Veterans Affairs Committee on April 1st, 2008

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Are there other areas of specialty? In the medical field, there are specialists in particular areas. Is that a fact with occupational therapists?

[Helen Gough]

Absolutely. There are hand therapy specialists. I'm currently taking stuff in hand therapy, so that's a specialty area. Not anyone can just walk into it. Really, there's anything. I'm certified in pain management, psychosocial, which is actually, interestingly enough, a pilot project being done in the Canadian Forces now—I don't know if you're aware of it—with a goal attainment program. I'm certified in that. Actually, I'll be using it for the first time with a senior veteran. That's the one I was talking to you about before, and it's going to be really interesting to use. So that's a specialty, of course.

If occupational therapists were embedded into the forces, we would need to send them to do special training. Right now the Brooke Army Medical Center down in Texas is actually a training facility for Canadian Forces health care professionals and can be used for occupational therapist training.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

So if they're embedded into the Canadian Forces, they're embedded in. But once someone becomes a veteran and you have specialists in OT, and they get spread out around the country, and they go to small towns where we struggle to have doctors, let alone others.... If occupational therapists are specialists, how do we overcome the issue of veterans who are in small towns having different needs from those dealt with by occupational therapists who actually are specialized and deal with the special issues that are different amongst veterans? Because now they're not embedded, they are dispersed.

[Helen Gough]

Right. I see what you're saying. So if you had the occupational therapist who's embedded and enlisted in the military and the veteran leaves, and now they're being offered an occupational therapist who is a generalist, say, in a rural town, you're wondering what the difference will be.

I think that's where the treatment plan comes into play. How are we going to supply what they've already been given, not only to, say, pain management that they're receiving or if they're receiving vocational counselling? The treatment plan before releasing them is crucial to figuring out what they're going to need over here in rural Manitoba. Now, if you can't supply it, then maybe we need to reconsider the timing. Maybe we actually might have to take that rural OT and get him or her trained in PGAV, with the pain program. Or maybe we have to do those kinds of special little things.

I know this is the ideal. I'm sorry sir, because I know you're saying that other people need it too. But maybe that's what we need to do.

But maybe a lesser solution that doesn't cost as much would be to find a university or a person who specializes in the area of the discipline, say an occupational therapist, and they collect evidence-based new articles that are the most recent things shown to work with veterans with specific problems, that can be distributed to occupational therapists in rural towns, and they're able to reference those. At least they're providing something more than the general treatment that they might be providing now, as I do.

[Bev Shipley, Conservative, Lambton—Kent—Middlesex, ON]

Thank you.

[The Chair, Conservative, Rob Anders]

Thank you very much.

We now go back over to the official opposition, and to Mr. Russell, for five minutes.

[Todd Russell, Liberal, Labrador, NL]

Thank you, Mr. Chair.

Good afternoon. I certainly appreciate the effort you've taken to present us with such detailed information from your perspective, in the particular vein of occupational therapists.

I'd like to build on something that Roger Valley brought up, which is in the papers today, and which is with regard to the effects on military families. It seems that it's not only that the veteran or the soldier suffers, but the family suffers or is affected. So I think we can extrapolate—maybe not one to one—to say that if we're talking about veterans' issues, it's not only the veteran we're dealing with, it's the family.

I'll make the hypothesis that you won't have a really healthy veteran unless you have a healthy family that surrounds that veteran. So if you go into a situation, if you're called in to go to veteran so and so, do you have much interaction with the family? I know you're dealing with senior veterans, and I'm not sure what your experience is with families, but do you deal with the family at all in terms of doing the assessment on the veteran himself or herself?

[Helen Gough]

I get a referral for the veteran. It's impossible for me not to look at the other stuff that's happening; it's impossible. I don't know whether that's just me, or is OT training in me, or what it is, but I definitely do. I know I can't treat the spouse, but I definitely take them into consideration when I'm there.

I feel I have to. They're part of the solution, really. Whether that's my having to train them in strengthening exercise—and I do them at the same time—or whether it be that I just place the grab bar two inches over because that little women and the six-foot-tall man have to.... And those are very prescribed, traditional OT things.

I know that may not sound like a big deal to people who are listening or who are going to be reading this, but little things like that really do help maintain the spouse's staying in the home as long as possible, which keeps the veteran healthy, which keeps him moving, keeps them going and feeding off each other.

So I take them into consideration. As to whether I'm supposed to, maybe I shouldn't be talking like this, but I do take them into consideration.

[Todd Russell, Liberal, Labrador, NL]

I think that's ultimately the point I'm trying to get at.

You're talking about it in terms of your particular occupation as an occupational therapist. But do you feel that in other professions, other services that may be provided to the veteran, that same type of approach should be taken?

[Helen Gough]

Absolutely.

I realize, though, in saying this, that you're going to have to put more money into it, I guess, because you're going to have to spend longer hours. If you were to say “Helen, you get to treat not only the veteran but the family”, I'd be putting in much longer hours. I may not mind; other people may mind. You'd have to probably put in equipment for the spouse as well. So there are obviously ramifications to saying, “Helen, as an OT you can now go to see the spouse”.

But what I was reading in some of the other things you spoke about, in previous sessions, is that it might cost less to do that in the long run. I'd be happy to do it. I think it's a very holistic approach for occupational therapists to take into consideration. Whether or not it's doable financially is, I guess, for you to decide.

[Todd Russell, Liberal, Labrador, NL]

Have you been in situations in which you're working with other care professionals dealing with the same veteran?

[Helen Gough]

Yes, actually, that just happened recently. I happened to show up, and a physiotherapist was the community worker for the wife, and so we were able to brainstorm. It was an excellent opportunity. Being an isolated OT, because I'm in private practice, I go in alone, so having that....

Is that what you were asking?

[Todd Russell, Liberal, Labrador, NL]

Yes. But in terms of a care plan for the veteran...?

[Helen Gough]

Yes. The health care team really does provide—

[Todd Russell, Liberal, Labrador, NL]

If you're surprised when somebody else is there, is there much sharing and collaboration?

[Helen Gough]

I think there is. If it comes across that our community occupational therapist, sent by Interior Health, is working with a veteran, we'll talk about who's going to take the referral, because obviously we can't overlap. I have access to Veterans Affairs. I literally have access to the phones of the area counsellors. That's excellent, because then I can just pick up the phone and talk with them and bounce things through.

It's the same concerning pressure management, which is a huge issue for veterans, with the nurse. I phone them up. They're right there, so I can collaborate with them, even as a private practitioner, which is great because I'm out on my own. I don't work for Veterans Affairs; I work for myself.

[Todd Russell, Liberal, Labrador, NL]

What I'm taking from some of your testimony is that we should push Veterans Affairs to take a more holistic approach to the care of veterans—and to doing away with even some of your sense of trepidation about saying “Okay, I'll move the bar two inches”, which I would also say is important—particularly with emotional issues that veterans and their families deal with.

[Helen Gough]

Absolutely.

[Todd Russell, Liberal, Labrador, NL]

I thank you for sharing that.

[Helen Gough]

Thank you.

[The Chair, Conservative, Rob Anders]

At this stage, my list is now exhausted, unless—

Oh, I'm sorry, Mr. Sweet; I'm a bad man. I thought you were crossed off already, sir; my humble apologies.

Now it's the turn for Mr. Sweet of the Conservative Party.

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

Thank you, Mr. Chair.

The testimony has been so robust and so complete that most of what I needed to know I have learned. But I want to have the witness maybe expand on what she alluded to a number of times, the understanding of the CF culture. Obviously that's very important to you.

In working with other occupational therapists, have you noticed some very clear examples, when someone comes from the public health care system and tries to serve someone who's a veteran, that they have some real lapses in their ability to bridge their service properly into their life?

[Helen Gough]

Which type of veteran do you mean? Are you talking about senior veterans, newly released veterans, or veterans like my husband?

[David Sweet, Conservative, Ancaster—Dundas—Flamborough—Westdale, ON]

For any where you've seen an occupational therapist, who is solely used to treating patients in the public arena, now having to come into your role. What kinds of gaps have you seen that are substantial?

There are two things: what kinds of gaps; and second, is there a way to accommodate them? It's quite easy for you, as you live with your husband. Well, sometimes you do. These folks are often away.

[Helen Gough]

He's back today and leaves in a week. I get him home after three months. This is good.