Week 4 Client centered care in OT

Autonomy

client alone knows their experience

partnership and responsibility

shared power. therapist = partner and facilitator, advice against harm. client = active in creating, implementing and monitoring

enablement

working towards doing. deep listening. language = client understanding and participation

contextual congruence 

individualizing to persons particular needs and situations 

accessibility and flexibility

needs of client vs needs of center are emphasized

Respect for diversity

client knows best, even if it seems far fetch. respect cultural influences on occupational choices 

Challenges to be addressed

Basing (intervention on choice/priorities)

increasing (participation)

allowing (success, risk, and fails)

changing (therapist role=facilitation)

broadening (intervention focus and participation)

Barriers to client center care

client expert therapist to be an expert and must want to participation. therapist = hard turning power over to client and let them lead. medical models difficulty to implement 

Sumison and Law - conceptual elements informing client centered practice 

power, listening and communicating, partnership, choice, hope 

listening and communicating

providing information to client in ways that address their needs and at their level of understanding 

Power differential

understanding language that client can understand and conveys partnership. plus allowing client to assume power for their program

partnership

elevating the clients status, must go beyond soothing or informing and try to engage client in what is important to them: satisfaction increases. time constraints 

choice

stages in inless affect ability to assume active participation. need to clearly discern and respond to desire for information vs taking an active role

hope

abundance of literature supports helping clients maintain hope during recovery process. defined differently by individuals, and connected to ones motivation. 

Client centered practice and heath promotion 

address habits, roles routines rather than deficits 

maintain health promotion on individual level. involving caregivers, other professionals, clients interest. 

health promotion can take place simultaneously with other treatment approaches 

health promotion and prevention as individual interventions examples

education to prevent pressure ulcers for client with SCI

meeting with a new mother to guide her through nursing to ensure positive feeding experiences for her infant 

drop in client for adults using wheelchairs to prevent any positioning issues 

health promotion and prevention as group interventions examples

mindfulness workshop for college students to help prevent burnout

board game groups for older adults at a senior center to slowing cognitive decline 

developmental play group for younger siblings 

health promotion and prevention as population interventions examples

educating teachers at an elementary school on handwriting programs and fine motor development 

self management programs for individuals with chronic illnesses 

Canadian Occupational Performance measure COPM 5th edition

individualized measure of clients self perception in occupational performance, client centered semi structured interview, used across the lifespan, conditions and contexts

COPM semi structured interview w quantitative measurement

identify issue in occupational performance (self care, productivity, leisure) 

treatment planning 

outcomes (measure change in a clients perception of performance over time 

COPM step 1

problem definition

identify need, wants, expectations, if they perform and satisfaction with performance 

COPM step 2

problem weighting, rate importance of problems

COPM step 3

scoring , clients rate their ability and satisfaction of 5 most urgent problems identified. ability and satisfaction score multiplied by importance score from step 3. goals of therapy either improve or maintain

COPM step 4

reassessment. step 1 repeated. makes process and progress concrete for both client and therapist

COPM step 5

follow up. next steps decided collaboratively: continue/change/discharge.

Advantages of COPM

increase client involvement, partnership and balance of power helps focus further assessment and intervention

supports notion that client is responsible for their health and process = more participation and empowerment  

disadvantages of COPM

clients perception of performance. client/family may have different perceptions of performance and satisfaction, cognitive ability may limit ability to participate in interview