The Value of the Generalist -or- Why I Am Still An OT

I graduated from a rural state university. I had looked at a couple of other OT schools, but they weren't the right fit for me. 

I've touched a few times on how I finally decided on majoring in OT. During a college tour, I explained the debate between architecture and OT to a professor who encouraged me to look into home modifications. That was my first area of OT that I found particularly exciting, and it stayed that way for the first years of OT school, right up until my Level II fieldwork approached in said field. That fieldwork let me know that I could not continue with that specialty, and I haven't done any work in the field since.

Let's pause for a moment to be thankful that I wasn't in an OTD program with a push to develop as an expert in a single area. Because if I had been 60-75% through a program and found out that I hated my focused area, I would be done. I certainly would not have continued research and another fieldwork in that area. Would I have been as open to the other areas of OT? Hard to tell. It may have seemed better to cut and run into another field entirely- PR, Med School, PT... who can say? It is certainly a common theme that many medical students get into their residencies and dislike their area of expertise, and many do leave the whole field.

However, my program was not focused on developing "experts," but excellent entry-level therapists. My research project was in a field that I have never chosen to work in, my favorite classes were not necessarily what controls my day to day work, and I knew that there would be on the job learning. (PS- ALL entry-level therapists regardless of degree will need to learn on the job). I knew that I had a great base in the basics of OT, clinical reasoning, and enough information to get me started in any job. Our school had an excellent pass rate on the NBCOT exam, and I was confident that I would pass. My first job at a small-town hospital center required me to treat acute hospital patients, skilled nursing patients, outpatient pediatric clients, and hand therapy patients. My background as a generalist paved the way for my success in this hospital system, and my own work following graduation built the skills I needed to continue to be successful.

To have a diverse workforce, you must have generalists. However, I have yet to see the OTD program that didn't have specific narrowed focus topics and advertising to make experts, not generalists. Anecdotally, I have not seen "experts" return to their small rural areas because there is no market for their services. Those areas that are an hour car ride away from a hospital need a generalist. And a specialist is not going to abandon their expertise to provide general services. While people often consider inner-city areas as underserved, they frequently forget that rural areas are underserved too.

Our commencement speaker asked us to embrace the idea of giving back to the small-town rural areas that represent so much of our university graduates. She stated that it should not be considered lesser to pursue a track as a generalist and provide the services that are so needed in a rural area. This idea struck a chord with me. For a long time, I had seen this idea of specialists being the most desirable practitioners in any field. I had not considered the value of a generalist, and that it was not a lesser role, but an extremely needed role for many people.

I'm very thankful for my education as a generalist. While I now feel like I am in my permanent job for the next 30 years, I started my career with 7 jobs in 7 years. It took me awhile to really find my niche and see where I want to specialize. I love OT because there is such a wide range of practice and it has been the best fit for me as I have grown and changed. But if I had picked a specialty in home mods, or acute care, or spinal cord injury, I would not have been able to find a job in our area. And I would not have necessarily kept one I could get. I would have looked for a different type of job entirely. And I would hate to have a person like me leave our terrific field due to hating their specialty or being unable to find a job that will pay specialist level money in their area.

I fully support a post-professional doctorate option for OTs. Several options- a clinical doctorate, a PhD, an EdD, whatever fits best for that person. But I think that pushing specialization early will keep a person from really trying out the OT field and finding the best fit. I know that was what kept me in OT even when my first idea was no longer feasible. Let's not lose this valuable part of our field.

Why I'm not following you on Twitter

I have seen other posts similar to this, but I am on Twitter a lot and still see a lot of these mistakes/personal peeves, so I wanted to share.

1. I personally don't like to be overloaded with an out of control feed of thousands of people. So I'm not going to follow you just because you follow or tweet at me. Sorry.
2. If your posts are all abbreviated and linked to facebook, I will not click through.
3. If your posts are all things you are posting on pinterest (especially if it is just reusing someone else's words about the pin)
4. If you tweet a whole lot, I might not be able to handle that. If I can turn it down by eliminating your replies and retweets, I will, but sometimes the volume is still too much. If you are active in multiple chats a day, I might not be able to accommodate that.
5. If you don't tweet very frequently, I will think you're not actually active. I'm not super demanding. A post within the week, or several quality posts a month is good for me.
6. If you don't have a real picture or profile description, I won't follow you. I need to see that you are interested in something that I am- OT!! or education, special needs, disability issues, early childhood development, or medicine. Consider using a hashtag in your profile to call attention to these interests.
7. If you have additional interests that are outside my own and take up a lot of your tweet volume, I won't follow you. I don't need to hear about your roto league, your politics, or your thoughts on TV shows everyday, but I don't mind the occasional random shoutout to something else.

Obviously people use Twitter in different ways, and you need look no farther than my "OT Family" to realize that. So these are my guidelines, but others might be drastically different. Twitter is my primary tool, when others prefer Facebook or another platform. What affects your professional social media usage?

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.

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!

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!

http://www.youtube.com/user/DeliveringOT

https://www.facebook.com/tOTal.ability

https://twitter.com/tOTal_ability

http://pinterest.com/TOTALABILITY/total-abilitytm-our-mobile-occupational-therapy-se/

http://www.linkedin.com/company/total-ability

http://www.linkedin.com/company/total-ability-solutions

Salary, Hourly, and Contract- understanding different types of employment

Occupational therapy is a great field with so many opportunities to work with different populations and in different settings. I always tell students that you have such flexibility that you can literally work as much (or as little) as you want. If I could have cloned myself a couple of months ago, I would have been able to work 80 hours a week. The other side of the coin is that I also now work only 2 days a week and still have financial security. To navigate this world, it is helpful to know the different types of employment that are available. Here are some descriptions and pros/cons to different types of employment.

Salaried employment is what most people think of with a "typical" job. You are paid a set amount per year and usually after a short probation period have an expectation of job security. Promotions may be available more readily, and most management positions are also salaried. Typically, you can negotiate for a raise at your annual review and may get a cost of living raise during this period as well. Salaried workers usually get benefits such as health insurance, life insurance, paid vacation days, and 401K eligibility/matching. CPR and other necessary certifications may be provided and reimbursed at your employer. Continuing education may be reimbursed and days off for education may also be paid. In an OT world, you may need to spend extra time outside of "typical" hours doing work tasks. There may be meetings during lunch times and you may need to stay late to see patients or do paperwork. There may be additional job responsibilities (the infamous "other duties as assigned") like participating in committees, representing the facility at meetings, etc.

Hourly employees may make more money than salaried employees and may be able to opt out of purchasing certain benefits in order to increase their pay. Part time employees will often be paid hourly .Typically, you will not be asked to work overtime because then you will be paid more, and bosses try to avoid that sort of thing. :) You will likely have to keep very close track of your time in, time out, and lunch times to ensure that you are paid accurately. Hourly OTs may still earn paid time off, but will accumulate it gradually as they work each hour. Depending on the employer, hourly employees may not be guaranteed a certain number of hours each day or week, and may also be the first person "furloughed" if someone is looking to cut costs.

Contract employees will likely make more money than salaried or hourly employees, but they are even more costly to the employer than it would seem from that knowledge. If there is a contract company, they are getting paid an extra fee from the facility for that employee. It's a very expensive proposition. It's important to remember that if this facility had any other options other than hiring a contractor (also known as a traveler) that they would have taken it long ago to save money. So there is a potential that you could be walking into a bad situation in one way or another, although you may also just be covering for an extended leave such as a maternity, sabbatical, or medical leave. As a contractor or traveler, all you are getting from the facility is your money. There will be no trainings, no benefits, and they're not going to want to have you taking many days off. You may be able to get these benefits through your contract company, they may also provide relocation assistance. If you have a continuing relationship with them, your contract company will do the heavy lifting of actually finding you placements instead of you looking for job after job, and will help you get through licensing procedures as needed. It's also a good way to see new areas of the country and a variety of practice areas. From the viewpoint of the facility, they will want you to be able to hit the ground running, maintain a higher productivity, and function without assistance. If there's a rehab tech, they are probably helping someone else. If there's a difficult patient, they might be on your caseload. If there's something else that needs done, it may well be shuffled to your schedule. You will be guaranteed a certain number of hours per week, likely for a set time period of a few months to a year. This is often not a good fit for a new graduate who may need more support starting out and is still learning the field. This can certainly be a full-time long-term gig if you live in a metro area or are willing to travel, but there is a degree of insecurity between placements. Contract companies vary with how much they require their employees to do above the actual OT work, as well as what benefits and placements they provide. In an odd twist, some facilities actually employ their entire therapy staff through a contract company instead of having on-site management and hiring. In this case, you operate more as an hourly employee.

Working prn (as needed) or OPT (occasional part-time) involves hourly pay at a high rate like a contractor. You may have a higher productivity standard and will likely not get very much assistance from the staff (both because you're expected to operate independently and because people won't know you as well). Your employers will want you to spend your time efficiently, and so you won't likely be asked to go to meetings or rounds. Similar to contract employment, you are filling a shortage. There is no guarantee of hours per week or continued employment from one day to the next. If you are with a large system such as a brand of nursing homes or hospitals with multiple facilities, you can get frequent calls and make it work as a prime gig, but it's a risky move. This is much better as an option for moonlighting. Many school system OTs have a prn job for summers or weekends to supplement their other pay. Again, this is rough to do as a new graduate (especially if you're balancing multiple facilities or different practice areas) and since you're not going to get staff support, you need enough experience to be independent with what's being asked of you.

There's a lot of flexibility in OT employment and knowing these options can help you make decisions on the jobs that are out there. Check out the "students" label and some of the Greatest Hits entries if you are curious about other facets of finding your OT job.

OTNotes Greatest Hits Volume I: 2008-2012

As part of my blogiversary, I wanted to celebrate entries that have gotten lots of views, lots of comments, or that I felt were particularly good writing. I've tried to group these thematically to make for best reading. If there is an entry that you remember and isn't listed, or something you wanted to say about one of the pieces listed, please feel free to share your thoughts in the comments!

Entries for Students - I started this blog originally to help people in OT school, so it should be no surprise that I have lots of popular entries for students.

How to get into OT school

Writing goals -I need to update this since my approach has changed somewhat since I wrote it

Writing Sensory Goals 

Case example with goals - This is an acute care joint replacement case

NBCOT study tips -please take note: this was written several years ago, has no info on simulation questions, and I cannot legally update it until 2014.
giving an inservice - should help you pick a topic and some basic presenting tips
searching for an OT job - short plug here, I have gotten 3 jobs from AOTA's OTJoblink. Consider it.
interviewing tips 

the importance of asking questions

Acute Care - How many hours have I spent in the hospital? A lot. Sometimes people in this area are very reductionist, but there is a lot to learn and improve upon if you're an OT in acute care.

How to compile a relevant past medical history
prioritizing evaluations - a few different methods
Acute Care Tips and Tricks - some essential tips learned after many years
who gets to go home? - 3 short case studies of "similar" people who all discharged to different locations
Adventures in serial casting - this is a review of the research surrounding serial casting efficacy
Patterns - a couple of patterns observed in admissions based on weather and other external factors


Pediatric- I'm still getting my sea legs in the land of peds, but here are a couple of good entries. As I start to feel more confident, there will probably be an uptick in this category
Mat Man  -maybe my favorite photo entry
infant toddler trauma awareness  -a lot of really good information on trauma training
starting in Early Intervention: assessment -how I picked my EI assessment


Energy Conservation- this is a fondness of mine. At one point I had a whole EC series planned... may still do something along those lines sometime.
energy conservation in the summer
energy conservation for holidays

Professional Issues- Various issues that I think are relevant to the profession in an overarching way

collaboration with Girl Scouts - I really want to see a greater connection between OTs and Girl Scouts
Malcolm Gladwell thoughts - remember when Malcolm Gladwell's books were really popular? here are some of his ideas applied to OT
OT twitter chat - some advice on getting started in twitter chat, which I would definitely encourage. Check out #OTalk2US if you haven't yet
thoughts on a Glee episode -the OT connections mirror version of this got picked up by AOTA's 1 minute update and really exploded. People were very opinionated over this issue, or just the show.

Personal Issues: glimpses of my more inner life

struggling to be an ot for family
reading without getting carsick -there really should be more information online about how to accomplish this
unanticipated blessings related to presenting at conference


Uncategorized- some of the randomness that is truly me
chicken dance - a little inspirational story that showcases my favorite strategy- make a fool out of yourself.
OT quotes -these are not quotes from OTs, but more meant to be generally inspirational. I should have renamed this or actually found real OT quotes, but it is what it is.

podcast with AOTA presenter -I did my very first podcast!

aquatic exercises -specific treatments for aerobic pool exercises. I now do several of these myself since I am doing prenatal water exercises
metacognitive analysis- how I approach puzzles



I think this is a pretty good list and definitely shows that I have some seriously diverse interests that I've been writing about the past five years. I think that I will probably make this an annual event, and reflect back on the best posts of the year. 

Pregnant in Healthcare: diseases to avoid

This is a hard article to entitle. Obviously, no one wants to be exposed to contagious diseases at any time, but by virtue of working in a hospital, there will be sick people around. This is a list of infections and diseases that should be avoided by pregnant women working in healthcare that was compiled by a former coworker of mine. Explanations of some of the possible effects of exposure to the fetus are directly from the links and citations noted. It's not my intention to cause anyone to worry, but just to give a little information to be used when building your caseload.

Please don't debate with me about the frequency of these complications or ask whether your child is at risk- I'm not a doctor, you should definitely discuss your concerns with your own OB. But this is information that I think is hard to find in one place and beneficial to many women trying to work while pregnant.

Herpes varicella/ Herpes Zoster (chicken pox, shingles) – exposure in the first 20 weeks or last 5 days of pregnancy can cause congenital varicella syndrome with a spectrum of musculoskeletal and visual birth defects.

Rubella (German measles) – Early exposure can cause congenital rubella syndrome, characterized by eye defects, heart defects, and mental retardation. Also raises the risk of miscarriage or stillbirth. This is covered by the MMR vaccine so you should be immune if you received it as a child.

Toxoplasmosis – early exposure is less likely transmitted but can mean more serious results, late exposure is more likely transmitted but has less serious results. This can cause eye, hearing, and learning problems.

Cytomegalovirus – transmission is rare, but possible effects of CMV on a baby include learning disabilities, mental retardation, and vision or hearing loss after delivery.

Parvovirus (slapped-cheek disease, fifth disease) – Can cause severe anemia which raises the risk of miscarriage or stillbirth.

Herpes Simplex – (STD) Exposure at birth may result in brain damage, blindness or death for the newborn.

Hepatitis B – this infection can be passed to the infant at birth, which poses the risk for developing chronic Hep B.

Pt with AIDS with mental status change (can be Cryptococcal Meningitis or "crypto") - this is a fungal, opportunistic infection. It can be transmitted to the baby and both of you could need to be treated. Certain drugs to treat this can cause miscarriage, so obviously inform your doctor if you are pregnant.

Bacterial Meningitis – can cause brain damage, hearing loss, or learning disabilities.

It has also been recommended to me that pregnant women avoid contact with people who have the flu. And it's always good practice to avoid contact with anyone with a fever or new unexplained vomiting or diarrhea. This article from Nursing Center has some additional information on risks that pregnant healthcare workers are exposed to, with some suggestions for how to mitigate these risks.

As a currently pregnant, currently recovering from very mild illness person, I can attest that it's pretty miserable being sick when you don't have many options for medication, are already tired, are at greater risk for dehydration, and are worried about the development of your child.

Knowledge is power- hope this list helps you feel more empowered as a pregnant healthcare worker!

Adventures in Scheduling

With all the crazy scheduling that is required as a therapist, you'd think they'd make you do logic puzzles as part of an entrance exam. Here are a few general thoughts on the mishaps inherent to scheduling. (this is a bit scattered since I'm still jet-lagged, so please forgive any dangling modifiers or unresolved thoughts)

First off, I think that there is this cultural norm of what a "workday" entails. If your parents worked non-medical white-collar jobs then you can probably identify with a 9-5 workday as we see in so many shows and movies (at least those that actually indicate that people WORK for a living, as opposed to being independently wealthy enough to just sit around and talk). Even in college, actual "working" time for me did not get up to 40 hours/week until the end of OT school (at which point we raced right on past 40 and never looked back). I know that there's tons of people out there doing simultaneous job and college, or 2 jobs regularly, all I can say is more power to you. But I had this expectation that a "normal job" would have normal hours and that the schedule would not be that bad.
I have realized that was complete BS.

This enlightenment took its time coming. On my phys/dys fieldworks, I had a hard time adjusting to a 7-330 schedule, especially with a nonexistent lunch that was dominated by meetings and paperwork. Despite that, people almost never left on time, needing to stay for one reason or another. It was frustrating as a student, waiting at the end of the day to get your notes signed and be told to have to redo them (now) when it was already past "quitting time." The woes of being a salaried employee- you will often work over the expected time.

Scheduling within your day is another insane proposition. In acute rehab, we had to work as a team to make sure (each day) that the client had their required time in all services, minimal time wasted sitting in the gym between services, at least one ADL per week, and so forth. In the hospital, coordinating cotreats was the biggest scheduling portion, and knowing that your whole day was likely to be derailed by patients going to tests and whatnot. The hazard of hospital work is ending up with a back-heavy day because not enough could get done in the morning. School scheduling had to work with the class schedule to make sure that they weren't being removed from important learning opportunities or special classes or being overbooked in a day. (We did pull-out services and I could not even conceive of how to schedule push-in during my year balancing so many different schools. I would love to hear experienced therapists' tips on that.) However good your schedule is, it is likely to get derailed by an IEP meeting or school assembly or lockdown drill. Outpatient scheduling might be assumed to be the easiest, but often you are dealing with people who need to be seen outside of their own working hours or school hours, so fitting in times can be tough.

I'm great at logic puzzles, but daily scheduling is a monumental frustration to me. One of the few beauties of being a prn employee is that I can just show up and do what is already assigned... and if the patient needs to schedule for their next time, I usually turf that to someone else.

Good coworkers will also adjust their schedules to help one another, even if it means balancing inpatient and outpatient work in the same day, or taking something difficult. But that is another thing that will wreck your schedule... and productivity if you have to track that.

My most common work now is as an independent EI contractor. I'm still trying to get into a good groove for getting the kids scheduled out right. Part of me doesn't want to over-analyze it because I don't have a huge caseload (yet?) or time demand, but my left brain would love to just have regular times for each kid each month. Evals have to be scheduled within 15 days of hearing about them, which is not really a lot of time to work people in if you do have a lot of other engagements... like holidays, which we have a few coming up.

Holidays are a whole issue all their own. Remember getting days off in school for holidays? And long Christmas breaks? That does tend to go out the window. Hospital and SNF people have to rotate through holiday coverage... when you start out, especially if you're young and childless, expect to work some of the biggies. I remember a boss telling me when I was interviewing that they paid so well for big holiday coverage (it was good- effectively 3x normal pay plus a PTO day to be used later) that they never had to force people to work major holidays. 6 months later, when those of us who were under 30 were all sitting there on Christmas day, I found those words to be particularly irritating.

Another fieldwork instructor would be laughing at the turn my life has taken. She had her own business, and I remember being aghast when told that we would be working on a major holiday. To student-me, I could not even conceptualize why you would be working on a national holiday. Well, now that I am mostly self-employed, I get it. I just scheduled a kid on a major holiday without even thinking twice. Major reasoning- I no longer get paid to take holidays... or paid regularly at all. If I have a "day off," it's just another day making no money whatsoever, and I've had plenty of those days for awhile. 

Now with my EI kids I would like to schedule multiple visits in a day in a geographically sensible way, but it hasn't worked well yet. If I do a community outing, it's hard to say exactly how much time that will take, so planning the next visit can be tricky. Accounting for travel time is hard sometimes as well. But there's just the general Murphy's Law that comes into effect here also: the people who live near each other will have opposing personal requests, one will want morning and another will want evening; one can only do Thursdays and another Tuesdays; everyone will want 10am; on and on it goes.

Is there a moral to these scheduling woes? (is there anything logical written by someone whose personal time changes have zapped her ability to do anything but stare like a zombie?) I guess the overriding theme would be that you have to be flexible. No matter how nicely laid out your schedule is, it is likely that it could all go to pot anyway. No matter your personal preferences for workdays, if you want to get paid and your employer decides you're working weekends or holidays, that's what will happen. Until you go into business for yourself, and then you'll probably work those days anyway. And if you like the freedom of "set your own schedule" prn work, it's probably good if you have a backup income and a good budget. 

April Challenge: give a satisfaction survey

Obviously, you want all your clients to have good outcomes (and not just good, but spectacular when possible!). That is easily measured during reassessments. But another factor is becoming increasingly more recognized in the medical world- client satisfaction.

Hospital reimbursement is starting to change in relation to how satisfied patients are with their care. Some workers are angry because "now I don't just have to do my job, I have to hold their hand the whole way" and some of the initiatives that hospitals go through can seem corny, over the top, or pointless. Generally, it seems like when therapists (OT, PT, SLP) go through these trainings, they aren't learning many new things because they were already asking the patients if there was anything they could do to make the day better.

In the hospital, we had our Press-Ganey survey ratings talked about everywhere. Some departments posted these results so that you would know how to improve, or how awesome you were doing. But if you work in a different environment, you may not have anyone else conducting a satisfaction survey for you. It's not difficult to create your own. You should want to know... even if your clients get the best outcomes in the world, if they're not satisfied with you or your clinic, they won't recommend your practice in the future. Or they'll say something like, "She's a good therapist, BUT (she's always running late/the clinic is a mess/it's really hard to schedule an appointment/ etc).

A quick google search will show you what some other therapists and clinics are using, I'm not going to publish them because I'm not sure how public they want them to be or what the copyrights are (and clearly I'm running late so there's no time to investigate). I thought that Tonya at Therapy Fun Zone had a pediatric satisfaction survey, but maybe it was Your Therapy Source... either way I can't seem to find it right now. If you have a survey you don't mind sharing, please link to it in the comments.

April Challenge: Offer to speak at a career day

Spring is here, and it is oft the time of career fairs around the area. Representing OT at a career fair is a great service to students and the profession.

OT is a profession growing "much faster than average" per the Bureau of Labor Statistics which makes it an attractive profession for students- it's very nice to know you can get a job after you graduate. At the same time, it is important to increase our work force- our scope of practice is broad, and if OTs cannot fill the need, someone else will. Therefore, the recruitment (and later training) of effective practitioners should be considered the personal business of every OT and OTA.

So today, put forth a little effort into looking for a local career fair. Many middle and high schools offer these in addition to community colleges. If this does not pan out, many teachers are willing to give you a short portion of class time to discuss a relevant career. Girl Scout troops are also a great group to reach out to, since many of the badges and journeys require a career connection.
Developing a presentation shouldn’t be difficult, it's just a time to enthusiastically share some of the numerous possibilities that a life in OT can have. I always try to emphasize the multiple entry points into the profession, give a description of practice in common areas (hospital, school, clinic), and talk briefly about some developing areas of practice (driving, low vision, home mods). You can do a full presentation in 15 minutes and who knows… maybe you’ll be the one who sparks the initial interest of a future master clinician, researcher, or AOTA president. At the very least, you're helping OT to become more widely recognized, which is its own benefit.

OT in DC and common sense

So the great team at AOTA's Federal Affairs branch has made a blog on OTC entitled "OT in DC." It has been very good thus far, and I wanted to make sure to share this post on why documentation is important- "How We Say It Matters." To me, that title is twofold- how we describe our OT services provided matters in getting reimbursed and recognized appropriately; and that there is a question we need to answer for our Fed Affairs folks and the public in general- how OT matters to the community and how that can be communicated.

This post is a great read to remind you that documentation is not just busywork, not just checkboxes, and not just a legal document. It's the proof that services of an occupational therapy practitioner were required and beneficial to the client. There is a common phrase that if it wasn't documented, it didn't happen. This post touches on the fact that clinical reasoning is invisible unless you, the practitioner, write it there. You know you did it, but does every person who could possibly be reading your documentation know that, and know that it was skilled? If we want OT to matter (and if you don't, you're probably reading the wrong blog) then we have to communicate our worth.

Also, on that note, not that anyone does this in writing but this is an important change to make in your oral communication. How often are you complimented for an idea or treatment and brush it off as "common sense?" Vow now to never say it again. If it was "common sense," it would not have required paying an OT to do it. That phrase diminishes all the intense coursework, fieldworks, and clinical reasoning of an OT. It seems "common sense" to you because of the framework you use for clinical reasoning, your experience, your intelligence. Not to be stereotypical, but women sometimes have a tendency to shy away from accepting compliments to avoid standing out or try to emphasize their cooperative tendencies. There is no reason not to accept a compliment to your clinical reasoning skills, you can do so gracefully (even returning one if appropriate) and acknowledge those skills instead of degrading them.

Our OT Identity

In celebration of World OT Day, we are discussing the Global Identity of Occupational Therapy. It's an interesting topic since there has been a lot of discussion about our national OT identity with the approaching Centennial. I think the best thing that I can share for this topic is my summary of two of the best AOTA sessions from the 2011 conference (and maybe from ever).


Last spring, there were two talks that best fit with the presidential address and stood out as completely awesome. One was "OT Survivor: Protecting Your Turf in a Competitive Healthcare Market" by Pam Toto and the other was "Practicing Authentic OT: Strategies for Becoming a Reflective and Reflexive Practitioner" by Debbie Amini. These ladies are both well recognized in the field. Energy was definitely palpable in both rooms, and I even got to meet (again) Suzanne Peloquin during one session. (If a Slagle lecturer shows up in your room- you know the topic is superb!) By discussing what was reviewed in these sessions, I think we can get great input into our OT Identity.


"What is occupational therapy?"


How often do we hear those words?! Yet Toto points out that each OT area has its own definition. What I do on a daily basis in the school system is nothing like what I used to do in the hospital and that would look nothing like the life of a hand therapist. Even within the hospital, my practice could vary widely from the NICU to the Neuro ICU to the orthopedic floor and so on ad nauseum. Toto said this was like blind men describing an elephant- we tend to describe our practice in a reductionist way of what we regularly do, sometimes missing the big picture of OT. This can lead to confusion from consumers, referrers, and payors. Amini points out that if we want to achieve the Centennial Vision goal of a consistent recognizable image, we much EACH take it as a personal responsibility. The "Authentic" version of OT is client centered and occupation based, with occupation as both an outcome and a treatment. Amini pointed out that this is often an espoused belief of practitioners, but not necessarily an enacted one.


A person may not even realize that they aren't enacting their beliefs until there is an additional level of reflection involved. Amini described reflection as thinking and critically examining yourself, skills, and practice. Reflexive practice takes reflection further by then comparing reflected behavior to espoused beliefs, determine any incongruence, and then act to change the behavior or the belief. This process can be done by personal journaling, mentoring, using the AOTA professional development tool, creating a portfolio, or joining a community of practice. Toto states that one of the best ways to advocate for OT is to practice consistency in areas you address, services provided, assessments and intervention approaches. In doing so, you create an image that others will remember and identify as occupational therapy.


There are perceived challenges to authentic and reflective practice. Amini includes corporate policies, reimbursement, productivity, supply cost, time, and decreased support from peers or supervisors. Toto described threats to our practice: complacency in our documentation (failing to specify our unique practice), viewing OT as a job instead of a career, moving from ADLs to preparatory/adjunctive treatments, accepting the status quo (including that laid down by the boss), and allowing any other service to be a "gatekeeper" to OT. Don't allow other professions to represent you. If your services are special and unique, NO ONE can say OT isn't needed! Remember that documentation is important. It's hard to remember that when you're writing 6 evals a day and don't think they're ever read. But think back to being in school when you learned about how each note was a legal document, the only proof of what really happened with a client. Toto discussed that it is important to use our practice framework language and reference evidence in our documentation. The most skilled part of a person's OT session may not have been the hands-on portion, but the clinical reasoning and decision making you engaged in. And speaking of clinical reasoning- don't short sell our value by saying that it's just "common sense!"


Toto discussed at length the importance of advocacy for OT. We're great at being advocates for our clients to get the best care, but more reluctant to stand up for ourselves. There are a limited number of healthcare dollars, and other groups would love to take our share. We can't be timid and "nice." As Dr. Clark said in her presidential address, if you let others take OT for granted, "it's not playing nice, it's playing dead!" Remember, there is no mysterious "they" who will advocate for you. AOTA and your state association may be able to take action on a government level to defend OT, but without your membership, they are hard pressed to do so. And they certainly won't be coming to all your referrers and coworkers and asserting the OT scope of practice. That falls to each of us. Amini reminds us (especially those AOTA members) to use the official documents as leverage during advocacy efforts.


Toto described that there are two ways to make light- you can be the candle or the mirror. When your client is successful, they need to understand who you were, what you did, and how your intervention has impacted their occupations and participation in life. Discuss and hand out goals. Hand out a business card. Make sure that you identify yourself as an Occupational Therapist and not just an OT or OTA. Have several elevator pitches for different audiences that include evidence. Most importantly, let everyone know the good that you do, so that others may receive your awesome authentic services.


I hope you find these points useful for your daily practice. The field of Occupational Therapy and our consumers will definitely benefit from authentic practitioners. Let's all strive for that in the coming week.

OT in HD: Presidential Address

AOTA President Florence Clark opened the 2011 AOTA Conference with an excellent presidential address describing the need for OTs to compete.

(Photo credit to Cheryl Crow, videographer extraordinaire, from the OT Connections Gallery)

We live in a world of competition. Especially now, in a time of health care reform where decisions are being made about what services are necessary in the future, we as occupational therapy practitioners need to be engaging competition with (not against) others to ensure our role in promoting occupational fulfillment to the public. Competition needs to be acknowledged. It drives innovation and can improve practice. It's not going away, so get comfortable with it. Victories are won often by teamwork, but always by competition. But, as Dr. Clark said, "let's face it- we're nice." OT attracts people who are cooperative and kind. But if you let others take OT for granted, "it's not playing nice, it's playing dead!"

"HD OT" requires power, and we as a profession need to embrace our collective power. We can't stand alone, but together, we have a power that can't be ignored. As a group, we are witnesses to the "transformative power of occupation" and this must be shared with the public! The public mindset is shifting toward wellness and participation, which is a foundation concept to OT. One example is the case of Congresswoman Giffords. Per Dr. Clark, it was not so much of a question of 'would she walk again?' but one of 'would she run again- for Congress?' People are concerned with the ability to fulfill a role- one of the things that makes life worth living!

Dr. Clark drew some analogies to Rocky, who demonstrates caring and competitiveness, sensitivity and toughness. We have to be "in the ring" during the healthcare debates. We have to bring our "playbook." That includes evidence on our effectiveness, increased grants, decreased hospital readmissions and documentation. Our documentation should not over-emphasize motor-based components, but embrace our multifaceted approach dedicated to the whole person, environment, and occupation. We need to be intensely involved in advocacy to make the message heard- that Occupational Therapy helps people LIVE LIFT TO ITS FULLEST!


A recurring theme of President Clark's address was to strive for "arete," an ancient Greek concept referring to excellence, effectiveness, fulfillment. We each need to strive for everyday excellence in our work, with our clients, and how we represent ourselves. Fire up your competitive juices!


Dr. Clark's message goes hand in hand with 2 other excellent sessions I attended and will share at a later date. I hope that the call to "arete" resonates with you.

What a week

What a long strange week it's been...

It was a busy, and sometimes downright lousy week. I had 2 people that I was asked to see, cleared for home with family supervision, and then neither family would take them home. It is really sad to see someone who could be in an assisted living or adult day care go to a facility due to the lack of help at home. I hate being put in the middle of these family power plays where the caregiver child just doesn't want to do it anymore but won't say anything until the person is hospitalized. In a strangeness typical of this topsy-turvy week, I also had a lot of people insisting that they would take their parent home when they were very debilitated and largely dependent. The only bright spot for me was getting time to do some follow ups on Friday and changing a rec(ommendation) from rehab to home. That lady had cleared up physically and cognitively and did great in our gym, she was so happy to go home.

One of my fellows with dementia was interesting, but frustrating to work with. Terrible short term memory and executive function to follow through with tasks. Getting dressed took us a very long time. Mod assist x2 for LE dressing. After he was already dressed, he needed to use the bathroom... got him sat down, specifically said DO NOT GET UP and then positioned myself outside the door to detect movement since those directions are so rarely followed. I heard him up and moving toward the sink, so I went in to find him walking with his underwear pulled up but pants still around the ankles, totally oblivious to any lack of completion of the task.

This has been a frustrating week as well since it has felt multiple times like different groups were trying to undermine our therapy recs. Obviously, we're all part of the team trying to facilitate best d/c plans for the pt. However, it's hard to feel appreciated by the rest of the staff when you're doing an eval and the home care coordinator walks in to set up home therapy and oxygen OR the doctor comes in to review discharge instructions OR the case manager has already stated the plan is for rehab. It makes you feel like an ancillary service that doesn't really matter to people. That is a feeling that I truly hate. I've also been at odds with people lately who can't respect my decisions NOT to see pts. The most recent of these was a gentleman who had a blood sugar of 500+ and was off the floor for testing for several hours. I was told, Oh, they've treated him and tested him since then, it'll be much better than that. With all due respect, prove it. This is similar to when someone tells me to see a pt. who has dopplers pending to rule out DVT, because "we don't really think they have a DVT." I need to know that my pts are stable to work with, and need for people to respect my judgment when they don't appear so.

I've long been angry at my apartment complex for their slow response to ice and snow, worried that my elderly neighbor ladies would fall and break a hip on the poorly maintained sidewalks. Leaving the house Tuesday, I caught on some significant ice and did a "Home Alone" style slip and caught 4 steps on my back. Extremely unpleasant, especially as a user of bouncy public transportation. Was finally starting to feel better on Friday, and then I think I strained my back a little doing a 2-person lift. And then we went skiing on Saturday.

A note about skiing- I cannot do it. My husband loves it and progressed in one season from terrible beginner to black diamond goer (to my extreme worry). I have tried it once and spent the whole time falling. But I went, and it was really hard since I was already dealing with nagging pains. and then I remembered exactly how hard skiing is on your knees! Pizza wedging, turning, constant bends- it is no wonder you hear about these Olympians s/p ACL surgery and everything else. For me, it was very taxing mentally and physically, but an interesting learning experience (I can say that now that I am safely on the couch again).


It is an interesting time to be an AOTA member. I did the responsible thing and voted for all the positions (elections close March 3) and I also tried to review the proposals from all the candidates. It was interesting to see how many of the candidates had included a blog (many on the OT Connections service) and the number and kinds of updates they had. The truly interesting thing will be to observe how many people continue their efforts after the election. One of the great things about OTC has been getting more insight into the organization. President Penny Moyers is excellent about blogging and responding to forums, I also find posts by Brent Braveman (speaker of the RA) and "Ask" Molly (from OT Practice) to be good to follow. And with this continued debate on the future of the organizational structure based on the recommendations of the Participation Ad Hoc Committee, there have been some very informative responses from the decision makers. Incidentally, there have been several people who have initiated involvement on OTC to be part of this discussion, and the differences between experienced users of social network and others also provides interesting points for contemplation.

What this discussion is missing is input from the new generation of AOTA members. To my observation, these new developments with the COOL and the VLDC are designed especially for the newer OT practitioner members to enhance the member experience and offer leadership opportunities for unrecognized, busy members. There is a lot of uproar over these changes, and the decision makers need to hear ALL the voices in this discussion. So PLEASE express yourselves in the forum so that our demographic is represented.

Snowy Day Thoughts

I am pretty well trapped here at home under several feet of snow.
I felt a little bad calling off work, but they haven't plowed my parking lot and barely touched the street outside the apartment. I really didn't want to walk 2 miles through the snow on the ground (and still coming down hard) to get to the metro (which is running on a delayed schedule) to get to my shuttle bus (also on a delayed schedule) to get to work and then possibly not be able to get back. And now they've actually pulled buses from the roads, and SNOWPLOWS due to dangerous conditions. It's just a little over the top.

I do feel like I made the right decision yesterday though... instead of my usual drive-metro-shuttle bus trip, I got up EARLY (I've been waking up at 5am for a few weeks unintentionally), drove to work and paid to park. Despite driving 30 miles instead of 4, I got home before the worst of the snow started. It was already pretty bad driving at that point, several of the roads having large piles in the middle of the road that got caught on my car's undercarriage, and turns being made hazardous by snow piles taller than my car.

So I'm taking my day off to try to catch up on some fun stuff... reading, finishing my puzzle, but I had a couple OT things to share.

Been trying to come up with some fun OT Month things to do... we are talking about having a carnival at work to promote awareness and need to come up with fun events, favors, etc. I would like to have some ways to increase interest in OT outside of the hospital staff too. I thought about wearing my OT t-shirts to work, but I try to keep all but my scrubs from the germs of hospital-land (to the point that my scrubs are kept in a separate hamper and washed separately from all other clothes). I just got a cute little OTR pin from NBCOT, but it may be a little too little to attract attention. Thoughts?

The other thing that I am currently finding interesting is the proposed restructure of the AOTA governance. This is found in the previous issue of OT Practice (here for members) and causing quite a stir. The theory is that the current structure of the RA and ~dozen large committees is unwieldy and not encouraging quick action, leadership development, or involvement from the membership. The plan is to dramatically shrink the RA, and get more participation from the membership at large through volunteer opportunities and ad hoc committees.

As I said, people are up in arms. This is an interesting OTC thread on the topic with a few people "in the know" in the fray. Here's another, it just hasn't developed much yet.

Personally, I have no attachment to the RA. I observed a portion of a meeting as a student delegate and was not impressed (bored out of my skull might have been more accurate). However, my conference roommate thought that it was really cool and wanted to become a member someday. Elections to the RA in my state were almost always unopposed and run by the same person. I don't recall getting any updates on RA progress at conferences or through state association newsletters. Since I didn't have a close back and forth relationship with my RA rep (not a bad thing necessarily either) I don't know that I will miss out on anything by decreasing the number of members.

I do agree with the theory that it's hard to break into the AOTA leadership... you see a lot of big name people running for offices again and again. So opportunities within the new COOL program that are easy access will make it easier to get feedback from some new blood. From a casual observance of AOTA releases and annual meeting conduct, I could tell that a lot of the work was being done by ad hoc committees instead of standing committees, so I don't know that we're losing much in that department either. I don't know that having the ASD classified as an organizational advisor makes much sense either. As a former member of the ASD, my involvement was limited to one day of mostly being presented to, not really involved with anything until we started the Centennial Vision talks. I'm sure the steering committee is more involved, but some of them aren't even students.

Lots to think about and bring forward to your reps before the AOTA Conference at end of April. Read up on the issue. Talk it out online, especially on OTC. And don't forget to vote in the AOTA elections before March 3.

Aimless Thoughts

Took a bit of an OT break with a vacay to Las Vegas and reading some novels instead of OT stuff pretty much since Thanksgiving. Now I'm back and ready to play! Been working on a few entries off and on, but this is mostly unstructured.

My NBCOT was due to be renewed this year, which caused a minor panic attack the other day. Not that I've been slacking on licensure or anything, I've been going to conferences, but there was a wrinkle I didn't anticipate. I graduated in May '07, but didn't test until Aug '07. My original state license did not require first year graduates to submit continuing ed to be recertified. And unlike the first 2 years of my OT schooling, I didn't pick up any CEUs in my final year due to silly things like fieldwork, graduation, getting married, etc. Somewhere in the back of my head, I had this idea that I wouldn't renew NBCOT until NEXT year, or at least until Aug of this year. WRONG-O. All 36 hours needed to be complete as of 12/31/09. I was tweaking out quite a bit, until I reread the guidelines for all activities that count (can't link it since NBCOT is rather difficult to navigate, but it should be readily accessible if you're due to renew) which includes staff inservices, fieldwork student supervision, and reading journal or textbook articles. In the past 2 years, I have actually read 40 textbook chapters afresh and over 20 journal articles. I had to go back and count though, because I was stupid and hadn't been writing it down. So major props to Your Therapy Source, HeathSkills, and ABC Therapeutics, who all either cite their resources for posts or write specifically about certain articles, because at least they can keep track of what they've read. I hope to start doing that. Usually the journals just pile up beside my laptop though, they don't actually make it into posts.

Switched some days around at work, I am on 11 of the next 12. ugh. but I am starting to get into a groove on the medicine floor. I think the biggest challenge is just striking a balance between evals and priority follow ups. We don't have as many people going to acute rehab as on the other floors, so the regulation for most recent note is a little more lax. Few happy stories on the medicine floor... you don't get to watch people making dramatic recoveries like on the other floors, there are a lot of repeat admissions and people just getting generally sicker.

Had a couple of people competing for saddest story before I left for vacation. Lady A has cancer and has been having seriously miserable orthostatic hypotension. She has been existing by running to her destinations in hope to make it there before passing out, and was admitted s/p fall on one occasion where that didn't work out superbly. I believe we had a standing BP in the 60/40 range (NOT GOOD). When I was getting her history, it was very sad, because she said she knew she wasn't going to live through her current chemo regimen. However, she at least had plenty to live for. "I want to make it to July," she said. She had relatives graduating college and high school, another getting married, and a major milestone anniversary coming up with her husband. I almost cried. I am a big believer in the power of things to live for though, so I really hope she makes it.

Lady B was a sad case as well, same day. She was majorly depressed, and in some cases very rightfully so. From her description, it sounded like her husband had dementia and she had been very hurt by him commenting about how he didn't love her anymore and some of the barriers that the healthcare machine had placed between them. However she also had some episodes of paranoia and visual hallucinations, as well as frequent falls (her admitting dx). I was thoroughly confused. 80 years old is pretty late in life for a schizophrenic break. An experienced PT pointed out that sometimes Parkinson's Disease presents with psychosis, and that seemed to make things make more sense. Sometimes I wonder if I will just know stuff like that off the bat.

Ms N was bumming me out the other day as well. I saw her before for a home safety evaluation, which was very unstructured and not super fun as her normal pleasantly confused affect turned into nasty and aggressive when asked to take part. She is normally very nice, saying hello to all who pass her room and wandering the hallways with supervision. But the other day she was walking and crying her eyes out, calling for her mother, totally inconsolable for the duration of the day. I was very sad for her, and for a lot of people in general. Dementia is such a harrowing disease.

Even as an OT I often feel helpless in my own family, where a grandmother is in the mod-severe stages of Alzheimer's Disease. I have tried to make suggestions where I can, but I'm not there 24 hours a day and really can tell that everyone is getting emotionally and physically worn out just trying to do their best. We're also beyond the point of many environmental adaptations, which is where my strength is. I think that it's overall better for her quality of life and her husband's to have them in their home, but it's hard. Right now, the major issue is her walking. She didn't learn to use a walker before AD, and has never been able to really grasp it since. Right now they are walking with handheld assist but she leans backward A LOT. It is scary to watch. Scary enough that when I was there I transferred her to a wheelchair to move her 15' to the dining room. Even then she almost fell out of the dining room chair that didn't have arms. I don't really know what to suggest to help with this gait problem. We did go out and get bed risers and cut them down to fit the dining room table so the wheelchair arms will fit under the table, and make eating a little safer. I had to leave strict instructions though that wheelchair was for meals and to the porch ONLY, she was not to sit in it all day. Need to check in and see how this is going. Any suggestions welcome.

Back to a few less depressing random notes-
I was reading an article about a guy who has motivating himself to lose weight by pledge drives and donating all the money to cancer research. Great idea I think, because sometimes it is not enough to be doing something "for your health." Saying "it's good for you" does not always make you do the right thing, but if you have that extra motivator of someone counting on you, it can make it worth it. In the comments section, a poster (#47) was asking for weight loss advice and I am sure she would take your suggestions:

Weight loss experts, I NEED YOUR HELP!! I'm the elder sister of a developmentally disabled adult (36) who is at least 200+ lbs overweight. Given his relatively small stature, we're talking about a dangerous level of obesity. My question is this: does anyone have any recommendations for programs, procedures, etc. for those with cognitive disabilities? Since his impairment (a mild form of Down's) is related to both motor and impulse control the usual advise of "eat less and exercise more" doesn't work. His impairment is sufficiently mild that he would be discomforted by placement in a program with very disabled individuals. His doctors have warned us that a stroke or heart attack are not unheard of in his age group and, obviously, further impairment would prevent him from even enjoying the limited amount of independence he now has. Any help would be very very welcome.

Comments do require an extremely short registration. My initial thought was that there are exercise videos for people with Prader Willi Syndrome, but these are marketed mostly for children and teens.

That article led me to a blog I hadn't seen before discussing Fat Prejudice in Health Care. These are stories that people have emailed in, so there is a lot of raw language, you probably shouldn't read it at work. However, it would be good to talk about at work, because I know there is a lot of prejudice in the OT/PT world. (Here is a PT related story) As a professional who is expected to transfer any patient, it can be intimidating to walk into some rooms. Yet I will say that the gastric bypass patients we see are among the most mobile of all referrals, usually welcome a little adaptive equipment to restore some independence, and are often good to go after 1-2 sessions. Obviously as OTs we need to make sure that we're treating all clients with dignity and respect. It's still good to challenge your thinking about your practice and make sure that's happening.

Exodus

There have been so many farewells here lately, and it's quite frustrating!

In the space of ~1-2 months, we are losing a lot of people at work. One of the front office staffers, 3 PTs (who all sit in my cubicle row) and likely 3 great rehab techs. Also, one girl from my row is likely to go out on maternity leave any day now. I don't want it to get quiet and lonely in my area, or lose contact with good friends. And now, I'm seeing goodbyes in the blogosphere. One of the leaders from Hospital Impact is onto other projects, though the blog will continue. OT Advocacy made what was to me a shocking announcement of retirement, after a relatively short but productive run and a feature in OT Practice. And debate continues for the future of OT Students... though understandable, I would hate to lose access to the outlook of a cherished virtual friend.

And another thing! What happened to our OT Blog Carnival?! 2-3 issues and then poof?

I don't really think of fall as a time for changes... more as a time to hunker down and stay the course. Plus, I'm usually too distracted by football season to want to shake up life in any other way. Maybe some new and interesting things will pop up, but it's no fun to be saying goodbye all the time.

Thoughts Spurred by Malcolm Gladwell

At the suggestion of my dad, I read Malcolm Gladwell's books over the summer, and have some OT-related thoughts from them.

As a disclaimer, before someone jumps in to attack my lack of critical reading skills, I am well aware that none of the concepts in Gladwell's books are his own research, but there is a limit to how many individual research articles any one person is going to read in a given lifetime. So these are distilled stories with ready-made inferences, but interesting and thought provoking nonetheless. Here are some OT-related thoughts from the books The Tipping Point (TP), Blink (B), and Outliers (O).

Reading the Face (B 197) The final chapter of Blink discusses the work of Paul Ekman and ability to read emotions through expressions and micro-expressions. While I think it would be interesting to see when people are lying, frustrated, or scared, I think I would have better use to just be more aware of my own expressions and the message that I am subconsciously sending.

Fusiform vs Temporal gyrus (B 219)- After discussing visual tracking during a movie between persons w/ and w/o autism, he touches on a study indicating that most people picture and view faces using the fusiform gyrus. However, an autistic individual uses the inferior temporal gyrus to view faces, which is the same location that most people use only for objects. I wasn't really aware of that specific neurological difference but think that it would make an interesting principle to guide treatment.

10,000 hour rule (O 35)- This concept is presented as one of the precursors to mis-named overnight success. Several examples were given of people who started working in an unpopular field and had logged 10,000 hours of practice by the time that the field was ready for rapid growth. This number is referred to as the number of hours of practice needed to become an expert in the field. This would be a little over 5 years of full time work. How many OTs work their first 5 years uninterrupted, let alone in the same practice area? Just a thought. Also makes the hours needed for board and specialty certification seem almost doable.

Culture of Honor (O 161)- There was a mention of how a cultural importance of honor in highland areas has continued into the Appalachian region, giving some reasoning behind the number of feuds in the past century. This concept is also of high importance to many urban residents, especially in places where gang culture is rampant. I just thought it was an important tip to promote developing rapport with your clients and deferring to be more formal and respectful until you have a well developed relationship with your client and can be more informal.

Parenting styles (O 104)- A study is referenced that talks about 2 parenting styles: "concerted cultivation" vs "accomplishment of natural growth." I don't have full definitions for these, but they are associated with high and low SES families, respectively. The former is where the parent would encourage social skills and talent development through modeling and empowering the child. This was associated with higher confidence and better interactions with adults. The latter is a style that is more passive, leaving some of the development left up to teachers, coaches, therapists, etc. I definitely saw both types of parents when I was working with peds. In my experience, the latter style makes it hard to have home program carryover.

Levels of mitigation in speech (O 194)- The levels are restated here, and were discussed in the book in relation to studies about plane crashes. The author of that link also references an article from a person in a different power-index culture, which was interesting. I would be very interested to see a study on what terminology was used in ERs for trauma or in ICUs in critical moments between the various staff members. I may write up my observations on the language that is used at the interdisciplinary care meetings. But as far as client-therapist interactions, I think you have to balance your styles based on the client and family cultural and learning preferences. As an OT I want to give options, not take them away, however as safety concerns become larger, I do get more commanding.

Transactive Memory (TP 187) I scoured my in-depth books on cognition and found no mention of this concept, however, there is some research on this concept in the fields of relationship studies and also in computer science. This is where a couple or a group have certain tacitly designated tasks or things to remember. I never know where the various charger cords or electronic devices are, but/because my husband always does. This can happen sometimes in workplaces as well, where you have specialists and go-to guys/gals for specific tasks or theories. I think this also accounts for some of the memory impairment that I see in hospital patients as well. If you're used to sharing memory tasks it's not the same when you're out of your environment and out of touch with those you are close to.

The Tipping Point (TP 9)- Obviously this is the main idea of the first book, the idea that at some point change becomes unstoppable due to the momentous force behind it. My question here is- when is OT going to reach a tipping point? When are we going to be highly demanded in multiple fields? When are we going to be the go-to professionals for daily living, low vision, home mods, driving rehab, etc etc ad nauseum? When are we going to be respected by legislation, hospital policies, and other professions? I AM READY TO TIP! I know this is implicit in the Centennial Vision, and I would love for us as a profession to tip by that time. So I guess I'm still at the phase of tipping that I am becoming the best OT I can be so that when consumers have my services they come away with a great message about the purpose and power of OT. Just important to try your best every day since you don't know who you encounter that will be talking about you later.

Hope that's enough inspiration to help me get through the week! Anyone else have Gladwell-related thoughts?