Therapists

10 Aug 2016

Easy Ways to Teach Your Child Problem-Solving Skills

problemsolvingLOL

Does your child get upset easily over small and easily fixable things, like a ball rolling under a table? It may be because he doesn’t realize he has any power to fix the problem. Luckily, you can teach him to feel more empowered. I introduce to you the PSST Method!

Download the PDF of this here: The PSST! Method: Teach Your Child How to Problem Solve

Or just read on.

 

 

 

The PSST! Method: Teach Your Child How to Problem Solve

Children who feel confident in their problem-solving abilities can better tolerate and handle unexpected events. All children of any age can benefit from learning problem-solving skills. Adjust your language or extent of experimentation based on your child’s age/ability/tolerance level. The steps stay the same. (Ideally, use them all in order. But using any is great.)

SAMPLE PROBLEM: Young John’s ball just rolled under the couch. John scrunches up his face, ready to cry. Daddy jumps up to go grab a broom handle and solve the problem.

WAIT! John needs to learn the steps BETWEEN the problem and a successful solution.

  1. Pause. Just briefly. See if the child will attempt to problem-solve. If not, proceed to step two. Eventually, your child may make the attempt.
  1. Frame the Problem. “Wow, the ball rolled under the couch, and we can’t reach it.” You can also provide “emotion” and “help” words. “Your face is turning red and you look really frustrated. You can say, “Please help me solve this problem.”
  1. Play “Dumb.” Whether you instantly have a solution or not, you can pretend you’re not quite sure what to do. Crinkle up your forehead and look thoughtful. “Hmmm….”
  1. Think Out Loud. Most adults problem-solve in their heads. If you can role-model the problem-solving process, you’re giving him valuable insight, and showing that it’s not magic. “The ball’s is under the couch. We have to get it out somehow…maybe we can try…” With an older child, you can ask them if they have any ideas.
  1. See What Happens. You may know that your hand won’t fit or his arm can’t reach, but he doesn’t. When it’s feasible to experiment (not a safety hazard or massive inconvenience), try it out. He learns a lot more that way. “Let’s see if your arm is long enough. Can you lie down and reach for it?”
  1. Repeat Steps # 4 (Think Out Loud) and #5 (See What Happens), until problem solved. “That didn’t work because the ball’s too far away, will my hand work? …No, too big. Hmm, maybe something small but long to help us get the ball.. see if this will work…no….hmm…let’s see if we can find something…oh, let’s try a broom handle!”
  1. Frame the solution. “The ball rolled under the couch and we were really frustrated and we didn’t know what to do. But we tried lots of ways to solve the problem and now we have our ball back. We are great problem-solvers!”

Repeat this process regularly. As he becomes more proficient, you can take more of a back seat to the problem-solving process.

Bonus: Consider sprinkling “What If’s?” into your conversations/play time. “We solved that problem! What if the ball landed in a tree? Or this hole? Or under the bed?” Talking is great, acting it out is even better. Play a game called “Problem-Solving Superheroes” where you deliberately practice these kinds of things.

 

 

Good luck – let me know how it goes!

PS: This method may seem obvious to you – but many caregivers would benefit from the reminder.


20 Jul 2016

Interested in practical adaptive equipment design?

Screen Shot 2016-07-20 at 1.48.12 PM

See flyer here:

Homemade Customized Adaptive Equipment

My lovely friend Beth has been working on practical adaptive equipment – creating it at a fraction of the cost of commercial design. I copied the following text from the flyer: “I want to customize or build adaptive items for children with special needs. My dream is to have a workshop where families, teachers and designers can meet. Footrests, booster seats and supportive seats can be purchased from special needs catalogs but they are generally hundreds of dollars. I make most items out of extra strong cardboard, plastic, fabric and foam. They are inexpensive, light-weight and last a long time. I took cardboard construction classes at the Adaptive Design Workshop in New York City. The founder, Alex Truesdell, won a McArthur Award for her work. Many students who take the class are interested in starting their own workshops. It really helps to have experience building things.

What products do your kids need most? What features do you need that you can’t find? What do you want but can’t afford? I would love to hear your ideas. I’m not in business yet. I just learned that product liability insurance costs a minimum of $3500 per year. (On top of general liability insurance.) I may have to find or create a position at an existing company or organization that already serves the special needs population. Apparently, the price of insurance is stopping many of my fellow students. Connections are welcome!”

Her contact information is provided in the flyer. If you have any interest in adaptive design, or want some ideas or to know more about her work, you should definitely connect with her.


21 Apr 2016

Encouraging Self-Advocacy in Young Children

In my (former) work as a school-based occupational therapist, I was saddened daily at the lack of self-advocacy in the majority of the children I was treating. I provide the following as a (fictionalized but typical) scenario where I help teach self-advocacy. 

The background information: Sam is 6 years old and in first grade. He spent two months in the NICU due to prematurity and gastrointestinal issues. He has mild motor developmental delays. He is small and adorable, and everyone feels protective of him. His parents, teachers, and peers are always quick to do things for him. He is cognitively intact, although his executive functions have been somewhat blunted through his early learned helplessness, the passivity that accompanies it, and the compensation by people in his environments. He is uncertain of his own abilities. He receives OT once a week through the school system. 

Scenario: Sam is sitting at the table. I hand him a piece of paper and tell him to “sign in” (which he does every week). I deliberately turn away and start rummaging through things, clearly busy. After about 30 seconds I turn around and he is still sitting there, and hasn’t signed in. 

“Sam, why didn’t you sign in?” I ask. 

“I didn’t have a pencil.” 

“Oh!” I say in over-exaggerated surprise. I dramatically retrieve a pencil for him “Next time, please tell me right away that you need a pencil!” 

We move on.

Next week, I repeat the scenario. I hand him his paper, tell him to sign in, and start to turn away. 

This time, he instantly says “I need a pencil!” 

I smile and super happily say “Oh! I forgot! Thanks so much for asking! Here you go!” 

We continue to work on similar examples each week. Often I am distracted or make lots of mistakes! Luckily, he helps me stay on track by letting me know what he needs. 

Sam, like many consumers, was unaware of his power to ask for what he needs. With guidance and education, he is learning how to be a self-advocate. 

Category: Activities, Occupational Therapy, Parents, Therapists | Comments: none

21 Mar 2016

The ethical issue of productivity in healthcare

I haven’t blogged in a loooong time and as I was going through old files, I found something I had written about “productivity” within healthcare and the ethical issues I have with it, as an occupational therapist.

Essentially, many hospitals/clinics/settings have a set amount of “productivity” (billable units of time, typically in 15 minute increments, and usually only gotten during client treatment time) that each therapist is expected to get each day. Now, of course productivity can be a good thing in that obviously we want occupational therapists treating clients versus sitting around eating bon-bons, but the reality is that most therapists are already rushing around all day, doing their best to see all their clients, do paperwork, schedule things, collaborate, etc. What I’ve found is that unrealistically high productivity standards tend to lead to ethical dilemmas.

 

Here’s an example I give, which I experienced during fieldwork in 2009:

I am working on a locked geriatric psych ward. I just finished up an occupational therapy treatment session with a very mobile male who frequently gets aggressive (throwing chairs in hallways and such). He has a short fuse and if he gets stressed/frustrated, he escalates. I’m supposed to meet productivity units and my time is very limited for the rest of the day. As I am walking out of his room where he has gotten into bed, he asks me for a drink of water. Patients can’t get it themselves. I hesitate and the following goes through my brain:

Scenario 1: I get him the drink of water as requested. It will require me heading down a long hallway and navigating multiple people who want my attention, tracking down a nurse for a key, going into a room and getting the water if there are even cups in supply, finding the nurse to return the key, and walking back. He may expect that it’s a simple request, but even if everything goes smoothly, it could take 5 minutes, and possibly closer to 15. I will lose at least one precious, precious unit, but at least he got a need meet as soon as possible and on first request, which means he will -more likely – stay calm. (Why it takes so much work to get water is a separate issue not addressed here!)

Scenario 2. Worst case scenario plays out. I don’t want to lose my productivity so I let him know I have to run but I will ask a nurse as I am headed out. It may be true, but I know full well the chances are extraordinarily high, thanks to strained resources, that the nurse will take mental note and get to it when she can, which may take a while, and that in the meantime, every time anyone walks by his room, he will ask whoever that is again, who will say they will tell his nurse, and he will become increasingly frustrated. Here he is asking for the simplest and basic of needs to be met and nobody will help him. He will escalate to violence, throwing chairs in the hallway as he tends to do. (There’s only one hallway/entrance – no way to get out if he’s blocking it) All other residents will be stuck inside their rooms as area staff deal with this. Now there are six people focusing on de-escalation. In the meantime, patients are stressed, nurses run behind on meds, and I may be stuck somewhere, having to wait until the coast is clear. Now all the employees have lost productivity, quality of care is suffering as now all the poor patients have to deal with this. And it’s certainly not fun for the agitated patient, either. And even if I had already left the area so it didn’t affect MY productivity, it was certainly horrible for those left behind. 

IF I DO SCENARIO 1: I get him the water, no escalation, everything stays more or less on track, and I have lost a unit with no good reason (in director’s eyes), which I may get scolded for later. The director doesn’t appreciate hearing “Well yes I didn’t get that unit but it’s because if I didn’t get him his water then X would occur then Y then Z so really I saved units.”

IF I DO SCENARIO 2: I don’t get him the water. I potentially get my productivity unit. The department is happy. If he didn’t end up escalating, I’m happy I did in fact get my unit, but I still feel guilty that I didn’t help him. If he did end up escalating because of not getting his water fast enough, I feel absolutely hideous. 

==========

I quickly learned through fieldworks that I am not able to handle a job with productivity units. I would have been fired quickly. I get too stressed out about it. Too much worst case scenario thinking and too hard of a time saying no (or if I do say no, I obsess). I need to work on those issues, I do know that! 

There are tons of very ethical therapists who work quite successfully in placements with productivity, obviously. I always wish I could be inside their heads to see what it would feel like to not go into worst case scenarios or always feeling bad about sometimes having to say no. Like in the situation above. I obviously went into worst case scenarios. 

Luckily the American Occupational Therapy Association (AOTA) has been addressing the issues of productivity and ethics in our field – helping ensure that productivity standards are realistic and don’t lead to increased likelihood of ethical dilemmas, for example.


30 Nov 2015

My occupational therapy capstone project is complete!

I wrote mine on “Increasing Awareness and Acceptance of Children with Disabilities Using Picture Books.” My Capstone Paper

I write about the importance of awareness and acceptance of children with disabilities, and how children’s picture books can serve as a form of disability awareness, which can promote acceptance, and therefore social inclusion…which ultimately leads to increased participation in occupation, which is the whole point of occupational therapy.

In addition, I talk about how OTs should consider incorporating picture books into their practice, and also how OTs should consider writing their own children’s books! It furthers the Centennial Vision, is a form of occupational justice, utilizes our unique talents, is in alignment with the Framework-III, and also has bonuses, on the business side of things. So far only four OTs that I know of have written five children’s book that have OT in them or even disabilities at all. Karen Jacobs, famous OT of the world, has written two of them. I want to be in the top ten. 🙂 Of course books about children with disabilities exist, but not enough of them, especially high quality ones.

Business wise, selling high-quality children’s books that exist already is a way to make a few extra dollars. And selling, giving away, or recommending them, especially if they are your own books, can be a value-added service, promoting satisfaction and loyalty. They are great for marketing. And if you write your own, especially if done as an e-book, you can make some money…well assuming it’s successful. Although to warn you, children’s books are hard to write well, and illustrations are quite costly.

To learn more about the process, read my capstone manuscript…the process etc is near the end, you can find via Table of Contents.

1DobynsKarenCapstonePaper

Use the Contact Me button on my website or email me…my name karendobyns, on gmail.com, if you want to say anything, because I just switched servers and the spam is out of control. I have over 2,000 comments and I won’t see yours…I have to get it fixed. Ugh.

Anyway….I got an A on my capstone YAY and after the presentation I give in 45 minutes through GoToMeeting (I think that’s the name), I am done with all but a single reflective post worth 1 point. 🙂 Post-professional clinical doctorate of occupational therapy (OTD), here I come!


9 Nov 2015

Cadillac OT versus Reality OT

A wonderful occupational therapist/educator wrote the following forum post on our OTD forum (we are getting our post-professional clinical doctorates in OT). I asked her permission to post it because it resonated. What we learn in OT school and what we discover in the real world are two different things – but we have to remember in the real world that what we learned in OT school is still a valid and burning flame within us we must nurture and allow to grow.

 

“I remember something that one of my professors once said: “What you get in OT school is the ‘Cadillac version of OT.”  I didn’t really understand it at the time, but the idea has stuck with me and I have certainly seen it in my own career.  A lot of what we learned in school is how it should be, but not necessarily how it is currently.  But we needed to learn it that way if there is any hope of changing things going forward.  Each of us are then charged with holding on to pieces of the “Cadillac version” that fit within our practice, working to change things in practice to fit more of that in, and adapting to what we cannot change.

I try to make my teaching fit that approach.  We emphasize occupation-based practice a lot in our curriculum, and we do teach preventative care and wellness, which aren’t necessarily reimbursed or even being practiced where our students complete their fieldwork.  But some of our students have been able to fit these things into the otherwise very limited medical model at their sites, and others have the desire to find practice settings in the future that will allow them to use these skills.” – J.D. 


25 Mar 2015

Mental Health Energy Conservation

I struggle with depression and anxiety on a all-too-regular basis. I practice mental health energy conservation on a daily basis.
Throughout each day, I’m constantly doing an internal MRI-like scan of my body, figuring out how I am doing and what I can handle. I’m constantly self-talking to myself for reassurance (“okay Karen, you’ve checked the lint and you’re right here, you can start the dryer and chances are high it won’t explode into a ball of flames…” and previewing what’s coming next. I know myself pretty well and know what kind of issues are triggers for me, or where I need to have control to be okay. I know what drains me and what rejuvenates me. I’m lucky to have those skills, and I think my occupational therapy training certainly contributes to those abilities.
I have what I call an anxiety budget, similar to the fibromyalgia “spoons” theory of where you only have so many “spoons” in a day so you have to use them wisely. My goal is to get through the day without using all my anxiety coins.
For example, parallel parking downtown is a HUGE stressor for me, as is giving blood. I would try hard to NOT allow those two big stressors to be on the same day, because I know I will be at a deficit. I try to space out big stressors. I make sure if I have to see a lot of people (at a “fun” event), that I hopefully only have to do it once that day, and have time after to rejuvenate.
Somedays I assess myself when I wake up and I can tell it’s going to be a hard day, maybe I’m extra anxious. If I don’t HAVE to do my laundry that day, I won’t. I need to save all the coins I can. Or, maybe I have to for some reason, but I am aware that on a good day laundry may take me “5” coins, and for this day it may take up “15” because I’m going to be extra worried today that the dryer is going to start a fire. Another example: starting a blender always kind of scares me, even with headphones on the noise freaks me out and sometimes I get scared of electrical fires in the walls or something. So on a good day maybe I make a smoothie for 3 coins because I can tolerate the noise and won’t obsess over a fire, on a bad day I won’t touch the blender because it would cost me 15 coins and I can’t waste them on that.
It’s a constant balancing act, but my awareness is very helpful. It also allows me some compassion and grace, because I have accepted that certain things are much harder for me than others, and that it also varies by day or even hour or even minute. It also allows me to be extra aware of doing harder activities when I feel okay, and saving littler ones for challenging days. It helps me be more functional and not beat myself up so much. (Believe me, there are plenty of times I beat myself up or can’t function – it’s an art, not a science.)
Sometimes, brushing my hair or just starting self-care routines make me want to cry because they seem so hard. That’s a day I’m just going to prioritize the absolute REQUIREMENTS to be semi-functional, and maybe I don’t get a shower that day, but if I brushed my teeth and put on clothes, it’s a win.
From what I can tell (see below for more details), there isn’t much awareness -or at least it’s not called this – of the concept of mental health energy conservation. I’d love to hear from occupational therapists (e-mail, Facebook, here…) who work in mental health on their thoughts on this concept, as I know they address these challenges, maybe with a different name.
The keys are to remember that every person has unique challenges, especially as it pertains to anxiety – my parallel parking may cost me 30 coins and may only cost you 2 coins, whereas my public speaking is 5 coins in my mind and in yours its 50. I think awareness of this need for energy conservation allows for a big step in acceptance, compassion, and potentially a change in functional approaches to the day.
I’m eventually interested in working with someone to do research on this, but not anytime soon!
——-
Okay, here’s what I just posted this on one of my OTD (occupational therapy doctorate) forums…I’m trying to be okay with B grades, I know this is not very well written, but hey….it’s a little assignment and I’m practicing mental health energy conservation by not obsessing over making it perfect. It was a qualitative query I came up with along with some discussion as to why (vague paraphrase of true directions)

How do adults (18-55) with mild depression describe their energy expenditure as it relates to participation in activities of daily life? 

 My review of the literature came up with no results that specifically focused on energy expenditure in relation to mental health and activities of daily life. The majority of articles focusing on energy conservation had to do with multiple sclerosis (Blikman, et. al, 2013), cancer (Mitchell, et. al, 2014), or other physical difficulties. Other articles focused on older adults and limitations in activities of daily life in the aging process, which occasionally addressed depression (Arbesman & Mosley, 2012). Others address activity limitations and depression with chronic conditions, but do not specifically focus on mental health. While I may have missed some articles in my non-exhaustive literature search, it’s clear that this is a very specific area that has had minimal attention.

Occupational therapists and many other health professionals have knowledge and experience in dealing with energy conservation, but it’s typically based on physical needs, not mental. Mental health occupational therapists clearly recognize that people with depression have limitations in ADLs, and that even an activity as benign and simple as pouring a bowl of cereal can seem exhausting. While they certainly address these issues, I don’t know if the therapists or clients are considering this or calling this a form of energy conservation. It would be interesting to see if adults with depression describe their energy expenditure for such tasks as physical or mental, or even perceive the limitation as an energy expenditure issue in the first place.

I think the occupational therapy field would benefit from a more evidence-based approach to managing energy conservation in younger adults with mental health challenges (I chose depression but I’d also be equally interested in anxiety). If there were an assessment that was linked to the COPM, it would allow the therapist and client to get the unique viewpoint of what activities take up the most energy expenditure for that particular client (emphasis on uniqueness), and give them goals for intervention. A support group and/or energy conservation program could also be appropriate for this population.

Occupational therapy is rarely seen in most major healthcare mental health settings these days, but mental energy conservation programs for ADLs could be a new way to promote OT in mental health, and a way to help more people handle their day to day ADL participation with more awareness, compassion, and knowledge, which may in turn reduce their limitations and allow increased participation.

References

Arbesman, M., & Mosley, L. J. (2012). Systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling older adults. American Journal of Occupational Therapy, 66, 277–283. http://dx:doi.org/10.5014/ajot.2012.003327

Blikman, L. J., Huisstede, B. M., Kooijmans, H., Stam, H. J., Bussmann, J. B., & van Meeteren, J. (2013). Effectiveness of Energy Conservation Treatment in Reducing Fatigue in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Archives Of Physical Medicine & Rehabilitation, 94(7), 1360-1376. doi:10.1016/j.apmr.2013.01.025B

Mitchell, S. A., Hoffman, A. J., Clark, J. C., DeGennaro, R. M., Poirier, P., Robinson, C. B., & Weisbrod, B. L. (2014). Putting Evidence Into Practice: An Update of Evidence-Based Interventions for Cancer-Related Fatigue During and Following Treatment. Clinical Journal Of Oncology Nursing, 1838-58. doi:10.1188/14.CJON.S3.38-58

 


14 Feb 2015

Creativity vs Expectations

I really enjoyed reading the following Facebook post by F.C. on the group page, “Pediatric Occupational Therapists”. (I recommend joining this group, a lot of high-quality information and resources.)I enjoy outside-the-box thinking and creativity, and at times I felt guilty trying to reconcile my work with some of the more rigid academic necessities. I did have a typical schooling so I understand “normal” expectations, but I think more like F.C.!

“I went to a very small alternative school from 1st grade through high school that really emphasized individuality and creativity. It was a wonderful place to be and we learned a lot of great life skills, but there was no OT and no one was too concerned with typical development. Fast forward 20 years and I am at my first fieldwork placement at a peds clinic, working with a little boy who was coloring. He was having a great time and using a bunch of different colors and free form drawing before he filled in the shapes… My supervisor (who is lovely) walked in and called him out on not coloring properly – oops! I had no idea up to that point (as a 30 year old) that coloring is usually supposed to be one color, fill the whole area systematically, etc. I thought this kid was doing great! It was an interesting reminder that my upbringing is always going to affect the way I see things and the way I treat. I’m still not sure of everything kids are “supposed” to be doing at certain ages, except out of text books, which don’t give us much.”


8 Feb 2015

Controversy: Patient versus Client versus Consumer?

PatientClientConsumer

Patient, Client, or Consumer? In occupational therapy and other healthcare fields, there is a semantic controversy over what us therapists/the public should be calling those who utilize occupational therapy services. Depending on the label used, we get a different feel for the relationship between therapist/person.

My friend, a psychologist, told me she likes to use the word “patient” because it came from Latin and means “one who suffers,” and she feels the people who see her are there because they are suffering. Some therapists prefer “client” as they feel “patient” has more of a superior-inferior feel, as well as a “medical model” feel, and many OTs feel we need to be more encompassing. Other therapists prefer “consumer” because it seems to have a more neutral connotation. I’m sure there are plenty of other reasons for the different labels. Some therapists feel very passionately about the “appropriate” label, others don’t really care, others use them interchangeably. I think there may be an even better label out there. Hmm. So I just asked my pediatric therapist friend what she calls the people she sees, and she said with a shrug, “child.” I loved that answer! Maybe that’s the best one of all. 🙂

What do you think? Patient, client, or consumer?


27 Jan 2015

Framework-III for OT Students/Practitioners, Cheatsheet

 

Miss OTPF Pageant

Miss OTPF Pageant Winner

The newly updated Occupational Therapy Practice Framework: Domain and process, 3rd edition, otherwise known as the Framework-III is an important document provided by the American Occupational Therapy Association, and all therapists and students should be intimately familiar with it. Figuratively. Only figuratively. I have slept with it though. Literally, in OT school, I fell asleep with the first edition more than once. That’s why they called me Miss OTPF.  We had a Miss OTPF pageant too, but the opposite of occupation-based in true parody style! Anyway. Moving on.  Now that I am back in school for my post-professional clinical doctorate in occupational therapy (OTD), the Framework-III and I are once again sharing a pillow, and I’m putting my crown back on, deserved or not.  

The true framework is quite long, so this just gives you a cheatsheet taste of categories/terminology. Here’s a 1- page PDF of this outline of the Framework-IIIFrameworkOutline.pdf

Occupational Therapy Practice Framework: Domain and Process, 3rd ed., (abbreviated/referred to as Framework-III)

 An official document provided by AOTA, summarizing occupational therapy’s unique approach to healthcare. Our domain focuses on “achieving health, well-being, and participation in life through engagement in occupation,” through a vision of “occupation based, client centered, contextual, and evidence based” care.

OTs must evaluate a client holistically and deductively with an “occupational profile”, using below categories as guidelines, before determining intervention approach.

Clients can refer to persons, groups, and populations [newly expanded definition]

Occupations (meaningful life activities that clients engage in)

  • Activities of Daily Living (ADL) – (personal hygiene, bathing, sexual activity, etc.)
  • Instrumental Activities of Daily Living (IADL) (care of others, community mobility, financial management, shopping, safety, etc.)
  • Rest and Sleep, Education, Work, Play, Leisure, and Social Participation

Client Factors (reside within client and influence client’s performance in occupations)

  • Body Functions, Body Structures, Values, beliefs, and spirituality

Performance Skills (observable actions with a functional purpose)

  • Motor skills (observed physical interactions, i.e. reaching, bending, manipulating)
  • Process skills (observed “executive functioning” during a task, i.e. initiating, sequencing, gathering, problem-solving)
  • Social interaction skills (observed during social interactions, i.e. transitions, gesticulations)

Performance patterns (behaviors related to activities of daily life)

  • Habits, Routines, Rituals, Roles

Context (environmental conditions that may affect client’s performance)

  • Cultural, personal, physical, social, temporal, virtual

*Please see reference for comprehensive details in each area. Use this brief handout at your own risk!

Example of citation in-text: We used the Occupational Therapy Practice Framework: Domain and Process, 3rd ed., ([Framework-III], AOTA, 2014) for our project. The Framework-III (AOTA, 2014) is awesome.

Reference: American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48.

 


Blog Archives