1. Welcome to the Trump Rehabilitation Centre The Search for a New Vision

2. WANTED Head Occupational Therapist

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

4. Current Practices Focus on client’s individual occupational performance components. Ex. Lifting teapot off shelf. Research is not occupationally based.

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

6. 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).

7. PhysicalInstitutional SocialCultural Environment Canadian Model of Occupational Performance Occupation Productivity Self-care Leisure Person Spirituality CognitivePhysical Affective

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. CQI Example: Client Pathway Psychotherapy Functional Assessment Splinting Orthotics Hand TherapyAssistive Devices Work Hardening Psychotherapy Hand Therapy Orthotics Splinting

15. Research on Occupation “Occupational therapists… will advance occupation and participation through… utilization of research knowledge.” Leadership Forum (2003). Evidence-based practice.

16. 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).

17. 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.

18. 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.

19. 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.

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

21. Monika, you’re HIRED!