Living with chronic conditions

Disease Self Management Programme” (CDSMP) out of Stanford University. The programme uses the book “Living a Healthy Life with Chronic Conditions”, and is a very structured approach. This programme has been around for some years and was being actively promoted by the Arthritis Foundation. It is also actively promoted in South Auckland where it has been running for over four years.

The programme has strong links with an occupational therapy approach as it is based on self management, self efficacy, problem solving, and action planning. The programme is aimed at community delivery by people with chronic conditions rather than just by health professionals (we qualified on both counts as we are health professionals, and both have a chronic condition). Participants receive support from each other in the group, and see that they are not alone with their conditions – that there are others out there who are managing. Accordingly, feedback from our three groups show an increased confidence to self manage.

In one group two women who had never met decided (on day one!) to team up for a walk three days a week. One of those women has subsequently gone on to pick up a course she had lost motivation for because of her pain. In another group, a young woman with chronic pain was not getting up before 10am most days, and set herself a target to be up before 10am, follow a walking and eating programme, and get involved in the community. She achieved this, and has gained significantly in self esteem. Another participant stated at the end of the course that she now accepted her terminal condition and was no longer denying what she needed to do to manage it.

The programme in Northland is called Whakamana Hauora, (promoting wellbeing). Content of the programme includes understanding the differences between acute and chronic conditions; identifying common problems; using your mind to manage symptoms; action planning (every session); dealing with difficult emotions; the nature of physical activity; tools for problem solving, breathing, relaxation, pain and fatigue management; education on healthy eating; making future plans; dealing with health care providers and systems; managing depression; positive thinking; and guided imagery. All of these are bread and butter to occupational therapists.

What do you need from an OT?	Explanation of the service.
Home and Community Environment assessment	Assessment of a person’s ability to access and move around their home or community environment and ability to perform everyday tasks in their home. Strategies for independence or safety may be taught. Alterations to the environment or adaptive equipment may be recommended.
Rehabilitation	Enabling a person’s participation in life’s activities and achieving their goals. Rehabilitation of physical or cognitive impairments resulting from brain injury, spinal injury musculoskeletal injury or other medical condition or event.
Technology solutions	Recommendation of equipment and technology that will enable access to and participation in activities. Might include technology for learning, visual impairment or controlling the environment.
Activities of Daily Living – Assessment and Treatment	Assessment of the way everyday tasks are performed. Recommendations about better and safer ways to manage are made. Alterations to the environment or adaptive equipment may be recommended. Recommendations for funders regarding level and type of personal support may be supplied.
Older Person’s Health and wellbeing	Assessment of a person’s ability to manage their everyday activities in their living situation. Recommendations for safe and easy ways to do activities and equipment and home modifications may be provided. May include provision of a treatment plan to support and enable the person to achieve their goals.
Child health, Learning and Development	Assessment and therapy services for children (and their families/whanau) with a variety of diagnoses whose ability to play, learn or perform daily activities is interrupted. Includes assessment and working with clients (usually children) with Autism Spectrum Disorders. May include working with people to develop skills for handwriting and other tasks that required fine motor skills.
Mental health and wellbeing	Assisting participation in chosen activities in people who experience social or emotional distress or mental illness. Supporting wellness, self management, lifestyle changes and recovery. May include support with stress management, life enhancement, family therapy, psychotherapy spirituality and sexuality.
Driver assessment and vehicle modification	Specialised assessment of a person’s fitness to drive and conditions which should be placed on a person’s license. Assessment for modifications required to vehicles to enable driving.
Worker safety, assessment and rehabilitation	Assessment and treatment of the injured worker and advice to insurers regarding the needs of injured workers. Design and support of return to work or work rehabilitation programmes. Can include recommendations for injury prevention. May include ergonomic assessments of workplaces and tasks. May include Functional Capacity Evaluations (FCE’s) to determine a person’s general work tolerances and abilities. May include vocational counseling through determining a person’s background, skills and abilities that can be transferred to alternative employment.
Workplace Health, Safety Design and Training	Evaluation of work environments, their design and practices in order to maximize safety, health and welfare of workers. Can include provision of workplace training for the prevention of injury, including moving and handling training. May include working with designers and architects to optimize healthy human-environment interaction.
Participation at home and community	Enabling a person’s participation in their chosen life activities and/or occupations. Includes people who have an age related disability, physical disability, mental health issue or intellectual disability .
Living well with Long Term Conditions	Enabling participation in everyday activities and roles in the presence of persistent challenges. Supporting self management and effective coping strategies. Includes Pain, fatigue, chronic health issues and disability. May include managing the changing needs caused by a palliative condition such as cancer and treatment so that a person can continue to do the everyday tasks that are important to them.
Managing Vision Impairment	Specialists who assess and treat the functional implications of vision problems. Includes managing symptoms (Glare sensitivity or migraine), teaching strategies for safety and independence with everyday activities, recommendations for modifications to home and work and special equipment, tools or aids.
Hand therapy, Splinting and Scar management	Specialists who assist people who have difficulty using their hands as a result of injury, a disease process or deformity.
Community/Organisational Strengthening and Culture Change.	Working with groups in community or organisational settings or policy development to enable participation for all people. May include review of Aged Residential Care or other residential facility to enable occupation for residents.
Mobility, wheelchairs and seating	Assessment of a person’s needs for specialized wheelchair and cushions, seating, and positioning. May include assessment of needs for mobility scooters.

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Living with chronic conditions