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?

OT for Hip Fracture

What can OT do for a person with a hip fracture or hip replacement? More info in the full post.
Note: this post was written several years ago but still holds true. Just be aware that surgeries and protocols are changing with time and each surgeon will have their own specifics they want followed. I worked at a facility where the surgeons preferred a 2-incision "mini" replacement that carried no precautions, and several who debate whether to use an anterior or posterior approach. Just be up to date on what is preferred by your medical team.


Often, if the hip breaks near the joint's socket, the orthopedic surgeon will perform a total hip replacement (THR). This is also a common elective procedure for individuals w/ degenerative joint disease (DJD). There have been several advances in the operation, and there are new techniques that are less invasive and don't carry hip precautions. If for some strange reason you were pushed into a room with a patient you had no information on, and wanted to know whether this patient had a THR w/ precautions or an ORIF/pinning w/o precautions, the presence of a brace that extends from ankle to groin or a giant triangular pillow attached between the legs is the flashing sign that says "YES, I HAVE PRECAUTIONS." Don't count on the pt. to remember, as you may not have done a full cognitive eval yet, and it may have slipped even a very intact person's mind after the anesthesia.

For the sake of this example, we'll assume that our subject "M" has a THR w/ the standard precautions (no hip flexion past 90*, no crossing midline w/ operated leg, no internal hip rotation) and the fourth (no active abduction) which is used depending on the location of the fracture and the surgeon. There will also be a note about weight bearing status. Often, a person electing to have this surgery at a younger age will be allowed to weight bear as tolerated (WBAT). If there is more concern over the stability of the joint or bones, the surgeon will want less weight on that leg. We'll assume that "M" is partial weight bearing, which means that only 50% of her weight on the operated leg. (This saves us from having to explain toe-touch WB with the uncomfortable metaphor of not crushing an egg under your foot; and from non-WB which means that you have to hop. I have done the hopping w/ several... most recently an 89 y.o. female, and progress was slow)

We'll assume that in the OT evaluation, the therapist developed an occupational profile of "M", highlighting her concerns and priorities. We won't go into that in-depth in this post, as I actually want to finish it at some point. But, from my 'chart review,' I see that "M" is an educated woman who was respected at her job and has family support. The report states that she lives in a high-rise, which is good because it probably has elevators, but could be bad if they have rules about adaptations to apartments for safety. She also has vision difficulties, which could complicate ADL retraining.

ADL retraining, or relearning how to do the basic activities of bathing, dressing, toileting, transferring, etc, will be a large part of an OT's treatment for "M." Learning and understanding hip precautions is also a major task- non-medical personnel are not likely to instantly understand hip flexion, adduction, abduction, so this is a key for the therapist to rephrase, review, and demonstrate precautions so that the patient does not forget them and does not pop their hip out. Standard hip precautions often have to be followed for 3 months, so it needs to become second nature. (I once had a gentleman w/ dementia in his 80's that could not remember and understand these. He liked to draw, so I taped paper up on the wall and had him stand and draw cartoons of people obeying hip precautions) Here's some quick ways to simplify the precautions while covering some of the contingency situations:

• No hip flexion beyond 90*: Don't bend over! Don't try to get anything off the floor without a reacher! Don't lean forward when standing up from a chair. Use the adaptive equipment for dressing. (As a therapist, you can also help by modifying the hospital bed so that the legs don't raise. Often a little button on the foot of the bed or on the outside of a rail)
• No crossing over midline: Don't cross your legs! Use the wedge or pillows between your legs in bed. Avoid sleeping on your side.
• No hip internal rotation: Keep your toes pointed up in bed, don't let them turn toward each other. Don't pivot on the operated leg.

How is "M" going to get bathed and dressed independently when she can't bend over? Adaptive Equipment/Devices. A "hip kit" is often recommended, but there are cheaper alternatives to the medical supply stores. Reachers and long sponges can be found at many discount and pharmacy stores. Long handled shoe horns are found at my local Dollar Tree. (I have a handout on how to make dressing sticks, long sponges, and sock aids from household items, but I can't lay hands on it. Will link to it later.) At any rate, an OT will work w/ "M" to help her develop new patterns and procedures for doing her daily tasks w/ devices as needed.

Transfers are often looked upon as "PT territory," but an OT can't expect to work without being comfortable helping people relearning safe transfers. This includes bed to chair, as well as into the tub or shower and to the toilet. Though the "comfort height" toilets are gaining ground, most people (and much of my hospital) has the standard 15" commode. This will not be workable for most individuals w/THR. There are risers for toilet seats, but I have always wondered about their sturdiness. I recommend getting a bedside commode / 3 in 1 toilet, throwing out the catcher/hat/pot, and putting it directly over the commode. In the tub or shower, I always recommend grab bars, and then experiment with different seats to see what works best for the patient. School-based OTs work to get their kids in the least-restrictive environment, I look for the least expansive tub chair that offers the patient the level of safety they need. I have had 1 person w/ THR demonstrate a safe step-in transfer to a tub, but most people will need some sort of seat to swivel into the tub. This is not natural to people, and takes practice.

As "M" progresses through the continuum of care from acute hospital, to skilled nursing, to home health (more likely than outpatient in her case), she will continue to work on more advanced skills that she had previously engaged in, such as cooking, car transfers, showering, etc, which OTs call IADLs. Hopefully someone will be able to visit her home as she gets near to discharge so that they can advise on home recommendations. That includes placement of grab bars, moving furniture, adaptations for low vision- anything to make "M" safer and more independent.

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.

Keeping Organized

I was lucky enough to be invited to contribute to a couple of OT Month pieces. One was on Abby's awesome pediatric OT blog and the other was for AOTA. In these, I shared some of the organizational tips that I use to try to keep life together. Here is a more elaborate and visual demonstration of some of the best.

My dad teaches high school seniors and as part of his unit on college prep always advises that the kids keep 2 calendars- one for the whole semester and another for the coming 4 weeks. I found this magnetic dry erase calendar at Sam's Club back in 2003 (?) for about $8 and have been using it religiously ever since. I only have to update a week at a time and get to use all the different color markers for coordination. It lives on the fridge and helps keep everything straight.

My high-tech method for the calendar is using Google Calendar, which I'm sure comes as no surprise to anyone who knows of my Google product allegiance. I love that it's integrated with my phone and google account on the cloud. Also, it's easy for my husband and I to add things to each other's calendars so we stay updated, and I can add additional calendars (WVU sports!) so I have other events automatically on my schedule. 

I love these accordion files for organizing all my different papers. I have 3 that I use for different collections of stuff. This one is labeled to keep track of my continuing education for the past five years (required in case of audit in my state), my various licenses, and papers needed for my early intervention renewals.

I got this finance organizer at the dollar store to keep track of my receipts so that I actually had them come tax time. I didn't write in the amounts because I want to reuse it and keep track of all my finances on a computer spreadsheet. You could also use a small coupon file for this same purpose.

In a super-useful variation of the accordion file, this one is broken down for all the days of the month. Especially beneficial when I was in the school system last year as I could place several copies of the relevant evaluation, a prior written notice, and a blank sheet for notes clipped together on the day for the IEP meeting. When I would get an email asking me to screen a child, I could throw the screening papers in the folder on the day I would next be in the school. Very handy when you have multiple sites to coordinate. I got this idea from the book Getting Things Done, which is the only productivity book that I've ever read and very useful.

Speaking of Getting Things Done, one of my favorite apps is Due Today which is based on the methods outlined in the book. You can check out my interview with Stephanie Yamkovenko on the AOTA website to see all the reasons I love this app (one of only a mere handful that I have actually paid for). On the shot, you can see that I have different priority colors, due dates, overarching projects (lots to do in the "baby" category, obvs), contexts, etc. I don't have any notes for these but they are helpful too. Subtasks also help to break up the large pieces and figure out what to do first- you can see that I need to get a cream colored shirt but only if the coral skirt fits. 

Do you have any great methods to stay organized that work well for your business or family? Feel free to share in the comments!

#AOTA13 Social Media Presentation

I wish I was preparing to head out to sunny California and join the OT A-Team in the second edition of our social media presentation, but let's be honest: if I haven't had the baby yet, I'm probably taking a nap. Here is some supplementary information to my part of the presentation.

Title: What’s New in Digital and Social Media for Occupational Therapy?   

Short Course 328  Saturday 2-330pm

Digital and social media can facilitate interventions with clients and advance occupational therapy practice. In this era of constant change it is difficult to keep up with the latest tools. Presenters will share their knowledge and expertise about five key categories of digital and social media essential for practice.



My category is networking- how we develop relationships and communicate online. You can watch my presentation on video here. Most people are familiar with social networking sites (Facebook, LinkedIn, Google+ and Twitter) but may not be aware of how to use these for professional development. There are also niche communities for therapists such as OTConnections or OT Exchange. Mainstream networks have an advantage over niche sites of greater usage, wider functionality, reduced cost, integration with other sites.

Here are some of the ways that you can use networking websites to advance your professional development as an OT practitioner.

Most people are familiar with Facebook since it has an estimated billion monthly users worldwide (http://newsroom.fb.com/Key-Facts).  Website is open to anyone with an email address and allows you to “friend” people you know, “subscribe” to public updates of others, and “like” pages representing brands, public figures, or organizations.

Many groups use Facebook because the wide usage is a great way to get lots of members for brainstorming and crowdsourcing of ideas. Group pages currently represent a way to start discussions, share resources or files, and host events. Some of the most popular Facebook groups are in the “4OT” series- OT4OT, AT4OT, MH4OT.

Public pages are a way for organizations, brands, or public figures to present information to the Facebook community at large. (These pages used to be truly public, offering a free website service, but this has changed) Page owners try to communicate with those that “like” them but can be limited by changing algorithms and restrictions from Facebook on number of posts allowed or likelihood of those posts to show in a person’s newsfeed.

Some of the negatives regarding Facebook usage include frequent changes in privacy and features without notice, the lack of control over what exactly appears in your newsfeed, and the advertisements (some of which are less obvious than others). Facebook is also publically traded and trying to turn a profit.

Exemplars: OT4OT group connects therapists around the globe as they share resources related to online technology and occupational therapy. Kawa Model page gets interaction from OTs related to the Kawa River Model.

Twitter is a microblogging site allowing only short updates of 140 characters or less. This provides a quick platform to provide a status update, share a link, or interact with a wide audience. This is an easy way to connect with peers or engage in upward networking with a public figure or organization. Hashtags allow for ongoing conversations on a subject or event.

Twitter chat can be topical or during events and offer a way to share resources, connect to other professionals, and process information in real time. Some offerings for OTs include the expanding #OTalk brand ( #OTalk2us #anzOTalk ) #occhat #aota13 #ot24vx. The 24 hour OT Virtual Exchange lecture series is a setup of live OT lectures presented via web video, which gets great worldwide attention on twitter. Anita and Chris have also been using twitter to solicit interaction from international participants for the OT classes they teach.

Twitter chats shouldn’t be carried off as a lecture. The best ones are dynamic between participants. Sometimes this is accomplished by having specific questions also tagged in the post, or by a few participants having a side conversation marked by their names. This should not be considered a distraction, but a separate learning process to synthesize ideas. Just as some people learn better by doodling or talking during an event, these ongoing discussions can help a person achieve a deeper learning than just sitting idly by.

Some of the disadvantages of twitter are that you are limited to a short phrase to share, so it can be hard to explain something in detail. There can be a large flow of information which can be overwhelming for some to manage (though tools like Tweetchat and aggregators can assist in this). While there are private messaging options, most conversations are very public. I sometimes have to unfollow people even when they are interesting because they have too many tweets or too many replies cluttering the feed… conversely, if you do not post very often your tweets may get completely overlooked.

Exemplar chat: #OTalk  -the original chat runs biweekly out of the UK (Tuesdays 3pm Eastern) on various topics related to OT. Make sure that you also check out #OTalk2US one Sunday each month at 7pm Eastern.   Exemplar user: @gilliancrossley who tweets her blog posts, helpful OT info, and participates in multiple chats.

LinkedIn is a professional networking site designed to contain only people you actually know to advance your business world connections. It allows you to build an online portfolio showcasing your work history, projects, and awards. You can see connections of your contacts to try to gain an introduction into a particular company. You can also search for jobs or be contacted by a prospective employer if your profile is set up in this manner. Group pages allow for discussions related to an overall topic.

Some of the downsides of this site that I have found are the frequent requests to connect from recruiters, lack of variety in group posts, and inability to message a person you may be acquainted with.

Google+ is part of the integrated google platform that allows you to subscribe to individuals’ posts and categorize them into interest circles. The advantage over groups here as opposed to other sites is that you can integrate easily with Google Drive to share and edit documents and video chat. The open video chats are a unique and worthwhile feature. There are a number of other features which do not have to be used in a “social” manner, such as automatic photo backup and updating your contacts on your phone. Google also uses its trademark algorithm to try to find interesting posts and people for you to add to your circles.

While Google is a household brand and has a variety of products (search, Android phone/tablet platforms, calendar, drive, etc), Google+ still needs to gain active users to really gain momentum. Social sites are only useful if their participants have a number of active connections. 

Individual blogs can also be a way for networking to take place. Frequent commenters can develop a community as they interact with one another over posts. Some of the qualities I look for in a good blog are frequency of updates (I prefer between once every 2 weeks to 3x/week), quality of writing and posts, and ability to foster interaction on the page. Tonya from TherapyFunZone has been trying to encourage monthly link-ups of fun activities in the comment section, and YourTherapySource also is good about encouraging interaction. The exemplar for a true networking community on a blog would be the Mothers in Medicine blog, which has a group of authors who also comment frequently on others’ posts as well as a large group of followers that comment also.

Trends in networking

Peer to peer communication remains a main use for social networking sites. But now it is becoming far more common for users to engage in upward networking- contacting celebrities or organizations directly and expecting a response. In the general usage, power companies are responding to users directly when issues arise. AOTA has really improved in the past 3 years of responding and recognizing OTs on social networking sites, and is great about answering questions. 

The netiquette for making new connections varies on the context and an individual’s preferences. I prefer to keep facebook friends to people who I actually know and am share more with those I am close to, but others (cough cough Erik) are fine with maintaining a more public presence. Most people keep their Twitter accounts open for all to follow. I try not to follow too many people as it can be too distracting for me. Facebook, Twitter, and Google+ all offer options to subscribe to public posts, instead of needing approval.

Integrated options are gaining ground across the web. These can offer ease of use if you no longer have to remember multiple logins but beware, this log in can follow you and be a sleeper program in the background. You may be unknowingly acting as an advertisement on your friends’ pages or affecting their search results. The use of your login may also give the site or application access to your friends or other private information. Social reader options are not taking off because people want to be able to read in peace. 

We are also seeing a big uptake in mobile applications for online sites and organizations like Google and Facebook making their own phones.  We now expect applications to work across multiple platforms to be useful. In the US, this is a matter of convenience, I want to be able to access information while on the go or without having to boot up a computer. But in many countries, access to the internet is primarily through mobile devices instead of computers. So mobile usage becomes essential for any connection to the international audience.

Most of the popular sites are basically stealing each other’s ideas and features. As Pinterest gained momentum, you saw an increase in visual media usage for the other sites, such as Facebook acquiring Instagram and Google+ encouraging users to share their uploaded photos. This feature thieving is at a point where some of the main social media sites are becoming bogged down with features that have been rushed to market in attempt to compete, and may not be fully functional or bug-free. I believe that this trend, along with the frequent changes in how content is presented and privacy is managed, is why many people take a hiatus from social networking.

My keywords for social networking are integration, moderation, separation, and filtration. I want to integrate my participation into routines that I already have instead of trying to start an entirely new habit. For me, this also means that I prefer to use applications that work on both my computer and my phone so that I have multiple options to access when I have the time. I moderate my screen time and don’t feel bad about un-following or un-friending if I find that someone’s posts aren’t helpful to me or are too time consuming. You also shouldn’t feel bad about having networks that you prefer and ones that you don’t use.  I keep my personal and professional lives separate online to an extent, which I think helps me stay less stressed and better balanced. Similarly, I try to filter what I allow in and what I put out. Thinking before I post or add someone else to my circle has been helpful. By following those principles, I can keep my overall media time low while still getting the useful professional development and lighthearted fun that I want. Social media usage can easily be balanced into your life to facilitate professional networking in an innovative way.

Overall, there are many options for OTs to find professional networking and information sharing online. Experiment with a few sites to see what works best for your interests, learning preferences, and time available. 

Check out my superb cohorts:
Anita @virtualOT  TechnOTs blog
Chris @chrisalterio  ABC Therapeutics blog
Erik @armyOTguy  Army OT Guy blog
Karen @funkist  Miss Awesomeness blog

and I believe special thanks is owed to Allison Sullivan @allisulliOTprof for running a twitter chat during the session (#SoMeOT )  and Bill Wong @billwongOT for assisting with streaming video.

Product Review & Giveaway: Aimee's Babies DVDs

When I started making out my baby registries, and had one on amazon.com where the options were limitless, I decided to cast a wider net than the "standard" baby gifts. I have been interested in infant massage since my time in the NICU but not able to work out the time or money to go to a certification class. When I saw a massage video from an occupational therapist (one with a newly reactivated blog I had been following even) I decided to add it to my registry and try to learn a little about massage before I had my baby. Unfortunately, no one bought the DVD for me. However, I purchased the massage video for myself at a discount when the Aimee's Babies blog ran a promotion. Aimee then contacted me about reviewing the massage and developmental milestones DVDs on this blog.

My husband and I watched the videos together and collected our opinions on them. This way, we would have both an OT and layperson opinion.

The Baby Massage video is available as a DVD or digital download, and has a supplementary app also available. The video first briefly reviews infant development in motor and sensory systems. Aimee approaches the need for infant massage through a sensory integration perspective. After the introduction, she demonstrates performing the full body massage on an infant with description of her actions. She uses the Baby's First Massage method, which is intended for a typically developing child.

My husband and I both felt that the developmental section moved very quickly. While I was familiar with the information, he was less so, and would have benefitted from a slower pace. There was also some confusion because not all of what was referenced applied to newborns (which is what I think of when I hear 'babies') but also to the 6 months and up group. The developmental section would have benefitted from more of a multisensory learning method- listing out the developmental exercises that were being spoken about or just referred to through the pictures. Some senses, like position-in-space, were only briefly referred to and that confused my husband as well.

After the developmental section, we got to see the massage. I was happy to see that Aimee discussed specific contraindications to massage and referred to the general benefits of massage. I would have liked to see a brief discussion of the research that has been done on infant massage. Again, my husband and I felt the pacing was a little too quick. We will definitely need to watch the video again before trying the massage. My husband commented that it would have been nice to have this at the pace like an exercise video so that you could perform the massage on your baby at the same time.

Since I knew the benefits of infant massage before watching the video, I think I was more receptive to the overall concept than my husband. While there were a few parts of the massage that gave me the willies due to my own tactile defensiveness, I felt like the overall massage showed good face validity in light of what I already knew. My husband, in a phrase I never thought I would hear, said that he did not feel confident doing the massage on his baby because he still felt the baby would be a "porcelain doll" and was afraid it might hurt him. I think a larger reference to the research might have helped assuage his safety concerns.

Next, we watched the First Year Milestones DVD. Aimee described the purpose of this video to empower parents to be more vigilant about their child's development. She stressed that parents should not overreact to the exact timeframe of the milestone, but that they should be able to discuss what the baby can and cannot do with their physician and the importance of early intervention if there is a delay. The video was broken up well with menus to skip to the appropriate age range.

This video is considerably longer than the massage video, so I could only get my husband to watch the newborn section. This section again has a sensory processing base, and was primarily devoted to reflexes (which makes sense given the age of the child). The newborn section was very distracting to me because much of the video footage was done during a photo shoot, so there were repeated camera flashes. The audio and visual for this section could have been better coordinated as well. Watching this video before the infant massage would have been helpful since it was more in-depth than the developmental review in front of the massage video.

In the 3-12 month sections, this video really begins to shine. The skills Aimee discusses are really well illustrated in the videos of the different children. The developmental exercises that are discussed are pretty easy to do and Aimee gives suggestions for how to incorporate them into the day. I really appreciated that she gave a specific time range for tummy time at various points, because I have seen in my EI work that parents really have no idea how much time to shoot for (if they are aware that tummy time is necessary to start with). These sections were really well paced and developed and would be very beneficial to anyone looking to learn more about development. Some of the terminology may be a little over the head of a layperson but did accompany a video demonstration of whatever was being discussed.

My husband described the video as "very educational" and found the video footage of same-age babies to be helpful in understanding the developmental concepts. He stated that the video was helpful and made him feel more informed as a first time parent. He also mentioned that this was presented like a class, and might be good as part of a new parent class at a hospital or pediatrician's office.

I thought that the developmental video would actually even be helpful in a college level pediatrics class to illustrate the concepts discussed. We had photos and a day or two where we observed our instructor interacting with an infant, but a video would have been a valuable addition. The video would also be helpful for practitioners switching into pediatrics. With a little tweaking and adding footage of abnormal development, this video could be re-edited to really focus on educating OT professionals, but it is a valuable resource as is.

SUMMARY The Aimee's Babies DVDs would be helpful for new parents in learning more about development and appropriate ways to interact with your child. I think that the developmental DVD should be a prerequisite to learning the massage, so giving both together would be a good idea. Prices are comparable or better to similar products, so that shouldn't be a problem. I'm excited to see the future of the Aimee's Babies line, as she has announced plans for toddler and preschooler videos.

GIVEAWAY!! To help share the love during OT month, I will be sending out the Developmental Milestones DVD to one lucky winner chosen at random. This would be great for a student, new parent, or anyone interested in better understanding the first year of development. All you have to do to be eligible is Like the Occupational Therapy Notes Facebook Page before next Friday, April 26, at 10pm Eastern time. The winner will need to send me their address by 10am Monday morning or a new winner will be drawn- I'm having a baby and can't afford to wait around!

I got the Baby Massage video at a discount during an Aimee's Babies promotion, and received the Developmental Milestones video for free. All opinions are my own, except where my husband's are noted, and I was not compensated or influenced.

Don't be like me

I get requests for advice from students or new practitioners every now and then via email. One thing I would like to say is "Don't be like me." Don't take this as self-depreciating, I know I have lots of good qualities. I tried hard in school and am a hard worker, I try to keep learning whenever possible and be creative and respectful with all my clients. But there are a lot of job-related decisions that I've made that I would hope other people could learn from.

- Don't think you need tunnel vision focus in school Though I am proud to say that I no longer get confused with a high school student, people are still often shocked when we have talked about my schooling in relation to my age. They can't understand how I got a masters degree and did x,y,z before n age. The short answer is that I was very driven and focused during school. My mom does career counseling and when I was tossing up architecture and OT she knew nothing would transfer between the degrees and that no university near us offered both. So she pushed me to do a lot of job shadowing and research to figure out which I wanted to do. I became one of the few people in the world who didn't ever change majors in college, and by the nature of a 2+3 program got my BA and MOT in 5 years. But there are things I didn't do in that process. I only got to play softball one year in college. I didn't get to do any study abroad or really awesome summer programs. I went in with blinders and finished on time, and while I excelled at that, I think that people should act on the opportunities that they really want (within reason), especially while they're in college. So while this method will definitely get you through school on time, it certainly doesn't have to be the only way.

- Don't apply for only one job When I started applying for jobs out of school I figured that people would take a little time to get back to me and I'd have time to put in several applications, go on a few interviews, and choose the best from that group. Things moved much faster than I anticipated after I put in that first application and while I felt it would have been acceptable to ask for a couple days to consider the offer, I couldn't very well ask for a week or two to put in other applications.

- Don't allow work to overshadow everything else When we moved to Baltimore for the sole reason of me working in a big place and experiencing that kind of environment, work (and travel to work) started dominating my life. I wound up (as many salaried workers do) working more than a standard 8 hour day, working through lunch to catch up, and even working at home in the evenings to stay caught up. While we made time for a lot of fun things, the day to day life was exhausting and completely unbalanced. We ate out all the time and hardly ever got any time outdoors to exercise or even exist. We barely had time for each other during the week. We very rarely saw our families. It was not a sustainable situation and reflected very poor occupational balance.

- Don't work for free Along the same line as above, if you value yourself, you can't work for free. Don't write evals after hours. Don't stick around and do extra notes. If you have work that needs to get done, find a way to get it done during your workday and get reimbursed for your time. Also, don't bankrupt yourself buying fun treatment materials.

- Don't interview or work burned out Burn out is a real thing, especially in the "caring" fields. Being stressed and emotionally overloaded doesn't make for a good worker and that can get reflected while interviewing for a new job too. Take steps to prevent burn out to start with, but make sure that you take time for yourself before you begin representing yourself to new people. It will also help you give fresher answers.

- Don't take a job that is a major stretch from your interests Sometimes, though you could imagine a way to make a situation work, it's just not a good fit. And if you know it's not a good fit, or there's red flags to indicate that it isn't going to work long term, just don't take that job.

- Don't change jobs while buying a house This is a major life lesson that I had no idea about. There were a lot of tears when we realized this was going to cause a problem, despite the fact that I was changing to a job with more hours and higher hourly pay. I ended up having to hold onto an unpleasant job longer than I wanted to, but fortunately didn't lose the other opportunity.

- Don't be afraid to try something new It can be a scary world out there and breaking out of your comfort zone into a new field is tough. There's a lot of work to catch yourself up into a new practice area. But it can be very worthwhile and you shouldn't let fear hold you back as long as you're willing to do the work and think that it will align well with your interests. OT Practice and OT Connections have had resources for changing practice settings, and it can be done successfully.

- Don't expect the worst This can be a self-fulfilling prophecy. Be optimistic and positive when starting something new instead of constantly worrying about the end game.

- Don't get desperate during a search Last fall, I started to get really depressed at the length and lack of results with my job search. I had offers after that and could have had a full-time placement but it very clearly wouldn't have been a good fit long-term. By sticking with my other work, finances remained stable, and I was able to wait on a better offer instead of jumping at the first life raft.

- Don't start a new job late in pregnancy You can totally interview for a job and get a new job while pregnant, there's no rule that says you have to disclose a pregnancy to a potential employer and there are a number of discrimination protections. But in the same way that being your best person is difficult when you're burnt out, I've found it difficult to really hit the ground running in a new environment when I am not physically capable of running. I didn't have to worry about the effect this change would have on insurance or FMLA eligibility due to the nature of this job, but that could be another factor for you to consider. And while my prn jobs have coworkers who have known me a long time and are very accommodating and helpful, starting in a new place means starting relationships from the beginning, and people will be less likely to offer their assistance for the little things.

- Don't be afraid to ask for what you want Sometimes, I am too quick to write off a situation. But you always have the ability to ask for different hours, pay, or other flexibility. The worst that can happen is that your boss or potential employer can say no. But if you don't ask for what you want, you won't know what can happen. One small (but frequently occurring) example is naming your salary. Sometimes women have a tendency to be too nice and want to meet an employer in the middle instead of standing up and saying what you want. By forcing myself to have a bit of a backbone, my salary requests were usually exceeded, not just met.

- Don't neglect your life plan This is where I am at right now. I don't have a five year plan at the moment. I have never had a fully articulated plan anyway, I've had multiple possibilities that could work and also had new doors open that weren't part of my original considerations. But in general, I think it is admirable to have a plan (if only a vague one) and make sure that the opportunities that you accept align with it.

_________________________________
Obviously you can make these mistakes and still survive or even thrive in the OT workforce. There's clearly varying degrees of how much of a mistake the different things have been, and learning from them is essential. I wouldn't be who I am as a practitioner or a person without my mistakes. Do you have a mistake to share?

Analyzing Functional Movement

(Editor's note: I wrote this several years ago and it just never made it to be posted. I think that it's still valid, but that will explain some of the references to my commute and we'll blame any errors on that too)

One of the skills learned in occupational therapy school is how to analyze functional movement, both in patterns and specific observations. While this is a skills that is taught in refined in school, you may have already intuitively noted some analyses of your own. Therapists are rather notorious for noting differences in movement patterns while out at the mall or other public spaces, but before schooling, people often notice when they spot a task occurring in an odd or different way. 

For example, I am frequently amused during my morning commute. There are 5-7 escalators that I take each day, and I usually walk up them to save time and musculature. But the amusing part comes in watching people step on and off the escalator. Some people pause in their usual cadence to get the timing right, but others come to a dead stop near the edge of the steps. Others take small, short steps and keep their pace the same. 

There is also a mechanical door that is on my path, and watching people either learn the pattern and change their pace (faster or slower) to appropriately interact or fail to learn the pattern and end up stopping the door is notable, if annoying (hey, who wants to be stuck in a mechanical door, even if you are studying movement?).

Everyone has their own movement quirks that they're likely unaware of. Maybe not as  involved as Robert Barone's food to chin behavior (video), but there nonetheless. Until we had our functional movement class and had to watch each other perform different tasks, I was unaware that every time I pour a liquid or focus intently, I tilt my head to the side of the movement. Do I subconsciously think that tilting my head as the liquid flows will keep me from spilling? I don't know, but it is what I do. 

The analysis of movement is a skill, and not just a fun party trick. If you don't know HOW a person goes about a movement, how can you expect to return them to their normal functioning? (Obviously WHY is also important, but that's another entry) Because each person is unique in their movements, you have to individualize the treatment they get so that it is relevant to their situation. 

One example is a woman I have seen multiple times on the orthopedic floor. Unfortunately, she has required multiple washouts and revisions of her LE joint replacements. She also has severe Rheumatoid Arthritis in all extremities. Typically, therapists approach a pt. s/p a hip or knee surgery with a walker, however, this lady is unable to use a walker due to her wrists and hands. So she usually throws new therapists with limitations in ROM, strength and weight bearing in all extremities. But with crutches and modified technique, she was able to transfer effectively.

Another great example of this was a wonderfully pleasant gentleman that I worked with after his hip fracture for several weeks on the transitional care unit. He had Parkinson's Disease, and several adaptations to achieve movement when he was un-injured. Prior to his hospitalization, he needed arm rails on his chairs and a lot of rocking to be able to stand up. This need didn't disappear after his injury, and in fact he had greater difficulties with movement not just because he now had a broken hip with lots of pain, but because his medication schedule got messed up in the hospital. So we needed to coordinate a.m. ADLs with pain and other medications, needed to use the toilet in the shower room across the hall instead of his room to allow better placement of grab bars, shoes before standing (NOT socks) and extra time to complete all tasks. If we hadn't carefully individualized his treatment and looked for solutions that fit his abilities, he likely would have required a much longer stay and been frustrated by the lack of independence.

Movement analysis and activity analysis are key to basic occupational therapy practice. Have you noticed a unique movement pattern on yourself or someone else? Feel free to share.

Student Stuffs Giveaway!

Life as a student... sometimes fun, sometimes stressful, sometimes unbelievable. And for one person, it's about to be unbelievably lucky!!


I like students. I like them to know that life gets better when you are being paid to work instead of paying for work experience. I like to occasionally pick on students IRL but avoid it online since my wit just doesn't translate well to type. But seriously, being an OT student can be great, since it means that you're almost an OT or OTA (which we all know is terrific)! So students need a little something special

I'm sending some of my gently used and most useful study materials. This includes a Quick Reference Dictionary for Occupational Therapy, spiffy laminated cards on multiple topics (anatomy, TBI, SCI, low vision, neuro...), and hard to find guidelines on safety for patients in acute care.

The Pencil Grip is a company that makes more than just grips, and they have sent another useful item for students. They make dry erase file folder labels, which I think would be infinitely useful when you're changing classes each semester and gaining new knowledge to be organized by the minute.

Remember that AOTA is always your best resource no matter your practice area. They have sent items to promote and explain OT, including 2 T-shirts, brand posters, and pens. For your everyday life, they've included a great tote bag, umbrella, and car decal that I'm sure will have great usefulness no matter your job site.

Included are some Dycem sample sheets, which will be handy when on fieldwork or trying to construct new adaptive devices. Also is a nifty NBCOT lunch box and pin for the Open Journal of Occupational Therapy, to remind you of helpful organizations in your post-student world.

If you're an OT or OTA student (even a very committed pre-OT student), enter now by leaving a comment below. Comments must be received before 11:59pm EST on January 31. Good Luck!

A very NEW NEW NEW year

I won't say "New year, new me" but there are a lot of changes taking place in my life.

Job changes are so ever present in this blog. If you are a student, you should be comforted by the fact that there truly are SO many options for OTs, it's often true that you can work as much as you want. The only downside of this right now is that I am dreading tax time with 4 (I think?) W-2s and a 1099 with small business deductions... it's enough to make you hyperventilate. At any rate- my early intervention work is something that I really enjoy. I have families that I am close to, coordinators that respect my evals and opinions, and a burgeoning caseload. It has taken 6 months (and the willingness to be very flexible) but the business has grown well. I still have my occasional hospital days, where it is nice to switch up and work with adults (particularly neuro cases) but I mostly enjoy visiting with my friends. But now, I will have the option to cut back on both as I want to with the onset of a new job.

I will be starting (very very soon!) at an outpatient pediatric facility 2 days a week. I had seen the job posting on AOTA's OTJoblink (what is this, the third job I've taken from there?) but was still debating about applying when I was contacted directly from site about my interest and asked to interview. I didn't expect them to be able to provide regular hours at a rate that would offset losses without some kind of crazy demand to drive to multiple locations or covering other types of outpatients, but they well exceeded my expectations. I look forward to getting started there and am really pleased to find a pediatric practice even in my small town area.

The reduced schedule will help me maintain some of my other OT activities and provide time to rest. I've also been spoiled pretty much since my first job- if you don't work 5 days every week it's a lot easier to make doctor appointments, get your errands done, and keep from being overrun with laundry. Again, students! You can work as much as you want to- 0-7 days/week. I've said before that after our move, though I miss some features of Baltimore, that life was largely falling into place for my husband and I with the exception of my job. Hopefully this will be the last moving piece for awhile and things will be settled nicely.

I
didrocked my sprint triathlon last year and really enjoyed it! I had wanted to work up to an Olympic distance for the fall or summer of 2013 by the latest, and hoped to work to running a half marathon by this coming August. Now I've had to reset those goals and think about working back up to a 5K by this fall. I had also hoped to get a Girl Scout troop started at my church but the girls' interest was intermittent at best and I truthfully didn't want to be doing a lot of work when people didn't really want to be there. I still have a Sunday morning class but I'm getting ready to step back from that as well- I'm starting to feel a lot more effective with toddlers than teens.

My involvement with OT extracurriculars is changing too. I anticipate this will be my last year as the VP of Advocacy for the state OT association (provided I can induce someone into running for the position). I expect that I will still be involved in the bill review committee or other events, but I won't be the go-to person anymore. There aren't a terrible number of responsibilities and things to do with that job, but when they need done, they need done NOW. I had to step back from my NBCOT work this year, which is sad because it is a great group of intelligent people and work that I really enjoy (not to mention nice trips that are very fun also!). I plan to reapply as a volunteer in the future, but I will be missing my SQDC peeps. Possibly worst of all, though I love my AOTA presentation group like a little OT family, I will not be able to accompany them as their continued tour of awesomeness hits San Diego this spring. I will be very sad to miss seeing these great people who are spread both cross-country and internationally- and some of the #OTalk2US #OTalk and #occhat crew that are visiting from abroad.

(Before you get too teary on my behalf, remember that with all ebb there must be a flow, and that I just am not good at telling news sometimes so I put it all in a crazy order)

This is a lot of life changes all at once, and though they were planned in various degrees, it's all to accommodate the change that you can't really possibly plan enough for. I'm having a baby! He's coming (ready or not) this spring and the one thing I'm sure of is that no amount of preparation is really going to cover it. There's awe and anxiety and excitement and attempts to not get overwhelmed... and a lot of naps. Change is coming to my life in ways I know I cannot even begin to anticipate. But I think it will be worth it.

Lest you worry, faithful reader, I will be keeping the blog. It is fun for me and so while there may not be copious posts (when have there ever been?), there will be posts. There may be baby related posts... it is what it is. This month I am celebrating my 5 year blogiversary, doing my first big giant giveaways (they are AWESOME!) and hope to clean out my drafts list one way or another. I still tweet more than I write fully because it's been hard for me to carve out writing time with some of the other demands of life (5 eval calls in a week, hello) and if you want a (more) prompt response then you should tweet at @OTnotes.

Hope that you are having a wonderful, healthy, happy new year as well! Who can really say what it will bring, but I'm certainly looking through rosey glasses right now.

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. 

#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... 

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?

Running documents to make a job search easier

I'm still in the midst of job searching and uncertainty. Though I am trying to maintain myself in a cool, calm, collected manner, I have still noted several times that there are things I wish I would have written down to make further job searching easier. ( I have previously covered some general job searching tips for OT students that you may also find useful) Read on for tips that can save you a few headaches.

-Running Documents
There are several documents that you should always have an ongoing copy of (no, not a record of your 5K speeds). I keep my items like this on Google Drive because it is accessible from any computer or my phone, but other cloud storage may work better for you.

Obviously you should have a working resume at all times. If you're really on top of things, you could have a running CV with details of each major project you are part of listed. (I have never needed to provide a CV for a job thus far, but some fellowship-type opportunities request them)

Though it shouldn't take up room on your resume, you should keep a list of your employers' addresses and phone numbers because this is often called for on job applications.

In a similar vein, you'll want to have a running document with contact information for your references. Include phone, email, and mailing address because everyone wants something different.

In OT world, background checks are frequently required, which means you should also keep a record of your own address for the past 7 years or so. (If you hate that idea and want to stay off the grid, keeping your fingerprints to yourself- you're in the wrong field.)

For a serious job search, I keep a list of viable job opportunities. I list out whether there is an active opening, what steps I have taken, and who my contact is at the company. This lets me have 1 place to see where my prospects are, which places are calling me back, and when I last heard from them. If plan A doesn't work out, it's easy to see what other lines are still in the water.

I haven't done this, because I have proven to have widely varied and changing plans, but it might be a good idea to have a working long term plan. In this could be personal goals for how you want to develop as a clinician. Writing these goals down is the first step to making them a reality, and being familiar with your own goals is important in an interview.

Unfortunately, having these documents won't completely streamline your job application process. There have been numerous times when I just want to hand people a few of these papers (or already have) but still have to fill out some repetitive application by hand because every applicant has to fill out the standard form. It's a pet peeve of mine, but not likely to go away anytime soon, so be aware of it.

Good luck to all those searching for jobs! Please feel free to share your helpful hints in the comments below!

Getting Started in Early Intervention: Assessment

I have recently been able to get started an early intervention system, providing OT to families in their homes and communities. It definitely required a lot of paperwork to get started, but there was also a need for mental preparation and acquiring tools. Though my school system job involved using IFSPs, I was providing services in a preschool and had (ample!) materials provided. Here are some resources that I used in preparing to perform OT assessments and treatment in an early intervention setting.

I reviewed a number of assessments when I was trying to decide what to buy. Some were seriously outdated or limited the areas assessed. I wasn't able to consider others because they were made to be a true team assessment, which is true of the TBPA. While I can't speak to the practicality of using the assessment as a team arena approach, I do want to discuss the intervention book. So often, the intervention books that come with assessments are rather worthless. This is a book that I want to add into my own collection. The intervention book has many strategies to increase skills in all domains and adaptations for performance factor limitations. I think it would be helpful to anyone in early intervention because it gives you information from a multidisciplinary point of view, so it had info that I had not previously been exposed to.

After looking at multiple assessments (which had to be on an approved list), I decided to purchase the ELAP. The fact that I needed to be able to assess all domains of development, not just motor or adaptive, was a heavy factor in this decision. Also, I needed to keep costs low and the manuals and scoresheets for the test were very reasonably priced and the kit can be assembled in a non standard manner. This is a criterion referenced test which allows you to figure out an approximate age. I have friends who use the EIDP, which is even lower in cost, but I was a little worried that I wouldn't see enough during the test to get a good assessment. I also decided later to purchase an infant-toddler sensory profile (the SPM-P is not approved in my state, so it is the only sensory measure).

This picture shows some of the materials I was able to get for my testing kit. Many of the items came from yard sales or discount stores. I have always loved the pipsqueaks markers, so they were a must-have item for me. I liked the tactile puzzles we had at school so I felt fortunate to find one for sale. I found a surprising number of high quality wooden beads and blocks for cheap, which I was super happy about. The orb over on the right has spinning lights and I got it for a quarter... it is going to be a favorite toy. I need more things that make noise for kiddos with visual impairments, but the squeaky toy I got (in the pet section) is super responsive and loud, so it will do for now. Not pictured, but worth a mention is the formboard puzzle I got from Manzanita Kids on etsy. They were very responsive to my custom order, made it with high contrast materials as requested, and it is a very high quality piece.


Other Resources:
What to Expect from an EI eval- from the dual perspective of therapist and parent

Abby's blog has been featuring parent interviews which includes tips they'd like therapists to know