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Occupational Therapy & Family Health Teams in OntarioWelcome to the Ontario Society of Occupational Therapists resource page for Family Health Teams interested in exploring roles for occupational therapists in primary health care and for occupational therapists interested in learning more about Ontario’s Family Health Teams and ways in which OTs may assist teams to effectively support. Ministry of Health and Long-Term Care Announces Funding for Occupational Therapy in Family Health TeamsIn October 2009, the Ministry of Health and Long-Term Care communicated its plans to move forward with planning to approve and fund Occupational Therapists as interdisciplinary health providers in Family Health Teams (FHTs). In a communication forwarded to all Ontario FHTs in March 2010, the Ministry announced expansion of the approved list of Interdisciplinary Health Providers (IHPs) in Family Health Teams to include occupational therapists. This change in policy will affect both existing and new FHTs. Family Health Teams interested in adding an occupational therapist to their staff may submit a request as part of their 2011 - 2012 budget application process. There is no deadline or time restriction that limits application for funding, however FHTs will be required to show evidence of their progress to achieve roster growth targets before new staffing will be confirmed. Learn more about Family Health TeamsWhere are Family Health Teams located?
Learn more about Occupational Therapy
Occupational Therapy in Primary Health Care
Occupational Therapy and Family Health Teams
Integrating Occupational Therapy into a Family Health Team
Sources of Evidence for OT in Primary Health Care
Nurse Practitioner-led Clinics
Who are Occupational Therapists?People live life to the fullest through meaningful occupations – the day to day skills, activities, interactions and experiences that engage us with our environment, our community and the people around us. Occupational therapists understand that one’s ability to participate in occupations that are important to them promotes health and well-being. The goal of occupational therapy is to influence people’s health by enabling occupation. Occupational therapists are regulated health professionals who work with people of all ages who are experiencing, or are at risk of experiencing, barriers to managing day to day occupations that are part of their daily living roles and responsibilities and that give meaning to their life. OTs work with their clients to first identify the barriers to their meaningful occupation (self care, paid and unpaid work and leisure) and then to help them to change or remove these barriers. Barriers may result from injury, illness, chronic disease, disability, mental health problems, learning disabilities, aging, social isolation, etc. Working with people or groups of people to maintain, assume or reassume the skills they need for their job of living, occupational therapists will assume a variety of roles – therapist, educator, counsellor, case manager, coach, resource developer and advocate. Funding of OT Services in Ontario’s Health Care SystemAlthough the government’s commitment to fund occupational therapists to work in Family Health Teams creates a new practice sector for OTs, the profession has a long history of work across all components of Ontario’s publicly funded health care system – in hospitals, rehabilitation centres, in CCAC funded home care services, in long-term care homes, in community health centres. A growing private sector marketplace exists funded by auto insurance, the Workplace Safety and Insurance Board, long term disability insurers, employers and clients themselves. There are approximately 4500 occupational therapists registered to practice with the College of Occupational Therapists of Ontario. Educational Preparation of Occupational TherapistsEducational preparation is attained at a Masters level in Canadian universities. This level of education develops critical thinkers who are skilful clinicians, team players and have developed research and evaluation skills that can be valued adjuncts to the Family Health Team’s efforts to monitor, evaluate and improve their patient care outcomes. OT professionals bring a strong background in mental health and physical health and rehabilitation to their work. Occupational Therapists Offer Unique Perspectives to Primary Health CareWith their unique educational preparation and holistic, client-centred focus on the domains of the individual (physical, cognitive, affective), his/her environment and his/her function with the aim of improving the overall health of the individual, occupational therapists are ideal interprofessional team mates for professionals working in Family Health Teams. With a core focus on enabling engagement in everyday living, occupational therapy is ideally positioned in the community, in primary care - where everyday living occurs. Occupational therapists will bring a focused attention to how patients’ health problems or challenges impact their capacity to manage safely, as independently as possible and with dignity in their home and community for both the short term and the long term. Occupational therapists have much to offer clients who are:
In a primary care context, occupational therapists have much to offer to enable clients to maintain their capacity for meaningful occupational performance. The strategic benefit of utilization of occupational therapists with vulnerable patients in the primary care practice is evident in discussion of the following figure.
Wallace & Seidman (2007) identify that people with severe chronic conditions and disabilities typically represent approximately 6% of a physician’s caseload yet consume 33% of primary care resources. Occupational therapists are well positioned to lend their expertise to these complex clients when their needs relate to the impacts of their health conditions on function and occupation. Efficient utilization of OT resources for this segment of the patient roster presents a cost-effective and successful alternative to repeated access to physician resources, which is heavily taxed by a small percentage of a practice. Patients in the middle section of the figure may require intermittent access to OT services when a patient experiences a functionally related need. Effective attention and problem solving of occupational performance issues amongst this sector of the roster is proactive and strategic in a health promotion, injury/illness prevention context. Maintaining function of vulnerable patients is a critical challenge to FHTs vested in improving health status of all patients. Maintaining function and health status of patients at this level may prevent or stave off a decline in health status that would result in movement to the higher demand segment of the roster. Rostered patients that fit in the bottom 72% of the triangle are less likely to require OT services. That said, episodic injury or illness may result in a short term need for attention to functional adaptation. Ready access to OT services that can promote maintenance of function and safe return to life roles (such as work) can contribute to reduced potential for complications of inactivity and earlier returns to work and life activity. Why Occupational Therapy in Family Health Teams?Occupational therapists have demonstrated positive outcomes in primary health care roles with populations of seniors, children, youth, workers, homeless people and those with mental health problems (Canadian Association of Occupational Therapists, 2006). In a review of the literature on evidence supporting occupational therapy in primary health care settings, Restall, LeClair and Fricke (2005), noted strong evidence to support occupational therapy roles to support management of rheumatoid arthritis, stroke, chronic low back pain, return to work, and the prevention of falls and functional decline in older adults. The also noted moderate evidence in support of occupational therapy with people with long term neurological conditions such as multiple sclerosis, parkinson’s disease and traumatic brain injury, chronic obstructive pulmonary disease, chronic fatigue, vocational rehabilitation and support for people with serious mental illness. In addition there is support for occupational therapy’s contribution to the appropriate identification of developmental conditions in children served in primary health care sites (Gaines et al., 2008). Occupational therapists will contribute meaningfully to the core activities of Family Health Teams – chronic disease management, injury and disease prevention, health promotion and direct care services. Examples of specific services or activities that could be provided by occupational therapists under each of these major activities are provided to illustrate the scope of the practice potential. Each FHT will have differing needs for occupational therapy services depending on the population it serves and the existing team membership. Chronic Disease Management:
Injury and Disease Prevention:
Health promotion:
Direct Health Care Services:
Potential roles for OTs working in Family Health TeamsWhile the breadth and focus of the OT role will vary from FHT to FHT depending on the characteristics and needs of the roster and the interdisciplinary team mix, the following are identified amongst potential roles that may be assumed by an occupational therapist working within a Family Health Team.
How will Occupational Therapists work within a Family Health Team?The integration of occupational therapy services into a FHT should be a complement to staffing/service structure of the team. Occupational therapists are skilled team members and value the quality patient care that results when inter-professional teams work well together. OTs would expect to function as valued, respected members of the inter-professional team, exercising the same to all team colleagues. The occupational therapist’s work within a Family Health Team may include:
These are roles that would be shared in common with other health professionals working in the FHT. Occupational therapists, like other health professionals in the team, would lend their unique professional perspective to team planning, joint program development and service delivery evaluation processes.
Occupational therapists may have unique practice patterns and needs that should be considered when establishing ratios for caseload management. For example:
Models of OT Service DeliveryFive models of service delivery can provide guidance to FHTs and occupational therapists as OT services are integrated into these settings. The models identified have been based and modified from those presented by McColl & Dickensen, 2009. These include:
The service delivery model of choice will be dependent upon the needs of the FHT and its roster. Regardless of the model selected, the integration of a new profession into a FHT will require access to the Electronic Medical Record (EMR), infrastructure such as assessment/treatment tools or materials, administrative support commensurate to that of other team members and use of secure space for individual or group sessions. Occupational therapists assume a professional responsibility to supervise occupational therapy students. The Family Health Team can provide a rich, inter-professional learning experience for occupational therapy students. At the same time, integration of student occupational therapists, supervised by registered OTs can provide a meaningful way by which to augment OT resources to the team. Contractual arrangements should facilitate the supervision of students. Direct Versus Indirect OT Time
The pie chart above illustrates the percent of time per function that an OT in an FHT might dedicate in a given day, week or month. The blue section, representing 50% of a full-time OT’s job over 49 weeks per year (assuming 3 weeks holidays deducted from 52 weeks per year), indicates the direct time spent with patients, either on a 1:1 basis or in groups. The red section of time, at 25%, would be spent on indirect patient care related activities related to the OTs clients and would include activities outlined above, i.e., documentation (required after each patient encounter), travel to home visits, follow-up to clinical interventions (e.g., preparing wheelchair prescription, consultation with suppliers, etc.), administrative duties, etc. The green section, representing 25% of the FTE OT’s time, reflects indirect time given to the FHT team for shared-care activities including consultation, case management, education, team meetings, provision of resources, etc., as determined by the unique composition/needs of both the team and its roster of patients. Sample Job Description for OT in Family Health TeamThis sample occupational therapy job description was developed and shared by Kerrie Dewachter, OT. Sample - Typical Week for OT in FHT
Note: With 33 patients/week x 49 weeks (assume 3 weeks/yr. = holidays with no coverage) = 1617 visits/year. Group sessions: may take a few weeks or months to arrange and implement. These would likely be co-lead with another member of the inter-professional team. Direct time: with patients, i.e., assessment/intervention or off-site visits (either individually, with a family member or in groups) =59% of week Indirect time: patient related: travel, documentation, statistics, preparation, forms,phone-calls/e-mails, research, planning, group set-up, etc. Team-related: team collaboration, education, triage of referrals, etc. =41% of week, or 20.5% each Note: these assumptions were tested amongst a small group of clinicians who have experience in primary health and their input was incorporated into the above chart. F Identifying Needs and Roles for Occupational Therapists in Family Health TeamsThe opportunities for value-adding utilization of occupational therapists in the primary health care environment are diverse and plentiful. FHTs will be guided by the unique needs and characteristics of their roster, the size and current skills of their existing team, availability of community resources. The following resources are suggested to support investigation and planning for integration of OT services into a Family Health Team.
Sources of EvidenceOT in Primary Health CareCanadian Association of Occupational Therapists. (2006). CAOT Position Statement Occupational Therapy and PrimaryHealth Care. Ottawa, ON: Author. Retrieved from www.caot.ca. College of Occupational Therapists of Ontario. (2003). Essential Competencies of practice of occupational therapists in Canada. Retrieved from http://www.coto.org/pdf/Essent_Comp_04.pdf. Clarke, F., Azen, S.P., Zemke, R., Jackson, J., Carlson, M. & Mandel, D. (1997). Occupational therapy for independent living older adults: A randomized controlled trial. Journal of the American Medical Association, 278, 1321-1326. Cumming, R.G., Thomas, M., Szonyi, G., Salkeld, G., O'Neill, E. & Westbury, C. (1999). Home visits by an occupational therapist for assessment and modification of environmental hazards: A randomized trial of falls prevention. Journal of the American Geriatrics Society, 47, 2397-1402. Dunn, W. (2000). Best Practice Occupational Therapy: In Community Service with Children and Families. Thorofare, NJ: Slack. Epstein, E., & Jaffe, C. (1992). Occupational Therapy Consultation: Theory, Principles, and Practice. Philadelphia, PA: Mosby. Gaines R, Missiuna C, Egan M, McLean J. (2008). Educational outreach and collaborative care enhances physician's perceived knowledge about Developmental Coordination Disorder. BioMedCentral Health Services Research, Jan 24;8(1):21. PMID: 18218082. Gitlin, L.M., Miller, K.S. & Boyce, A. (1999). Bathroom modifications for frail elderly renters: Outcomes of a community-based program. Technology & Disability, 10, 141-149. Kelly, M. (2009, December). OT in Ireland. (C. Janet Craik, Interviewer) Krauser, J. (2009). Personal Communication. (A. Murphy-Turliuk, Interviewer) Toronto: MOHLTC. Legg, L.A., Drummond, A.E., & Langhorne, P. Occupational therapy for patients with problems in activities of daily living after stroke. Cochrane Database of Systematic Reviews 2006, Issue 4. McColl, M.A., Dickenson, J. Interprofessional Primary Health Care: Assembling the Pieces. CAOT Publications, Ottawa, 2009. McColl, M. A., Shortt, S., Godwin, M., Smith, K., Rowe, K., OBrien, P., et al. (2009). Models of integrating rehabilitation and primary care: A scoping study. Archives of Physical Medicine and Rehabilitation, 90, 1523-1531. Rebeiro, K.L., Day, D.G., Semeniuk, B. O'Brien, M.C. & Wilson, B. (2001). Northern Initiative for Social Action: An occupation-based mental health program. American Journal of Occupational Therapy, 55, 493-500. Restall, G., Leclair, L., & Fricke, M. (2005). Integration of occupational therapy and physiotherapy services in primary health care in Winnipeg. Winnipeg, MB: School of Medical Rehabilitation, University of Manitoba. Retrieved from: http://umanitoba.ca/faculties/medicine/units/medrehab/media/ot_pt_phc.pdf Scandinavian Journal of Occupational Therapy, 2007, Vol. 14, No.
3, Pages 150-159 , DOI 10.1080/11038120600968811 Clients using community
occupational therapy services: Sociodemographic factors and the occurrence of
diseases and disabilities. Retrieved from: Sellwood, W., Thomas, C.S., Tarrier, N., Jones, S., Clewes, J. & James, A. (1999). A randomized controlled trial of home- based rehabilitation versus outpatient-based rehabilitation for patients suffering from chronic schizophrenia. Social Psychiatry & Psychiatric Epidemiology, 34, 250-253. Steultjens, E.M., Dekker, J., Bouter, L.M., Jellema, S., Bakker, E.B., & van den Ende, C.H. (2004). Occupational therapy for community dwelling elderly people: a systematic review. Age and Ageing, 33(5), 453-460. Wallace, P. & Seidman, J. (2007) Improving population health and chronic disease management. In j. Dorland & M.A. McColl (Eds), Emerging approaches to chronic disease management in primary health care. Montreal: McGill-Queens University Press. Mental HealthWasylenki, D., James, S., Clark, C., Lewis, J., Goering, P., & Gillies, L. (1992). Clinical issues in social network therapy for clients with schizophrenia. Community Mental Health Journal, 28, 427-440. Home Intervention/Fall Prevention EvidenceSchryburt-Brown, K., Dixon, C., Paton, D. Connolly, S. & Craik, J. (2004). Occupational therapy assessment toolkit of fall risk in the elderly: A review of the literature. Occupational Therapy Now, November/December, 17 – 23. (available online). DementiaDementia and CaregiversPain ManagementPulmonary DiseaseArthritis & Chronic Disease ManagementCott, C., Devitt, R., Wong, R., Soever, L., MacKay, C. (2005). A client-centred health service model of primary health care and rehabilitation for arthritis. Arthritis community Research & Evaluation Unit (ACREU). Available online at: http://www.acreu.ca/pdf/pub5/05-04.pdf Steultjens, E.M.J.,Dekker, J., Bouter, L.M., van Schaardenburg, D., van Kuyk, M.A.H., & van den Ende, C.H.M. Occupational therapy for rheumatoid arthritis. Cochrane Database of Systematic Reviews 2004, Issue 1. Improving Community MobilityBarker, D.J., Reid, D., & Cott, C. (2004). Acceptance and meanings of wheelchair use in senior stroke survivors. American Journal of Occupational Therapy, 58, 221-230. (copy available online). End of LifeBye, R.A., Llewellyn, G.M. & Christl, K.E. (2001). The end of life. In B.R. Bonder & Wagner, M.B. (Eds.). Functional Performance in Older Adults (2nd ed.) pp. 500-519. Philadelphia: F.A. Davis Company. (available at Gerstein). Jacques, N.D. & Hasselkus, B.R. (2004). The nature of occupation surrounding dying and death. OTJR: Occupation, Participation and Health, 24, 2, 44-53. (available online). |
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