090: Collaboration: Experiences & Attitudes (Part 3)

Show Notes:

Overview of Themes and Subthemes

1. Factors Influencing UD Implementation (Part 1)
   1. Lack of Demand/Interest
      1. Consumers
      2. Professionals
   2. Systemic Barriers
      1. Lack of standards 
      2. Incentivization of UD implementation 
      3. The need for personalization
      4. Cost and aesthetics
2. Dynamics and Challenges of Interprofessional Collaboration (Part 2)
   1. Belief in interprofessional collaboration
      1. Value in a team of professionals working together with specific expertise
      2. Value in ongoing collaboration
      3. Professional growth
      4. Motivation to work with other disciplines
   2. Disconnect between professionals
      1. Attitudes and stereotypes
      2. Language differences
      3. Differences in processes
   3. Payment
3. Relevance to Occupational Therapy (Part 3)
   1. Therapeutic use of self
   2. Challenges OTs can help solve
   3. Availability of work

Transcript:

Sarah: [00:00:00] You’re listening to Good Fit Poor Fit. Our podcast is part of The UD Project, a small business rooted in occupational therapy that looks at how the design of a home environment impacts how well people of different ages and abilities perform everyday activities. We chat about this unique perspective to boost your knowledge and help you consider what can be changed in communities like yours.

Learn more about our work at universaldesign.org.

Hello Good Fit Poor Fit listeners, and welcome back to part three of our series in which we’re discussing newly graduated OT student Anisha Carr’s research. If you’ve joined us for parts one and two, you’ve taken a deep dive into experiences and attitudes of professionals as they share their thoughts on interprofessional collaboration and universal design within residential housing. We have [00:01:00] looked at Factors Influencing UD Implementation, and Dynamics and Challenges of Interprofessional Collaboration. And this episode is going to wrap up her research. If you want an outline of all of her themes and subtitles, I’ve listed them in the show notes as a reference.

Rebecca: So to kind of wrap it up a little bit, Anisha, what is the relevance of all of this to occupational therapy? How are you thinking that this could really impact the field?

Anisha: Yeah, so that’s actually my last theme, called Relevance to Occupational Therapy. There are three topics within this theme that I want to discuss before we wrap up this podcast. Those topics are therapeutic use of self, challenges that OTs can help solve and availability of work. First, let’s discuss therapeutic use of self.

Sarah: By utilizing therapeutic use self, OTs not only address the physical adaptations needed in a space, but also consider the [00:02:00] emotional and psychological comfort of their clients. This skill is particularly valuable in an interprofessional team where the focus may often be more technical and less on the client’s subjective experience.

The ability of OTs to bring this human centered perspective to projects can help bridge gaps between technical solutions and addressing occupation based needs of the client, ensuring that modifications not only meet physical requirements but also enhance the quality of life for individuals.

Anisha: So though the concept of therapeutic use of self was addressed throughout six of the 16 interviews, only one participant, which was an OT, actually referred to it by name. Most of the other professionals recognized the value of this special technique, but they were unaware that it’s actually a fundamental skill in occupational therapy and a significant contribution that OTs can make to the field.

Rebecca: Yeah, one participant, an architect with many years of experience working directly with [00:03:00] clients, describes his own utilization of therapeutic use of self, unaware of its connection to OT. They said…

Robert: I don’t know if it’s just that I am a good listener and a good communicator… I did an aging-in-place home assessment two months ago and there were three adult children at the table and the 78 and 79 year old. The female’s fallen a couple of times. I mean, at some point, I have my hand on his hand, we are shedding a tear, other times I’m making a joke… And making them laugh… It has to be comfortable, right?

Rebecca: This participant’s unique ability to build rapport and make the clients feel understood stands out as a significant asset in the industry, particularly when addressing sensitive issues such as aging. This ability to create personal connections not only enhances client satisfaction, but also highlights a potential limitation in other firms where building professionals may lack strong interpersonal skills. The success of these companies might be restricted due to their inability to effectively engage and communicate with clients, highlighting the value of these personal [00:04:00] skills in the industry and potential for OTs expertise in the area that are not just body mechanics related.

Anisha: So this next topic within this theme is the specific challenges that OT’s can help solve. Through their expertise and understanding occupational and functional performance, OTs play a crucial role in enhancing the effectiveness and inclusivity of accessibility related projects. Here are two examples of designers sharing their experiences with an OT and it working out well. The first is an industrial designer and the second is an architect. The industrial designer said:

Henry: Between our sales department, myself, our design department, and our marketing department, we all have opinions about what feels best for reaching or grabbing. When I talk to our occupational therapist about things, she says… ‘Well in the time that I spent in the field, this was my experience’ and then it just shuts down every one of our thoughts about like ‘oh, maybe they handle should do this.’ She’s like ‘Yeah the human [00:05:00] body is not really intended to or the wrist isn’t intended to bend that way, this way’… So I’ll say, expedited the design process… helped us become better at explaining our designs.

Anisha: This is what the architect said.

Malcolm: I don’t know about your body, and your activities of daily living now or in the future, depending on your age. That’s where I suggest, hey, let’s talk to your doctor about an occupational therapist being a part of our design team.

Sarah: I love the examples where the value of OT was seen in these quotes and how the OT helped streamline the design process with the industrial designer and show more factors in the process and in the products that needed to be considered. The architect also recognized the limitations of their expertise and where the OT’s knowledge was crucial for being a part of the team.

Another architect you shared about, Anisha, also encountered a project involving a client with complex needs stemming from Parkinson’s disease, [00:06:00] where she sought out help from an OT and a CAPS instructor to learn about how differently Parkinson’s can manifest in, different people and what might be needed to be in place now and in the future, which allowed for her to make more informed decisions about the design.

Rebecca: These three examples give us a lot of insight, and this illustrates instances where professionals recognize the knowledge gap and the need for OT input to address specific areas within OT’s scope of practice. When professionals acknowledge these gaps, they can effectively leverage occupational therapy expertise to enhance their designs and ensure comprehensive solutions that are valuable for greater inclusivity and functionality. OTs also help out with more than just the physical environment. Here’s an example of when the environment was picture perfect, but socialization was missing.

Louisa: They moved the grandma into the basement. It was super functional. It had all of the elements there. But the only [00:07:00] way she could get to it was if she walked around the side of the house. Well, what ended up happening was she moved in there, and the family upstairs didn’t really come down and visit much and… the grandma didn’t really come up much, and so she started experiencing like this social isolation, even though she was like in this beautiful space. And so there are parts of design that go beyond the design elements… and just how physically accessible it is. You’ve got to think about everything that they want to engage in. How someone’s roles and routines someone’s desires for being social. I think that’s also what an occupational therapist brings into this as well. Just being able to visit and connect with other people.

Sarah: Yeah, that’s an excellent example of an OT’s diverse set of skills and perspectives as related to the design of a home. Okay, Anisha, take us home here. Share more about our last category in regard to the availability of work. [00:08:00] I know I’ve seen the need for OTs to be in this area of practice, but all the complexities of what we’ve been talking about significantly impact our ability to be on the project for the entire time and to get paid adequately.

Anisha: Yeah, definitely. So OT’s noted issues such as low pay rates and difficulty billing for their services. Some who primarily focus on home modifications did not have issues finding work doing home assessments, but found limited availability for UD projects and opportunity to work on an interprofessional team. They didn’t have problems finding work, but they had difficulty getting paid for every aspect that they felt it was helpful for them to be there for. This sentiment is echoed by this particular OT, who emphasizes the importance of her continued presence after initial recommendations are made. However, she notes that she often has to sacrifice her own time to fulfill this role. Here’s what she said:

Ruth: All those extra visits that I made to the home during the construction phase, I didn’t get paid for that time. [00:09:00] You know, I did that specifically because I mean the state pays one rate and that’s it, even for the follow-up, you don’t get paid another for another visit so… I took my own time to go out there and and go on-site… Unfortunately, that’s just time you’re not going to get paid for… You’re investing your time, your personal time into learning it.

Rebecca: Yeah, OTs often struggle to work around the complexities of billing for the various aspects of their involvement in the process, encountering difficulties in getting reimbursed for their services. While it’s often possible to develop strategies to work within insurance frameworks and bill for all services, OTs still find themselves receiving compensation at lower rates compared to other professionals typically involved in the design process, despite their valuable role.

Anisha: Other OTs noted that they always found ways to get paid for their work. It took a lot of research and utilizing loopholes in the system they worked within. It appeared to be common for OTs to resort to working for free or picking up other jobs to supplement home mods, which I [00:10:00] believe calls for a need for more education for OTs around how to conduct home assessments and work on UD projects and be able to document their time and be compensated for it. An architect reflects on her hesitancy to bring on an OT full time, citing similar reasons to why OTs might opt for part time roles in those modifications.

Monica: So it behooves me to call the occupational therapist because they’re dealing with that all day, every day, whereas having an occupational therapist on my team would limit what their capacity is because some of my clients don’t need that.

Rebecca: Yeah, I can definitely see what she’s saying here, but in my opinion, I feel like the concept of having an OT on the team always makes sure that the projects can be as universally designed as possible. I definitely understand that when you’re running a business, there are different limitations and structures that you’re working within, but, and I may be biased, um, I think having an OT on the team could really help all the time.

Sarah: Yeah, I agree too, because I could [00:11:00] see them adding value into the homes of other people who might not have a disability yet and they’re thinking towards the future. And I’ve also seen a lot of OTs forgo the medical route to get paid and just try to get paid as the service provider with an OT background.

Many don’t find it worth it to get paid through their traditional medical payment system because it limits what they can recommend and how many visits they can see someone. Many would rather be a consultant or a concierge type model where people can just pick the services they want. Some have better success than others, depending on the structure of their business and their geographical location.

Rebecca: Yeah, that definitely makes sense. I can envision where this would be really dependent upon the geographic location, the population that you’re serving, people’s abilities to A, find out about this type of service, and B, pay for it. So, I can see where that would be really varied. And it’s unfortunate that that is the route that some folks have to take to make [00:12:00] these differences.

So, Anisha, the study underscored the complexity of interprofessional collaboration in universal design, highlighting opportunities to improve collaboration and elevate the role of OTs in universal design teams. It also emphasized the importance of education and training in universal design principles to enhance professional understanding and interprofessional dynamics.

Sarah: Rebecca, that’s a fantastic summary of Anisha’s research and a nice way to round out the last episode of this three part series to explain it. And really this is a lot of great stuff, Anisha, thank you so much for taking the time to tell all of our listeners about this, and I hope it brings about more unique ways to collaborate now that we’re digging into some of the complexities. When describing the difficulties and value of this area of practice, I have often had people, you know, come up to me and give me some suggestions.

Right. So, well, why can’t you just collaborate [00:13:00] with builders and architects? Well, we can, but it isn’t as easy as it sounds, but it sure is a valuable puzzle to figure out. You have put a lot of hard work into uncovering perspectives from a wide variety of service providers. Who all really share the same passion for UD and are wanting to find ways to make things even better for collaboration in the future. Anything else you want to add before we finish up?

Anisha: Yeah, I’m really glad that I was able to talk to all of these people. And through this study, I was able to meet a lot of different people who really had passion for this. And it gives me hope that we will be able to create, effective and efficient interprofessional collaboration teams in the future. One thing that I’d like to note about this study is the homogeneity across the group. Though the study utilized five distinct professional groups, the most significant themes were consistently shared across all of the groups. Based on my primary research and the interactions with professionals within the field, I really [00:14:00] expected to discover themes that were specific to each profession, such as architects being less open to collaboration, and OTs being the most open. However, I found it really fascinating that the participants from diverse fields shared a common passion for accessibility, which influenced the similarity in their attitudes towards collaboration a lot more than I had expected. I think that by increasing awareness about the benefits of collaboration and conducting further research on UD interventions using interprofessional teams, we can really develop better practices and create more holistic and inclusive housing solutions.

Rebecca: Absolutely. I couldn’t agree more and listeners, thank you so much for joining us today and learning all about Anisha’s very thorough and very wonderful research. And we will be back in your feed real soon.

Sarah: Thanks for listening to Good Fit Poor Fit. If you want to learn more… first, find more episodes with transcripts and show notes at goodfitpoorfit.com. Don’t forget to subscribe! Second, check out our courses at [00:15:00] go.universaldesign.org.

We cover housing topics like advocacy, collaboration, home modification, universal design and task adaptations. Lastly, if you have questions or topics you’d like us to discuss, email us at [email protected]. Thanks for fitting us into your day.