Client Based Practice: Essential to the OT Discourse, but is it understood?

Frances WorsterBrock Cook

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"Pieter Bruegel the Elder - The Tower of Babel (Vienna)

What is Client Based Practice?

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What is Client Based Practice?

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…..according to the literature

An approach to providing occupational therapy which embraces a philosophy of respect for and partnership with people receiving services. Client-centred practice recognises the

autonomy of individuals, the need for client choice in making decisions about occupational needs, the strengths clients bring to a therapy encounter, the benefits of client-therapist partnership and the need to ensure that services are accessible and fit the context in which a client lives (Law et al, 1995, p253).

'demonstrate respect for clients, involve them in decision making, advocate with and for clients m meeting their needs and otherwise recognise clients' experience and

knowledge' (p49, CAOT 1997)

“Person centred practice for older persons is treatment and care provided by health services [that] places the person at the centre of their own care and considers the needs of the

person’s carer” (Victorian Government Department of Human Services, 2003).

What is Client Based Practice?

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…..according to Therapists

“to be responsive to the family’s/carer’s ability to take on the information/therapy provided by specialists/therapists. As a consequence, our support is often provided in ebbs and flows, and even though this is not ideal to progress a client’s skills to support greater participation, I believe that this is something that must be respected: Families are often balancing many competing baskets and we are a small part of their world. Empowering families to take on more active roles in their child’s progress in therapy is so important, but must respect their competing emotional and energy reserves.”

“because goal-directed therapy is crucial to working in a rehab setting, CCP is also key as you need goals meaningful to the client to encourage participation. Working with a few clients that have TBI's, one of the main challenges I've come across is that insight, judgement, motivation and initiation can be heavily impacted from brain injuries. As you can imagine, these factors are going to influence goal-setting. I think it is essential to involve family and friends to enhance the goal-setting process to try to overcome these barriers while facilitating a structured goal-setting process to encourage self-discovery.”

“The client / family were at the centre of it and it felt like they were empowered to make the decisions (using other team members information to allow this to be informed).  Language is turned around to meet the needs of the client / family e.g. ‘What do you want to achieve’ and ‘How do we work on this together’. Open and honest communication where there is the ability for all team members (including the client and family) to share their perspective and then come to a mutually agreeable decision / point.  This sometimes means that the clinician needs to 'step down' from their thoughts / views to respect the wishes of the family, and I believe this does not take away from the integrity of the therapist / their duty of care as long as they have outlined what they would recommend and the reasons why and this is documented.”

What is Client Based Practice?

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…..according to people we work with.

“They perceived the occupational therapy environment as contrived and as limiting choices and opportunities for exploring personally meaningful occupation. A focus upon the illness rather than the individual served to diminish any partnership between the client and therapist and exclude the client from decision-making processes.” (Rebeiro, 2000)

“fear of hospitalization, fear of anger from service providers if they complained, and fear of their illness; disillusionment with service providers; poor self-esteem; and feelings of marginalization.” (Cooring, 1999)

“health care routines and technologies often require patients to be passive and submissive and that any attempts at assertiveness or control are considered to be disruptive by health care providers.” (Gerteis, Edgman-Levitan, Daley, & Delbanco, 1993)

Why is CBP important?

…and what happens when it breaks down?

Barriers to Client Based Practice

Client Driven Practice

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Introducing…

Therapist Client

Spectrum of Therapeutic Decisions

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Call to Arms

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ReferencesCanadian Association of Occupational Therapists (1997) Enabling occupation: an occupational therapy perspective. Ottawa: CAOT Publications ACE.

Corring, D. (1999). The missing perspective on client-centred care. Occupational Therapy Now, 1(1), 8-10.

Fisher, AG. (2013) Occupation-centred, occupation-based, occupation-focused: same, same or different? Scandinavian Journal of Occupational Therapy. 20(3):162-73

Gage M (1994) The patient driven interdisciplinary care plan. Journal of Nursing Administration, 24(4), 26-35.

Gage, M. (1995) Re-engineering of Health Care: Opportunity or threat for occupational therapists? Canadian Journal of Occupational Therapy. 62(4) p197-207

Gage M, Polatajko H (1995) Naming practice: the case for the term client- driven. Canadian Journal of Occupational Therapy 62(3), 115-18.

Gerteis, M., Edgman-Levitan, S., Daley, J., & Delbanco, T. (Eds.). (1993). Through the patient’s eyes: Understanding and promoting patient-centered care. San Francisco: Jossey-Bass.

Rebeiro, K. (2000). Client perspectives on occupational therapy practice: Are we truly client-centred? Canadian Journal of Occupational Therapy, 67(1):7-14

Sumsion, T. (2000) A Revised Occupational Therapy Definition of Client-Centred Practice. British Journal of Occupational Therapy, 63(7):304-309

Townsend E (1998) Using Canada's 1997 guidelines for enabling occupation. Australian Occupational Therapy Journal, 45, 1-6.Wilkins, S. Pollock, N. Rochon, S and Law, M. (2001) Implementing Client-Centred Practice: Why is it so Difficult to Do? Canadian Journal of Occupational Therapy, 68(2):70-79

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"Pieter Bruegel the Elder - The Tower of Babel (Vienna) - Google Art Project - edited" by Pieter Brueghel the Elder (1526/1530–1569) - Levels adjusted from File:Pieter_Bruegel_the_Elder_-_The_Tower_of_Babel_(Vienna)_-_Google_Art_Project.jpg, originally from Google Art Project.. Licensed under Public domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Pieter_Bruegel_the_Elder_-_The_Tower_of_Babel_(Vienna)_-_Google_Art_Project_-_edited.jpg#mediaviewer/File:Pieter_Bruegel_the_Elder_-_The_Tower_of_Babel_(Vienna)_-_Google_Art_Project_-_edited.jpg

Image Reference

Frances Worsterfrances.worster@gmail.com

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Brock Cookwww.brockcook.com