Occupational therapy has long run under the radar in the eyes of both health providers and patients. Occupational therapy is underutilized, simply because our scope of practice is not completely understood. As the health care system shifts toward value and pay-for-quality, occupational therapists have the opportunity to demonstrate efficiency and lower costs by providing quality client-centered care.
During my occupational therapy training at Boston University, we spent long hours learning how to build treatment plans based on the values, beliefs and interests of our patients rather than our own beliefs of what will work best. At that time my fellow grad students and I found this frustrating and yearned for black-and-white information to treat our patients’ specific diagnoses. Now, 10 years later, client-centered care is the essence of my work. Referrals are sent for chronic pain, head injury and diabetes, but to some extent the diagnosis is secondary. My initial questions address what the patient values and what makes their life meaningful: “What will make you feel it is worthwhile to come in and see me?” “What are your essential daily activities?” It is through these questions that I begin to understand what motivates an individual rather than what is wrong with them.
The client-centered approach focuses on providing quality-based care that engages the patient in the therapeutic process. My patients work hard to attain their therapy goals, but the motivation to achieve their goals doesn’t come from me. It arises out of the process taken from our first meeting. Patients become intrinsically motivated and inspired because their treatment gets to the essence of what is important to them.
Several weeks ago I was sitting in a room of physicians discussing the increasing pressures placed on them by insurers to reach quality measures and demonstrate value for their services. A common sentiment was, “Why are we held responsible for what our patients do outside of our office? We are not behavioral specialists, we are doctors.” All I could think of is that every primary care physician would benefit from an occupational therapist as part of the coordinated care team — whether in office or on a referral basis. Occupational therapists are experts in helping patients make the link between what their physician instructs them to do to improve their health and making it happen in their daily lives.
I have been fortunate enough to be doing just this at Manakai o Malama over the past two years with many success stories. I recently got a referral for a patient with pre-diabetes, weight gain and hypertension. The doctor had been trying to get him to adopt new eating habits and, at the very least, consistently take his medication. During our first meeting he looked exhausted. Through my initial questions he was able to paint the picture of a dad who works a physical job he enjoys, is a primary caregiver for his two rambunctious kids and spends any available after-work time playing music gigs for extra money. As I led him through a self-reflection activity, he soon identified that his lack of sleep was affecting many areas of his life. He opted to take a break from playing music and with the extra time engage in physical activity with his kids. This resulted in his kids behaving better because they, too, got more activity and quality time with dad. Subsequently dad was able to complete household tasks such as cooking healthful meals more easily. After working together, his diabetes test improved, he had lost 15 pounds and his hypertension was better controlled.
As the health care environment shifts, physicians who align themselves with occupational therapists give their patients a better chance of meeting their health goals. Occupational therapists improve the quality of care by providing a client-centered approach that enables patients to engage more completely in daily behaviors that improve health, thereby lowering costs. The presence of an occupational therapist on the care team is a win-win situation for all involved.
Hilary Valentine, OTR/L, is a practicing occupational therapist. She is the lead occupational therapist and clinical administrator of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center. Please submit your questions to info@manakaiomalama.com.
