Welcome to Episode 5 of Beyond Barriers, Navigating Health and Function, developed and produced by the Society of Alberta Occupational Therapists.

I am your host, Pam Hung from Edmonton, Alberta, and we are talking to occupational therapists that work with clients in different practice areas to learn more about the many ways occupational therapists promote engagement and participation in everyday life activities.

Today we are speaking with Catherine Eckerle, an occupational therapist working in private practice that provides occupational therapy services to adults in Calgary and southern Alberta.

Originally from England, Catherine has spent the last 20 years in Canada, completing her Bachelor of Arts.

of Arts in Kinesiology at Western University, her Master of Arts in Physical Education at the University of Alberta, and her Masters of Occupational Therapy from the University of British Columbia.

She has lived in Calgary for the last eight years, providing occupational therapy services to Albertans across the province.

Today, we will dive into what brought her to this area of OT practice, how she has supported clients and their families in participating in everyday life activities, and how OTs are unique health professionals in the community.

Let's get started.

Welcome, Catherine.

Please tell us a bit about your work as an occupational therapist, working in the community with adults.

And what drew you to work in this area?

So working in the community, being able to be in people's homes or at their workplaces really appealed to me because I can see the client's world.

I can see where they're having their occupational difficulty.

It really allows me as a visual person to have a clearer picture, a much better understanding, and to be able to more creatively problem solve.

sometimes when clients come into a clinic for an assessment, you might miss critical information.

they just may forget to tell you something or may not know that something is worth sharing with you.

But when I'm actually in their home environment and I'm asking them to demonstrate and explain what their difficulty is, it just gives me a much clearer picture because not all of our homes are the same.

And one bathroom or one bedroom or kitchen, definitely kitchens are significantly different from each other.

So, um, the more information, the better.

Plus, I just love learning about people's lifestyles and seeing the diversity of our community by actually being out in it every day and driving all over the city and seeing all the different demographics.

I just love being out in the community.

Yeah, that's great.

And even just getting a sense of what people's environment, what context they're actually in always gives us a bit, like you say, more information about what their living space is like and sort of more insight into their experience as well.

Exactly.

what are some of the types of challenges your clients face on a day to day basis?

so my clients are as diverse as they can be.

they have challenges with anything from almost any daily task or role that you can think of.

So it could be something that we perceive as like a simple self care task.

It could be toileting, showering, dressing, could be cutting your toenails, could be anything to working, driving, parenting, um, sleep, sex, uh, Snow shoveling, literally any, any essential task or role that you're having difficulties with, that's when we come in.

so we also work with the unhoused population on a myriad of goals like access to housing, financial supports, medical support, community connections, socialization, et cetera.

when it comes to health conditions, again, we work with people from short term injuries.

So I think like broken bones, chronic conditions, whether that's spinal cord injuries, neurodegenerative conditions, maybe someone with MS or ALS, concussions, brain injury, dementia, mental health, anxiety, and depression.

Really any health condition.

We really work with everyone across the spectrum.

Yeah, and that really spans like both physical and mental health, which is something that I think is fairly You know, somewhat unique to OT, given that we kind of look at all those parts of the picture, within a person or community So yeah, that's really varied.

you must have some really interesting experiences with clients.

So, you know, given that you work with such a diverse range of clients, how do you or, um, or your team, if you've got one in your practice as occupational therapists, help people that experience these challenges?

So we do have a team here, in Calgary and in Edmonton.

and really as an OT, regardless of the geographic area that we're in, we bring our medical rehab lens to essentially be detectives.

We gather all the irrelevant information.

We work out, what is the client's goal?

Are they trying to get back to driving?

Do they want to manage their medications independently?

Do they want to improve their cognition?

And essentially from there, once we know what the end goal is, we assess and work out where are they right now?

What are the barriers that are getting in their way?

What education, equipment, support, or services can either eliminate, modify, or compensate for those barriers?

So simply put, what do you want?

What's stopping you?

How do we fix that?

Nice.

Yeah, that's a nice way to, to really sum it up, right?

Um, and, you know, keeping that really sort of client centered, person centered lens there in mind and at the forefront too.

given that you work with lots of different groups of people and individuals, do you work with people that are more in their, client support system, such as maybe their family members, other caregivers, educators?

who else do you support within, that client circle?

Absolutely.

Um, so as most people typically have a family or support network, it's vital with their consent, of course, that we involve them for, for many different reasons.

One, sometimes it's to ensure that recommendations are being carried out appropriately when we leave.

We're normally only there for one to two hours.

We're not with them 24 7, so it's good just to have someone else hear the information.

Sometimes it's for safety reasons.

It could be because the caregivers or support people are attending medical appointments with them, so that they're second eyes and ears of the client.

Especially because it can become very overwhelming trying to remember everything yourself.

and because they might notice concerns that a client hasn't disclosed.

whether that's due to poor insight or a sense of pride.

There are really important other factors to consider.

And of course, the caregiver themself might be having difficulty managing their own care, because if they're providing care for someone else, they could be burning out.

Maybe they're not physically able to, cognitively, emotionally able to, then further support are needed.

if a client doesn't have a family or support system, then actually part of our role is connecting them with appropriate community resources.

So whether that's social opportunities, volunteers who visit and help with grocery shopping or housekeeping, depending on what the difficulties and goals are.

So it could be either working with the support system in place or helping find an appropriate support system.

Yeah, that's great.

And that's kind of another piece to a client's environment or context that we take into consideration as occupational therapists too.

when we're thinking about, occupational therapists contributing to and promoting clients health and wellbeing, occupational participation, how does, how does your role as an OT contribute to that?

I may be a bit biased, but I'd say that OTs are as essential as physicians, psychologists, and social workers in our clients health and wellbeing.

we support the physical, the cognitive, the mental, the spiritual, and all other areas of health.

We are whole person focused.

So even if we're at your home to assess your mobility, chances are we're unofficially also just being mindful of your cognition, your social supports, your access to community supports, your mental health.

Um, we don't work in a vacuum.

As occupational therapists, we're typically case managers.

We're collaborating with your other treatment providers, with your family, with your insurance, with your employer, with your lawyers, et cetera.

so we try to take on the role as case manager.

The client of course is the head coach of the team as it were, if we're bringing a sport analogy into it, and we're there as the assistant coach to help ensure that all of the pieces are there and the communication is across the team.

Right.

Yeah.

And working in private practice, I know sometimes that can be a little bit separate from other healthcare providers or healthcare professionals.

How do you collaborate with other healthcare professionals when you're working with clients and their families or support systems?

we work with every health professional, honestly, from the expectors of the physicians or physiotherapists, um, to those that maybe people think of less often.

So I work with, dentists.

I've collaborated with, orthotic and prosthetic specialists, social workers, psychologists, et cetera.

but we also work with builders.

We work with renovators.

We've collaborated with the dog walker, home care, housekeeping, honestly, whoever needs to be involved.

For whatever reason, to facilitate the goal, with consent, we're collaborating and making sure that whoever needs to know, knows.

So we tend to be more of the case manager or healthcare team coach, as I mentioned, we're coordinating with all the other providers, making sure everyone has the information they need.

There are no redundant appointments by having too many cooks in the kitchen, too many people involved.

and really essentially providing the client with the information to make informed choices.

Yeah.

And I mean, that's, you know, really depends on what, what the client's goals are, what their needs are, are kind of provide some guidance into who else needs to be involved in their care.

what challenges have you faced as an occupational therapist working in this field?

So as a Private Occupational Therapist, so fee for service, the biggest challenge typically is having clients have the resources to pay for services and then the recommended equipment, treatment and supports.

it's really easy to say.

Oh, you can't manage the stairs.

You should have an elevator to access all floors of your room, but that's not necessarily, of course, within the means of every client.

so having to problem solve creatively for alternatives, which can also involve sourcing funding.

Um, so money, money is generally one of the biggest barriers.

Um, and sometimes dealing with insurance providers or lawyers Can be a bit difficult, because not everyone necessarily has the same goals.

the client's goals, working to support the client as best as possible in those situations and providing them with all the information to make informed choices, and trying to advocate for their needs while providing the appropriate service to the insurance provider.

that balance, that balancing act of wearing multiple hats as an occupational therapist.

nice.

Yeah, that's actually exactly what I was just going to say that it is a bit of a juggling act to, you know, work with different people, working with the client, make sure that their goals are addressed in a way that works for them so that they can do the things that they want to do in their day.

I'm thinking about other healthcare practitioners or.

so much for joining us today, and to all of our healthcare professionals and even maybe some of those other people that you work with, when you're supporting clients, what do you wish they knew about OT?

How do you think this might improve patient care?

So much.

I wish people knew about OT.

Me

Um, yeah, so much.

I think one of the main things that I wish other health practitioners knew about us is that we work in cognitive and mental health.

We're not just physical health.

most people tend to think of occupational therapists as either return to work coordinators, which we are, or as equipment providers, wheelchair prescribers.

Which we are, but most don't know that we can actually specialize in cognitive assessment and treatment, which I do a lot of.

We can help people improve their attention, their memory, their executive functioning skills, and often when there is that physical cognitive change in health, or there's been a significant life transition, There's normally a mental health component, of course.

So we work extensively in mental health too.

I also really wish that practitioners knew that we can help clients access funding for equipment, for renovations, for treatment.

Sometimes people are put off by private practice because we're fee for service, but when you weigh the initial assessment cost, you know, 100 to 200 an hour, depending where you are in the country and what's being provided, with the potential access to thousands of dollars of funding, In my opinion, it can be worth the expense.

Um, so I wish that practitioners knew about that too, that we can help clients access funding.

Yeah, that's such a good point.

And there's even just so many people I talk to, whether it's a family member or a friend about, um, Someone they knew needing equipment and they just went out and bought it.

And I, you know, would think of and even say to them, you know, there's actually funding programs that can help, you know, support paying for some of those things.

of course there's, you know, sometimes a wait list and you have to wait for an assessment and that sort of thing, but those funding options are so important to improving access to particularly equipment for people, even orthotics, right?

Yeah, absolutely.

And unfortunately I've run into the case where someone, for example, needed a wheelchair, some mom or dad or whoever ran out and grabbed one because just not knowing, right, that there's So much more to wheelchairs than just to sit on it, and that's it, and it wasn't the right type, wasn't the right size, was putting them at risk for pressure injuries, and you know, they've done their best to help, but because of the lack of awareness that an OT had to be involved, or an OT or a physio who specialized in seating and wheelchair prescription should have been involved.

Now they've got this expensive piece of equipment that's not quite right, that we can't necessarily modify or return.

So now we're looking at more money in the long run, um, unfortunately.

Absolutely.

know, OTs have some of that kind of specialized skill set to do those assessments, make those measurements, looking at the space that a piece of equipment might be used in and seeing how all of those things fit together, um, to work for, to work for a client.

Okay, so yeah, given we've talked about, you know, some of the things that we wish other people knew about OT, what are some things you think could help to address some of those misconceptions of the OT role?

Education, education, educations, and podcasts like this one, of course.

Um, so, um, my company, for example, we regularly provide free or low cost in person or online educational webinars on OT in a variety of topics.

we provide occupational therapy and aging in place webinars, with the local senior center.

Practical tips on how to manage neuropathy symptoms to the Calgary Neuropathy Association.

Um, there's, there's so much that we could do as occupational therapists and as the public to educate ourselves about the role of OT.

Whether it's OT's networking with their local equipment vendors, their home care providers, rehab facilities, and also networking with the non healthcare providers.

People tend to Stick to their lane and not think of outside of the healthcare providers that are involved.

So like the builders and renovators, the real estate agents, we can provide them on educate, give them education on the role of occupational therapy with aging in place decisions or networking with lawyers and insurance companies to educate them on what OT can do to support clients, improve their independence, their safety, their quality of life after injury or illness.

just getting out there, as an occupational therapist and educating the public one person at a time.

it really is a ripple effect.

just spreading the word,

Yeah, it's

at a time.

It's true.

And there's, you know, there's, there's a lot to be said for, helping someone understand more of what OT does so that they can share with the next person, or maybe they have a family member who's accessing the health system and working with an OT gives them kind of a better understanding of it.

I feel like every time I speak to someone about what occupational therapists do in different areas, they're always surprised.

Like, oh, I thought, they just, helped provide equipment, but there's, yeah, there's so much more to the breadth of the breadth of our profession, for sure.

Absolutely, and just because you've worked with one occupational therapist, it's kind of like that saying, just because you've worked with one doesn't mean you necessarily have worked with all of them.

Like, I normally run into people who are like, oh I know an OT, they help me in the hospital.

Perfect, completely different from what I do.

Very essential role, of course, but very different from what I do in the community.

Can I tell you about what we do in the community and how it's different?

Or sometimes when you're working with, um, working with parents, then they might have occupational therapists for their children and be familiar with OTs in the school system, a completely different world from, again, the community private occupational therapy practice.

So yeah, just cause you've met one of us, doesn't mean you've met all of us.

Oh,

That's just kind of the essence of, you know, Of this, of this podcast series, because we want people to understand how broad our scope can be in different areas.

so, given, yeah, that, you know, you work with lots of different people.

You work with people with lots of different diagnoses.

How do you typically get referrals in private practice?

they come from everywhere.

we receive referrals directly from the public or maybe a family member, support person.

we receive referrals from healthcare providers, from living facilities who maybe don't have occupational therapists on staff.

or an independent living facility who doesn't have medical teams on staff.

we receive referrals from equipment vendors when people are looking at wheelchairs.

That's it.

That's why you've got to establish those relationships with the vendors, they know when to bring you in.

how do we get referrals from lawyers, insurance companies, employers, renovators, real estate angels, and essentially either from the client or anyone in their support system, anyone in their circle that's noticed, you There's a difficulty.

so generally I tell people when, when should I refer to OT.

I normally say if in doubt refer, we'll let you know if it's appropriate.

Or as a case manager, we can let you know Who would be more appropriate, whether it's social work, physiotherapy, psychology, but typically we tell people an OT referral can improve client care anytime that client's experiencing a barrier to a goal due to a medical or life transition reason.

If something's getting in their way and stopping them from being them or doing what they want to do, that's probably when you bring in an OT.

Great.

Um, can you share a bit of an example or paint a picture of a time when your contributions in client care led to improvements in their quality of life?

I'm sure you've got lots of examples, but probably hard to choose just one.

Yeah, honestly, it can be anything from adjusting a walker that a person's had for ages that wasn't at the right height and having them say Oh, that's much better.

Yes.

Yes, it is.

Um, or, or doing a full home accessibility renovation project with a client after a spinal cord injury, and setting everything up to be wheelchair accessible.

Or it could be getting a phone call from a client a month after discharge saying that they're continuing to be successful balancing work and life after return to work program.

Um, I think the most recent example would probably be supporting a couple who'd been in a car accident, and they needed help with discharge planning and coordinating with the hospital team.

So I had to set up their private home care with them to fill that gap before our public system could start.

There's always going to be little gaps.

Uh, I went to the home without them with family while they were still in hospital to assess the equipment needs based on the home environment, coordinated with the local vendors, make sure all the equipment was rented and delivered and set up before they were discharged.

Then coordinated with the couple.

So they were all set up when they were discharged.

Um, and make sure that we had their meal services set up because both of them were injured.

housekeeping was set up.

they couldn't drive because of their injuries.

We just set up transportation accounts with local taxi providers.

and then coordinate all of that with the insurance company.

So they're not paying out of pocket and getting reimbursed and having that additional stress to everything.

and then making the referrals to the in home physiotherapists because they couldn't get out to see the local physios.

setting up some of the virtual psychology sessions too, because of the trauma involved with the significant event and then both being injured.

and of course, once they're discharged, reassessing, the equipment and service needs, providing updates, being in regular contact with them during their rehab.

So, in the days, weeks.

And in the month or two that followed, just checking in and changing the plan and adjusting it based on what had changed, how they were managing, what did they need?

and eventually, months later, of course, once they're physically and psychologically feeling much more ready for it, I was involved with assessing their return to work appropriateness and coordinating their gradual return to work plans.

With modified duties and hours, of course, and some equipment initially.

so I worked with that couple for months and got to know them fairly well and was really involved from pretty much almost the very beginning with the hospital, all the way to getting them back to work and being sustainable with work, which is fantastic.

Um, it's not just getting them back and making sure they get back, they can still.

Manage everything at home and in work.

Um, so that's not necessarily always the case.

Sometimes we are hired for just a one off assessment or a safety check.

We're providing peace of mind to a client or family member, maybe after a recent fall or a recent health change, and we're just checking that, you know, We're confirming that they have everything that they need to be safe and successful.

So when it comes to occupational therapy, like contributing to client's care, it significantly varies.

It depends on what we're brought in for and what the client's goals are.

Yeah, for sure.

what a nice example of sort of, I think all the different ways that OTs can, you know, support clients, so I guess in that situation, my question is like, how did you end up getting connected to that couple?

Like, did a family member contact you or was that done through the hospital or how did that work right at the beginning?

So that was an insurance provider that reached out because we'd worked with them before.

It was for a couple that was actually out of province, so it just makes it a little bit more complicated because they don't have Immediate access to our local public.

I'll put our health services out here.

Once you're out of province, just another layer of red tape that OTs help to navigate and coordinate for you.

so my role was trying to get them into the system here, get them set up with all the local supports, because they have been injured.

Like I said, out of province and then having them transported back to the province, get them set up in home, trying to do a lot of it virtually.

yeah, a little bit more complex.

Okay.

Lots of layers there.

That's for sure.

Um, kind of flipping back to sort of your own experiences, your own interests and passions.

Are you able to incorporate, some of your own interests into your work in private practice?

Oh, absolutely.

I mean, that's one of the key reasons I am in private practice.

Um, I love learning about people's stories, their experiences.

Um, I'm a big problem solver.

I love playing detective and being creative.

I love being within the medical field, but also not in that medical clinic setting, if that makes sense.

Um, and being out in the community, out in the real world.

In my car, driving around, seeing everybody.

I love exploring all these new daily occupations that people have.

I'm working with clients on, it can be anything.

I'm working with a client right now on 3d printing, and coding, because we're working on some fine motor activity after a stroke.

And instead of just your usual, okay, let's reach for a ball.

Let's do some arm stretches, you know, that you'd probably do in the clinic, try to make it a bit more functional and fun.

yeah, we're doing some 3d printing.

So I get to not just incorporate my passions and that's not necessarily a passion of mine, but I get to incorporate the client's passions into what we do, which is the most important thing, right?

Is that, that motivation, that rapport to get them invested in, in working towards their goal, and not just giving them generic sort of clinic activities, but getting them to work on their goals.

through fun, meaningful activities, which is the whole point of occupational therapy is working with people on the activities that make them, them.

for sure.

And then, I mean, you're learning something new as well, which is wonderful.

I also love that, you know, you kind of talk about OT as being a detective and a few other people we've interviewed in these podcast episodes have, talked about OTs being curious and that really kind of connected with that detective piece that you were talking about.

Which I think is such a cool way to describe it.

so getting close to the end here.

what is one thing that you think everyone should know about occupational therapy?

Ooh.

It's hard

think that,

one.

yeah, it is hard.

There's so much I want to tell everyone.

That's why we're doing the podcast.

we can work nearly anywhere with anyone, any age.

Any difficulty, any situation.

I really like to think of OTs as not just detectives, but we're kind of like your go to jackable trades in healthcare.

Um, like I said, we work with people from the unhoused to the higher socioeconomic demographic.

We can work in schools, we can work in the community.

I work with seniors and adults.

we work with people in end of life care.

There are OTs working in the NICU in the hospital with, with Preemies.

we literally, we can't do everything, but we, we try.

We can pretty much work anywhere, anyone, anytime.

If you have an occupational difficulty or having trouble with a day to day activity or in a meaningful occupation, a meaningful task for you, most likely we can help.

Yeah, and I mean, that's one of the reasons I chose occupational therapy too.

It's just that, you know, there's so many opportunities to work with, with patients.

Lots of different populations, lots of different groups of people in lots of different places.

So I think that sums it up really nicely.

if someone was looking for support from an occupational therapist, how could they find more information or to work with an occupational therapist?

So I refer clients to the Find an OT list on the Canadian Association of Occupational Therapists.

That's the CAOT, our national organization.

So there's a list of private OT providers, and we're one of them.

you can search by demographics.

So whether you're looking for, someone who works in hand therapy, who works with children, who works in mental health, you can also look at The geographic demographic too, so whether you want someone who's in Vancouver or in Calgary.

So I referred them to the Find an OT list if for any reason we're not able to provide services to them.

Or if you're wanting to access free OT services, through your local healthcare agency, then I recommend that they call Healthlink, um, or ask, which is the service we use here in Alberta, 811, uh, or ask their family physician for a referral.

Because there are free occupational therapy services.

through Alberta Health Services, just with everything, there can be a bit of a wait, um, but those are available as well.

So I make sure that people are aware of both options.

Yeah, for sure.

And there are some public resources on the Society of Alberta Occupational Therapists website too.

so we've just got one last question to wrap up.

given that, you know, there might be some people listening to this podcast that maybe are interested in being an OT.

Maybe that's something they're thinking of as a career path or maybe a next career.

Cause I know a fair number of OTs that had, you know, different careers, Before they became an OT, what qualities or skills do you think are important for OTs or for someone who is interested in becoming an OT?

think you have to be a curious, creative, problem solving people person.

but most importantly, you really just have to be genuinely interested in the human connection.

It really is a privilege to be allowed into someone's home, into their life, and to have them share Some of the most personal concerns with you and to work with them, to address those concerns, and work on their goals respectfully.

So it certainly takes a certain type of person.

I do encourage everyone to join the OT field.

There's, uh, there's always a need.

I think it's fantastic industry that we're in.

if you're curious, you're creative, you like playing detective, you like helping people and problem solving, occupational therapy is probably for you.

That's great.

Yeah, that's wonderful.

Thank you so much for spending some time with us today, Catherine, and sharing, sharing your experiences, sharing your insights about occupational therapy and how we promote participation in meaningful activities.

Thank you again so much for being here with us today.

And that wraps up episode five of Beyond Barriers.

Thank you so much, Catherine.

Thank you.

Thanks for having me.

This is a recording of the outro for each episode.

This is a podcast produced and developed by the Society for Alberta Occupational Therapists.

Our podcast is hosted by occupational therapists and is intended to educate and get listeners excited about all the different ways that OTs support health and well being for people at all stages of life.

If you enjoyed this episode, Feel free to subscribe and follow Beyond Barriers, Navigating Health and Function on Spotify, Apple Podcasts, or wherever you get your podcasts.

Thanks for listening.