Current Trends in Occupational Therapy Practice (2021)

#1 – Telehealth and mHealth

2020 saw a spike in “telehealth” Google search and this is no doubt caused by the pandemic and the initial lockdowns around the world. Notice how after the spike for telehealth, searches for telehealth continue at a new floor just under 25 on the interest over time scale. (A value of 100 is the peak popularity for the term. A value of 50 means that the term is half as popular.)

What about mHealth and what exactly is it? mHealth stands for mobile health. It is the use of mobile devices for health management. A commonly used example of mHealth is self-triaging and self-diagnosing using websites or Apps like WebMD. As almost every teenager adult, and older adult in the United States likely has a cell phone, mHealth use will likely increase. Currently, the track record for triaging and diagnosing with mHealth is not that great.

“However diagnostic accuracy was only 34% and triage advice was considered appropriate in only 55% of non-emergent cases.” [1]Rowland, S.P., Fitzgerald, J.E., Holme, T. et al. What is the clinical value of mHealth for patients?. npj Digit. Med. 3, 4 (2020). https://doi.org/10.1038/s41746-019-0206-x This is likely to improve as the Apps get better, more data gets collected, AI becomes smarter, and the overall technology matures. Does this mean we all won’t need doctors to diagnose anymore? Not necessarily. But on the OT front, increased telehealth and mHealth adoption is a good sign for society as has the potential for humans to take control and engage in their health management occupation.

have you used mhealth recently for your own health management?

#2 – Personalization of Care

This is a trend that is becoming more common in the broader healthcare community. With the medical model, “patients” often had passive involvement in their care as the doctor often took control. “In a healthcare context “paternalism” occurs when a physician or other healthcare professional makes decisions for a patient without the explicit consent of the patient. [2]University of Missouri School of Medicine. (n.d.). Provider-Patient Relationship. Retrieved from https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/provider-patient-relationship Why are we seeing a shift towards personalization of care? One of my hypotheses is the ease of access to information, related to the trend in #1 of mHealth. Patients are becoming more knowledgeable and better informed, which may promote more involvement in their own health care management. The same would apply to clients and patients in occupational therapy. Perhaps clients may have seen a post on social media or watched a video on YouTube about a new effective intervention such as Mirror Therapy (MT) and they ask their occupational therapy practitioner what they think. This is why it is important for occupational therapy practitioners to explore different CEUs including new approaches, interventions, and technologies.

While this may be becoming more prevalent in the broader healthcare world, occupational therapy practitioners have been focusing on the client with the intention of created and fostering a client-centered relationship. Still, it is easy to overlook personalization and client-centered approaches when we face pressures of productivity, barriers with insurance, lack of equipment, poor funding, shorter lengths of stays, or other pragmatic and work-related political issues. For example, it is not always about doing the ADLs, but personalizing the plan of care to clients and what they find meaningful and want to achieve through engagement in occupations.

Continue to provide personalized care by being client-centered.

#3 – Adaptability

Adaptability was the challenge for 2019-2020 with the surge in COVID-19 cases and uncertainty. When the data was not available and procedures and protocols seemed to change every day, e.g., masks are not proven to protect us, wear a mask, we don’t have any N95’s, wear an N95, wear a mask in public and indoors, don’t wear a mask outdoors, but indoors, don’t wear a mask at all. The public is getting mixed messages (understandably) and so are occupational therapy practitioners. Habits and routines are difficult to change, but occupational therapy practitioners needed to adapt in order to literally survive (when it came to preventing disease and infection from SARS-CoV-2). Although a portion of the population in the United States is vaccinated, many remain unvaccinated and are vaccine-hesitant. Worldwide, the numbers are even lower due to disparities, access, education, and healthcare gaps. Adaptability can be seen as a good thing if occupational therapy practitioners “own it” and work with it because they can model for other professionals as well as their clients. “I got the COVID-19 vaccine because the research says it is safe, despite it not being fully approved by the FDA.”

The new handshake of 2021.

In the beginning of the pandemic, many people wanted things to go back to “normal”. Now, we think of how we currently take precautions as the “new normal”. This is adaptability. And even if the pandemic were to literally end as of tomorrow, occupational therapy practitioners will need to adapt to other trends in culture and society in order to be relevant and bring value to their clients.

Give yourself a pat on the shoulder for being adaptable.

#4 – More Inclusion

“Occupational therapy acknowledges that Western philosophical traditions and a privileged Western world-view inform how occupational therapists are educated, socialised and practice.” [3]Iwama, M. K. (2006). The Kawa model: Culturally relevant occupational therapy. Churchill Livingstone Elsevier. [4]Nelson, A. (2007). Seeing white: A critical exploration of occupational therapy with Indigenous Australian people. Occupational Therapy International, 14(4), 237–255. https://doi.org/10.1002/oti.236 [5]Watson, R. M. (2006). Being before doing: The cultural identity (essence) of occupational therapy. Australian Occupational Therapy Journal, 53(3), 151–158. … Reference List

In American culture, many advocacy groups and movements have sparked a trend for more inclusion. Black Lives Matter, LGBTQIA+ rights, Stop Asian Hate, LatinX were some themes of inclusion when America was divided during the presidential election and general politics of me vs. you. My hypothesis for why so many of us now have a voice (which can be seen as a good thing and a negative thing, e.g., bad such as conspiracy theorists) is due to the Internet, and everyone has a connected device of some sort. The Internet can give a single person a voice and allow them to be heard – for better or for worse.

I would assume that most occupational therapy practitioners are “inclusive”, especially when it comes to our clients. However, just as we have seen with other activist movements and our lack of awareness of certain cultures, we should reflect on how we act or have been acting and whether it is inclusive or not.

“Without critical reflection on Western models of health and care and associated white privilege, there is no possibility of understanding the negative effect socially sanctioned clinical practices have on the health and wellbeing of marginalised communities.” [6]Pease, B. (2010). Undoing privilege: Unearned advantage in a divided
world. Zed Books.

An example is my wife’s nursing program website. The first thing you see is an older photo (they probably have not updated their website in a while) of a group of blonde White female nursing students. I feel like this type of messaging, and it is messaging as you are advertising your program to encourage students to enroll, is very “tone-deaf” and outdated. I was immediately turned off because I felt excluded, just I had when I was growing up as a minority in San Francisco, one of the most diverse cities in the world.

Mary Reilly on criticism in her Slagle lecture from the 1960s,

“The public use of criticism by a profession has been spelled out best by Merton’ who sees it as a prevailing spirit within a group necessary to maintain a group’s progress. Its greatest usefulness is that it acts to repudiate a smugness which assumes that everything possible has already been attained. Its presence commits an association to keeping its members from resting easily on their oars when they are so inclined. In general, Merton finds that criticism stings a profession into a new and more demanding formulation of purpose and maintains a policy position of divine discontent with the state of affairs as they are.” [7]Reilly M. The Eleanor Clarke Slagle: Occupational Therapy Can Be One of the Great Ideas of 20th Century Medicine. Canadian Journal of Occupational Therapy. 1963;30(1):5-19. … Reference List

It is easy to unintentionally fall into this practice. When I look for stock photos to post for my blog posts, both free AND paid websites feature primarily white people. Occupational therapy practitioners do not only work with a particular population of people in society. People will have a hard time relating to you, for example, if you are a social media ‘advocates’ who only focus on one movement and not others. Similarly, in the spirit of inclusivity, we would not want a president who only focuses on one group of issues and is biased against the others. On the other end of the spectrum, OTs such as my professors from OT school are doing brave things to model inclusivity. They are participating in BLM, LGBTQIA+, Stop Asian Hate efforts in person and not of the same ethnicity or background.

While it may seem like I will contradict myself, there is such a thing as overdoing it and coming off as a “bandwagoner” or doing it for purely profit and without morals. My wife was having a conversation with a male nurse who was gay about how the media and brands all seemed to overwhelmingly support “pride month” this year in 2021. Many critics feel like these businesses did this as a “me too” to sell their products or services. Customers are smart and are not buying into it. The same could be said about our clients and recipients of OT services who are becoming better connected and informed. Just like with everything else in life, there is a balance.

Inclusion is a big and complicated problem in society partly because we have all gotten comfortable. However, we can start by using the power of the Internet to be less exclusive. We can participate in the inclusivity movement as occupational therapy practitioners by thinking of ways to be more inclusive of everybody starting with our own personal life.

Do what makes you uncomfortable. The more you do it, the easier it becomes.

#5 – Disconnecting and Taking Mental Health Days Off

Most of the trends mentioned so far have had some connection to technology. Technology will continue to play a major role in our lives, but it may also be invading it as well. With a cell phone, I can literally call anyone else on the other side of the planet who has a cell phone themselves (and they don’t even need to be connected by wires). And lots of people have cell phones. San Francisco ran out of 415 area codes because of the rapid adoption of cell phones. Mobile devices, computers, TV, smart home devices are becoming increasingly more invasive in our lives. These devices provide a lot of sensory stimuli that can wear on our mental health: notifications, e-mails, spam phone calls, text messages, likes and comments, zoom meetings, Amazon delivery alerts, Alexa accidentally mistaking us for using the wake word and eavesdropping on us, our Smartwatches pinging us of every little thing, our devices alerting us and needing to be recharged, and the list keeps growing.

Messaging you often see in movie theatres.

As occupational therapy practitioners, we almost have to be connected for work, school, and our personal life. If you are not, you may risk becoming less efficient and productive and ‘falling behind’. All of these devices have been taking a toll on my mental health. Lately, I have been following an “information diet” as described by Tim Ferriss’ The Four Hour Workweek. I stopped reading the news, unfollowed almost everyone on my feeds, don’t really watch TV or Netflix anymore, and primarily consume what positively affects me. Even if it still involves quite a bit of screen time, I have never been happier. I am less upset by random things I read about, get ‘triggered’ less by politics and offensive posts, and waste less time. Instead, I am becoming better educated, spending more time with my family, and being a productive member of society. This is an extreme example of “unfollowing”, but even something like temporarily disconnecting or having less screen time and taking a mental day off is perhaps all you need to “recharge” yourself. Teach this to your clients (and a teenager) too!

Have you disconnected lately? consider adopting a “low-information diet”.

References

References
1 Rowland, S.P., Fitzgerald, J.E., Holme, T. et al. What is the clinical value of mHealth for patients?. npj Digit. Med. 3, 4 (2020). https://doi.org/10.1038/s41746-019-0206-x
2 University of Missouri School of Medicine. (n.d.). Provider-Patient Relationship. Retrieved from https://medicine.missouri.edu/centers-institutes-labs/health-ethics/faq/provider-patient-relationship
3 Iwama, M. K. (2006). The Kawa model: Culturally relevant occupational therapy. Churchill Livingstone Elsevier.
4 Nelson, A. (2007). Seeing white: A critical exploration of occupational therapy with Indigenous Australian people. Occupational Therapy International, 14(4), 237–255. https://doi.org/10.1002/oti.236
5 Watson, R. M. (2006). Being before doing: The cultural identity (essence) of occupational therapy. Australian Occupational Therapy Journal, 53(3), 151–158. https://doi.org/10.1111/j.1440-1630.2006.00598.x
6 Pease, B. (2010). Undoing privilege: Unearned advantage in a divided
world. Zed Books.
7 Reilly M. The Eleanor Clarke Slagle: Occupational Therapy Can Be One of the Great Ideas of 20th Century Medicine. Canadian Journal of Occupational Therapy. 1963;30(1):5-19. doi:10.1177/000841746303000102