Client based practice: Essential to the Occupational Therapy Discourse, but is it understood? A presentation by Brock Cook & Frances Worster at the OTAQLD14 State Conference.

1. Client Based Practice: Essential to the
OT Discourse, but is it understood?
Frances Worster
Brock Cook
#OTAQLD14

2. 2

3. 3
"Pieter Bruegel the Elder - The Tower of Babel (Vienna)

4. What is Client Based
Practice?
#OTAQLD14

5. What is Client Based
Practice?
'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)
#OTAQLD14
…..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).
“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).

6. What is Client Based
Practice?
“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.”
#OTAQLD14
…..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.”
“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.”

7. What is Client Based
Practice?
…..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)
#OTAQLD14

8. Why is CBP
important?
…and what happens when it breaks down?

9. Barriers to Client Based
Practice

10. Client Driven
Practice
#OTAQLD14
Introducing…

11. 11
Spectrum of Therapeutic Decisions
Therapist Client

12. Call to Arms
#OTAQLD14

13. References
Canadian 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
"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
#OTAQLD14
Image Reference

14. Frances Worster
frances.worster@gmail.com
#OTAQLD14
Brock Cook
www.brockcook.com