the waiting game

There are many different types of the waiting game. I'm playing a two at the moment. I'll start with the most recent waiting game that I experienced today.

I started off my day with my first student running into my classroom. He doesn't know his routine well enough to have made the conscious choice to come to the OT room. He was clearly evading school. "That's ok, I'll take him" I told the aide that came running in after him. We had our semi-productive OT session and then I gave him one minute on the timer then back-to-class we go! Timer goes off, and then I play the waiting game. I tried every behavioral intervention strategy I know trying to get him to go back to class. He tried every avoidance and attention getting technique he knew to get what he wanted. 45 minutes later he went out to close the classroom door, where I block him from going back in my room and prompted him to go back to class.

 The other waiting game I'm playing right now is waiting for California Children's Services (CCS) to call. I have allotted two days in my schedule for me to work there. Two weeks before school I was told I was going to work there. After an interview, and an observation at one of their clinics I'm still waiting to hear back. The unknown is taking a toll on me. I'm not sure if I'll be chosen to work there, even though I was told by my contracting company that I had the job. If they decide that I'm not a good fit, then it's back to square one between my contracting agency and the district. Will they fire someone so they can reduce the days there? Will my contracting agency provide two more days with the district? If so, where will that be? What if I don't like where I'm placed?

 The other big drama today..
 I have a student with very severe behavior challenges. Last Friday he wouldn't get on the bus; it took four adults to get him strapped into a harness that strapped him into the seat all the while stating, "I don't want to go home to mom and dad"(this is the abridged version of the story). Today, a similar scenario began to unfold of him not wanting to getting on the bus. So instead of allowing the entire struggle to continue, his teacher did not put him on the bus. Somehow, however, his teacher did still manage to get scratched up pretty bad. Both of these situations involved his transition to the bus and him wanting to take home toys from school. The mom finally came to get him after many phone calls around including the district office. The principle told the mother that this was not going to happen again. That if the boy was going to put up another big fight getting on the bus, then a relative or close friend would have to be available to pick him up. The mother said that it's impossible for anybody to retrieve him. The principle said that the last resort would be that they'd have to call the police to have him picked up.

 I feel so strongly for this child. He is not potty trained yet (can't state his age for confidentiality reasons) and comes to school in dirty, ill-fitted clothes. He is not cared for, and it breaks my heart. When it's his turn for OT he loves it. He loves having the attention and wants to do well (well most of the time). Today in OT, he did something unusual. He knew that I wanted him to stop coloring under the table so he one-upped me. He looked straight at me a with a crayon in each hand scribbled really hard on the desk. I did not react and calmly grabbed a clorox wipe and had him scrub it off. I told him I was happy with his work and let him continue with the next class activity. Sigh, I am worried about this child.

September Newsletter

Newsletter this month: September is the month where the students are getting back into their school routines. I have found in my professional experience that most people (adults too) can benefit from routine. Having a bedtime ritual can be crucial to winding down the activity of the day and preparing for one of the most important routine of the day…sleep. Sleep is where all the learned activity of the day is stored into memory. Sleep restores the body and mind so that it is ready for new information. Without restful sleep it is difficult to concentrate on all the tasks demands that fill the day. This month in Occupational Therapy, the focus is on getting to know each other and the theme is apples. The handwriting activities are centered on their interests. Apples harvest in the fall and thus play a central role in the association with going back to school. Apples are also good to eat! They provide a nutritious sweet snack that is a good substitute for a sweet craving. They are also high in fiber and thus are good for your gut. ☺

Bystander

The other day I was sitting eating my lunch on my steps by my classroom trying to tune out the children playing around me. However, right in front of me I started to notice an altercation between two preschool students. One wanted to pass between two particular cones, the other child was blocking. I thought, they'll work it out, the other kid can just go around. That is not what happened though. The child trying to pass starting pushing back on the other child. At that point, in retrospect, I should have said something. The kid blocking the cones pushed back and the other one fell. At that point another teacher noticed and disciplined the two students. She then turned to me and frowned and walked away. Whoops.

As I am around little people all day, I realize that as an adult I have a responsibility for all the children in my field of vision. I am learning that it is my duty to keep all children safe from harm whether that be from each other, themselves, or the obstacles around them.

Another byproduct of that is that when I see children in public space I have to stop myself from wanting to intervene. Sometimes, it is when a parent is mistreating a child or is allowing unsafe behavior carry on.

"Hot Case" and a student

I heard about "hot cases" in the school system, but have yet to be privileged enough with one of my own. Hot case, is code for parents of a child you are treating or one that want you to treat is threatening to get lawyers. It is a very high profile case that has everyone stressed out and worried. At first, I was excited, wow my first hot case. I get to explain everything I'm doing and why. I feel like a real specialist. However, it reared it's ugly head when the principle was stressed out that I decided not to assess the little guy, especially when his mom wanted me to. Ok, to save everyone the headache it turns out I can assess him. My boss and I thought, if he's not in special education then he won't qualify for OT services, which is true. So it's a waste of time to assess, but I have to do it anyway. The rules change for a parent who is demanding and threatening to sue.

This week I also took on a college graduate that is gaining hours to apply for OT school. It's fun to explain everything. You know what they say, "you learn it better when you have to teach it". I hear myself talking about sensory integration, developmental milestones, OT in the schools, how I plan my treatments, etc. I've found that I learned a lot about OT in past few years.

Back to school = Back to sick, Humility

First day of treating the kiddos on Monday and I think I squeeze-hugged the wrong little dude. Working in the schools is a peti-dish of viruses. I got my first cold and I'm sure it won't be my last. I was looking forward to really getting going this week, but alas I had to call in sick today so I don't infect everyone else.

I had dinner the other night with my OT cohorts and have found that working with kids is a privilege. There are lots of OT jobs out there, I had two job offers this summer, but working with children is a special type of OT job. Most new-grads don't get to work with kids right away if they didn't have an internship working with the little people. One friend waited 6 months to get her "peds" (short for pediatric) job. Another is moving to HI to gain more experience working in the schools, she already had a peds internship as well. I guess what I'm trying to do be grateful for the opportunity to start working with kids right away. Sometimes I can get caught up in politics of it should be like this, or it should be like that. Who am I to judge being a new grad? How long do I call myself that anyway, a year?

I'm still learning a lot about what it means to be an employee. I haven't worked for someone else in about 10 years. I did massage at places, but that doesn't really count for working in a professional work environment. I feel like I might make a couple blunders here and there, I get hard on myself for being too out-spoken and direct. I am learning that there is a certain finesse with working with others that I feel I might still be rough around the edges. I continue having to learn to be humble in my experience as a therapist and a person. I'm still working on who I am as a person, a job that will never be done.

Patience

I want to talk about patience for a minute since it has come up a few times regarding the work I do. Several people lately have told me, surprisingly, how much patience I have to work with people with special needs- whether they are physical or cognitive deficits. First, I want to say that patience is a skill  I  learned over time. As a young person in my 20s I don't think anyone that spent any time with me could say I was patient. Quite the opposite really. However, over time starting with my work in massage therapy, I started to become more compassionate towards people in pain. I know what real pain feels like having scoliosis and feel I could relate to other people in pain. Secondly, by going to school and learning about different diagnoses I came to understand various predicaments of the human condition. I first noticed this aspect of learned patience when I was studying mental health and was in line at the grocery store. Someone was taking an extra long time to get their stuff together. Normally, I would have started to stamper becoming impatient with each passing minute. This time I found myself thinking to myself, what if this person has a mental illness or a brain injury (a condition that is not outwardly visible) and struggles with organization. Thirdly, as I've worked with people I have learned that it really doesn't help any situation to be impatient; it can have the reverse effect by making people stressed out and flustered. Lastly, I will work with someone for 30-75 minutes an then am done. When it comes to a family member or a close friend requiring patience you are with them a lot longer and patience can be a lot more challenging and emotional. When I have a family or friend of a patient say, "you have so much patience!" I remind them not to feel inadequate because it is a very different experience being the therapist. 

The end of SNF (for now) and new beginnings

I start back at the schools in about a week. However, I'll be going back to work in the SNF environment per diem (on an as needed basis). The great thing about per diem is that I get to determine how often I want to work there. 

My last day at the facility was great. I got to see most of my favorite patients and I ran a successful ice cream group. I did this particular therapeutic activity in my clinic at school with success. Everyone was surprised at how easy and fun it is to make ice cream. I think food tastes that much sweeter when you put a little effort into it. I received a thoughtful gift from one of my patient's daughters. It's a wall hanging about being compassionate and giving, along with a heartfelt card and scented candle. I feel I made a difference in her (the daughter's) life. This work really feels rewarding to me when someone acknowledges the impact that I've had on their life. 

It's interesting to work so closely with people. Having worked with adults this summer I have gained better people skills. I can see people's attributes in a more clear way, and quicker than I used to. I used to think that my OT mentor (the person who introduced OT to me, Andrei) had x-ray specs on when it came to reading people. For example, if I felt any certain way he would comment on it. I thought, can he hear my thoughts? What I have come to realize is that people have common facial expressions and body language that indicate various emotions. This, combined with careful questioning and vocal tone can give a lot of important information. As a therapist, I have learned to read all of this information quicker and in more subtle ways. I use this to my advantage when I want someone to do something; by finding what does and does not motivates them and by being considerate of what they may feeling.

New opportunities await in my career that I am looking forward to. I got the schools that I was hoping for and hence  am very excited to be working with my favorite population of people thus far, preschool age children with special needs.  Examples of this are, speech and language impairment, autism, downs syndrome, hard of hearing and deaf, blind, drug-exposed, and genetic impairments. I know that a lot of these have a stigma attached to the diagnosis, so let me state that regardless of the impairment the quality of the person is very much present regardless of the stigmatizing diagnosis. 

The other exciting career venture is that I have an opportunity to work in home health. I haven't agreed to anything yet, but a have a job possibility that would involve me going to people's houses and assessing what their OT needs are. It is an area of OT that is often reserved for very skilled and experienced OTs. I am honored that someone I worked with would refer me. It is a setting that feels very real, since the therapist works in the home.