#10minTues : Facebook privacy

It's Tuesday! Went to bed late but haven't been able to sleep since 5am! This afternoon is going to be unpleasant!

 Figured I would get my entry done now because I'm pretty sure that I will crash this evening. It's been a very busy time lately and only getting busier. I thought I would have this week to finish some EI visits, get the house clean, and pack for our trip- but when I get prn calls and calls for new evals, I can't very well turn them away, so what was already a busy week is now a PACKED week.

 I'm working on contacting companies to get donations for cool Blogiversary giveaways in January, which would obviously be easier if I had a little more down time but I think it will get done. Looking for apps, small items, coupons. I was hoping to be able to do an entry or two on "my favorite things" but I think I have expensive tastes! Example- my grandma loves her HandyBar, which I got for $10 at #aota12, but they sell for $25 and up online.

 Main topic today: Facebook, and social media use in general. My buddy Erik, aka @armyOTguy will tell you to be active on social media as an OT practitioner and to be consciously promoting a personal brand. That is a good thing to do, and could be effective marketing for both you and the profession. However, based on my own personal experience and my Facebook newsfeed, I would not advise that. Students are educated on HIPAA and privacy to the point of getting glazed over whenever it's mentioned. But it would appear that despite that, it takes social media users some time of trial and error to really figure out where that boundary is- it's usually more restrictive than they think. Similarly, students are educated on professionalism and professional behaviors, but may not be prepared to apply those to an abstract social media setting. 

Personally, I kept a blog intermittently during college. It faded during OT school because I was locked in the health sciences building for 40 hours a week. But I know that there were times when I was aggravated with a class or concept or group project and had a post that was probably less than professional regarding OT or the program. We didn't get Facebook at my school until I was already in OT school for awhile, so we didn't have too many problems there, but did have a tongue-in-cheek OT facebook group that probably wouldn't have gone over well with the administration. And we definitely had people who replied-all on the listserv and got in serious trouble for one reason or another.

 As surprising as it could be, there were several of us in our small class who had contact with "local celebrities" (for lack of a better word) and I think that the fact that we weren't yet immersed in social media culture played a factor in keeping each person out of privacy violations and associated trouble.

 That was my (ever aging) experience. Now I have some Facebook friends who are OT students (usually because they were my friends before they went into OT school, I don't have a crazy Facebook following). And sometimes it is cringe-worthy to see their updates about school. Even something that may seem benign to you may not be so construed by your program, future employer, classmates. Examples (straight from my feed, mind you!) include: calling professors clueless; saying portions of your program are useless; fieldwork complaints; patient descriptions; assignment gripes; various program criticisms... you get the drift. None of these were terrible glaring violations ("I think Mrs Smith in room 33 has the ugliest scar evar!") but they do not promote a positive image of the poster or the profession. These are not from clueless people, but just people who don't have a good understanding of professional representation yet. It (should) come with time.

 I reiterate- it should come with time. Having a job and a license increases many peoples' sense of responsibility for their actions. But my suggestion to you is to take steps to be extra careful.

•  First of all, don't post things that you aren't OK with every person in the world reading. Mom, dad, program director, dean of admissions, fieldwork CI, future employer, and the patient themselves. 
• Remember that it is not all about you. Each person (including the patient!!) is entitled to their story. Just because you would be ok with someone sharing your story if the situations were reversed does not give you permission to post theirs.
• Thinking and delaying before posting to twitter or facebook will probably help you self-censor. Things that seem fine in the heat of the moment may not seem so later in the day after you've had some time to consider.
• Button down your privacy settings. There are times when I turn off the ability for people to even search for my existence on Facebook. (clearly, I have a social media presence, but I try to keep personal and professional separate on a few platforms)

So that's my soapbox. I welcome other peoples' opinions on these issues, but my personal recommendation is to err on the side of caution to avoid issues down the line. Time's up! a lot closer to 30 minutes than 10... 

10 Minute Tuesday- Intro and cell phones

I am going to start my new feature, which may dribble a bit in the holiday time but I want to make it regular in 2013. This involves me writing for 10 minutes and topic switches are permitted- anything to get the post written!

Obviously I missed getting this done on Tuesday but I essentially worked 13.5 hours and was nothing short of exhausted. Did inpatient hospital in the morning, outpatient in the afternoon, and an early intervention client late that evening. It's funny to see sensory overload sometimes, I came home and my husband wanted to talk to me about a video he was watching at the same time that there was something on the TV and I just had to tell him to choose. I could not possibly focus on all that when all I really wanted to do was get in a fetal position and sleep for 20 hours.

Sad that I missed today's #occhat which appears to be on adaptive equipment use and practices when issuing equipment. I have lots of thoughts on that and have posted before, may need to do another after reading their grabchat. I also have interesting really old-school AE pictures from when my mom was in school to do voc rehab. It's neat to me to see how people used to make certain things, and some of them have completely gone out of vogue but would still be useful. The copyrights are expired on most of them so I will have to scan in some pictures if people are interested.

OK my main topic was going to be cell phones, and how essential they really are in today's world and especially my OT practice. I seriously cannot imagine doing my early intervention job without my phone. For today' client alone, I was able to do the following:

- text to confirm the appointment before driving there

- access my master file of client names and addresses

- get directions and navigation from an unfamiliar starting point

- show an app that would be helpful to the family's goals

Seriously, without my phone, I would have had to use my rolodex to get their number,  just leave a message on their machine and hope they'd be home when I got there, have to add in an extra 25+ minutes to get back on my familiar route, and spend a lot of time making equipment by hand. I have also used my phone to show a picture of a toy that would be helpful, and in the school system it was so crucial to get a picture of hand function for the evaluation. That's barely scratching the surface of what it is capable of, but I really couldn't do without it in practice.

Time's up! Hope you enjoyed this post and that I'll be able to keep up the pattern.

What's up Wednesday?

Not a lot of time to write, but I want to get a couple of ideas down.
I'm kinda ready to jump to January and start some New Year's resolutions personally and professionally. I wouldn't necessarily hold for the traditional start at the beginning of the year, but life is HOPPING for us right through the end of 2012. My early intervention caseload is really taking off (hooray increasingly regular employment!) and with the holidays the hospital and outpatient center have been calling me in for more prn work. Great, but really busy! I'm trying to get some artwork done for friends for Christmas, which is challenging from a double standpoint- deadline and lack of artistic talent! Holidays for us always means lots of traveling to see family and friends, but my husband will also have to potentially work during our normal holiday time so that they have a product by year's end. And if that's not enough- we have a trip to Sweden coming up in the middle of all that.

So life is really busy. Not sure how I'm going to get all my visits in... I'm suspected a lot of make ups in January. I am trying to snap out of my previous blog funk and think it's been going ok. I plan to implement 2 new changes for blogging. One is to assume that ideas are rotten after 2 weeks. I may extend that deadline out a little bit, but I need to take quicker action, write what I think, and be done with it instead of ruminating over the details as much. I get very frustrated with myself when I see that someone else has acted on an idea I had, and it happens much too frequently for my taste. To enable this is change #2, I am going to try to do at least one 10 minute post per week. I'm going to allow myself to jump topics within it and let it be a little more stream of consciousness if needed, a'la Awesomeness.

My 5-year blogging anniversary is coming up in 2013 and I am excited! I just realized that this morning. I want to allow myself some celebration around that. I am planning a feature on the blog's Greatest Hits... I am proud of some of the writing that I do, but it seems to me that the best writing gets the least attention, so I'm going to put some of that out there. There should also be a giveaway, so I'll have to take some time to think of something appropriately celebratory. And I think there will be some big news to announce during that time as well.

I'm going to take that excitement and help channel it into today- because I am going to need it! Crummy night's sleep where I should have gotten up at 4am, eval to write, doctor appointment, and late night EI visit with an hour drive there/back. Gogo gadget excitement!

Trauma Awareness for the Infant/Toddler Population

I recently attended our state conference and there was a standout session by Marcella Jacobs of the Kennedy Krieger Institute on OT and Trauma Training for Infants and Toddlers. It was very informative and thought provoking, so I've decided to share some of the things that I learned from that session. Warning, there are some sad references in this post, because of the types of trauma that infants and toddlers incur.

First off, she brought up a point that maybe some will find as common knowledge but I think is important to reiterate. If you move into a specialized OT role (though we all interact with children of trauma, knowingly or not), or a position that is not traditionally filled by an OT, you are going to have to look outside the OT CE box to learn new and relevant things. So to become a trauma-aware OT practitioner, she looked to courses offered mainly to psychologists and other groups that would apply to her OT life. Something to think about when planning your professional development.

As someone who has spent so much time in the phys-dys hospital world, "trauma" usually means multiple orthopedic injuries with potential (possibly undiagnosed) neuro injuries. Obviously, this isn't the same in pediatrics. Trauma to an infant or toddler can be any experience(s) that cause continued autonomic nervous system activation which changes the chemistry and constructs of the developing brain. So while that can be physical, such as shaken baby syndrome, it can also be chemical, such as prenatal drug use, or emotional, in the case of abuse. Other potential causes of trauma include neglect, hospitalization, or disaster. Being placed in foster care and having a continual rotation of caregivers and "siblings" can also be traumatic.

Brain scans show that compared to a person who did not have a traumatic experience, a person s/p trauma may have less activity in the fronto-temporal regions. This includes a less active parietal lobe which can lead to decreased speech. Occipital lobe activity is increased, which is sometimes seen in a child's hypervigilance.

Children with disabilities are at an increased rate for abuse and neglect, so it is likely that OTs will encounter children who have gone through or are going through a traumatic situation. I remember an upper-elem student that I worked with who was very verbal about the effect that his disability had on his family life- his deep sadness at not having his parents around was continually heartbreaking to me. And truthfully, if you are worried that your parent might not come back for their next scheduled visit or whether a complication of a condition you barely understand will land you in the hospital tomorrow, how can you really be ready to learn and grow?

I had not heard of the term "PURPLE crying" before, let alone knew that it was a normal baby phase. But when this was discussed it was clear that this would be a time when abuse would increase. Personally, this was incredibly intimidating and terrifying to me as a person who does not have children yet, but by having the information, new parents are more prepared for this time period. The aftereffects of shaken baby syndrome are just horrendous... I may never forget the faces of the toddlers and older school children I saw who had survived, and the EI team was absolutely inconsolable after a child died from this.


I had also not heard of the ACE study, which looks at the effect of 'adverse childhood experiences.' The ACE score is from 0-10 and measures exposure to traumatic experiences in the first 18 years of a person's life. There are multiple studies that have shown an increased risk for adverse health behaviors (smoking, drugs, alcohol use), heart disease, suicide attempts, development of depression, cognitive impairment, and early death. Again, these questions make me think of the kids I saw in the school system some of whom had such varied awful life experiences.


There are numerous signs/symptoms of trauma in infants and toddlers. Withdrawal can be common, and OTs may also notice decreased purposeful play, sensory processing differences, and uneven development/splinter skills. There are many invisible symptoms as well which have major effects in a child's life. This includes decreased growth hormone, decreased development of mirror neurons, decreased brain size and development, and decreased serotonin.

OK, this has been intensely depressing so far to write up. And it may have been that way for you to read. If you've made it this far, you deserve a reward, and if it's been making you sad you may need to inflate those endorphins through exercise or finding a way to think happy thoughts. (chocolate? cat videos?) Not trying to make light of the situation, but having ways to deal with the stress you're exposed to as an OT is imperative to prevent burnout. I think that this was one of the reasons that I couldn't tolerate ICU rotations well.

Finally, the good stuff! Some treatment ideas! These are more directly from the presentation but I am going to share them because I think that it is a difficult resource to get. The CDC states that the most effective treatment model for infants and toddlers is to promote parent/child attachment. This is directly in line with the early intervention model of empowering parents to improve their child's development. Research shows that music followed by tactile input is the most effective treatment. Ms Jacobs recommended using both a sensory integrative and trauma informed treatment approach. Helpful tips included making sure to decrease the stress response before doing anything else; being mindful of your own nonverbal cues including eye contact and touching; avoiding teasing and sarcasm; and being consistent and kind.

Parents, definitely consult with your therapist before trying any treatments, anything listed here is considered to be tried at your own risk. I have listed some suggestions that were offered by Ms Jacobs.
Gentle tactile stimulation through grooming and play
Calming music (Vibrational healing sounds were suggested) and performing typical preschool songs with motions
Swaddling and infant massage (if you are trained)
Cooperative games between child and parent- ball games, rapper snappers
Consider deep pressure activities such as weighted blanket or body glove with both parent and child (again, only with therapist supervision! Don't put weights on your kid!)

It's horrible that any child is exposed to trauma, but with proper training and intervention, there is a way for OT to make a difference to these families.

This was a terrific presentation and I'm happy to be able to share some of Ms Jacobs' awesome insights with you.

Further Resources:
National Child Traumatic Stress Network: tons of great resources especially for those in schools
CDC resources on Child Maltreatment
Child Trauma Academy: has free online trainings
You can also email the presenter Marcella Jacobs if you have direct questions

Thought from Spaghetti- Ask questions!

I was making spaghetti the other day and it brought back thoughts of activity analysis and fieldwork that I thought I would share. 

I remember my very first Level 1 fieldwork instructor being worried that I didn't ask enough questions. I'm a shy person by nature and also tend to think on things for awhile before asking questions so I see if I can figure it out on my own. It took me a long time to see her point, but asking questions is essential in OT.

If I was in rehab, and engaged in a cooking task (not hard to imagine that being an activity) it would be an interesting experience. A lot of my "cooking" is actually "microwaving" or "putting frozen meal in skillet." Not something I'm proud of but it is where I am right now. When I think of a meal that I actually make, spaghetti is pretty frequently it. But a lack of questions on the part of our imaginary therapist could yield a very different experience than I intended.

If a therapist didn't ask many questions after learning that I wanted to make spaghetti, they would still probably feel like they knew how to accomplish that goal. Buy some spaghetti noodles, a jar of sauce, bingo bango there's your meal, there's your occupation-based activity, your patient is rehabilitated. But I would be so unhappy if someone thought that was how I would make spaghetti at home, how I would want to continue making spaghetti. That is someone's idea of spaghetti, but it is certainly not mine.

If they did ask questions, they'd learn that I don't really want spaghetti noodles- I say "spaghetti" but usually mean rotini (springies) or penne. And I want to take the sauce and paste and spices and mix my own sauce. I need sugar, garlic powder, onion powder, and maybe oregano. I don't want to measure anything except with my eyes and hands. I need to be able to stand there and mix it all up with my spoon. Ideally, I'd make it with meat but that's become an issue of late (e.g. since 1996). I don't do raw meat if I can avoid it, and I've gotten pretty good about avoiding it. After all this, I need to be able to shake the parmesean cheese to get the lumps out, and pig out on my favorite meal. 

Why do I want to do it that way? It was the way my mother did, the way I learned to do it, and the way I want to keep doing it. By asking questions, someone could figure that out. So be sure to ask, ask ask. 

Here's some good ones you may want to try. The follow up is as important as the initial. 

What is your main goal that you'd like to accomplish through therapy? What does that look like?

How are things going now? What makes the situation better?

What have you already tried? Are you willing to change the task by trying ... ? What is essential not to change?

The Presidential Election and the Effect on Healthcare

I normally don't do this. Even with people I speak with in person, I don't get very political. Partly due to the effects of being a blue dot in a red state, partly out of actual politeness and avoiding arguments, and partly because I don't think that most political discourse has an effect on how people actually vote. But as should be obvious from the title and the disclaimer thus far, I'm going to go there today. You have been warned. (as always, I'm sure that my employers -such as they are- and state associations that I am a member of have no voice in what I write, and the views are purely my own)

My father is an economist/history teacher and political discussions were the norm in our household from a young age forward. I now spend a good deal of time interfacing with our state lobbyist regarding how we can best protect and promote OT in my role as VP of Advocacy. I am a registered Democrat, but would more accurately describe myself as a political cynic. I think yard signs should be banned for anyone running for a higher office than the state legislature. I think that the debates should be abolished since they only serve as moments to spit out talking points, cherry picked statistics, and are altogether worthless until you see the Fact-Check. I get super irritated watching both candidates move closer to the center as election day nears and simultaneously knowing that a third-party candidate has no chance at all in going far enough to keep the other two honest. Don't even get me started on the rights of a SuperPAC.

So I pay attention to things. And I have to say that I'm disappointed in the campaign so far from both sides. Obviously the negativity does not make for optimal TV viewing (all hail Netflix and DVR!) but even from a purely strategic point of view I think that both have made serious errors. The campaigns have chosen to push  repeatedly on little buttons when they had larger ones at their disposal. And from the ads in my region, you'd think the entire election was about abortion, and nothing else. I hate hearing how "this is the most important election of all time" or "this election will change the course of history" or "we couldn't last four years with X". It's all ridiculous, and a lie.

But there are still legitimate topics that will realistically concern people in the coming years. Healthcare should be of large concern for everyone, since it is a service that everyone will eventually need to use, a funding source for many of us, and affects the quality of life for our families and clients. So knowing how the candidates intend to approach healthcare (and reform, because the cat is already out of the bag) is important.

You've heard what they say- "The (insert party here) is trying to destroy Medicare as we know it!" But both sides have proposed changes to how the healthcare system will work. I say system and not just Medicare because Medicare is the driving force behind how other insurances set their coverage and rates. And it's not fiscally solvent. As the baby boomers age, we will have a larger number of people to insure, who are living longer, and fewer workforce members (to both tax and charge higher commercial premiums)- this is a recipe for bankruptcy. Change is no longer optional.

Both campaigns have essentially proposed similar tactics, which shouldn't be surprising if you consider that the ACA was drawn around Romney's plan instituted in Massachusetts. However, they continue to parse words (vouchers! exchanges! Obamacare!) in attempt to make the differences seem more drastic. Both plans would allow you to take federal money to purchase insurance from a marketplace that offers the minimum Medicare/federally defined benefits. The ACA proposes to re-prioritize Medicare monies to start some of the funding for their tasks, and intends to cut costs long-term through preventative care and a board of advisers who propose strategies to cut costs without cutting benefits. There are some lofty goals, and it will be interesting to see how we simultaneously shift to prevention and wellness while cost-cutting. The Republican plan intends to make Medicare a pay-into contribution system, counts on competition to drive down costs, and the government pays a premium cost for any insurance and places overage costs onto the insured person. Unfortunately it becomes quite a gamble for the insured person if competition doesn't reduce costs sufficiently, since they wind up holding the bill, and remember that many Medicare beneficiaries are on a fixed income.

Both plans claim to reduce Medicare spending by the same amount. Neither method has been proven to work. Both plans rely on Medicare cuts- the Republicans intend to use that money for tax cuts and deficit reduction, while the Democratic plan uses that money to fund Medicaid. The word from the Republican camp was that Medicaid (like FEMA and other state-benefit programs) would need to become completely state funded without federal support. Being native to a dirt-poor state, I worry about the feasibility of making that happen without major cuts to an already strapped system.

This is what I think is important, and I base this upon the clients I have worked with over the years. So many of my families depend on Medicaid. If they do have insurance, many times one parent was effectively forced to stay in the same job for fear of not getting the child covered under a new plan due to having a preexisting condition. I have worked long enough to know that all it takes is one accident or completely unexpected health event (e.g. aneurysm, child's cancer,etc) to completely bankrupt a family with or without insurance. I believe in protecting the people who are most disadvantaged- children, the poor, the disabled, the elderly. So though there certainly isn't a perfect option at this point, no golden ticket to magic wonderful healthcare, my vote is to continue the ACA.

This is an important issue, and I would advise you to read more if it concerns you.  My sources:
Here's a rundown from Politifact on truthfulness of claims on healthcare.
This one is specifically on the ACA (Obamacare) and claims made by both sides.
and one more specifically on Medicare claims

Will Medicare as we know it change or persist?
What the Romney-Ryan and Obama Medicare plans have in common
Democrats vs Republicans: 2 approaches to Medicare