Burke, Janice P

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Moving occupation into treatment: clinical interpretation of \u22legitimizing occupational therapy\u27s knowledge\u22.

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Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Occupational Therapy FacultyPapers Department of Occupational Therapy9-1996Moving occupation into treatment: clinicalinterpretation of "legitimizing occupationaltherapy's knowledge".Janice P. BurkeThomas Jefferson University, janice.burke@jefferson.eduLet us know how access to this document benefits youFollow this and additional works at: https://jdc.jefferson.edu/otfpPart of the Occupational Therapy CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Occupational Therapy Faculty Papers by an authorized administrator of the Jefferson Digital Commons. For more information, pleasecontact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationBurke, Janice P., "Moving occupation into treatment: clinical interpretation of "legitimizingoccupational therapy's knowledge"." (1996). Department of Occupational Therapy Faculty Papers.Paper 42.https://jdc.jefferson.edu/otfp/42Moving Occupation Into Treatment: Clinical Interpretation of "Legitimizing Occupational Therapy's Knowledge" Janice Posarery Burke Key Words: health • history of occupational therapy • human activities and occupations • purposeful activity Janice Posatery Burke, MA, OTRJL, FAOTA, is Assistant Professor, Department of Occupational Therapy, College of Allied Health Sciences, Thomas Jefferson Universiry, Edison 820, 130 South 9th Street, Philadelphia, Pennsylvania 19107. This article was acceptedfOr publication june 14, 1996 I f, as Wood (1996) encourages, occupational thera-pists seize the opportunity to further develop their knowledge and communicate the societal values that are inextricably bound to their practice, they wiJl un-doubtedly march into the 21 St century with an excite-ment and enthusiasm that will revolutionize the scope and depth of occupational therapy. Therapists will be able to work in a greatly expanded range of settings, delivering a wide band of service. In addition to continuing our efforts with persons who are chronically ill, we will inter-vene with persons who suffer from the chronic problems that result from poverty and being disadvantaged, who confront new kinds of disruptions and displacement due to newly emerging corporate practices (e.g., downsizing and rightsizing, which are quickly making the idea of fUll-time, long-term work obsolete), and who wish to en-gage in preventive and wellness activity. In these extended roles, we would be focusing our attention on how occu-pation can be addressed in evaluation, treatment, and measurable outcomes. The recognition that occupational therapists are the keepers of knowledge pertaining to "adaptation through occupation ... [that] has historically constituted occupa-tional therapy's unique domain of concern" (Wood, 1996, p. 626) is both exciting and empowering but also somewhat threatening. As a clinician, I ask myself, "Why have occupational therapists been so unwilling to articulate their core concepts?" The reasons seem to be many. Without question, external factors have impinged on our development of a knowledge base. Certainly, our unlikely partnership within medicine and the hard sci-ences has stifled our perspective and diverted our atten-tion. Placed in a world where the primary orientation is directed toward solving problems of acute pathology and the reduction of disease through drugs and surgery, our commitment to persons with severe and chronic disabili-ties has been compromised. Our discomfort with repeat-edly addressing issues of fUnction within an environment that has, until recently, shown only nominal interest in the concept has resulted in our taking a backseat to our own knowledge development. Compounding our limited attention to developing an increased understanding of how we promote occupa-tion through adaptation has been a lack of interest in treatment protocols, program development, and research projects from outside interest groups (e.g., administra-tors, managers, grant and special project officers) that would facilitate the kind of work that would contribute to the fUndamental core of our field. We have been out-The American journal OfOccupt1tional Therapy 635 Downloaded From: http://ajot.aota.org/ on 01/27/2015 Terms of Use: http://AOTA.org/termssiders in the world of external funding for research and development, and as such, we have been unable to find the resources and support to engage in the kind of think-ing that promises to expand our understanding of occu-pation; as citizens in a reductionist world, we have been unable to recognize and make use of evaluation, docu-mentation, and research methods that fall outside of the dominanr medical-scientific model. For example, our failure to consider the use of the phenomenological per-spective has limited the type and scope of inquiry we can make into occupation. It is difficult to sit among a group of professionals who value cause-effect understanding of ilJness and disease and initiate or pose questions regard-ing environmenral press, just-right chalJenge, and self-initiated activity. Turning inward, I can name a host of internally based reasons for occupational therapists' failure to under-stand and embrace "the very heart of clinical practice" (Wood, 1996, p. 628). As Wood (1996) outlined, the ele-ments of adaptation through occupation are exceedingly complex and densely woven into the tapestry of our work. The adaptive responses that are elicited through occupational therapy are multidimensional, far reaching in their effects, difficult to organize, and difficult to explain. Indeed, in response to reading about them, I wonder: "Do we avoid bringing our work into sharp focus because we fear that we will not be able to explain, and thus prove, that what we do makes a difference? Are we put off by me recognition that occupation has a pro-found effect on behaviors that go beyond the activity selected in any given session?" We are faced with the daunting task of understanding and explaining what it means to work in a meaningful way with a patient. The effect of that work plays out in a wide range of occupa-tionally related behaviors that go beyond the boundaries of our clinic walls and the limits of our timed sessions, which can seem overwhelming to any therapist who is faced with an increasing caseload and dwindling time. Does our uneasiness about how to explain and claim credit for the success cause us to let successes go undocu-mented and responsibility go unstated? In my own prac-tice, I am constantly confronred by the need to find ways to say what I intuitively believe-the knowing how part of myself For example, when a father brings his son to therapy and proudly reports that his son's teacher is noticing an improvement in the boy's handwriting, I am confronted by the absence of cut-and-dry definitive proof that I have contributed to these changes. I must make the connection (for the father and myself) that the activities I provided (e.g.) putting small objects into the boy's hands; providing him with opportunities to play with toys that would help develop the intrinsic muscles and arches of his hand; coaxing eye-hand coordination; increasing strength, mobility, and interest in manipula-tion of small objects) directly facilitated the boy's process of adaptation through occupation. Similarly, when I work on a project, such as making a pot holder with a 9-year-old girl who has a poor fine motor skill, poor self-concept, and low self-esteem, I cannot assume that the momer or teacher will definitively associate what goes on in occupational therapy with positive changes at home and school. We expect the changes that are reported to be widespread and system oriented because of the multi-dimensional nature of occupation and the integrative effect of activity on the person, yet they are very hard to point to specifically. The power of occupation has been easier to explain when my ideas about occupation were applied to the organization and transformation of an occupational ther-apy department. Several years ago, I agreed to participate in redesigning an occupational therapy department in a moderate-sized rehabilitation hospital. In an effort to provide a consistent philosophy and approach to care (evaluation and treatment), the director of the depart-ment asked me to initiate a series of in-services, work-shops, and related projects that would transform the staff members and treatment setting into an occupation-ori-ented environment. Beginning with the introduction and adoption of a common language to talk about patient problems and solutions, we adopted the Model of Human Occupation as an organizing framework for thinking and doing; this served as a unifying perspective to guide practice. The project, which was implemented over a period of months, resulted in the physical reorga-nization and redevelopment of the department (chang-ing not only the organization and location of supplies and treatment materials, but also the actual objects that would be used to provide occupational therapy) as welJ as a redistribution of staff member efforts. The power of a unifying framework as a basis for organizing ideas and actions cannot be overstated. After the participating therapists embraced the language and focused on human occupation as the hinge for their practice, there was no stopping them. They organized into work groups on the basis of their own interests as well as their day-to-day needs. We had countless spin-offs from our main project, including the development and implementation of a mentoring system for new therapists joining the department (which first resulted in a manual for the department and later as a published book). Ano-September 1996, Volume 50, Number 8 636 Downloaded From: http://ajot.aota.org/ on 01/27/2015 Terms of Use: http://AOTA.org/termsther spin-off was an environment team that first brain-stormed ideas and later created and built treatment stations (e.g., a home repairs station, a home maintenance station) based on the patient groups that were most commonly treated in the setting and patient requests concerning their occupational needs. Treatment changed. Therapists are now able to interview a patient then go to the cabinet and find what they need. For example, a woman spoke of her occupation as homemaker and the confusion she experi-enced subsequent to her stroke. The therapist was able to reach for a kit filled with a set of dishes, napkins, and sil-verware to practice with the woman the organizational and problem-solving skills needed for table setting. Similar kits for check writing or list writing are also available to the therapist in this department. Making Professional Changes: A Shift in Direction As we publicly clarify the relationship between occupa-tion and function, we will need to develop a host of new skills, especially those grounded in the art of confronta-tion and negotiation. We will need to recognize that we are not a technical or adjunctive therapy that can quietly contribute to patient improvement in an additive way. Rather, we are central to the therapeutic process, design-ing and directing a much larger and more defll1itive change in the persons receiving our service. Consequently, more attention will be on us, more questions will be asked, and more answers will be needed. We will trans-form ourselves into key players in the restoration of health and function through occupation rather than stand by as supportive, silent partners. That everything around us is changing provides a tremendous impetus for practicing therapists to take some new and innovative steps to understanding the practice of occupational therapy. As I think about mov-ing toward an expanded understanding of occupation, I have the need to create some basic rules about what must be in place, in the treatment environment as well as in myself, if I am to make the best use of the time and ideas that will be generated around occupation in any given treatment session. Along with Wood's (1996) explication of four key elements of organizing knowledge concerning the adap-tive process of occupational therapy, I am adding a few specifications of my own for the treatment environments in which I interact: 1. The environment I create in my clinic, a home, a school, or a communiry must hold a sense of excitement, novelry, and intrigue for the patient as well as myself. I can do this by creating situations where the patient can explore a field of choices during each therapy session. I must find a way to provide the patient with the opportuniry to expe-rience a feeling of possibilities to be explored. 2. The environment must be equipped with what I really need. JUSt as therapists in the rehabilitation setting who work with patients who occupy their time doing simple home repairs need access to simple electrical wiring and plumbing setups, I need access to the occupations my patients engage 111. 3. I need to advocate for access to environments, such as the middle school science classroom where a student needs assistance with organizing materials while the science experiment is going on. I can no longer allow myself to be segregated in a one-to-one treatment interaction that removes the person and the therapist from the actual situation that is problematic. When I reflect on myself as a therapist, I must recognize that I will need: 1. To know what questions to ask: Who is this per-son? What does he or she care about? How can I shape this session to be a turning point for him or her? 2. To think about this patient as an occupational creature. I need to look at each person as func-tioning within an occupational world that is defined by special cultural preferences, interests, and values. 3. To develop systems that help me organize and share my thinking. I need to find a way to docu-ment my reflections and ideas from one treat-ment session to another by keeping a journal, maintaining some kind of coding system based on ideas that I generate during treatment about occupation, taking and watching videotapes of sessions, and finding another therapist to be my partner in this kind of thinking. 4. To develop and tryout new ideas all the time. 5. To spend more time watching myself and others engage in occupation. These observations will give me ideas about how a person's occupational nature drives the choices that are made during leisure, work, and rest time. 6. To promote what I do by providing clear and understandable explanations to my referral sources (e.g., physicians, case managers, health The American journal ofOccupatiomd Therapy 637 Downloaded From: http://ajot.aota.org/ on 01/27/2015 Terms of Use: http://AOTA.org/terms--------mainrenance organizarion represenrarives, school psychologisrs) as well as direcr and indirecr recipi-enrs of my service (e.g., school adminisrrarors, parenrs, reachers, srudenrs). Thar occuparjonaJ rherapy is, as Wood (1996) pro-poses, close to undemanding and arricularing irs role in promoring adaprarion rhrough occuparion in a way rhar rhe public will comprehend and sociery will benefir rmly represenrs rhe promise of our work. I look forward ro paniciparing in rhe producrion and promorion of ideas, research, and rrearmenr rhar is driven by such powerful forces . .!. Reference Wood, W. (19%). Legitimiz.ing occupational therapy's knowl-edge. American Joumal ofOccupational Therapy, 50, 626-634. CORRECTION To "The Value of Srudying Occuparion: An Example 1982)" should read "Chimpanzees and bonobos, borh Wirh Primare Play" by Wendy Wood (May 1996, Vol- species of apes, possess berween 98.7% and 99% DNA ume 50[5], pp. 327-337): similariry to humans and rhus represenr rhe mosr closely The senrence reading "Chimpanzees and bonobos, rdared nonhuman primare species to ourselves (Zihl-borh species of apes, possess less rhan 99% DNA simi- man, 1982)." lariry to humans and rhus represenr rhe mosr closely re- The AjOT editorial sraff regrers rhis error and hopes lared nonhuman primare species to ourselves (Zihlman, rhar readers were nor inconvenienced. .., September 1996, Volume 50, Number 8 638 Downloaded From: http://ajot.aota.org/ on 01/27/2015 Terms of Use: http://AOTA.org/terms

Moving occupation into treatment: clinical interpretation of  legitimizing occupational therapy\u27s knowledge .

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Moving occupation into treatment: clinical interpretation of legitimizing occupational therapy\u27s knowledge .

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