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Top 10 Emerging Practice Areas To Watch in the New Millenium
By Cynthia Johansson
Where will you practice in 2010?
In 1998, AOTA President Karen Jacobs said, "We have only just begun to identify and reach some of the most dynamic markets for our services." She was right.
Since then, interest in emerging practice areas has soared, as opportunities in long-term care and other traditional settings have declined. Some practitioners already work in so-called "emerging areas," while others are still considering new markets, either on a full- or part-time basis.
Here's a brief look at how current events, legislative changes and professional advocacy are reshaping the face of OT practice today, based on information gathered by the AOTA's Communication Department.*
- Ergonomics consulting. Industry is looking for ergonomics consultants, thanks to a growing awareness of the link between ergonomics factors and injury in the workplace. The November 1999 release of the Occupational Safety and Health Administration's proposed ergonomics standard on work-related musculoskeletal injuries has further accelerated interest. Beyond the regulatory developments, evidence continues to accumulate about the benefits of ergonomics programs, including reduced workers' compensation costs and increased employee morale and productivity.
Occupational therapy practitioners are already serving as injury prevention and workplace modification consultants to industry and state governments. Practitioners with experience in work hardening and rehabilitation programs are beginning to take on consulting duties related to injury prevention. Some practitioners with ergonomics, business and consulting expertise have even established businesses to help other therapists set up their own consulting practices.
- Driver rehabilitation and training. The recent landmark decision by the American Medical Association to assign physicians the ethical responsibility to address driver safety issues with patients will boost the demand for driver rehabilitation services.
While physicians have the responsibility of reporting at-risk drivers to motor vehicle authorities, before reporting they can refer patients for evaluations and additional treatment, according to the AMA.
Driver rehabilitation specialists say that most physicians won't want to be the "bad guy" and will prefer to send patients to specialists such as occupational therapists, who are trained to evaluate and road test questionable drivers. The involvement of physicians is likely to boost the demand for driver rehabilitation professionals, create new programs, and expand awareness of the role of occupational therapy in driver training and evaluation.
Additionally, aging Baby Boomers, accustomed to independence and mobility, are likely to take whatever steps are required by physicians or motor vehicle authorities to stay behind the wheel as long as possible. Some are already paying out-of-pocket for driver rehabilitation services for aging parents and loved ones to maintain their own peace of mind.
Another important future role for practitioners is in developing transportation alternatives for clients who can no longer drive safely. Because research has shown that the loss of mobility typically has a devastating effect on a person's mental and physical health, designing plans that consider mobility, as well as psychosocial and quality of life issues, will be integral in maintaining client wellness and reducing health care costs.
- Design and accessibility consulting and home modification. Occupational therapy practitioners currently provide consultation to architects, designers, engineers, contractors, and public facility managers on accessibility provisions within the Americans with Disability Act of 1990 (ADA).
As more and more people chose to "age in place," the concept of universal design -- designing homes to accommodate everyone -- is gaining popularity and increasing demand for consultants with knowledge of special populations.
Home modification consultants for older persons and persons with disabilities should also find an expanding pool of customers. According to gerontology experts, the number of people needing more supportive home environments will grow dramatically in the next three decades. By 2020, the population of those aged 65 years and older will increase to 54 million.
The anticipated growth of Baby Boomers, and the fact that people with and without disabilities are now living into their 70s and beyond, suggests a strong market for supportive and elder-friendly housing. Given further scientific evidence, governments may begin to implement stronger policies to support the delivery of health care in community settings (including programs to maintain elderly wellness) in order to reduce spending on hospital and nursing home care.
Occupational therapy practitioners make excellent home modification consultants because they are trained to assess a client's mobility, sensory and cognitive limitations and potential obstacles in the home environment. Consultants also inspect contractors' finished work to insure that structural modifications meet clients' needs.
- Low Vision Services. The Balanced Budget Refinement Act of 1999 allows optometrists the ability to directly refer Medicare Part B patients to occupational therapists for services such as low vision rehabilitation, as of January 1, 2000. Many older adults have vision loss that is secondary to age-related diseases of macular degeneration, diabetic retinopathy and glaucoma.
Occupational therapists should research state practice acts and regulations, as well as state health insurance laws that may limit referrals by optometrists.
- Private practice community health services. According to trend watchers, consulting to assisted living facilities remains a wide-open opportunity. Practitioners provide workshops in fall prevention recommend environmental modifications, and can also provide rehabilitation services under Medicare Part B. Practitioners also train staff to promote activities of daily living (ADL), and design fitness programs for residents. There is a particular need for interventions to help clients maintain their participation in preferred leisure activities.
- Technology and assistive device development and consulting. Advances in computer and communications technology and the trend toward delivering health care services in cost-effective community settings is contributing to a growing demand for home care and assistive devices. More public awareness of the quantitative and qualitative benefits associated with assistive devices is needed, including more outcomes research. The projected growth of the aging population should fuel demand for new technologies and assistive devices that prove cost-effective and help to maintain quality of life and mobility.
- Welfare-to-work services. Under provisions of the welfare reform plan signed into law in 1996, recipients must find work after two years on financial assistance. By October 2002, half of all welfare recipients must have left the rolls or be in work-related activities, or states become subject to financial penalties.
Occupational therapy practitioners fill a particularly important role in welfare-to-work programs due to their ability to assess performance capacities and address cognitive and social skills. They also work collaboratively with clients to identify suitable and satisfying work settings.
With $3 billion in federal welfare-to-work grants allotted to the "hard to serve" in fiscal years 1998 and 1999, some states are beginning to address a cluster of "work-related" disabilities, from mental illness to learning disabilities and visual impairments. Practitioners with mental health backgrounds typically receive referrals from community mental health centers with welfare-to-work grants for vocational support services. Practitioners also work as technical consultants to state governments on work site accommodations and the vocational needs of persons with disabilities.
- Health and wellness consulting. Although some overlap exists between opportunities in home and community health (e.g., consulting to assisting living facilities), this area represents services primarily to corporations and individuals exploring lifestyle and occupational enhancement and change.
Occupational therapy practitioners conduct corporate wellness seminars that focus on job performance issues and well being. Seminars address physical, social, emotional, cognitive and spiritual facets of living.
The 1997 publication of the University of Southern California's "well elderly study" in the Journal of the American Medical Association laid the groundwork for additional studies on occupation-centered intervention to increase and maintain health in the elderly living independently in the community.
- Ticket to Work services. The Ticket to Work and Work Incentives Improvement Act, signed into law in December 1999, will, among other things, allow Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) beneficiaries to receive job-related support services through "employment networks" of single or multiple providers. The employment networks can be public or private sectors entities. The Ticket to Work component is scheduled to begin January 1, 2001, with full implementation in three years.
Opportunities include serving on advisory panels, working as program managers, and providing employment support services.
- Addressing the psychosocial needs of children and youth. The multiple shootings at Colorado's Columbine High School in April 1999 shocked the nation and underscored the need for closer attention to the psychosocial needs of children and youth. Occupational therapists with mental health backgrounds are ideally suited not only to assess the psychosocial climate of schools, but to design dynamic activity programs addressing violence prevention and other youth issues.
Some occupational therapists say school-based occupational therapists, by virtue of their training and daily contact with students, should integrate psychosocial assessment and interventions into treatment plans.
Resources
Practitioners interested in new and emerging markets should join the AOTA Special Interest Sections (SIS), which offer quarterly newsletters and the opportunity to network through Internet discussion groups.
Several emerging practice areas are already "hot" topics within the Listservs: for example, the Work and Industry SIS (ergonomics consulting), the Home & Community Health SIS (consultation to assisted living facilities, community and civic groups), the Physical Disabilities SIS (driver rehabilitation, home modifications), and the Early Intervention & School SIS (interventions to address violence prevention and other adolescent issues through school and community recreation programs).
For more information on SIS resources, see the "Platform" in the January 3, 2000 issue of OT Practice, "Join the SISs in Finding Our Hidden Colleagues," by Virginia Stoffel, chair of AOTA's SIS Steering Committee.
*Note: This article was originally published in OT Practice, January 31, 2000.