My Experience with OT and Outcome Measures
If you are struggling with being consistent with using objective measures in your OT practice, I feel your pain. Let’s rally together and get our sweet buns back on the road to being evidence-based and highly justified (a.k.a. critically using objective measures).
5 Steps to How I Improved Use of Objective Measures
Convicted. That’s how I felt after doing three things.
First, Mandy Chamberlain and I had a conversation. In this conversation (via a podcast on home health) I admitted (it’s about integrity) that I have begun using more observation rather than objective and validated measures during OT assessments (except when it comes to cognition in which I am currently and actively pursuing evidence on best practice including plans to meet with Mary Platt in person the first week of June to discuss more about the use of the ACL in home health and have reviewed research from the American Alzheimer’s Association).
Take home message: I felt convicted that I needed to change my approach to using objective assessments.
Secondly, I had begun using a Find Your Flow form to address key stressful areas in my days as a home health OT. While doing this, I became more aware of how I perceived myself as having a mis-fit between a challenge and my skill level while with a patient. The scenario was that I making a strong safety recommendation and felt super stressed at how resistant the patient was to making the change.
Use of the “Find Your Flow” form helped me realize I could find a way to increase my skill in communication and documentation of the conversation in order to manage the challenge (i.e.stress) in future scenarios. According to research on flow, a low skill level (compared to the challenge at hand) can cause anxiety. I realized my skills around the area of being clear, objective and feeling confident that I was handling (and therefore documenting) it correctly were, well, in need of strengthening in order to provide me a bit more flow and less stress in my HH OT practice.
Sooooo (thirdly)...I enrolled myself in a bada** online CEU course for home health OTs. After finally finishing the full 6 hr CEU on defensible documentation by Diana Kornetti and Cindy Kraftt (who regularly consult with home health companies and therapists) I was left feeling humbled and inspired to share these experience and a few quick, do-it-today goals for others in a similar spot who were looking for practical steps to take.
According to this CEU training, Kornetti and Krafft, state the level of assist (min, mod, max) is not enough. WHY are these things happening? THAT’s the question that will lead to picking a solid objective measure. Then decide, which objective measure could help capture this? Even using at least a functional measure like the Modified Barthel Index would be a more standardized way of documenting the patient’s functional status. Doing this would help capture and emphasize the expertise of OT vs one person’s opinion, and therefore also better support future validity of our profession as a whole.
Based on even more conviction that objective measures are not only important, but are also very do-able, I’m sharing 5 short term goals that helped me make progress towards more flow in my OT evals and documentation (not to mention more evidence-based practice).
Here’s what I am committing to… and yes, they are specific and do-able short-term goals. (Your welcome. And yes, I’ll be fully honest with you in this commitment and even show you my real responses.)
1.) Therapist will (non-judgmentally) identify the top 3 reasons s/he does not currently use an objective measure in every assessment and re-assessment (within 2 weeks).
- Too stressed.
- Waiting to get it perfect before I start. (Yep, real thought.)
- Seems like it’s too overwhelming and not knowing where to start (aka room for skill development to match the challenge).
2.) Therapist will (non-judgmentally) identify the top 3 reasons why s/he is interested in using more objective assessments (within 2 weeks).
Finally ready to commit to being more evidence/best-practice based because I know that’s really what’s best also for my clients and this profession as a whole. It’s not about me. It’s about what works.
- Finally feeling more skilled and confident that I CAN do it realistically and sustainably.
- Not as stressed anymore so I have the energy to take it on.
3.) Therapist will complete at least one CEU/training on defensible documentation in his/her related practice area in order to improve documentation skills (within 2 months).
4.) Therapist will identify at least 5 objective measures which relate to key areas limiting goal achievement among caseload in order to more easily utilize objective measures on a daily basis (within 2 months).
- Modified Falls Efficacy Scale
- Modified Barthel Index
- BORG Exertion Scale
- BONUS (Recommended by Mary Platt): LOTCA-G
5.) Therapist will implement at least one form of objective measure pertaining directly to patient’s TOP goal area during 3 assessments per week for 4 weeks. (Would I like to set this for 100%? Of course. Have I learned to set the first goal to be at least inspiringly do-able? Ab-suh-friggin-lutely.)
- Done: Modified Falls Efficacy Scale (MFES)
- Done: General Practitioner Cognitive Screen (GPCOG)
- Done: Modified Falls Efficacy Scale (MFES)
The Take Home message?
I recognized an area of weakness and am doing something specific to address it. I pursued a course and built my skills (to help increase my chances of having more flow). I recognize I’m not perfect and this will take time to become more proficient...and that’s OK and worth it.
Will you join me in taking full ownership of using objective measures consistently during at LEAST evals in your practice?
“We are not advocating writing more, we are advocating writing (and evaluating) better.” -Kornetti & Kraftt (emphasis and agreement added by me)
About the Author
Monika started writing for OT Potential after working as an OT for nearly 6 years. After spending time in outpatient, acute, inpatient rehab and SNFs as a local contract OT in Nebraska, she found her niche in home health. She started writing more when she realized there was a lack of resources that emphasized effective do-it-today strategies for the home health OT. She takes what helps in her own occupational therapy practice, and creates simple, potent content to help you, her fellow OT.
She believes that as you develop unique strategies to ground and care for yourself while practicing as an OT, that your clients and practice (not to mention life) naturally become more potent and meaningful. So she writes to help support that as a vision for the world.
Her projects have ranged from a Home Health OT E-book to a newly updated Find Your Flow form for daily transformation of stressful scenarios using flow-based evidence. She is also a regular guest blogger writing about topics of flow and OT burnout home health OT and motivational interviewing. She's also served as an author at OT Practice addressing team collaboration and home health tips, and as a life coach via Polish Your Light.