OT in school

I've been getting the question, "What does an OT do at schools?" I feel that the online blog may help me clarify the answer to this question. Most of the goals for the child are centered around handwriting. However, our job is to problem-solve why kids are having trouble access the school curriculum. Even though many goals are handwriting based, it's fun to explore why to develop those little hand muscles (called fine motor skills). This means, play-doh, finger paints, shaving cream with letters, rough-and-tumble play, swinging, singing songs with hand movements, and anything my OT brain can think of. We (my supervisor and I) run groups for some of the special needs classrooms. Sometimes we'll doing something related to handwriting, like letter formation, or writing sentences, or it could be an art project.

I like learning about all the different diagnosis and the developmental levels of children. I am also liking seeing sensory integration in action. The different sensory systems that literally have brain wires that cross for children to be able to make sense of their world. I'll write more on sensory integration another time, that's worthy of it's own blog post.

This internship has re-confirmed my love for the younger population. Oh yeah, I've always wanted to work with children. :)

New Motivation

Today at the pre-school I had a very interesting conversation with an Educational Specialist working with Deaf and Hard of Hearing (HOH) babies. She is a cranial sacral therapist among many other talents. Having been a massage therapist myself for many years, I have a interest in the type of work she is doing. Her job is multi-dimensional: involving families, babies, trauma, sign language, spirituality, cranial sacral, and teaching by encouraging development. I found a deep interest and passion in her work. I would love to develop the sensitivity to work with children and infants in profound ways. I walked away from her classroom with a new motivation, cranial sacral therapy.

I have also been trying to teach myself SEE, Signing in Exact English, to communicate more with some of the HOH children I work with. The teacher also loaned me a DVD for learning sign language.

I would like to utilize all the resources I can to work with little ones.

This internship has helped me reaffirmed my desire to work with children. It so much fun!

"A tough pill to swallow"

"A tough pill to swallow" is how a friend and fellow OT cohort described the realization that working in an adult rehab setting might not be the best environment for her. I like the medical analogy and I feel the same way. It could have been that I had to get up really early (I'm not a morning person), or the specific parameters of that particular skilled nursing facility (SNF), a post-acute rehab setting, that contributed my feelings.

I got better at the treatment planning, documentation, and quality patient care. My biggest strength being that I always had great rapport with my patients. However, there were many times that I felt like a walking mistake, or wondering when I was going to make another one. A PT noticed I wasn't smiling anymore, and mentioned it to me. For a few weeks it was difficult to even smile at work, I was so concentrated on not making mistakes. I wasn't even myself anymore.

The bulk of my concern was on pleasing my supervisor, and really trying to succeed. I often felt I was on my supervisor's bad side. I disappointed her when I ran a group poorly, had a to rewrite a documentation note or didn't anticipate my time correctly. I really took her negative feedback personally. It was really hard not to. I tried to tell myself, "I'm learning, I'm a student", but when we sat down to talk about my progress I felt that I was lacking in my what it takes to be a great OT. I would question myself, "do I have what it takes to be a great OT?" In the back of my head I know that I will become a great OT, but that's just it, it has to evolve over time, it doesn't come over night.

About 1/2 way through the internship, I got a wake-up call: she told me, "you should know this by now". That is when I realized I had to use other resources other than the ones I was given. My ability to grasp concepts is not difficult when given the tools to do so, and when I was in school I always had other students and teachers to turn to when I struggled.

There could have been many aspects of working in my last internship contributed to my struggle. However, I learned so much from my internship about myself and my ability to grow and adapt in difficult environments, in addition to all the on-the-job knowledge.

I am now working in the Mt. Diablo School District, and I really love it so far. I really love being around children, they often want to play and have fun! Now that's therapeutic. The hours are great, and often get home early and start a little later. I have so much more energy; that is really going to help when working with little ones. I have a great supervisor. She is outgoing and fun and gives consistent positive feedback. :) I'm looking forward to treating children and developing my skills in the pediatric environment.

3-Dimensions

I have been reflecting on my internship as a over-all experience as I get closer to being done with my first fieldwork experience. Everything that people say about learning on the job being valuable experience is true. I feel I have a more complete picture of what occupational therapy is about.

In school we learn about different diagnosis, treatment approaches, therapeutic use of self, and many other 2-dimensional aspects of treatment. However, I am realizing that OT is 3-D experience, not just the client being multi-dimensional, but also the work place.

In a person, you have their diagnosis, con-current diagnoses, the family, the social and medical history among other dimensions. In the work place you have schedules, the people you work with (manager, your manager's manger, doctors, nurses, therapists, etc), documentation, billing payable time, among many other sifting and changing parameters. It's not so simple as just going in a treating a diagnosis or even the person, most aspects of a person and a work-place come into play every treatment session.

I've really had to learn be mentally flexible and roll with the punches (sometimes it feels like I'm getting punched). I'm still getting the hang of it, and I really feel like a beginner. There are times when I feel I should know how all these parameters should fall into place. When I make mistakes juggling parameters, or seeing the 3-D of a person or work place, can make some days frustrating.

Despite all my growing pains, I know in my heart that I have found my life's work. I will continue to persevere in my journey, I've come this far...

Active learner

Interesting that my last blog was titled "taking a backseat", since that's exactly what I feel I had been doing last week at my internship. I had a really rough week last week, one that I hope to never endure again. I was getting in trouble with documentation, my group, my time management, and pt care. What was going on with me?! I realized on Friday, when I talked to the director of rehab, that I had been taking a backseat on my learning. I was waiting for my supervisor to tell me what and how to do certain things or how to arrive at mastering this internship. I would hear of other student interns having manuals and talks everyday with their supervisors and overall more hand-holding than I'm getting at my fieldwork site. I put the blame on her, felt frustrated that I was being left to fend for myself and make all these mistakes. Here's what I learned: I needed to be more proactive about my learning at this facility. I need to practice writing notes, giving evaluations, and taking precautions to ensure that I give excellent quality care to everyone I treat.

As I realize this crucial mistake in my learning experience, I hope that I can now move forward to really be an "OT Student". I'm still not an OT. I'm just the intern; I need to be humble, ask for help, and accept criticism with acknowledgement of my learning.

taking a backseat

I have something that I am learning about myself as a person in this internship. That is when someone wants to criticize me, my reaction is to explain my reasoning. However, that comes off as being defensive. How do I learn to shut my mouth and take what is being told to me? By acknowledging this aspect of my personality, I hope that I can be more mindful when someone calls me out. The person saying whatever they are saying has a reason and their perceptive should be respected. I need to exercise more self control.

In the last week or two (ever since I left a towel on the floor in the shower room) I have been heavily supervised. When that is the case, I somehow end up making more mistakes. I know that I have performance anxiety and so when someone is really testing and observing me, I constantly screw up. Today that happened and I attribute part of my mistakes to not having control over my schedule. Since I am really supervised my supervisor basically tells me what will or won't work for her in her schedule. I didn't have enough time to prepare for my group, get my notes done, and do an Individual treatment session in one hour. As a result, I was running late, and I forgot to get equipment. Where's your head at Lee-Anne? I've got to get it together, and be able to change gears as I shift into the next activity of my day. (Justification/Defense: I had a pt in the morning who was crying about having to stay at MC and I was trying to resolve the issue).

Sigh, two more days left for the week.

Hard day or hard career?

It's really hard to have perspective when this internship is the only *real* experience I have with practicing OT. There are certain aspects of OT that I really thrive at, and others that are continually hard for me. I guess that is true with every job, but I am striving to find out what it is that is limiting me.
Here are some of the things I think it could me: poor memorization, not fully understanding what is being asked of me, not understanding a core concept and how to do it, a difference in working styles (and not fully knowing what mine is), decreased brain power at the end of the day, less structure than I'm used to, or maybe the setting (skilled nursing) isn't right for me.
Ok you might be wondering what the heck I'm talking about... Documentation.

Missing School

Having been out of school for two months and getting a taste of the feeling of being a student today made me long for my academic days. Most of my graduating class met today to discuss our internships/fieldwork. I had a relaxed morning of waking up at 8:00am versus my normal 5:00am arousal time. I was able to squeeze in errands and chores that I am normally too tired from work or too busy to do. I long for the days that I had time to do stuff during the day. Maybe I will choose to work part-time or per diem when I officially get a job.

It was really nice to hear other students share some of their frustrations they are dealing with, as well as positive aspects of working as an OT. Most of us have had similar experiences with being challenged and experiencing how rewarding it is to work with people. I felt less isolated to hear that other people felt similar ways to the unique experience of being an "intern". Having other peers around is therapeutic.

I miss the camaraderie that came with seeing the same group of peers day in and day out. I like having people around me that know me. I feel that I have to start all over when it comes to making "work friends". My fieldwork site is temporary and thus am hesitant to put much effort into forming lasting relationships. Also, it takes some time to develop friendships and feel I don't have the opportunity.

I'm sure I'm having a grass-is-always-greener moment. When I was in school I couldn't wait to be done with it. Now, I'm in this weird holding place where I'm neither in school or working. I'm just paying my dues.

overwhelmed

It's my 3rd week of my fieldwork requirement (internship) at a skilled nursing facility and I got a little overwhelmed today. It's not the first time, I've had one day like this each week so far. Today I got overwhelmed with paperwork. I had my caseload of seeing patients for a total of 4 hours, then took on another patient making it about 5 hours of seeing patients one after the next: giving showers, exercises, activities of daily living (ADLs), running groups, etc. I knew at the end of the day I was going to have lots of paperwork (a discharge, an evaluation, insurance, and billing for each patient). I'm still learning what's involved with each of those since I don't do them everyday. After messing up several times with the wording and levels of progress the last paper I messed it up again! Didn't I just learn this mistake?! Man! I felt like an idiot. I realized I was overwhelmed when I was on the verge of tears. Really?! I'm going to get this upset over this minor thing?! On the drive home I was able to calm down a bit. Upon reflection, I start to feel the flow of working in OT and I get excited. Then, I realize I still have so much I am still learning. Sigh, to be a novice. I'm so ready to start working already!

wrapping up school

It's my final week of graduate school and I've been planning on writing in my blog for about a month now...I have an observation about attending a graduate program in OT that I've been thinking about for a while that I want to share.

Having the opportunity to work with clients has taught me to look beyond the exterior of a person. I have always tried to judge people for who they are, not what they look like. However, when someone is physically disabled they may not be able to fairly represent themselves the way they want. A person may be trapped in their body. Identity is lost in disability and a new "disabled" identity may be formed. Many outside influences shape who we become. However, there's a delicate balance between being influenced and making choices that control who you are. I would like to be a positive influence for my client to make the choice to strive towards being able to show who they are.

An observation about my fellow OT cohorts..

We have been on this ride together for two life changing years. Together we have matured into becoming practitioners. Through school's challenges we have bonded in our professional growth. We have come out the other side of our academic milestone transformed. We are more passionate, social, caring and considerate. I feel that the program has helped inspire change for us to be better people. I feel this change in myself, and I have seen my classmates treat each other and clients with a beautiful kindness. I will always have a special place for those that I went to school with. I have worked with most everyone and have had the opportunity to get to know many of my classmates. Which brings me to another thought...

Once I get hired at my first OT job I will have to start all over in getting to know everyone I work with. I feel I just got to know everyone and will not see them on a daily basis anymore. :( It took about two years, will it take another two years to get to know people at work? And then what happens when I want to move on to a different setting in two years? I will have to start over again. Is that what it takes to grow professionally? I hear that the OT community is small. Hopefully I will be able to build a professional reputation. I hope that I can go on to publish and do presentations at conferences. I am already planning on going to Japan for WFOT. I suppose I will get to see some people at conferences but I know some cohorts I may never see again. This thought makes me very sad.

anxiety + enthusiasm + overzealousness = productive OT?

Mix all the ingredients above and you get how I feel right now. There is so much I want to do in occupational therapy! I'm really excited that I have a venue to direct my life's work.
Here's some of the idea swarming around in my head:

• Get Frank Kronenburg and maybe Jane Dressler or Dr. Richardson on Oprah to talk about OT--to do this I may need signatures or testimonials from my cohorts to make the case. Anyone know how to get on Oprah? 
• Program development in the Developmental Pathways for Kids (DPK) model--this combines sensory integration AND integrated play groups (IPGs)--in SF or east bay
• Curriculum development in schools that have integrated classrooms (classes with children with special needs) to have IPGs. 
• Write letters to help programs that help people with disabilities the services they need to thrive.
• Get people from school involved in going to talk to our legislators
• Start an adaptive equipment rental or for cheap service. I would do this by collecting partially  adaptive equipment such as reachers, wheelchairs, walkers, AFOs, etc. from flee markets, wall-greens, and clients, and recycle them by giving them to those who need them. 

With only two more months, my time at school is running out. I want to be able to utilize my network of professors and students to help me in accomplishing my goals. I have to tell myself that if I don't get everything done before I start work, I can refer back on this blog when I want to add another project to my plate. I'm so anxious that I won't get the support I need for future projects later when my cohorts are working. As for my instructors, i'm afraid they will forget who I am, or I won't be a priority since I'm no longer a student.

Occupational Justice

My favorite class this semester is Occupation Justice. I realized that I can combine other disciplines that I've studied before into my budding career, such as sociology and social work. Occupational justice is a higher level of occupational therapy. It is a avenue of OT that allows for program development and bringing OT to under severed populations. As Rachel Thibeault (2006), a Canadian OT, discusses about helping people, "we try to find a way to meaning, balance, and justice. I chose occupational therapy because it blends science and humanism, intellectual rigour and compassion." I have the same view.

In regards to Occupational justice, Ot is a "relationship between people's dignified and meaningful participation in daily life and their experience of health, well-being, and quality of life" (Kronenberg & Pollard, 2005).

>>a side note, I realized I've been totally conditioned to cite my sources. I have to do it for everything I turn in at school, so it's become a habit.

I would love to incorporate this aspect of OT into my life-long career. I don't want to forget that. I'm afraid of getting wrapped up in a 9-5 job when I graduate and forgetting how much I loved this topic. I have high hopes of transforming the world.

Initial ramblings

I often have ideas that come to me about the process of graduate school and fulfilling my dream of becoming an Occupational Therapist (OT).

Today I was thinking that going from year one of grad school to year two reminds me of when I was in elementary school switching from one grade to the next. You learn so much in one single year, felt so much growth and transformation that it's like your a little kid again. Last year when the class ahead of us was having graduation and fieldwork meetings with facility I thought wow they get to graduate soon. Now I'm in that position they were in a year ago. Wow, I'm now one of the big kids. I get to fill out forms, applications, and deal with the bureaucracy of graduation that lays ahead of me.

A quote that caught my attention today is that "OTs provide healthy habits by replacing the destructive ones" --in relation to mental health.

I'm looking forward to documenting this process and progress. I feel so much is changing in me as a developing person. I know there is more growth to occur, so even though I wish I started this earlier, I still have a lot of change to process.