Sutcliffe 1
[Type text][Type text][Type text]
Sutcliffe 14
Katie Sutcliffe
Dr. Ron Gimbel
Health 4200
27 July 2015
Public Health Determinants and Trends
For my Health Science Internship, I had the unique chance to
experience two very different occupational therapy sites. The first
occupational therapy internship site that I started at was AnMed
Health Pediatric Therapy Works located in Anderson, South Carolina.
I was at Pediatric Therapy Works for eight weeks and earned more
than 90 hours of internship experience there. I observed not only
my preceptor, who was an occupational therapist, but physical
therapists and speech-language pathologists as well. In working
with pediatrics, I was able to apply the knowledge that I have
gained as an undergraduate student in times when I was faced with
commonly seen conditions, such as Down syndrome, autism, cerebral
palsy, and much more. My second occupational therapy internship
site was at Clemson Sports Medicine and Rehabilitation located in
Seneca, South Carolina. My preceptor there was an occupational
therapist, who specialized in hand therapy. During my time at this
site, I learned a lot about many conditions including radial and
phalangeal fractures, adhesive capsulitis, tendon lacerations, and
others that needed hand therapy treatments. I also earned more than
90 hours of observation at this internship site over the course of
nine weeks. Both of the internship sites had occupational therapy,
but they were very different. I will discuss each site separately
to address each of the public health topics. The three topics I
will cover include Social Determinants in Health, Organizational
Behavior and Governance, and the Preprofessional
Concentration-Specific Question. 1. Social Determinants in Health
Modern public health has recognized a variety of social
determinants of health. Pick one or more, from one of the 3
categories, of these social determinants of health and reflect on
how it (they) may have influenced the type, variety, and/or need
for the health or medical services delivered at your internship
site:Healthy Places The daily conditions in which people live
Availability of clean water and adequate sanitation Availability
and cost of electricity and other fuel Availability of options for
physical activity (parks, sidewalks, health clubs, bike trails,
etc.) Availability and cost of foods for healthy eating
According to Healthy People 2020 (2015), social determinants are
anything within our environment that affects our daily lives, which
ultimately affects our overall health. This may include the level
of safety for housing, educational quality, economic situation,
transportation availability, subjection to crime and violence, etc.
These social determinants and others are the cause for inequities
in health between different geographic locations (Healthy People
2020, 2015). One social determinant that affects our health is the
health of the place that constantly surrounds us. For my first
internship site, I will discuss how healthy places are crucial to
the type and need for occupational therapy services that AnMed
Health Pediatric Therapy Works provides. AnMed Health Pediatric
Therapy Works During my time at AnMed Health Pediatric Therapy
Works, I saw how daily conditions, in which people live, affect the
type and need for occupational therapy services. I was exposed to
occupational therapy for home health, an elementary school, and the
outpatient facility. While all three uses of occupational therapy
are significant in patient development, it was home health that
showed me how much living conditions could affect the type and need
for its services. According to the American Occupational Therapy
Association (AOTA) (n.d.), occupational therapy is focused on
adjusting the surroundings of the patient to better suit that
patient and his or her needs. An occupational therapist will
evaluate a space, such as the patients home, and be able to help
make these adjustments (AOTA, n.d.). A patient could come to the
outpatient facility for occupational therapy once a week and then
try to implement the treatment plan at home. However, in a patients
home, the therapist can better see what type of environment is
surrounding the patient on a daily basis and not just what is in
the clinic. It is likely that an environment can hinder the
developmental process if a patient has been learning certain
exercises during treatments at the clinic but cannot practice the
exercises at home. The home environment, causing potential limiting
factors, may affect the type of services needed for that patient. A
home evaluation might be needed to see if any adjustments could be
made to assist in the progress of the child. Being able to go to
patient homes and provide the necessary care there is crucial for
that patients development. For example, an occupational therapist
that has been treating a child with a brachial plexus injury could
be using certain equipment not available at home. It is important
to be aware of the conditions of the childs home, so the therapist
can know whether the patient will be able to practice outside of
the clinic. Also, the therapist can inspect the home to make sure
the patient will be able to safely practice the exercises involved
in treatment. By observing home health, I was able to see how much
occupational therapy services are needed and how the conditions
that people live in may affect treatment services. I was also able
to see how different types of occupational therapy are needed in
order to best suit patient needs. Some children are bed-bound and
cannot easily visit an outpatient facility for treatment. Also,
some caregivers are disabled and cannot get the patient to the
outpatient facility easily. This is why a variety of treatment
services need to be offered to patients that have such difficulty
getting to their therapy treatments. Patient development should not
be stunted just because he or she could not get to a treatment
facility. I have found that AnMed Health tries to provide as many
services in a variety of ways as possible for its patients. Other
determinants such as availability of clean water and adequate
sanitation are also not only important for treatment but necessary
for a persons overall heath. Clean water is something we take for
granted in America. We can easily walk over to a faucet, turn it
on, and have clean water instantly provided. However, even in
America some patients families do not have this luxury either.
Sanitation is also just as important, but still there is a lack
thereof. I did travel for home health occupational therapy, so I
saw a range of living situations. All of the homes that I observed
had clean water and adequate sanitation, but had they not it would
have greatly affected the health of the patient being seen. This is
also true for the clinic because it is so crucial to the variety of
treatments provided. There was a leak in one of the hospitals
pipelines, and we were told not to use the water for a few days at
the clinic. It was not until then that I realized how important
clean water usage and sanitation were, especially for feeding
treatments.Another crucial determinant for health is the
availability of electricity and other fuel. During my time spent at
Pediatric Therapy Works, I witnessed a horrible storm that passed
through the area. The power went out at the clinic twice that day.
Staff members were calling patients parents to tell them to pull
over somewhere safe and not to drive through the storm. During this
time, no one could be treated while there was not any power.
Thankfully, the power outage did not last very long and services
resumed back to normal. However, this may not be the case if a
patient had been at home for a home health treatment. Not having
electricity affects most things that we do to function on a daily
basis. If electricity is not available, then a family, including a
patient, would suffer beyond just treatment purposes. Electricity
may be viewed as a luxury for us in America, but it can play a
large role in patient improvement for his or her weekly treatments.
Additionally, physical activity plays a significant role for
occupational therapy treatments and success. Since the patients at
Pediatric Therapy Works were children, it was a necessary aspect of
treatment to have some type of physical activity goal. Children are
known for having a lot of energy, and they need to have a place
where they can have an energy outlet, such as a park. Once a child
leaves the therapy clinic, it is up to the parent to find a source
where that childs energy can be expelled. Being able to practice
therapy exercises outside of the clinic is essential to the
developmental success of that child. By having options for physical
activities, it enhances the variety of services that can be held by
therapists. For example, a swimming pool could allow for aquatic
therapy treatments. Aquatic therapy would allow a child to build
strength and increase their range of motion. Pediatric Therapy
Works currently uses a pool not located at the clinic, but
nonetheless they still are able to offer that as an extra service.
Also, having green space options have allowed children to practice
their camping skills outside of the clinic on one of the grassy
lots nearby. Being able to offer a variety of treatments and
services to these children will increase the spectrum for assisting
in their abilities to do skills independently, which is ultimately
the main goal. Lastly, the availability and cost of foods for
healthy eating does play a factor in the variety of services
offered for occupational therapy at Pediatric Therapy Works.
Through this internship, I have learned that occupational
therapists help children with poor feeding habits. Many patients
have problems with food textures, smells, and appearances to the
point that they have a severely limited range of food they will
eat. As you could imagine, this greatly affects nutrition and puts
a stress on the patients parents as well. I observed several
feeding treatments during my time at the clinic. After one of the
evaluations, I wondered if the therapists received compensation for
the food that they provide during the treatments. I learned that
they do not receive any compensation for this food. My first
thought was that the cost of food, especially healthy food, must
add up to be an expensive cost. If the goal is to get the patient
to increase the amount of food he or she intakes, and in particular
nutritious food, then it is necessary to have the funds for this.
This type of expense can hinder the ability of a patient to receive
healthy foods, which of course affects their treatments but mainly
their overall health. The therapists do the best that they can to
provide what is necessary for feeding treatments. However, families
with financial struggles will have difficulties in providing the
range of nutritious food needed for their children.
Clemson Sports Medicine and Rehabilitation Employment and decent
work: Safety and health of working conditionsAt Clemson Sports
Medicine and Rehabilitation, I saw many patients with a number of
injuries that needed hand therapy treatments. Most injuries were
due to accidents from falling or because the patient was hurt
on-the-job. This was another area that differed from my other
internship site due to the fact that the other site was only for
children. These children did not work, so there were not any
work-related injuries that I was able to observe there. However, at
Clemson Sports Medicine and Rehabilitation, I saw this more
frequently than I expected. By seeing patients that injured
themselves at work, it reminded me how important occupational
safety really is. Even though there were only a handful of cases
like this, my preceptor mentioned to me that this type of injury
was the majority of what he saw at a previous therapy clinic. He
said he used to treat patients near an area that had a lot of
construction. Since I had not been exposed to much hand therapy
before my internship, I did not realize how places of work, such as
a construction site, affected the type and need for a service like
hand therapy. Other social determinants were present that affected
health as well, but the work-related injuries stuck out to me the
most. I would listen to the patient evaluations and be in a sort of
awe state about how their injury occurred. I also realized that we
take for granted public health services in general until an injury
occurs that makes us appreciate interventions that are set in
place. Unfortunately, it does seem to take something like an injury
to enforce new safety ideas around the work place. After witnessing
patient work-related injuries, I saw why there is a great need for
the hand therapy specialization area even much more so than I
originally realized. Yes, people, especially the elderly, do fall
and obtain injuries that may call for hand therapy treatments, but
worker safety is also an issue for many jobs. Some jobs that are
more dangerous, including construction laborers, factory workers,
loggers, soldier, transportation drivers, farmers, etc., may
especially need hand therapy. Although hand therapy does not have
to be for these dangerous jobs only, it is an important service to
have around in case of any work-related injury occurrences. A
patient could work at Lowes and have a heavy object fall on his or
her hand causing a fracture. The bottom line is there is a need for
occupational therapy. In particular, the specialization services
offered by hand therapists at Clemson Sports Medicine and
Rehabilitation are necessary and relevant to patients in nearby
areas.
2. Organizational Behavior and Governance Our health care system
is an interface of multiple structures for the organization,
financing, management, delivery and evaluation of a wide variety of
health-related services. Based on classwork and your experience in
your internship, (a) identify a structure, role or function that
you believe is crucial to the services (availability, quality, cost
effectiveness etc.) provided at your internship site. (b) How is
that structure, role or function facilitated by, (or impeded by)
things like organizational culture, organizational functioning,
policy or law? (c) If you could change the law, policy, or
organizational practices to make the system more
effective/efficient, what would you change? (d) Explain why. AnMed
Health Pediatric Therapy Works At Pediatric Therapy Works three
therapy disciplines, which includes occupational therapy, physical
therapy, and speech-language pathology, are located in one
outpatient facility that offers access to a variety of services.
This is crucial to the availability of the services offered by
Pediatric Therapy Works. The outpatient facility is located on 701
North Fant Street Anderson, South Carolina. What is important about
this address is that the clinic is across the street from AnMed
Healths Medical Center Campus. Families can bring their child or
children to Pediatric Therapy Works and still have great access to
a nearby medical network. This clinic is not just in a convenient
location, but AnMed Health knows that people cannot always travel
to the clinic to receive treatments. By having all three
disciplines together it allows for a variety of treatments to be
allocated among patients through co-treatments, which I observed
several times during my internship. I learned how co-treatments are
very helpful for a patients success. I also learned that different
therapists co-treating simultaneously, by law, must not be treating
a patient with the exact same treatment plan. For, example, a
physical therapist could not treat a child with an exact treatment
plan as an occupational therapist. AnMed Health also allows home
health as an available service for patients who cannot easily come
to the clinic for treatments. AnMed Health allows services, such as
occupational therapy, to make visits within public school
districts. I traveled to both home health services and an
elementary school for three weeks of my internship. I was unaware
of these services when I first started my internship, but realized
quickly how busy this type of schedule would be. As an intern, I
was shared between two occupational therapists. On Tuesdays and
Wednesdays, I would travel with one occupational therapist for home
health services and clinic appointments. On Thursdays, I traveled
with another occupational therapist for school treatments and home
health treatment. I learned through the variety of services offered
that AnMed Health allows patients many opportunities to receive
treatments. Through previous observation from past clinics, I have
never witnessed such variety. I realized how offering many options
for care is crucial to health care availability. It is easy to not
realize just how many patients cannot readily visit an outpatient
facility. We are surrounded by so many types of medical practices
where a patient can drive to or is driven to a clinic of some sort,
receives treatment, and then leaves to go back home. Traveling to
patient houses reminded me of how there is true difficulty for some
parents or caregivers to get their loved ones over to an outpatient
clinic. Whether it is because of a disabled caregiver or a
bedridden child, AnMed Health has provided multiple services that
greatly increase its role and function in availability. The
services offered by the three disciplines at the clinic are
facilitated by the organizational culture present at AnMed Health.
Throughout my internship, I witnessed caring therapists that tried
their best to see everyone on time and give the patients quality
care. I saw many back-to-back treatments, co-treatments, and even
some group treatments. The clinic was always busy with returning
patients as well as new patients. To assist its organizational
culture, AnMed Health has Building Blocks in addition to its
mission and vision. According to AnMed Health (n.d.) these Building
Blocks include: 1. Exercising a Passion for Serving Others2.
Exceeding Expectations-Being the Provider of Choice3. Pursuing
Excellence and Quality4. Fostering a Nurturing Culture5. Living a
Culture of Yes6. Benefiting the Community7. Practicing Financial
Responsibility 8. Maintaining High Standards9. Embracing
Differentiology10. Living the CredoWere in This Together These
Building Blocks were upheld at my internship site on a daily basis.
I have sat in on a staff meeting, and I have heard the all of the
health topics discussed during it. The staff really does care about
providing their services as much as they can. There is a rule about
a certain number of no-shows within a certain amount of time that
can cause a patient to be discharged. They want to make sure that
patients have a good attendance rate. There are patients who really
need therapy that cannot go because the therapists are completely
booked. If a patient continuously has a bad attendance rate, then
it is not fair to another patient, who needs therapy and can attend
scheduled treatments. This is why I believe that because of AnMed
Healths expectations that the staff have a strong foundation of
values to start from and to ensure that they continue their
excellence in care. This includes providing services in the best
way possible. If their clinic was not structured the way that it
was physically and morally through these values and expectations,
then the care and availability would suffer tremendously at
Pediatric Therapy Works. As for improvement, I would suggest that
the organizational practices be changed in a way that certain
therapists are hired strictly for home health treatment and school
treatments. There were many days where therapists were booked
back-to-back and had to constantly go from clinic to home health or
to schools then home health then back to the clinic. It was
basically a runaround for the therapists. When I would travel for
home health, we would spend a couple of hours at patient homes and
then come back to the clinic to see other patients. Sometimes
traffic or distance traveled from the clinic can cause the
therapist to be late getting back to the clinic. Hiring someone to
specifically do one area of therapy whether it is home health,
schools, or inpatient care, would cause less of a runaround and
more time and energy for that therapist in patient treatment. I
understand that they may be trying to utilize the therapist as much
as possible, but occupational therapy is a growing field and hiring
more therapists is very possible. This may be an approach that may
not cut costs, but would improve availability in the long run.
Clemson Sports Medicine and Rehabilitation Insurance plays a large
role in therapy treatments. Americans now have to have insurance
due to the Affordable Care Act of 2010 or be fined otherwise. While
I was at Clemson Sports Medicine and Rehabilitation (CSMR), it was
very problematic for some patients to have authorization before
treatments could begin. I witnessed one patient in particular who
could not receive treatment until he or she was authorized to. The
authorization took a while to come through to the point that his or
her injury was going to be even harder to treat because he or she
did not start therapy in the ideal amount of time that he or she
should have. This in the long run causes more treatments and
ultimately more costs. In the last few years health care has seen a
change with insurance with the Affordable Care Act of 2010. Also, a
relatively new aspect of insurance claims for Medicare is something
called G-codes and modifiers. According to the Centers for Medicare
and Medicaid Services (2014), the G-codes have to be included on a
Medicare claim, which is necessary for functional limitation
reporting. Insurance providers will have a better grasp on a
patients condition, results, and spending through this functional
reporting (CMS, 2014). At CSMR, I observed many systems that occur
throughout the clinic to make it function as a well-oiled machine.
From the time a patient walks into the clinic, the internal system
starts to flow. The entire clinic consists of a front office and
treatments rooms on the second floor. The first floor is where the
organizational functioning can be witnessed through a hierarchy
chain such as an employee, who does the coding and billing, a
director of marketing and recruiting, vice-presidents, and
co-owners. It is a very detailed system of events that occurs in
the clinic as I came to learn during my internship. CSMR is
considered the Home Office, which means all of the major components
of the company and business from over than 30 branches runs through
the first floor of the CSMR building. Through interviewing
employees about their responsibilities, I learned that the most
important part of it all starts during the first visit a patient
has when he or she walks into the clinic. From that point,
everything else follows and if one thing is done incorrectly it has
a domino effect on the rest of the system. One part of the whole
system that I found to be crucial to the services was health
insurance. Insurance is so important to have in order to receive
treatments. Due to the more complicated system of adding G-codes
and modifiers for functional reporting, a FOTO survey was
implemented at CSMR. FOTO is an acronym for Focus On Therapeutic
Outcomes (FOTO, n.d.). The mission according to FOTO (n.d.) is We
support clinical excellence by perfecting measurement and
standardizing on demand reporting of comparative quality and value.
Below, I have created a small diagram to show two of the most
important steps at CSMRs new patient registration.
I have worked many times with FOTO surveys as an intern at CSMR.
The survey is relatively new at the clinic, as it has only been
implanted for a year or two. In a discussion about the surveys with
my preceptor, he told me that he thought it was helpful to review
the survey answers to see what patients may be struggling with. He
also said it was helpful for seeing potential timelines for
outcomes of different conditions. On the surveys, the patients
answer detailed questions about functional limitations that they
may have. The survey also helps my preceptor with generating
G-codes, which is a part of Medicare. It is given every few visits
again to patients to measure where they currently are and where
they should be. The survey is helpful with seeing if any progress
is made in addition to witnessing visual progress. Overall, this
survey is a great addition and improves the quality of services
offered at CSMR. Insurance claims are facilitated by the
organizational functioning at CSMR. The second floor of CSMR, where
I spent most of my time, consisted of therapists and front office
staff that reported to a clinic director. The director, however,
was not the main person in charge at this clinic since it was the
main corporate office. The owners, vice presidents, and other
directors were located on the first floor. There was a hierarchy
that existed within the home office that affected all of the
decisions made within the clinic including the implementation of
the FOTO surveys. The survey information that includes the
generation of G-codes is used within the billing system contained
on the first floor of the clinic. By having a system setup that
begins with the front office staff and runs through the employees
on the first floor for medical coding and billing, the claims made
for insurance are a lot more effective and the overall quality of
the system has improved. The implemented FOTO survey is largely
focused on improving quality. It is not a mandated thing that every
clinic has FOTO surveys, but every clinic has insurance claims and
has to have functional reporting by the therapists. There should be
a policy in place that makes clinics have some sort of survey
system similar to one like FOTO. In order to improve quality,
clinics need to be consistent. If one clinic has help with
gathering data about patient functional limitations and generating
G-codes, but the other does not, then that creates a disparity
among the clinics. I believe there should be a nationwide policy
that requires a standardized type of survey that would assist
therapists with improving quality of care, functional reporting,
and the generation of G-codes for Medicare compliance.
3. Concentration-Specific Questions Preprofessional
Concentration: Professionalism is an important component of a
health care workers contract with society. Not only do we need
health professionals who participate in good evidence-based
decision-making, but we need caregivers who apply those decisions
in a way that is professional and ultimately supports
patients/clients. Professionalism has many components. Among them
are maturity, responsibility, communication skills and respect for
other persons, especially patients/clients. Describe a situation or
individual that you encountered during your internship that
exemplifies professionalism, and explain how/why this is true. What
did you learn from your internship that can help you improve your
own professionalism?
During my internship at two different occupational therapy
sites, I encountered many therapists, office staff, aides,
volunteers, patients, and patients family members. By having a
different experience with each of these groups, I was able to
compare professionalism among each individual in various
situations. I witnessed acts of professionalism among several
people between both of my internship sites, but the person who
comes to mind in exemplary professionalism overall is Ms. Cathy
Styles. She is one of the occupational therapists at AnMed Health
Pediatric Therapy Works. I had the pleasure of getting to know Ms.
Styles as one of my preceptors for eight weeks. The reason she
comes to mind is due to her caring and trusting persona, her
responsible and respectable nature, and the equal treatment she
displays from person to person. The first few weeks of being at
Pediatric Therapy Works, I was able to see how much Ms. Styles
cared for her patients and how they responded back by trusting her.
I could ask my preceptor about any patient I observed her treating
in therapy, and she could efficiently explain a diagnosis or any
relevant matter concerning a particular patient to me. I could see
that she gave herself fully to being an occupational therapist.
This was a wonderful thing to experience as I, myself, have been
through many encounters with medical professionals from various
fields. It is rare to see someone in the medical field so dedicated
in their work and with patients at the level that she was. Also,
the generosity that my preceptor displayed was truly amazing to
witness. I could tell how much she cared and that her patients
trusted her. Trust is sometimes hard to come by between a medical
professional and patients these days. After observing their
responses to her, I aspired to want to have that kind of
relationship with patients as an occupational therapist one day.
Another professional trait my preceptor possessed was being
responsible. Responsibility is necessary for most jobs, but in the
medical field one must take on a great deal of responsibilities and
be able to handle them well. I found that Ms. Styles did that. From
week to week, she was always prepared for each therapy treatment,
and she always made sure that her tasks were completed. I was
impressed by how hard she worked to make sure her notes were
complete because, as I am sure most therapists would agree, getting
your notes done for the day is a challenge due to busy schedules. I
typically would leave in the early evening and she would still be
there trying to complete her notes for the day. Lastly, Ms. Styles
was respectful whether it was with a patient or another therapist.
She respected peoples differences and treated everyone equally. I
very much enjoyed seeing her interacting with different patients.
She never showed distaste or favoritism from one patient to the
next. This is extremely important as a medical professional to
treat people equally even if some patients may present themselves
as a more difficult case. I would observe my preceptor treating
patients of all types of diagnoses with the same kind smile, equal
effort, and quality in treatment. For anyone who has been treated
for any condition, you have maybe experienced favoritism or the
opposite and felt like the medical professional was uninterested.
That is a horrible feeling that affects patient-provider trust and
overall may affect the success of a treatment. To feel equal and
respected as a patient is key to having a happy patient and a
favorable outcome of treatment. The biggest area of professionalism
that I could use to help my own professionalism is respect and
equal treatment. I was shown how far each of those components could
really go within the work environment and along with patients. A
close second to respect and equal treatment would have to be the
trust and the care aspect of professionalism. I could tell if a
patients parent trusted my preceptor by his or her response. Also,
the patient would cooperate more and complete treatment well, which
would lead to more improvements from week to week. By observing one
of the feeding evaluations with my preceptor, it showed me just how
professional she is with her patients. The way that she spoke was
very calming, which gave a sense that the patient would be in good
hands and that everything was under control. She also told the
parent and the patient that if they felt like they were not a good
fit together to please say something whether it is to her or the
supervisor. I thought this was a wonderful thing to let the parent
and patient know. They could feel comfortable in addressing a
potential issue by letting them know if something was wrong or
things were not working out well. Also, I admired how she spoke
directly to the patient, who was of an age that could understand
the situation. I believed that this allowed the patient to feel
more in control of his or her therapy and that he or she had a
voice in the situation. I can remember growing up and the way it
felt when someone treated me like a child and that did not have a
voice. I so badly wanted to experience some sense of autonomy. As a
student pursuing a career in occupational therapy, I will keep this
memory of my experience with me so I can improve my own
professionalism. I will also keep in mind how important respect and
equal treatment are as I strive to be the best therapist that I can
be in the future.
Works CitedAnMed Health. (n.d.). Mission/vision. Retrieved from
http://www.anmedhealth.org/about-
us/mission-vision.aspx
(AOTA). American Occupational Therapy Association. (n.d.). About
occupational
therapy. Retrieved from
http://www.aota.org/about-occupational-therapy.aspx
(CMS) Centers for Medicare and Medicaid Services. (2014).
Functional reporting. Retrieved
from
http://www.cms.gov/Medicare/Billing/TherapyServices/Functional-Reporting.html
(FOTO) Focus on Therapeutic Outcomes Inc. (n.d.). About foto.
Retrieved from
http://www.fotoinc.com/about-foto
Healthy People 2020. (2015). Social determiants of health.
Retrieved from
http://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health
