I know I have written about this before, but it is essential to keep reminding ourselves of our unique selling point as occupational therapists. We put the client at the centre of our practice and work to maximise someone’s occupational performance. This can be achieved by enabling, relearning or modifying and adapting the environment so a chosen activity can be accomplished. These options are there to enable our clients to achieve their personal goals and also to support them to do the activities they need to carry out.
I become increasingly concerned when occupational therapists in my area of specialism (housing), state that they do not need to complete a comprehensive specification for the recommended housing modifications following an assessment. The specification document is key to making sure that surveyors and builders know exactly what is needed for the client and if, unfortunately, something goes wrong there is a clear and concise written record of what necessary works were required to meet that client’s needs.
Simply putting ‘level access shower,’ ‘accessible kitchen,’ ‘ramp’ or ‘wash dry toilet’ leaves the decision making up to another professional, who may have some knowledge, but nowhere near the level that an occupational therapist has. Their expertise lie in bricks and mortar and not with a client’s functional ability, any necessary carer requirements, or the interaction with their environment. This can lead to errors being made during the building process, which will ultimately impact on the client’s long-term function and their psychological wellbeing. Therefore all occupational therapists working in this field need to complete a comprehensive specification and drawing, including, but not limited to, sizes, heights, products and positions.
It is also vital to put down the specific requirements of a piece of equipment that may be needed as well as the adaptation, for example, a changing table or toilet. I understand that in statutory services you cannot be seen to favour one product over another, however you can clearly define the features and benefits of a product that are essential to meet your clients’ and their carers’ needs and if one product is the only one to meet a clients’ needs then you have a duty to state this and have your clinical reasoning documented on why only this product will suffice.
I encountered a recent clinical example of this while I was working with a colleague in statutory services. I had reviewed the adaptation requirements for a client for them and the family were happy for me to assist with the project, only to be told that it was not an OT’s job to specify what size and type of shower area was needed. On questioning this they said it was the surveyors job. The specification then went to the surveyor with very limited information and the drawings came back from the surveyor with a shower area so small not even the present paediatric shower chair could fit into it and be turned to manage the essential personal care tasks.
However I had measured the child and her equipment, observed the showering and washing routine with the carers and mum, taken into account the child’s potential growth, the shower chairs optimal position and could clinically justify a size and fall for the shower area. Once my specification and drawing had been passed onto the surveyor he redesigned the shower room to meet the client, carer and family needs.
When reflecting on this situation, it made me so upset, as time and resources were wasted, if we had spent a small amount of additional time reviewing the actual needs of the client and jointly drawn up and agreed a comprehensive specification, not only would we have had the correct drawings first time around, we would not have wasted valuable clinical time correcting the mistake.
The situation reminds me of an old proverb ‘more haste, less speed’. You make better progress with a task if you don’t try to do it too quickly, spend time getting it right the first time and more importantly, get it right for our client.
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