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?

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: Sue Ludwig and NANT

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


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

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

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

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

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

 

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

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

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

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

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

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

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

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

Entrepreneur Series: Chris Alterio and ABC Therapeutics

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

What was your tipping point to go into private practice?

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

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

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

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


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

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

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

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

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


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

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

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

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

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


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

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

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


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

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


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

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


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

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

Educational Resources for OTs working with Infants & Toddlers

I really like working in Early Intervention. Depending on how the state sets up the organization, an EI worker may find themselves pretty isolated with limited training opportunities for improvement. And if you're self-employed, you can't be dropping hundreds of dollars on continuing education classes that may or may not be beneficial. Here are some free online resources that can help the transition, as well as some other books that I have found helpful. (as always, I have no financial relationship with any service unless directly mentioned)

Zero to Three is the national page for infants and toddlers. They have podcasts in English and Spanish, policy based webinars, and free parent resources and guides. They also offer a professional journal ($78/year) with options to pay for CEUs and a yearly national conference.

Pathways.org provides a number of great visual and written resources for families and professionals. They have handouts on a/typical developmental comparisons and the importance of tummy time, among others. They have a free course and videos online to help professionals identify atypical development.

Virginia's early intervention system offers free archived webinars, online modules, and additional resources on their website. Check out their professional development center, and their informative blog articles. They even invite submissions from other authors, so this may be a way for you to expand your writing repertoire. This is one of the best state sites that I have found, but checking other states' pages may turn up many useful resources.

This Prenatal Drug Exposure Handbook(pdf) from a Michigan school district has been very helpful for me when discussing with parents what the potential sequelae of exposure are at different ages and start them with a list of practical tips for the child as an infant, toddler, and older child.

Feeding issues are so prevalent in the infant and toddler ages. One of the best sites that I have found is Your Kids Table, written by an OT with great sensory and behavioral strategies to try to broaden a child's diet.

Early Intervention Support offers many resources, mainly for parents on typical development and frequent issues with the 0-3 population.

Beyond Basic Play is a blog by a PT with great info on development as well as "tips and tricks" to facilitate certain developmental tasks such as catching a ball or moving between positions. Great basic tips to incorporate into practice.

Aimee's Babies is a site that I was not familiar with before. She is an OT who has re-initiated her blog and also sells DVDs and apps for parents to help their child's development. I haven't tried these out personally but they appear to have good face validity.

Info Spot for the Special Tot is run by an OT and mom and has lots of good information and resources on typical toddler issues.

The best book that I have bought has been Transdisciplinary Play-Based Intervention. I feel like this is a great resource for how to address the full scope of skills for infants and toddlers and gave a lot of good ideas on how to adapt activities. Some of this was information I knew or could reason out from school, but learning about ways to embed communication, emotional, and cognitive development was really valuable.

I'm really hoping that my upcoming course will be excellent. It was hard to spend the money knowing that I can count the course for state and national requirements but not for the EI service, but I know I need to get moving on some CEUs before the baby comes. I am really excited about it and excited to have an educational day at all. I am sad to miss my NBCOT and AOTA peeps and the great educational offerings that I usually get there. I truly am an OT Geek and like to learn new things. Please share any resources you have for working with infants and toddlers in the comments section- especially if they are free!

Trauma Awareness for the Infant/Toddler Population

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

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

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

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

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

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


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


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

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

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

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

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

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

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

The Tweetable Conference

There is so much that I want to share and discuss about the 2012 AOTA Conference! This post is all about Twitter.

This statement may mark me as an old person to some people, and borderline crazy to others, but here we go: I remember when there was no twitter. And even then, when there was twitter, I had to post via text since I had a non-smart phone. In a very small, very unimportant claim, I remember being the only person to tweet during the AOTA conference. It was 2010, the hashtag was the incredibly formidable #AOTAconference2010 and I was very much tweeting to myself.

Wow, we have come so far, in such a short time!

2012 should be known as the year that social media came to conference in a BIG way. The sheer number of users has increased so much, and the willingness to use these tools in the midst of the conference has never been matched. I think that we were helped by having many of the OT4OT professionals present, and that the AOTA staff had a good online presence too.

The biggest boon was Karen Jacobs' Slagle lecture. Not only did she give the audience permission to tweet, she encouraged it, had her own live-tweeter, and brought her own hashtag. (wouldn't it be hilarious to be a time traveling OT and take that sentence back to AOTA 10 years ago? no one would have any idea what it meant!) Her message on promoting OT was excellent, and I hope someone recorded it so that it can be shown to students and practitioners everywhere. Interacting with others during the speech was really beneficial for remembering key ideas and getting great views on what was said.

I loved the tweeting from my co-presenters and our audience during our social media presentation. It was terrific to get a feeling of who was in the audience before actually meeting anyone. We were able to stream our presentation live and even got a tweet from an OT in England who was able to watch! Twitter was a great way to connect with the crowd and the world at large and hopefully it will start some new discussions about the future of the conference.

Twitter is an excellent tool for coordinating members of an event. It was great to meet and reconnect with so many of the online crew, and get real-time reactions to the events at hand. If you're not already on twitter, I would encourage you to start. Here was one good recent article about the value of twitter. Hit me up @otnotes and hopefully we can tweetup IRL at some point :)

Come to my AOTA12 sessions!

Are you in Indianapolis? Then I hope to see you at my #AOTA12 sessions! Read through for details.

Session No.: SC 300
Session Title: (AOTA) Using Social Media Resources Effectively, Efficiently, and Ethically
Session Start and End Times: Saturday, April 28, 2012, 9:30 AM - Saturday, April 28, 2012, 11:00 AM

A panel of bloggers and social media experts will talk about how to integrate various social media platforms into your occupational therapy practice. There will be discussion on using AOTA's ethical guidelines for social media in daily life.

Our awesome panel features terrific bloggers who I hope you're following:

Christopher Alterio (ABC therapeutics)

Karen Dobyns (OT Students Belong)

Anita Hamilton (Virtual OT)

Erik Johnson (Army OT Guy)

Session Number: SC 314
Session Title: (AOTA) State Legislative and Regulatory Forum: Trends, Scope of Practice, Autism, and Health Care Reform
Session Start/End Time: Saturday, Apr 28, 2012, 1:45 PM - 3:15 PM

I will be a panelist discussing legislation in Maryland. This includes our Lobby Night event, working with a lobbyist and our bill review committee. We will also discuss the impact of Maryland budget legislation on OT board and licensure fees and how we were able to advocate.

Hopefully these will be informative to all in attendance and no one will be disappointed with content/delivery/my height/ etc. Saying that I am nervous might be putting it mildly, but hopefully it will all go well.

April Challenge: Spend 30 minutes on research

Occupational Therapy strives to be an evidence-based profession. But when we get caught up in the daily grind, it can be difficult to find and put into use the best evidence in our field. If you are only being exposed to evidence once or twice a year at continuing education courses, it's going to be difficult to have an evidence based practice.

Even though we often feel that we don't have enough time for (fill in the blank), there is a way to make time for things that you deem important. Instead of putting it off for another day, pledge to take 30 minutes today to research something important to your practice. This is the length of one treatment, one lunch, one TV show, two Facebook times. Just do it (just for today) and watch as the other important items will filter in around it.

This might be a time where you can catch up on articles that you have marked or printed out from journals and just not gotten around to reading. Maybe you’d like to start looking into a treatment or evaluation technique more in depth (serial casting? Pinch and grip strength? Handwriting speeds?).

There are multiple ways to access research at various points of the evidence ladder. The easiest is having a subscription to a journal (free to AOTA members) or search service (free when renewing NBCOT registration), but it’s certainly not the only way. If you work at a teaching institution, even prn, they should have access to some full text online libraries that are relevant to OT (and if they don't, you should advocate for something to be added). Many hospitals have libraries with actual staff members (so forgotten in our internet age) who may be able to order something for you via interlibrary loan. Some professional associations offer a subscription to an online search as a membership benefit. A membership in your university’s alumni association may carry access to their library. A search on google scholar may turn up an online journal with free access (such as the oft-used in my AOTA presentation Journal of Medical Internet Research).

While it doesn’t replace reading a full article and evaluating the evidence yourself, many blogs (Your Therapy Source, ABC Therapeutics) discuss articles when they appear and spark discussion regarding their findings. AOTA posts Evidence Briefs for members in a multitude of fields. Additionally, you can also find summaries of certain topics on OT Exchange, or search the forum discussions on OT Connections.

This is an important activity. You should be able to discuss your evaluation findings and treatment methods knowing that they are backed by current research. If you find a hole in the evidence, why not take an extra 2 minutes to shoot an email to a university OT program and suggest a study for their students to conduct? If you complete this activity, please briefly share in the comments what you were researching, an article you found, or any other pertinent information.

April Challenge: Reflect on a favorite occupation

As OTs know, an occupation is not your job, but anything you do to fill your time. Everyone’s daily life is made up of hundreds of occupations of varying importance to them. Today’s challenge task is to take a moment to reflect on an occupation that is one of your favorites.

Some people love cooking or driving or gardening. It doesn’t matter for the purposes of this exercise, any valued occupation will do. This is a time to reflect on what impact the occupation has on you. Feel free to answer some of the following guide questions:

-How long have you been engaged in this occupation?

-Was there ever a time when you stopped performing this occupation? Why did you return to it?

-What benefits (tangible and intangible) do you derive from this occupation?

-Does this occupation impact your life as an OT practitioner?

-How would your participation change if you were affected by a change in your physical or cognitive abilities?

By taking a moment to reflect on something personal and important to you, it is my hope that you will have a renewed respect for your clients this week as they work to recover former occupations or develop new ones. It is an arduous process (which is why there is no “Rehab” reality show) and it demands an empathetic and effective practitioner to facilitate.

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.

New roles & responsibilities

I have taken on some additional OT tasks this year, and it's getting to be an interesting balancing act.

A flashback to begin the story: when I was in high school (not all that long ago) I often had this feeling of being overextended, existing in a state of mild panic at most times. Totally unassigned time (especially that which was not merely procrastination) was rare. Looking back, I was doing A LOT. Probably too much. As a sampling (just of items I can quickly remember, which probably neglects a few) I was involved in 2 sports, at least 5 extracurriculars (not including special events such as talent show) and a part time job while carrying a not-wussy list of classes. I say this not to brag, but to give some perspective of who I was/am. My freshman year of college was completely opposite- I went to class, I goofed off with my friends, I took midday naps, maintained my (very) part time job, and I did not care about much else. This actually had a reverse effect of sometimes making me feel anxious and somewhat empty at times.

I added activities back in and out around the MOT program. I added in AOTA and SOTA my first year in the program and my state association soon after. Responsibilities grew over time. After graduation, I was again pretty inactive at first, which was justified in my mind by moving to a new town, starting a new job, and getting married all in quick succession. But again, I added items back in, even doing extra program development for work in my free time.

So as the years have passed, I have added activities in and out as it suits me. Things tapered off with the move to Baltimore but have increased again now that I've been settled awhile. The most noticeable time commitment is work, which with my poor balancing act between productivity and completing notes has led to me taking work home frequently.Inpatient staff is doing more covering of outpatients while also handling staffing shortages of our own. This has created a baseline level of stress for me, trying to stay on top of the daily grind and being unhappy that I can't seem to squeeze it all into an 8 hour day. I also had a level I student recently, which was fun despite the time involved and seemed to work out even a little better than last time. Just leaving me at a baseline level of exhausted.

In addition to work, I have taken a more active role in my state association. I was 'elected' as VP of Advocacy Relations for MOTA and have been involved in monthly business meetings and bimonthly legislative reviews with our bill review team and our lobbyist. It is a great group of individuals, I feel like we have a diversity on the group that allows to have insight into almost all the issues. It seems that no matter what the bill of concern, if we say, how do the OTs in that field feel, we will always have a representative. Our Lobby Night event went well, we've also had several members present testimony to various committees in support of bills. Legislative activity rolls by quickly, so it's kept me quite busy trying to keep the pace.

My other new OT activity is very concentrated in the amount of effort but will only be officially meeting twice a year. I got to go to California last week for a 2 day NBCOT conference developing simulation questions. First of all, I did not even know that they had added these type of questions to the exam since I took it. It is truly a challenge for your critical thinking skills. Looking at the example I was sent, I wasn't sure that I could take the test, let alone write it. I met a great group of OTs, in and out of academia and in all ranges of practice. Everyone I met was intelligent, friendly, and committed to giving back to the OT community. If it's any consolation to the students out there, as hard as you will work studying to take the exam, others are working just as hard to write it according to the blueprint and keep it fair for entry level OTs. I haven't had the feeling of brain jello for a long time, but we worked to exhaustion on those items.

Last major OT activity is the upcoming AOTA Conference. I am certainly looking forward to it, but I've got enough stuff on my plate that I'm not frequently thinking of it as a 'getaway' or anything like that. I'm excited because it's close enough to drive, and I will get to go with my best friend. I've gone to 3 conferences in past years, but never with a buddy, so that will be nice. I'm trying to cool it on the overscheduled program and see if I can take things at a calmer pace for once. I think that it's interesting in how things are scheduled at the conference. Last year, I felt like there were more NICU courses, so it's hard to tell if that was a passing trend, more people holding out for the NANT conference, or just a random event. This year, I saw 4 interesting acute care courses- all scheduled at the same time, so that's a major bummer. I've noticed that I selected more stroke related courses this year, including one that I tried to attend LAST year and the presenter didn't show up for. I'm disappointed that I didn't do more with my new-found knowledge last year, so I'm going to take off the day after to see if I can synthesize some things before heading right back into the workplace.

With all these new roles and responsibilities, I have had difficulty keeping up with other tasks. My google reader has completely overflowed to something like 500 unread items, I haven't been able to get the state association legislative webpage up and running yet, and I won't even tell you how long this post has been sitting in drafts. I have 2 AJOTs that haven't even been opened, let alone read. I have about 300 pages left in The Count of Monte Cristo and really would like to spend a solitary day finishing that. Concert season is coming up too. Obviously, there will be things that get left behind. I'm trying to prioritize and find a dozen extra hours in the day. Until then, I'm just doing what I can and hopefully will stumble into some occupational balance.

Coming Soon- World OT Day!

When I saw this link listing the schedule of online speakers for World OT Day (10/27/10) I started to get really excited!
There are some very famous OTs on this lineup, including Karen Jacobs, Kit Sinclair, Erik Johnson, Michael Iwama, and the current president of the World Federation of Occupational Therapists, Sharon Britnell. Props to Merrolee Penman, who appears to be behind the effort.

I am always seeking to learn more about occupational therapy and think that seeing the world perspective will be very interesting. I'm not sure if these sessions can be accessed at a later time- I will be working and sleeping through most of them. However, here's what I plan to catch (times EST):

2pm: Erik Johnson "Occupational therapy within a military setting" I got to see a short video from Erik during the 2010 AOTA Conference and follow his blog, so I think this will be a pretty interesting and worthwhile session. I'm going to see if we can get a group together to watch at work, and if that doesn't fly, I'm going to take a late lunch and break out the headphones.

5pm: Michael Iwama "The Kawa model: Heralding a new paradigm in occupational therapy" I don't know a lot about the River Model and think this will be a good introduction.

The following presentation 6pm "Re-Connecting: Using Facebook for Social Networking after an Acquired Brain Injury" looks interesting, but I have to get on the bus and get home sometime, so I'll probably have to miss it. (Same goes for 2, 3, 4, 7, 8, 9 which all occur during sleepytime)

7pm: Lindsay Eales & Roxanne Ulanicki "iDance: Transformative Occupations" Looks very unique and awesome, I expect to see many more OTs involved in dance, gymnastics, and other wellness outlets in the future.

8pm: Annette Rivard "The power of professional commitment" self explanatory

9pm: Sharon Brintnell "Images of now and visions for the future" also self explanatory. If you've ever been to an AOTA conference and felt the energizing rush following the president's speech, you know how instrumental that can be for taking momentum home with you and putting new learning into practice. I expect nothing less from our WFOT leader.

It seems that watching these sessions would count towards renewal through NBCOT under "attending workshops/courses/independent learning" (refer to renewal PDF) and depending on your state may count for license renewal as well.

Don't forget that week is also the time for OT Wikiflash, a time for mass editing of Wikipedia to better reflect Occupational Therapy. If you're new to wiki editing, get registered and play in the sandbox now so you can be ready. This is a great way to achieve our Centennial Vision goal of being "widely recognized." I've previously lauded a pediatric blogger for her prolific work on Ehow; Claire Hayward, Anita Hamilton and Will Wade have been active in promoting this event.

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?

What I'm Reading Now

Current reading pile

• Mansfield Park, Jane Austen- trying to finish this so I can get on with everything else. The first 200 pages were not particularly exciting, but now it's picking up
• The Tipping Point, Malcolm Gladwell- borrowed this from my dad and my husband now picked up the audio book. I'm a little competitive, so I'll have to keep up while he's reading.
• Stroke Rehabilitation: A function-based approach- I bought this quite a while ago, but now need to get around to reading it since I will be on the neuro side of the floor quite soon.
  
• OT Practice 7/13- did take a break from the novel to go through that. Have to browse the OT Connections Forum to see what the conversations are about that... the main article was interesting, I just need to process it in relation to my own life.
• Rehabilitation of Traumatic Brain Injury in Active Duty Military Personnel and Veterans: Defense and Veterans Brain Injury Center Randomized Controlled Trial of Two Rehabilitation Approaches (Archives of Physical Medicine and Rehabilitation Vol 89, Dec 2008)- Saw this referenced in the previous OT Practice and it referred to 2 different treatment approaches that I wanted more information on. Haven't set out to tackle it yet.
• Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational "categories" (Canadian Journal of Occupational Therapy April 2009 Vol 6 Num 2)- Saw the abstract on Karen's blog and had my library buds pull it for me. Should be an interesting challenge to daily practice.
• Validation of a New Coma Scale: The FOUR Score (Annals of Neurology 2005; 58:585-593)- I saw this in our new employee handbook in the 'preparing for neuro' section. I can't remember if I learned about this before or not. I know that we did the Glasgow Coma Scale and the Rancho Los Amigos Scale for Brain Injury, but I thought I would look into this. Not sure if it is used on our floor or not, but it's worth learning about.
• 17 files from my neuro professor/coworker- piles of powerpoints, buckets of documents, all in preparation for the scary neuro floor. eeep!
  

So that's what I'm up to. I love reading, but sometimes there is too much... this doesn't even take into account my Google Reader list or daily newspaper browsing. Anyone know an electronic reader that will transport the information into my mind?

Gaining ground

so I'm not such a newbie anymore. I even turn in the right direction now when getting off the elevator...

In fact, we're getting near to floor rotation time, so soon I should move on from medicine for awhile and into a new frontier. The medicine floor is sometimes a drag... I hate seeing people with multiple admissions or trying to tell people that they aren't safe to go home. However, I have seen some cool things in the past months, including one lady who had a neuro disorder so rare that they were collecting her CSF for research and a guy recently with an unknown tick-borne illness (learned a new word, Rickettsia). I have definitely had some times where I wondered whether I was smart enough to work at this hospital, but everyone makes mistakes and I am learning. Definitely taking a closer look at lab values, figuring out more about those.

I have gotten to take 2 visits into the NICU in the past couple of weeks. I work with a girl who is really experienced with feeding and so I got to see the different units and today I got to see a baby intervention in the feeder/grower area. It's interesting stuff, but unfortunately I don't get to devote a lot of time to learning this (since they're kinda paying me to do other things too) and it's such a specialized area that it seems that it would 1. take a lot of time to learn and 2. be best to learn in person from an expert as opposed to on your own.

The whole peds/NICU interest causes me internal unrest, as I really don't know what areas of OT that I want to go into. Yes, I know that I am young, but I have such broad scattered interests that I have no idea where I'm going. Early this year, I had made out different possible career tracks and things connected to each... there were at least 4 and I had programs and interests on each card that I'm not willing to give up, so the range remains broad. In similar news, I just volunteered to do my first home mod evals as an OTR/L... don't know what will come of this, if anything. don't even know if it is volunteering or consulting for money, which I will definitely have to figure out :-P

I have been stressing out the past couple of weeks, it's been busy at home and work and I have been dancing on the edge of tweak out. I have a wonderful (albeit unpaid) vacation that I am leaving for this Thursday after being at work everyday for 11 days (1 was a conference). I truly need a vacation at this point. I had planned to schedule blog posts ahead of time, but I don't know how many I will get done. The other thing that I have thought of doing on vacation is reviewing info for my next rotation (neuro or ortho & ICU) but I think I am coming up on a point where I just desperately need a break. I have been pretty devoted to reading OT stuff for about 90 minutes each day (metro ride) and I just want to move to something less taxing on my brain. I have lots of ideas right now but I think that my mental health needs me to not overwork for a week. Should be a good time with family, actually try to relax for an extended period instead of running around like a vagabond. Have to learn how to balance life.

Slow on the Updates

Some busy times lately...
So for the first time in 2 or 3 weeks, I finally was able to discharge a patient on the evaluation. I have been so busy lately and working over a lot because every person I have seen has needed subacute rehab or nursing home placement, which means that they all needed goals written and follow ups done... very time and thought consuming. Wednesday we only had 7 new evals (only!) for 3 OTs, so we actually got to the follow up cards... one of the other girls said, "did you pick up? You still have cards in here" and the answer was yes, I have a full load today, but I just have too many people to actually see them all in a day. Been exhausted all week really. Sleeping on the metro instead of reading.

Trying to answer a Call for Papers for my state conference... haven't decided whether to submit for AOTA as well or not. Having a hard time following through on the requirements to write it up, very pathetic as I have no trouble writing on here, but once there's a deadline my brain is locked and procrastination sets in. I am obviously not going back to school any time soon.

I am going to Orlando in 2010 for the AOTA conference, and hopefully will get reimbursed for it from our continuing ed funds. I'm actually in a strange CE situation... I was a little panicky earlier in the year, but picked up 2 hours just applying for my new license. If I present at my state conference, that's 6 hours (have to pay to register anyway) plus a few as credit for the presentation, and my hospital is offering a stroke course for 6 hours that is super cheap for employees, so I could finish the rest of my hours right there no problem. But I am interested in the AOTA course Integrating Mental Health Into OT Practice with Older Adults... it is another 6 hours and still priced very fairly for members. I think it would be very helpful for me, but from a financial or efficiency standpoint, it doesn't make sense. I can't carryover extra CE hours in my new state, and I will have more than enough from the AOTA conference for 2010. In theory I guess I could order it and then just hold off on submitting the exam until I need it (2011?) if it is active that long. I am also holding onto 2 completed CE articles from OT practice on contemporary motor control that I hadn't submitted since I can't find my coupon.

A world with many options is simply a world filled with too many decisions...

I do have 2-3 interesting case studies I will post soon. Busy set of weekends coming up- worked last 2, had a visitor last weekend, at my parents' house for a wedding this weekend... Even though we always try to cut back to have relaxing time we always get large stretches of weeks in the summer and fall that are heavy on travel. Hope everyone is enjoying summertime before we hit triple digit heat on the East coast. :)

Interesting OT Connections threads

I've been trying to spend a little more time on OT Connections, especially in the posting department as opposed to lurking. Here's some topics that I have found interesting in the past few days.

You will have to be logged into OT Connections for the links to work- membership is free, you oughta be a member!

Food for Thought- a really good student project involving nursing home residents having greater control over meal time

Documentation on PDAs- a home health group is going paperless

OT Practice Discussion Forum- anyone can post topics now, I will probably x-post some thoughts on articles both here and there

Oncology Research Articles- I am looking for good rehab research relating to pts w/ cancer

Activity Book for Alzheimer's Patients- Barbara Smith shares her method for creating an activity book, some good suggestions on the thread

SI for Geriatrics- some good information about bringing sensory strategies to the older adult population

Hope that this is a good jumping in point for anyone who hasn't taken the leap into the OT Connections networking pool. Anything else captivating your interest on the site?

Interviewing Tips

I am not an expert about getting jobs, but I have been through a few successful interviews recently. Here are some tips that I recently wrote out for a friend. This is not comprehensive, any of these topics could be significantly expanded.

Basic Interviewing Tips- I'm not going to really cover these since most OT students have probably gone through at least one interview in their lifetime, if only the one to get into school. Wear something nice, conservative, that you are comfortable in. Bring extra copies of your resume. Learn about the company before you go. Use positive body language. Etc.

Rule #1- You are interviewing THEM as much or more than they are interviewing you. So the questioning should be a 2 way street. You have questions, you deserve to get them answered before you make a decision. Make a list- If there's anything clinical that you really liked or didn't like at your fieldworks, you can form a question to devise whether a similar situation exists at the new place. You should get information about what they offer for 401K, health insurance, days off and other benefits from the HR department, and they should get you that information before you leave that day.

Questions they will probably ask you:
- about the experience and interest you have in their population
- about your goals for professional development/ what you want to get out of the job
- your strengths/weaknesses
- might ask you to describe a situation when you overcame an obstacle at work or resolved a conflict with a coworker
(Here are some more interview questions, I'd say the ones about coworkers and goals are most likely to appear in your future)

Be honest in your appraisal of your abilities. A recent job candidate rated herself "10/10" in dealing with all types of diagnoses, therapy techniques, and practice locations- despite only having a year of experience. Also, it can be good to pause briefly before answering a question, especially if you find yourself often making foot in mouth statements. If you're nervous about how you'll react to questions and handle things on-the-spot, many college campuses have a career center that will offer to do free mock interviews or resume workshops. Check it out, you're paying for it anyway. If that's not available, have a trusted friend or adult interview you and offer constructive criticism.

Another question that will definitely come up is what you expect to be paid. (this might even be on the job application) I'd encourage you to discuss this with your professors, but there are also other good resources. Enter your state into this page on the Career InfoNet and see the wage table for your target state and compare it to the nation as a whole. You can also look for your city or metro area on the left sidebar. This gives you a good idea of the range, although I don't know anybody getting paid in that 90th percentile area. Advance also has a salary calculator, but you have to sign up to play with that. In my experience, their sample size has been too low to be truly helpful. Don't get dazzled by the money though- you're looking for the best overall place, the money will come. Also, FYI- sign on bonuses are taxed VERY high.

You should also take time to point out anything awesome on your resume or portfolio and explain how you got the honor and why it's special. For example, "I wanted you to know that I was elected to the office of Grand Poohbah of the Water Buffalo by a group of my peers to coordinate volunteer efforts in our community." Nobody knows why you were honored or what the title means until you explain it.

In the post on searching for a job, I mentioned that you should look at several sites and try to do multiple interviews in a near time frame. You'll want to keep detailed notes of what you liked and disliked about each site, what their typical day was like, anything important that they told you. Keep the names of everyone you talk to- try to get business cards as that will make it easier. And remember that you should send a follow up thank you note after the interview- email is acceptable.

If you feel like the interview went well and the facility looks promising, you can ask to have a shadow day. I strongly recommend doing that. See what a normal day is like, what the expectations are for productivity, get a feel for the balance of the caseload. Among other things, you can ask your future coworkers what they really think about everything, see what kind of people they are.

You want to take your time to consider any and all positions that are offered you, but you should be timely and polite about it- your interviewers are trying to fill their positions quickly and will appreciate your honesty. Nobody is asking you to commit to a position on the interview day, but be timely.

After all that, if you decide to accept, you'll have to pick a start date and all that. So if you come out of the initial interview feeling positive about the place, or if you are definitely living/practicing in a certain state, you will want to start investigating the licensure procedure there. Figure out the timing, how long it will take to get a license. Consider whether you need to start work right away with a temporary, or if you want to take the NBCOT exam first. I didn't want to try to balance studying and working, but it depends on what you want. All that plays into the potential start date.

Bottom line- be honest, be you, and try to find the best fit for your personality and for your skills to grow. Good luck everyone!

Search for an OT Job

Spring is in the air, as signified by the inch thick of pollen on my car each day. That means that there will be more folks w/ respiratory issues in the hospital and more new OTs starting their first job search!! I'm not a career counselor, but I survived my first searches, and here are some tips to hopefully make your search more fruitful.


There are a few questions which frame the whole job search, but I think most people have this under control. You should know the constraints of your search. Are you getting married or otherwise needing to stay within a certain geographical region? Do you have others to support or just need to make enough to cover your own expenses? Do you need to start work immediately or can you take some time off after graduation? Thinking about what you need can help you narrow your focus and concentrate on what's important to you.

I think it's easier looking for a job in a specific geographical area than just looking for random jobs anywhere. And while you can do a good portion of your job search from far away, thanks to the wonders of the internet, it is easier to do after you have moved and settled in the area. Not a luxury everyone has, I didn't. I haven't had very good luck searching on the internet sites that cater to all professions (i.e. Monster) but when I was seriously looking it was in a more rural region. Even now though, searching for OT jobs in Baltimore only pulls up 9 options. What I do find on sites like this is info for contracting companies, services that run nationwide.

So you can use profession-specific search engines to assist the search. If I remember correctly, I found my first job on the AOTA sponsored OT JobLink. Will this get integrated into OT Connections? Don't know, but it remains a reliable source for finding and communicating w/ employers... like monster, it allows you to upload a resume and have it be searchable or not. If you're an AOTA member (and of course you should be!) then there's no reason not to use this tool. OT Practice has nice color ads organized by region and job type and Advance always has hundreds of ads in the print magazine, you can search their listings as well. 2 other sites come up in a google search, but I haven't used either- OTJobs.com and JobsOT.com. I don't have time to give them a full trial, but I suspect that they are likely to have more national staffing companies than location specific jobs.

If you have a location in mind, it's easy to find links to the Chamber of Commerce for the different areas, you can search for hospitals or nursing homes in the area to see if they list on their website that they're hiring. Also finding local newspapers online will often let you search the help wanted ads. I get a lot of emails and mailers w/ job opportunities (that's actually how I found out about my current job), the other way to find a job is to ask your friends and acquaintences what's open in their area(Hello Facebook!). I still get emails to my school email address from classmates who have job openings at their facilities. Going to conferences big or small will also provide you with a time to network and find out about openings.

Even if you don't see an opening on a company's website, don't assume their not hiring. (Unless it's for the feds, they're pretty clear about when there's an opening) You can always call the rehab department or submit a resume without a specific opening, you will probably have more luck with this if you're willing to do prn work.

Not much to say about choosing a setting, except to keep your options open. It is very possible that you could try something different and find out that you really like it. Going into my last job, I thought that I would prefer the SNF floor over the acute care since it would be more like rehab, and I had no expectations of even participating in pediatrics at all. I didn't know the way I would appreciate those different areas. If you can find a site to give you experience in several different populations and diagnosis types, I'd say that is very valuable. It is much easier to learn to be a specialist after getting a firm grasp on being a generalist, I think.

Once you've found a few places that look promising, go ahead and set up interviews. If you can do all your interviews within the same general time frame, that will be helpful, since each place will probably want to pressure you a bit to commit or decline the opportunity quickly. Just make sure you keep good records of the benefits, daily details, and pros/cons of the different jobs so you don't get confused about what facility had what. More details on acing the interview in another post.

Anyone else have tips for finding a job? Feel free to share. One of my professors used to say that you'd be innundated w/ employment offers once you had a job, so even if prospects look bleak, remember that Job 1 could allow you to find Job 2.