28 Apr 2011

Busy busy busy IEP season for a school OT!

I gotta tell y’all, I am woorrrrrnnn out. I have been working all day, coming home, doing a few chores (ie shower, commute, fix lunch for next day), and otherwise pretty much working all night until midnight or, like Monday night, until 2 am. It’s IEP season in the schools so things are crazy! Seeing as how this is only my second week alone in this new job, I’m having to work hard to keep up with all the paperwork. But everyone I work with is phenomenal and supportive and it’s going to be okay. Don’t be freaked out by how much I work, I’m sure half of it is unnecessary, but it helps me feel more in control. I don’t work well under stress so having the day planned out helps. Of course things change (ie I discover a kid is on a field trip) but at least I have a skeleton in place. I just need to get used to how things work (and figure out how to better organize things). I need to invent a better OT cart to carry around – I got the foldable box one from Office Depot. Not impressed. And it’s not big enough either, haha. I haven’t searched online to see if they have any like hardcore OT rollies that are like double deckers. I would probably be willing to pay a lot of money for a really good one, I carry this sucker around nonstop and it’s about to die after only a few weeks.

I am going to try hard to do a picture post this weekend of a lot of the stuff I am using/carrying around with me. I tried to do a picture post the other night as I went through all my own personal K-4 papers of childhood, but Picasa misbehaved 🙁 Apparently I used to spell my name backwards, ie starting with the N, e, r, a, K. And look at me, I turned out okay (don’t comment)! So maybe my reversals kids will be alright too. 🙂

Okay so….now that I’ve done a brief update to say I AM REALLY CRAZY BUSY…I am really crazy busy and therefore really crazy to be blogging right now. I need to prep for tomorrow! Starting…NOW!

Category: Occupational Therapy | Comments: 1

20 Apr 2011

Copying from the board, exerting too much pressure writing…OT ideas please

Needing ideas for…

A) Child using too much pressure when writing (ie thick dark lines; fatigues easily from the effort of pressing so hard)

B) Giving a 15-minute or so lesson to an entire 1st grade class on copying from the board.

Have got a few ideas that I will share at some point soon, but would love to hear from my readers in the meantime. Going to do a quick Google search now (my brain is fried for the night…proof: I spelled that brian), and then go to bed…my goal was ridiculously early and it's already an hour past that….

Category: Occupational Therapy | Comments: 9

18 Apr 2011

Sooo many decisions to make for OT playtime :)

I bought a Staples “Easy” button this weekend so kids could hit the “That was easy!” button after completing a task. 🙂 I also bought stuff in Staples dollar section, like foam alphabet and a foam elephant puzzle. And a bizarre, long twisted eraser. And some gum since some of the kids attend better with it. And some creepy bugs. And then I'm going through old stuff, I found an old magic kit that I am pondering, plus an old road trip book for kids that I might steal some ideas from (like doing the cats cradle or whatever its called, in your hands)….and I have Animalia, and an adult coloring book for some of the more advanced kids….and some poms to use with Zoo sticks….etc etc. And a $1 Pilates ring I got at Target years ago that I use to have the kids put their entire body into and then out, somewhat like putting on/off clothes. (IE put over head, wiggle over body and down to feet, step out of it, then step back in and go bottom-top.) You can also use a tied in a circle theraband to do the same thing.

I need to take pictures of my OT stash which is accumulating daily and share more of it. Or maybe make another video – my last one about my pediatric toolbox is like…3 years old. Unfortunately I think I've spent more on OT toys lately than I've actually made in salary, haha. Most of it is from the dollar store or dollar sections, but it adds up quickly. 🙂 And then I have a lot in my old craft bins I'm grabbing. It's a little overwhelming actually. Too much of a good thing, in a way. I need to figure out just what I want for tommorrow's kids and not go crazy figuring out the rest! 🙂 One day at a time.

I also printed out a bunch of Tonya's TherapyFunZone stuff, like animal shapes and cootie catchers!! (I totally wrote cootchie by accident….that would be inappropriate).

One thing I'd love some feedback on is BEHAVIOR strategies. Like if I have a elementary school aged child who avoids cutting, drawing, writing, etc, how do I encourage them to do it? I am guessing people will say to avoid it for the most part as well and focus on underlying skills that are deficient and causing the difficulties. Or say use rewards. I just read an article on kidsatthought.com about how using reward systems is ultimately not helpful long-term. I think for a while, as the kids get used to me, since I'm new to this job, I will try to focus a little more on fun stuff so they grow to like me…then once they like me and think they're gonna have fun, I bring out the hard stuff and show them how wrong they were. 🙂 KIDDING – I'm very big on making OT fun for them. Magical. But that takes a lot of hard work. So. I'm working on it. And I can't work on it if I am blogging. So. Off to go print stuff and go through my big ol' toolbox to figure out tommorow's games!

One wise OT (Orli I think?) once told me I could use the same activity in a given day with each kid, but modify it accordingly. IE a day where the children make spiders – it could be made easy or hard depending on how much cutting, gluing, coloring, writing about it, etc….and obviously based on what the child is working on in OT. So a kindergardener and 5th grader could do it at varying levels of difficulty and be working on completely different things. (IE one child is doing it for sequencing, another for fine motor). I liked that idea. I wouldn't do it all the time, but I could see how occasionally it would work well. Especially on theme days, like near Halloween.

Notice how I said I was off to do something then wrote another whole paragraph. Not cool, Karen. Okay this time I mean it. 🙂

Category: Occupational Therapy | Comments: none

16 Apr 2011

Treating Private Patients in OT

Jena Casbon contacted me about writing this article – I think it’s interesting. I hadn’t thought about taking a private patient or two on the side. And I probably wouldn’t do it any time soon since I don’t have enough years of experience. But it’s something to think about for the future. 🙂 PS I have no idea how it works from a billing standpoint!

Treating Private Patients: A Great Opportunity for OT’s

Experiences During School Will Prepare You For…
It never ceases to amaze me how rich and diverse the field of Occupational Therapy is. Many incoming and early graduate students tend to think of our field in terms of:

  • age range (mostly in terms of “kids or adults”)
  • specific impairments such as arm and hand dysfunction, sensory integration, dementia, vision impairments, driving safety, or ADL’s
  • areas of practice such as physical health, mental health and community
  • treatment settings such as pediatrics, rehabilitation in hospitals, home health, private clinics, work hardening

Throughout your undergraduate/graduate coursework and clinical placements, you will gain exposure to a wide variety of age groups, disorders and practice locations. These experiences will help build your clinical skills, while molding yourself into a competent clinician.

Your Early Career
The first year after graduating from your OT graduate program is a both stressful and liberating time in your career. In many ways, you are on your own now: able to work on the areas where you feel your patient needs the most help. This degree of autonomy can be scary for many new grads, but hopefully your supervisor, colleagues or former graduate school classmates can support and encourage your clinical decision making.

During the first few years of your career as an Occupational Therapist you will continue to learn so much about disorders, how patients can present differently, how to manage patients and family dynamics, etc. At this stage you will likely begin to gravitate to a specific age group, diagnosis, etc. I urge you to take as many continuing education courses (CEU’s) as you can as you build your expertise. You may even opt to change jobs or settings in order to gain more exposure to different aspects of our field. All of these things will help you to grow and provide excellent care for your patients.

I Wonder If I Could Ever Have A Private Practice…?
Almost every OT friend of mine started out dreaming one day of having a private practice- but as they got into the field more and more, the safety of a regular job with consistent pay won out over the risk of going out on their own. To be honest, starting a private practice has a lot of extra work, extra responsibilities and headaches- but the trade off of high-income and more autonomy is very alluring for some people.

Private Patients: A Great Way to Start
Most of us got into this field because we love to help people, not because we wanted to make money. As time goes by though, the reality of car or house payments, wanting to have extra income for our families, vacations, etc. starts to hit and we become frustrated with our regular pay. Another benefit to private patients is flexibility of your schedule and also getting to treat ideal patients. Treating privately is a great way to help more people while making more money by seeing one to several private patients on the side.

How Does Private Therapy Work?
At some point, you will know colleagues that are treating private patients and a patient or family member will ask if you can provide private treatment. Private occupational therapy is often requested as a way to deal with:

  • to provide consistent therapy during gaps over the summer for school-aged children
  • to supplement therapy already being received (kids or adults)
  • to continue therapy if insurance won’t continue to pay for services (kids or adults)

Most private therapy occurs in the patients’ home and OT’s are paid either through cash/check or reimbursed through an insurance company. Therapists need to have their own liability insurance, document their treatment, market their services to obtain more clients and pay taxes on this extra income. Most therapists charge between $75-$125/hour for their services.

Is Private Therapy Right For You?
I recommend that you have at least 2-3 years experience as an OT before you begin treating privately. You need to build up your expertise in a diagnosis or treatment technique so that your services are truly valuable to your private patients. Because you’ll be doing this on your own, you need to develop a level of confidence about both your clinical and business skills before you start. Starting to see private patients is almost like your first year of practicing all over again. Once you have some practice and experience, you’ll feel much stronger. Some clinicians start with private patients and then graduate to starting their own free-standing private practice- others keep their regular job and see private patients on the side.

I hope this has helped open your mind to yet another really cool aspect of the field of Occupational Therapy!

H. Casbon, MS CCC-SLP is a Speech-Language Pathologist and founder of The Independent Clinician. After graduating from Emerson College in 2005, she has worked with adult outpatients in a rehabilitation hospital and inpatients in a skilled nursing facility. Three years into practicing as an SLP, she began treating private patients- but the lack of a “how-to guide” bothered her, so she wrote one.

Follow Jena on Twitter @IndClinician and Facebook http://www.facebook.com/independentclinician
Be sure to visit http://www.IndependentClinician.com to learn more about how to treat private patients.

Category: Occupational Therapy | Comments: 4

13 Apr 2011

Nurse in haiti, part 2

My cousin is a nurse that recently went to Haiti for a week to help….this was her second e-mail she sent out. Again, I know she is a nurse and not an OT, but it’s healthcare and I think there are a lot of parallels at times!

Hey my loves 🙂
I don’t know where to begin and I will likely drop a few tears while writing this email, in part because it is 6:45 in the morning and has been a while since I slept, but mostly because I am so extremely moved by this country (the very little I have seen) and these people.
I am a girl of many words (as you all know) and strong opionions (as you also all know) so, it is strange to find myself in a place where I truely have no words to convey what I am feeling but, here I go….
I think it might be hard to put things into words because there are such striking contrasts here. I have never, and I mean NEVER been in a country so poor. It is striking. Turn out we are volunteering at the trauma center in Port Au-Prince. When a crash victim (there are many) shows up, you DO NOT just carelessly cut off their clothes. Unless they are dying, you respect the jeans the boy has on… they may be his favorite. The first guy that came in, unconscious, in the back of a pick up truck, we lifted him onto the backboard, go him into the “ËR”, and in all the chaos, I said, shouldn’t we just cut off his clothes? The Haitian doctor looked at me and said, No, lets try and save his clothes. Trama shears back on the counter. I have now become obsessed with saving people’s clothes. Today, I was starting an IV on a woman in triage (I am finally figuring out the old school IV tools they have here, yeah!!!) and I got blood all over her dress. I could see the distress in her face and made sure to have the translator (we have awesome translators) tell her that I would find a way both to get her into the ER as well as to get the blood out of her dress. Luckily, my old school hydrogen peroxide trick worked wonders (although, I was worried about wasting h202)…
But, worse than missing material things, something unique to Haiti (I think) is that people are also missing family. I have NEVER, and I mean NEVER NEVER, seen people who love each other so much. I mean, not that you can quantify love, but it is EVERY MOMENT of EVERY day. Nurses do not clean, bathe, and feed their patients. The family is here, around the clock, helping their loved ones. There is a 15 year old girl who is horribly ill with metastatic ovarian cancer, her stomach is grossly distended from liver failure, and she is often in pain and/or short of breath. Her mother is at the side of her bed all day, all night, every day. She is in a cot. Her mother sleeps in a chair with her head on the bed. Or, there is a grandmother who recently had her left leg amputated, her grandson comes every morning (her daughter has passed) and strips her down, bathes her, feeds her, etc…. Or, there was a grandfather. He showed up barefoot at 4 in the morning to the emergency room carryinhg his 8 month old grandson. His legs were horribly swollen, he looked almost to old to care for this baby, yet, he sat there, awake and vigilent, soothing the little baby as a group of doctors and nurses swarmed in to take vitals, blood,etc. Or, there was a father, wiping tears from his eyes as his 4 year old daughter sat on our cot in the emergency room with a cough… I don’t know what it was like before the earthquake but, people have lost so much here… its like it has made them love more.
Ever since I became a nurse, I get this super positive reaction from people when I tell them what I do. It’s always felt odd to me because I never identified with nursing… I just kind of fell into it but, it was never a direct goal of mine. I can proudly say, as of this morning, I finally get it, and I love nursing.
I feel so honored to be doing what I am doing. I really, despite any amound of rambling, could never begin to capture how much emotion I am feeling. Long story short, you get to be with people, holding their hands, during the most critical moments of there lives. I don’t even speak the same language as the people here, but, as a nurse, you cope. You say with your eyes, and your hands, what you cannot say with words. You learn to talk with everyone. And it is SUCH an INCREDIBLE HONOR to be with people during these MAJOR moments in their lives.
Man, and nursing is FAST and DIRTY! 🙂 Man, you move, and you think. Constantly. Without stopping. Two of our emergency room beds are chairs, so, you can imagine there are no chairs for us to sit down in. We are on our feet, literally, and I mean very literally, all night. Last night, I was holding a tiny little baby who came in with a fever, vommiting and diarrhea, when he beautifully took a large loose crap down the entire front of my body. No worries. That why I wear scrubs right. I handed him off, ran into the back (aka my home) changed srubs (no time for a shower) and went back to the emergency room right as a man rolled up unconsious in the back of a pick up truck (pick up trucks seem to be the mode of transportation to the haitian emergency room). Another long story short, withing 10 mins, I had blood all over me (including my exposed arms, yuck!) only later to be in a wresting match, with another nurse and the crazy patient, as we tried to get some sedatives into this nutso drugged self. I didn’t bother to change my scrubs again. Meanwhile, just because you are knee deep in blood fighting with a confused, drugged, haitian man doesn’t mean you can forget about the baby. With my hands pushing haldol, one eye on the patient, my other eye is looking at the iv bag for the infant. There are no pumps in haiti to do your work for you….
sigh. so much to say but, I have to wrap it up. The doctor in line behind me wants to skype with her family before her kids go to school.
So, last thoughts.
After work today, “T”, my coworker and I, found out that there is a prayer service before clinic begins. All the people who are not critically ill enough to be seen in our 4 bed emergency room are turned away and told to come back for clinic in the morning. So, when we finshed at 6 am, we went to the clinic, which opens at 8. At least a hundred people where gathered. At 0730, a woman came, and began a prayer session with a song. Everyone stood, together, and sang, not for all that they don’t have, but all that they do. They prayed for strength and cried out. “T” and I stood there in our bloody scrubs.
I can’t even say exactly what made us cry becuase there is so much here to cry about. You can cry from saddness. You can cry for love. you can cry for beauty. You can cry for gratitude, to the people here, for accepting us, for this experience, for every moment of life. you can cry becuase never before in your life have you felt so human. (karen’s note: this was my favorite paragraph. I bolded it.)

At the end of the ceremony, the woman leading it, gave a thanks to all the volunteers who have left their families and their contries, to help the people of haiti. and of course, tears continued to flow down our cheeks.
Anyways, I can’t hog the computer, and I have so much more to say, but most importantly, I love you guys.

Category: Occupational Therapy | Comments: none

13 Apr 2011

Blogging blizzard complete

I am sorry if your eyeballs have popped out of your head after like fifty thousand new blog posts. I got through literally hundreds of e-mails. Again, at expenses of taxes, cough. So when the IRS comes knocking at my door, I blame y’all. 🙂

I finally realized what I should have done – is save them all as drafts and then post like, one a day, rather than posting five thousand at once. I didn’t realize this until late in in the process. So now I have like six saved to do over the next few days/weeks as I remember….I don’t know how to automatically post them regularly at a certain time, with blogger.com. Dunno if it’s possible. Don’t care enough to find out.

I look forward to all y’all’s comments!! One thing about catching up on e-mail/blogging is that then you get this whole new deluge of comments/e-mails. A vicious cycle. BUT I LOVE THEM SO PLEASE E-MAIL/COMMENT YOUR HEART OUT. I’m just slow to respond!

So it took me about two hours to do this blog blizzard – my cat is bored. That says a lot. Good night.

Category: Occupational Therapy | Comments: 2

13 Apr 2011

Job interview thought process

Some of the questions I wanted to ask when I was job interviewing within a hospital….

weekend rotation
how many pts a day
common diagnoses
continuing ed support/reimbursement
teamwork between OTs/PTs here
rotating diff teams and units?
typical salary/benefits????
how big is the department?
what skill set do OTs need?

Category: Occupational Therapy | Comments: none

13 Apr 2011

OTs in Mental Health

I need to see if my friend Brooke, who works in Mental Health as an OT at a prestigious location, would post something on mental health OT! I saw this comment and wanted to re-post it and ask if I have any mental health OT readers! I loved my mental health rotation even though it was challenging and even scary at times. I need to revisit it in my brain and see what else I can post!

Mel writes:
Hey! I’m an occupational therapist in Montreal and I found your blog a couple of years ago when I first graduated. I’ve been working in mental health for the last 3 years with adults who have psychosis or mood disorders. I agree that there aren’t that many OTs working in mental health and there’s even fewer who blog about it so I was really excited with your post. I think as OTs we definitely have more to offer than assessing cognitive levels. I think the values of our profession and our ability to analyze activity allow us to assist this population in their rehabilitation and recovery. Although I often struggle with defining (and defending) my role in psychiatry, I think we play an important part in helping them reintegrate into the community and redefine themselves.

Category: Occupational Therapy | Comments: none

13 Apr 2011

Matthew, a UK OT asks about Fieldwork placement…

Matthew asks:

Not sure if this is appropriate to ask for input from your readers as I don’t know if you have many from the UK but we are looking to offer an internship / placement opportunity to prospective OT students and would love to get any feedback around what would be the most helpful way of structuring this to make sure we give the students the most benefit:


Any feedback from your readers would be fabulous and well done once again and hope it all goes well.


Category: Occupational Therapy | Comments: none

13 Apr 2011

Tips to Incoming OT Students? Anything to add?

I was asked recently (by an enthusiastic Klaudia) if I had any updates to my “Tips to Incoming MOT Students”, seeing as how I wrote that in month into OT school and now I’ve been out for several years. http://otstudents.blogspot.com/2007/04/tips-to-incoming-mot-students.html, and so I re-read it and decided….that first of all, wow, I wrote that in April of 2007, so this is five years later, zomg. 🙂 I feel crazy old. But you know what? All those tips are still true. I don’t think I have any new ones to add – the ones about being flexible and remembering the OT world is small (so watch the gossip) are probably the most valid. Anybody else have thoughts on the matter? New ones to add?

Category: Occupational Therapy | Comments: none

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