Crafts as a positive outlet

One of the things that has been a struggle for me over the past several years when I started fieldwork and real work was being able to go home, not be stressed, and separate from the previous 8+ hours. Being in a caring profession and also wanting to please the people around me, I often had excess stress that made me worry about burning out. I felt like I was good at hospital OT, but it was hard not to carry the stress with me constantly. Acute care has a very short timeframe- everyone needs something from you and needs it NOW. Today. Yesterday. And you are with people during what is frequently an awful time of their life, and not all of them are going to be OK. It's really hard for me to separate from that. 

So in that respect, the school system is much better for me in that the timeframes are much longer- if I miss a day I can make things up in the coming weeks. There are still heartwrenching stories, but I feel like I'm having a more positive effect to help balance it out. 

The other assist in this balancing act has been taking some advice to have positive outlets outside of work (and for me that often includes the blog) that require some effort and concentration and help with the stress. So despite being the self-described "least crafty OT" I have taken up some crafts as a way to create something and enjoy myself in another way. 

I made these scarves over the summer. I had a t-shirt day where I made 2 scarves and one terrible vest. The pink one required actual use of a pattern and sewing machine, so I felt really accomplished.

I was very surprised at how quickly this arrangement came together. They're all silks for my front porch and though I brought out Christmas colors before Halloween, it was fun. I like having a little extra color out there and hopefully will change it out in the springtime.

This is one of my favorite things, and it was so easy. I printed out an 8x10 of a beach photo I had taken and used double sided tape to secure a perfect sand dollar I found a few years ago. 

The other project I did over the summer was making a board book for my son. I had no idea that you could buy blank board books, but you can for pretty cheap! Then I went to an office store and had pictures printed on full page labels, and just stuck the pictures on the pages. So simple, and yet it gets lots of compliments and he enjoys looking at the family photos.

As much as I enjoy my brain games (crosswords, sudoku, etc) and my OT pursuits (including the blog), having a more physical and tangible task has been better for my mental health. There's tons of research on the ill effects of too much screen time, too much Facebook time, etc and that is an easy rut to fall into when you're tired from working and caregiving. But I hope this is a change that I can continue so that I have continued growth in my own mental health as a member of a very caregiving profession. I'm always going to care about my kids and carry some of their stories with me outside of our time together. But being able to set it aside in a box is crucial to going on with the rest of my life.


Using a Christmas Tree for Child Development

I am really in the Christmas spirit this year. Partly because I was looking for some happiness and positive energy after a bleak fall, and partly because this year my son can really start to enjoy the season. He pays attention to everything and has plenty of commentary about what's going on, so he was very excited when the first decorations went up (during his naptime) and asks everyday to turn the lights on.

For a little while, there were no ornaments on the tree. I didn't want my little climber to get any ideas and try to get up to the higher branches, and I know that there is no way to keep some ornaments intact around kids (they can come back in 10 years or so...). But I decided to make the tree a more interactive experience for him with minimal hassle from me.

Closer view of some soft ornaments
A couple ornaments for mom on top, most for the baby on the bottom.

I set out the ornaments that were soft and unbreakable. I took off all the wires that we normally use to hang ornaments. I made sure that all of them had a loop to hang by- some needed additional yarn to have a larger loop. The loops are varied lengths and materials which presents different challenges. I also made sure to put out a bucket and box so that my son had a location to put in and take out (a favorite toddler past time).

I really only showed him how to pinch and spread open the yarn loop to make it large enough to fit on a branch a handful of times, and that was enough to inspire hours of self-directed play. It's a very easy activity to set up, and from that we have an easy starting point for practicing communication and cognition concepts. We talk about the characters, what color they are, on/off, in/out, up/down - it's a very natural way to play with a child and promote development in multiple areas.

Here's some ideas for good ornaments for toddlers and preschoolers to use for their personal decorating:

- Pipe Cleaners / Beads: If you have a preschooler or an older sibling, there are plenty of ways to make inexpensive, unlikely to break, ornaments that you can treasure as kids' projects in years to come.
     - Easy bead and pipe cleaners
     - A variety of easy ornaments
     - Triangular beaded candy canes
     - lace and bead wreath
     - pipe cleaner wreath

- Plastic Canvas: One of my aunts just loved to do plastic canvas crafts. Some of these were designed to be magnets, but many were ornaments. Since they are all yarn, they are no worries about injury or ornament damage.
     - Pre-made from Etsy
     - Ornament patterns  1  2  3
- Clothespin ornaments: The pinching requirement to operate these is another great fine motor challenge, and it makes for a nice change of pace.
     - DIY Snowmen
     - Etsy set

While ceding my tree to my toddler seemed pretty logical to me, especially since I don't want to spend everyday telling him not to touch the most interesting thing in the room, my husband reminded me that it was my OT brain and not just a "common sense" thing. So hopefully this will be a helpful share to others.


My Next 30 Years

I think I'll take a moment, celebrate my age 
The ending of an era and the turning of a page 
Now it's time to focus in on where I go from here 
Lord, have mercy on my next thirty years 
-Tim McGraw "My Next Thirty Years"

 I've had a number of milestones over the past couple of years, and thought I'd spend a little time reflecting back and looking forward.

My 30th birthday hit me pretty hard. I was still in the newly in the throes of motherhood, and learning that there is never a day off or vacation from that role. All I asked for was to be able to take a nap, and if memory serves, I did not get it. I had also started back to work at a sort-of new job. No one remembered it was my birthday. Other stuff going on as well, I can't really remember. I did reflect personally, but didn't get around to making a more public reflection. I think I'm ready for that now.

In many ways, I feel like I have spent 30 years just finally getting my life started. I spent the majority of those years in school and college, which was a fairly direct route since I didn't change majors or anything. I got married. I moved all over (something like 7 places in 7 years?) and worked all over and got to live in a big city for awhile. We bought a house. I found out what kind of work I like to do, and where I wanted to be, and made it through "my year of patience" to finally get the job. We got a supportive church family and some stable friendships. We had a beautiful baby and really became a family.

After taking my job and going through all the orientation, I started thinking about the next 30 years. My husband started talking about when I have put in 30 years with the schools that I'll be fully vested and at the top of my pay grade. It is weird to think about working for the length of time that you've been alive. It can feel more like a life sentence that way, I wouldn't recommend it. Looking in that way, it's as if I spent 30 years preparing, 30 years working, and then I would have less than 30 years of actual living, not beholden to anyone else.

Obviously, you live everyday. You live for the journey, not the destination. You find your daily rewards and enjoy everything you can. There's no point in worrying too far ahead about 30 or 60 years down the road when you might get hit by a bus tomorrow.

My dad used to say that you have to be able to keep some of the introspection, gigantic life questions, and such in boxes- you can't leave them out all the time or you'd never get out of bed. You can't ignore them forever and really understand many things. This is a moment to reflect, not a spiral of navel gazing.

My next thirty years will be the best years of my life 
Raise a little family and hang out with my wife 
Spend precious moments with the ones that I hold dear 
Make up for lost time here in my next thirty years

My priorities have changed a lot in the last 10 years. I have gone from worrying only about myself to having a family. Family has eclipsed (but not eliminated) my personal aspirations. Leisure pursuits have changed dramatically and often, and managed to survive after a year of neglect. I don't know if men can really identify with this change in perspective, but I think it's fairly common in women. I'm pursuing a more mature balance of my occupations and even my moods.

I do foresee that the time ahead of me will be wonderful. For all that I have traded in settling down into a stable life, each day now with what I have is far better than what I could have had. For all that has passed me by, I am trying to remember the good times with fondness and let go of the things that were not worthwhile. Everything til now has brought me to this point, where things are largely well. There are toddler tempers and work stresses and general crap, but overall, things are great. Let's hope it continues to be so.


My Personal Performance Goals

I had some interest on Twitter (where I am so much more active!) about the performance goals I had to write for work. Essentially, the term is our district's way of saying SLO's (student learning objectives) that can be personalized to oneself.

Because these goals are sorta-kinda related to SLOs, I tried to find some OT related SLOs as a starting point. This wikispace has some example OT SLOs, the only ones that I could find on the internet. If you will peruse, you will notice they are EXTREMELY DETAILED, which from my understanding, SLOs have to be. Redundant even. I didn't get the message that our goals could be significantly less detailed, so I think I've overshot on my goals a bit. Such it is.

With my caseload, my kids have a wide range of ages and abilities. So I couldn't think of (in the time allotted) a good measure of student performance that would have a large group to pull from. My largest group of students are those in the regional certificated classrooms. For many reasons, including that I am evaluated as a teacher though I have not trained as a teacher, I wanted to spend more time in these classrooms learning special education techniques, dynamics, and observing the skills of the teachers and students in action. So I set a goal to observe for 1 hour each week, bringing myself to each classroom at least twice for 30 minutes in the course of the year. (I know this does not seem like a lot of time, but my schedule is packed and it is actually difficult to even get that amount of time.) I adapted a teaching reflection sheet that I found to keep a record of insights and questions.

My second goal involves our district's technology focus. There is a push to expand our technological reach and impact. I made a twitter account for our department and sent out an initial survey on usage of social media for professional development. Analyzing these responses (weighted on a Likert scale), I identified a few questions to focus on for growth (specifically, those that had a lot of room to grow). I have prepared a presentation and will be working with our team on getting started. We have a range of users, from the very tech-savvy to those who do not use social media at all. It will be interesting to see how well I differentiate instruction to the group! It is also interesting to sort of feel like a social media manager and be trying to figure out how to do that job. I hope that we will be able to meet on branding and find some great ways for us to grow as team.

So those are the (measured) targets I am working toward this year, in addition to working with my students, interfacing with teachers and parents, and several other irons in the fire! I don't feel as compelled to have true SLO goals since all my kids are working toward IEP goals that have to be constantly measured and reported quarterly anyway.  I have probably over-thought and over-measured these and they may need to be adjusted at midyear. But it is nice to have some concrete personal goals. This also helps me narrow down my focus, which long time readers will recognize as a major challenge for me!!

Do you have to write SLOs or a similar type of goal as a school-based OT? Do you have to write performance goals in a different setting, such as a hospital. Please let me know below, it would be great to dialog about this!


self care for young children

I really enjoyed putting together the Chores for Young Children entry, what OTs might call IADLs. Here is the compliment- the ADL for young children, between 6-18 months.

Obviously kids are mostly reliant on mom and dad for care, but as they get older and more able to interact with the world, they can begin self care tasks with support. These skills necessarily overlap with gross motor skills and communication skills. If you have a child who is having trouble learning a new skills, you may need to isolate down to only a component instead of asking for a motor response and a communication response simultaneously.

When I think of basic ADL/self care, I think of feeding, grooming, bathing, dressing, and toileting. (It's the FIM training in me). I will address those areas.

One of the first self care tasks that a child can do is eating. Very young children can learn to put their hand to the bottle or breast to focus on hand to mouth activity, and 5-6 month olds may hold their own bottle. (most recommendations are for a child to not take a bottle to bed with them, FYI) If you introduce foods around this time, a child can actively participate. Yogurt or thickened cereal will stick to a spoon pretty easily, and the child can dip the spoon instead of scooping, and start feeding themselves. They will likely need assistance for much of the meal, but starting this bit of independence early is very important.

Grooming is another area where young kids can participate early. With a soft bristled brush, a child can brush their own hair after a demonstration even before 12 months. If you use baby wipes or a wet washcloth to clean up after meals, provide a second one for the child to work on their own hands and face first. The third part of grooming is brushing teeth, which can be a battle for some kids. However, we started with a set of graduated brushes by Nuby that move from being all rubber to having bristles. This worked well for my son and he loves to imitate us and move the toothbrush himself. Your mileage may vary- the mouth is a very sensitive area!

My baby loves bathtime, but again, this can be a struggle for some kids. Keeping the bathroom warm and steamy by running the shower beforehand can be helpful. As your baby starts to learn words for their body parts, they can better understand lifting that part for washing or using their own washcloth to help. They may even enjoy dumping rinse water on themselves. In a related way, my son loves to help apply his lotion after bathtime. We put a little squirt on his stomach or legs and he works on rubbing it in.

When it comes to dressing, it is easier to take something off than put it on. So very young children will work on doffing hats, socks, and pullover bibs. Then you will start to see the child help you put his arms through shirts and take a more active role in dressing. By 18 months, the child can play at dressing with spare, larger clothing in free time. Be forewarned, he might start undressing in awkward places! Doffing clothes before bathtime is often a good time to practice. You can begin work on fasteners by undoing velcro closures on shoes, though getting them off his feet may still need help.

Finally is toileting! You can teach your baby to change his own diaper in 2 easy steps! Really? Of course not, just checking to see if anyone is reading this far! But it is realistic to have an older child  (~15 months) carry the clean diaper to the changing table, and tap his hips or tummy to indicate that he has a dirty diaper. I do have friends who potty trained very young, but at this point we're just working on indicating so that he can concentrate on other skills.

What do you think? Are there additional strategies or self care tasks for toddlers that you'd like to share? Please let me know!


Chores For Young Children

My primary life role at this point is as mommy, though I definitely bring my OT perspective to the table. This can mean presenting my toddler with frustrations to find the "just right challenge" or trying to have him follow an "if/then" chart. Another feature has been including self-care and chore tasks early on into our routine. Kids like having a purpose, being helpful, and celebrating an accomplishment so learning chores is positive at any age. I am focusing on chore activities for kids under 18 months.

(isn't he just adorable, even from the tush angle?)

Before your child has the motoric control to help with chores, you can narrate the activities you are doing as he is with you. This can be very simple- "I'm turning off the light. Now I'm locking the door." etc. This helps build his speech processing and general cognition.

One of the first things we taught our son was how to turn the light switch off. It was easier to push down than turn up, and it gave him an instant and noticeable effect. We probably started this about 7-9 months and it continues to be a favorite.

Placing things in and out is another early skill that is learned. Before he could really follow directions to transport an object, we let him play in the laundry baskets and dump items in and out (before they were folded!). Then he graduated to putting dirty clothes in the hamper, into the washing machine, and taking trash to the trashcan. (13-15 months)

Kids enjoy housework activities with real or child sized versions of typical cleaning items. Usually this is more of a pretend play than actual help, but there are some exceptions. A regular swiffer sweeper can be modified so that it is small enough for a child to use, and can then still have the swiffer wipes attached. Also, the swiffer dusters are lightweight and can be used for cleaning surfaces your toddler can reach. Any dirt picked up is a bonus, since it's something he enjoys anyway. (14-18 months)

Here's a list of some of the chores that we have been working on. Obviously all of these should be done only while the child is supervised and with child-safe products. You may also want to visit my pinterest page for ADL activities which has several additional lists of chores and guides for teaching children with disabilities. 

Turning lights on/off
putting dirty clothes in basket
pushing basket to room
putting dirty clothes in washing machine
pressing buttons to start washing machine, dishwasher, Roomba (my son is fascinated by buttons... I try to discourage this but he has gotten really good about starting the washer even without me helping him)
Taking trash items to trash can
picking up spilled food (crackers, large pieces)
cleaning tray with a wipe after eating
taking bowl to sink to be washed
picking up toys
sweeping the floor
spraying cleaner on windows (there are a ton of recipes for child-safe cleaners, or you can just use water)
putting away bath toys
hanging up towel

Please feel free to share additional ideas! I will do another post on self-care activities when I can!


goodbye summer

Another summer officially over and now I'm back to work for reals. I can't really say I'm on maternity leave from the blog anymore, so I'll explain more in this post.

My baby is not a baby anymore... he's a real walking, semi-talking little boy. It continually astounds me that he is able to do so much and learn so well. Truly an experience unlike any other.

As he has gotten older and I had my first summer off in the school system, I have been able to find some leisure time. But I am leaning toward leisure pursuits that have a tangible result. This summer, I made a shadow box, a board book, some t-shirt scarves, and a photo book on shutterfly. I haven't wanted to spend a lot of time on the computer, and it was next to impossible to get my brain in gear to thoughtfully write a post. I haven't even read many posts through my rss reader.

I still spend too much time on my phone, as my poor little fingers and growing sudoku numbers can attest. But I'm trying to cut back there as well. And now that I am on the computer everyday for work purposes, I really am not anxious to pick one up at home. 

So I'm not sure what that means for the future of the blog. I have lots of great ideas and have been taking photos to share still. I liked doing the interviews and I think people enjoyed them. I like the quick-sharing on twitter but I usually don't have the time for tweet chats when you can actually discuss a topic further. 

I'm going to try to return to writing, but I'm most hopeful that I have leisure time at all and that I consider it well spent. The start of the school year has been very stressful, and combining that with 2 funerals requiring out of state multi-day travel has been awful, so I already feel underwater. And while writing definitely has its place as a stress-reliever, the analytic nature of crossword/jigsaw/sudoku puzzles provides a lot of comfort, and completing projects (as terrible as my craft skills are) may take precedence. 


Celebrating an OT Ironman

I recently received an email from an OT that I had worked with many moons ago, Allysin Bridges. Allysin is one of those superb people that has positive energy and is just wonderful to have around, a great representative of OT daily and even with the state legislature. And in an example of good things happening to good people, Allysin was selected from a lottery to participate in one of the greatest races in the world- the Ironman Triathlon Championship in Kona, Hawaii. If you're not familiar with triathlon, it is a three part race requiring the athlete to swim, bike, and run. The Ironman takes this to a level that only an accomplished athlete can finish: 2.4 miles of open-water swimming, 112 miles biking, and a 26.2 marathon run! I think that participating in an Ironman is reason enough for joy, but Allysin is taking it to another level of awesome by racing to benefit the Blazeman Warrior Foundation for ALS! Read on to learn more about Allysin's story and her challenge which is much bigger than a bucket of ice water!

- Where are you working now?

I am working for JHU School of Nursing on the CAPABLE study with Dr. Sarah Szanton. It is a grant funded program to help low income, Baltimore City older adults age in place safely using a three discipline approach - an OT, RN and a handyman (we are working with CivicWorks). I love it!

- How did you get interested in triathlon? Have you completed an Ironman before?

I had returned back to MD in 2002 after finishing grad school at NYU and had picked up a few (ahem) pounds. I was bored with the gym and was looking for another outlet. A neighbor told my mom about triathlons (she had been doing them for years) and that was her outlet. So I looked into it and I had been a mountain biker since I was 18 and loved the water so I figured it would be a good fit. So I did my first experience was Dewey Beach Sprint. I was pretty green going into it not really knowing the logistics of it (like transitions!) but I finished with a huge smile on my face and knew I had been bitten by the tri-bug. I then went into longer tri's (1/2 Ironmans) with Team In Training and I really loved the spirit and comraderie of the tri community. I trained a year for FL IM 2006 with 10 of my TNT friends and we all but 1 finished (she went back the following year and crushed it!). I took a hiatus after that to have babies and went back to it in 2011 and don't plan to stop until my body tells me so (but I don't listen well).

- How many hours are you training now each week? How do you find a balance between work, family, and training?

Training for an Ironman is a different animal. And knowing it's the World Championship, even more so. My big training days are on the weekends. And those usually add up to be 5-7 hours each day at this point since I am only 8 weeks out from the big day! A week, I average 15-23. It's basically a part time job. The balance of life while training for this type of endurance event is difficult. I rely on my mom, Jason (my sons' dad) and Dennis (my partner). Many people joke and call themselves "Ironman Widows." It is definitely a lot of time dedicated to this one thing, but in the end, this is a once in a lifetime experience and fortunately, my loved ones understand that and back me up.

- Have you found support from your colleagues in your athletic pursuits?

Aside from them thinking that I am clinically certifiably nuts, they are very excited for me. My boss knew that I was getting close to crunch time and offered a different schedule that will work out great for the next couple months. I'm very lucky. I can't get any of them to train with me though!

- You are racing for the Blazeman Warrior Foundation for ALS because you have a personal connection with this disease. Can you tell us more about that?

They are personally invested in finding a cure and raising awareness as they lost their son, Jon, in 2007 to the disease. Jon did the Kona IM in 2005 after being diagnosed and finished! ALS hits me hard. My dad died of it in 1997 after being diagnosed 2 yrs prior. It was devastating to watch an incredibly healthy and vibrant man turn into a shell with no movement, speech but had all his mental capacities. I think that's the worst part of it; being completely aware that your body has betrayed you. Imagine how annoying it is when you can't reach that itch on your foot when your shoes are on. It's like that but he couldn't scratch it and eventually couldn't even tell us he had an itch. I also feel that the caregivers go so unnoticed and they are in need of so much support.

When I became an OT, I knew that I was not capable of treating patients with ALS. I would break down as soon as I saw the diagnosis. I tried again in 2012 in an outpatient, multidisciplinary setting. They appreciated my personal connection to it but not so much what I had to say. There isn't anything positive I can tell people because it ends the same - the diaphragm shuts down and that's it. I tried comforting the patients and caregivers especially but I just didn't feel I was doing them any good as an OT. I was too close. To this day, I am haunted by the death of my dad. That's why I am passionate about finding a cure. It has to stop.

- Do you have any tips for families dealing with ALS or therapists who many not be used to the disease?

Advice: give the caregivers TLC because they are going to need it during and after. Keep researching and keep up with the newest technology for communication. Coping strategies are going to be important for all involved. It's hard for us, I think, as OTs to separate sometimes from our patients, especially when there is a personal involvement. But for those who are good with ALS patients, I thank you, applaud you, and owe you! They need you!

- Have you found any part of your OT training to be helpful in triathlon training?

Great question and I had to think on this a little. A lot of the sport is mental, whether it's during training or the race itself. It's funny how your brain can get in your way. So I have to refer back to skills I've taught my patients (a lot of psych stuff). Planning out tasks, setting goals (that's a big one), asking for help (this is a work in progress). Anatomy and physiology really helps when I have to describe and locate my pain! Actually, A&P and kinesiology help a lot during strength training, stretching and simple modalities.

- Do you have any advice for finding balance between work, family, and leisure pursuits?

Let them all mingle and be involved whenever possible. On the same coin, be sure to set aside time for just those roles/aspects - they deserve it.

- Any other info you want to share is welcome!

After I finished FL IM, I told myself that I'd do one more, and if at all possible, it was going to be Kona. I knew I wouldn't qualify so when I thought the timing was right, I put my name in for the Lottery. April 15th, Mike Reilly made that dream come true when he called me and told I was going to Kona, baby! He actually has the phone call on his website :)

Way to go Allysin! Completing such an awesome athletic pursuit is great, but to do it to fundraise for others is absolutely terrific! If you can, please consider making a donation through Allysin to the Blazeman Warrior Foundation. The Ironman championship takes place October 11 and is televised (in an abbreviated format) in the US.


Summertime and the living is ... different

Ahhh... sweet summertime. As a school-based OT, it's a good time. Not easy, per se, but still good. 

I very much enjoy my job. It's the best fit that I have ever had with coworkers and type of work. Particularly, there are many built-in mind breaks that are really beneficial for me to stay sharp. I'm usually at a different school everyday, so I have time to be refreshed and think of things to do at each place (or sometimes overworking to try to do something before the coming week) and the natural break of the school year helps as well. I was never great while in school myself about doing all the productive things that I could do, and I don't know that it will be much better as an adult. But it is good.

I had a major grocery extravaganza, purchasing a number of items that I've never worked with before in hopes of following some new recipes. There's a lot of international flare in them, which reminds me of living in the big city and eating at splendid restaurants. Last week was the first week of vacation, and I made a Greek beef and orzo casserole, today I made a Thai chicken pizza. I also made a set of freezer meals on Saturday, so overall that's a lot more kitchen time than I do normally. I would like to become a more competent cook so that making dinner after work isn't an ordeal. I am hoping to spend some time in the kitchen this summer to work towards that goal.

I haven't done a lot of reading since the 18 months that I took to read the entire Wheel of Time series. Someone recommended another series and I just haven't been able to jump into another fantasy land yet. I did bring home a couple of work-related items to read and review for the coming year. One of these is the Coleman Curriculum for school-based OTs, which I hope to do a review on.

Today was my first full day off with only myself. Husband went to work, Baby (dare I say, toddler) went to daycare, and I was left to my own devices. Last week I got several calls to pick him up due to fever so there was never a full day. I slept in, watched crap TV, and spent most of the day in the kitchen. I did 3 crossword puzzles without hints (ahhh, Monday). I tend to loll about a bit when not scheduled, especially after a period of strict scheduling. Just as I started to get ideas for the coming days, I got a text to call me in for some prn work at the hospital. Totally needed, since we have a number of home repairs to pay for, but it does require a change of plans from relaxation to productivity.

I spend an inordinate amount of time writing during the school year. Session notes everyday, emails everyday, progress notes, evaluations, programs. However, it seems really hard to break back into blog writing. I have taken a long break, obviously, but I have plenty of ideas. I just have to remember how to connect the dots. I've read that one of the best ways to get writing done is to have a routine and stick with it, but my schedule that is so subject to flux makes that difficult. But I do want to get into a regular writing habit this summer that I can stick with during the school year.

Lots of busy-ness coming up for me... family vacation, family visiting times, trying to get together with friends, and trying to make enough to offset the cost of my second state license, daycare, and new windows (ugh). I'm trying to get active again, going so far as to climb a mountain, and have actually lost 5 pounds in 3 weeks, so I'm happy that is finally going in the right direction. My little boy is starting to chatter, walk on his own, and climb, so things are getting very exciting with him. My life is good, even if my blog isn't. And that's what's most important. So I'll set my summer goals and new school year resolutions and work towards those plans, but I'm learning to just enjoy the day to day successes and smiles that come along the way.

Happy summer to you!


Baltimore Attractions

The 2014 AOTA Annual Conference is fast approaching! Here are a few tips regarding attractions from my lived experience in Bawlmoor- your mileage may vary, but hopefully this will be helpful.

There are numerous neighborhoods in Baltimore, which is confusing and you may wish people would just tell you in relation to your current location. this is a nice map you may want to refer to. Also, if you get directions from a non-GPS source, you're likely to get either numbers or names for roads, which can be a little confusing since they all have numbers and names (e.g. 83 is Jones Falls Expressway AKA JFX).

Baltimore is equipped with multiple public transportation options. The light rail runs North and South, from Hunt Valley (which has an outdoor mall and indoor movie theater) to the airport. The Metro runs NorthWest and SouthEast, connecting Owings Mills (another mall) and inner city Baltimore, with the ultimate stop at the Johns Hopkins and Kennedy Krieger buildings. The metro is low cost and pretty safe, however the time between trains increases drastically after 5pm. The standard bus runs all over the city, but I did not use this and can't comment on it. The special Charm City Circulator bus runs through downtown and is free. Keep in mind that it only runs in one direction, and wait times between buses can be longer than expected.

Things to See:
Harborplace is home to an indoor/outdoor shopping plaza and multiple chain restaurants (California Pizza, Cheesecake Factory, etc). It is a nice place to walk around and there are a few unique places such as the little fudge shop. If you're up for a longer walk, the other side of the harbor has Federal Hill and I believe several walking trails are lined up there. Fort McHenry is farther South so you may want to get a ride down there but I've heard it is nice to walk around.

Thursday and Friday the Orioles are playing the Red Sox at Camden Yards. Let me just say- I have been to the inner harbor area once when the Red Sox were in town, and had I known that their visit would overlap with the conference... I might have thought twice about coming. I still would have come, I just would have been very grudging about it. I'm not anti-Sox, but it will be absolutely PACKED downtown those days due to the games. It is cheaper for a Bostonian to come to Baltimore and see the game than to try to get tickets at Fenway Park. And so they do. In droves. If you plan on eating anywhere within 2 miles of the park (excluding the AOTA expo on opening night), plan on waiting about 2 hours. If you are able to go to a tour of Camden Yards sometime it is really cool to see the behind the scenes action and appreciate how it was built from an architectural standpoint. 

The National Aquarium is a great collection of marine life. Great for kids, cool if you haven't seen it. Bear in mind, when you buy tickets, you are buying to enter at a time in the future, not that precise moment. You may be walking around outside for a considerable time before you are allowed in. Say hi to the 3 legged sea turtle in the main entryspace for me, I have been there a few too many times.

The Baltimore Comedy Factory has DL Hughley in town. I don't believe Rams Head or PowerPlant Live have any major events planned. I've seen ads for Geppi's entertainment museum (across from the ballpark) and heard nice things about it, but never been there. And if you've never been to IKEA, there's one in White Marsh and one in College Park, just don't buy anything too big to take home. I recommend the Pear Cider and Cinnamon Rolls.

The number one inanimate thing that I miss about Baltimore is the food. I dream about eating in Baltimore sometimes. It's sad.

Lexington Market- is a hopping place for lunch. This is a block or two North of the Convention Center. It will be crawling with Hopkins employees in their signature scrubs, and super busy, but people like it.

Little Italy- you absolutely cannot pick a bad restaurant in Little Italy. The competition there is so fierce, nothing lousy can make it. If I could have lived here, I would have gained hundreds of pounds by walking to awesome food every night. the only bad thing about the timing of the conference is that it is not during the time when they show outdoor movies for free. If you are driving, they have a garage that is relatively cheap not far from the restaurants.
.     Sabatino's is a good red sauce place, and everything is very quick. Chiapparelli's serves their iconic salad and a variety of pasta and non-pasta dishes. Amicci's might be my favorite place, with salads that are simultaneously sweet and savory and unique dishes such as Peppi's Lasagna which are all delicious. Germano's features live entertainment. Nobody gets dessert outside of Vaccaro's, home of delightful gelato and pastries galore. 

Pazo- If you have a group that likes Mediterranean tapas, this is a nice place to go. A little pricey, and I believe it has a dress code.

Nacho Mamas- has sentimental value to me as a fun (little) Mexican place in the Canton/Fells Point area.

Don't Know Tavern- Now we're talking real sentimental, this is the little WVU version of Cheers that exists in the Federal Hill area. If WVU basketball hadn't completely tanked this year, this would be the place to catch a game. You'll probably never go there, but I love them.

Chap's Pit Beef- If you watch Man vs Food, this dive was on an episode. My husband thinks this place is awesome. Know that you can't eat inside and that you probably shouldn't go at night.

Also- apparently Baltimore is a great place for seafood, particularly crabs. Hate it, don't eat it, you'll have to look elsewhere for that info.

I have to leave off my favorite food place, because they don't take reservations and always have a wait beyond compare. But I must eat there this trip... even if I have to go alone, even if it takes 4 hours. And if even one person reads this and got in line ahead of me, it could be ugly. sorry, but I have my priorities.

Hope this is a helpful organization of a few attractions in the area! I never end up going anywhere at conference because I'm either preoccupied at conference events (AOTPAC night what what!) or exhausted from conference sessions. But maybe someone else will have some fun. See you all in Baltimore!


Time Warp

It's incredible that life can simultaneously move so slowly and so quickly at the same time. I'm astonished that we're halfway through the school year (with many of my resolutions from August still unmet...) and that the baby is in his third outside trimester. The days can drag on, and by the time evening free time rolls around I'm pretty well done for the day. I'm not even well able to hold conversations by that point, so devoting brain power to functional writing is pretty well out of the question. I do still want to continue to blog, but it's going to be pretty far on the back burner for awhile.

I registered for the AOTA Conference and am looking forward to reuniting with some of my buddies from school, my old job, the state association, and the online world. I'm eager to get back to some of my favorite Bawlmor places and enjoy some much needed ME time. 

I do hope to get some entries done in the not-too-terribly-distant future... My current treatment bag is Olympic themed so I'm pretty excited about that. Until then, look for me on twitter.


Entrepreneur Series: Sue Ludwig and NANT

This installment in the OT Entrepreneur Series is Sue Ludwig, president and founder of the National Association of Neonatal Therapists (NANT). This is a professional organization designed to support, network, and educate the OTs, PTs, and SLPs in the NICU.

  What was your background before starting your business? 
 I’ve been an occupational therapist for over 20 years. At least 17 of those years have been spent in the neonatal intensive care unit (NICU). For the past decade, I’ve also been a national speaker as well as a consultant to NICUs in the US in the areas of neonatal feeding, developmental care and leadership. 

 Why did you decide to start your OT business? 
 I started the National Association of Neonatal Therapists (NANT) for several reasons, including: 
 1) as I consulted around the US, I realized that therapists who worked in the NICU had no way to connect with each other. Often we didn’t even know of another therapist who did what we did! We were isolated and didn’t know where to go for specialized education, mentoring or validation. That also meant we recreated the wheel for every project, goal, and directive. 
 2) Every neonatal therapist I met was passionately invested in their practice. They LOVED working in the NICU. And they were self-motivated which is something I admire in anyone.
 3) The babies in the NICU deserved knowledgeable, highly specialized therapists. You can do harm in the NICU if not properly trained. This gnawed at me.
 4) I had more to give. I had a vision. It just took me a long time to believe that I could be the leader of this grand endeavor. 

 What was your tipping point to get started? 
 I had previously worried about if I would have the approval of my peers when starting and leading this organization. I wasn’t sure if I fit my own definition of a powerful leader. My mentor kept telling me, “No one is going to anoint you worthy. Only you.” (This statement stops one in her tracks.) I remember lying in bed one night wondering how I’d feel if someone else decided to start this organization. I was afraid they wouldn’t have the same perspective or that they’d limit it to one discipline. It was then that I realized that I did, in fact, have a very specific vision and I wanted to see it come to life. 

How did you take your first steps to starting a business? 
 My first step was to hire a business mentor. I still have the same mentor 5 years later. This was a critical and invaluable step. We need to learn from those who are several steps ahead of us. High level mentoring saves time, mistakes, and money while adding depth, strategy, and forethought to business. I’m thrilled that this is the route I took. 

Have you found a benefit from social media marketing (twitter, facebook, blogging)? What are some of the strategies that you have used to maximize your success in this field? 
 Yes I have found huge benefits from using social media. I’m not sure many businesses can afford NOT to have a social media presence. I have a very personal approach to all of my communication, whether it’s social media or our weekly newsletter. I did not want NANT to be just a ‘big organization’ that didn’t relate to its members. I AM them. I want them to know I have their backs. Everything I do is to support them professionally and personally and in turn, support babies and families.


What were some lessons that you learned in the initial stages of your business? Were there challenges that were difficult to answer during this time? 
I learned thousands of lessons. I learned that I actually really love business (who’d have thought?!). Being an entrepreneur is stressful and highly rewarding. I learned that my colleagues around the world are doing amazing work that often goes (or went) unnoticed. I learned that every NICU in the world needs therapists who see infants through our unique lens. I learned that there are many opportunities out there, but to let my true vision guide the choices I make. If the opportunity isn’t in alignment with that vision, I let it go. The challenges were similar to those any new business faces: learning how to hire the right people, how to make the business more scalable, how to avoid being the bottleneck for decisions and creative content. Each challenge helps me grow and learn. It’s not for the faint of heart. 

How long did it take for you to hire additional help? 
 I hired help before NANT even went ‘live’ in the world. My mentor was very clear in teaching me that there are some things I just never need to do. That I could start small (hiring-wise) but needed to learn to delegate immediately to people who were fantastic at executing work that I should never do. That way I could focus on what only I can do. This was sage advice. 

 What was your original goal, the hope you have for the business? 
 My vision was for NANT to become a sustainable business so that we could keep serving our members. But my goals are more long-term. I’ll consider it successful if I leave a legacy…if NANT outlives me and continues to thrive beyond my wildest imagination…if neonatal therapists fully understand the value they bring to the NICU team and stand in that value – humbly, decidedly, intentionally.  

What is the best thing about owning your own business? The worst? What surprised you most? 
-The best thing: Freedom. Being able to bring my kids to school or be there for sporting events and other important moments. Even if it means working extra hours on other days, the freedom to be present for my husband and kids is priceless. I’m also so grateful to work every day toward a vision that inspires me, grounds me and pushes me. Not everyone loves their work. I am fortunate that I do. 

-The worst: The stress of responsibility. I want to make sure I’m moving this field in the right direction. Luckily I’m surrounded my amazing colleagues who contribute to this journey. 

-What surprised me the most: Selling out our first national conference in 2011! And the nearly instant acceptance of NANT by other neonatal associations and professionals as well as AOTA. The neonatal community is small (no pun intended) and I’ve found it to be supportive beyond measure. 

 What are some tips that you could give to OT practitioners considering starting a business? 
-Be prepared to live outside your comfort zone- personally, professionally and perhaps financially at first. This isn’t a bad thing. You’ll emerge stronger. 
-Get a mentor. You might have your MBA already and that’s great. It’s just not the same thing as knowing the steps to take when you begin on Monday morning or how to implement all you know. 
-Consider your true motivation for starting the business. All the money in the world won’t make you want to get out of bed and work at a job you hate. Look for the deeper meaning and stay true to that vision. 
-Have fun with it! Surround yourself with people who buoy you and are not prone to drama. Support them in the same way. 
-Be kind to yourself. Schedule self-maintenance. Sleep. 
-Understand that you have a unique contribution to make to the world. Express that through your business to serve others.

Many thanks to Sue for sharing her perspective on business ownership! If you're thinking of practicing in the NICU, NANT is a great resource to make that a reality. Check out their annual conference and website!


Entrepreneur Series: Tonya Cooley of Therapy Fun Zone

This special Thursday-edition of the OT Entrepreneur Series features Tonya Cooley, author/owner of the Therapy Fun Zone blog and online therapy store. Tonya is a prolific OT blogger and has some great tips on starting down that path for others.

Can you tell me a little about your business?

When asked questions about my business, it is a little difficult to answer because it is not straight forward, and it is very atypical. Therefore, I will first explain what my business is. I currently work contract for a school district as an OTR, and in my off time, I run a therapy blog called Therapy Fun Zone. I post about fun and different therapy activities to help inspire creativity. I also create therapy games and share some for free, and some are available to purchase. It is the blog aspect of my business that I will focus on since it is interesting and unique.

Why did you decide to start your business? I initially started Therapy Fun Zone near the end of my first year as a school therapist. I was a very experienced therapist, and had been treating kids for 20 plus years, but most of my experience was in a well-established setting with plenty of home program and activity resources, so I never lacked for activities and inspiration. When I started in a small school district, they had never had their own OT before, so they had no eval template, no worksheets, activities, or toys, and no home program resources. I was also not used to working with kids that were so high functioning, and needed to come up with some activities that would really challenge them. I scoured the web to find ideas and had to make some stuff of my own. Then I had a parent tell me that their last therapist only worked on practicing the same thing over and over, and she loved how I made the activities fun. That really hit a nerve, and I don't think children will fully participate in therapy if it isn't fun.

It was right after that exchange that I decided to make my own website for fun therapy activities in order to make it easy for people to find them.

Can you share a bit about the financial side of your business?

When I started Therapy Fun Zone, I had no expectation of making money. I just wanted to share ideas and connect with other therapists. I was already set up as a business though because I had invented a baby product a few years earlier, and already had a business license, business bank account, business name (TMC Adaptations), accounting software, and a tax id number. I made a lot of mistakes with my baby product (Hug n Hold) financially, and so I tried not to make those with Therapy Fun Zone. I planned to just spend my time on it, and not spend money on it.

Have you found a benefit from social media marketing? What are some of the strategies that you have used to maximize your success in this field?

Therapy Fun Zone is essentially dependent on social media as it is a blog, and I get a lot of traffic through the blog from facebook and pinterest. I would say that some of the keys to success with blogging and social media is to get on a schedule. I have been blogging on and off on other sites since 2005, and none have been successful until Therapy Fun Zone. From the beginning I had to treat it like a business even though it wasn't making any money because I wanted it to be successful even if it wasn't in a monetary way. I post at least once a week, and people can count on that. Sometimes I schedule my posts way in advance, but make sure they are spread out to once a week. I have seen some therapy blogs that post a bunch of articles all at the same time once a month. That does not work in your favor. If you have a bunch of articles, don't post them all at the same time. Spread them out and keep people coming back at a steady pace. I have also found that I can't keep up with more than once a week and get completely burned out. I also then post my blog posts to facebook, pin on pinterest, and then share other people's interesting things on facebook and pinterest.

What were some lessons that you learned in the initial stages of your business?

I would still consider my business to be in the baby stage. I am still learning a lot, am getting better and more efficient, and am learning the extra computer design stuff. Maybe in my next life I will be a computer programmer. Financially I think that I currently break even, or make a couple hundred dollars a month. It is not yet an option for me to quit my job, and if I did, where would I get the ideas for new therapy activities. I think that the website may finally now pay for the web hosting. Maybe someday it will pay for more. The moral is, if you think you can make a bunch of money by blogging, don’t kid yourself. It is a lot of time expense with no financial reward, but it has other rewards. I consider it a success because it is currently one of the largest therapy blogs out there, and gets over 100,000 page views a month. In big business blogger terms, that isn’t a lot (they get 1,000,000 hits a month), but in small OT blogger terms, it is darn good.

Button Pizza... yummy ADL
What was your original goal, the point that you aspired to reach and consider that you had "made it" as an entrepreneur?

My original goal was to share therapy ideas, and I think that I have definitely accomplished that. In the beginning, I wanted Therapy Fun Zone to not suck as a blog/website. I now think that it is pretty awesome, and I am quite proud of myself and my website design skills. I am currently working on taking it to the next level, and making it more of a joint effort. I recently added a new shopping cart that makes it so that other therapists can sell their products on my site too. I think that it could be really useful to have all of the resources that therapists make out there and available to other therapists. We will see where it will go.

What is the best thing about owning your own business? The worst? What surprised you most?

The best thing about having started Therapy Fun Zone is that it really stimulates my brain, and it keeps me inspired. The worst part is keeping track of the finances (not my thing). Most surprising is how much I love making therapy games, and that I enjoy website design. I am also surprised to find that I don’t like writing. My joy comes from creating, but then I have to write about it or no one else can benefit from what I have created.

What are some tips that you could give to OT practitioners considering starting a business?

As far as advice about starting your own therapy blog, I say just do it. Either you love it or you don't, and you never know where it might take you. Specific blogging advice would take many many posts, so I will try to work on those over at Therapy Fun Zone. If you want to try your hand at creating products, come join me and open up your own shop at Therapy Fun Zone. You could try your hand at blogging by being a guest blogger too.

Either way, you must have fun.

Thank you Tonya for your insights! Very helpful information for our next era of OT bloggers and innovators! Be sure to check out all of Tonya's fun activities on her blog, facebook, or pinterest sites. And come back next week for our last interview of 2013!


Entrepreneur Series: Paul Fontana, Center for Work Rehabilitation

I am very pleased to present the next interview in the OT Entrepreneur Month Series- Paul Fontana. This is an exciting moment for me since Paul is the first "OT celebrity" that I ever met, so it's great to be able to share this story. Paul is the owner of both the Fontana Center, a fitness center that offers OT and massage therapy; and the Center for Work Rehabilitation, a multi-functional industrial rehabilitation and consultation business. Read on for some great insights on starting a very unique business.

What was your background before starting your business? How did you take your first steps to starting a business? Did you have a mentor?

I was very fortunate to have worked for a private practice contract company in northern Indiana. The company would contract to provide OT / PT services to hospitals, schools, outpatient clinics, home health agencies, etc. Our owner, Mr Jack Gamet, RPT understood that the OTs and PTs that he hired did not go into therapy to run a business. So if he did not train his key people on basic business principles then he knew that his business and how to manage both people and the business that we would soon become unmanageable. So Jack purposefully decided not to accept one new contract for a year while he hired expert in the field of management to teach his select group of therapists how to become managers - they taught us strategic planning, goal setting, budgeting and financial planning, supervision and leadership skills training, program development and marketing / selling technique training, etc. I was fortunate enough to be one of the therapists selected to participate in this training.

As I developed the programs at 2 sister hospitals that I was the chief OT for, my immediate supervisor, Mr Thomas Cole, OTR brought me up into an area supervisory position where I was then charged with assisting other facilities with program development and growth. Under Tom’s leadership and growth I learned how to analyze a business potential objectively looking at my strengths and weaknesses from a critical standpoint, develop a business plan then analyze that plan critically to see if it would be worthwhile. This process of leadership development was quite successful as we eventually grew to have facilities in 9 different states.

As I progressed in the company I eventually became Director of Operations for the OT / ST divisions. As such part of my job was to look to the future and develop strategic plans to ensure the growth of the OT and ST programs offered by the company. In the early 1980’s managed care was just beginning to appear on the horizon and from where I was it appeared the goal of managed care had little to do with quality improvement and all to do with cost containment. And this centered around reducing the payment to the providers. At the same time Medicare underwent some significant changes that had the potential to adversely impact our business. As part of my job of looking to the future and trying to ensure that our company was strategically aligned to meet the changes on the horizon, I heard about this "new" concept in care that was being performed out in California – work hardening and functional capacity evaluations.

I traveled out to California and spent a significant amount of time visiting Dr Leonard Matheson (clinical psychologist) and Linda Ogden, OTR who were running the program. I became convinced that this was the future for OT for our company. This was an area of practice that centered around occupation and in my opinion was a perfect fit for OT. And no one was doing it in the 9 states that we had facilities. I brought this concept back to my owners (jack had sold out and there were now 4 owners) but they said that the company was in the medical business and they were not interested in expanding out into this area of practice. I decided that this was an area that I was interested in so I gave the company a 1 year’s notice and made plans to open my own clinic in this area of practice.

My time with Restorative Services and through the mentoring of Mr Jack Gamet, RPT, Mr Tom Cole, OTR and Dr Leonard Matheson I believe that I had the skills and knowledge base to venture out on my own into this new area of practice. Using the strategic planning / program development skills that I learned I was able to do market analysis in the states that I was interested in working thereby helping me to narrow down the state that I would eventually move to. Furthermore the fiscal management and budgeting training helped me to plan for the future as well as help both myself and my wife to feel comfortable with my decision .

Prior to my moved to Louisiana in 1986, Dr Carolyn Baum was very helpful in allowing me to spend time observing in the work hardening program that she had at Washington University in St Louis. In addition to this I spent several weeks working in south Louisiana meeting with potential referral groups (physicians, rehab nurses and medical case managers, vocational counselors), insurance company personnel and claims adjuster as part of the environmental analysis to see if my idea of the industrial OT programs would a) be reimbursed, b) whether there was any competition, and c) whether or not I could get referrals.

To this day I am convinced that without the mentors that I had that I would never have been able to develop the industrial programs and sustained the business that has served the communities in south Louisiana and Houston Texas where I have clinics for the past 27 years. I did not get an MBA but feel that with the executive management training that was provided by my company and the mentoring I had from both Mr Gamet and Mr Cole that I had the necessary skills to move forward with my own practice.

Nobody likes talking about money, but how long did it take for you to turn a profit/hire additional help/be able to quit your other jobs?

When my wife and I decided to open up our own business I did not have another job, nor was she working outside the home. She felt comfortable that I had done the preliminary work and that I could make this work before I announced that I was leaving my job as Director of operations. We did the budget to see what was the absolute least amount of money we needed to bring in to keep the roof over our heads and the family fed for the first year and were confident that we had enough in savings to get us through until revenue started coming in. Also, being an Occupational Therapist where I knew that if I needed to I could always do home health in the evening and weekends if I needed some additional revenue to keep us going until the business took off was a very valuable help.

When I opened the Center for Work Rehabilitation in 1986 I was the only employee. I not only did all the marketing but evaluated the clients, typed my own reports and performed all the rehab on the clients. It did not take me long before I realized that I could not make money at this by typing my own reports. Within the first 6 months I was in the black, paying all my bills, including paying myself enough to keep the roof over our head and food on the table. By the end of the first year I hired additional professional help to allow me to get out of the clinic to meet new customers, stay in touch with current customers and perform work on site to ensure growth.

With the ups and down of the business I have had years where I made more money as an OT than I ever imagined I would and other years where I paid my OT Technicians more than I took home, just to keep the business open. At one point my wife and I had to liquidate all the kids’ college fund monies we had set aside just to keep the doors open until the industry turned around, which thankfully it did.

What were some lessons that you learned in the initial stages of your business (first year, first five years)? Were there challenges that were difficult to answer during this time?

Having worked in a private practice environment before opening my own business I already was used to working long hours and even 7 days a week if need be. Therefore this was not something that I had to get used to. Luckily the business growth was close to what I predicted and my wife was able to stay home with our growing family. This was an important aspect of the growth and financial wellbeing of the company because as I was making inroads with industrial customers I would be called to travel to job sites, including to offshore drilling rigs, salt mines, and manufacturing facilities out of state where I would be working for multiple weeks at a time. Some of these requests were spur of the moment where I did not have time to preplan but rather had to be at a heliport in 4 hours. Had I not had the advantage of a supportive family this would have been extremely difficult.

The business model that I was developing was something the insurance industry as well as the physicians were not exposed to so I was starting from scratch to get folks to understand what I was doing and why. At times this was difficult.

Having grown up with ethical training (where my word and a hand shake was sufficient for work) had some drawback as associates I worked with took my idea and opened their own programs to compete against me. That was a challenge that I did not anticipate having. I was also surprised to have physicians directly and indirectly seek compensation for referrals – “what’s in it for me” was asked of me by several important referral sources. Another important referrer wanted me to train LPN’s how to do therapy then give him space in my clinic where he would send all his clients and my professional staff would provide the supervision. When I told him that I would not do this as I felt it was both unethical and illegal his response was, "I have 300 – 400 clients that I can send you".

Developing "partnership" with my industrial customers was a huge asset to my business. By becoming a critical part of their "fit for duty" program I had customers provide me with equipment needed for simulations, access to their training to improve my knowledge of their business, etc. At one point when I was unable to access my equipment nor facilities until the courts intervened, the Vice President of Human Resources for a major drilling company told me “I cannot run my business if you are not in business.” In 2 days I had use of an 8,000 square foot warehouse to use as my clinic. During another time when the price of oil dropped to such a low that made drilling in the Gulf of Mexico too expensive that companies stopped all hiring, one of the claims manager for a major drilling company asked me how this was affecting my business. I told him that business was so slow that I may not be able to stay in business. A week later I had a contract to travel offshore and develop 31 physical job descriptions for this company. The claims manager told his boss that they needed to make sure that I stayed in business because when they needed me to rehab their employees, I needed to be there.

What is the best thing about owning your own business? The worst? What surprised you most?

It allows me to set my agenda professionally, to devote time and energy on giving back to the profession. I did not have to get approval from anyone to spend the time / energy to become actively involved with the Louisiana OT Association (President for 4 years), AOTA (Region III PAC Chair then AOTPAC Chair followed by a term as a Director on the Board then Secretary to the Board of Directors). I enjoy the opportunity to work with business and industrial customers who are generally only interested in results. Being able to go on site, help them with problem resolution and implementation is what I like best. That and this work allows me to do a fair amount of teaching which I really enjoy.

Worst can be the lost family time. Working with industrial customers as a private individual you have to be there when they call or they may go elsewhere. There were vacations that I missed because of a job request or because a therapist I had working for me quit so I now had to miss the vacation to cover in the clinic.

Also, having continual staff turnover. Many of the OTs that work with me stay 1 ½ - 2 years then leave to work in the hospital, out patient clinics or nursing home for fear that they are losing their “treatment” skills. That certainly is true. Having worked in this industry for 27 years I cannot imagine how to treat a stroke patient or a pediatric client. However I have skills that others do not have. But trying to find clinicians to work in a non-climate controlled environment doing industrial fit for duty programs and not having to retrain every 2 years has been tough.

What are some tips that you could give to OT practitioners considering starting a business?

- First and foremost have a mentor. Not only regarding business management but therapy skills management

- Be ready to devote the time and energy it takes to make it work

- Be sure to do a good objective market analysis and self analysis of your skills and abilities before hand

- When planning financial areas, although you need to be realistic, be extremely conservative regarding revenue generation and high on cost expectations. If you can make it during the worst case predictions you will be ok. If not, you may need to re-evaluate. Things beyond your reach of influence will occur.

Thank you so much Paul for your detailed responses! Great wisdom regarding mentorship, needs assessment, and preparedness. You can learn more about the business at the Fontana Center Website - http://www.fontanacenter.com/


Entrepreneur Series: Christel Seeberger of tOTal Ability

Today's entry in our ongoing series reflecting OT Entrepreneurs is Christel Seeberger of tOTal Ability, a private practice in Canada with a secondary online resource store.

Why did you decide to start your OT business?
I was an occupational therapist with almost a decade of experience in different countries (Canada and the USA) and a variety of settings with a clientele across the lifespan before starting my private practice in 2002.  I decided to start my private practice while training to run a marathon.  I run very slowly, so I had a lot of time to think!  I thought a lot about occupational therapy and gaps that I saw in the public system.  I was motivated to fill the gaps.

How did you take your first steps to starting a business?
I started small and really built the practice client by client. I sought out both formal and informal mentoring opportunities, many from women in business style entrepreneurial groups.

Have you found a benefit from social media marketing (twitter, facebook, blogging)? 
Using social media is like learning a new language!  What I appreciate the most about using social media is being connected with such a huge community of knowledge and leadership.


What were some lessons that you learned in the initial stages of your business?
A lesson that I am still practicing every single day is to say, “no”.  It enables me to say, “yes” to something better in the future.

How long did it take for you to turn a profit?
One of my oft quoted personal and business mantras is, “only spend money you have, on things you really need”.   So, I have always made a profit from day one, never spending more than I earn to grow the business

What was your original goal, the point that you aspired to reach and consider that you had “made it” as an entrepreneur? 
Like many entrepreneurs, I started out creating a job for myself.  My private occupational therapy practice ( www.totalability.ca ) has grown, now with 8 contract OTs on the team, and we provide mobile occupational therapy in three cities in our province.  It was only when I started my second business, www.totalabilitysolutions.com which has downloadable eBooks with occupational therapy resources, activities and advice for parents, teachers, caregivers and professionals that I realized, I truly was an entrepreneur.

What is the best thing about owning your own business?
My worst day running my own business in private practice is still better than my best day in public practice working for someone else!

What are some tips that you could give to OT practitioners considering starting a business? 
Do your research first!  Not every idea you have is a good one.  Be business smart.  As occupational therapists, I think we always want to help.  But when you make smart business decisions you get to help more people at the end of the day.

Thanks to Christel for participating in the series! Definitely some great advice on being business savvy and improving the OT world. Be sure to check out tOTal Ability around the internet to see great OT content!


Entrepreneur Series: Chris Alterio and ABC Therapeutics

This entry in the OT Entrepreneur Interview Series is Chris Alterio of ABC Therapeutics, a pediatric private practice in New York state.

What was your tipping point to go into private practice?

I was a part time private practitioner since my entry into the profession. At first I did contracting and home health care in addition to my primary employment. I think that this is a very common entry point to private practice for many therapists.

Over time I learned that I enjoyed my consulting and contract work much more than work within institutions. Most of that likely has to do with my own sense of intrinsic control that I prefer to have over my work, and sometimes working within institutions felt somewhat stifling.

A tipping point for me came after a period of employment where I was very disenchanted with the power structure at my job. I was working in a hospital that was going through a merger and it was stressful in many ways. I disagreed with the strategic direction of the institution and of my supervisors and it was no longer a healthy 'match' for me. At that time I 'liberated' myself and began my private practice, which initially involved private pediatric home care. That is how ABC Therapeutics was started - 14 years ago!

I hired my first employee sometime in 2003. At one time I had nearly 25 employees, but I did not like the 'feel' of that as it seemed I was spending all my time with personnel management and contracts. I prefer the intimacy of the private clinic and home care - so now we do very little contracting and I have decreased my staff rather significantly. When I had a larger staff I felt like I was turning into a contract agency and that is not what drew me into private practice, so we refocused our efforts on outpatient clinic and home based care.

What was your original goal, the point that you aspired to reach and consider that you had "made it" as an entrepreneur?

My 'original goal' was to help families interact with their school systems and learn how to navigate their systems and advocate appropriately so their children could receive the most appropriate services. Families were seeking out private in-home care with me because they were dissatisfied with their school-based services. In the beginning I believed that I would spend 2-3 years educating families and helping school districts to appreciate what these families wanted - and then things would just be 'better' and there would no longer be a need for my services. That was incorrect thinking.

What I learned over time is that although the people working within these systems are generally kind and they generally have the best interests of the children in their hearts, the systems themselves are unwieldy and overly bureaucratic and in fact they are not always designed to be user friendly for parents. I am not sure why it didn't occur to me, but this was precisely why I wanted to leave institutional employment! So, it was a rather naive thought that I would 'fix' these systems from an external perspective when I couldn't even fix them from an internal perspective!

So after a while I came around to a new way of thinking, and that was that there were a lot of needs in the world and that it was my goal to help parents meet those needs no matter what the systems in place were. Sometimes that means working within those systems. Sometimes it means helping families doing things on their own. Each day that goes by is a reminder that the work will probably never be done, because each day the phone rings and it is new people calling.

With regard to measuring if I 'made it' as an entrepreneur, I never really consider it all too much. In honesty, at the end of each very long day I walk through my building and look around at the equipment and I remember the echoes of children's voices - and I actually just give thanks and say a prayer for how blessed I am to be able to do this work every day. Those moments, at the end of each work day, kind of help me to keep things focused.

How did you take your first steps to starting a business?

I had some concerns about my ability to support my family and start what seemed to be a risky venture at the same time, so I took a position as academic fieldwork coordinator at a college and used that as a 'base' while my private practice grew. I was able to complete the fieldwork coordinator tasks on a part time basis and this gave me the flexibility to develop my business.

Early on in the process I learned a lot of information by trial and error. Over time I learned what I needed an attorney for, what I needed an accountant for, and what I needed marketing consultation for. I developed a network of other small business providers who in turn provided their expert services to me.

My early success was attributable mostly to the experiences I had previously in paid employment as a Supervisor. I already understood personnel management, and I had experience with billing systems, and I understood the care delivery systems that I was interacting with. With the help of consultants to guide and teach me about areas I did not know I was able to develop a solid base for my private practice.

After three years I was able to leave my position at the college and focus on the private practice full time. Also, at that time I returned to school for doctoral study. That experience was also instrumental in my professional development and I want to emphasize my appreciation for my doctoral program and the excellent faculty at Nova Southeastern University.

Have you found a benefit from social media marketing (twitter, facebook, blogging)?

I began blogging in 2005. In one of my first posts I wanted to express to whoever might be reading what starting a private practice was like. I was still struggling with the technology and quirky inconsistency of the format and I was unable to upload a picture that captured my feelings. This is what I wrote:
"I wanted to talk about private practice, and perhaps talk a little bit about what I went through in the last 36 hours, and perhaps talk about a broader desire to help other people get involved in private practice - but now that I can't upload my picture I am feeling a little deflated."
It was of Thelma and Louise, flying over a cliff, preferring to face death than capture. That is kind of what entering private practice is like. I am not sure how important my blog was for promoting my practice specifically. In many ways I think the blog is more widely read and considered by OT colleagues, and in fact that is mostly who my topics are intended for.

I did not start social media marketing until 2009 and by that time my private practice was fully established. Again, I do not know if social media marketing was directly responsible for reaching an audience about my practice. Rather, I believe that what happens is that if someone Googles 'ABC Therapeutics' then they see a heavy web presence. That may matter to some people - and if so - then I suppose that social media marketing is helpful in that regard. Actually, I think that more traditional print and other media has been most effective for direct marketing of my business. Social media is supportive.

What is the best thing about owning your own business? The worst? What surprised you most?

The best: The ability to serve. My 'bosses' are the families. I get to tell kids daily - "YOU are the boss of ME!"
The worst: Financial concerns, payroll, cash flow management, frighteningly high account receivables, and of course the uncertainty of health care in general these days.
Surprising: My ability to very effectively manage the worst parts of it successfully!

What are some tips that you could give to OT practitioners considering starting a business?

Every day brings new lessons. Every day is an opportunity for more learning and more growth. If I learned anything early on, it was that I need to learn lessons every day. I think that when I first started I didn't realize that.Continue your education, every day. Identify a passion, believe in it, and live it. Finally, don't be afraid of holding tightly onto the things you believe in and speeding over a cliff.

Thank you so much Chris for your story! Please be sure to check out the ABC Therapeutics online world including great blog entries from Chris.

ABC Therapeutics Website!
ABC Therapeutics Blog! 
Like ABC Therapeutics on Facebook!