expert interviews Jun 15, 2021

I recently had the chance to talk with Sarah Zera, an Occupational Therapist and the owner of Moxie OT. She's also the host of The Moxie OT Podcast. Sarah focuses on how occupational therapists can improve the lives of their clients by helping them get back to the activities they love to do the most. While working on her Doctorate in Occupational Therapy, she studied evidence-based practices that helped her clients return to their most valued and life-affirming activities. It's for this reason that Sarah and I talked about all of these valuable insights to how we design our practices, how we can add value to those clients and organizations that we work with, and keeping on top of evidence-based practices so we can provide value as much as possible to those that we serve. 

Here’s an excerpt of our conversation:

Why did you get into OT in the first place?

Sarah Zera: I have to admit, I'm one of those folks that didn't know very much about OT when I entered my program, but I was always interested in working in the medical field pretty much my whole high school career. I was comfortable working with people with disabilities. I’ve cared for several family members with disabilities, so it did feel like a natural fit for me. I love helping people do the things they need to do and want to do. I love the variety—one session, I could be working in dressing with someone. In the next session, I might be working with an attorney going back to work.

There's so much overlap between Ergonomics and Occupational Therapy. What I understand from talking to people in my program is that many occupational therapists may apply ergonomics processes when returning that attorney to work, doing an accommodation, or addressing risk.

Sarah Zera: Absolutely. Those of us that are more generalists might apply general ergonomic skills. I tend to work with folks with neurological injuries, so we're really concerned about their posture, making sure that they don't increase their pain during the day, and that they have the rest breaks that they need. But many OTs do move forward and specialize in ergonomics and that holistic view. Our ability to consider the context of the situation and environment really sets us up for success in ergonomics. When you think of the movement towards entrepreneurship that we're seeing in Occupational Therapy or in healthcare in general, ergonomics is a perfect fit.

When we’re first chatting on the phone, you mentioned this idea of a “lag” between research and best practice. Can you explain what that means day-to-day?

Sarah Zera:  A few research articles have found that there's a 17-year  time gap between research and clinical practice. In my OT mind, I can recognize how hard it's been for me to implement the best evidence, but it's incredible that that goes across the medical field. 

One of the reasons why this happens is because system change is hard in those organizations. One of the practices that I use as an OT was developed for a one-on-one setting. I worked in a setting that worked with groups of clients, so applying that to my groups versus an individual client was really difficult. I struggled with being able to implement the best practice. Truthfully, as healthcare providers and organizations, we tend to be a little bit stubborn in setting our ways even when we're trying to be open. If we feel that we've seen good outcomes with a certain practice, then we don't tend to want to change. We all know how busy we are, and it's hard to take the time to learn new things. 

Another one is that the researchers need to involve those practitioners or those organizations in knowledge translation projects or research projects that help us implement the evidence. Often, we disseminate that information and then expect people to just do it. But if we're not giving people the time, the training, and the mentorship to learn how to do these things, they're less likely to be put into practice. If you have mentorship to help somebody to practice, and learn, and problem-solve through those skills, you're more likely to see a change. There’s a lot of discussion right now on how we can decrease that gap.

That’s interesting. One of the things that the members of my Accelerate program enjoyed is the monthly literature review and keeping on top of it. And like you said, if you bring in a new best practice, the infrastructure will have to change to support that and disseminate it. So I can see that from people keeping up to date with literature reviews and the slight change within an organization, it will take 17 years to implement because there are a lot of moving parts.

Sarah Zera: Right. From the individual practitioner all the way up to the organization supporting both that time and learning. Sometimes, we also need to change the way that we're implementing the practice, and that's hard. I love that you started that literature review. I think that really speaks to that additional support that we need too. Maybe somebody reads the article and tries it, and it doesn't work. They can bring that back to the group and problem-solve.

Would you like to share any memorable clients that you worked with?

Sarah Zera: The Cognitive Orientation to daily Occupational Performance Approach (CO-OP Approach) was the approach that I was trying to use in my setting that worked with clients and groups but was created for individuals. So what I did for my doctoral project was that I flipped it into a group intervention. I had quite a variety of clients. I had one young gentleman who worked in tech and had a terrible brain injury. I had another gentleman who's a personal trainer. I had a stock market trader, and I had a journalist and professor. 

One of my favorites was that gentleman who was an instructor and journalist. He’s quite impaired, his one arm wasn't working. This CO-OP Approach really focuses on problem-solving, which is not what he’s doing. He just hung out at home because he couldn't problem-solve how to get out and do the things that he wanted to do or just waited for the caregiver to do something for him. Getting to work with him in this group, we worked on small goals. He really wanted to go to Whole Foods and buy his coffee, and he wanted to walk there. Week by week, he got another block further down the road, but he problem-solved what he needed to do. He applied this approach to other things that were important to him. And so, we finished that group at the point where he had gotten to Whole Foods and gotten his coffee. But he continued to apply these strategies throughout the rest of his recovery, and he's back to work, he’s walking, and his arm started working again. It’s just a huge success story for me being able to implement this practice that I've really been working hard to figure out how to do, and for him as he returned back to his life.

Have you noticed anything in your career that some might consider surprising?

Sarah Zera: In that same group, the young gentleman who was a fitness instructor, he was also very impaired. He wanted to get back to feeding his dogs. He had a symptom called ataxia, so he had a lot of trouble coordinating his body. But his dogs lived in the basement and he was living upstairs on the main floor. So I was trying to make him practice the skills of feeding his dogs and break down the activity, but he wanted to feed his dogs for real. He actually started climbing the stairs down to the basement with the support from his family. So as an OT, the win for him was getting to do the thing that’s important to him—feeding the dogs. But we had this secondary win for him: improving his ability to climb stairs and getting that extra exercise at home, not just in the clinic. That’s when I know that the clients are really motivated—when they start doing more than we asked of them.

Working with clients on their goals because it increases their motivation is a common win. I tend to share that story with clinicians to explain the importance of those motivations and client-centered goals, but I use that practice of using those client-centered goals with my entrepreneurial clients as well. 

How has the OT industry shifted during your career so far?

Sarah Zera: One issue that many of us in healthcare are facing, especially OTs here in the US is those higher productivity standards and lower reimbursement rates. These issues are leading to higher rates of burnout for OTs and other healthcare professionals. So one thing that I noticed in my clinical career is that organizations are able to do what some people will call ‘burn and churn’. They wear these professions out, and there's always new graduates that they can hire that are fresher and don't have the same family requirements. It’s really unfortunate because every time someone leaves, they take that institutional knowledge and that clinical experience and knowledge that more experienced therapists have with them. It’s one of those things where big policies are making changes right at the one-on-one client level. 

I think the flip side is that because of a pandemic and because of these other conditions, more OTs and other healthcare professionals are getting into entrepreneurship. We're finding ways to support each other through services like yours, and we're changing the landscape of what we have. We're more likely to be able to work with clients in their homes versus only seeing them in that clinical setting. So I think there are also good things happening right now too as a result of, I suppose, these policy changes.

Do you have any pieces of advice for people who are starting off in the OT profession?

Sarah Zera: Never burn any bridges. The rehab world and the OT world is very small. Folks know each other, folks get a reputation. So don't burn any bridges, don't quit a job without proper notice. 

Use your social network to support you. Create a community of practice of other professionals that are doing similar things as you, or join one. There are so many out there that are developing, so do what you need to do to find those folks that can support you in your journey. 

Where do you think the OT industry is treading for the future?

Zera:  I think entrepreneurship. Like I said, that's allowing us to provide a lot better services for our clients. Many of these OT entrepreneurs are doing Mobile OT, so they're going to clients’ homes. The best practice that an OT school we talk about all the time is working with people in their lived environments, so I think that’s one of the huge ways the industry is going. 

But OTs are also making really big strides in community-based practice and occupational justice. So we're working with other community service agencies. Some OTs are working with homelessness projects, working with vocational programs, or working in prisons. So we talk a lot about occupational justice and how folks have the right to participate in the things they need to do and want to do. You see a lot better outcomes in prisons if folks have access to doing things that are important to them. So the other big and exciting shift in OT right now is community-based practice.

And that’s it! The biggest thing that came out of this interview today is the idea of collaboration and staying on top of the research so you can provide as much value as possible to your clients. And I'm reminded of what we're doing in the Accelerate membership. We’re providing that community for you!

If you're thinking about adding ergonomics to your expertise, the Accelerate program has that collaboration opportunity and community to support you on your journey. On top of that, the Accelerate offers monthly curated literature review so you can stay up to date with where the industry is going. So if you are interested to see if something like the Accelerate program could work for you, I’m opening an enrollment on June 28th. I only open this four times a year! 


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