A case manager's guide to occupational therapy
by Victoria Holness-Waud
Back to basics, what is occupational therapy?
Occupational therapy provides practical help to people overcoming illness or disability in order to pursue the activities (‘occupations’) that matter to them, supporting people of all ages and with a wide variety of conditions to reach their full potential. Increased independence and satisfaction in all aspects of life is our goal, especially in those day-to-day activities relating to self-care, productivity and leisure.
Self-care refers to everyday tasks such as dressing, washing and food preparation, as well as managing medication and medical appointments where required. Productivity typically comprises work or school, including such organizational tasks as managing a diary and keeping appointments. Leisure involves every variety of social activity, such as going for a meal in a restaurant, visiting the cinema, or participating in favourite sports and hobbies.
In short, occupational therapists are skilled professionals who find solutions to everyday problems. They will therefore be experts in a diverse range of fields, from the use of wheelchairs and other assistive technology, to pain management and coping with fatigue and anxiety, and can readily identify when an adaption of a client’s environment or provision of equipment can help them function more comfortably and effectively.Occupational therapists are also educators: they advise not only clients on how to approach tasks more effectively, but assist family members, carers and employers to support the client themselves.
Involving the client at every stage, occupational therapy is therefore very much person-centred therapy. The holistic (‘whole person”) nature of the profession allows for the full sweep of an individual’s needs to be considered - whether physical, psychological, social or environmental - in a way that no other single vocation does.
When to instruct an OT on your case?
An occupational therapist can be instructed to work with your client to achieve their maximum level of functional independence; this might involve a simple ‘one-off’ assessment and recommendations or may require more complex ongoing work. Below are some examples of areas of occupational therapy specialism:
Seating and 24 hour postural management
This can involve advice on static or dynamic seating, powered and manual chairs, complex positioning for adults and children.
Vocational rehabilitation
This can be for clients looking to return to work post trauma, it can involve looking at job roles, compensatory techniques and coping strategies / techniques to overcome anxiety or fatigue for example.
Hand therapy
This can involve assessments and advice following trauma or burns for example. It could be package of one to one treatment sessions, and examples of treatment methods are splints, minor aids or a home programme.
Housing and equipment
This can range from simple advice on aids to help with daily life to property reviews for clients who are currently in rehab units or 24 hour care environments with a view to property purchase and adaptation. Major adaptations involving reviewing plans and working with architects and contractors all form part of this area of occupational therapy.
Rehabilitation
Rehabilitation covers brain and spinal injury, orthopaedic trauma and all injuries that are affecting function. The OT will set client focused rehabilitation goals to be achieved through collaborative working with the client and therapist.
Paediatrics
A paediatric occupational therapist working on a case management case will be able to assess and advise on complex paediatric cases including seating, housing, sensory, play, assistive technology, moving and handling. Paediatric cases tend to require comprehensive OT involvement.
Moving & Handling
This can involve assessments and equipment recommendations, advice, training, reviews, moving and handling plans.
What are some examples of therapies an occupational therapist might undertake?
Depending on individual circumstances, an occupational therapist might pursue one or more of the following activities with clients or their families:
- Rehabilitating motor functions, restoring the ability to control movement, coordination and muscle power, including “fine” motor skills such as handwriting
- Developing improved cognitive skills such as concentration and memory, or compensatory strategies when these are impaired
- Educating clients and family members about particular conditions and their management of those conditions
- Monitoring and supporting pain management
- Teaching the client how to perform specific tasks differently in order to make them easier, and breaking complex tasks into manageable stages
- Recommending or providing devices or equipment that make activities easier, safer or more effective
- Assessing risks and difficulties likely to be posed by home or work environments, for example for wheelchair users or those at risk of falling, and recommending solutions
- Planning a weekly timetable of activities to boost a client’s engagement or productivity, improving their outlook and quality of life
- Providing advice on managing fatigue and tiredness
- Teaching financial management and budgeting skills in the face of changed circumstances
How do case managers and occupational therapists work together?
For an OT to work successfully in the independent sector we would expect them to have the following clinical and professional skills:
- A solid foundation of clinical and service knowledge gained from a minimum of 5 years spent in the statutory sector.
- Advanced clinical assessment and analysis
- Sound clinical reasoning and problem solving
- Confidence in their own decision making
- Articulate to explain decisions, opinion and outcomes to clients, case managers and solicitors.
- Strong report writing
- Adaptable and responsive to the needs of individual cases.
- A positive and professional manner
- Adherence at all times to the Code of Ethics and Professional Conduct for Occupational Therapists
- Readiness to collaborate and work as part of a multi-disciplinary team with joint goals, alongside various other health and legal professionals
If an OT has the above qualities they will work collaboratively with the case manager to ensure that:
- They quickly build an effective, one-to-one therapeutic relationship with clients and their families, establishing rapport, trust and understanding
- Assessment goals set out by the case manager are clearly addressed both at the time of the assessment and in the report.
- They provide a holistic assessment ensuring that, where possible all areas of ADL are addressed
- Their report contains a detailed analysis of activities to identify where difficulties are coming from and professional opinion as to how this is affecting function.
- Recommendations are goal orientated, timely, realistic and achievable.
- Fully costed and reasoned recommendations are provided to allow maximum chance of funding approval.
In line with the Loughlin judgement an OT should provide monthly reports detailing that monthly activity undertaken and progress against the original goals set.
What qualifications / registrations and memberships should an occupational therapist have?
There are some that are essential registrations for a therapist to practice in the UK and others that are considered important for best practice.
Essential
‘Occupational therapist’ is a protected title and can only be used by those with a working with a diploma or degree-level qualification in Occupational Therapy and registered with the Health and Care Professions Council.
Best Practice
To ensure they employ the most advanced, evidence-based therapeutic principles and techniques, therapists should attend to their on going professional development through regular attendance at professional training events and are also likely to be members of professional bodies such as the College of Occupational Therapists (COT) or those that are relevant to their chosen specialism.
Finally, occupational therapists should possess adequate professional indemnity insurance and a current Disclosure and Barring Service (DBS) certificate.
What are the advantages in paying for an independent occupational therapist?
Independent therapists have usually accumulated extensive experience prior to undertaking private practice. They will have spent some years working in the NHS or social care, developing a good grounding in general therapy as well as in their areas of specialism.
At the same time, they will be unconstrained by the bureaucratic processes often imposed on them in statutory sectors. Ultimately, this means that the therapist is better able to develop a comprehensive, individualised treatment programmes leading to the best possible outcome for the client.
Most importantly, choosing to instruct an independent therapist means choosing the expertise and experience that are brought to a case, greater control over input with clients, and the assurance that he or she will be located within a reasonable travelling distance.
OT Practice therapists
We have a nationwide network of expert occupational therapists that cover all of the areas described in this article. If you think your client would benefit from occupational therapy, our office based client management team of OTs will discuss the details of your case and offer expert advice pre referral. If you wish to proceed, your client manager will work with you to find the right specialist OT for your client. Give them a call on 0330 024 9910 or email: enquiries@theotpractice.co.uk
