Welcome to the Trump Rehabilitation Centre

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Welcome to theTrump Rehabilitation Centre

• The Search for a New Vision

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WANTED

• Head Occupational Therapist

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Overview

• Rehabilitation Center research institute
  current practices.
• Vision for future
• Holism client-centeredness.
• Research evidence based practice.
• Conclusion

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Current Practices

• Focus on clients individual occupational
  performance components.
• Ex. Lifting teapot off shelf.
• Research is not occupationally based.

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Vision

• Holistic approach to occupational therapy.
• Client-centered practice.
• Focus on research in occupation.
• Evidence based practice.

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Holistic Approach

• A person is a whole being mind, body spirit.
• Client-centered practice enables treatment of the
  whole person.
• Canadian Model of Occupational Performance
  accepted model in Canada.
• CAOT (1997).

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Canadian Model of Occupational Performance
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Benefits of Holistic Approach

• Comparative Study
• Buddenberg Schkade (1998).
• Rehab for hip fractures in elderly patients.
• Biomechanical versus Holistic Treatment.
• Results
• Holistic treatment ? greater improvement on
  client chosen tasks.

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Benefits of Holistic Approach

• Comparative Study
• Jackson Schkade (2000).
• Rehab for hip fractures in elderly patients.
• Biomechanical versus Holistic Treatment.
• Results
• Holistic treatment ? higher improvement rate.
• Holistic treatment ? greater client satisfaction.

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Benefits of Holistic Approach

• Case Study
• Capitulo Silverberg (2001).
• Mount Sinai Medical Center, New York.
• Provider-Centered ? Patient-Centered delivery
  model of care.
• Results of change
• Improved quality of care.
• Increased patient staff satisfaction.
• Decreased costs.

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Benefits of Client-Centered Approach

• Case Study
• Rebeiro (2000).
• Hospital mental health services.
• Not client-centered.
• Client raised issues
• Focus was on illness rather than individual.
• Lack of choice.
• Not part of decision making process.
• Lack of partnership in treatment.
• Decreased therapeutic value of occupation.

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Benefits of Client-Centered Approach

• Continuous Quality Care Improvement Model (CQI)
• McLaughlin Kaluzny (2000).
• Patient-centered care provides optimal services
  compared with site-centered.
• 1960s, 80s Patient-centered not EBP.
• 1980s, 90s EBP, but site-centered.
• Focus of Model
• Goals set by patient.
• Treat patient, not impairment.
• Practical in light of financial constraints.

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CQI Model

• Mass Customization
• Module A treatment component.
• Ex. Psychotherapy, splinting, etc.
• Client selects modules.
• Modular approach supported by EBP.
• Decreases need for later services.
• Assures long-term effect on quality of life.

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CQI Example Client Pathway
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Research on Occupation

• Occupational therapists will advance occupation
  and participation through utilization of
  research knowledge.
• Leadership Forum (2003).
• Evidence-based practice.

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Evidence Based Practice

• Evidence-based practice (EBP) encourages the
  integration of high quality quantitative and
  qualitative research, with the clinician's
  clinical expertise and the client's background,
  preferences and values to implement interventions
  that produced the desired outcome. "
• Sackett et al. (1996).

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Benefits of Research on Occupation

• Perspective
• Law (1998).
• Importance of evidence based practice
• Financial accountability.
• Maximize benefit for allowed cost.
• Fosters client-centered perspective.
• Ensures best practice.

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Benefits of Research on Occupation

• Perspective
• Dubouloz, Egan, Zweck, Vallerano (1998).
• Evidence Based Practice identifies clients most
  likely to benefit from services.

• Perspective
• Stewart (1999).
• Evidence Based Practice enables therapists to set
  goals and measure outcomes.

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Concluding Remarks

• A holistic approach to treatment will benefit the
  client, the therapist, and the organization.
• Research on occupation supports EBP, and will
  lead to improved credibility of the organization,
  decreased costs, and improved intervention
  outcomes.

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Discussion

• What did you think of Monika's vision?
• Do you think we should hire her?
• Why? Why not?

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Monika, youre HIRED!