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What Are You Fit For

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What Are You Fit For

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What Are You Fit For?

Emerging practice areas for occupational therapists

Due to changes in reimbursement, the number of traditional occupational therapy (OT) positions has declined. Therefore, it is necessary to look elsewhere for job opportunities (Kerr, 2000). It is important to understand that emerging practice areas may not be specifically designed for OTs to perform, but they provide other avenues for OTs to explore because of their special OT training.

OT students at St. Ambrose University who undertook a research project designed to explore emerging practice areas for new occupational therapy graduates and/or currently practicing OTs found a variety of positions for which OTs can qualify.

We wanted to know what specific non-traditional work settings now exist for occupational therapists, and what is the occupational therapist's current and future role within these settings? In our quest we found an abundance of information in the literature pertaining to five such areas: case management, ergonomics, driver rehabilitation, wellness and prevention, and low-vision rehabilitation.

Our qualitative data showed that the responsibilities of a non-traditional practice area are closely related to the responsibilities of a traditional practice area in these settings. The subjects used many of the skills they learned in their OT training, including assessment/evaluation, task analysis, and clinical reasoning/client centered treatment. This could expand the horizon in which OTs are qualified to practice, and introduce occupational therapy to other professions and practice areas.

Case Management
Case management "utilizes a collaborative process to assess, plan, implement, coordinate, monitor and evaluate the options and services required to meet an individual's health needs using communication and available resources to promote quality, cost effective outcomes"(Lohman, 1998, p.65). It also may include patient advocacy, education, psychosocial issues, community needs and wellness promotion. Case management should assist the individual in achieving success and satisfaction in community life by offering a continuity of care, accessibility to resources, and opportunities for independence. Case managers are certified by examination and certification must be renewed every five years. It includes continuing education. OTs in this field say they use communication skills, clinical reasoning, leadership skills and flexibility.

Driver Rehabilitation
Occupational therapy practitioners are ideally suited to perform necessary evaluations to assess functional skills within the context of a structured driver rehabilitation program. Additional training is required to pursue a career in this field, however. (Jacobs, 1994).

Driving programs have been expanded to include clients with significant physical limitations and the elderly, two populations with which OTs now work. The main goal of driving rehab is to restore transportation independence (Kalina, 1996). Restoring independence to the client is at the root of occupational therapy, which allows OTs to function easily and effectively in a driver rehabilitation program.

Pre-driving assessments include a history of sensorimotor system function, hearing, vision, proprioception screening, range of motion (ROM), manual muscle testing, grip and pinch strength, and cognitive-perceptual abilities (French & Hanson, 1998).

Wellness Consultant
Wellness includes good nutritional habits, exercise at least three times a week, adequate sleep, safe sex if one is sexually active, and balance in work and leisure. The occupational therapy practitioner works as a coach and facilitator of problem-solving strategies. The increased need for wellness consultants is due to an increase in overweight Americans, an increased interest in health and fitness, and an aging population (Burkhardt, 1997).

Prevention and early remediation are important focuses of occupational therapy in this area, because both have been part of the intellectual and emotional heritage of the occupational therapy profession (Johnson, 1986). OTs also address areas such as stress, coping skills, and behavioral changes (Johnson, 1986). In the wellness arena OTs can function in settings such as homes, schools, labor union halls, industrial plants, businesses, hospitals, and town halls (Maynard, 1986).

Ergonomics
Ergonomics is the study of the relationship between people and their occupations, equipment and environment. OTs already use ergonomics principles to increase function and to solve problems related to interaction with the environment. Using proper ergonomics principles can impact an individual's occupational performance in self-care, productivity/work and leisure ("Occupational Therapy and Ergonomics," 1997).

The need for ergonomics programs is due to the increase of work-related injuries. By redesigning the work environment, ergonomics programs can decrease the amount of Workers' Compensation that companies have to pay out each year. OTs are trained to look at the person, environment and occupation fit (Jacobs, 1998), proper body mechanics, work simplification techniques, and recommendation of ergonomic equipment (Hanson, 1996).

Low-Vision Rehab
Visual impairment is one of the leading causes of disability and handicap in the United States. Visual disorders can increase risk for falls, decrease ability to read labels, decrease involvement in activities that require adequate vision, and decrease self-care and safety (Pazell, 1998). The goal of a low-vision program is to enable people with low vision to continue to live productive and satisfying lives as independently as possible.

These programs should not be limited by specific conditions. A team approach combines ophthalmology and occupational therapy services. Patients can be seen one to two times weekly, depending on their needs, and treated in the clinic, home or community.

Occupational therapists conduct the initial evaluation that is used to determine if therapeutic intervention is necessary; it must be established that the patient's vision loss has resulted in a functional limitation in ADL or unsafe performance of ADL, or both (Warren, 1995). Occupational therapists working in low-vision rehabilitation must have additional specialized knowledge of the ocular pathology causing visual loss, and the application of optical devices (Warren, 1995).

Other Emerging Areas
Other non-traditional areas in which OTs are working include forensics, welfare-to-work programs, and home modification. Forensics includes working with chronically mentally ill clients, sexual offenders, juvenile delinquents, or prisoners who become ill while serving sentences (Lloyd, 1995). We did not find extensive information on these areas in the literature. However, they are important emerging practice areas and OTs need to be aware they exist.

Doing the Study
From a list derived from databases and through snowball sampling of other OTs, we selected 127 occupational therapists working in case management, ergonomics, driver rehabilitation, low-vision services and wellness consultation in the United States to voluntarily take part in the study. Participants were asked to identify their levels of education, states in which they currently practice, areas of employment, and duration of employment in those areas.

Student researchers created an electronic mail survey, based upon a thorough review of the literature, and sent it to the subjects, who were instructed to complete the 19-question survey. The survey questions addressed work histories, current job responsibilities and job satisfaction.

Student researchers received 30 of the 127 surveys back from the subjects. Twenty-five of the surveys met the inclusionary criteria.

The subjects' responses regarding the three main responsibilities of their jobs occurred in six main themes. The three most common were assessment/evaluation, treatment and consultation/recommendation. Other common themes were management, documentation and education. When asked what skills the subjects' use in their current positions that they learned in their OT training, respondents noted these common themes:

  • knowledge of the impact of diagnosis,

  • communication,

  • documentation/goal writing,

  • psychology background,

  • kinesiology/anatomy background,

  • management skills, and

  • understanding the importance of occupation.

    The three most common themes were assessment/evaluation, task analysis and clinical reasoning/client centered treatment. All of the respondents felt that there is a role for OTs in the future of their current areas of practice due to the increase in aging, disability, and forensic populations, the holistic/comprehensive training OT's receive, and OT skills in adaptation and activity analysis.

    Descriptive statistics showed that seventy-five percent of the respondents have BS degrees in occupational therapy. Thirty-six percent currently practice in the north central region of the U.S.—Minnesota, Iowa, Illinois, Wisconsin, Missouri, Michigan and Indiana. Respondents have been in practice an average of 13.2 years, working in non-traditional practice areas an average of 6.6 years. Eighty-eight percent reported that these were not their first OT jobs. The participants did not become aware of non-traditional practice areas through journals, newspapers, professional publications, fieldwork or academic education. Twenty-four percent of participants said they learned of their practice areas from other OT practitioners, and 28 percent reported other sources. Eighty-four percent of the participants did not complete level-II fieldwork in emerging practice areas.

    Discussion
    Every respondent felt there is a current and future role for OTs in their areas of practice due to the increase in the aging, forensic and disability populations. The participants also noted the holistic training that OTs receive and OTs' skills in adaptation and activity analysis. The results of the survey support the literature review, reiterating that OTs have the skills and training required to practice in the specified non-traditional settings.

    Following data analysis, the researchers found there was a high frequency of responses from the north central region of the United States, due to the fact that the snowball sampling originated in this area of the country. For this reason our results cannot be generalized to the entire U.S. but may more accurately project the skills needed and for emerging practice areas in this region of the country.

    Most of our respondents held BS degrees, verifying that an entry-level education met requirements needed to begin practice in these emerging areas. A majority of the participants did not complete a level-II fieldwork in their current areas of practice.

    During the student researchers' quest for information about OTs working in non-traditional settings, data analysis showed that the highest percentage of the OTs surveyed work in driver rehabilitation. The second highest percentages of responses were from OTs practicing in other areas such as forensics and life coaching. Responses were also received from case management, ergonomics and wellness prevention settings. Our cross tabulation showed that the majority of respondents are satisfied or very satisfied with their current position and would not leave if a traditional practice area became available. The survey responses showed that the participants have practiced in their non-traditional setting, on average, half of the time they have been OTs. The participants remaining in their area of practice could be due to the high satisfaction rate reported on the surveys.

    Limitations
    As research was completed, we noted limitations in two major areas. Participants had to download the survey from our Web page, and those without the 2000 version of Netscape could not do that. This significantly decreased the response rate, and prohibited willing OTs from participating. The decrease in response rate made it impossible for researchers to generalize findings to the entire U.S.

    It was more difficult to find OTs working in wellness prevention, low vision, and ergonomics than it was to locate OTs practicing in case management and driver rehabilitation. Had we started to gather possible participants well in advance, there would have been adequate time to create a study population evenly distributed throughout the country and among non-traditional areas.

    References available upon request.

    Kathryn E. Best, Mandy L. Noblitt and Sarah A. Synold are OT students at St. Ambrose University. Brenda Hughes, MA, OTR/L, is their supervisor.




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