On The Job with Emma Saltmarche, Behavioural Supports Ontario Clinical Leader
On the job with Emma Saltmarche
Raised in rural Ontario, Emma Saltmarche set aside her country comforts when she moved to Toronto in her late teens. It was during her schooling as an occupational therapist at McMaster University in 2009, when Emma decided Hamilton was where she wanted to put down her roots. She made it happen two years ago when she took a job as St. Joe's first Behavioural Supports Ontario Clinical Leader.
What does your job entail?
Typically we work with older adults with cognitive impairment who demonstrate responsive behaviours that can interfere with the safe delivery of care, that can create a barrier with being able to move or flow through the system or that put themselves or others at risk. Once we've determined the individual meets the criteria I will do an initial assessment which includes a full chart review, interview with family, interview with as many members as possible of the care team and observation of the patient. All of this can take place over several visits. Once we have a clearer sense of what can be contributing to the behaviours of concern I will put together a care plan. What sets my care plan apart from medicine or geriatrics or psychiatry is that it's entirely non-pharmacological.
What would your care plan look like?
Sometimes the care plan is very straight forward like modifying the approach to how that person is communicated with, how they're physically handled, how they are engaged throughout their care routine. Other times it's much more complex and that's where I really enjoy working in a hospital setting where we have this abundance of resources, this collection of experts in various practice areas and we can put our heads together to figure out what's going on.
Why would that make a difference?
Often times the drivers to behaviours are multi-factorial. They're overlapping so it is more efficient and effective for me to be able to work with all the different members of the team who have expertise in those different areas. Then we can draft something collaboratively.
How do you become involved with a patient?
Anyone on the care team can identify a need for me. A referral would be issued quickly by social work, nursing, nurse managers, nurse practitioners or the geriatrics team. Anyone can do it. I will triage it based on acuity and how many referrals are coming in. Then I'll set up an initial visit.
What training do you have?
I'm an occupational therapist with additional training in geriatric mental health and dementia care. My interest in the practice are began when, in school, I had a placement in geriatric mental health in Northern Ontario. During that placement I had a preceptor that was very comfortable giving me a lot of independence and autonomy as a student clinician. She had me visit patients living in the community with cognitive impairment and I worked on a life story project with them. Through that project I recognized the value of being able to help older adults tell their story, especially for people who are isolated, and the importance of having that story heard. And we took those stories and turned them into something tangible for them and for their families. It was a really powerful experience for me at that time. I really enjoy working with older adults. After graduating I worked in long term care, and then eventually moved into the community setting doing something very similar to what I'm doing now.
Did you always know you wanted to work in health care?
My mom is a nurse and my step-dad was a physician, both community based so obviously that played a role, but for a long time I wanted to be an interior designer. I still have fantasies about doing that one day or maybe finding a way to marry the two.
What do you find most rewarding about your role?
I'm lucky to get to spend time with patients, time to figure out what matters to that person, how to connect with them, and then trying to translate that to the care team to help facilitate connection between the care team and the patient. That is very satisfying and you can see the outcomes of it almost immediately.
What do you do to unwind?
I have a dog and we hike. This is how I transition from workplace to home. It happens at the Royal Botanical Gardens or on the Rail Trail or the Red Hill Valley.
Coffee or Tea?
Coffee, made at home with either a French press or Aero press and a little milk!