OT Insight
Märamatanga whakaora ngangahau
Magazine of the NZ Association of Occupational Therapists /
Whakaora Ngangahau Aotearoa (Inc)
Vol. 34 No.4
June 2013
Contents
Features:
1 & 7 Choosing and Using
Cognitive Assessments
10
An Australian Adventure
Pearson's Always
Learning Award
13
Let's talk about this!
Changing the behaviour
of certifying fit for work
Regular Columns:
4
NZAOT News
15
e-Book Review
17
Information Exchange
18
OTBNZ Report
19 CPE Calendar
Choosing and Using
Cognitive Assessments
By JoAnne Gilsenan
Cognition!
T
his fascinating subject can be fraught
with questions and concerns when it
comes to identifying cognitive problems or
skills or function. Cognition is impaired
not only by neurological disorders or
head trauma but by many chronic
conditions such as heart disease and
mental illness. Cognitive impairment is
common. It often goes undetected in
the course of standard clinical
assessments, yet it is known to have a
profound impact on an individual’s
occupational and social performance
(Hartman-Maeir, Katz and Baum, 2009;
Nokleby, et.al, 2008). Formal cognitive
screening, therefore, has an important
role in the occupational therapy clinical
evaluation process. Depending on the
assessment or screening tools chosen, a
formal cognitive evaluation can not only
provide indication of cognitive impairment, but
may also assist to determine brain pathology,
inform rehabilitation potential and possibly predict a degree of recovery
(Donovan et al, 2008; Nokleby et al, 2008; Woodford and George, 2007).
Given that assessing cognitive function is of such importance, so too is the
selection of tools used to carry out the assessment. This raises the question, how
are occupational therapists in New Zealand making decisions about which tools
to use when assessing cognition? Frequently we have chosen assessment tools
according to those available to us in our workplace. We find the assessment
template and if lucky a manual to advise us of the correct procedure, scoring
guidelines and interpretation of the results. We may also find ourselves providing
cognitive assessment using tools that are not of our choosing because they are
the traditional tools used by the team we work in. We may be doing cognitive
assessments but find the assessment tools we use lack the scope to identify the
impact of the cognitive disability on occupational performance.
Choosing an assessment tool
ISSN 1174-6556
continued page 7
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June238
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NZAOT
NZAOT COUNCIL
NEW ZEALAND ASSOCIATION OF OCCUPATIONAL THERAPISTS
Founding Officer: Hazel Skilton Executive Director: Siobhan Molloy
President
Ma-ori Perspective
WFOT Delegate
Council Member
Council Member
Council Member
Council Member
Rita Robinson ph 07 889 6485
Email: rita.robinson.ot@
gmail.com
Karen Molyneux ph 09 236 9033
Email: karendgallagher@
gmail.com
Merrolee Penman
ph 021 735 239
Email:
merrolee.penman@
op.ac.nz
Ruth Spain ph 021 1825 363
Email: [email protected]
Isla Emery Whittington
ph 021 067 1174
Email:
[email protected]
Clare Thompson
ph 021 0239 9238
Email: chthompson@
hotmail.co.nz
Jo-Anne Gilsenan
Ph 027 664 1336
Email: [email protected]
SPECIAL INTEREST GROUPS: Convener contact details at www.nzaot.com
Acute Care: Sarah McMullen-Roach • Adults with Intellectual Disability: Helen Allen • Children & Young People’s Occupational Therapy: Rita Robinson
Driver & Passenger Assessment & Rehabilitation: Kevin O’Leary • Hand Therapy: Alison Derbyshire • Health of Older People: Jill Judson • Independent Practitioners: Seeking convener now!
Leaders and Managers: Tim Dunn Mental Health: Pam Schofield • Neurology: Shona Paterson • Occupational Therapy Supervision: Ann Christie; Merrolee Penman; Carolyn Simmons Carlsson
Occupational Therapy & Sustainability: Vicky Smith • Oncology and Palliative Care: Tanya Loveard
Pain Management: Bronnie Thompson • Physical Community: Joanne Harper • Primary Health Care: Kirk Reed
Rheumatology: Seeking convener now! • Spinal Cord Injury: Seeking convener now! • Vocational Rehabilitation: Grace Imiolek
Wheelchairs & Seating: Maria Whitcombe-Shingler • World Federation of Occupational Therapy: Merrolee Penman
NZAOT OFFICE: Level 9, 85 The Terrace, PO Box 10493, Wellington 6143; Tel: 04 473 6510 Fax: 04 473 6513; E: [email protected]
EDITORIAL OFFICE: Editor: Tina Larsen. E: [email protected]. Submissions: Please refer to NZAOT website for author guidelines.
Letters to the editor may be abridged over 300 words.
Publishing & Advertising Management: Tasman Image/Adprint Ltd, Wellington, NZ. Advertising Manager: Pam Chin. Tel: +64 4 384 2844, Fax: +64 384 3265. Email: [email protected]
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Disclaimer: OT Insight is published by Tasman Image Publishing for the NZAOT (Inc). Views expressed in articles and letters do not necessarily represent those of the Association, and neither
NZAOT nor Tasman Image Publishing endorse any omissions or errors on products or services advertised. NZAOT nor Tasman Image Publishing accepts liability for its contents or for any
consequences which may result from the use of any information or advice given.
Vol.34 No.4 June 2013 3
NZAOT News
W
elcome renewing and new
members. NZAOT membership
received a small boost as we
say hello to 150 brand new members.
We are all challenged by the rapid
growth in technology - I graduated in the
early eighties and I understood computers
Siobhan Molloy
lived in rooms the size of gymnasiums, not
Executive Director on my desk or on my phone!
Congratulations – the vast majority of you
have successfully navigated the internet, downloaded modern
browsers, negotiated with your IT departments for easy access,
asked a colleague for help and activated your new member online
profile. Next challenges – have you found us on Twitter yet; have
you ‘liked’ us on Facebook or how about an APP for our
conferences?
(Editor note: The APP idea is a twinkle in Tina’s eye – not yet a
reality but we can dream).
What is the politically correct term for
someone who is not very internet savvy?
n
She lives most of her life offline, only checking email
once a month.
n
He isn’t on the grid, so the cell is the main way to
contact.
n
A proud Luddite when it comes to the net, he doesn’t
own a computer and only surfs [at the beach].
More definitions welcome. J
Retrieved 28 May: http://bit.ly/18v6mdX
NZAOT Strategic Goal 1: VISIBILITY: Everybody in
Aotearoa New Zealand understands what
occupational therapy/whakaora ngangahau is and its
value.
Championing the profession of occupational therapy/whakaora
ngangahau is what we do everyday. Making a difference about how
occupational therapy is understood and perceived is all of our
responsibilities. At an individual level every occupational therapist
shares a responsibility for representing the profession and you do this
in a number of ways with every interaction you have with patients,
your colleagues and in your personal everyday lives. The association
also has its part to play and does this through your support.
Horizontal Integration – primary health care
The primary health care special interest group tackled some meaty
questions recently. You responded to the questions:
o How
can occupational therapy contribute to a more integrated
primary health care sector?
o How
can we collectively develop capacity across the primary health
care sector to meet the workload challenge?
o What
might our shared vision for the future of primary health care
look like?
4 Vol.34 No.4 June 2013
Your insights to these questions have laid the foundation to how
occupational therapy will be represented at the multidisciplinary
primary health care leaders forum: ‘Horizontal Integration’. Member
Catherine Fink and I will participate in this forum. The aim is to set
the scene for building on ‘our collective capacity and capability
towards a more integrated primary health care service, and to develop
a shared understanding of what it means for our workforce, our
patients, and our communities’. For a synopsis of your views – see the primary health care SIG or
contact the office.
Health and Disability NGO: MOH Forum
I recently attended this forum which brings together representatives
from the health and disability NGO sector. This forum is an
opportunity to network and keep up to date with key issues affecting
the sector.
A slow-slip event?
The economic reality of New Zealand’s fiscal challenges and our
changing demographics lie at the heart of pressures building up in the
health sector and is shaping our future. The strong message has been
– health services need to be delivered differently – we cannot keep
doing the same thing and expect the same results. Doing more with
less through increased productivity and innovation continues to be the
mantra. Colin James, political analyst gave an interesting overview of
disjunctive events that have, and are shaping our lives beginning with
the first world war, the depression and subsequent wars, financial
crashes, globalisation, European destabilisation to the current global
financial crises. He believes fundamental changes have occurred and
we will not be going back to ‘business as usual’ and that the lines
between the public and private sector will become more blurred. Hon
Tony Ryall made it abundantly clear:
1. We all need to work together – that is the DHBs, PHOs, NGOs and
the private sector alongside the government departments.
2. We need to focus on results – that is setting clear objectives and
delivery against these objectives and demonstrating the differences
made.
Carpe Diem
Occupational therapists have a choice, we can observe the slow-slip
event (a prolonged silent earthquake), and find the world may have
moved on with or without occupational therapy - or we can seize the
day and become part of the journey.
President, Rita Robertson says: “We all need to take time to
think about the issues at stake; think about how occupational
therapy will meet these challenges and become part of the
solution. I urge members to meet in their local area networks
and debate – what will occupational therapy look like in 2020
and beyond. The reality is, there will be less occupational
therapists per head of population, there will be many more older
people requiring services – and there will not be a bottomless pit
of money to support every innovation and idea. How are we
going to lead the charge to deliver occupational therapy
differently, to work together across the sector, to focus on results
and at all times keep the client (whatever and whoever the client
is) at the centre. Is it time to let go of some traditional areas
where we thought we were the only ones with the expertise and
knowledge and realise that less complex tasks could be done by
someone else, leaving us to be the specialists in occupation and
practice at the top of our scope?”
For presentations or watch the video of the minister’s speech:
http://ngo.health.govt.nz/what-we-do/ngo-moh-forums/2012-2013
Independent Health and Safety Taskforce
Member Sarah Donaldson participated in the Health and Safety
Taskforce Conference in February 2013 alongside representatives
from a range of medical, nursing and allied health professional
bodies as well as various government and other industry sectors.
The taskforce are assessing our current health and safety
performance and recommending a package of practical measures
to the Government that would be expected to reduce the rate of
fatalities and serious injury by at least 25% by 2020. The main
themes of discussion were:
n urgency
for the profile of health & safety to be lifted
new agency – who, what, where
n funding for the agency
n priority of the five main industries
n systematic changes
n capability of the health & safety profession
n worker participation
n leadership
n the
The completed taskforce report is available to read: http://
hstaskforce.govt.nz/
Key outcomes desired include a new Act to be introduced along
with the proposed new operational agency (with policies and
work plans for that Agency) by the end of 2013. That a national
health and safety strategy is developed and that policy work is
funded to develop detail for differentiation of ACC levies and
business health & safety rating schemes along with corporate
liability.
The health and safety of New Zealanders is important and we
all want to get home at the end of each day, unlike the Pike River
workers and the 100 workers each year who do not return home
to their families.
Sarah says, “I was privileged to participate and give my
feedback on this important process. My feedback was varied but
largely in the area of health as my recent experience in health
promotion has further highlighted the concern of worker’s poor
health … not just ensuring that safety measures are in place. We
are all responsible for our own health; however employers can
make supportive work environments and cultures that assist us
with our individual goals in this area.”
Watch this space for long awaited change in health & safety
which will affect all New Zealanders and support healthier and
safer workplaces in the future.
ACC: Transition from hospital to home
Member Mary Butler, a member of the Consumer Outlook
Focus Group wants occupational therapists’ views on how you
think the transition between hospital and home discharge
planning processes for ACC clients is currently working.
Look out for this very important survey on the NZAOT values
exchange (http://nzaot.vxcommunity.com/) – this is your
opportunity to have a voice for your clients – be their advocates.
Mary says, "The ideal discharge process is supposed to be:
assessment – home visit – assessment after one week – and again
after six weeks. However, is this the reality; is there a consistent
navigation between one part of the transition process and
another; are expectations around social assistance unrealistic;
should cultural considerations be built into assessment; is
assessment of care fragmented; are there issues due to the criteria
around the use of transport for rehabilitation and how flexible is
prioritizing?"
NZAOT Strategic Goal 2: ADVANCING SKILLS: A
strong dynamic and sustaining association advancing
occupational therapy/whakaora ngangahau.
NZAOT Clinical Workshops ‘Reflections on Practice’
What’s in it for me?
You have an opportunity to look to your skills and practice, with a
huge range of workshops from New Zealand’s leading occupational
therapy practitioners and academics.
At the workshop you can:
n achieve
many of your CCFR goals
opportunities to improve your cultural responsiveness
n glimpse the future with an update on rehabilitation services
from ACC and examine occupational therapy practice in
PHO’s
n develop well rounded approaches to occupation focused
assessments
n take
Use this time to:
n challenge yourself
n look into new areas of occupational therapy practice
n link up with peers in similar areas of interest and focus.
Through practical learning opportunities you will leave the workshop
knowing more, with increased confidence in your practice.
Passion, drive, energy, focus, opportunities and direction all await
you. Time to stop and look up to the horizon and start ‘doing’.
What’s in it for my employer?
Your employer needs to ensure that occupational therapists are
suitably skilled, and continually develop their competencies to meet the
HPCAA registration requirements. Your employer can provide you with
a comprehensive continuing professional development opportunity
through the only three day occupational therapy focused education
opportunity this year.
Participation at the clinical workshops will provide you with
opportunities to develop skills used in everyday practice and inspire
passion and commitment in your work.
The NZAOT clinical workshop is a cost effective, time efficient and
long lasting investment in occupational therapy.
Time to come to this year’s NZAOT Clinical Workshops,
‘Reflections on Practice’, 18-20 September, Wairarapa.
Local Area Networks
In computer speak this relates to a group of computers and associated
devices that share a common communications line or wireless link.
Typically within a defined area such as a home, school, computer
laboratory, or office building.
In NZAOT a local area network or LAN refers to a group of NZAOT
members who work in a particular geographical area, regardless of their
employment situation or practice area and who meet together to share
information, ideas and advance occupational therapy together.
Auckland LAN
Cognitive bias was the topic of discussion led by Dr Barry Hughes at
the recent 30 May meeting.
➤
Vol.34 No.4 June 2013 5
➤
Waikato LAN
Carolyn Paddy has answered the call and “would like to get the ball
rolling” so has volunteered to organise the next LAN meeting. She
says, “Some of my cohort went into roles where there was no
other occupational therapist to provide support and I think as we
branch out into new areas this is going to become more common. I also really enjoy hearing what other people are doing, along with
socialising and networking - if you do too, come along and join
the Waikato LAN. Details of date, time and place will be e mailed
individually in the near future.
If you wish to notify your interest, please contact Carolyn. carolyn.
[email protected]
NZAOT Strategic Goal 3: ORGANISATIONAL WELLBEING:
The association is equipped to deliver the strategic goals
in alignment with its vision, mission and values.
Leadership and Representation Opportunities
What better way to champion your profession and develop
leadership skills than by standing for election to the NZAOT council.
The council comprise seven members: the president, the delegate to
the World Federation of Occupational Therapists, the Mäori
perspective and four council members at large. Three positions will become vacant at the AGM (19 September):
1. president whose role it is to provide leadership and direction for
the association
2. council member at large
3. delegate to the World Federation of Occupational Therapists
ANNUAL GENERAL MEETING
New Zealand Association of
Occupational Therapists/Whakaora
Ngangahau Aotearoa (Inc)
Thursday, 19 September 2013, in conjunction with the
NZAOT clinical workshops in Masterton.
Notices of Motions
Members are entitled to submit an agenda item or notice of
motion for the consideration of the AGM.
Such agenda items, notices of motion and nominations to
council must be in the hands of the executive director (acting
on behalf of council) to [email protected] by 5pm, 1
August 2013.
Nomination forms can be downloaded from:
http://www.nzaot.com/about/council/about.php
All motions must be written in clear, positive language and
signed by both proposer and seconder – who will be members
entitled to vote at a meeting of members. All motions must be
accompanied by position papers/rationales to clarify the
reasons for the motions.
Nomination forms available online – http://www.nzaot.com/about/
council/about.php and are due by 1 August 2013.
Honour and Recognition
SIGHT LOSS
SERVICES
CHARITABLE
TRUST
Two fantastic opportunities to nominate your colleagues –
closing date 30 June 2013.
n Hazel
Skilton Founder’s Award for recognition of service to
people (open to full and retired members of NZAOT excludes
student and associate categories). n NZAOT
Achievement Award for recognition of exemplary
practice (open to full members of NZAOT excludes student,
associate and retired categories).
Full details and nomination forms in the February OT Insight or on our
web site:
http://www.nzaot.com/about/awards/Hazel.Skilton.Founders.
Award.php
http://www.nzaot.com/about/awards/occupational.therapy.
achievement.php
Professional Indemnity
Are you in private practice? Have you taken out professional
indemnity?
Find out more here:
http://www.nzaot.com/about/membership/indemnity.php
Existing members who already have professional indemnity cover
will be sent an e-bill for renewing their indemnity cover in late
June, and will also have to fill in the application form.
New to indemnity insurance – download your member form at the
above web address.
6 Vol.34 No.4 June 2013
OUR GOALS
• To promote awareness of low vision and the needs
of people who have experienced loss of sight.
• To provide equipment, information, advice,
support and education for people with low vision,
their families and rehabilitation professionals.
OUR SERVICE
• Low Vision Centre in Auckland including
consultations with Low Vision specialist
optometrist, non-optical aids and reading lights.
• Information booklet and pamphlets.
• Website with information and catalogue of
non-optical aids, lights.
• 0800 phone line advice.
For more information and availability of low vision aids:
www.sightloss-services.com
Continued from page 1
Choosing and Using
Cognitive
Assessments
I
n this article, I will present information on
choosing an assessment tool. I will provide an
analysis of three standardised cognitive assessments
which I have used in practice, outlining the rationale for
choosing the tools, including the strengths and limitations of the assessment. The
assessment tools discussed are: the Allen Cognitive Level Screen – 5 (ACLS-5); the
Cognitive Assessment Scale for the Elderly™ (CASE); and the mini-mental state
examination (MMSE). It is hoped that this information will support therapists to make
discerning choices about the tools they use, and to look at the qualities of assessment
tools not covered in this article to verify their relevance and usefulness in their work
settings.
By JoAnne Gilsenan
Dementia Education Co-ordinator,
West Coast DHB
Ko Ngati Apa Ki Te Ra To,
ko Kai Tahu toku Iwi
Ko Puaha Te Rangi toku Hapu
Ko Inangahua ahau
Ko Jo-Anne Gilsenan toku ingoa
My interest in cognition and the
assessment of cognition was born
early in my career and I sought to
identify the most useful assessment
tool to describe the impact of
cognition on occupational
performance. I am a current
member of the Allen Cognitive
Network and served as a board
member and member of the
Leadership Team for this
organisation from 2008 until 2011.
As an occupational therapist I have
worked in both mental health and
physical settings.
Choosing an assessment
The choice of an appropriate assessment tool requires sound clinical reasoning. It is
important to consider a number of factors such as: the appropriateness of a cognitive
assessment to the individual being assessed; ethical concerns such as consent; time it takes to
carry out the assessment and the impact of this on the individual; the purpose of the
assessment - will it answer the question you want answered; the reliability and validity of the
assessment - the theory base supporting the assessment. It is also important to know what
information the assessment will provide, and what level of knowledge is required to interpret
this information so it is relevant to those receiving it (Hartman-Maeir, Katz and Baum 2009;
Vancouver Coastal Health 2011).
Additionally, assessment choice will depend on the role of the therapist and the setting they
are working in. Considerations based on the therapists case load, time frames and outcome
expectations will determine the type of assessment required. In an acute setting focused on
discharge planning, for example, a brief screening assessment will be useful; whereas in
rehabilitation, a more comprehensive evaluation process is necessary. Regardless of the
setting, an assessment which provides the greatest range of information is preferable. It is
useful also to regard the ongoing value of the assessment in terms of re-assessment or
validation of the initial results, particularly if the individual assessed is transferring to another
department or service.
Occupational therapists have the unique perspective of viewing cognition in relation to
everyday task performance. This impact of cognition on activities of daily living is known as
functional cognition (Austin, 2006; Donovan et, al, 2008 Pollard, 2010). Many of the
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Vol.34 No.4 June 2013 7
assessment tools available for assessing cognitive ability have been developed
from a neuropsychological perspective. They focus on the assessment of
cognitive domains such as aphasia, apraxia, attention, language, calculation,
memory (both short and long term), processing speed, orientation, executive
function, perception, abstract reasoning and so on. (Douglas, Letts and Liu,
2007; Donovan et al, 2008; Nokleby et al, 2008). A standardised assessment
tool may provide specific information to support the diagnosis of brain
pathology, or provide a profile of focal cognitive impairments to assist with
recognising functional skills and deficits. However, for a more complete,
individualised and reliable assessment of occupational performance, the use of
additional evaluations such as direct observation, an environmental
assessment, and feedback from family and other supports will be required
(Donovan et al, 2008; Hartman-Maeir, Katz and Baum 2009).
Allen Cognitive Level Screen – 5 (ACLS-5)
The key elements in Claudia Allen’s Cognitive Disabilities Model (CDM)
strongly link cognitive processes to occupational performance. In 1985
Allen defined a cognitive disability as a “restriction in sensorimotor actions
originating in the physical or chemical structures of the brain and producing
observable and assessable limitations in task behaviour” (p.31). The CDM
describes a co-existing hierarchy of cognitive abilities and activity demands
which make up the Allen Cognitive Levels. These levels are described in an
ordinal scale ranging from level 1.0 to 6.0 with level 1.0 being a state of
coma and level 6.0 being an ability to apply abstract reasoning. The Allen
Cognitive Level Screen (ACLS) was developed as a tool to identify an
individual’s functional cognitive ability as per this scale which emphasises
global rather than focal cognition. (Allen, 1985; Austin, 2006; Pollard,
2010). The theory encompasses the concept of the ‘just right fit’ which
takes into consideration what the individual CAN do, what they MAY do
and what they WILL do. The CAN do, indicates biological capability; MAY
do, supported capability; and WILL do, is based on individual preference.
This cognitive assessment is an occupational therapy tool and HartmanMaeir (2009) claims it is the “only cognitive screen developed in
occupational therapy” (p.7). It has a strong theory base to support
interpretation and is backed up by extensive research. (Allen et al., 2007,
Hartman-Maeir, Katz and Baum 2009). The administration and scoring
criteria has been revised regularly with the fifth edition published in 2007.
Strengths:
l
Short administration time – 15 to 30 minutes
l
Portable – able to be administered in any setting comfortable for the
individual
l Occupational performance based
l Very clear, easy to follow administration and scoring instructions
l Not reliant on verbal skills
l Extensive research demonstrating reliability and validity
l Strong theory base
l Occupational therapy designed
l Provides reliable information
l Suitable to use with a variety of diagnoses
l Predicts functional cognitive abilities
l Cross-culturally sensitive
l Generally perceived as a positive experience by individuals being assessed
l Retest is possible at and below 4.4
l Part of a battery of assessments to use for validation of scores and
treatment evaluation
Limitations
l
More rigorous standardisation has increased the cost of the Allen
Cognitive assessment tools
l Requires a sound understanding of the CDM theory to provide accurate
interpretation of results – this entails training and a time commitment
l Unable to be used with individuals with a marked visual impairment
l Not suitable for use with children
(Douglas, Letts and Liu, 2007; Tancock; Allen et al., 2007; Earhart, 2006)
8 Vol.34 No.4 June 2013
Cognitive Assessment Scale
for the Elderly™ (CASE)
The CASE is a screening tool designed to diagnose
cognitive impairments in the elderly, particularly those
which arise from diseases linked to old age such as
dementia. It was created as an intermediary alternative to
very short screening tools and lengthy neuropsychological
assessment batteries. The CASE has 103 items which are
grouped into ten categories:
1. Temporal orientation
2. Spatial orientation
3. Attention, concentration and calculation
4. Immediate recall
5. Language
6. Remote memory
7. Judgement and abstraction
8. Agnosia
9. Apraxia
10.Recent memory
Each category has a score of 10 and there is an overall
score of between 0 and 100. The mini-mental state
examination (MMSE) is also carried out as part of the
assessment and scored separately. Once the scores have
been established, they are transferred to a cognigram which
is a graph of the results. The graph can then provide a
visual comparison of results with the normative data. This
comparison allows the assessor to compare the results of
the individual to the group scores of others in the same age
and education range, thus determining the presence of
cognitive impairment and potentially identifying a profile of
decline to support a diagnosis. (Geneau and Taillefer,
1996)
Strengths:
l
Administration time is less than that of more
comprehensive neuropsychological assessments
l Easy to learn and straight forward to administer
l Clearly defined administration criteria
l Well researched normative data for both normal subjects
and subjects with a diagnosed organic cerebral syndrome
l Can be used as a screening tool to monitor treatment
and to track cognitive changes
l Cognigram provides a visual representation of the results
which illustrates areas of deterioration and a clear
comparison to the normative data
l Supports the identification of focal cognitive abilities
which can support interpretation of functional concerns
l Has reproducible directions and scoring sheets (even
though copyrighted)
l Low cost
Limitations:
l
Abilities measured by the sub tests imply cognitive
mechanisms but don’t directly measure cognitive
functions
l Administration time is between 45 and 90 minutes – can
be arduous for individuals with cognitive and physical
impairments
l Not suitable for those with language difficulties
l Can trigger negativity and frustration if the individual
being assessed perceives a sense of failure
l No reliable functional cognitive outcomes
l Limited information obtained from results
l Cultural bias to Canada and the USA
l Not recommended in the presence of illiteracy or
language disabilities
(Geneau and Taillefer, 1996)
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Mini-Mental State Examination (MMSE)
The MMSE was designed in 1975 as a brief screen initially for
detecting the difference between organic and non-organic
cognitive disorders. Now used for screening and monitoring
dementia and delirium. It is the most commonly used cognitive
screening tool in Canada, the USA and the UK. It consists of six
categories resulting in a score out of 30. Interpretation is based
solely on the total score. The scope of this test is purely to identify
the presence of cognitive impairment specifically caused by
dementia. (Douglas, Letts and Liu, 2007; Donovan et al, 2008;
Woodford and George, 2007).
Strengths:
l
Administration time is very brief
l Good for identifying memory impairments
l Well known requiring little explanation of results
l Numerous studies supporting sensitivity and specificity
l Low cost
Limitations:
l
Scores dependent on the individual’s education level
Cultural barriers
l Skewed results can occur if the test is carried out in either a
familiar or non-familiar environment
l Not recommended for use with individuals with language
difficulties
l Poor inter-rater reliability
l Limited range of cognitive components included in the test
l Limited ability to detect a range of dementia types
l Data is unreliable for prediction outcomes
l Inconsistent outcomes: a score of 0 might not indicate a
cognitive impairment, just as a score of 30 might not indicate an
absence of cognitive impairment.
l
Conclusion
The choice of a cognitive assessment tool strongly depends on the
information required to implement appropriate treatment. As
occupational therapists, our professional concern is with occupational
performance. With this in mind a key question to answer when
considering which assessment to choose is how well will this
assessment tool provide information about functional cognition? The
level of knowledge a therapist has about the tool they are using will
also influence the degree to which they can interpret the results. It is
therefore recommended that prior to using any assessment tool a
level of research is carried out. It is useful to have information about
more than one tool flexibility in choice, as one assessment tool may
not be suitable for all situations, and for an in-depth analysis of an
individuals need, a range of assessments may be necessary. If limited
time is a factor in the choice of assessment tool it is important to
identify one that offers a broad scope of appropriate information.
Learning in your time at your place
Courses which will fit with your lifestyle
Opportunities to network with like minded therapists
Select the courses that are relevant to you to create
your own unique PG Cert/Dip/Masters
Semester Two, 2013
29 July—29 November (14 taught weeks plus breaks)
Clinical Reasoning
This course will provide students with new ways of understanding
therapists decision making processes.
Vocational Rehabilitation
This course aims to provide both evidence based theory for effective
disability management and return-to-work planning, as well as the
foundation practical skills that therapists use to assist employees to
successfully return-to-work. Pre-requisite entry criteria applies.
Occupational Therapy in Primary and Population Health
There are significant opportunities for occupational therapists to
work within primary health. This course will help therapists position
themselves to provide such services.
Supervision for the Helping Professions
This course is designed to enable students to explore and critique
current models of supervision and the practice of supervision in relation
to their own supervisory practice. Students will have an opportunity
to develop and justify their own framework of supervision with
consideration to their own strengths and areas for growth.
Specialty Practice
The aim of this course is to facilitate occupational therapists with
specialist experience to examine the diverse roles and responsibilities
of the specialist practitioner. Using examples from their practice and
exploring the relevant literature the course will enable therapists to
articulate and be more explicit about their specialist knowledge and
skills.
Negotiated Study
This course provides students with the opportunity to explore in depth
a topic of special interest related to their occupational therapy practice.
Students must have already successfully completed two postgraduate
level courses to be eligible to enrol in this course.
*all courses offered are dependent on meeting minimum enrolment numbers
Contact us now to discuss your study options or to receive
our regular Postgrad Post (newsletter). Contact:
Debbie Davie
Postgraduate Administrator
Email: [email protected]
Penelope Kinney Postgraduate Programme Coordinator
Email: [email protected]
Forth Street, Private Bag 1910, Dunedin
0800 762 786 www.otagopolytechnic.ac.nz
www.facebook.com/OtagoPolyOT
Reference available on request.
Vol.34 No.4 June 2013 9
An Australian Adventure
Pearson’s Always Learning Award
by Glenda van de Ven-Long
A
travel-worn pack remains as evidence of a very busy three weeks conducting a
self-guided study tour in Australia. As the Pearson’s Always Learning Award
winner of 2012, the adventure I embarked on was to research working with
people exhibiting challenging behaviours as well as multiple and complex needs. A
personal focus of mine, I attended advanced training and met with expert
occupational therapists in this field.
Weeks in the planning, air tickets purchased, itinerary in hand, back-pack in the
luggage hold; I was still pinching myself as I boarded the plane, not quite believing
that I had been given this extraordinary opportunity to extend my learning in an
area I feel passionate about. Not only did I have the opportunity to learn about
recent research findings and evidence based interventions based on proven models
of practise, I was about to have the opportunity to see the models in practice.
I have sorted out my learning into a meaningful summary by asking these
reflective questions:
n What did I learn?
n So what?
n What now?
What did I learn?
Glenda, R, with her cousin Lauren at the
Healesville sanctuary in Melbourne.
Glenda is a self-employed
occupational therapy practitioner who
has had a rewarding and challenging
career as an occupational therapist in
New Zealand, Australia and the United
Kingdom in the fields of mental health,
various physical settings and also as a
health educator.
In September last year, Glenda van de
Ven-Long was awarded the Pearson
Always Learning Award for Occupational
Therapy. The Pearson Always Learning
Award was established to give
occupational therapists a chance to
pursue professional learning activities
that they feel passionate about. Glenda
received $5,000 towards professional
development.
Clinical practice is guided by research, and the knowledge gained enables
occupational therapists to select appropriate models of practice, to prioritise
treatment approaches, and to structure their own professional development.
Grahame Simpson, Senior Research Fellow/Research Team Leader and a clinical
specialist of the Liverpool Brain Injury Rehabilitation Unit in Sydney arranged for
me to visit the unit. He provided me with 1:1 training on the ‘Challenging
Behaviours Project’, a study undertaken by the New South Wales Brain Injury
Rehabilitation Directorate for the Agency for Clinical Innovation. This research was
of particular interest to me. The objectives of the project were:
1. Establish prevalence of challenging behaviours after traumatic brain injury
2. Examine the course (time-span) of challenging behaviours
3. Determine the major co-morbid factors related to challenging behaviours
4. Examine the personal, carer and service burden of challenging behaviours
1. Prevalence
The study found that the prevalence of challenging behaviours after traumatic
brain injury (TBI) is high - 53% of clients in the study (659 clients in total) met the
criteria for challenging behaviour. The three most prevalent challenging
behaviours were: inappropriate social behaviour; verbal aggression; and adynamia
(lack of initiation).
So what?
n Addressing
challenging behaviours is a matter of core business for occupational
therapists, therefore, therapists require skills in behaviour management.
n Inappropriate social behaviour, verbal aggression and adynamia are often the
reason why people are excluded from participation opportunities in the home
and community. Research can now support occupational therapists prioritising
treatment interventions to target these behaviours.
2. Course
The study found that the prevalence of challenging behaviours remained
unchanged over the three month period. There is evidence that the course of
challenging behaviours can persist post-injury for many years and even worsen
with time (Sabaz, 2011, Todd et al., 2004).
So what?
n A
lack of participation in life roles is a predictor for challenging behaviours
developing in a person after TBI.
n Understanding this enables occupational therapists to focus on community and
life role integration at an early stage to prevent challenging behaviours
becoming entrenched patterns of a client’s function.
10 Vol.34 No.4 June 2013
3. Co morbidity
Co morbidity factors such as drug and alcohol use and mental
health were found to be significantly related to the presence of
challenging behaviours as well as the level of cognitive impairment
and disability (Sabaz, 2011).
So what?
n This
knowledge assists occupational therapists to plan their
professional development pathway. Up-skilling in best practice in
the area will enable therapists to provide and support integrated
treatment approaches, the assessment and identification of mental
illness and drug and alcohol use, and the treatment of these
conditions.
4. Burden
The study showed that, when compared with people not displaying
challenging behaviours after a TBI, the burden of challenging
behaviour was demonstrated in reduced participation in life roles for
the person; high levels of care and support need for the family;
increased demand on services; and elevated levels of unmet need.
The Challenging Behaviours Project identified that a client’s
exclusion from services and participation in life roles is both a
consequence and a contributor to the development and maintenance
of challenging behaviours, particularly when there is no meaningful,
supported participation opportunities provided for them. Several
studies (Sloan et al., 2004, 2009 and Todd et al., 2004) have
demonstrated that when a person begins to engage in meaningful
community activities successfully, then challenging behaviours reduce
- even when this occurs many years after the initial injury.
So what?
interventions aimed at reducing participation restrictions are targeted.
The research conducted on this model is well worth a read.
The Behaviour Consultancy Model
Diverge; a behaviour consultancy has developed a six-stage
framework for the management of challenging behaviours in the
community. I had the privilege of receiving two full days of training
where I observed clinicians in action with clients in their homes
implementing the framework. The framework includes: site visits;
crisis management; engagement; intervention; education; and
on-going review. It is often assumed that the person with the brain
injury should be the target of change; however, this framework
acknowledges that - due to their brain injury - the client may have
very limited potential to change. An emphasis is therefore placed on
setting realistic expectations and structuring the person’s
environments.
The Transitional Dependence Model
Ermha is a community organisation supporting the recovery of
people who are experiencing the effects of a severe mental illness and
those with complex needs associated with a disability (brain injury),
substance use or housing instability. The Transitional Dependence
Model was developed by Ermha and is a comprehensive model of
support designed to provide the program structure, staff development
and culture required to support positive outcomes for people with
complex support needs. I had three fantastic days immersing myself
in the service and receiving 1:1 training. At the heart of everything I
observed was a deep respect for the people who used the Ermha
service. The Transitional Dependence Model assumes that behaviours
of concern are a way for the client to communicate their unmet
needs. The model uses the principles of reflective practice that
Skills in facilitating ‘upward spirals’ of positive behavioural change
will enable clients to sustain successful integration into their
community and life roles.
A ‘whole-of-client’ approach is required, considering all factors that
impact on supporting a client’s positive behaviours in the community
including: environmental modification; education and on-going
supervision for the client’s family; support workers and members of
the community involved in the person’s daily life.
What now?
The next step towards assisting clients with challenging behaviours
to achieve successful community participation is a hefty dusting of
evidence-based models of practice, and skilled occupational therapists
to implement them. During my three weeks in Australia I met with
seven different rehabilitation services and one occupational therapy
network group in Sydney and Melbourne. Three models that I
observed in use in Melbourne in three different services that stood
out for me are:
The Community Approach to Participation
Sue Sloan, an occupational therapist and clinical neuropsychologist
established a private practice in 1994. She teaches at Monash and
LaTrobe Universities, has published her work and is a frequent
presenter at conferences. I spent two full days receiving 1:1 training
from Sue and observed occupational therapists working with clients
in the client’s homes and in the community, applying the Community
Approach to Participation Model that Sue and two of her colleagues
have developed. The Community Approach to Participation
advocates a participation focused approach using participation
orientated assessments, rather than an impairment-focused approach.
Directly focusing on participation as the desired outcome of
interventions enables the therapist to address not only the injury
related factors, but also the environment, and personal factors that
may facilitate or impede role performance (Sloan et al., 2009). This
model assumes people can increase their level of community
participation despite complex persisting impairments. Therefore,
Vol.34 No.4 June 2013 11
enables clinicians to examine their behaviours and responses to
clients, thereby supporting the creation of positive environments. The
model asks “what can I change?”, rather than, “what does the client
need to change?” The goal of these guided reflective practices is to
continually ask “under what circumstances does this person behave
appropriately and how can we participate in the creation of that
environment?” (Crinall, 2012).
implement the environmental and antecedent change. This structure
based on clinical reasoning and research promotes success and assists
a person to compensate for severe and ongoing impairments to
ensure the sustainability of participation.
For more information on the research and models of practice
described in this article contact Glenda at glenda.vandeven-long@
hotmail.com or cell: 027 344 0382.
All three models emphasise:
References:
high level of therapeutic relationship between the client and the
1. Crinall, S. (2012). The Ermha Transitional Dependence Model of Support:
professional. It is seen as a vital element in supporting effective and
Increasing independence for people with dual disability and high and complex support
long lasting positive behaviour change and increasing
needs. Ermha Service Development Unit.
independence.
2. Kelly, G., Brown, S., Todd, J. Kremer, P. (2008). Challenging Behaviour Profiles
n consistency of approach across all those involved with the client.
of People with Acquired Brain Injury Living in Community Settings. Brain Injury, 22 (6),
This is crucial for long term success.
457-470.
n a long term view. With ongoing reviews enabling appropriate
3. Sabaz, M. (2011). NSW Brain Injury Rehabilitation Program: Challenging
interventions as the person’s life situations change.
Behaviours Project: Adults: Brain injury Rehabilitation Directorate NSW Agency for
n a diminishing approach with planned, structured and regular
Clinical Innovation, 1-68. ISBN 978-1-74187-635-2
reduction of interventions. Typically a high level of initial
4. Sloan, S., Callaway, L., Winkler, D., McKinley, K., Ziino, C., Anson, K. (2009).
intervention followed by a period of consolidation during which
The Community Approach to Participation: Outcomes Following Acquired Brain Injury
supports are scaled back.
Intervention. Brain Impairment, 10 (3), 282-294.
n a
Conclusion
It was no surprise to learn that participation in life roles is one of
the key factors for preventing and/or minimising challenging
behaviours. However, there are many skills required to successfully
achieve this. Community rehabilitation goes beyond simply placing an
individual in a community situation such as a leisure group.
Occupational therapists are the experts at identifying a person’s
interests and activities; guiding the selection of appropriate
environments in which activities take place, and matching the
person’s skills to the demands of these situations. Factors such as
simplifying and grading tasks, engagement, and on-going education
of those people surrounding the person are crucial because they
5. Sloan, S., Callaway, L., Winkler, D., McKinley, K., Ziino, C., Anson, K. (2009).
Changes in Care and Support Needs Following Community-Based Intervention for
Individuals with Acquired Brain Injury. Brain Impairment, 10 (3), 295-306.
6. Sloan, S., Winkler, D., Callaway, L. (2004). Community Integration Following
Severe Traumatic brain Injury: Outcomes and Best Practice. Brain Impairment, 5 (1),
12-29.
6. Sloan, S., Callaway, L., Winkler, D., McKinley, K., Ziino, C. (2012).
Accommodation Outcomes and Transitions Following Community-Based Intervention for
Individuals with Acquired Brain Injury. Brain Impairment, 13 (1), 24-43.
7. Todd, J., Loewy, J., Kelly, G. (2004). Managing Challenging Behaviour: Getting
Interventions to Work in Non specialised Community Settings. Brain Impairment,
5 (1), 42-52.
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Changing the behaviour of certifying fit for work
Pip Catchpole BHSc(OT), PGrad Dip (OT)
P
ip has experience with older
people, spinal rehabilitation
and hand therapy. She now has a
private practice and she specialises
in workplace assessments,
graduated return to work
programs, workplace injury
prevention and management,
functional reactivation programs
and functional job descriptions.
Getting people back to work is
a vital part of client rehabilitation,
and occupational therapists have
a key role in shifting attitudes
about the positive benefits of
prescribing time at work. This topic requires urgent discussion.
Best practice suggests an early return to work following injury
will improve a client’s health outcome1. More people appear to be
comfortable advocating time off work, rather than supporting
return to work and rehabilitation opportunities. In March 2013,
73% of medical certificates (prescribed nationally), certified clients
fully unfit. Are we communicating enough with GP’s, specialists
and employers to support our injured workers to return to work?
What is becoming increasingly evident is the need for a paradigm
shift, from prescribing time off work to prescribing time at work.
The average time people have off work after an accident
notified to ACC is several months3, but the chances of someone
returning to work decrease with every week they’re not at work:
n someone
off work for 20 days has a 70% chance of returning
FACTBOX
What occupational therapists can do
1. Support GPs and specialists: Occupational
therapists working within vocational rehabilitation can
support GPs and specialists to deliver best practice
certification of injured workers. This will enable their
client’s recovery at work. If your client has the capacity to
engage in any activity then FFSW medical certificate should
be encouraged, even if light/alternative duties are not
available at their work. This will not impact weekly
compensation. This will enable ACC to activate functional
strengthening/activity programmes to then support your
client to engage in activity, in preparation to then resuming
normal work when appropriate.
2. Education to employers: An occupational therapist
is often the first person an employer will see regarding their
employees rehabilitation. The information you
communicate to employers is pivotal in promoting the
benefits of a healthy and sustainable return to work
following injury. Often this is an opportunity to ‘set the
scene’ for your client’s employer regarding expectations
that an early return to work is part of the rehabilitation
process. You can educate on supporting ACC services
available and dispel some myths that ACC is only pushing
people back to work. The first consideration should be an
expectation for work presence – not work absence
following an injury.
to work
n someone
off work for 45 days has a 50% chance of returning
to work
n someone
off work for 70 days has a 35% chance of returning
to work1,2
Nearly all clients an occupational therapist will see will be fit for
some type of activity. Occupational therapy is the best profession
to understand the benefits behind certifying for capacity not
incapacity. We have a responsibility to consistently talk about this
and by doing so we will support a shift in culture within our health
system and communities towards an increased focus on what
people can do, not what they cannot.
A shift in overall attitudes is necessary to ensure that employers
and employees recognize not only the importance of preventing
ill-health, but also the key role the workplace can play in
promoting health and well-being.2
Our influence can make a difference and shift the paradigm
towards accepting work as an essential component of
rehabilitation. We know this is the best approach to adopt for our
clients so let’s do it. The challenge is set. Feedback and
comments are encouraged to [email protected]. Let’s talk about
this.
1. Australian and New Zealand Consensus Statement on the Health Benefits of
Work, Position Statement, Realizing the Health Benefits of Work, Australian Faculty of
Occupational and Environmental Medicine. 2012.
2. Dame Carol Black. (2008). Working for a Healthier Tomorrow.
3. Working and Health. Why being off work may do you more harm than good. NZ
Listener. 7-13 May 2011.
Vol.34 No.4 June 2013 13
14 Vol.34 No.4 June 2013
e-Book Review
Brain Injury Rehabilitation
Basics Series: A Guide to
Providing Community –Based
Intervention. Sharie Woelke (2012)
Available as a series of 7 downloadable e-books purchased
online via http://www.woelkeot.com/publications/.
Reviewed by Sarah Mather,
Director, Therapeutic Solutions Training.
The series of e-books (outlined below) are available for purchase
separately for approximately $7 CAD, or $35 CAD for the full series.
1. The Framework of Intervention
2. Symptom-Based Intervention - Part 1 3. Symptom-Based Intervention - Part 2 (Executive Function)
4. Intervention in the Home
5. Intervention in the Community
6. Intervention in the Workplace
7. Worksheets and Examples
This e-series has been designed by occupational therapist, Sharie Woelke, as a
practical guide to give rehabilitation therapists ideas and tools for planning
community based neuro-rehabilitation.
e-Book 1: The Framework of Intervention
This volume sets the scene for the series highlighting the author’s philosophies
and beliefs on the principles of community rehabilitation. It covers principles of
goal planning, creating structure in rehabilitation, therapeutic relationships and
processes. In this e-book (and throughout the series), the focus is on the
rehabilitation process rather than specific approaches and techniques in
neuro-rehabilitation.
e-Book 2: Symptom Based Intervention - Part 1
This book includes sections on attention, information processing, vision, self
awareness, fatigue, memory, sleep, motor functions, behavioural and vestibular
functions.
e-Book 3: Symptom Based Intervention - Part 2
This book focuses on cognitive functions: planning, problem solving, and
executive functions.
For books 2 & 3 there are some good practical tools and suggestions. However,
I would have liked to have seen more background theory, evidence of clinical
reasoning, and references to support content and recommendations.
e-Book 4: Intervention in the Home
The importance of a supportive and safe home environment is explored in this
section with some good templates for planning crisis situations and dealing with
day to day challenges such as meal preparation.
e-Book 5: Intervention in the Community
Engagement in community activities is the focus in this book covering: a
person discussing their brain injury with others, driving, shopping, fitness, leisure,
school activities and pre-vocational activities.
e-Book 6: Interventions in the Workplace.
This is the book that I feel is least directly transferrable to New Zealand practice.
The content covered is quite general and I consider it would most suit a general
community rehabilitation team doing a little vocational rehabilitation, as opposed
to a specialist vocational rehabilitation service.
Again, I would have liked to have seen recent and specialist vocational
references and more specifics on symptom management related to the workplace.
Sharie has presented a lot of ideas and some good checklists, however, this section
lacks a cohesive representation of the occupational therapy process over time with
a client in the workplace.
The American models of practice and funding sources for vocational
rehabilitation can differ somewhat from New Zealand practice. This means that
many practice recommendations could not always be replicated in our local
environments due to contract and funding differences.
e-Book 7: Worksheets and Examples
This volume finishes up with some general case studies and a collection of
worksheets including resources such as planning sheets, finances and budgeting.
Narrow keyboards are “in.” They minimise shoulder
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against the old 500mm wide keyboards. Posturite has a
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The vertical mouse takes the twist out of the ulna
and radius and relieves RSI symptoms. The
newest vertical mouse is the Penguin which
can be used left and right hand and has
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Check out our web site to see the products to support your
health and safety work in the office. Keep up to date and get on
our OT mail list. Email us your name and email to
[email protected] www.ooscare.co.nz
Phone 0800 667 227 “Good health “ at your work place
Cost, Availability and Use
The cost of approximately $7 CAD each represents good value in my mind but
do remember that the purchaser will need to print out and store the volumes at
their own additional cost. As the cost is reasonable, individuals may choose to
purchase all the volumes. However, they should be aware there is a degree of
repetition throughout the series - especially the first 12 pages of volume 1 which
is repeated in each volume.
Summary
Author Sharie Woelke has set out to share some of the useful resources that
she has collected and developed over the years, and packaged them into a
rehabilitation framework to assist in the treatment of neurological clients in the
community. The greatest strength of this series, is that it is designed to be a
practical tool, providing applied case studies and templates that can guide a
therapist in planning treatment sessions for mild to moderately impaired clients.
Despite the first e-book’s framework of intervention and rehabilitation
philosophies content, I would have liked to have seen some more theory and
direct application of references to display clinical reasoning throughout the series
- however I do acknowledge that this series was intended as a practical recourse,
and not a research oriented document.
The writing style is easy to follow - laid out as a manual rather than a book,
however repetition is evident when purchasing the whole series. The information
presented is not original as such and similar content could be found via other
resources. I also consider that the series could have been shortened significantly,
whilst still proving a good resource.
None-the-less the collation of content combined with case studies and
treatment suggestions could be helpful to a time-poor therapist with therapy
sessions to plan. It is obvious Sharie Woelke has worked hard to compile a
collection of useful and practical forms and tools within one resource at a
reasonable cost.
Vol.34 No.4 June 2013 15
16 Vol.34 No.4 June 2013
Information Exchange
A Credit and a Legend!
by Shirley Milligan
still), very strong and
featured on many of the
national radars. Julie held the
role of NZAOT treasurer, was
part of organising
conferences, courses, and
local area meetings. At one
such meeting therapists from
Christchurch met their West
Coast counterparts half way
Julie Shepherd, right, pictured with
at Paddy Freeny’s pub on
Shirley Milligan.
the way to the West Coast.
Julie was active in national
council meetings, OT Week, and for home hosting when meetings
were held in Christchurch; all lots of work and fun as well.
The next era (1995) was when Clare O’Hagan invited Julie to join
Therapy Professionals Ltd as the inaugural occupational therapist (a
true pioneer within the health scene). Julie assisted Clare to set the
direction for the company and she was employed by Therapy
Professionals for 17 years.
Going forward, Julie and husband Stew now have a brood of
grandsons who are key to their lives; they will no doubt get more of
her time.
All those who attended the function wished Julie and Stewart
health, wealth, happiness, and lots of fun.
In March Julie Shepherd retired after more than 30 years - and
many of those years were in Canterbury - a true Cantabrian!
Many of Julie’s colleagues and friends were there to celebrate. Her
first contact with occupational therapy was entering the sole New
Zealand School of Occupational Therapy which was located in Point
Chevalier, opposite the then Oakley Mental Hospital. Miss
Rutherford, esteemed principal, took great pride in her stewardship of
carefully selected students. Students were paid 8 pounds per week
during training, and then were bonded and placed throughout New
Zealand for two years.
Julie’s first job was back in Christchurch in the pre-renovated
Burwood Hospital and then off to Wellington to the newly
commissioned Ewart Hospital, where she worked with Mary Cook
(who attended the retirement gathering). After Wellington, Julie
headed back to Christchurch with husband Stewart and first daughter
in tow.
By the early 1970s Burwood was in the planning stages of a new
occupational therapy department and a spinal unit.
Time for family consolidation next: Three daughters, a husband
well positioned in his mental health career, and then back to work,
prodded by husband and Marion Parlane (another NZAOT member
who attended the party).
By this time, DHBs and CHEs had morphed themselves many times
and Julie has many stories of new mental health clinical areas
High TBI Burden in Aotearoa
planning (some up to plan 35!) and commencing new services, as well
Findings published in the Lancet journal in December 2012 showed
as lots of tales of service delivery.
that New Zealand’s traumatic brain injury burden especially mild TBI, is
At this point Julie had time and enthusiasm for the professional
far greater than would be estimated from the findings of previous
association – the Canterbury-Westland branch was always (and is
studies done in other high-income countries. It is six times greater
than even the World Health Organisation estimated, and far higher
OT Graduates
than that reported in Europe and North America.
Obtain your 2 years post
Research into New Zealand’s high brain injury rate has been
graduate experience while
boosted recently with six scientists awarded grants from the Health
working in Australia
Research Council to help improve the prognosis of New Zealanders
with brain injuries.
These results are a stark demonstration of the large and continuing
Occupational Therapist
shift in global disease burden away from communicable to nonMultiple Locations
communicable diseases and away from premature death to years lived
Due to recent referral increases, APM is looking for Occupational Therapists
with disability. This rising burden from non-communicable diseases
to join our team as Rehabilitation Consultants at one of our following
which include musculoskeletal conditions will impose new challenges
locations:
on health systems.
• Darwin • Gold Coast • Hobart • Launceston
• Parramatta • Sydney • Townsville • West Perth
Change the way we think and behave
Joining APM as a Rehabilitation Consultant will enable you to work with a
variety of clients to provide innovative & tailored solutions & gain experience
necessary for NZ registration, while you work.
APM has proven results in Increasing workplace productivity & performance
and a reduction of lost time, minimising & / or preventing injuries, and
returning injured workers back to suitable employment.
Who We Seek?
New Graduates; Strong writing skills; Sound communication skills; A
commitment to drive quality outcomes; Accept & drive accountability for
yourself; A sense of humour & adventure.
Benefits We Provide
Negotiable remuneration packages; Flexibility; Laptop, Smart phone,
business tools; Professional development program; Manageable & variable
caseload; Career advance & progression. Relocation Assistance may be
available. Eligibility for NZ registration upon completion of 2 years.
Does this sound like the right environment for you?
If so, we are looking for the right person to relocate to one of our locations.
For more information, please contact us at: [email protected]
www.apm.net.au
The Government has committed to a number of initiatives in
Budget 2013 to improve the lives of those that live with
disabilities, this includes $6 million over the next two years to
continue the Think Differently campaign.
Think Differently is a social change campaign to encourage and
support a fundamental shift in attitudes and behaviour towards
disabled people. It’s about maximising opportunities and focusing
on what people can do rather than what they can’t.
The campaign has an ambitious task of connecting with all New
Zealanders (disabled people’s organisations, employers, educators,
businesses, families, whänau, and influencers), providing an
opportunity for everyone to make a difference.
One of the signs of an inclusive society is that disabled people
are not overly represented in unemployment statistics.
In New Zealand, more than 60% of disabled people are
unemployed – yet the majority of disabled people (75%) don’t
need any extra support to work.
Employers, then, are one of the key audiences the Think
Differently campaign is trying to influence.
http://www.thinkdifferently.org.nz/
Vol.34 No.4 June 2013 17
aspects of the code of ethics/conduct, which internationally are
increasingly generic
That review formed the basis of the survey undertaken during April to
give people an opportunity to indicate how they thought such issues
could be addressed. The survey included: questions about how practice
might continue to change in the future; how we might acknowledge Te
Tiriti both in and beyond daily practice; and overall, whether people
thought the competencies needed a major review. Just over 400
therapists participated, a less than 20% response rate. A summary of
the responses underpin the next round of consultation.
The next step will be to hold a series of consultation workshops
around the country - each lasting about an hour and a half - providing
occupational therapists with an opportunity to have more input into the
changes the Board proposes to make. People will be able to attend
workshops whether or not they contributed to the survey. The
consultation round will also include a number of stakeholders, for
example: other regulatory authorities, the New Zealand Association of
Occupational Therapists/Whakaroa Ngangahau Aotearoa, the
occupational therapy programmes, Health Workforce New Zealand, and
particular groups of therapists such as those in private practice and
Mäori therapists. Currently we are expecting the workshops to be held
in June and July 2013 - a list of where and when they are being held will
be posted on the OTBNZ website plus practitioners will be emailed. The
workshops and consultations will help shape the proposed changes for
the Board’s consideration.
OTBNZ meets its responsibility under the HPCA to establish and
maintain the systems that ensure people receive appropriate services. It
does this through reviewing and advising therapists of its expectations.
Occupational therapists have a responsibility to practice ethically and
competently. At the clinical workshops in Masterton there will be a
presentation about these changes - come and learn what is expected of
you!
n
Review of competencies
T
he Occupational Therapy Board of New Zealand (OTBNZ) has a
review of the competencies and the code of ethics underway and
will report on this in September at the NZAOT clinical workshops in
Masterton. The review is not a short process and we are currently
about halfway through - some of you will have been involved already
and more people can expect to be involved during the next phase,
which includes more face-to-face consultation. The OTBNZ code of
ethics and competencies for registration as an occupational therapist
are both now quite old; last reviewed in 2004. Since then there have
been numerous changes in occupational therapy practice, our
understandings of the contexts of practice, and how we prepare
people for entry to practice.
Initially OTBNZ contracted one of our kuia to prepare a review of
what was happening nationally with other health disciplines and within
occupational therapy internationally. The full review is available on the
OTBNZ website under general info/policies and publications. Search for
Competencies project initial review.
Four key issues were identified:
n the uniqueness of the context of practice in this country, as other
countries do not have the detail, integrated language, or bicultural
emphasis modeled in our competencies and in those of other health
professions in New Zealand
n the focus of the competencies, as ours currently do not include
nonclinical roles such as management or education
n the nature and number of competencies, as diversifying models of
practice means our competencies may not cover the breadth of
where and how occupational therapists work
Andrew Charnock
Chief Executive / Registrar, OTBNZ
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STAIRLIFTS
Up and Down with Ease
Install a Stannah stairlift and enjoy
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NZ WIDE
CPE
Continuing Professional Education Calendar
2013
June – October
Interactive Drawing Therapy. 2013 Venues: Nationwide.
Also available Intermediate and Advanced courses, Teacher
Training and IDT Retreat. E: [email protected]
or W: www.InteractiveDrawingTherapy.com
Talking About… Professional Development Workshop
Series 2013. Newtown, Wellington. Programme available
from http://www.skylight.org.nz/uploads/files/ta-2013_
programme.pdf. For further information E: [email protected], W: www.skylight.org.nz or ph 0800 299 100.
June - November
July
October
1 – 3
He Manawa Whenua – Indigenous Research
Conference 2013. Auckland. For further information
E: [email protected]; W: http://www.waikato.ac.nz/
rangahau/hemanawawhenua
4 – 5 ‘Dyspraxia – The Manual You Were Never
Given’ Dyspraxia 2013 Conference. Auckland. Early Bird
Registration closes 21 June.
E: [email protected]
4 – 14 Clinical Reasoning Using Sensory Integration
Theory and Principles with Diverse Populations
including Autism, CP & Visual/Hearing Impairment. 4-6 July Auckland, 8-10 July Melbourne, 12-14 July Sydney
W: www.sensorypotential.com
or E: [email protected]
November
Cognitive Behavioural Therapy; Introductory two-day
workshops. Open to everyone working with people
who experience mental difficulties. Places limited, book
early. Hamilton: 13 & 14 August; Christchurch: 19 & 20
September; Auckland: 10 & 11 October; Wellington: 7 &
8 November.
For further information E: [email protected]
or W: http://www.thecbtclinic.co.nz/pb/wp_214154bb/
wp_214154bb.html
8 – 12 Association for Contextual & Behavioural
Science (ACBS) presents the 11th World Conference for
Acceptance and Commitment Therapy and Conextual
Behavioural Science. Sydney, Australia. W: http://
contextualpsychology.org/wc11
June
August
25 – 26 The New Zealand Healthcare Congress 2013
‘Innovate: Adapt: Evolve’. Facilitated by the Medical
Technology Association of New Zealand (MTANZ).
Auckland. E: [email protected] or W: http://
www.healthcongress.org.nz
27 – 28 Treating Post-traumatic Stress Disorder.
Auckland. Presented by clinical psychologist Dr Leah
Giarratano. W: www.talominbooks.com
27 – 28 Council on Licensure, Enforcement
& Regulation Third International Congress on
Professional & Occupational Regulation. Edinburgh,
Scotland. W: www.clearhq.org or Adam Parfitt, executive
director, E: [email protected]
Online CPE
Participate in recognised
professional development
in your own time, at your
home or workplace.
Register at www.onlinecpd.co.nz
Courses available:
24 – 26 Occupational Therapy Australia 25th National
conference. Adelaide, South Australia. E: danip@
thinkbusinessevents.com.au
20 – 23 ‘Forging the Future’ 23rd Annual TheMHS
Conference. Melbourne, Australia.
W: www.themhs.org or E: [email protected]
29 – 31 i-CREATe 2013 7th International Convention
on Rehabilitation Engineering & Assistive Technology.
Gyeonggi, Korea. W: www.icreateasia.org
or E: [email protected]
30 - 31 'The Body at Work 2013' Occupational Health
Physiotherapy Group Seminar 2013. Wellington.
Contact: [email protected] for further
information, flyer and registration form.
September
11 - 12 Cognition and Brain Injury. Facilitating
rehabilitation from acute to community settings.
Auckland. E: [email protected]
or W: www.therapeuticsolutions.co.nz
18-20 September 2013
NZAOT Clinical Workshops
EARLY BIRD
REGISTRATIONS OPEN
UNTIL 15 AUGUST 2013
www.nzaotevents.com
Difficulties with Handwriting:
practical tips for practical people
presented by Rita Robinson.
Develop a Vision for your Business
free to all those who register - you
do not even have to do a course!
27-28 Singapore Health & Biomedical Congress
‘Advancing a Shared Vision Toward Healthcare 2020: Synergising paradigms for a patient-centred health
system, affordable and accessible for all’. Singapore. E: [email protected] or W: www.shbc.com.sg
20 – 22 More to Life than Services international
conference. Auckland. ImagineBetter provides advice
and thought-leadership to people with disabilities and their
families. W: http://www.imaginebetter.co.nz/event_details/
p/47/c/53/More%20to%20Life%20than%20Services
December
2 – 4
Health Services Research Association
of Australia and New Zealand (HSRAANZ) ‘Doing
better with less: Enhancing health system
performance in difficult times’. Wellington. W: www.
healthservicesconference.com.au
2014
April
3 – 5
‘Koru: life, growth, movement’ 10th
Australasian Lymphology Association conference.
Auckland. W: www.alaconference.com.au.
13 – 15 NZAHT Conference 2014 New
Zealand Association of Hand therapy Combined
Conference with the Society of Hand Surgery.
Queenstown. W: http://www.nzaht.org.nz/
courseconferences.php
May
26 – 31 19th European Congress of Physical &
Rehabilitation Medicine. ‘Together for a better life’. Marseille, France. W: www.esprm2014.com
www.facebook.com
search for NZAOT Facebook
www.twitter.com
follow @CommsNZAOT
www.nzaotevents.com
2013 NZAOT clinical workshops
IN-SERVICE TRAINING:
UPDATE YOUR KNOWLEDGE
ON STAIRLIFTS IN NZ
Two hour educational (not product)
in-service sessions including
morning or afternoon tea.
Please note: Any occupational
therapist may set this as an
objective under their Continuing
Competence Framework for
Recertification (CCFR).
To arrange, please contact
Neil at Acorn Stairlifts,
0800 782 475.
Vol.34 No.4 June 2013 19
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