CRAFT Model - Functional Therapy's Expansion of the Wholistic View of Personhood

This is a snapshot of an interactive presentation we are developing to help consumers and therapists to better understand the interaction of Functions, Abilities and the Context in which we live.

 It embodies a globe which contains the Context of the person; the pillars represent four domains of Abilities; and the pillars support the platform of Functions or 'Things we do'. These are also known as Occupations.

In the interactive presentation we represent external supports by additional pillars and external burdens as weights. The new adage 'The more you do the more you can do!' plays into this system by the performance of functions feeding back into the diameter of the pillars; doing more means you develop more ability. The system works to try to maintain a balance and the old adage 'All work and no play makes Jack a dull boy' is represented by relative sizes of the Functions, with too much of one unbalancing the others.

This is an adaptation of several models with painstaking effort to add a significant reworking so as to avoid infringing anyone's copyrights. The CRAFT model is a reimagining of how we can propound a more integrated vision in Healthcare. It is published under a Creative Commons Copyright and we would ask that you reference us and http://www.functionaltherapist.org/ when you copy or adapt it.

"Don't worry about people stealing your ideas. If your ideas are any good, you'll have to ram them down people's throats."
- Howard Aiken

I hope you enjoy this preview of our interactive presentation as much as we are proud to present it to you.

Yours,

Ed Kaine, OTR, RFT

President of the American League of Functional Therapists

RegisteredFunctionalTherapist@gmail.com

Functional Therapy... the Next Generation of Occupational Therapy!

Discussion with a discouraged OT Grad Student.

This is a reprint of a facebook discussion with a Masters OT student. Reprinted with permission of SVS.

From: SVS June 6 at 8:18pm
Hello Ed,
It has been a while since I bent your ear about the OT field.

I have been having concerns while in grad school concerning the efficacy of OT treatment; the validity of it as a science, do people believe it helps them?
I am falling prey to adverse notions and thinking that PTs, CNAs, Recreational Therapists, Psychologists - can all do what OTs do, working as a team - and that OT will be phased out due to medicare cuts.
Family members who have aging parents have felt that OT was pretty much a waste of time and that PT was what helped.
Am I totally off base - or is there something to what I am feeling? Do you believe OT is here to stay? Do you believe that the field will continue to produce jobs and will help people?
If you share your insights with me ---I thank you!
-SVS

Response: Ed Kaine June 6 at 10:01pm

Thank you SVS for your question and I understand your concern.

Congratulations on getting into grad school working towards OT... and keep heart.

I really did think that OT was doomed when I graduated. I still believe the biggest barrier to the profession's popularity is its incomprehensible name, hence the drive to change it to 'Functional Therapy' which is closer to it's meaning and purpose. That said, I was wrong, OT, maybe as Functional Therapy, is here to stay. I actually thought that we'd just teach everyone our wholistic philosophy and our prefession wouldn't be needed; it made too much sense for it not to be adopted wholeheartedly by anyone who cared for people. I was wrong, it hasn't caught on like I expected, and thus we fulfill an essential role, the Health Care generalist.

Imagine, the profession is coming on its 100th anniversary in 2014 and it is still revolutionary in it's ideas. It is true that other fields are encroaching on the supposed territory of OT but they continue to have large gaps (as in each of the fields you mention could do a small part of what OT does). The truly wholistic philosophy of OT (as represented by the CRAFT model) is the gem of genius behind the applied science and craft of OT. It has been hard for the other groups you mentioned to grasp this core philosophy.

For example, Physical Therapy will often be consulted to find out if the patient is safe for discharge, they do this by answering the question "can they walk and not fall over?" Well, couldn't this question could be answered by anyone just looking at a patient? If they can get up then off they go. Functional therapy argues that it is not as simple as this... it is not whether you can walk with balance (though that is important) it is whether you will make bad judgements while walking that might cause you to fall. If you sat up and felt dizzy you would call for help... not so for someone with decreased attention and recall, for them an overwhelming need to go to the bathroom may override the safety message, and thus the patient falls.

How do you treat this? By doing more of it. The more you do the more you can do! And you don't do it only in a clinic but you carry it over into every day things.

OT and Functional Therapy qualify heartily as an applied science; in every treatment you have the potential to do an experiment. You see something, you hypothesize on its cause and postulate an approach, you try it and if it works you continue, if it doesn't you go back and start over. OTs recognize that if they don't see something improving within the session they are doing something wrong and should change the approach.

Most clinicians go through a phase of not knowing if they are effective. I started to wonder that maybe people were just getting better because they would anyways (despite my work). I then had a funny situation that lead to an unintentional longitudinal study.

JK had extensive brain cancer and was not expected to do very well, in fact his sisters had wondered why we were doing anything with him. I asked them to give us a chance and see if we could help, as he had wanted to be able to go home, and they agreed. I was going on vacation but I saw him for one or two sessions before I left and I had progressed him to some functional mobility in his room, got his arms moving and got him doing some functional tasks; I saw a lot of potential to get him home. I was away for one or 2 weeks and when I returned he was in exactly the same condition as when I had left (maybe worse). Within a few days I had him up, I got him walking in the parallel bars, getting dressed, playing cards and getting back to his life. In a matter of weeks he went home where he lived a few months until he passed away. His sisters came to me and were so happy that I had done that for him and I was happy too.

I would never have subjected a patient to that longitudinal study on purpose; I expected the PTs and covering OT/COTA to continue the work but they hadn't seen his potential and they didn't know the approach. The good thing is that it helped me to really know the value of OT and my own effectiveness.

I am dedicated to the field, I tend to think it would be good career for anyone, but I'm sure it has as much to do with aptitudes and interests. If you become an OT it is unlikely that you will ever need to be out of work... in fact more than most careers it affords you a way to branch out from strict health care. OT has remained in the top 10 jobs and is often in the top 5 for my whole career.

It is natural that your family doesn't know much about it, less than 10% of the population of the USA knows much about it. Even after an intensive course of OT with a patient the family and the patient often called me a PT (actually maybe more than they called me an OT). OT is nearly unknown, despite this it remains near the top of the careers list. Just imagine if we could popularize it beyond its humble but effective current state. I believe the field will continue to help people long after I'm gone. The idea that each of the fields you mentioned could do part of what OTs do is exactly my point, it is the fact that we can do it all and integrate it in one treatment that is the gift. The idea that everyone can easily work as a team is difficult, 'to a hammer, every problem looks like a nail', an OT is more like a whole toolbench. Health care has a lot of specialists but needs a 'jack of all trades' to bridge the gaps between them, OTs fill that role.

If you're creative, resourceful, and an excellent problem solver OT / Functional Therapy is the field for you. There are other fields that might be able to use your potential but few do it as completely as OT.

I hope you'll keep considering it, your questions suggest that you're open minded. Just imagine one field that could bring the most effective parts of the 4 disciplines you mentioned and then can integrate tools from other areas too (social work, medicine, nursing, education, etc.) It's a great field.

Yours,
Ed Kaine, OTR/L, RFT
Registered Functional Therapist RFT
President of the League of Functional Therapists, LLC.

Functional Therapy, the next generation of OT!


P.S. I may re-work this into a blog post, do you mind if I reprint your question? I would like to print your name also but if you would prefer initials I can do that too.

From: SVS June 7 at 8:48pm

What an amazing response. I thank you for it. Yes, you can publish my question, I would prefer that you use my initials.
Where did you receive your education? In Canada? It has served you well, indeed! Not to mention, of course, your accumulated work history. You'd be a great role model for any OT students who are having doubts. Do you teach?
Okay, so enough flattery!
I thank you, again and I especially like your characterization of OT as the "jack of all trades" It is such a clear description and I learned from it - that OT is unique in that it is so comprehensive - fully accounting for the whole person and how best to deliver services to that person. I wish most others had some appreciation of OT - don't we all. My sister is married to an anesthesiologist who told me to go into nursing because when money gets tight, OTs are cut. Also, my sister had no idea what OT is.
During my first fieldwork, Team meeting in the morning. The COTA seemed to be devalued by others - her opinion was rarely solicited. It is my hope that where I work the hierarchy/the system will not devalue me. I'll do what I can to make sure that doesn't happen, by speaking up.
-SVS