The CRAFT Model - Dynamic Variations of a Holistic Model - Part 5

Restoring Balance To The Platform

In the preceding scenarios we reviewed the sources of imbalance, now we will discuss a central principle of Functional Therapy, supporting function.

Let's revisit the model as it is unbalanced by a deficit in abilities. No matter the ability pillar we can upset the balance of functions. Most often healthcare professionals work to restore the physical body, in fact, most of medicine is working towards addressing physical complaints, symptoms and problems. The deficits from mental, social and motivational impairments can lead to similar imbalances.

Let's return to the person with the deficit of the motivational pillar. This might have been caused by a depression or perhaps the depression is caused by the imbalance of functions; by not performing a balance of functions you can lose your motivation. Consider the lack of balanced function as a risk for other deficits.

The CRAFT Model is a snapshot of the status of an individual; consider personal history an elucidation of which caused which, in other words we get to find out if it was 'the chicken or the egg'. I wish to popularize the idea that an imbalance in functions could lead to other deficits any of the other areas. 

In order to most effectively help a person we work to restore balance to function. In this case we depict an external support, possibly a social support, to help restore balance to the platform of functions. 

"The worst place to decide whether to get up and get dressed is in bed." - Unknown  

By supporting a person doing functional things we allow them to use their mental, social, physical and motivational abilities in  functional way. In short, "the more you do, the more you can do." They also engage with their physical environment, social supports, temporal situation and consider their cultural background more deeply. The Functional Therapist and Functional Therapy Associate works to assess the limitations and then seeks to expediently restore balance. The ability to call on the whole model and more gives Functional Therapy its strength.

OTs and Functional Therapists might occasionally find themselves off the course of purely a functional or occupational approach to care; the CRAFT model seeks to help get us back to the value of doing functional things in therapy. We must consider the paths of remediation and compensation as ways to restore function along with external support and means to seek balance in function as a reasonable jump off point for a return to living.

Thank you for reading.

Yours,


Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC

P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line. 

The CRAFT Model - Dynamic Variations of a Holistic Model - Part 4

Contextual Barriers to Function

Today we'll explore the imbalances in the model as imposed by contextual barriers. Let's review the CRAFT Model as we consider the Context Level.

The CRAFT Model is built on the Context of the individual. One premise advanced by the World Health Organization in 1980 is that environmental, or as we call them contextual, barriers can limit life roles and hold a person back from reaching their full potential. In the CRAFT Model we represent this as unbalancing the person. Let's look at the external barrier as a depiction of contextually imposed imbalance...

With or without any disability or volitional causes, external barriers can impose functional imbalances; let's consider some particular external barriers.

Cultural Barriers

The culture of a people can be hard to define but fresh eyes can often distinguish differences. For instance, in New England some basic premises are that most work days are 8 hours, that men and women work in certain careers that are somewhat gender typed, that racial prejudice is discouraged and that education is valued. In some European cultures a siesta, or afternoon period when work closes for a nap is customary, in other places it is very discouraged for women to work outside the home or even to be educated, and other stark differences in equality between different groups. Imagine the effect of a culture which prevents a little girl from learning to read, or who's family must give a dowry to have their young daughter married. These are just more dramatic examples of how the culture of a place, an institution or even a family may affect an imbalance in the roles you take on.

Temporal or Situational Barriers

The temporal (time based) or situational context is often interpreted through cultural eyes. What happens in the different times of day, times of year, times of life? What happens in a situation where people or events are involved? In the middle of the night, after 'bankers hours', in the winter, or when we're at retirement age in America. In terms of situational barriers, times of war or famine spring to mind as particular situational and temporal barriers to full human potential.

Social Barriers
When there may be many positive people and supports in a person's life imagine the debilitating impact if a harmful person as a parent, or caregiver. A person in a position of trust may betray it; a misleading statement or a lie may lead to disaster. In a group people may make unwise choices, a gang may influence a person to harm others or break the law. In light of these, more and less dramatic mistakes can be made.

Physical Barriers
When a person with a mild limitation in mobility confronts a major physical barrier it can prevent them from participating in activity. Something we now take for granted, like ramps into buildings and at curb sides, can allow a person to enter their workplace, and a lack of them can prevent someone from working, or shopping, or getting into a movie. Our culture has often worked to limit physical barriers, and OTs have often been the catalysts to find other barriers. Not all cultures have such strong advocates or such resourses that they can provide these adaptations. Consider the availability of prosthetics, wheelchairs, reading glasses and other devices to overcome physical ability barriers in the developing world. Consider the availability of clean drinking water, food and shelter as aspects of physical context and we can see part of how this area can expand.

The areas of the 4 contexts overlap in areas and are interpreted through the experience of the person in their context. In this article we only touched the surface of how we might interpret barriers in context; it is for the eyes of the OTs and Functional Therapists along with engineers, architects, governments, businesses, and individuals to find and continue to work for the betterment of personhood through removal or compensation for external barriers.

In light of all the potential limitations that may be caused by external environmental or contextual barriers we may also find where external supports help a person regain balance. That will be the focus of our next discussion as we elaborate on dynamic variations of the CRAFT Model.

Thanks for reading,

Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC




P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line.










 

The CRAFT Model - Dynamic Variations of a Holistic Model - Part 3

The latest posts have depicted imbalances at the Functional level and the Ability pillar level. In this we will identify the change we have made at the Context level; you'll notice that, with a nod to Gary Kielhofner and the Model of Human Occupation, we have added the Temporal Context to the context level.

Each of the contexts influence the effectiveness of the Abilities and the choice and balance of Functions. In previous posts we have reviewed the Physical, Cutural and Social aspects of context; why does the temporal context merit inclusion at the context level? We'll see it plays a particularly important role in our lives.   

Temporal relates to factors of time. On the most rudimentary level that could include the time of day, or time of year, but let's also consider factors like time of life. For instance, we are currently preparing for the start of a new school year. That has aspects of it being August, but also of the time of our lives; it is much different for my children who will be going to school than for me who will be getting them ready in the morning and helping to get them there 'on time'. Also, it will be different at 7am than it will be at 3pm; temporal factors have influence on all other areas.

Time influences us greatly and we initially left it as part of the Abilities as in the time of a person's life (and it certainly remains there) and as a modifier for social and cultural contexts. Now though, considering that we have included it here I hope you can see how well it fits.

If you would like to learn more about the Model of Human Occupation for a thorough look at the multifactorial influences in a persons life I reccommend this link: http://books.google.com/books?id=WOYkTQNvNUgC&pg=PA5&lpg=PA5&dq=temporal+moho+model+of+human+occupation&source=bl&ots=ZL9YhsqRGG&sig=y10u4LhupUoOU1z0c8xu5WNFHTI&hl=en&ei=3ExvTL7DNYK88ga98ZHwCw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CCIQ6AEwAg#v=onepage&q=temporal%20moho%20model%20of%20human%20occupation&f=false. This is Google Book's full version of the text Model of Human Occupation: Theory and Application By Gary Kielhofner. This important text is a core part of an OTs training, and I am proud to reference it here. 

When we graduated from University with our degrees in Occupational Therapy we marvelled at our new eyes for seeing the world. We were given a gift in being able to pull together the many ways that people function and we had tools to help them. It is the gift of seeing a person wholistically and in relation to the many other persons and factors around them. In some ways we are almost constantly surprised at the amazing feats we can acheive and at the relative of simplicity of its 'common sense'. OTs and Registered Functional Therapists and Associates have a very refined and deeply trained 'common sense'; and I want us to share it with the world.

Thank you for reading.

Yours,

Ed Kaine, OTR, RFT
President of the American League of Functional Therapists, LLC

P.S. If you would like to join our emailing list and get updates and newsletters about ALOFT and the International LOFT please email ALOFTMail@FunctionalTherapist.org and enter "Subscribe" in the subject line.  

The CRAFT Model - Dynamic Variations of a Holistic Model - Part 1

Balance and the CRAFT Model


The CRAFT Model, the Context Related Abilities Functional Therapy Model, is a holistic model for a person living a life. As a concept it is designed to be dynamic and responsive to changes. In this article we will review the model and then focus on our the things we do (functions or occupations) and the concept of striving towards balance.

Lets review the CRAFT Model briefly. The Model is built upon the surface of a globe, this represents the context of the individual. The 3 aspects of context are the Physical Environment, Cultural Background, and Social Supports. If we consider a person in their workplace we encounter the physical layout of the place, this includes obvious things like accessibility with ramps and elevators but also less concrete things like propinquity (the proximity of your colleagues). This ties closely to the social environment and supports of your workplace; who can you rely on, who can you consult and who you can't. This is closely tied to the culture of your institution and to the area of the country in which you live; does work start at 8 am, are there lunch breaks, is overtime expected / appreciated / discouraged, is there a siesta?

Upon this context springs the abilities of the individual; the following are some examples to help you as you consider a person and the various abilities they display. The Physical pillar may be the most obvious, almost all of the effort in medicine goes towards realigning this area. Medications are most often directed at restoring organ function, reducing pain, reducing inflammation, etc.; surgical medicine is primarily focused on physical correction while most exercise and therapy is dedicated to restoring physical strength and structural integrity of a persons physical self. The Mental pillar is also significant as a person's safety and function relates to their attention, judgement, memory, orientation, etc.; more attention has been placed on this as the population ages as conditions like Alzheimer's Syndrome are more prevalent, but brain injury has highlighted coping skills and many challenges even for the very young. The Social pillar governs how a person interacts with others, different from the the social supports, these are the abilities that allow a person to maintain friendships, read others reactions, be empathetic, etc.; autism and schizophrenia have highlighted some of the social interaction disorders but as we know the spectrum from the charismatic to the recluse displays many skill levels. The Motivational pillar embodies those skills that get us up in the morning, ready for the world and its challenges; depression may make its biggest impact on this area, causing a malaise that may prevent a person from using many of the other abilities.

Upon the ability pillars sits the platform of functions or 'things we do', these are sometimes called 'occupations' by OTs. In particular we have three categories: Work, Leisure and Self Care. These are divided by the meaning of the activity; for instance cooking can be for work if you are employed as a chef or are preparing food for your family, or cooking could be self care if you are making a meal for yourself, or it could also be leisure if you are making a recipe from a new cookbook or magazine for a fun change. The meanings of the tasks reflect which category it goes into. Now let's explore an old adage where someone is out of balance.

"All work and no play makes Jack a dull boy."

This is what it might look like on the CRAFT model. What might be the consequences for Jack? Well, we can see that Jack's sleep and hygiene might be suffering, also his creativity may be stunted as he is not opening himself to outside leisure pursuits. He may in fact be a "dull boy." What might happen to his ability pillars, he might most obviously suffer from a lack of exercise and his physical health may falter, there is some evidence that working far too much overtime may lead to other deficits in mental performance, but he may also find himself irritable or lacking motivation. This may then impact his social supports who might be angry about him cancelling the vacation and a wife who is considering divorce.

As you can see, we have a dynamic model that allows us to quickly visualize the state of imbalance that someone is in. Over the next few articles we will explore other imbalances and what we might visualize as ways to help a person back to a purposeful and functional life.


Please leave any questions, ideas, or comments on the model below or email: RFT@FunctionalTherapist.org.

Thanks,



Ed Kaine, OTR, RFT
President of the League of Functional Therapists

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

Survey Results Are In - Very Encouraging! A Little Statistical Background.

Over the last few weeks we have been trialing and tailoring our survey. I'd like to thank all the people who helped us by taking the survey. In the end we had a very good tool that participants praised as interesting and enjoyable.

Someday I'll tell you about our $49 lesson but right now I'll tell you of ALOFT's wonderful success.

First, a bit of statistical background. In order to make our survey results as generalizable to the public as we could we sought to have a stratified random sample. The factors we decided on were that we could accept a 5% error rate in the responses. Also we wanted a 95% confidence level, or only a 5% possibility that the results could be due to chance. We set our expected variance to require the maximum number of responses by setting it to 50% (as in equal chance a subject would pick one or the other). Then we wanted to generalize this to the population of the U.S.A. These mean that we would have a sample that would cover 304 Million (as of summer 2008) so we added many more and found we could cover the world's population with 385 subjects.

Then again we were only sampling people in the U.S.A. so we can really only generalize to the U.S.A. We went with the higher number to allow internally guided exclusion criteria and sampling methods to allow exclusion from certain aspects of the study based on background factors.

In the end we had 500 completed surveys with 87 partially completed or eliminated due to just randomly hitting the keyboard rather than answering. So, of the 500 we confirmed many of the intuitions we had had and learned several new and supportive things that we had been unable to quantify.

So far it is saying to us at ALOFT "keep going, this can be a very helpful and positive thing." We had several criteria for the study that would have indicated that we were on the wrong track, none of those were evident. We will be sharing different results from the study as we go along.

If you are interested in this data we are interested in sharing it with you in a meeting. We can setup online meetings if you would like to delve further into any results.

Look for our results in the coming days and weeks.

Yours,

Ed Kaine, OTR, RFT
Member and President of ALOFT

RegisteredFunctionalTherapist@gmail.com

How Language May Shape Our Thoughts.

Please check out this article in the July 9, 2009 Newsweek. What’s in a Word? Language may shape our thoughts. By Sharon Begley It has some very interesting insights into language and how people think about things.


I previously discussed this topic related to the use of our title, in particular asking whether we should use the O-Word (Occupation). The answer was and is, "yes". It allows us to expand the way we think about function. However; with this is a warning that the meaning of this word for most people is not what it is for an Occupational Therapist. What about the O-word?

The challenge is open to try to expand the definition of Occupation. It does not appear that this will be possible in this year or in the next few. I discussed this with a representative of Mirriam Webster's Dictionary and it was not possible. Let's get our definition in the Dictionary!


What does this mean for us? To me it means we need to consider the words we use to promote our profession and that it does matter whether people understand the word we are using.

With only a very limited definition of Occupation available to people how can we blame them for not understanding. It is up to us to reach out to the people. We can do this by using words that have positive meaning and capture the essence of what we do.

In the word "Functional" we have the basic idea of the way we work. We structure our treatments with a focus on the function task you must do. This may involve addressing the cognitive skills, the physical skills, the motivational and social skills that go into the task. Then the functional task itself, be it work, self care or leisure, is can be the focus of our treatment. It is the emphasis on doing something functional (not just fixing the structure) that Occupational Therapy has brought to the world. By using the protected title of Registered Functional Therapist we can more clearly help people understand how we can help them.

Functional versus Occupational on the Visual Thesaurus

It's something to think about.

Yours,

Ed Kaine, OTR, RFT
President of the League of Functional Therapists

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

Crucial Converstations Training being considered for League of Functional Therapists

Over the last 30 years an innovative company call Vital Smarts has done research to find skills for exceptional communication. It has been applied in particular to Health Care in several settings. At Maine General Hospital they found that the training alone improved care.

Check out: Crucial Conversations® Training Improves Patient Safety at Maine Healthcare System http://www.vitalsmarts.com/userfiles/File/pdf/case_studies/mainegeneral_health.pdf

Just by taking this training their hospital improved in all the following ways.

They took the training across the board and they saw massive improvements.

What could you do if you were a better communicator? How would your health care facility improve? How would your relationships in your work and in your life improve? Who wouldn't be better if they were better able to hold conversations where emotions were strong?

These skills are skills for life. We are considering offering this course for practicing and non-practicing RFT and RFTAs, and our supporter members. This may be in mid 2010 depending on interest. To let you know, the course could cost $995 is you were just taking this training. However; since you are members or considering membership we should be able to significantly reduce that price. We are in dialogue about it currently with Vital Smarts team.

We are very excited about the prospect of offering these life changing lessons to our membership. Let us know what you think about it.

Please check out http://www.vitalsmarts.com/ and http://www.vitalsmarts.com/crucialconversationstraining.aspx?id=frombanner to get more information on these exciting courses.

Yours,

Ed Kaine, OTR, RFT

President of the American League of Functional Therapists

RegisteredFunctionalTherapist@gmail.com

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

Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial

This is a very important article for patients anticipating or recovering from ICU stays. In this randomized controlled clinical trial, Occupational And Physical Therapists took ventillated patients through a course of functional tasks. In the process they had a trememdous impact on patient's lives.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60658-9/fulltext

This shows that it is not just about surviving. Healthcare has the technology to save your life, but it's therapy, and particularly "Functional Therapy", that cares about getting you back to a life of purpose and meaning.

Congratulations to the excellent teams at the University of Pennsylvania, University of Chicago and University of Iowa. The effort to take and confirm scientifically things we know (or think we know) intuitively is very appreciated.

Go Therapy, even in this critical and frightening time in a person's life, the worry that you are too sick to do therapy is turned on it's head. You might be too sick not to do therapy.

Yours,

Ed Kaine, OTR, RFT
President of the American League of Functional Therapists
http://www.functionaltherapist.org/

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

Suffolk News-Herald | Occupational therapy a vital healthcare link

Suffolk News-Herald | Occupational therapy a vital healthcare link

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