Heartside Occupational Therapy Clinic

The Western Michigan University Student Occupational Therapy Clinic at Hearstide provides services to adults who are of homeless status within the community of Grand Rapids. Referral sources include St. Mary’s physicians providing services at the Heartside Clinic. The focus of referral for OT services would be as an assessment of client’s abilities, or to provide OT intervention.

Heartside Health Center serves people who are homeless and without a permanent residence. This includes people living on the streets or in missions, shelters, transitional housing and single-room occupancy hotels. Their mission also extends to people who are doubling up with other families on a temporary basis. Most, but not all, clients come from the Heartside area of Grand Rapids, the poorest section of the city. On average, more than 600 medical and social work visits per month are provided.

Homelessness and poverty is associated with dire implications for public health and health care systems. According to the National Alliance to End Homelessness, in 2012 there were 633,782 people experiencing homelessness on any given night in the United States. At the community level, the Grand Rapids Area Coalition to End Homelessness reported that in 2009 there were over 5,000 people who entered the homeless system.

Client evaluation process

Clients are many times referred to OT for an ability screen. This screen is a condensed version of what is typically performed during a functional capacity evaluation in the community environment. Individuals treated at the Heartside clinic may have recently been released from prison and are working with Michigan Works to obtain employment. Physicians may refer these individuals to OT to identify the physical abilities of the individual to assist in identification of appropriate employment. This can be essential to lead to the end of homelessness for these individuals. Clients may also be referred for an ability screen because they have suffered an injury and need clearance before they can return to employment. Additionally, clients may be referred for an ability screen because they have suffered from an injury, or suffer from a chronic disease and possibly may not be able to return to work. These clients are then evaluated to identify their abilities to assist the physician in completion of disability paperwork. Students perform an hour and a half assessment to help determine patient’s physical performance.

In performing evaluations, students apply concepts from the biomechanical frame of reference while assessing client factors such as strength, range of motion, lift and carry, push and pull, and grip and pinch. The rehabilitative frame of reference is also utilized to determine needs for splinting, adaptive equipment, or activity modification. Students use the PEO and Model of Human of Occupation to develop goals that are client- centered and focused on occupations that hold meaning to the individual.

Client intervention process

Many times, clients are identified during the ability screen that could benefit from occupational therapy services. For example, a client may have experiences a long term shoulder limitation that may improve from OT services. OT Assessment and Intervention would then be initiated following MD approval. Clients may also be referred for OT services following identification of need my M.D. and referral from the Heartside physicians. Students use established frames of reference identified at evaluation to identify appropriate interventions.

Assessments used

• Interviews
  • Canadian Occupational Performance Measure Beck Depression Scale
  • Employment history
  • Pain scale (location/severity)
• Observations
  • Perceived exertion level
  • Assessment of circulatory limitations
  • Repetitive activities (stair climb, squat, reaching multiple planes, bending, crawling, fine motor)
• Performance capacity/self care
  • Assessment of vitals (blood pressure, heart rate, oxygen saturation level) active/passive ROM
  • Manual muscle testing
  • Sensation using monofilament mini kit
  • Functional reach to assess for risk of falls
  • Pinch and grip strength (also using assessment of bell shaped curve and rapid exchange)
  • Coordination using nine hole peg test
  • Physical capacity of lift (floor to knuckle, knuckle to shoulder and shoulder to overhead)
  • Two handed carry and single arm carry static push/pull ability

Typical interventions

Interventions are provided on a walk-in basis dependent on client needs and goals. Students work with clients to develop appropriate treatment strategies that are client centered and focused on independent living and return to work.

Psychosocial focus

Clients served present with various physical and psychosocial limitations. The majority of the clients evaluated present with one or more psychosocial factors influencing their lives. The psychosocial component is addressed through the use of the Model of Human Occupation and Cognitive Behavioral frames of reference. Assessments used by OT students to address the psychosocial aspects in our clients are the COPM, Beck’s Depression Scale and MADS. These assessments allow us to evaluate the severity of the client’s psychosocial state and form our interventions. Many times these individuals are also then referred for counseling services also provided at the Heartside or through Network 180.

Through the interview process students gain insight into the complexity of homelessness, and the psychosocial barriers that contribute to joblessness in conjunction with physical impairments.

Interprofessional opportunities

Occupational therapy students receive referrals from physicians located within the clinic and must maintain communication with physicians regarding the status of each client. Students have the opportunity to observe/listen in as nurse case managers triage calls from the community regarding medical issues. Students also are able to work with case managers as they advise clients and work through the process of setting individuals up with the marketplace associated with the Affordable Care Act.

By the end of the semester, it is expected that the students will have developed the following basic competencies regarding working with individuals of homeless status presenting with both psychosocial and physical limitations:

Evaluation and Intervention Process

• Building therapeutic relationships and therapeutic use of self.

• Developing client-centered and occupation-based intervention plan supported by appropriate theoretical approaches and evidence.

• Providing intervention directed toward improving independent living.

• Documentation skills that communicate client performance, goals and progress with accuracy.