Module 1: CMCCE/Collaborative Practice

Question 1

What is client centered practice?

Answer 1

Collaborative approaches aimed at enabling occupation, OT demonstrates respect for clients, involve them in decision making, advocate with and for clients in meeting their needs, and otherwise recognize clients’ experience and knowledge

Question 2

What are the elements of client-centred practice?

Answer 2

Power, listening & communication, partnership, choice, and hope

Question 3

What are the three reasons that we are moving away from CCP and towards collaborative relationship focused practice?

Answer 3

Client = Individual: Too often, the client is considered an individual, when they could be a family, group, community or population

OT’s Positionality: CCP discourse ignores the impact of who the occupational therapist is (race, disability, gender expression, identity, sexuality, religion, class) and how this might impact the therapeutic relationship

Context: CCP discourse ignores systems of oppression that privilege and marginalize. These systems are built into health care

Question 4

What are the four elements of collaborative relationship focused practice?

Answer 4

1. Contextually relevant
2. Nuanced
3. Safe
4. Rights-based self-determination

Question 5

What is contextually relevant in collaborative relationship focused practice?

Answer 5

Recognizing our social positionality within larger systems - colonialism, white supremacy, ableism, heteronormativity, patriarchy shape health systems

Calls on us to be critically reflective and mitigate any conflicting values and beliefs we may have with the client

Intersects with cultural humility

Question 6

What is nuanced in collaborative relationship focused practice?

Answer 6

The therapist being critically conscious of how to build respectful relationships with the people who they work with. Seeking to understand stories through narrative reasoning and recognizing the oppressive nature of “time” in a neoliberal, capitalist society.

Question 7

What is safety in collaborative relationship focused practice?

Answer 7

Preventing harm and mitigating risk too our clients (although our clients have the right to live with risk and make informed choices)

Physical, mental, emotional, spiritual, and cultural safety. OTs should address systemic issues that create barriers to safe OT practices

Question 8

What is rights based self determination in collaborative relationship focused practice?

Answer 8

Power sharing, participation in decision making, honours rights, strengths, and abilities to make decisions for oneself (group, community)

Acceptance of diverse worldviews, respect and trust

Question 9

What are challenges to collaborative relationship focused practice?

Answer 9

Social structures, social positions, and sources of diversity which create chasms and challenges that must be crossed for therapists to be effective in their everyday practice.

Question 10

What is the Canadian Model of Client-Centered Enablement?

Answer 10

A model that depicts the interaction between the client and the occupational therapist, including enablement as the core competency of occupational therapy. It gives us language to describe what OTs do.

Question 11

What is enablement?

Answer 11

The core competency of OT, drawing on an interwoven spectrum of key and related enablement skills which are value-based, collaborative, attentive to power inequities and diversity, and charged with visions of possibility for individual and or social change.

Question 12

What are the foundations of enablement ?

Answer 12

Enablement foundations are the interests, values, beliefs, ideas, concepts, critical perspectives and concerns that shape enablement reasoning and priorities.

Includes:

1. Choice, risk, and responsibility
2. Client participation
3. Vision of possibility
4. Change
5. Justice
6. Power sharing

Question 13

Characteristics of enablement skills:

Answer 13

Interwoven and overlapping (use more than one at once)
Are responsive to clients and their context
Collaboratively informed by client and therapist
Idiosyncratically adopted by OTs (everyone is going to use these skills differently)
Can be invisible, taken for granted, and undervalued
Guided by scholarship and evidence, including client and professional judgment
Used throughout the process of practice.

Question 14

What are the enablement skills?

Answer 14

They capture the essence of OT, related to the 7 competency roles of the profile of OT practice in Canada, published by CAOT in 2007. (expert in enabling occupation, communicator, collaborator, practice manager, change agent, scholarly practitioner, professional)

Skills are: adapt, advocate, coach, collaborate, consult, coordinate, design/build, educate, engage, specialize

Question 15

What is adapt?

Answer 15

Adjusting or tailoring occupations, based on occupational analysis of the physical, mental, cognitive, social, economic, or other environmental demands and requirements of an occupation, to make suitable or fit for a specific use or situation.

E.g. Adapting the occupation of showering for a client with fatigue and balance issues by recommending the use of a shower chair and grab-bar.

Question 16

What is advocate?

Answer 16

An active skill that includes raising awareness of issues that others may not have recognized, challenging others to think differently.

e.g. Advocating for a boy with sensory processing disorder to not have his recess time taken away as a punishment because it helps him to self regulate.

Question 17

What is coach?

Answer 17

A specific conversational partnership for enabling occupational change that assists clients to clarify what is important to them, access their strengths, resources and creativity, choose goals and design and follow a plan of action to get what they want.

e.g. Working with a client with generalized anxiety disorder to identify her strengths and use those skills to revise her resume, identify connections she has in HR, and apply for a job.

Question 18

What is collaborate?

Answer 18

Power sharing - working with clients on occupational issues, versus doing things for or to them. Sharing talents and abilities in mutual respect with genuine interest, acknowledgement of others, empathy, altruism, trust and creative communication to achieve results that are greater than the sum of individual efforts.

e.g. Working with a client with a spinal cord injury to design a wheelchair that is suited for them.

Question 19

What is consult?

Answer 19

With clients, exchange views throughout the practice process, in management, education or research to confer with team members, social agencies, government or business representatives, and groups.

e.g. Consulting the social worker to better understand your client’s home situation.

Question 20

What is coordinate?

Answer 20

With clients, integrate, synthesize, and document information, link people with resources, manage teams with students/staff, facilitate interaction between teams, initiatives and stakeholders.

e.g. Connecting a client who has experienced trauma to a non-profit support association with their permission and a community based OT.

Question 21

What is design/build?

Answer 21

To formulate a plan for, to devise, or to form a strategy. Used by OTs in the creation of assistive technology, orthotics, changes in the built or emotional environment, program development and implementation.

E.g. OT certified in hand therapy builds and designs a splint for a client recovering from surgery.

Question 22

What is educate?

Answer 22

With clients, employ philosophies and practices of adult and childhood education, notably experiential and behavioural education that emphasize learning through doing.

e.g. Educating a team member on what OT can offer.

Question 23

What is engage?

Answer 23

Involve clients in doing, in participating and becoming occupied.

E.g. Engaging a child to put on a shoe with a verbal and visual cue.

Question 24

What is specialize?

Answer 24

With clients, use specific techniques in particular situations, examples being therapeutic touch and positioning, the use of neurodevelopmental techniques to enable children to participate in occupations, or psychosocial rehabilitation techniques to engage adults in their own empowerment.

e.g (embedded in definition)

Question 25

What is the enablement continuum ?

Answer 25

A continuum of how well the enablement process has gone in OT, includes ineffective enablement, missed enablement, minimal enablement, and effective enablement.

We typically fall between minimal and effective enablement - there might be limited resources or time to address all occupational issues.

Question 26

What is ineffective enablement?

Answer 26

Negative and potentially destructive, co-dependence between the OT and the client, lack of collaboration of the OT with the client (OT dominates and views self as expert), fractured relations and value clashes, incongruence/irrelevance, potentially offensive, ineffective use of resources, accountability skewed to interests for costs and not client interests.

Question 27

What is missed enablement?

Answer 27

Mutual agreement of no need for professional enablement
OR
Missed opportunity, vision, conditions for enabling
OR
Insufficient resources, unsuitable sociocultural, physical, and/or emotional conditions, unsuitable accountability for what might have been down.

Can include someone not wanting OT after receiving a referral.

Question 28

What is minimal enablement?

Answer 28

Non generative, single issue focus, mechanistic, prescriptive, risk averse to just right challenge
Over-reliance and faith in expert’s definition and prediction of risk
Sociocultural restrictions, minimal resource allocation
Accountability stresses technical interventions

Could include if the location you work at focuses on a singular issue (discharge planning) and you are not able to address other occupational issues.

Question 29

What is effective enablement?

Answer 29

Ideal outcome - positive and generative, mutual and valued process
Mediated, negotiated, values, beliefs.
Congruence and resonance
Seizing opportunities, new possibilities, grounded in hope
Balance risk taking, just right challenges
Appreciative of limited knowledge regarding risk, shared expertise and responsibility
Attentive to structured inequity, diversity, injustice in enabling individual and social change.
Accountability for enablement conditions, processes and outcomes.