This is a topic that I have been very interested in since both of my clinical fieldwork educators were so different in years of experience and practice area. It's challenging to compare settings with such differing productivity standards but this article reviews whether these factors effect productivity while having a fieldwork student. The results concluded that there was no clinical difference and that having a level 2 fieldwork student doesn't not lower a clinicians productivity. Practice area and years of experience may be influencing factors for one's productivity level but do not directly impact them. This is important to know when taking on your first student or when considering taking on your first student.

Fieldwork in meant to teach the student how to integrate academic knowledge with application skills at increasing levels of intensity. This article reviews some concepts that aid in the transference of knowledge to practical skills. Having a role model or mentor is known to play a vital role in shaping, teaching, assisting, and coaching students to become future therapists. They must also observe the patient- therapist dyad. Clinical reasoning often emerges during the interaction between the therapist and the patient. The therapist's reason for decision making should be questioned early in the clinical observations. The therapist approach is one of the most difficult to understand. Educators must ask encouraging questions. As they relate theory and technique into their treatment they should ask probing questions at certain points in the clinical reasoning process. Then, they must interact with a consistent patient population. Students must repeat interactions with the same patients to learn how to effectively carry out treatment plans using patterns and trends. Story telling, chunking information, videotaping, and case studies all help in teaching and developing the clinical reasoning skills needed for a student to emerge into an entry level practitioner.

This systematic review looks into research that reviews the effectiveness of interventions for community integration and normative life roles for patients with serious mental illness. The review looks at occupation and activity based interventions and interventions which focus on performance skills and performance patterns, context and environment, activity demands, and client factors. There is moderate to strong evidence for the effectiveness for social skills training and moderate evidence for life skills and IADL skills. The evidence for neurocognitive training in correlation with work skills training, social participation is moderate. Client centered intervention produced limited evidence. It was summarized that a natural environment as more beneficial than the clinical environment was inconclusive and needs more research in this area.

This article reviews the concept of medical necessity as it relates to the Patient Protection and ACA. This article reviews how one can advocate for patients to help them meet their personal and community related needs. One needs to be able to recognize their responsibility, know how to find laws that relate to patients coverage of needs, and understanding what disability means. The term medical necessity refers to the medical appropriateness of a particular intervention in a particular case" (Hill, 2012, p. 449). Therefore, insurance companies use these definitions as a basis for allowing or denying payment or for the access to various services.

The consumer's growing acceptance of treatment for those with mental health issues and substance abuse problems have increased the demand for services in these areas. However, even though there is an increased usage of mental health and substance abuse services, evidence supports that there is a considerable unmet need for mental health and substance abuse treatment. Clinicians believe that the quality of care under managed care is seen as a hoax, in that they believe that the sole intent of managed care in psychiatric services is cost control or cost containment.
"A restrictive managed care system that refuses to address issues such as housing, employment, and supportive rehabilitation efforts for persons with long-term mental illness may force families and the community to bear the burden of providing necessary services that the system will not allow."
Currently, in the private sector, managed care emphasizes brief, focused therapies for persons with mild to moderate psychological difficulties. Occupational therapy might run the risk of being lost in the turmoil of mental health care system changes. This can pose as an ethical dilemma. OT is a small part of the mental health treatment picture because there are few occupational therapy practitioners in these settings . To develop cost effective programs and services, OT needs to be visible, proactive, and accountable to encourage the use of community based services instead of inpatient services, developing proper guidelines and protocols for treatment. In this way, we provide the services for those who are in need in our communities.

There have been many investigations into the correlation between survivors of critical illnesses and cognitive impairments of patients admitted with sepsis or those in surgical or medical ICUs. These survivors of critical illness acquire severe cognitive impairments post hospital course of which can mean notable dependence among patients who were autonomous prior. I encourage you to read the resources and explore further, especially if you are headed to an acute setting. The research can provide you with further understanding of post acute impairments in the acute setting and post acute.

http://www.icudelirium.org/outcomes.html

This evidence based review provides an overlook into the effectiveness of occupation based interventions to improve occupation post stoke. It reviews 39 articles of which most address ADLs. The review focuses on pinpointing the evidence for occupation based interventions. The results of the review support occupation based treatment approaches that address ADL performance. The evidence that relates to the other areas of occupation are less conclusive.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281705/

After hip surgery in the acute setting, occupational therapy works with the patient to instruct in energy conservation, proper body techniques, joint precautions that may limit functional activity, and self care. For those of you going into an acute setting for your 2nd level 2 fieldwork on an orthopedic unit, AOTA gives a good outline of what an OT will work on with the patient in the first couple therapy sessions together.

http://www.aota.org/about-occupational-therapy/patients-clients/adults/hip/dailyactivitiesafterhipreplacement.aspx

This study offers a glimpse into the concerns and frustration therapy has during the discharge phase of acute care and what therapy can do to help aid patients with post acute management of their occupations. Therapy is primarily concerned with transferable skills that will follow the patient into the community. Simply put, this research focuses on the question, what does a patient need to acquire these transferable skills to thrive in the post acute environment? Two models were identified to be fundamental for the success of patients. Within these models, concepts that include being believed in, and feeling ready for transition.In addition, having a phone number to call was also comforting and helped with the transition. In the same model, providing the patient with adequate resources significantly boosted their confidence in taking care of themselves after transitioning home. The occupational hierarchy model similar to Maslows Hierarchy of needs. These needs were developed starting with self-care, home management, work, satisfying leisure pursuits, and ending with self-fulfillment. In the conclusion, it is discussed that these needs and concerns addressed by hospital patient helps the OT to better form predischarge plans for helping the patient transition home.

http://ajot.aota.org/article.aspx?articleid=1862374&resultClick=3

Patient readmission is commonly seen at the Cleveland clinic and I found this to be an interesting read into understanding how hospitals might do things different to reduce patient readmission.

This synthesis report was written by health analysts and managers to summarize research that focuses on the reasons behind why specific hospitals are able to decrease their patient readmission rates. The article pinpoints ways that top hospitals have been able to reduce readmission rates and recommend ways other hospitals may be able to do the same. The article discusses how environmental factors, post-discharge follow-up, and patient knowledge of health conditions can all reduce readmission rates, among other factors. This review was useful to better understand how hospitals might improve their quality of care for the patient during their hospital stay and post discharge.

http://www.commonwealthfund.org/~/media/Files/Publications/Case%20Study/2011/Apr/1473_SilowCarroll_readmissions_synthesis_web_version.pdf