CAOT Position Statement
Telehealth and e-occupational Therapy(2011)

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It is the position of the Canadian Association of Occupational Therapists (CAOT) that the ongoing development of tele-occupational therapy and e-occupational therapy will promote opportunities for effective, efficient and accessible occupational therapy services, education and resources to all Canadians. CAOT recognizes that the growth and sustainability of tele-occupational therapy and e-occupational therapy are essential elements of being consistent with the principles governing our health care system and represent the underlying Canadian values of equity and solidarity (Government of Canada, 1984).

Recommendations for occupational therapists:

1. Occupational therapists advocate for tele-occupational therapy and e-occupational therapy to  promote access to occupational therapy services, education and resources where appropriate.
2. Occupational therapists collaborate with stakeholders at national and regional levels to promote and engage tele-health services.
3. Occupational therapists use national guidelines to promote high standards of tele-occupational therapy and e-occupational therapy (e.g. National Initiative for Telehealth Guidelines [NIFTE], 2003).
4. Occupational therapists use research evidence to inform and identify best practices that attain effective and meaningful outcomes in tele-occupational therapy and e-occupational therapy.
5. Occupational therapists engage in continuing professional development to enhance their skills, knowledge and expertise in the delivery of tele-occupational and e-occupational therapy services.
6. Occupational therapists are mindful that regardless of service delivery method (e.g. in-person visit versus tele-health visit) professional standards of practice are upheld (i.e. issues of privacy and confidentiality, client safety).


CAOT Initiatives

To enable occupational therapists to develop and deliver quality tele-occupational therapy and e-occupational therapy services, CAOT will:

1. Collaborate with the profession and stakeholders to advance quality tele-occupational therapy and e-occupational therapy services in the public and private sectors throughout Canada. Stakeholders may include unions, government, employers, employees, members of the public. 
2. Facilitate professional development activities and services to build capacity for occupational therapists to engage in tele-occupational therapy and e-occupational therapy.
3. Provide occupational therapists with access to research-based evidence to support implementation of the best tele-health practices.
4. Develop and implement a communication plan to inform members of these initiatives.

Background

The Canadian Association of Occupational Therapists is a professional not-for-profit national voluntary organization that provides resources and services to develop excellence in occupational therapy. Occupational therapists are graduates of university programs with baccalaureate or master’s entry-level degrees and are regulated health professionals in all 10 provinces. Occupational therapists work with individuals and groups of all ages and levels of ability to promote health, well-being and justice through occupation.  Occupations are groups of activities and tasks of everyday life that people are engaged in such as work, volunteerism, school, leisure and personal care.

Occupational therapists provide quality services in health care organizations, community services, schools and industry in both the public and private sectors. An evidence-based, client- centred approach is central to occupational therapy service delivery (Canadian Association of Occupational Therapists, the Association of Canadian Occupational Therapy University Programs, the Association of Canadian Occupational Therapy Regulatory Organizations and the Presidents’ Advisory Committee, 2009). Occupational therapists utilize key enablement skills: adapt, advocate, coach, collaborate, consult, coordinate, design/build, educate, engage and specialize (Townsend & Polatajko, 2007).

The Canadian Association of Occupational Therapists advocates for equitable access to quality occupational therapy services for the health and well-being of the people of Canada. CAOT recognizes engagement in meaningful occupations as an important determinant of health. Through occupational therapy, Canadians are enabled to maximize their productivity, reduce lifestyle restrictions and avoid unnecessary dependency (CAOT, 2008).

Occupational therapists are challenged by Canada’s vast geography and uneven population distribution to meet the five principles of the Canada Health Act: accessibility, universality, comprehensiveness, portability and public administration (Government of Canada, 1984). With the advancement of technology and reduced communication costs, it is now feasible to deliver health care services and education across large and small geographical distances through “telehealth” (Miyazaki, Liu & McCracken, 1996; Miyazaki & Liu, 1997; Miyazaki & Liu, 1998). The first telehealth centre in Canada was established at the University of Alberta in February 1996 with tele-occupational therapy as one of the key services (Liu & Miyazaki, 1999; Miyazaki, Liu & Kovacs, 1998) Telehealth can be defined as “the use of information and communications technologies to deliver health services and transmit health information over both long and short distances” (Canadian Telehealth Forum, 2010). Therapists can use Telehealth as a tool to facilitate multi-disciplinary communication, provide ongoing client care and education, reduce referral wait times and prevent unnecessary travel. It can also be used for therapists to access educational resources to maintain professional competencies as required by their provincial registrar and for administrative purposes for program planning. 
 
Over the past decade, there have been numerous reports that have paved the way for developments to capitalize on the potential for tele-occupational therapy/ e-Occupational Therapy. These major reports confirmed that knowledge, evidence and information will be central to the health services and systems of the future. A key agent of change in the transition to this future will be information and communications technologies, or ICT (Canadian Network for the
Advancement of Research, Industry and Education (CANARIE) (1996 & 1997)).

The Report of the Commission on the Future of Canada (Romanow, 2002) described telehealth as a promising method to deliver health services. Telehealth was identified as a means to improving access to health care services by people in rural and remote areas.

The National Initiative for Telehealth Framework (NIFTE) (2003) is an important milestone in the development of the telehealth field in Canada. This framework was developed by a multi-stakeholder interdisciplinary group. The NIFTE Framework of Guidelines consists of a structured set of statements designed to assist individuals and organizations with the development of telehealth policy, procedures, guidelines and/or standards. The document examines guiding principles and suggested guidelines for five main content areas related to telehealth including: clinical standards and outcomes, human resources, organizational readiness, organizational leadership and technology and equipment. Guidelines are essential to address the unique elements that characterize excellence in occupational therapy services and the application of evidence-based practice to attain effective and meaningful outcomes.

Glossary

e-occupational therapy: is Occupational Therapy and education through the internet.

Occupational therapy: is the art and science of enabling engagement in everyday living, through occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life. (Townsend & Polatajko, 2007)

Telehealth: is the delivery of healthcare services and education at a distance via the use of communications and information technologies.

Tele-occupational therapy: is the remote delivery of occupational therapy services and education through communication and information technologies.

References

Canadian Association of Occupational Therapists (2009). Joint position statement on evidence-based practice. Retrieved on November 8, 2010 from http://www.caot.ca/default.asp?pageid=156

Canadian Association of Occupational Therapists. (2008). CAOT Position statement: Access to occupational therapy. Retrieved November 10, 2010 at http://www.caot.ca/default.asp?pageid=421.

Canadian Network for the Advancement of Research, Industry and Education (CANARIE) (1996). Towards a Canadian Health Iway:(CHI) Vision, Opportunities and Future Steps. Ottawa, ON: Author. Retrieved on October 11, 2004 from http://www.hc-sc.gc.ca/ohih-bsi/pubs/1998_nchis/nchis_e.pdf.

Canadian Network for the Advancement of Research, Industry and Education (CANARIE) (1997) Telehealth in Canada, Ottawa, ON: Author.

Government of Canada. (1984). Canada Health Act. Ottawa, ON: Author. Retrieved on October 11, 2004 from http:// www.hc-sc.gc.ca/medicare/chaover.htm

Liu, L., & Miyazaki, M. (1999, August). Telehealth at the University of Alberta. Paper presented at the First International Congress on Telehealth and Multimedia Technologies, University of Alberta, Edmonton, Alberta.

Miyazaki, M., & Liu, L. (1998, October). Tele-learning in health science environment. Paper presented at TEXPO, Fredericton, New Brunswick.

Miyazaki, M., Liu, L., & Kovacs, L. (1998, May/June). Applications of Telehealth in occupational therapy (Abstract page 53). Paper presented at the 12th International Congress of the World Federation of Occupational Therapists, Montreal, Québec.

Miyazaki, M., & Liu, L. (1997, June). Telehealth and interdisciplinary clinical education (p. 18). Proceedings of the Canadian Association of Occupational Therapists Annual Conference, Halifax, Nova Scotia.

Miyazaki, M., Liu, L., & McCracken, P.N. (1996, November). The use of “Telehealth” for providing services to geriatric clients in remote communities, and for postgraduate education of health professionals. The Gerontologist, 36 (special issue I), 231).

Romanow, R.J (2002). Building on values: The future of health care in Canada. Retrieved on October 11, 2004 fromhttp://www.cbc.ca/healthcare/final_report.pdf.

The National Initiative for Telehealth Guidelines (2003). The National Initiative for Telehealth (NIFTE) Framework of Guidelines. Retrieved on October 11, 2004 from http://www.cranhr.ca/pdf/NIFTEEnvironmentalScan-ExecutiveSummary-May72003.pdf

Townsend, E.A. & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa, ON: CAOT Publications ACE.

Position statements are on political, ethical and social issues that impact on client welfare, the profession of occupational therapy or CAOT. If they are to be distributed past two years of the publication date, please contact the Director of Professional Practice, CAOT National Office, CTTC Building, 3400-1125 Colonel By Drive, Ottawa, ON. K1S 5R1. Tel. (613) 523-2268 or e-mail: practice@caot.ca.

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