio<br />
Registration<br />
Now Open!<br />
AOTA/NBCOT National<br />
Student Conclave<br />
November 18–19, 2016<br />
Dearborn, Michigan<br />
Registration<br />
Opens<br />
August 24!<br />
Chronic Conditions<br />
December 2–3, 2016<br />
Orlando, Florida<br />
Registration<br />
Opens<br />
September 7!<br />
Oncology<br />
January 20–21, 2017<br />
Houston, Texas<br />
Registration<br />
Opens<br />
October 25!<br />
SP-119
Continuing Education Opportunities<br />
To advertise your upcoming event, contact the OT <strong>Practice</strong> advertising department at 800-877-1383, 301-652-6611, or otpracads@aota.org. Listings are $99 per<br />
insertion and may be up to 15 lines long. Multiple listings may be eligible for discount. Please call for details. Listings in the Calendar section do not signify AOTA<br />
endorsement of content, unless otherwise specified<br />
Look for the AOTA Approved Provider Program (APP) logos on continuing education promotional materials. The APP logo indicates the organization<br />
has met the requirements of the full AOTA APP and can award AOTA CEUs to OT relevant courses. The APP-C logo indicates that an individual course<br />
has met the APP requirements and has been awarded AOTA CEUs.<br />
SEPTEMBER<br />
Cleveland, OH Sept 23-24<br />
AOTA Specialty Conference: Autism. Learn evidencebased<br />
practices that will prepare you to meet the needs of<br />
children, adolescent, and young adults on the autism spectrum.<br />
Earn up to 20 contact hours, including Pre-Conference<br />
seminars. AOTA Member: $325, after August 24: $370,<br />
Nonmember $490, after August 24: $550. www.aota.org/<br />
autismconference<br />
Columbus, OH Sept 30–Oct 1<br />
WEIGHT LOSS: The Next Therapy Frontier (15 live hrs).<br />
BE PART OF THE SOLUTION! Learn skills to treat your<br />
clients for weight loss/inflammation/chronic diseases. Gain<br />
knowledge to grow your business in this much needed area<br />
of practice with a structured, reimbursable, evidence-based<br />
treatment system focused on intensive lifestyle interventions.<br />
Flash drive of manual and client education guidebook<br />
included. To register: www.healthehabitsforliving.com or call<br />
337-261-9188. Like us on Facebook!<br />
OCTOBER<br />
Sioux Falls, SD Oct. 1–2<br />
Eval & Intervention for Visual Processing Deficits in<br />
Adult Acquired Brain Injury Part I Faculty: Mary Warren<br />
PhD, OTR/L, SCLV, FAOTA. This updated course has<br />
the latest evidence based research. Participants learn a<br />
practical, functional reimbursable approach to evaluation,<br />
intervention and documentation of visual processing<br />
deficits in adult with acquired brain injury from CVA<br />
and TBI. Topics include hemianopsia, visual neglect, eye<br />
movement disorders, and reduced acuity. Also in Kansas<br />
City, Mo, November 5–6 and Wilmington, NC, March<br />
11–12, 2017. Contact: www.visabilities.com or (888)<br />
752-4364.<br />
Dobbs Ferry, NY OCT. 14–15<br />
Optimizing Executive Function: Strategy Based Intervention<br />
in Children and Adults. This course will provide<br />
in-depth information on treatment of cognitive dysfunction<br />
across the lifespan, with a focus on executive function<br />
impairments. Case applications of intervention principles<br />
across different ages and populations will be discussed.<br />
Instructors: Joan Toglia and Izel Obermeyer; Contact: Mercy<br />
College, 914-674-7837 for questions, SHNS@mercy.edu<br />
AOTA CE PRACTICE AREAS<br />
ASSESSMENT & EVALUATION<br />
BRAIN & COGNITION<br />
CHILDREN & YOUTH<br />
GENERAL FOCUS<br />
MENTAL HEALTH<br />
PRODUCTIVE AGING<br />
REHABILITATION, DISABILITY, &<br />
PARTICIPATION<br />
WORK AND INDUSTRY<br />
VISIT WWW.AOTA.ORG/CE FOR A COMPLETE<br />
LISTING OF ALL AOTA CE COURSES.<br />
for details and registration. Pre-registration $375 (7/1-8/1);<br />
Reg. Registration $425(8/2-9/16). AOTA CEU Application<br />
Pending (12 contact hours / 1.2 CEU’s)<br />
Baltimore, MD Oct 22–30<br />
Lymphedema Management. Certification courses in<br />
Complete Decongestive Therapy (135 hours), Lymphedema<br />
Management Seminars (31 hours). Coursework includes<br />
anatomy, physiology, and pathology of the lymphatic system,<br />
basic and advanced techniques of MLD, and bandaging for<br />
primary/secondary UE and LE lymphedema (incl. pediatric<br />
care) and other conditions. Insurance and billing issues,<br />
certification for compression-garment fitting included.<br />
Certification course meets LANA requirements. Also in<br />
Palm Beach Gardens, FL. AOTA Approved Provider. For<br />
more information and additional class dates/locations or to<br />
order a free brochure, please call 800-863-5935 or visit<br />
www.acols.com.<br />
NOVEMBER<br />
Boca Raton FL Nov. 7–8<br />
The Impact of Disabilities, Vision & Aging and Their<br />
Relationship to Driving. Course designed for driver<br />
education and allied health professionals who wish to<br />
apply their knowledge of the different types and levels of<br />
disabilities to the driving task. 15 ADED/1.5 AOTA hours<br />
offered. Contact ADED 866-672-9466. Register online:<br />
www.aded.net<br />
ONGOING<br />
Internet Ongoing & 2-Day Onsite Trainings<br />
Become an Accessibility, Home Modifications,<br />
& ADA Consultant. Instructor: Shoshana Shamberg,<br />
OTR/L, MS, FAOTA. 25+ years specializing in design/<br />
build services, technologies, injury prevention, and<br />
ADA/504 consulting for homes/jobsites. Start a private<br />
practice or add to existing services. Extensive<br />
man-ual. AOTA APP+NBCOT CE Registry. Also in Baltimore,<br />
MD, August 28–29, 2016. Contact: Abilities<br />
OT Services, Inc. 410-358-7269 or info@aotss.com.<br />
Group, COMBO, personal mentoring, and 2 for 1<br />
discounts. Calendar/info at www.AOTSS.com.<br />
Seminar sponsorships available nationally.<br />
Online Course<br />
Clinician’s View ® offers unlimited CEUs for one low<br />
price. Three great options. 7 months for $177, 1 full year<br />
for $199, and Super Saver 2 full years for $299. More<br />
than 640 contact hours, more than 780 PDUs, and more<br />
than 100 courses of clinical video continuing education<br />
approved for CEUs by AOTA and accepted by NBCOT for<br />
PDUs. Approved by BOC for athletic trainers. Take as many<br />
courses as you want for the duration of your unlimited coupon.<br />
Go to https://www.clinicians-view.com for previews<br />
of all courses and details. Click on Unlimited CEU Offer.<br />
Phone: 575-526-0012.<br />
NEW COURSES FROM AOTA CE<br />
AOTA Digital Badges now available<br />
for select AOTA continuing education<br />
courses.<br />
Learn more! Visit www.aota.org/digitalbadging<br />
Online Course<br />
A Contemporary Occupational Performance Approach<br />
to Pediatric Self-Regulation Part I: Theoretical<br />
Framework and Evaluation Considerations by<br />
Meredith Gronski, OTD, OTR/L and Theresa Henry, MSOT,<br />
OTR/L. This course will present an evidence-based theoretical<br />
foundation for authentic practice with children and<br />
youth who struggle with emotional and behavioral regulation.<br />
This course will offer a comprehensive framework<br />
for evaluation from an occupational performance perspective,<br />
focusing on assessment tool selection and developing<br />
a comprehensive, yet targeted measurement model.<br />
Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour).<br />
Order #OL4930. AOTA Members: $24.99, Nonmembers:<br />
$34.99. http://store.aota.org 0716<br />
Online Course<br />
A Contemporary Occupational Performance Approach<br />
to Pediatric Self-Regulation Part II: Self-<br />
Regulation Intervention Framework and Strategies<br />
by Meredith Gronski, OTD, OTR/L and Theresa Henry, MSOT,<br />
OTR/L. This coursewill present the most effective treatment<br />
strategies from a comprehensive foundation of evidencebased<br />
practices, all within the context of the PEOP (Person/<br />
Environment/Occupational Performance) framework, from<br />
Part 1 of this 2- part course. The primary focus of this<br />
course will be on client-centered, environmentally-relevant<br />
interventions that lead to productive occupational performance<br />
across the developmental continuum from early<br />
childhood to adolescence. Earn .1 AOTA CEU (1.25 NBCOT<br />
PDU/1 contact hour). Order #OL4931. AOTA Members:<br />
$24.99, Nonmembers: $34.99. http://store.aota.org 0716<br />
Online Course<br />
Applying the OT <strong>Practice</strong> Guidelines for Adults With<br />
Neurodegenerative Diseases by Katharine Preissner,<br />
EdD, OTR/L. Evidence-based practice is integral to successful<br />
client outcomes. This course is intended to assist<br />
occupational therapy practitioners in providing evidencebased<br />
assessment and interventions to adults with neurodegenerative<br />
diseases (NDDs). The course facilitates<br />
the use of the practice guidelines by presenting the information<br />
in a multimedia format and walking the learner<br />
through case studies that illustrate important concepts in<br />
the guidelines. Four interactive case studies are presented<br />
that address the following NDDs: Multiple Sclerosis (MS),<br />
Parkinson’s Disease (PD), Amyotrophic Lateral Sclerosis<br />
(ALS), and Transverse Myelitis (TM). Earn .15 CEU (NBCOT<br />
1.88 PDUs/1.5 contact hours). Order # OL4896. AOTA<br />
Members: $34.95, Nonmembers: $49.95. http://store.<br />
aota.org 0216<br />
Online Courses<br />
Occupational Therapy: Across the Parkinson’s Disease<br />
Continuum Series - designed and created in collaboration<br />
with the Parkinson’s Disease Foundation. These<br />
online courses are designed by expert occupational therapy<br />
practitioners in the field of Parkinson’s to help their colleagues<br />
to ensure best practice care for people living with<br />
the disease. These courses will provide practical, evidencebased<br />
knowledge across the continuum of Parkinson’s care<br />
to help occupational therapists evaluate and treat individuals<br />
in all settings — including in home care, community rehabilitation<br />
and long-term care practice settings. Earn .2 AOTA<br />
CEUs (2.5 NBCOT PDUs, 2.0 contact hours). Members/<br />
Nonmembers: $19.95. Module 1: Overview of Parkinson’s<br />
Disease (Order #OL4960); Module 2: Assessment in Parkinson’s<br />
Disease Intervention (Order #OL4961); Module 3:<br />
26 AUGUST 22, 2016 • WWW.AOTA.ORG
Continuing Education Opportunities<br />
Occupational Therapy Intervention for Parkinson’s Disease<br />
(Order #OL4962); Module 4: Parkinson’s Disease: Emerging<br />
Research, Resources, & Beyond (Order #OL4963).<br />
http://store.aota.org 0216<br />
Online Course<br />
Using the Occupational Therapy <strong>Practice</strong> Guidelines<br />
for Home Modifications by: Carol Siebert, MS, OTR/L,<br />
FAOTA and Stacy Smallfield, DrOT, OTR/L, FAOTA. This course<br />
addresses the home modification process, strategies, and assessments;<br />
types of home modification interventions; he importance<br />
of integrating home modifications into daily life; and<br />
examines the procedures for reviewing, selecting, and organizing<br />
evidence in the guidelines. Earn .15 CEU (NBCOT 1.88<br />
PDUs/1.5 contact hours). Order #OL4895, AOTA Members:<br />
$34.95, Nonmembers: $49.95, http://store.aota.org 1115<br />
Online Course<br />
Social Skills for Children with Autism Spectrum<br />
Disorder (ASD) by Sharon A. Gutman, PhD, OTR,<br />
FAOTA & Emily I. Raphael-Greenfield, EdD, OTR. The<br />
course presents the theoretical basis and guidelines for<br />
the SIMPLE Intervention and illustrates its use through<br />
written and video demonstrations. Instructions for 11<br />
warm-up and 10 role-play activities are embedded in the<br />
course. Video clips are provided to demonstrate many<br />
of the activities. The SIMPLE Intervention can be used<br />
in the school system or in private practice. Earn .2 CEU<br />
(NBCOT 2.5 PDUs/2 contact hours). Order #OL4897,<br />
AOTA Members $49.95, Nonmembers $64.95, http://<br />
store.aota.org 1115<br />
Self-Paced Clinical Course<br />
Traumatic Brain Injury (TBI): Interventions to Support<br />
Occupational Performance, Neurorehabilitation<br />
in Occupational Therapy Series, Volume III, edited by<br />
Kathleen M. Golisz, OTD, OTR, and Mary Vining Radomski,<br />
PhD, MA, OTR/L, FAOTA; series senior editor, Gordon<br />
Muir Giles, PhD, OTR/L, FAOTA. This course provides the<br />
core concepts and theoretical foundations that inform occupational<br />
therapy across the continuum of care for people<br />
with TBI as well as detailed discussions of occupational<br />
therapy assessment and intervention at each phase of<br />
the recovery, rehabilitation, and community and social<br />
reintegration continuum. Earn 2 AOTA CEUs (25 NBCOT<br />
PDUs/20 contact hours). Order #3034, AOTA Members:<br />
$259, Nonmembers: $359. http://store.aota.org 1115<br />
Organizational Ethics: Occupational Therapy <strong>Practice</strong><br />
in a Complex Health Environment 2nd Edition presented<br />
by Lea Cheyney Brandt, OTD, MA, OTR/L. This newly<br />
updated course will explore organizational ethics issues that<br />
may influence the ethical decision making of occupational<br />
therapy practitioners. Course material will explore ethical<br />
conflicts that may arise between the practitioner as an organizational<br />
employee and as an autonomous health care<br />
provider. Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact<br />
hour). Order #OL4950, AOTA Members: $24.99, Nonmembers:<br />
$39.99. http://store.aota.org 0716<br />
Online Course<br />
Health Literacy: Effective Client Communication and<br />
Education by Cheryl Miller, DrOT, OTR/L. This clinically<br />
relevant interactive course is designed for occupational<br />
therapy practitioners who desire effective, meaningful, collaborative,<br />
and profes sional interactions with clients and<br />
caregivers in any practice setting. Effective communication<br />
is required to help clients achieve desired outcomes and<br />
goals. Earn .2 CEU (2.5 NBCOT PDUs/2 contact hours).<br />
Order #OL362SC. AOTA Members: $65, Nonmembers:<br />
$89. http://store.aota.org<br />
Online Course<br />
Cancer Series - Module 1: Impact of Psychosocial<br />
Aspects of Cancer on Occupational Engagement by<br />
Kathleen Lyons, ScD, OTR, Author; and Claudine Campbell,<br />
MOT, OTR, CLT and Lauro Munoz, MOT, OTR, CHC, Series<br />
Editors. This module, the first in AOTA’s Cancer Series, addresses<br />
three psychosocial challenges (distress, depression,<br />
and anxiety) and three psychosocial opportunities (lifestyle<br />
changes, spiritual growth, and life completion) that may occur<br />
within the context of cancer. Earn .15 CEU (NBCOT 1.88<br />
PDUs/1.5 contact hours). Order # OL50, AOTA Members:<br />
$49.95; Nonmembers: $64.95. http://store.aota.org<br />
Online Course<br />
Cancer Series - Module 2: Lymphedema and Breast<br />
Cancer for OT Practitioners by Claudine Campbell,<br />
MOT, OTR, CLT and Series Editors: Claudine Campbell,<br />
MOT, OTR, CLT & Lauro Munoz, MOT, OTR, CHC. This module,<br />
the second one in the AOTA Cancer Series, explores<br />
the differences between primary and secondary lymphedema,<br />
and the 5 stages of lymphedema. The module<br />
examines the causes and symptoms of secondary lymphedema,<br />
specifically breast cancer related lymphedema.<br />
Methods for measuring the severity of lymphedema are<br />
addressed, together with OT intervention strategies for<br />
meeting the physiological, psychological, and emotional<br />
challenges associated with breast cancer related lymphedema.<br />
Finally, a case example walks the learner through<br />
an OT evaluation and recommended interventions for a<br />
client with breast cancer related lymphedema. Earn .15<br />
CEU (NBCOT 1.88 PDUs/1.5 contact hours). Order #OL51.<br />
AOTA Members: $49.95, Nonmembers: $64.95. http://<br />
store.aota.org 0216<br />
Online Course<br />
Preparing for ICD-10 Implementation Webcast, Second<br />
Edition by Sharmila Sandhu, JD & Elaine Craddy<br />
Adams, OTR/L. The long awaited transition from ICD-9 to<br />
ICD-10 occured on October 1, 2015.This webcast presentation<br />
provides legislative and regulatory background<br />
information about transition, and reviews basic information<br />
about ICD-10 as well as additional coding basics. Considerations<br />
in preparing your workplace for the transition as<br />
well as how to choose and document ICD-10 codes are<br />
Master real-world expertise<br />
Online Post-Professional Master of<br />
Occupational Therapy<br />
Raise your level of hands-on excellence while boosting<br />
your career with this unique, practice-based curriculum,<br />
delivered with the flexibility and convenience of<br />
leading-edge online learning. Incorporating extensive<br />
interdisciplinary support and feedback through an<br />
on-going community of mentors and peers, it’s an<br />
exceptional opportunity to advance and excel.<br />
Get real about mastering practice-based expertise.<br />
www.atsu.edu/AMOT<br />
A post-professional Doctorate of Occupational<br />
Therapy is also offered online.<br />
FIRST IN WHOLE<br />
PERSON HEALTHCARE<br />
D-7811<br />
OT PRACTICE • AUGUST 22, 2016<br />
27
Continuing Education Opportunities<br />
Assessment & Intervention Training<br />
Two Days of Hands-On Learning (1.6 CEU)<br />
Upcoming Locations & Dates:<br />
2016<br />
Freehold, NJ Sept. 23–24<br />
Columbus, OH Sept. 30–Oct. 1<br />
San Antonio, TX Oct. 20–21<br />
Leesburg, VA Nov. 4–5<br />
2017<br />
Livonia, MI Jan. 6–7<br />
Gainesville, FL Jan. 13–14<br />
Irvine, CA Jan. 20–21<br />
Greeley, CO Feb. 9–10<br />
San Leandro, CA March 2–3<br />
Atlanta, GA March 17–18<br />
Houston, TX May 19–20<br />
Birmingham, AL June 30–July 1<br />
For complete training schedule & information visit<br />
www.beckmanoralmotor.com<br />
Host a Beckman Oral Motor Seminar!<br />
Host info (407) 590-4852, or<br />
info@beckmanoralmotor.com D-7829<br />
Faculty<br />
also discussed. Earn: .1CEUs, 1 Contact Hour and 1.25<br />
PDUs. Order #OL4894. AOTA Members: $24.99, Nonmembers:<br />
$34.99. http://store.aota.org<br />
SPECIAL INTEREST TOPICS<br />
Continuing education courses based on Special Interest<br />
Quarterly articles that are published 4 times per year by<br />
each of the AOTA Special Interest Sections. Each Special<br />
Interest Topic is comprised of 2 thematically connected<br />
quarterly articles selected for their insight and immediate<br />
applicability to practice. AOTA CEUs, contact hours, and<br />
NBCOT PDUs are earned after successful completion of<br />
the accompanying exam.<br />
Special Interest Topic #1: Models of <strong>Practice</strong> for<br />
Increasing Self-Awareness by Caitlin Synovec, OTR/L;<br />
Courtney Dauwalder, OTD, OTR/L, MFA; and Christine<br />
Berg, PhD, OTR/L, FAOTA. Earn .1 AOTA CEU (1.25 NB-<br />
COT PDU/1 contact hour). Order #CESIT01 AOTA Members:<br />
$24.99, Nonmembers: $29.99. http://store.aota.org<br />
Special Interest Topic #2: Intervention Models<br />
for School Age Youth by Sarah A. Schoen, PhD, OTR;<br />
Lucy Jane Miller, PhD, OTR; Shannon Hampton; Meira L.<br />
Orentlicher, PhD, OTR/L; Dottie Handley-More, MS, OTR/L;<br />
Rachel Ehrenberg; Malka Frenkel; and Leah Markowitz.<br />
Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour).<br />
Order #CESIT02 AOTA Members: $24.99, Nonmembers:<br />
$29.99. http://store.aota.org<br />
Special Interest Topic #3: Enhancing Quality of Life<br />
for Older Adults by Cristina Michetti, OTR/L; Joanne Gallagher<br />
Worthley, EdD, OTR/L, CAPS; Laura Caron-Parker,<br />
OTR/L; and Sharon Nichols, CTRS/L. Order #CESIT03<br />
AOTA Members: $24.99, Nonmembers: $29.99. http://<br />
store.aota.org<br />
Find your way. The South Way.<br />
Earn your Doctor of Occupational<br />
Therapy or AAS or AS in Occupational<br />
Therapy Assistant degree the South Way,<br />
with hands-on training and one-on-one<br />
mentoring. Choose from online,<br />
on-campus, or a hybrid class schedule.<br />
800.504.5278 | SouthUniversity.edu<br />
Programs, credential levels, technology, and scheduling options vary by school and are subject<br />
to change. Not all online programs are available to residents of all U.S. states. Administrative<br />
office: South University, 709 Mall Boulevard, Savannah, GA 31406-4805. ©2016 South University.<br />
All rights reserved. Our email address is materialsreview@southuniversity.edu.<br />
See SUprograms.info for program duration, tuition, fees and other costs, median debt,<br />
salary data, alumni success, and other important info.<br />
D-7801<br />
Visit store.aota.org for additional special interest topics.hours).<br />
Order #OL4886. AOTA Members: $65, Nonmembers:<br />
$89. http://store.aota.org<br />
Webcast<br />
From Volume- to Value-based Productivity: What it<br />
Means for the Future of OT <strong>Practice</strong> by presenter Gerben<br />
DeJong, PhD, FACRM. Learn how upcoming changes in<br />
post-acute policy will change the value proposition of occupational<br />
therapy from one of maximizing reimbursement to<br />
creating value for all stakeholders—patients, family, payers,<br />
and providers. Earn 1 contact hour (1 NBCOT PDU). Order<br />
#WA1219. AOTA Members: FREE!, Nonmembers: $9.99.<br />
http://store.aota.org 0416<br />
Webcast<br />
Home Modification Webcast Series. Learn how upcoming<br />
changes in post-acute policy will change the value proposition<br />
of occupational therapy from one of maximizing reimbursement<br />
to creating value for all stakeholders—patients, family,<br />
payers, and providers. Earn 1 to 1.5 AOTA CEUs (1.25–1.88<br />
NBCOT PDUs/1–1.5 contact hours) per completed webcast.<br />
AOTA Members: $24.95, Nonmembers: $34.95. Enabling<br />
Design: A Person-Centered Approach (Order #WA1226); Occupational<br />
Therapy’s Role in Assisting a Patient Transition from<br />
Hospital to Home (Order #WA1225); Fundamentals of Pediatric<br />
Home Modifications (Order #WA1224); Setting up a Home<br />
Modifications Business (Order #WA1223); From Inspiration<br />
to Installation: The Search for Creative Ideas to Solve Home<br />
Mod Challenges (Order #WA1221); Meeting the Psychosocial<br />
Needs of Clients (Order #WA1220). http://store.aota.org 0416<br />
Webcast<br />
Lifestyle Redesign Webcast Series. The award-winning<br />
Lifestyle Redesign® manual is now a continuing education<br />
course. This six-unit course provides practical guidance in this<br />
preventative occupational therapy program for independentliving<br />
older adults. The 12 text modules, including those on<br />
longevity, stress, home safety, and navigating health care, are<br />
incorporated into 6 webcast units to illustrate how to incorporate<br />
the program into practice. Earn 1 to 1.5 AOTA CEUs<br />
THE (1.25–1.88 RICHARDS NBCOT PDUs/1–1.5 contact hours) per completed<br />
webcast. AOTA Members: $24.95, Nonmembers: $34.95.<br />
GROUP<br />
TRG Unit JOB 1 (Order #: #WA1231); Unit 2 (Order #WA1232); Unit 3<br />
STH-16-0026<br />
(Order #WA1233); Unit 4 (Order #WA1234); Unit 5 (Order<br />
CLIENT: #WA1235); Unit 6 (Order #WA1236). http://store.aota.org 0416<br />
South University<br />
TITLE:<br />
Distinct Value<br />
OT<br />
Demonstrating the Distinct Value of Occupational<br />
PUBS:<br />
Therapy—Module 1: An Overview by Amy Lamb, OTD,<br />
OT <strong>Practice</strong><br />
OTR/L, FAOTA. Join Dr. Amy Lamb as she provides an overview<br />
of the Distinct Value priority of AOTA. You will learn how<br />
INSERTION DATE:<br />
7/11/2016<br />
this priority and the Distinct Value statement were informed<br />
TRIM: by historical and current leaders within the profession. You<br />
4.687" x 4.375"<br />
will also learn how health care changes in America due to<br />
LIVE:<br />
the Affordable Care Act are creating opportunities for the<br />
na<br />
profession as well as calling us to action to more accurately<br />
BLEED:<br />
naarticulate our distinct contribution to the health and wellbeing<br />
of those we serve. Earn .1 AOTA CEU (1.25 NBCOT<br />
COLOR: CMYK<br />
SWOP PDU/1 contact hour). Order #OL4891. AOTA Members:<br />
CONTACT: $24.95, Nonmembers: $35.95. http://store.aota.org<br />
Kathleen<br />
Pendergast Distinct Value<br />
214-891-2918 Demonstrating the Distinct Value of Occupational<br />
Therapy - Module 2: Infusing the Distinct Value<br />
into Occupational Therapy <strong>Practice</strong> and Documentation<br />
by Amy Lamb, OTD, OTR/L, FAOTA. In this module<br />
you will learn how to articulate the distinct value statement<br />
as well as how the priority will help the profession<br />
in achieving the centennial vision. In addition, Dr. Lamb<br />
will offer strategies for communicating the distinct value<br />
of OT through daily documentation and explain why this<br />
is so critical in an era of changing healthcare systems.<br />
Earn .1 AOTA CEU (1.25 NBCOT PDU/1 contact hour).<br />
Order #OL4892. AOTA Members: $24.95, Nonmembers:<br />
$35.95. http://store.aota.org<br />
28 AUGUST 22, 2016 • WWW.AOTA.ORG
Employment Opportunities<br />
Faculty<br />
Faculty<br />
Assistant Professor, Midwestern University<br />
The Midwestern University Occupational Therapy<br />
Program in Downers Grove, IL has immediate<br />
opportunities to join an established occupational therapy<br />
master’s degree program. The program is currently in<br />
the Pre-Candidacy phase of the transition process from<br />
a M.O.T. to an O.T.D. Program.<br />
Applications are invited for full time tenure track faculty positions as an<br />
Assistant Professor. Successful applicants must possess:<br />
1) an earned doctorate in occupational therapy or a related field<br />
2) licensure as an occupational therapist in Illinois<br />
3) at least 5 years of clinical experience; and<br />
4) instructional experience in a college or university academic program.<br />
Experience in pediatrics, adult rehabilitation or program development/<br />
administration is preferred.<br />
Rank and salary are commensurate with qualifications and experience.<br />
Interested applicants should apply online at www.midwestern.edu. Application<br />
packets should include a letter of interest, CV, and the names and contact<br />
information of 3 professional references. Additional questions may be directed<br />
to Mark Kovic, OTD, OTR/L. FAOTA, Chair, OT Program Search Committee,<br />
Occupational Therapy Program at mkovic@midwestern.edu.<br />
Midwestern University is an Equal Opportunity/Affirmative Action employer that does not discriminate<br />
against an employee or applicant based upon race, color, religion, gender, national origin, disability,<br />
or veterans status, in accord with 41 C.F.R. 60-1.4(a), 250.5(a), 300.5(a) and 741.5(a).<br />
F-7826<br />
OT PRACTICE • AUGUST 22, 2016<br />
Faculty<br />
Salem State University requires the addition of<br />
a full-time, tenure-track occupational therapy<br />
faculty member to teach in a growing program.<br />
The ideal candidate will possess knowledge of<br />
accreditation standards, experience in program<br />
development, and have a strong background in<br />
research and grant writing and MS direct-entry programs. Additionally, we are seeking<br />
a full-time, temporary, one-year faculty member with some knowledge of accreditation<br />
standards, curriculum development, research and grant writing. Teaching assignments<br />
for both positions may include courses in part-time evening combined BS/MS OTA bridge<br />
and MS direct-entry programs.<br />
The Occupational Therapy program at Salem State seeks to engage the student in a journey<br />
of transition from OTA to OT. The creation of a professionally enhanced, culturally competent<br />
and critically thinking practitioner is a major objective of this academic program.<br />
An important outcome of the program is to instill the value and importance of life-long<br />
learning for a profession that is continuously changing and growing in its complexity and<br />
scholastic advancements. Students learn to embrace their commitment to the profession<br />
and work toward setting and attaining both personal and professional goals. The acquisition<br />
of leadership skills, appreciation of alternative treatment directions taking place in the<br />
profession and the formation of solid foundation skills in the area of research is critical in<br />
the development of entry-level clinicians graduating from Salem State. The attainment of<br />
such goals leads to an individual who appreciates values and is committed to the future<br />
prosperity of occupational therapy.<br />
Salem State is a teaching university, committed to our students’ learning and growth, many<br />
of whom are the first in their family to go to college. Collegiality, student success, collaboration,<br />
initiative, continuous improvement and accountability are highly valued in our<br />
organizational culture and we seek a colleague who shares those values and wants to be<br />
part of our community.<br />
Salem State University is an equal opportunity/affirmative action employer. Persons of<br />
color, women and persons with disabilities are strongly urged to apply.<br />
To view the entire postings and apply, please visit salemstate.edu/jobs<br />
F-7822<br />
OCCUPATIONAL THERAPY<br />
Faculty Position<br />
New faculty will join a department<br />
with a 74-year history of excellence.<br />
NON-TENURE TRACK POSITION<br />
Assistant Professor<br />
(position# F39910)<br />
REQUIRED QUALIFICATIONS<br />
• Earned doctorate (e.g., OTD) or<br />
doctoral candidacy<br />
• Ability to complement and<br />
expand existing Departmental<br />
expertise<br />
• Strong written and interpersonal<br />
communication skills<br />
• Commitment to working with<br />
diverse faculty, staff and students<br />
PREFERRED QUALIFICATIONS:<br />
• OT licensure or eligibility for<br />
licensure in Virginia<br />
• At least 3 years of experience in<br />
practice and/or academic<br />
settings<br />
• Teaching experience in OT or<br />
related disciplines<br />
RESPONSIBILITIES:<br />
• Teach and advise OTD students<br />
• Coordinate student OTD leadership/capstone<br />
projects<br />
• Contribute to Department service<br />
and research<br />
APPLICATION:<br />
Please visit VCU’s e-jobs site at<br />
https://www.vcujobs.com<br />
CONTACT: Dr. Jodi Teitelman, Search Committee<br />
Chair at jlteitel@vcu.edu for position<br />
information or http://sahp.vcu.edu/occu<br />
for more information about VCU’s OT<br />
Department<br />
Virginia Commonwealth University is an equal opportunity,<br />
affirmative action university providing access to education and<br />
employment without regard to age, race, color, national origin,<br />
gender, religion, sexual orientation, veteran’s status, political<br />
affiliation or disability.<br />
F-7832<br />
29
Employment Opportunities<br />
National<br />
Program Manager for Board & Specialty Certification<br />
Come to AOTA and help us build the profession for the 21st century and grow our advanced<br />
specialty credentialing programs<br />
This national level position will be responsible for the<br />
oversight and growth of AOTA’s Board & Specialty<br />
Certification program. This includes exciting collaborative<br />
work with academic institutions, further developing<br />
& refining the user experience for all certification applicants<br />
and continuing to build the value of this program for<br />
our members. The position will be responsible for staying<br />
abreast of the external continuing competence environment,<br />
as well as assessing our members’ needs in this area.<br />
Additionally, the program manager will have staff liaison<br />
responsibilities for the Commission on Continued Competence<br />
& Professional Development (CCCPD), the Board for<br />
Advanced & BOS053149B Specialty Certification 1 (BASC) and the Special<br />
Interest Sections Council (SISC).<br />
AKWAN<br />
PY ASSOC 2016<br />
The successful candidate will have demonstrated expertise<br />
and knowledge in areas of professional development & continued<br />
clinical competence. The candidate should have very<br />
strong leadership, management and communication skills, as<br />
well as the ability to manage projects effectively. The candidate<br />
should also have a proven track record of working well with<br />
teams and keeping an open mind to innovative ideas. This<br />
position requires a Master’s Degree at a minimum with an<br />
OTD or PhD preferred. Ideal candidate will have 8-10 years of<br />
experience or a combination of formal education and experience.<br />
Experience should demonstrate progressive leadership<br />
responsibilities. The candidate must be technologically proficient<br />
in a Windows environment. On-site status is highly preferred,<br />
but long distance tele-commuting may be considered.<br />
KINTHE0388<br />
AOTA offers a comprehensive benefits package OT that <strong>Practice</strong> includes Magazine 401(k) employer match, health insurance, transportation/<br />
parking subsidy, plus much more! Please send letter of interest, an up-to-date resume and salary history to: jobs@aota.org or<br />
send to: AOTA, HRJob/PM-BSC, 4720 Montgomery Lane, Bethesda, MD 20814 or Fax: 240-762-5147. EOE<br />
U-7815<br />
Midwest<br />
Kindred Rehab Services, Inc. d/b/a RehabCare<br />
is seeking an Occupational Therapist to work<br />
full-time in our Streamwood, IL facility. Must<br />
possess or be eligible for a State of Illinois<br />
occupational therapy license. Please e-mail<br />
your resume to: Nichole Brewer at:<br />
Nichole.Brewer@rehabcare.com.<br />
M-7831<br />
West<br />
ARIZONA OTs—$65,000<br />
Phoenix, Tucson, & Burbs<br />
602-478-5850/480-221-2573 Schools,<br />
16 wks off, 100% Paid: Health, Dental, Lic,<br />
Dues, CEU-$1,000,401K, Hawaii/Spanish I<br />
trips… Jobs@StudentTherapy.com<br />
*STARS* StudentTherapy.com<br />
W-6037<br />
FIND AOTA ON<br />
Stand apart from<br />
the ordinary.<br />
www.OTJobLink.org<br />
PR-283<br />
30 AUGUST 22, 2016 • WWW.AOTA.ORG
AOTA for You • Evidence in <strong>Practice</strong><br />
TBI<br />
Children<br />
and Youth<br />
Interested in increasing<br />
your evidence-based<br />
practice (EBP) knowledge-base<br />
and skills in a<br />
school setting? Cahill, Egan,<br />
Wallingford, Huber-Lee, and<br />
Dess-McGuire’s (2015) article<br />
featured in the March/<br />
April 2015 issue of the<br />
American Journal of Occupational<br />
Therapy demonstrates<br />
the effectiveness of<br />
a 17-month EBP initiative<br />
to significantly improve<br />
EBP knowledge and skills<br />
for school-based occupational<br />
therapy practitioners.<br />
To learn more about the<br />
initiative and how it can be<br />
used to build your own EBP<br />
skills, visit www.ajot.aota.<br />
org. For more school-based<br />
practice EBP resources,<br />
visit www.aota.org/<br />
practice/children-youth/<br />
evidence-based.<br />
Work<br />
& Industry<br />
Learn how a structured<br />
intervention program can<br />
reduce pain and improve<br />
body posture in health care<br />
professionals in the Critically<br />
Appraised Paper (CAP)<br />
at http://goo.gl/iOxo25.<br />
Based on a peer-reviewed<br />
article, the CAP provides an<br />
at-a-glance summary of the<br />
effectiveness of an ergonomic<br />
program that offers<br />
education and skill training<br />
to address work-related<br />
body posture and lower-back<br />
pain. The program<br />
can be used as in-service<br />
or continuing education<br />
opportunity to prevent or<br />
restore function for health<br />
care professionals. For other<br />
CAPs and information on<br />
opportunities to submit<br />
or serve as a reviewer for<br />
a CAP, visit www.aota.<br />
org/practice/researchers/<br />
evidence-exchange.<br />
Mental Health<br />
Learn how a life review<br />
writing workshop can<br />
reduce depressive symptoms<br />
and increase social support<br />
in older adults in the<br />
Critically Appraised Paper<br />
(CAP) available at http://<br />
goo.gl/ygVZUw. Based on<br />
a peer-reviewed article, the<br />
CAP provides an at-a-glance<br />
summary and methods of<br />
a randomized control trial,<br />
8-week writing workshop<br />
held in senior residencies.<br />
Occupational therapy<br />
practitioners can use the<br />
program as an intervention<br />
to address the psychosocial<br />
needs of older adults. For<br />
other CAPs and information<br />
on opportunities to submit<br />
or serve as a reviewer for<br />
a CAP, visit www.aota.<br />
org/practice/researchers/<br />
evidence-exchange.<br />
Rehab<br />
& Disability<br />
A recent AOTA systematic<br />
review reported moderate<br />
evidence that activity-based<br />
interventions focused on client-centered<br />
goals delivered<br />
in a relevant environment<br />
by an occupational therapist<br />
can improve occupational<br />
performance for individuals<br />
with TBI. To find out more<br />
and learn about other key<br />
evidence recommendations<br />
in areas such as cognition,<br />
vision, behavior, motor<br />
function, social participation<br />
for individuals with<br />
TBI, check out the Critically<br />
Appraised Topics (CATs) at<br />
www.aota.org/practice/<br />
rehabilitation-disability/<br />
evidence-based.<br />
For more, check out http://www.aota.org/<strong>Practice</strong>/<br />
Researchers/EBP-Resources.aspx<br />
GRAPHICS © GETTY IMAGES<br />
Education<br />
I<br />
ncorporating<br />
evidence-based practice (EBP) into the<br />
classroom is essential to help students understand the<br />
value of EBP and to prepare them to apply EBP as<br />
fieldwork students and new practitioners. AOTA has<br />
numerous EBP resources and tools that can be seamlessly<br />
incorporated into curricula to provide students with a<br />
strong, comprehensive background of EBP in many practice<br />
areas. To learn more about how to incorporate the resources<br />
into curricula, visit www.aota.org/education-careers/<br />
educators/evidence.<br />
Productive Aging<br />
What is the distinct value of occupational therapy<br />
to address driving and community mobility? In the latest<br />
AOTA Everyday Evidence Podcast, Wendy Stav, PhD, OTR/L,<br />
SCDCM, FAOTA, explains how occupational therapy services<br />
help older adults stay safe on the road and access the community<br />
despite age-related changes. To listen to the podcast and<br />
learn more about the evidence for driving and community<br />
mobility, visit http://goo.gl/v5h4D0.<br />
OT PRACTICE • AUGUST 22, 2016<br />
31
Social Media Spotlight<br />
How do you infuse<br />
OCCUPATION<br />
into your daily practice?<br />
We asked our friends on social media to<br />
share practice-based examples.<br />
Send yours to promotions@aota.org.<br />
Advocating for OT<br />
Last month, AOTA staff and members advocated for OT at the<br />
national conventions. It’s an opportunity to interact with policymakers<br />
outside the traditional D.C. setting. Check out what they<br />
were up to:<br />
1<br />
2<br />
Working in public<br />
schools, I work with students<br />
doing community<br />
integration during the<br />
school day. We grocery<br />
shop, practice community<br />
navigation, bowling,<br />
Zumba—whatever is<br />
meaningful to my students.—Erin<br />
Villanueva<br />
Some of the cabinet<br />
doors in our ADL apartment<br />
were getting loose.<br />
What better activity for<br />
our retired contractor<br />
patient than to grab a<br />
screwdriver and tighten<br />
them for us!<br />
—Kara Vautour<br />
3 4<br />
Today we had a patient<br />
who used to be a hairdresser<br />
French Braid two<br />
therapists’ hair.<br />
—Kainaan Nelson<br />
I had a 99-year-old vet<br />
reach up to the top shelf<br />
in his closet to retrieve<br />
his WWII hats so he<br />
could show them to me.<br />
—Ruth Blameuser<br />
5<br />
OT Connections<br />
— A prospective student asks whether she is too old<br />
at age 35 to become an OT. See the inspirational<br />
reactions. www.aota.org/otc/nontraditional-student<br />
— Have you seen the new OT evaluation CPT codes?<br />
Your colleagues are discussing how the codes might<br />
affect OT practice. www.aota.org/otc/new-codes<br />
— An AOTA member is starting a private practice and<br />
has questions about billing Medicare and private<br />
insurance. Can you help them out? www.aota.org/<br />
otc/private-billing<br />
11. AOTA President Amy Lamb<br />
met with Senate Majority<br />
Leader Mitch McConnell (KY)<br />
at the Republican National<br />
Convention in Cleveland.<br />
2. Chris Metzler, AOTA’s chief<br />
public affairs officer, spoke<br />
about the Americans with<br />
Disabilities Act at the Democratic<br />
National Convention in<br />
Philadelphia.<br />
3. Heather Parsons, AOTA’s<br />
director of Federal Affairs,<br />
met with OT champions<br />
Representative Paul Tonko<br />
(NY) and Senators Ben Cardin<br />
(MD) and Brian Schatz (HI) at<br />
the DNC.<br />
4. 4 AOTA members Wendy<br />
Fox and Paula Kramer and<br />
AOTAPAC Chair Yvonne Randall<br />
attend a lunch in support<br />
of the Achieving a Better Life<br />
Experience (ABLE) act.<br />
5. 5 Barbara Glauser, AOTA<br />
member, John Ray, AOTA’s<br />
legislative representative, and<br />
Amy Lamb met with Representative<br />
Glenn Thompson<br />
(PA) at the RNC.<br />
PHOTOGRAPHS COURTESY OF CHRISTINA METZLER (1, 4),<br />
HEATHER PARSONS (2, 3), PENNY AMMERMAN-THOMPSON/AMY LAMB (5).<br />
32 AUGUST 22, 2016 • WWW.AOTA.ORG
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AOTA/NBCOT<br />
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SC-134
The Role of Occupational Therapy in<br />
Reducing Hospital Readmissions<br />
Earn .1 AOTA CEU<br />
(one contact hour and<br />
1.25 NBCOT PDU).<br />
See page CE-7 for details.<br />
Marnie Renda, MEd, OTR/L, CAPS, ECHM<br />
Occupational Therapists and Founder/Owner, Rebuild Independence<br />
LLC, Cincinnati, OH, and Adjunct Faculty Member, Xavier University,<br />
Norwood, OH<br />
Susan Lee, MS, OTR/L<br />
Occupational Therapist and Research Scientist, Center for Assistive<br />
Technology and Environmental Access, Atlanta, GA<br />
Marian Keglovits, OTD, MSCI, OTR/L<br />
Occupational Therapist, Washington University in St. Louis, School of<br />
Medicine, Program in Occupational Therapy<br />
Emily Somerville, MS, OTR/L<br />
Occupational Therapist, Washington University in St. Louis, School of<br />
Medicine, Program in Occupational Therapy<br />
This CE Article was developed in collaboration with<br />
AOTA’s Home & Community Health Special Interest Section.<br />
ABSTRACT<br />
The implementation of the Affordable Care Act led to the Centers<br />
for Medicare & Medicaid Services mandate to reduce costly<br />
unplanned hospital readmissions. As a result, hospitals are<br />
actively seeking solutions to reduce readmissions, which now<br />
have financial penalties. This provides occupational therapy<br />
professionals the opportunity to demonstrate their expertise<br />
and knowledge in contributing to a reduction in readmissions.<br />
The role of occupational therapy in reduction can include care<br />
coordination, fall prevention, medication management, assistive<br />
technology acquisition, and community re-integration.<br />
LEARNING OBJECTIVES<br />
After reading this article, you should be able to:<br />
1. Describe the impact of the Affordable Care Act on hospital<br />
readmissions<br />
2. Identify known risk factors for hospital readmissions<br />
3. Name the current conditions considered in the ratios for<br />
calculating hospital readmission rates<br />
4. Identify three practice areas in which occupational therapy<br />
practitioners participate during the discharge planning process<br />
INTRODUCTION<br />
The rapid change in the health care system toward value-based<br />
purchasing, propelled by the Affordable Care Act of 2010 (ACA),<br />
provides an opportunity for occupational therapy practitioners to<br />
expand their traditional roles and showcase their distinct skills.<br />
Reducing hospital readmissions is one such area where occupational<br />
therapy can demonstrate the value of its services, improving<br />
the health and wellness of clients while reducing health care costs.<br />
The ACA was designed to facilitate changes in our health care<br />
system by linking quality of care to reimbursement. In doing so,<br />
health care providers are encouraged to discover and use best<br />
practices to create optimal outcomes while reducing cost. The<br />
Medicare Payment Advisory Commission (n.d.) in June 2011<br />
identified hospital readmissions as a critical area to be addressed.<br />
Hospital readmission is defined as a repeated hospitalization<br />
within a defined period of time. CMS defines a readmission as a<br />
hospitalization occurring within 30 days of discharge. This includes<br />
readmissions to any hospital, not just the hospital at which the<br />
patient was originally hospitalized (Boccuti & Casillas, 2015).<br />
CMS spends an estimated $26 billion annually on hospital<br />
readmissions for Medicare recipients (Rau, 2014). Of those<br />
readmissions costs, about $17 billion has been identified as<br />
preventable, stemming largely from substandard care, including<br />
poor resolution of the cause for hospitalization and inadequate<br />
post-discharge care (Benbassat, 2000).<br />
CMS began measuring and reporting the incidence of hospital<br />
readmissions for particular medical conditions in 2007. In an<br />
effort to create transparency, this information is available on the<br />
Hospital Compare website (www.medicare.gov/hospitalcompare).<br />
CMS reports each hospital readmission rate compared with<br />
hospitals nationally to determine each hospital’s Excess Readmissions<br />
Ratios for specific medical conditions. Hospitals with<br />
readmission ratios above the national average are issued financial<br />
penalties of between 0.01% and 3% of total revenue (CMS,<br />
2014a). Currently, CMS measures readmission rates related to<br />
the following medical conditions: acute myocardial infarction,<br />
chronic obstructive pulmonary disease, heart failure, pneumonia,<br />
total hip arthroplasty, and total knee arthropasty, with coronary<br />
artery bypass graft surgery to be added to this list next year (CMS,<br />
2014b). Because CMS reimburses hospitals using 3-year performance<br />
periods, Excess Readmission Ratios have a long-lasting<br />
financial effect on the organization. This has resulted in hospitals<br />
becoming highly focused on reducing these ratios by ensuring<br />
discharges are effective in returning patients home and keeping<br />
them there. Although measuring readmission rates is new, it has<br />
already shown to have had a significant impact. The hospital<br />
readmission rate dropped from 19.6% to 18.4% within 30 days of<br />
discharge in 2012 after the penalties started (Dharmarajan et al.,<br />
2013), translating to significant cost reductions.<br />
Although limited, available research provides strong evidence<br />
to support several methods to reduce admission rates. These<br />
include conducting patient needs assessments, performing<br />
AUGUST 2016 l OT PRACTICE, 21(15)<br />
ARTICLE CODE CEA0816<br />
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CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).<br />
medication reconciliation, providing patient education, arranging<br />
timely outpatient appointments, and providing telephone<br />
follow-up (Kripalani, Theobald, Anctil, & Vasilevskis, 2014).<br />
No single intervention alone reduced hospital readmissions<br />
within 30 days of discharge (Hansen, Young, Hinami, Leung,<br />
& Williams, 2011). Hoyer et al. (2014) found that patients with<br />
higher functional status at the time of hospital discharge have<br />
lower readmission rates than patients with more functional<br />
impairments. Thus, improving functional status during hospitalizations<br />
is thought to be an important strategy for lowering<br />
readmission rates. It is expected that our knowledge of the<br />
factors contributing to unplanned hospital readmissions will<br />
continue to expand rapidly in the coming years.<br />
It is essential that occupational therapy practitioners understand<br />
the impact occupational therapy services can have on<br />
hospital readmissions and be prepared to provide these needed<br />
services. Occupational therapy practitioners need to be a vital<br />
part of the discharge planning team, at all phases of a client’s<br />
hospital stay and transition back into the community. They<br />
have an opportunity to add value in discharge planning, fall<br />
prevention, home modifications, medication management, and<br />
assistive technology (AT) to reduce hospital readmissions.<br />
ROLE OF OT IN CARE COORDINATION AND DISCHARGE PLANNING<br />
Discharge planning is a process in which patients’ needs are<br />
identified and a plan is formed for a smooth transfer from one<br />
environment to another (CMS, 2014a). Occupational therapy<br />
practitioners provide a unique perspective on their clients’<br />
functional abilities, which, in conjunction with medical considerations,<br />
influences the determination of the appropriate<br />
living arrangement after discharge. In addition, occupational<br />
therapy practitioners possess a broad skillset that is beneficial<br />
in identifying and coordinating individuals’ needs to ensure full<br />
participation in desired activities and roles.<br />
Having worked with the individual throughout his or her<br />
stay to increase functional abilities needed for day-to-day living,<br />
occupational therapy practitioners offer the most comprehensive<br />
insight about the individual’s functional abilities relative to<br />
his or her baseline level of function. When there is a change in<br />
functional status from baseline, occupational therapists are able<br />
to provide recommendations regarding how activities should be<br />
modified to eliminate activity barriers, and what level and type of<br />
assistance their clients need to complete daily activities safely.<br />
Occupational therapy practitioners collaborate closely with<br />
other health care team professionals, such as case managers,<br />
nurses, physical therapists, speech-language pathologists, and<br />
physicians, to create an interdisciplinary plan of care and a coordinated<br />
and appropriate discharge plan. The American Occupational<br />
Therapy Association (AOTA) has consistently shown<br />
support for increased involvement of occupational therapy in<br />
the discharge planning process. In November 2015, CMS proposed<br />
revisions to requirements for discharge planning in acute<br />
care hospitals, long-term care hospitals, inpatient rehabilitation<br />
facilities, critical access hospitals, and home health agencies.<br />
The intention of the proposed revisions was to allow patients<br />
and their families’ access to information that helps them make<br />
informed decisions about their post-acute care. In January 2016,<br />
AOTA submitted comments to the proposed revisions requesting<br />
that an occupational therapist be listed as part of the discharge<br />
planning team needed to perform discharge assessment<br />
and planning (Bogenrief, 2016). This was on the grounds that<br />
occupational therapists assess, treat, and consider discharge and<br />
transitions as part of the evaluation of a client’s functional and<br />
cognitive status on an ongoing basis. AOTA strongly supports<br />
the involvement of patients in determining their goals of care<br />
and discharge planning, as well as taking into account realistic<br />
caregiver support after discharge.<br />
Recent research points to the need for greater emphasis<br />
on functional and environmental factors during the discharge<br />
planning process. Changes in functional abilities place increased<br />
demands on the patient’s ability to participate in pre-hospitalization<br />
roles, and are cited as a factor contributing to preventable<br />
rehospitalization. For example, Tao, Ellenbecker, Chen,<br />
Zhan, and Dalton (2012) reported that the extent of self-care<br />
deficit was positively associated with risk of rehospitalization,<br />
and others have identified caregiver burden as a predictor of<br />
hospital readmission (Bonin-Guillaume et al., 2015; DePalma<br />
et al., 2012). DePalma et al. (2012) also reported that returning<br />
to the community from a recent hospitalization with unmet<br />
activities of daily living (ADLs) was associated with a higher<br />
probability of readmission. These findings suggest that an early<br />
identification of individuals in need of additional support, and<br />
coordination of necessary services, may prevent unnecessary<br />
re-hospitalization. Occupational therapy practitioners are well<br />
positioned to be an asset in this realm through offering their<br />
professional expertise in (1) analyzing pre-hospitalization roles<br />
and their clients’ likelihood of resuming them; (2) identifying<br />
the need for adaptive equipment and caregiver assistance; and<br />
(3) identifying and coordinating community needs in mobility,<br />
activity participation, and more. After the needs are delineated,<br />
occupational therapists can coordinate training sessions with<br />
family caregivers to ensure that the needs will be adequately<br />
met. In collaboration with social workers and case managers,<br />
occupational therapy practitioners can identify community<br />
resources, such as additional funds for home modifications<br />
and AT, transportation services, and support groups, to extend<br />
support services available.<br />
ROLE OF OT IN FALL PREVENTION<br />
Fall prevention is an important aspect of the discharge planning<br />
process, as it can reduce hospital readmission and increased<br />
disability. The rate of falls following discharge from a medical<br />
hospitalization are as high as 40%, and up to 15% of those who<br />
fall require re-admission to a hospital (Hill, 2011; Mahoney,<br />
2000). In addition, 20% of older adults presenting to the emergency<br />
room for a fall have had one or more hospitalizations in<br />
CE-2 ARTICLE CODE CEA0816<br />
AUGUST 2016 l OT PRACTICE, 21(15)
Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.<br />
the previous year (Close et al., 2012). Falls can have a range of<br />
negative effects on older adults including injury, activity restriction,<br />
institutionalization, and death. Because of the increased<br />
risk of falls after hospitalization and the potential for a fall to<br />
cause readmissions, fall prevention is an important area for<br />
occupational therapy to address in discharge planning.<br />
Falls are often preventable, with proven strategies to reduce<br />
older adult fall risk. Effective fall prevention programs include<br />
evidence-based practice of occupational therapy, durable medical<br />
equipment (e.g., home modifications), and referral to community<br />
programs (AOTA, 2010). Occupational therapists are distinctly<br />
skilled to assess the person and environment. Occupational<br />
therapists should identify personal limitations and environmental<br />
hazards that have the potential to cause falls and make subsequent<br />
recommendations for a combination of fall prevention<br />
interventions. Fall risk factors that occupational therapists may<br />
assess include lower-extremity weakness, impaired balance,<br />
cognitive impairment, incontinence, sensory impairment, fear<br />
of falling, medication adherence, and environmental hazards<br />
(AOTA, 2012). In addition to risk factors that put all older adults<br />
at risk for a fall, identifiable risk factors that are present in older<br />
adults at high risk for a fall post discharge include dependence<br />
in one or more ADLs before hospitalization, a history of falls,<br />
preexisting mobility impairments, and prior hospitalizations<br />
(Mahoney, 2000). Occupational therapy is well positioned to<br />
identify patients with fall risk factors and implement or assist<br />
with care coordination for recommended interventions.<br />
A recent systematic review conducted in conjunction with<br />
AOTA’s Evidence-Based <strong>Practice</strong> Project found home modification<br />
interventions are effective for high-risk older adults when<br />
high-quality interventions are implemented by an occupational<br />
therapist (Clemson, Mackenzie, Ballinger, Close, & Cumming,<br />
2008). High-quality interventions include evaluating person<br />
and environment factors, using a valid fall hazard assessment<br />
tool, evaluating functional capacity within the home environment,<br />
and following up for modifications/adaptations. Interventions<br />
must include at least three of the four criteria to be<br />
considered high quality (Clemson et al., 2008). When implementing<br />
home modification programs for fall prevention, it is<br />
important for occupational therapy practitioners to ensure that<br />
they provide effective, high-quality, evidenced-based interventions.<br />
Home assessments pre-discharge from a rehabilitation<br />
hospital reduced falls within the first month post discharge for<br />
cardiac, spinal, deconditioned, and orthopedic trauma patients,<br />
indicating that these may be target populations to reduce fall<br />
readmissions (Johnston, Barras, & Grimmer-Somers, 2010).<br />
Another review found strong evidence for multifactorial programs,<br />
including home evaluations, physical activity or exercise,<br />
education, vision and medication checks, and AT (Chase, Mann,<br />
Wasek, & Arbesman, 2012). The most successful fall prevention<br />
interventions use a multifaceted approach. Recommended exercise<br />
programs include Tai Chi, for better balance (Wolf et al.,<br />
1996); Matter of Balance (Tennstedt et al., 1998); Otago Exercise<br />
Program (Robertson, Campbell, Gardner, & Devlin, 2002);<br />
and Stepping On (Clemson et al., 2004). Occupational therapy<br />
practitioners may also work with nonprofit organizations or<br />
government agencies to implement fall prevention initiatives<br />
within the community (AOTA, 2012).<br />
ROLE OF OT IN MEDICATION MANAGEMENT<br />
Medication management has been identified as one way to help<br />
reduce hospital readmissions. Research indicates that as many<br />
as 50% of patients do not adhere to medication routines (Lee,<br />
Grace, & Taylor, 2006) and 30% of patients failed to fill new<br />
prescriptions (Fischer et al., 2010). Medication non-adherence<br />
is primarily the result of patients forgetting to take their medication<br />
or choosing not to because of unpleasant adverse effects<br />
or their view that the medication is not necessary (Hughes,<br />
2004). Between 23% and 40% of persons in a nursing home are<br />
admitted due to medication non-adherence (Pan, Chernew, &<br />
Fendrick, 2008; Strandberg, 1984).<br />
Factors in medication management include the patient’s or<br />
caregiver’s knowledge of the medications needed, the reason(s)<br />
for medication, the medication’s side effects, access to medication,<br />
and ability to administer it. Many different health care<br />
practitioners can provide education to increase adherence to<br />
medication routines; however, occupational therapists have the<br />
ability to identify the problems that individuals have in correctly<br />
adhering to their medication routine. In addition, occupational<br />
therapists and occupational therapy assistants have the skills<br />
and knowledge to help clients integrate medication administration<br />
into their daily routine effectively, thus increasing medication<br />
administration accuracy and compliance. Occupational<br />
therapist and occupational therapy assistants have the skills to<br />
help clients learn to manage taking medications and the impact<br />
of side effects on their daily activities to increase performance<br />
and safety.<br />
Often, patients are prescribed new medications or medication<br />
instructions change when they are hospitalized. Occupational<br />
therapists are able to review medication information<br />
sheets with their clients and evaluate their ability to understand<br />
and use this information. Practitioners can then help clients<br />
understand medication instructions and incorporate them into<br />
their daily routines and habits. For example, diuretics prescribed<br />
to manage congestive heart failure can cause patients to need<br />
to use the bathroom more frequently. The occupational therapy<br />
practitioner can discuss timed voiding, simplified clothing<br />
fasteners, and mobility issues related to accessing the bathroom,<br />
especially away from home, and other strategies to manage or<br />
avoid incontinence, and this in turn should increase the client’s<br />
compliance with taking the medication as directed (AOTA Legislative<br />
Affairs and State Regulatory Affairs, 2016).<br />
“The OT role in medication management can include:<br />
• Recording medication dosages and routes per agency policy<br />
when required as part of an assessment<br />
AUGUST 2016 l OT PRACTICE, 21(15)<br />
ARTICLE CODE CEA0816<br />
CE-3
Continuing Education Article<br />
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).<br />
• [Referring clients] back to their pharmacy/doctor or<br />
referral to nursing if the patient needs to be taught specific<br />
information about a medication that is not provided on<br />
written instructions<br />
• [Ensuring] that patients know how to take their medications<br />
and are in fact taking them as directed. If not, the OT<br />
can explore reasons why they are not being taken or are<br />
taken incorrectly.<br />
• [Identifying], through the assessment process, when the<br />
patient takes medications within their daily routine and<br />
when there have been disruptions to that routine that<br />
interfere.<br />
• Identifying habits and routines that have worked to support<br />
appropriate medication management for the patient in the<br />
past. How can we work with them vs. changing them?<br />
• [Assessing] medication management as part of the patient’s<br />
overall ADLs so tasks can be accomplished timely, allowing<br />
for medications to be taken within the prescribed time<br />
frame relative to food, blood sugar, etc.<br />
• [Considering] how OT skills and knowledge around energy<br />
conservation techniques can assist with managing all<br />
ADLs.”<br />
(AOTA Legislative Affairs and State Regulatory Affairs, 2016)<br />
Given that medication non-adherence is a significant risk<br />
factor for hospital readmissions, it is essential that practitioners<br />
understand their potential role and initiate providing these<br />
needed and valued services.<br />
ROLE OF OT IN ACQUISITION OF AT<br />
AT is frequently part of an effective discharge plan, as it<br />
facilitates functional performance and minimizes barriers to<br />
function. However, for provision of AT to be an effective part<br />
of reducing hospital readmissions, individuals must be receptive<br />
to and actually benefit from the AT.<br />
“Despite their utility, a high proportion of assistive technology<br />
users abandon their device for reasons relating to<br />
unmet expectations of the device, difficulty of use, lack<br />
of social support or inappropriate instruction. Adopting<br />
an assistive technology device that meets the needs of the<br />
individual requires collaboration between the assessors,<br />
the client and their family/caregiver, and the service provider.”<br />
(Harris, Rosenwax, Hunter, & Andrews, 2014)<br />
Therefore, it is crucial that recommendations for AT are<br />
based on a skilled assessment of fit between the individual’s<br />
needs and features offered by the equipment (Stark, Somerville,<br />
Keglovits, Smason, & Bigham, 2015). Occupational therapy<br />
practitioners’ understanding of occupational needs and performance,<br />
coupled with their skills in activity analysis and focus<br />
on achieving client goals, are indispensable to the AT provision<br />
process (AOTA, 2015a). Occupational therapy practitioners can<br />
provide a broad range of services in the process of AT provision,<br />
including evaluation, recommendation, justification of need,<br />
advocacy, awareness of funding resources, fabrication, customization,<br />
training, and follow up (AOTA, 2015b).<br />
Occupational therapy practitioners also recognize that<br />
recommendation is only the first step of the extensive AT<br />
provision process. Recommendations of AT must be followed<br />
by identifying sources of funding, as well as providing support<br />
to acquire the equipment and training for correct use. Often,<br />
the individuals’ needs and desires for AT and durable medical<br />
equipment are not sufficiently met with federal and private<br />
insurance alone. Thus, community resources, such as diseaseand/or<br />
injury-focused nonprofit organizations, area agencies<br />
on aging, and Medicaid Waiver Programs, may serve as critical<br />
sources of support for obtaining a needed piece of equipment.<br />
Practitioners may also collaborate with individuals to leverage<br />
their existing relationships with local organizations to obtain<br />
additional sources of support.<br />
ROLE OF OT HOME ASSESSMENT AND MODIFICATION<br />
Home assessment and modification are essential to the discharge<br />
planning process, as they can directly impact individuals’<br />
ability to participate safely in ADLs and instrumental ADLs<br />
(IADLs) in their home and enable older adults to age in place.<br />
The role of the occupational therapist is to assess occupational<br />
performance in an individual’s home to gain a better understanding<br />
of his or her to complete desired activities there.<br />
Through the assessment process, the occupational therapist can<br />
identify environmental barriers that prevent the individual from<br />
engaging in activities. This is especially important prior to discharge,<br />
because an individual’s abilities may have changed and<br />
he or she may need additional supports at home to live independently.<br />
This assessment process provides the occupational<br />
therapist with the opportunity to identify and address any safety<br />
issues in the home prior to discharge that could lead to a fall<br />
and result in readmission, and help determine whether a person<br />
should be discharged home.<br />
In addition to an in-home assessment, the occupational<br />
therapist can make recommendations for home modifications,<br />
such as adding grab bars, ramps, lifts, railings, shower<br />
chairs, and other adaptive equipment, as well as removing<br />
environmental barriers, such as clutter, throw rugs, or cords<br />
across pathways, which could contribute to a fall and hospital<br />
readmission. An occupational therapy practitioner can also<br />
assist the individual in obtaining the equipment, through a<br />
local durable medical equipment vendor or a health equipment<br />
lending program; coordinate with local contractors to<br />
install architectural modifications as needed; and follow up<br />
to provide necessary training to ensure that the recommendations<br />
meet the needs of the individual. Home assessment and<br />
modification help ensure that an individual’s home is safe and<br />
provides appropriate support for the individual to engage in<br />
activities after they are discharged, while reducing their risk<br />
of readmission.<br />
CE-4 ARTICLE CODE CEA0816<br />
AUGUST 2016 l OT PRACTICE, 21(15)
Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See page CE-7 for details.<br />
ROLE OF OT IN COMMUNITY RE-INTEGRATION<br />
Reintegration into previous roles and activities in the community<br />
is another important part of a successful discharge after an<br />
inpatient stay. Participation, or involvement in a life situation,<br />
can often look different and potentially be more challenging<br />
after an injury or illness. Additionally, after an inpatient stay,<br />
individuals often wait to continue to make gains in rehabilitation<br />
and return to their baseline functioning before feeling like<br />
they can assume previous roles in the community. As a result,<br />
many individuals never become fully reintegrated back into<br />
their community. However, because of occupational therapy’s<br />
focus on participation, we are well suited to address community<br />
reintegration. This begins with using performance-based<br />
assessments with occupational histories, instead of relying<br />
solely on assessments that measure only basic ADLs (Wolf,<br />
Baum, & Connor, 2009). Occupational therapy practitioners in<br />
inpatient settings need to take all of these factors into consideration<br />
to make appropriate recommendations for additional<br />
therapy after discharge. Community reintegration is likely to<br />
occur in free-standing community reintegration programs (e.g.,<br />
vocational rehabilitation), home health, outpatient therapy, or<br />
private practice. Thus, occupational therapy practitioners have<br />
the ability and the responsibility to advocate for appropriate services<br />
for their clients on discharge to receive the services they<br />
need, beyond basic ADLs.<br />
Occupational therapy practitioners are qualified to play a<br />
vital role in connecting patients to needed community resources<br />
necessary for both community re-integration and discharge<br />
planning to reduce hospital readmissions. The role of the occupational<br />
therapist is to identify and access the needed community-based<br />
resources, which can include AT, medical equipment<br />
covered and not covered under insurance, services (including<br />
homemaking or personal care attendants), home modifications,<br />
and support groups. Completing a detailed occupational profile<br />
can aid occupational therapists in identifying potential community<br />
supports and resources available to client, or simply to<br />
encourage them to use the resources available. For example, a<br />
therapist could help a client with Parkinson’s disease access a<br />
local chapter of the American Parkinson Disease Association’s<br />
adaptive equipment loaner closet to get a portable ramp or adaptive<br />
utensils. In addition, the occupational therapy practitioner<br />
can recommend that a client pursue a local grant for home<br />
modifications to get needed grab bars for the shower. Perhaps<br />
the individual just had a life-altering injury and now needs to<br />
be connected to a support group, or the spouse needs to be<br />
connected with respite care to allow for optimal occupational<br />
performance. By accessing these needed resources, occupational<br />
therapy practitioners can help ensure that clients get what they<br />
need in a timely manner to help reduce readmissions. Therefore,<br />
it is important that practitioners, in all care settings, are<br />
aware of the resources available to the clients they serve outside<br />
of the basic medical equipment provided by Medicare or other<br />
medical insurance providers.<br />
CASE EXAMPLE<br />
Mr. Xavier was a 68-year-old male who was readmitted to City<br />
Hospital 20 days after his initial hospital admission because<br />
of complications of stroke. Mr. Xavier was initially discharged<br />
home with orders for a home health care agency to provide<br />
nurse visits for medication preparation once a week, and a<br />
home health aide to visit twice day for ADL and IADL assistance.<br />
However, Mr. Xavier was readmitted to the hospital after<br />
sustaining a left humerus fracture after falling when attempting<br />
a toilet transfer by himself.<br />
City Hospital, following the lead of top-performing institutions<br />
recognized for their clinical performance and dedication<br />
to patient-focused care, wished to consider areas in which the<br />
initial plan of care could have addressed to avoid Mr. Xavier’s<br />
return to the hospital. During Mr. Xavier’s second stay, the<br />
leadership team performed an in-depth analysis of their performance,<br />
and sought to address these points in their plan of care.<br />
On evaluation and conversation with Mr. Xavier, the team<br />
found out:<br />
• Home health RN prepared medications, but Mr. Xavier<br />
was responsible for taking them correctly and on time. The<br />
team learned that Mr. Xavier could not independently open<br />
his pill bottles after his stroke because of weakness and<br />
impairment in coordination in his affected hand. He had<br />
not received any further therapy to address this decreased<br />
ability to use his hand or to address his difficulty taking his<br />
medication correctly on a daily basis.<br />
• Mr. Xavier did not receive any rehabilitation after discharge,<br />
as he was able to complete his basic ADLs independently<br />
in the hospital. In addition, he did not have<br />
reliable transportation and had not attempted to drive after<br />
his stroke, so even when outpatient therapy was initially<br />
discussed, he was hesitant to agree as he did not think he<br />
had a reliable way to get to therapy.<br />
• Side effects of Mr. Xavier’s new medication post stroke<br />
included drowsiness and increased need to urinate.<br />
Although Mr. Xavier had been verbally educated on these<br />
side effects, he did not remember, as he received numerous<br />
instructions on discharges. The connection between the<br />
side effects and Mr. Xavier’s decreased independence with<br />
toilet transfer at home was not addressed in the home, as<br />
he did not receive any occupational therapy in the home<br />
post discharge. Mr. Xavier tried to wait to use the toilet<br />
only when the aide was present to help with transfers, but<br />
that proved to not be very feasible. Instead, he chose to<br />
limit his water intake, which created a risk of dehydration.<br />
• As a result of the physical changes he experienced from his<br />
stroke, his fear of falling during daily activities increased<br />
significantly. Thus, he severely restricted his activities in<br />
the home, including limiting his meal preparation, getting<br />
dressed on his own, grooming, and getting his mail. He was<br />
too embarrassed to let his daughter know about his significant<br />
decrease in change in activity.<br />
AUGUST 2016 l OT PRACTICE, 21(15)<br />
ARTICLE CODE CEA0816<br />
CE-5
Continuing Education Article<br />
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).<br />
• Mr. Xavier needed grab bars installed and a railing on his<br />
steps going to his upstairs. He also had other needs outside<br />
of Medicare-reimbursed AT, which was not adequately<br />
addressing his needs. Mr. Xavier had not been educated on<br />
alternative sources.<br />
As a result, the plan of care for Mr. Xavier’s second stay<br />
included the following:<br />
• Intensive fall prevention education/training from his<br />
inpatient occupational therapist. He was also referred to a<br />
community-based exercise program, which provided transportation<br />
to and from the exercise class.<br />
• An in-home assessment completed with Mr. Xavier before<br />
he was discharged from the hospital. During this visit, the<br />
occupational therapist identified environmental barriers<br />
to performance in the home and also noted fall hazards.<br />
The therapist made recommendations for appropriate<br />
home modifications (e.g., she marked the correct installation<br />
location for grab bars) and was able to organize the<br />
completion of the home modifications through volunteers<br />
at Mr. Xavier’s church.<br />
• Based on the in-home evaluation, the occupational therapist<br />
also made recommendations for appropriate adaptive<br />
equipment and was able to obtain the equipment for Mr.<br />
Xavier through a local health equipment reutilization<br />
program.<br />
• While on the home visit, the occupational therapist and<br />
Mr. Xavier discussed the basics of his medication management<br />
routine and identified potential barriers to the routine.<br />
During the remainder of Mr. Xavier’s inpatient stay,<br />
the therapist worked with nursing to help Mr. Xavier incorporate<br />
his new medication schedule into his daily routine.<br />
Additionally, the occupational therapist recommended that<br />
Mr. Xavier’s medications be provided in packages he could<br />
open with one hand.<br />
• Mr. Xavier was educated on his increased need for social<br />
support. Afterward, he agreed to contact a family member<br />
to ask for help, as well as establish a local contact to<br />
provide help. A conference was organized with the family<br />
member and local friend, for which a registered nurse,<br />
social worker, occupational therapist, and physical therapist<br />
were present.<br />
• The recommendation for increased level of rehabilitation<br />
on discharge included outpatient occupational and physical<br />
therapy.<br />
CONCLUSION<br />
The implementation of the Affordable Care Act led to the<br />
CMS mandate to reduce costly unplanned hospital readmissions.<br />
As a result, hospitals are actively seeking solutions to<br />
reduce readmissions, which now have financial penalties. This<br />
provides occupational therapy professionals the opportunity to<br />
demonstrate their expertise and knowledge in helping reduce<br />
readmissions. The role of occupational therapy in reduction<br />
can include care coordination, fall prevention, medication<br />
management, assistive technology acquisition, and community<br />
re-integration.<br />
REFERENCES<br />
American Occupational Therapy Association. (2004). Assistive technology within<br />
occupational therapy practice (2004). American Journal of Occupational<br />
Therapy, 58, 678–680. http://dx.doi.org/10.5014/ajot.58.6.678<br />
American Occupational Therapy Association. (2010). Specialized knowledge<br />
and skills in technology and environmental interventions for occupational<br />
therapy practice. American Journal of Occupational Therapy, 64, 44–56. http://<br />
dx.doi.org/10.5014/ajot.2010.64S44<br />
American Occupational Therapy Association. (2012). Fact sheet: Occupational<br />
therapy and the prevention of falls. Retrieved from http://www.aota.org/<br />
About-Occupational-Therapy/Professionals/PA/Facts/Fall-Prevention.aspx<br />
American Occupational Therapy Association. (2015a). The role of occupational<br />
therapy in providing assistive technology devices and services. Retrieved from<br />
http://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/AT-fact-sheet.pdf<br />
American Occupational Therapy Association. (2015b). The role of occupational<br />
therapy in providing assistive technoloy devices and services. Retrieved from<br />
http://www.aota.org/-/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/AT-fact-sheet.pdf<br />
Benbassat, J. (2000). Hospital Readmissions as a measure of quality of health<br />
care advantages and limitations. Archives of Internal Medicine, 160, 1074–<br />
1081. http://dx.doi.org/10.1001/archinte.160.8.1074<br />
Boccuti, C., & Casillas, G. (2015). Aiming for fewer hospital U-turns: The Medicare<br />
Hospital Readmission Reduction Program. Retrieved from http://slcsuperiorhomecare.com/wp-content/uploads/2015/06/Kaiser-Readmission-paper.pdf<br />
Bogenrief, J. (2016, January 4). Re: Medicare and Medicaid programs; Revisions<br />
to requirements for discharge planning for hospitals, critical access hospitals, and<br />
home health agencies [CMS–3317–P] [Letter to Andrew M. Slavitt]. http://<br />
www.aota.org/-/media/corporate/files/advocacy/reimb/news/archives/<br />
archived-letters/aota%20discharge%20planning%20comments%20cms-<br />
3317-p.pdf<br />
Bonin-Guillaume, S., Durand, A., Yahi, F., Curiel-Berruyer, M., Lacroix, O.,<br />
Cretel, E., … Gentile, S. (2015). Predictive factors for early unplanned<br />
rehospitalization of older adults after an ED visit: Role of the caregiver<br />
burden. Aging Clinical and Experimental Research, 27, 883–891. http://dx.doi.<br />
org/10.1007/s40520-015-0347-y<br />
Centers for Medicare & Medicaid Services. (2014a). Discharge planning.<br />
Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Discharge-Planning-Booklet-ICN908184.pdf<br />
Centers for Medicare & Medicaid Services. (2014b). Hospital Readmission Reduction<br />
Program (HRRP): Fiscal year (FY) 2015 fact sheet. Retrieved from https://<br />
www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/<br />
Value-Based-Programs/HRRP/HRRP-2015-Fact-Sheet-.pdf<br />
Chase, C. A., Mann, K., Wasek, S., & Arbesman, M. (2012). Systematic review of<br />
the effect of home modification and fall prevention programs on falls and the<br />
performance of community-dwelling older adults. American Journal of Occupational<br />
Therapy, 66, 284–291. http://dx.doi.org/10.5014/ajot.2012.005017<br />
Clemson, L., Cumming, R. G., Kendig, H., Swann, M., Heard, R., & Taylor,<br />
K. (2004). The effectiveness of a community-based program for reducing<br />
the incidence of falls in the elderly: A randomized trial. Journal of the<br />
American Geriatrics Society, 52, 1487–1494. http://dx.doi.org/10.1111/j.1532-<br />
5415.2004.52411.x<br />
Clemson, L., Mackenzie, L., Ballinger, C., Close, J. C., & Cumming, R. G.<br />
(2008). Environmental interventions to prevent falls in community-dwelling<br />
older people: A meta-analysis of randomized trials. Journal of Aging and<br />
Health, 20, 954–971. http://dx.doi.org/10.1177/0898264308324672<br />
CE-6 ARTICLE CODE CEA0816<br />
AUGUST 2016 l OT PRACTICE, 21(15)
Earn .1 AOTA CEU (one contact hour and 1.25 NBCOT PDU). See below for details.<br />
Close, J. C. T., Lord, S. R., Antonova, E. J., Martin, M., Lensberg, B., Taylor,<br />
M., ... Kelly, A. (2012). Older people presenting to the emergency<br />
department after a fall: a population with substantial recurrent healthcare<br />
use. Emergency Medicine Journal, 29, 742–747. http://dx.doi.org/10.1136/<br />
emermed-2011-200380<br />
Dharmarajan, K., Hsieh, A. F., Lin, Z., Bueno, H., Ross, J. S., Horwitz, L. I., …<br />
Krumholz, H. M.. (2013). Diagnoses and timing of 30-day readmissions after<br />
hospitalization for heart failure, acute myocardial infarction, or pneumonia.<br />
Journal of the American Medical Association, 309, 355–363. http://dx.doi.<br />
org/10.1001/jama.2012.216476<br />
DePalma, G., Huiping, X., Covinsky, K. E., Craig, B. A., Stallard, E., Thomas III,<br />
J., & Sands, L. P. (2012). Hospital readmission among older adults who return<br />
home with unmet need for ADL disability. The Gerontologist, 52, 454–461.<br />
http://doi.org/10.1093/geront/gns103<br />
Fischer, M. A., Stedman, M. R., Lii, J., Vogeli, C., Brookhart, M. A., & Weissman,<br />
J. S. (2010). Primary medication non-adherence: Analysis of 195,930<br />
electronic prescriptions. Journal of General Internal Medicine, 25, 284–290.<br />
http://dx.doi.org/10.1007/s11606-010-1253-9<br />
Hansen, L. O., Young, R. S., Hinami, K., Leung, A., & Williams, M. V. (2011).<br />
Interventions to reduce 30-day rehospitalization: A systematic review. Annals<br />
of Internal Medicine, 155, 520–528. http://dx.doi.org/10.7326/0003-4819-155-<br />
8-201110180-00008<br />
Hill, A.-M., Hoffman, T., McPail, S., Beer, C., Hill, K. D., Oliver, D., … Haines,<br />
T. P. (2011). Evaluation of the sustained effect of inpatient falls prevention<br />
education and predictors of falls after hospitalization-follow-up to a randomized<br />
controlled trial. Journals of Gerontology, Series A: Biological Sciences, 66,<br />
1101–1012. http://dx.doi.org/10.1093/gerona/glr085<br />
Harris, C., Rosenwax, L., Hunter, S., & Andrews, A (2014). An evaluation of<br />
assistive technology outcomes for home and community care clients (HACC) of the<br />
Independent Living Center (ILC) Assistive Technology Service. Retrieved from<br />
http://ilc.com.au/wp-content/uploads/2014/05/ILC-Project-CONSUMER-Final-Report-130314.pdf<br />
Hoyer, E. H., Needham, D. M., Atanelov, L., Knox, B., Friedman, M., &<br />
Brotman, D. J. (2014) Association of impaired functional status at hospital<br />
discharge and subsequent rehospitalization, Journal of Hospital Medicine, 9,<br />
277–282. http://dx.doi.org/10.1002/jhm.2152<br />
Hughes, C. M. (2004). Medication non-adherence in the elderly: How big is the<br />
problem?<br />
Drugs & Aging, 21, 793–811.<br />
Johnston, K., Barras, S., & Grimmer-Somers, K. (2010). Relationship between<br />
pre-discharge occupational therapy home assessment and prevalence of<br />
post-discharge falls. Journal of Evaluation in Clinical <strong>Practice</strong>, 16, 1333–1339.<br />
http://dx.doi.org/10.1111/j.1365-2753.2009.01339.x<br />
Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing<br />
readmission rates: Current strategies and future directions. Annual<br />
Review of Medicine, 65, 471–485. http://dx.doi.org/10.1146/annurevmed-022613-090415<br />
Lee J. K., Grace K. A., & Taylor A. J. (2006). Effect of a pharmacy care program<br />
on medication adherence and persistence, blood pressure, and low-density<br />
lipoprotein cholesterol: A randomized controlled trial. Journal of the American<br />
Medical Association, 296, 2563–2571. http://dx.doi.org/10.1001/jama.296.21.<br />
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Medicare’s technical assistance to and oversight of providers—June 2011 recommendations.<br />
Retrieved from http://www.medpac.gov/documents/Jun11_RecommendationsSheet.pdf<br />
Medicare and Medicaid Programs; Revisions to Requirements for Discharge<br />
Planning for Hospitals, Critical Access Hospitals, and Home Health Agencies;<br />
Proposed Rules, 42 C.F.R. §§ 82, 484, 485 (2015).<br />
Pan, F., Chernew, M., & Fendrick, A. M. (2008). Impact of fixed-dose combination<br />
drugs on adherence to prescription medications. Journal of General<br />
Internal Medicine, 25, 611–614.<br />
Patient Protection and Affordable Care Act, Pub. L. No. 111–148, 42 U.S.C. §§<br />
18001-18121 (2010).<br />
How to Apply for<br />
Continuing Education Credit<br />
A. To get pricing information and to register to take the exam online<br />
for the article The Role of Occupational Therapy in Reducing<br />
Hospital Readmissions, go to www.aota.org/cea, or call toll-free<br />
877- 404-2682.<br />
B. Once registration is paid, you will receive instant email confirmation<br />
with password and access information to take the exam<br />
online immediately or at a later time.<br />
C. Answer the questions to the final exam found on page CE-8 by<br />
August 31, 2018.<br />
D. On successful completion of the exam (a score of 75% or more),<br />
you will immediately receive your printable certificate.<br />
Phillips, B., & Zhao, H. (1993). Predictors of assistive technology abandonment.<br />
Assistive Technology, 5(1), 36–45. http://dx.doi.org/10.1080/10400435.1993.<br />
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News. Retrieved from http://khn.org/news/a-guide-to-medicare-readmissions-penalties-and-data/<br />
Robertson, M. C., Campbell, A. J., Gardner, M. M., & Devlin, N. (2002).<br />
Preventing injuries in older people by preventing falls: A meta-analysis of<br />
individual-level data. Journal of the American Geriatrics Society, 50, 905–911.<br />
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Shyu, Y., Chen, M., & Lee, H. (2004). Caregivers’ needs as predictors of hospital<br />
readmission for the elderly in Taiwan. Social Science & Medicine, 58,<br />
1395–1403. http://dx.doi.org/10.1016/S0277-9536(03)00334-4<br />
Stark, S., Somerville, E., Keglovits, M., Smason, A., & Bigham, K. (2015).<br />
Clinical reasoning guideline for home modification interventions.<br />
American Journal of Occupational Therapy, 69, 6902290030p6902290031–<br />
6902290030p6902290038. http://dx.doi.org/10.5014/ajot.2015.014266<br />
Strandberg, L. R. (1984). Drugs as a reason for nursing home admissions. Journal<br />
of the Health Care Assoction, 10, 20–23.<br />
Tao, H., Ellenbecker, C., Chen, J., Zhan, L., & Dalton, J. (2012). The influences<br />
of environmental factors on rehospitalization among patients receiving<br />
home health services. Advances in Nursing Science, 35, 346–358. http://dx.doi.<br />
org/10.1097/ANS.0b013e318271d2ad<br />
Tennstedt, S., Howland, J., Lachman, M., Peterson, E., Kasten, L., & Jette, A.<br />
(1998). A randomized, controlled trial of a group intervention to reduce<br />
fear of falling and associated activity restriction in older adults. The Journals<br />
of Gerontology Series B: Psychological Sciences and Social Sciences, 53B, P384–<br />
P392. http://dx.doi.org/10.1093/geronb/53B.6.P384<br />
Wolf, S. L., Barnhart, H. X., Kutner, N. G., McNeely, E., Coogler, C., & Xu, T.<br />
(1996). Reducing frailty and falls in older persons: an investigation of Tai Chi<br />
and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries:<br />
Cooperative Studies of Intervention Techniques. Journal of the American<br />
Geriatrics Society, 44, 489–497.<br />
Wolf, T. J., Baum, C., & Connor, L. T. (2009). Changing face of stroke: Implications<br />
for occupational therapy practice. American Journal of Occupational<br />
Therapy, 63, 621–625. http://dx.doi.org/10.5014/ajot.63.5.621<br />
AUGUST 2016 l OT PRACTICE, 21(15)<br />
ARTICLE CODE CEA0816<br />
CE-7
Continuing Education Article<br />
CE Article, exam, and certificate are also available ONLINE. Register at http://www.aota.org/cea or call toll-free 877-404-AOTA (2682).<br />
Final Exam<br />
Article Code CEA0816<br />
The Role of Occupational Therapy in Reducing Hospital<br />
Readmissions • August 22, 2016<br />
To receive CE credit, exam must be completed by<br />
August 31, 2018.<br />
Learning Level: Entry<br />
Target Audience: Occupational Therapists and Occupational Therapy<br />
Assistants<br />
Content Focus: Category 2: OT Process; Category 3: Professional Issues<br />
1. Which of the following medical conditions is not currently<br />
being measured by the Centers for Medicare &<br />
Medicaid Services and used in the Excess Readmission<br />
Ratios?<br />
A. Pneumonia<br />
B. Total hip arthroplasty<br />
C. Myocardial infarction<br />
D. Spinal cord injury<br />
2. Hospital readmissions began to decline in the first<br />
several months after mandated measuring went into<br />
effect in 2012.<br />
A. True<br />
B. False.<br />
3. The following strategy is within the scope of occupational<br />
therapy services.<br />
A. Recommending changing the timing of when a drug is<br />
taken<br />
B. Recommending different dosage amounts to clients<br />
C. Encouraging a client to increase dosage of pain<br />
medication<br />
D. Reviewing medication information sheets<br />
4. Evidence-based risk factors for hospital readmission<br />
includes which one of the following:<br />
A. Increased functional impairment<br />
B. Low social support<br />
C. Racial minority<br />
D. Low socioeconomic status<br />
5. Evidence-based fall prevention strategies does not<br />
include which of the following:<br />
A. Home assessment to identify fall hazard<br />
B. Home modifications and/or adaptive equipment<br />
C. Review of medication by pharmacist for interactions<br />
D. Home exercise program<br />
6. High quality fall prevention treatment does not include<br />
one of the following:<br />
A. In-home assessment<br />
B. Recommendation of adaptive equipment<br />
C. Home hazard checklist<br />
D. Training on home modifications<br />
7. When making recommendations for assistive technology<br />
(AT), occupational therapy practitioners should include<br />
one which of the following:<br />
A. Personal factors and environmental factors<br />
B. Standardized recommendations<br />
C. Environmental factors<br />
D. Referral to durable medical equipment provider for<br />
recommendations<br />
8. Occupational therapy has unique expertise to address the<br />
following areas in the discharge planning process except:<br />
A. Community mobility needs<br />
B. Identification of pre hospitalization roles<br />
C. In-home care coordination<br />
D. Training and/or modifications to address unmet activities<br />
of daily living needs<br />
9. Environmental barriers can be identified correctly<br />
through the following process:<br />
A. Interview the client while he or she is inpatient<br />
B. Conduct an in-home assessment with the client present<br />
prior to discharge<br />
C. Ask family members about how the home is set up<br />
D. Have the family member conduct a home hazard<br />
checklist<br />
10. All of the following practice areas are common settings<br />
during which community reintegration can be emphasized<br />
except:<br />
A. Home health<br />
B. Outpatient therapy<br />
C. Private practice<br />
D. School-based settings<br />
11. All the following are common reasons for non-use of<br />
assistive technology except<br />
A. Realistic expectations of the AT<br />
B. Difficulty using the AT<br />
C. Lack of social support<br />
D. Inappropriate AT instruction<br />
12. The role for occupational therapy practitioners is expected<br />
to expand over the next decade?<br />
A. True<br />
B. False<br />
CE-8 ARTICLE CODE CEA0816<br />
AUGUST 2016 l OT PRACTICE, 21(15)