**Top 12 Things You Should Know For Your Fieldwork**

A list of things to help occupational therapy students prepare or get through their fieldworks/internships in preparation for becoming an independent practitioner.

1. BE PROACTIVE AND REACTIVE. If you have a patient with fragile X syndrome tomorrow, research it in advance. If you see a patient with fragile X syndrome and realize you would benefit from more knowledge or have questions, research it after. Maybe you can present your supervisor with some helpful resources you found, or be better prepared for next time.

2. ASK QUESTIONS, AND KNOW WHEN TO ASK THEM. Supervisors and practitioners of any field are hopefully happy to answer your questions. It’s a great sign that you are processing and synthesizing information. But when you are both with a patient, use your best judgment as to whether it’s an appropriate time to ask it. If in doubt, don’t ask it then. Write it down so you don’t forget or at least scribble a “trigger word” reminder down for later. Bombarding your supervisor with questions at the last second of the day while they hurriedly try to get their act together, isn’t appreciated either. Collaborate on finding a good time to ask the questions.

3. YOU WILL MAKE STUPID MISTAKES AND IT’S OKAY. I’m not talking about safety ones here, I’m talking about basics. Forgetting where you put your pen, or being unable to open a simple container, or bumping into something. You are nervous and on your best behavior and you are trying soooo hard to impress your supervisor. That means you will make the stupidest mistakes of all, and we get it. We were there too. We (likely) aren’t judging you harshly for mistakes that we know are from nervousness.

4. SAFETY COMES FIRST. Stupid mistakes with opening a container are fine, dropping a patient is not. If you don’t feel safe with a patient for any reason (whether it’s for a physical impairment or mental health/cognitive reason), you need to ask for guidance. You may hesitate because you don’t want your supervisor to realize you don’t know how to do something you probably should by now, or to cause them trouble. Guess what? It causes them FAR more trouble, and FAR less confidence in your abilities, if you make a mistake that hurts a patient because you were more concerned about yourself than the patient.

5. HAVE A “CHEAT SHEET”. Common abbreviations, alarm codes, locations, phone numbers, little tidbits of information, whatever. Jot it all down. Keep an index card on your clipboard or in your pocket. When you’re stressed, and you likely will be, you are going to have trouble remembering all the little things you usually don’t have issues with. It’s appreciated when you don’t have to ask your supervisor every 5 minutes for a code they’ve given you twice now.

6. BE EXTRA HELPFUL . Your supervisor will eventually (hopefully) be helped by your presence, but at first, you are an awful lot of extra work, no matter how amazing you are. See something that you can easily put back in place, or clean off, or make more efficient? See a little errand you could run? Offer to do it, or ask permission. You may want to do it without permission but just ensure it’s not something being done deliberately. For example, don’t put away a 100-piece jigsaw puzzle that is laid out, with 6 pieces still undone, unless you are positive it’s not being saved for some reason. Don’t try to organize a drawer of equipment unless you understand its purpose, usage patterns, and knew that someone jumbled it up yesterday but that it looked a specific way the day before.

7. FOCUS ON LEARNING EVEN DURING DOWNTIME AT WORK. If you have any downtime in your work day beyond your legitimate break (haha, good luck) or lunch, you should be actively learning. This is your chance. It’s so tempting to get on your phone a while and veg out during a gap. Maybe sometimes you need it for your mental health or to deal with something. But ideally should be researching, or cleaning, or formulating questions, or updating your cheat sheet, or something that shows determination and drive. Don’t be too zealous and don’t bug your supervisor too much if it’s clear they need a break. But at the very least, ask if there is anything they would like you to do or anything you can do to help, during the downtime.

8. EXPECT AND WELCOME CONSTRUCTIVE CRITICISM. You’re a student, you’re interning, you don’t know everything. You will make mistakes you don’t even know you’re making. Maybe you will talk too loud, or be “too” helpful. (One time I was trying to get my kids to advocate that they need a pencil by giving them a writing task, paper but no pencil, and then deliberately turning away to occupy myself. My shadow jumped up to get it before I could – a perfectly valid thing to do, but I had to give her feedback to wait until I asked since it was often a deliberate act on my part.) Maybe you won’t realize you are insulting a patient with your word choices, or that you keep forgetting to teach a certain skill. The whole point of your internship is to grow. You can’t grow if you aren’t aware, and “you don’t know what you don’t know.” It may sting, especially when you are trying your best and had such good intentions. Try to therefore hold the intent of the person giving you feedback, which is only about making you be even better than you already are. Don’t be defensive. Nod and give appreciative for the feedback.

9. YOUR PLACEMENT/THERAPISTS MAY NOT BE YOUR IDEAL, AND YOU CAN STILL LEARN A LOT. Maybe you really, really, really wanted to do pediatrics, but instead you got a hand specialty. Maybe you have a super stern or um, supervisor with a conflicting personality type, versus the warm/fuzzy one you craved. If there is a true moral/ethical/safety/major concern, speak up to your fieldwork advisor at the school for a potential placement change. If it’s a frustrating/annoying experience, get advice, but realize you are likely in it for the three months if it’s a Level II. You will still learn a lot, even if it’s a lot of what NOT to do, or to work in the face of adversity. A lot of employers ask their potential employees about a time they had a conflict with a coworker, and this will be great for that interview question! Lucky you, right????

10. YOU WILL SOMETIMES FEEL LIKE AN IMPOSTER. It’s okay, we get it. We have all been there. Sometimes we’re still there, when we encounter new situations or change areas of practice. You may feel like you have no idea what you’re doing, but if you are doing it safely, and look confident, and your supervisor, colleagues, and patients are not giving you negative feedback, you’re probably just fine. You will think “gosh, they say I’m doing a good job, but if they REALLY knew how little I know, they wouldn’t say that. I’m just hiding it.” Happy to tell you that you’re probably doing better than you think. Give yourself some credit.

The ten above are pretty universal for all fieldwork students, and the two below are more targeted towards people like me, who have had a long struggle with depression and/or anxiety, and found fieldwork even more challenging than normal, because of it.

11. YOU WILL GET IT EVENTUALLY. This is somewhat similar to the fraud piece. You will likely feel overwhelmed at first, that you will never understand it all, that it’s just way too much, and you will fail. That everyone else can do it, that something is wrong with you, that all your schooling was worthless because you won’t get through the fieldwork. You will be scared. You will be SO CONVINCED it won’t click. But guess what, it will and does. It takes at least a week to start to get a picture of anything, and by the end of the second week you’ll have so much more knowledge than you would have guessed, although a lot of it you may not even give yourself credit for. With every week, more and more scaffolding will help you learn. Unfortunately, at the same time, they’re increasing your independence, so it’s somewhat of a balancing act in terms of anxiety. Keep telling yourself out loud, over and over and over again, whether you believe it or not, that you will get through it. Because you will. It’s a miracle, I’m hardly even exaggerating for once, that I made it through. I’m a great masker, nobody at work truly knew the extent of it. But I did it. YOU WILL TOO. AND IT IS WORTH IT. Because once you’re out of fieldwork, you can go into what you WANT to go into. You can do what feels comfortable, you can work without necessarily feeling like someone is watching you intently, you can start to relax. Which leads to…

12. USE YOUR RESOURCES. This may be your exercise/yoga class, a meditation session or church, a good friend, family, a hobby, the Internet/social media, mentors, textbooks, whatever. Something that gives you confidence in your knowledge, or lets you decompress/relax, or gives you support in whatever form you need. This can also include a psychologist and/or a psychiatrist. I would not have gotten through fieldwork, 100% for sure, without many of these resources, and most especially a psychologist and psychiatrist. Not something I should ideally mention to the world, and many of you people over the age of 35 or so will grimace that I admit it publicly (different perceptions of privacy), but IT IS SO IMPORTANT for people to realize how prevalent it is, and that only happens if people admit it. Yep, I struggled a lot in fieldwork, mostly due to the anxiety disorder. And yes, it was all worth it. And I’ve been a practitioner less time than many of my coworkers because of needing breaks, but I’m on my fourth year now of being a practitioner. And I love, love, love, love being an occupational therapist. And I would do the entire process all over in a heartbeat, even though it nearly killed me at times. IT WAS WORTH IT. If you have passion for the field, and you ARE WILLING TO ADMIT YOU NEED HELP in whatever form that takes (yoga, friends, counseling, any of it), you have a high probability of success.

By the way, I’ve written a little about OT Student fears in the past, and some ways to impress your professors, and if you go to my archives, I wrote roughly a thousand posts in OT school during 2006 to 2009.

Click “Read More” for the rest of the information, which may be helpful to prospective students who have no idea what I am talking about when I reference Level I and Level II fieldworks. 🙂 

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The Inspired Treehouse – OT/PT blog and misc

I saw that AOTA (the American Occupational Therapy Association) posted a link to one of the blog entries done by the Inspired Treehouse, http://theinspiredtreehouse.com/

I checked it out and I loved it. It’s done by several OTs and a PT. Great quick tips. Go see and revel in their awesomeness. 🙂

In other super obvious news, I’ve been neglecting the blog lately. And Twitter. Mostly active on Facebook at https://www.facebook.com/missawesomenessdotcom lately. We’ve had an interesting topic being discussed over there, about productivity units and ethics and how the two typically don’t mix as it pertains to high quality of care.

I’ve had a lot going on in personal life and unfortunately the blog has been somewhat on back burner. Today I spent over three hours tangled in phone trees (guess i need an inspired treehouse) and I was practically in tears near the end of that time as it was quite a frustrating experience. My favorite phone tree is the one that is a pain to navigate, then tells you when you finally get to the right place, that the maximum number of people are on hold right then and to try again later. Which I did. Four times. And a few times a few days ago as well. Augh. I think I have a better chance of winning the lottery than getting a hold of someone at that business.

I’m looking forward to doing some fun blog posts on some Melissa & Doug items that they sent me to try out and write about, and a few other items such as the Spot It game, Ark items, etc.
As long-term readers know I’ve been in the elementary schools for 3 years…now I’m not, and I have several 2-year-olds and several 4-year-olds I’m seeing. I had forgotten how tiring the littlest ones are!

Monster Cheese – Most Popular OT Toy I've found :)

*Video transcript at bottom.

My cheap “Monster cheese” is my number one most consistently popular toy, hands-down, among kids under the age of 10 or so. This has been true for over three years, since I discovered it. Even my former OT kids with poor memories who run into me  months later will ask about him. He’s most requested as a reward, which I love since he is also a great “work out” for our occupational therapy sessions.

He works on bilateral coordination (using both the hands), motor planning (figuring out how to maneuver the hands/fingers to get items into it and then back out), imagination/creativity, silliness (some kids are scared of monsters, but monster cheese isn’t scary!), fine motor skills, etc.

Sometimes I use it in my evaluation specifically because it is a novelty where I know the child has never encountered anything like it, for a motor planning/attention/direction-following/imagination assessment as I show them technique. It also takes a little strength which is challenging for some of our younger children with weakness.

At the end of his meal, monster cheese gets so full he has to throw up. That’s their favorite part. And he can hold a LOT inside of it, with his “hyperflex” material. So we get all our friends back!

The cheese is made by PlayVisions and it is called “Stretchy Mice and Cheese”. I originally found it on officeplayground.com as a fidget. It comes with two big mice. It’s also at TherapyShoppe.com now as a great texture/sensory fidget. But I quickly discovered it was way more fun when the cheese ate tiny objects, and somehow “monster cheese” was born. You can buy the cheese on multiple sites, and Amazon is definitely not the cheapest, but it is the most convenient. It eventually gets dirty because it picks up flotsam. Try to be kind to it. You can wash it with soap and water, and then talcum powder it after to help it not be so sticky . Mine lasted a few years before they got super dirty looking, although are still useable. I just got some nice fresh ones. I use all my tiniest toys (Safari Good Luck Minis, Zinkies, Squinkies, etc) with him. The picture shows Good Luck Minis.

Buy at Amazon for convenience http://www.amazon.com/Play-Visions-Stretchy-Mice-Cheese/dp/B0018KJTBC/ref=sr_1_1?ie=UTF8&qid=1402117896&sr=8-1&keywords=stretchy+mice+and+cheese

or buy at TherapyShoppe to support a smaller store! https://www.therapyshoppe.com/category/P559-stretchy-mice-cheese-special-needs-calming-sensory-fidget-toy

Good Luck Minis https://safariltd.com/products/view/gl-mini-wild-america-fun-pack-349922

In this video, I’m working with four year old Michael, who has now met Monster Cheese several times. He really struggled to feed it the first few times but now he has it down. 

K: Okay. These people probably haven’t seen monster cheese before. 

M: Hey, ninja’s going to be eaten.
K: Nooo not the ninja.
M: He got eaten. The car’s going to be eaten.
K: Noooo.
M: The car is trying to go in this spot.. the car got eaten. Now more’s stuff going to be ate. This balls are going to be ate. Hey the balls got ate.
K: Poor balls.
M: Nader [cars character] is going to be ate…soon…he going to eat all the sticks.
K: I feel like this is a not good day for most of our friends.
M:. Look at these guys….he just ate the ninja….because monster cheese is a bully.
K: Monster cheese is a bully.
M: He’s kind of eating stuff that doesn’t taste good for him, and he tries to eat stuff that’s not good for him.
K: You know monster cheese, we have to have a talk with you about nutrition.
M: No he doesn’t want to.
K: I don’t doubt that.
M: He’s trying to go right through the holes. But he eats sticks all up. He ate a stick.
K: Oh that could be painful.
M: He’s very interesting.
K: I found some cookies. Do you think he would like some cookies?
M: He will. But he can eat this cookie.
K: Can he?
M: Yes.
K: Be careful with that stick
M: He has a stick right in his mouth.
K: Yeah. That probably hurts.
M: That doesn’t hurt for monster cheese. Because he eats every stick he likes…he pokes his whole body up.

K: That’s true, I guess that’s how he had to get holes, huh.
M: He’s trying to get more holes. Oh he’s going to eat this turtle.
K: Not my turtle. Anything but the turtle.
M: He ate his turtle.
K: Rude.
M: He’s a rude guy.
K: He is rude.

M: He eats ….he’s going to eat the dinosaur.
K: Don’t eat my robot friend.
M: He’s going to eat his robot friend.
K: Nooooo
M: Yeah he can.
K: Well luckily I have another one, he can’t eat them both right?
M: Yes he can. He’s eating the robot.
K: Oh no. Maybe we’ll save him later. You think we’ll be able to save them later?

M: He’ll eat all the eyeballs.
K: But I need them to see.
M: No.
K: How are we going to make our eyeballs if we don’t have eyeballs?
M: He’s eating all the eyeballs.
K: This is a very sad day for us, isn’t it.
M: He’s trying to eat all the guys, and now he’s just a ninja pokey.
K: A ninja pokey?
M: He’s a monster cheese pokey.
K: I wonder if the ninja will be able to help everyone else get out.
M:But the ninja’s stuck in the belly.
K: But maybe he can like kick his way out.
M: But he has to tell all the people to get out.
K: That’s true. He has to help them.

M: But he’s eating all the eyeballs so all the persons will get smooshed by eyeballs.
K: (Laughs)
M: That would be funny?
K: That would be very funny. I like that idea. Although it’s a little sad too.
M: But he’s going to eat all your friends.
K: (gasps)This is going to be a rough day, I can tell.

M: He’s getting stuffed. Monster cheese is going to throw up.
K: I hope he does, because I want my friends back.
M: But he won’t throw up, forever.
K: Oh I think I have a trick we can play on him in a minute. Maybe that will help.
M: He will….(indecipherable)….this thing.
K: He looks like he has a toothpick in his mouth, like he’s just cleaning his teeth.
M: He’s just cleaning his teeth with a stick.
K: :(laughs)
M: That’s funny?

*Parents gave verbal/written permission for this video to be shared.
*Youtube gave the suggestion of “Munster Cheese” as a tag AHAHAHAHAA love it.

This is what a good dad looks like. :)

His son is in the “blue ghost” aka body sock, and dad is sooo scared! 🙂 Not the blue ghost!!!!

I love body socks for imaginative exploration as well as proprioception/giving the child a better sense of their own body in space by providing a lot of input. In this case he was crouched down, but when he stands up, it fits tightly against him. If you use one, follow all safety precautions including removing tripping hazards, ensuring he can breathe comfortably, etc etc. (The opening of the sock is on the side facing away from the camera and he had ducked into it.)

*Dad gave permission for the picture to be shared! Best Dad Ever.

Sharpies are your efficient best friend

Put amount on gift card. Cross out and our new balance as needed. I also always forget what is the less drowsy vs drowsy formula of Dramamine when it’s hanging out naked. I sharpie up anything that I otherwise have to keep reminding myself of. Efficiency. Yay.

Why is your name "Miss Awesomeness?"

Obviously because I’m awesome. The End. No just kidding.

This is the story of the evolution from normal me Karen, to having a character called “Miss Awesomeness”.

I’m writing this up in detail partially because people tend to be curious about the name’s origin, and partially so I can address the suspicions of extreme insecurity and/or narcissism that come along with a name like “Miss Awesomeness”, as it’s been pointed out to me.

I was working with a kindergartener (who has requested the name of “Rex” for this story) who could never remember my name. Rex enjoyed working with me and knew me well! Week after week he didn’t know my name and it drove me crazy. Finally I teasingly whispered to Rex that my name was actually “Miss Awesomeness” and then forgot about it. The next week, as always, I asked him my name, hoping for Miss Karen. Shockingly, he remembered “Miss Awesomeness”. We all thought it was hysterical.

Now, the hilariously unexpected part: the name began to spread. If that was the only name that he knew, the teachers/parents had to call me that because otherwise he would stare blankly. It turned out many of my littlest kids could remember that name better than my real one. And it meant other kids heard reference to a “Miss Awesomeness” and were intrigued. And kids went home and told their parents they got to see Miss Awesomeness.

It was as if I were a character, like Cinderella or something. It also helped that I also have always worn glittery eyeliner and glittery hair tinsel, and typically had some fun toys or things with me, so I was somewhat of a kid magnet anyway. I loooove when a child with autism will look me in the eyes to better see my glitter eyeliner, or when I walk out onto the playground to retrieve a kid and their eyes widen at the sun on my glittering hair. Yes, I have the fashion sense of a four year old. I would totally wear a tutu if I could get away with it. I can’t. But I have to work with kids forever, for how else can I rationalize constant glitter and toy buying?

I was working at four schools and the two I was at the most were the ones that had the character name spread. I didn’t go out of my way to teach a kid my name as Miss Awesomeness unless it was with a child who has trouble with memory or motivation or I knew would be amused. It was more just another tool I could pull out if it helped.

It’s gotten to the point that most of the kindergarteners at one of my schools know me only as Miss Awesomeness. I only know about five of the hundred? or so of them, but most of them seem to know me. For some, it’s a casual acceptance (I walk past and they say Hi, Miss Awesomeness), and for others it’s an exciting moment, a spotting, a multiple exclamation point kind of encounter.

I’ve found out in various ways that quite a few kids, who are not on my caseload, talk at home about Miss Awesomeness. I’m still not sure what they could talk about since it’s not like I dance with dragon puppets on tables or anything. Although hmmm, note to self, good idea….ahahaah. It’s the name/character that appeals to them.

I’ve written this story up before I think, but maybe not to this level of detail. A legal mentor just told me that he worries people will hear of a company called Miss Awesomeness and think I’m insecure or narcissistic, and that makes sense. He recommended I rename my company and just have Miss Awesomeness be a character, kind of like Ronald McDonald but hopefully not as creepy.

The thing is, I know when I see a company with a bizarre name, I am amused and intrigued and more likely to use them. I do my best work with the type of people who see the humor in life and don’t take those kinds of things seriously. Luckily, there are plenty of those types of people!! I did seriously consider changing the company name, and got some great feedback for both.

However, as I kept having to call services support or do legal paperwork or whatever for starting the company, I realized how much silliness the name evoked. Most of the support staff laughed instantly. One lawyer kept a straight face when she asked me a clarifying question about trademarking, but as soon as I teasingly asked her if she had been shocked/laughed when she first saw the name, she began to giggle. It also gave me an opportunity to brief people on working with children with special needs. 🙂 Everyone needs to laugh, and it’s especially vibrant when it comes from an unexpected source. I am getting all sorts of business mail now, and every SINGLE FREAKING TIME I see Miss Awesomeness over my name, I laugh.

In conclusion, the name began as a total joke but it spread because it worked – children remembered the name, and it made me/OT seem extra interesting, due to its neurolinguistic effect. I’m happy to admit that at times I suffer from insecurity but not excessively, that I am often not very awesome, and also want to note that anyone who regularly uses social media has at least a smidge (cough) of narcissistic tendencies, so that includes me. But overall, the name is about silliness. 🙂 And so is the company. So. It stays!! 🙂

The things little OT kids say :)

I taught one of my adorable 5th grade girls the meaning of the word “abundant.” She paused and used it in a sentence. “My brother has an abundant amount of hate.”

AHAHAHAHAHA

Advertising tip for bulletin boards: bring your own pushpins

Keep a little container in your bag. When you see applicable bulletin board, have your own pushpin so you don’t have to try and share with forty others. Leave a few too so less likely to have it covered due to pushpin shortage!

Functional Fixedness: Good OTs work to lose this!

http://en.wikipedia.org/wiki/Functional_fixedness

I’ve been fascinated by functional fixedness lately. It’s all about how humans have this cognitive bias to look at an object and its intended purpose, and not necessarily think or realize how it could be used differently. The article explains it a lot better than I do. Shocking, I know.

Anyway, as the saying goes, necessity breeds invention. So true. And in the OT world, a huge piece of becoming a resourceful OT, especially with home visits, is seeing how to use objects differently than originally intended.

Consider doing some exercises where you look at an object and then see if you can brainstorm what else it could be used for. I think this would be an especially awesome exercise to do with OT students!!

For example, it’s classic OT knowledge that there are about fifty things you can do with a phone book in treatment. I often have the children tear out a page and crumble it up within one hand before throwing it into the hungry shark (recycle bin). Or they carry it. Or they look up something. Or its duct taped and used as a foot stand. Etc etc.

What about a hanger. Does it have to hold some sort of clothing or accessories? What else could it do? In one Pinterest pin I’ve seen floating around, the type of hanger that squeezes shut on pants was being used in a kitchen to hold open a cookbook.

I think creative people rarely have trouble with functional fixedness, and the same is true for people with very minimal resources. OTs are also pretty good at losing this bias. I’m trying to think of some good examples but alas, recall is one of my weakest areas, and I’m tired. So. In closing. Marvel at the world and how many people have functional fixedness. I certainly see it a lot in children with autism or similar challenges where they have very rigid perspectives. Pretty much immediately I start trying to tear away at their functional fixedness. You’re a better problem-solver when you have a more flexible approach and that includes an understanding that nothing is as it seems….change the world…make it a better place… ::sways::: ahahahah

The Fires of San Diego, Symbolism, Sadness

The fires here in San Diego are encroaching upon the place I’ve been temporarily staying, which is in Escondido. I’m staying with my mom in La Jolla for now and will lose some things I care about, but it could certainly be worse. I’m waiting to see if it gets an evacuation order. I won’t go back to get anything, too scary and it’s a 40 minute drive and I didn’t bring too much anyway as it was only for 2 months, but it’s hard to concentrate on work when I know the fire is coming so close to that area.

Of course, while from the selfish standpoint I’m worried about my stuff, I’m also sad and worried for all the people, animals, and all life that is affected by these fires. Wishing all well. Oddly, I often think of people who have been burned and the symbolism of their healing postures.

When in unbearable pain, either physical or psychological, our instinct is to curl up into a fetal position. It’s a very primitive action. With burns, unfortunately, that fetal position of comfort is the most damaging, because of the risk of contractures. Their body may heal into that position and then the person can’t stretch anything. They end up in an "airplane" position or what I think of as a crucifix position thanks to my Catholic school background. It’s the exact opposite of the comfort they crave. And yet the open position, the lengthening, the bearing of the body and exposure, is where the true healing takes place, the person has the best chance of functional recovery.

In my journey through a path of psychological healing from chronic trauma (a story coming one of these days), I always think and use this analogy to help me. That while my instinct is to hide, to be fetal, to contort into a closed position that feels most comforting and safe, it’s actually the most damaging. That the healing takes place when I am open, when I expose myself (um, mentally, lol), when I allow myself to symbolically open and be seen.

There hasn’t been many injuries related to these fires, as of yet, and I’ve actually never experienced fires. I wasn’t living here at the time of the San Diego Wildfires of 2007. Yet for years I’ve thought of the symbolism of healing from fires.

I pray and hope you pray (in whatever form that takes), that those in the path of danger, or those who have been, are able to handle their circumstances with grace and peace.