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Introduction

Most readers will probably agree that one of the basic components necessary for occupational therapy to survive is uniqueness. Today's healthcare dollars are shrinking at an ever-increasing pace and insurance companies want to ensure that they are paying for services that are medically necessary and that aren't being covered by another discipline. Or in other words, insurance companies want their money to go to services which are necessary and that no other provider can do better. It seems apparent that all medical professions must have a unique contribution to offer their clients. But, what is meant by the term unique?

Definitions
Unique: Having no like; unparalleled; incomparable (1)

What Makes A Profession Unique?
Without only a few exceptions, a profession's uniqueness does not lie in it's treatment approaches or interventions. For example, any qualified profession that is appropriately licensed can perform spinal manipulation. Chiropractic does not 'own' the procedures and neither does physical therapy. Another example might be the assessment tool called the Canadian Occupational Performance Measure (COPM). This tool, while developed by occupational therapists for occupational therapists, technically it can be administered by any qualified individual. So, if it's not treatment approaches that make a profession unique, what is it?

One measure's of a profession uniqueness is how a client's problems are framed. For how a problem is framed is what drives treatment, outcomes and what should be an unparalleled approach to healthcare. For example, many professions are involved in the care of an individual who has experienced a stroke. For the most part, each profession will identify the individual's 'problems' from a different perspective. The case manager may see the client as having financial problems, the Neuropsychologist may see the client as having memory deficits. The PT may see the client as having physical problems. So, how a profession 'frames the problem' is one measure of their uniqueness. How then, should occupational therapy frame not only stroke clients but all clients' problems?

A Better Way For OT to 'Frame the Problem'
There is much debate and in my opinion, much inconsistency, in how occupational therapists frame clients' problems. For various reasons, many OT practitioners frame problems using a traditional medical model approach to treatment. For comparison sake, this approach is very similar to how a PT might approach clients' problems.
Within this approach, the client's primary "problem" almost always resides with a body system of some type. In the medical model, specialists exist to address medical conditions that have medical diagnoses and that respond to medically-based intervention.
While OT currently tries to fit within this medical model, much of our history, literature and future resides not in this model, but within a unique model that more includes, psychological, social and environmental models, as well as physical models. This unique model had a name, although it is infrequently used; the model's name is occupation.
Within this model, a stroke client's "problems" are NOT that he can't move his arm or remember his name. The 'problems' are that he can't dress himself, drive the car or use the phone. In this model, the cause of the problem is that the client can't move their arm, but in and of itself, the arm is NOT the problem.

Advantages of an Occupational Frame of Reference
When OT's frame client's problems from an occupational model, they can rest assured that they are capturing the most salient desires and needs of the client. An occupational model, while unique to medicine, has numerous benefits over most of the models currently in existence. Using occupation to frame clients problems encourages therapist, clients and other health care providers to focus attention on occupation.
This model is unique but is not outside of the current medical model under what most therapist work and are paid. Much of medicine is about restoring function. The word function, while not the same as occupation (See the OTnews Letter 1:5), can be translated well enough to make occupation fit. Doing so, allows clients, referrers, and payers exposure to occupation and hence a reference to occupational therapy. If OT's never use the word occupation in our daily language, how can we ever expect others to do so either.

References
Random House Living Dictionary (1995). New York: Random House

Occupationally Yours,
Ron Carson


Welcome to the consumer section of the OTnow web site. This site is designed to inform consumers of occupational therapy's history and unique contribution to helping people regain independence and quality of life.
History
The profession of occupational therapy was founded in the very early 1900's. In its infancy, occupational therapist served in military and para-military professions to help wounded WW I veterans to return back to the community as viable and productive citizens. During the developing years of the OT profession, occupational therapists provided their clients with diversional activities which helped to keep their minds focused on areas other than their injuries. OT's had a strong humanitarian approach to care and strived to see the dignity and intrinsic worth of each and every client that received their services.

Definition
Occupational therapy is a health CARE profession concerned with helping individuals relearn or learn to occupy themselves with meaningful and important activity. OT's typically work with men, women, children and infants who are enduring trauma, acute or chronic injury or congenital defects. Humans across the life span have occupational needs and loss of occupation can signify illness and illness is reflected in loss of occupation.

Role of OT
The role of an OT is as varied as the needs of the consumer. All humans have occupational needs and wants. OT becomes involved when someone is unable or unwilling to meet these needs. For some, the needs can be a simple as not being able to brush their teeth and for others the needs can be as complex as not being able to maintain a steady vocation (i.e. employment).

Tools
What an occupational therapists does to enable clients to engage in occupation is again varied. Occupational therapist may manufacture a splint to allow the client to eat; They may provide specific treatment to allow a client to sit up and put on their shirt by strengthening weak muscles; Or the may modify the environment to allow clients to access their bathroom. Occupational therapists are often creative and see possibility where others only see impossibility.

Payment
Occupational therapy is reimbursed by most insurance provided a physician's order indicates a medical necessity for our services. In the absence of a physician's order, may occupational therapist operate on a self-pay service


Welcome to the inaugural issue of the OTnow weekly newsletter.

It is my belief that this newsletter should be for you, the reader. While I rarely run short of opinion, I truly hope that this will become not a labor of my love but of many different therapists. I hope that many of you will be encouraged to contribute information, articles, links, or feedback for possible inclusion in future issues.

The next newsletter will tackle the ever-threatening issue of expanding PT practice acts. Florida's PT Association has recently sought approval of a new act which allows the State's PT's to address self-care, community and work re-integration. While both National and State organizations are attacking this problem, I think each of us might be able to do something that will help slow the encroachment into our traditional practice area.


Introduction
Within the confines of this newsletter, it is possible to only discuss some of occupation's most salient points. Hopefully, however, this will not discourage readers to seek further understanding. While some readers may question the need to even discuss occupation, I believe that defining and understanding occupation should be important to all of us because:
(1)Occupation should be our ‘preferred’ language
(2)As a therapy profession, we "own" occupation
(3)As occupation's legitimate owners, we should be experts

Definitions
I have learned that defining occupation can be simple and easy or complex and difficult. Webster's College Dictionary defines occupation simply as:
"Any activity in which a person is engaged" p. 936
While this definition is indeed simple, it greatly undervalues the deeper and more complex meanings of occupation. There are many definitions of occupation striving to capture these deeper meaning. For example, Kielhofner’s Model of Human Occupation defines occupation as:
“doing culturally meaningful work, play or daily living tasks in the stream of time and in the context of one’s physical and social world”. pp. 3
Common threads running through other definitions of occupation include themes such as:
Occupation is the fabric of our lives
Occupation is a measure of our health
Occupation is a basic tenet of our happiness and quality of life
Many definitions of occupation say similar things but do so in a unique and different language. Perhaps, the key to understanding occupation’s deeper meaning is to find the language which speaks to you.

What it isn't

Being able to adequately and correctly define occupation includes not only knowing what it is, but also knowing what it isn’t. Often, occupation is used synonymously with activity, task, activities of daily living (ADL) and function. However, occupation is not the same as these often-confused terms because they do not encompass occupation’s deeper meanings. For example, one component of Activities of Daily Living (ADL) considers how a person dresses. However, dressing from an ADL perspective, typically does not addressed why or why not a person dresses or what the meaning of dressing might hold for a person. It is because of this lost meaning that ADL is not the same as occupation. This concept also holds true for function. Function is not the same as occupation and next month’s OTnews will address why.

Japanese 日本語訳

はじめに

ほとんどの読者はおそらく生き残るためには作業療法に必要な基本コンポーネントの1つは、一意であることに同意します。今日の医療ドルはますますペースで縮小していると保険会社は、彼らが医学的に必要があることと、別の規律によってカバーされていないされているサービスのために払っていることを確認したい。換言すれば、保険会社は彼らのお金が必要であり、他のプロバイダがうまくやることができないことであるサービスに行きたい。これは、すべての医療従事者が自分のクライアントを提供するユニークな貢献を持っている必要があることは明らかと思われる。しかし、どのような用語ユニークとはどういう意味ですか？

Favorite お気に入り

あの赤いヤツが帰ってくる。ジオンの赤い彗星、シャア・・・じゃなくて、赤いヤツ、日本の空を我が物顔で飛び回っていたあの、JALが東証に戻ってくる。なんとIPOの予想調達額は8000億。当然、業績は、2000億以上の利益を引っさげて、ANAを叩きのめしにやってくる。

ボッテガヴェネタでは珍しい、素材にPVC(塩化ビニール)を採用した、マルコポーロというバッグです。この素材のいいところは水に強く、汚れもあまり目立たないので、仕事やプライベートにヘビロテでガンガン使えます。デザインもオーソドックスで、お値段もボッテガヴェネタにしてはお手頃。梅雨の時期など、サッと拭くだけでいいので、とても便利で使い易いですし、大人カジュアルな感じがとってもおすすめです。

本物のフランクミュラーの見分け方
レザーベルトの場合、ベルト裏側の縫い目を見てください。表から見る縫い目は、本物・コピーともにあまり差が無いものが多いのですが、裏を見るとその違いがはっきり判ります。本物（③）とコピー（④）は裏側の縫い目が少し映っていますが、本物のフランクミュラーは表と同様にしっかり縫われているのに対し、コピー（④）はなんとも頼りなげな縫い目です。このようにレザーベルトの場合、コピーはベルト裏側の縫い目にまで気を配って作られていません。

１.　貸金業法１８条１項により貸金業者が弁済を受けたときに交付すべき書面の記載事項についての内閣府令（貸金業法施行規則１５条２項）は、法の委任の範囲を逸脱しており、無効である。２.　過払い金返還請求において、債務者が利息制限法所定の制限を超える約定利息の支払を遅滞したときに、当然に期限の利益を失する旨の約定は、利息制限法１条１項の趣旨に反し、無効である。

数年前に大ブレイクしたセリーヌのブギーバックが、今、私のクローゼットの中にあります。あの頃はプチブレイクしたけど、いまじゃラゲージにその座を奪われて見る影もなく、持っているとちょっと恥ずかしい感じになってきました。
そんなこんなで、新しいバッグを探していたんですが、品物の質が良くて、そこそこブランドイメージがあって、コーディネイトしやすいバックって、なかなか無いもんですね。まぁ、そんな欲張りな事を言っているので、決められないのかもしれないと思い、取りあえずはお気に入りのブランド セリーヌから何かないかなぁ・・・とネットで検索していたところ、ドストライクのバッグがありました。
それは、トラペーズというバッグでした。私はそこがいいと思っていたのですが、友人は何度も「ヘンな形」と言っています。トラぺーズってあまり聞きなれない言葉なんですが、フランス語で台形の事らしいです。見たまんまのネーミングなんですが（笑）、その聞きなれないところも好きだったりします。