Pediatric OT group on FB – wonderful resource for occupational therapists

If you are in pediatric OT, or interested, consider joining this Facebook group: https://www.facebook.com/search/keyword/?q=pediatric%20occupational%20therapists

The Facebook group name is "Pediatric Occupational Therapists", it’s got over 11,000 people in it, and surprisingly it’s closed? Meaning you have to ask to join and see the posts, if I understand correctly.

The posts are frequent and typically high quality in the responses/comments (of course it depends on the question as to how many responses you get).

I learn a lot from that group, although the hardest part is the blows to my self-esteem as I see how incredibly knowledgeable most of the posters are!! One in particular, Linda Nelson, is an incredible stand-out with her evidence-based resources. She posts articles constantly. She overwhelms me with her awesomeness. Another wonderful poster is Beverly Moskowitz, who runs realotsolutions.com, and is the inventor of the Size Matters program. She has so much experience and writes very thoughtful posts. Seriously I am overwhelmed with how wonderful the posters are. And underwhelmed with my grammatical ability.

But I figure, perhaps incorrectly, that I would rather post with some unedited writings than only post when I have time to edit them perfectly. Because I would never post if so, this is just a side hobby!

Anyway, I highly recommend this group for ped OTs or those interested.

Halloween Spider

Test to see if this posts via e-mail.

I survived two major OT stressors in a row! Yay

1. I survived four long days in Utah (left day before/day after so really 6 days)! I met all the people in my post-professional doctoral OT program (OTD) and everyone was incredibly nice. Like sickeningly nice. Like amazingly nice. 🙂 Only a few of us (38 people I think?) had less than five years of experience. Many had decades of experience. Some were directors, or long-term managers, or owners of clinics…a very impressive crowd. We all fly in once a semester for a multiple day on-site learning experience. This was the first one. 🙂

The entire visit was phenomenal. Utah was beautiful, and the employees of Rocky Mountain University of Health Professors (RMUoHP) were all stellar. I feel like I’m being paid to write this because it sounds so over the top. But it’s true. Every single person we encountered was friendly and knowledgeable and went above and beyond. Not a whiff of incompetence was found. Of course, meeting the cohort and our professors was incredible. I really enjoyed getting to see everyone’s personalities up close and personal!

Our two program directors seem as different and as similar as can be. They seem like they are an old mostly happily married couple that make their shared life work, even though I get the feeling their personality traits may vary widely. Like that TV couple where one is messy and one is clean? I am thinking Felix and Oscar or something, but that sounds like two men. I’m getting confused.

We also met our two statistic instructor, both having to do with evidence-based practice/analysis/design. Dr. P is absolutely hysterically funny and I think one day she and I will be BFF. Even if it’s one-sided and I just follow her around like a stalker puppy, wide-eyed and pawing at her ankles. I guess I would be a teacup sized puppy. She is French-Canadian and talked about having a cat in her throat. Turns out she meant frog. I love her. She is also good about making statistics feel more or less approachable/doable.

The other instructor, Dr. V, is not as into humor, although she does seem to appreciate it. In other words, she doesn’t hate me. Since I don’t know how to be serious to save my life, she clearly tolerates humor. She is very knowledgeable and she does not mince words. (I feel like mincing words is technically a way to be concise, because it’s like you chop them up. So why is NOT mincing words meant to be conciseness? Am I confused yet again?) I appreciate her style and intent/approach to learning, and she was at times amusing. She taught us a lot about critical appraisal and opened our eyes to how often and how easily abstracts/results/discussions are manipulated. Startling.

I do have to say that I am pretty sure this instructor is not someone you want to mess with. As in, if she ever got mad at me, I would probably instantly jump off a cliff because I will otherwise die a slow and painful death. I know this because there is apparently a researcher she despises, and based on the examples and explanations she provided over the course of our day with her, it was clear this researcher will live in torment until the day he dies. 🙂 I’m kidding, of course. I think. I hope.

Trying to teach statistics to post-professional students, some of whom (grammar?) have not been in school in like 20 years, is like trying to teach ducks how to sit in a row on a tightrope. There are a lot of falls and a lot of heads smashing into things. Mostly its the instructors smashing their heads into walls though, not so much the ducks. Us ducks just fall, look stunned and confused, then shake our heads and waffle our feathers. I hear teachers have a high rate of alcoholism, and I wonder how many of them taught statistics to students of social sciences. There is a reason vodka is called "teacher water"!!

No seriously. I loved loved loved my cohort and instructors in real life. I loved loved loved the people at Rocky Mountain, and the views of Utah from campus were stunning.
Oh, and the other two highlights? One was meeting Jan who does the distance learning technology components, and she is an incredible and fun woman devoted to helping us "learn how to learn" in a distance education model.

The other was meeting JOY, the medical librarian. She is aptly named. She is quite possibly the funniest person in the entire world. She is the other person who has to be my post-graduation BFF, again it’s fine if it’s one-sided. I will follow her around like a teacup puppy as well. But I guess I will have to clone my little puppy self first since I can’t follow around two people at once. I have to also be a puppy with thumb opposition, since I have to write down everything they say. So I think this stalker-teacup-clone-puppy-with-opposable-thumbs plan of mine is becoming increasingly unlikely.

Joy is from the South, and she has the honeyed accent to prove it. She’s smart as a flagellated whip and every cell of her body is filled with sass. She knows how to correctly assert the librarial power of her glasses/bun combo. But she’s an adorable blondie so the whole "mousey" part of the stereotype doesn’t apply.

"Remember the bun," she would assert, pointing at it while fixing us with a steely glare. Our eyes would widen in fear at the thought of ever doing something wrong, like forgetting the PMID number in our article requests. She was a crack-up, and everything is always exaggerated when a slow drawl is involved.

Overall I would say that I love my RMUoHP program for the post-professional OTD. I wasn’t sure what to think as I hadn’t met anyone who had done their program. I am relatively sure it is not as rigorous as a program run by some heavy hitter in the AOTA world, like Karen Jacobs (Boston I think?).

There are some pretty high-profile OT celebrities and I bet their programs are insanely challenging. I don’t know for sure though since I don’t know how to compare it. And different programs have slightly different lengths depending on how they structure it, ie how many credits a semester. Our program is plenty challenging in lots of ways, although academics are a strength for me, so doesn’t feel that horrible. The time it takes is the biggest issue.

I do know that if I were working full-time with a family, that this program would throw me over the edge. A LOT of the people in my cohort are in that boat, and I am so impressed they are surviving.

I have the energy capacity of a 90 year old, so I get tired just thinking about their lives right now. Anybody who can do a post-professional OTD while working full-time is a superhero in my eyes. So apparently there are a lot of superheroes out there.

I have pictures from the trip, but my blog is being weird. We had to increase some server stuff (don’t ask me the technical details, I just do the social parts!!) and now the pictures bounce. I have posted several things lately that I then had to go back and turn into drafts, because the pictures didn’t show up. 🙁 Grrr. It’s in progress.

The other major stressor I survived, was that less than a week later, I presented at state conference to over 200 OT Students. It’s Tonya’s fault (therapyfunzone.net) as I was her co-presenter. She is amazing too.

It’s funny that I can do what many others can’t, stress-wise, like present in front of hundreds, and work on a doctorate. Neither of those are THAT stressful to me. Yet what normal people do every day, like get up and go to work all day, and do basic and instrumental activities of daily life? Kills me. I freak out. I get overwhelmed. I panic. A lot of it at this point seems to be sleep-related, so we’re working on figuring that out.

Speaking of which, it’s nearly 2am. I’ll have to talk more about the presentation soon.

In conclusion. I survived two big events. They were major tests of my current stress tolerance, and I passed. 🙂 But I have to work on better tolerating the daily stressors. In more conclusion, I love my OTD program. Ask me again tomorrow though when I finish a few assignments. AHAHAHHA

The End.

APA Formatting in Word

APA Format Hanging Indent for References

This is a 45 second screencast I made that just quickly shows how to do a proper hanging indent (for APA style references in Word document) in Microsoft Word 2011 for Macs.

Don’t forget you can also search the Help toolbar in Word, Google (which brings up the tutorials that Microsoft Word has on its website), and Youtube, for help.

I’m having to re-learn all these APA pieces for the post-professional doctorate of occupational therapy program (OTD), because I last did these things five years ago! Many of the post-professionals in my cohort are a little older and are learning the APA formatting in Word for the first time, so I’m trying to help out where I can with mini screencasts like the one linked above. I’m not great at it myself, but I can usually figure it out with some searches on Google.

The in-person component of the OTD program!

There are many post-professional occupational therapy doctorate programs (versus entry level), and I think the vast majority of them are online. However, some have an in-person component at least once a semester. I chose one that did, because I hear that it is really helpful to meet your cohort and professors. It helps you learn who everyone is, and better appreciate their input and collaboration.

I have now spent five weeks in my OTD program and have encountered all the names of different people, but I cannot keep them straight to save my life. I know that there are quite a few men in the program (semi unusual in typical OT world), and that I don’t have much experience in comparison to most of my cohort. Many of them have been in practice 20+ years and are managers/directors. A surprising number of them seem to be school-based. Only three names so far have stood out to me. Let’s just call them Anna, Banna, and Danna.

Anna is always the first to post on every forum and I know nothing about her, but I know if I see a single posting on a newly opened forum for that week’s work, that it’s her! I can’t figure out how she does it!

Banna is a therapist in the “small world” category who knows one of my former fieldwork supervisors and lives in Tennessee where I used to live. She has ten trillion years of experience and very quickly emerged as an outstanding engager/encourager.

Danna is a sweet and enthusiastic younger therapist (I think), who has tried doing some affirmation writing with her students after I brought it up, and I can tell by our interactions that we have some similarities in our mindset.

There are tons of other great people, I just haven’t had their names pop out at me. Because there is no scaffolding to any of these people (in my head that is), I haven’t been able to link their information to a name, and even though I’ve seen their name and info in tons of forums, I just keep not attaching it as data about the person. They should require us to write a quick biography, with a clear picture, that we all get a copy of in one accumulated file! Because we all wrote one in like four different forum spots, but it got confusing quickly.

So, now it’s time to go meet everyone! (Hey, robbers: I don’t live alone, sorry.) The last few days have been super stressful trying to catch up, and I’ve been overwhelmed, but I know everyone is. And I am proud of myself for not “shutting down”, and doing my best to get on top of things. I worked hard to preview and plan for all my typical anxiety triggers, and got a lot of resources (internal and external) to help me handle the energy conservation components.

I realized, for example, that on Wednesday night, there is a big dinner reservation at a local restaurant and I had said I would go. But when I thought about it, I realized that with my fatigue issues and how much anxiety I expend on such a dinner (getting there, interacting with everyone socially in a large environment, the challenge of dividing a large bill correctly, and the drastically decreased amount of time to rest), that it will overdraft that day’s energy budget, and I will be at a deficit for the next day. So I won’t go after all.

I did bring my hula hoop, all coiled up for travel, but it’s a little big for my bag so cross your fingers that it’s not irretrievably warped when I get there. Very good for stress relief/fun. 🙂 I wanted to bring a giant one, but even coiled it was way too big for my suitcase.

This is kind of like a business trip, and I realized today that I’ve never been on one! They want us to dress business casual and I had to go back and dig through my closet to find some. I was trying on clothes this morning and it was very Goldilocks. “These pants are too small…these pants are too big…these pants are juuusttttt….more or less….right.”

The woman next to me in the airport just commented on her missing daughter and said, “it must be a long cigarette she’s smoking.” AHAHAHAHAAH yikes.

My plane is running late – was supposed to join a few others on a shuttle, but it’s not looking good. Oh well, hopefully it will work out! I already took the less drowsy Dramamine – the 45 minute shuttle ride will otherwise be an issue. I love Sharpies, because I always get confused as to what Dramamine is drowsy versus not drowsy when it’s not in its original box and is just in the silver poppies because its just the ingredient. So I Sharpied it on the silver poppy and that made my life easier today. ::beams:: Also fun to sharpie gift card balances on the gift card.

Okay I don’t have ADD but I am bouncing around. Because I can. And wow, really I should be studying right now. So I will stop writing this insanely long message. All I can say is, I know I will be glad to meet everyone, and I also know it will be a major test of my functional capacity these days!

Update: Made it to Utah and am in my hotel room. Unfortunately there were some delays/misses but alas, alas is well. Time to look at stats ::whimpers:: 🙂

Where's Waldo? But for Science – How Online Volunteer Programs can be used in Occupational Therapy

http://www.cnn.com/2014/09/30/opinion/sutter-wildlife-crowdsource/index.html?hpt=hp_t3

This article had some great implications for occupation-based therapies. Possible assignment for fieldwork students at bottom!

ARTICLE: Where’s Waldo…but for science” by John Sutter.

The article explains how an innovative program in Africa is being used to prevent poaching of rhinos and other wildlife, using a Where’s Waldo? approach. A drone takes pictures of the land of a wildlife refuge, and then the program coordinators has online volunteers sift through the pictures and circle any animals they find. They are called “digital rangers” and it was a way to quickly do a land survey.

My favorite part was the picture and caption. It shows an overhead land shot, with five clearly defined animals in the picture. The caption says "There are five oryxes in this photo. Can you spot them? If not, please don’t volunteer with this project.” It made me laugh. I attached the photo here, which came from the linked article.

The article made me think about how being a “digital ranger" would be a fabulous occupation-based method of working on important skills. While the book "Where’s Waldo?" may be appealing and appropriate as a play-based modality for many of our kids, it can be insulting to some of our older clients, or in my case, overwhelming.

However, as an adult, working on important skills via contributing to an online volunteer project aimed at conserving wildlife? Pretty Awesome. You get to work on problem solving, and scanning, and attention, and figure/ground, and all sorts of great yet often challenging skills, yet in a highly motivated state. (And could be done with the occupational therapist present to ensure accuracy!)

I also think many of our kids would prefer this type of task to the Waldo book, as primarily the kids who like Where’s Waldo? are the ones who least need to work on those skills.

Unfortunately, I believe this particular example was not open to the public, but the implications are far-reaching in occupational therapy. I’m realizing there are probably tons of projects that request online volunteers. For projects that allow the volunteers to spend as much or as little time as they want, the OT could sign up as an online volunteer and then work with appropriate clients in short bursts of time. I think Google Earth may have some.

Also, www.freerice.com is a brilliant site that allows you to gain knowledge while simultaneously giving to charity. For example, if you play their vocabulary games, each correct answer gives a donation of a few grains of rice to a charity. It can add up, and they have expanded to have many different learning games. Check it out.

Can any of you think of sites that ask for online volunteers? Or sites that allow you to gain knowledge while donating to charity? There are just so many possibilities. Maybe one of these days a fieldwork student could spend some time searching for online volunteer and charity opportunities and post a list to OT Connections. I was thinking it might be a great task for patients who have had traumatic brain injuries.

So……OT students or occupational therapists….assignment. Find online volunteer and online knowledge/charity sites, and share them!

Hair straightener/flat iron as iron?

My friend Elle told me she uses her flat iron to deal with wrinkly sleeves/collars. A lot of people (mostly younger) don’t even have irons anymore. Granted I can’t do my entire curtains this way, but the edges were particularly wrinkled!

Use at your own risk and be safe. Don’t burn your house down.

It seems to me like an energy conservation technique – to just quickly use your flat iron for a sleeve or collar and not pull out the heavy iron and such.

Be careful, buttons/zippers/accessories would likely melt, and like I said, do at your own risk!!! A cool life hack if you don’t set anything on fire while using it. 🙂

The importance of sensory play

I brought an apron with me to a client’s house because I knew we would be playing with whipped cream! I chose the whipped cream over shaving cream so that some tasting could take place. I bought the can of cream before the session and we used up the entire thing. We put plastic finger puppets on top of the canister, we drove cars through it, we got some plastic bugs dirty enough to need baths…

The child has a lot of tactile defensiveness and I was determining how it would affect typical play. I wanted to see if he could be coached into participation via modeling, distraction, slow exposure, or what, so that I could educate the family on how to approach this type of play. Children learn a lot – and get a lot of input – via exploring their environments, so if the child doesn’t have a willingness to get near new textures/sensations, it will affect their ability to learn how their hands work in differing situations as well as cause/effect/characteristics of items, and much more.

There are PLENTY of children who have issues with tactile defensiveness regardless of parental intervention.  Yet I’ve  noticed that many of the children who show signs of tactile defensiveness are being raised by parents who also dislike getting their hands dirty or have never thought to do sensory play. Sometimes educating the parents on the importance of sensory play, pointing out the similarities between parent/child, and/or showing them the strategies of exploration for a hesitant child, is enough to make a big difference in a child’s willingness to participate. Also, letting them know that children who are tactilely defensiveness typically do much better with firm pressure rather than light touch.

Does anybody have any favorite types of sensory play? I love water beads.

Started the journey of getting a clinical doctorate in occupational therapy (OTD)!

I started my post-professional clinical doctorate program on September 2nd. It is an OTD (Occupational Therapy Doctorate) through Rocky Mountain University of Health Professions based in Provo, Utah.

It can be confusing to understand how doctorates work. Essentially clinical doctorates are used in actual practice. Doctors of psychology, optometry, dentistry, physical therapy, etc, are NOT actual MDs. They have a clinical doctorate like DDS, OD, PsyD, etc. Which is what I am getting as an OTD. For all of those areas, excepting perhaps psychology, most of them do not have PhDs. If they do have a PhD, it is in addition their clinical doctorate, not instead of.

Even in psychology I believe that most either have Masters or a PsyD (clinical). Many of these doctoral degrees can be entry-level (typically after a Bachelors). Meaning  the student has no actual practitioner experience and is starting from scratch.

However, there are plenty of practitioners who go into a post-professional program, which means we have been in practice for usually at least a year and typically 5+, so we have a lot of experience that guides our doctoral degree.

Most of the post-professional versions, at least in OT and probably most programs now, are primarily online. We all have our Masters (or older practitioners may have been grandfathered in through their Bachelors), and have been in practice for likely many years. In other words, many of us are established full-time practitioners with families. We have a very different level of experience going into this program.

At this point the next step is all of the scholarly work of research, writing, analysis. etc. At this level of schooling the professors are typically providing guided learning, not a typical lecture style where we are taking in basic information.

Getting a doctorate was not in my plans, at least not now, but as I describe later in this post, I had good reasons.

As I went through the orientation modules for this program, I was quickly humbled at how far technology has come for distance learning. I graduated from my Masters in OT program in 2009, and even back then distance education was not nearly as rigorous as it is now. But five years is a LONG time in the technology world. Back then people thought of online learning as the “University of Phoenix” style jokes. And now that I say that I may hear from angry people who had a good experience with that university. I don’t know anything but the stereotype that it was essentially a way to pay money, do a small amount of work, and get a degree. Please let me know if I am wrong (I certainly have not explored the evidence on it, this is completely hearsay!)

All I know is, I think some people still get skeptical when they hear of online programs. But these programs are rigorous, and interactive, and as I said above, humbling. I’m 32 and I was a very early adopter of technology. I started WORKING online when I was 13, way back before child labor laws and child protection laws were in place. (The labor wasn’t an issue – the protection was.)

And yet even with my familiarity with online work, more so than most people my age, I’ve had a lot of technology learning to do for this program! Wow. I am really impressed with a lot of the older professionals in this program, many of whom are NOT very familiar with online learning. To throw in a major tech learning curve on top of trying to do a doctoral degree while working full-time and taking care of a family? Wow. That’s discipline.

I used to think about doing a PhD, but realized that since I don’t have any strong interest in research or academia, it wouldn’t be a particularly enjoyable journey. I do love teaching, but not on the formal level of lectures of theory that students need to know for a test. And I love getting other people to research things, but I don’t want to do it myself.

I wrote another few pages about why I am doing this program now, and then I get hesitant about being so publicly transparent. I go back and forth on how much to share. I cut out those few pages and put them on my computer in case I decide to use them sometime later. I have shared in earlier posts that I have a very long history of depression and anxiety so I guess I can repeat that part. Some of it may be neurochemical, but most of it is based on over a decade of secrets (some of it thanks to that online world), and therefore a lot of pain.

I was relatively functional when I ignored it all, but it took a lot of energy to always wear a mask that made me look fine. It was exhausting and I paid a heavy price. As the years went by and the secrets continued to compress my soul, my weariness grew, and the darkness inside got so dense it felt like I was turning into a black hole. I was walking oh so perilously into Robin William’s world.

I crashed. Sometimes you have to hit rock bottom to get the momentum to (start to) bounce back.

To make this incredibly long story slightly shorter, and to not get too intimate, I had to fight. But even if you have a machete, you have to be in the thick of it to thin it! Wow I think my word play is so clever…hahaha.

So while I’m dealing with the fight, I haven’t been nearly as functional as I was when I ignored it all. But I also wasn’t okay. I’m better off now, with much more limited function, than I ever was before. Because now I at least know there is a light inside of me somewhere, even if I can’t see it. And sometimes I glimpse it, and sometimes I feel it. I’m just starting to feel better, but I struggle with feeling like the sky could fall any day now, where I wake up and the heaviness is back. It’s happened many times before, so it’s a legitimate fear.

Even doing better, I can’t tolerate much these days, and I will likely not be able to do full-time direct service again (or any job with a schedule controlled by others). I am introverted (I can still appear outgoing, but it’s draining), I don’t like unpredictability, typical work schedules are nearly crippling, and I have always had dread every time I’m about to see a client, no matter how much I love them and feel confident in my therapeutic ability. It’s not obvious because I am very, very skilled at wearing a mask when necessary, which has been at least half my life. Only in this last two years did it get increasingly impossible.

I am only working a few hours a week. I spend a lot of my time getting help in kind of a customized outpatient program.  But I’m making progress. I am doing this doctorate as a form of vocational rehabilitation so that I can stay within the field of OT even if I can’t do much direct service. Because it’s online (minus four days a semester), there is wiggle room within the modules to have off days, and the schedule is mine (often I work best late at night).

My goal with this “vocational rehab” clinical doctoral program, which is a lot less stressful (academics are my biggest strength) than direct service, is to find a way to stay firmly entrenched within the field of OT, but in ways that cater to my strengths and do not require a direct service model. I would love to keep a few direct service cases a week no matter what, but I am hoping to build up a curriculum for elementary schools as this doctoral program’s capstone project, or similar types of products, where I can work my own hours and have a lot of time for off hours/off days. I also hope that I will eventually be more up for furthering the Miss Awesomeness business cause of a more mainstream community empowerment model through the developmental knowledge that OT has provided me. Doing a presentation causes me less stress than direct service, weirdly enough.

The point of sharing all of this is that I want to get back to blogging. Some of it will be more typical blogging and pediatric-based, but some of it is going to be the journey of getting a clinical doctoral degree in occupational therapy. A lot of it will just be the “neurotypical” journey of getting an OTD, just like I did with my Master’s program where I rarely said anything about the mental health struggles. But sometimes, when it’s affecting me (which I anticipate being less and less), it will be acknowledged as a factor.

I have thought about doing this as a separate blog called 296.33, OTD, or something similar. (The ICD-9 code for depression for insurance purposes is 296.33 and I liked how it rhymed with OTD!)  I got feedback from many mentors and they varied in their opinion.

I know many, mentors or not, will disagree and feel I’m harming my future with this decision, but I need to do it anyway. I don’t want others to feel as alone as I have felt. I’m keeping it on the Miss Awesomeness blog for now, but may switch it over to  and delete any current entries. But maybe I’ll keep it here, and just show that it’s okay to be un-awesome sometimes. 😉 However, I am going to compromise and not share as much as I would like to, and keep it at a more formalized level (as formalized as you can get with vulnerability and transparency).

The good news is, even when frequently at varying low capacities, I’ve done a lot in the field of OT. It’s just that at full capacity, I can do so much more, and I know my potential. And I know 100% for sure I will be successful, and that I’m healing, and that the light is there. The journey will remain rocky but I’m learning how to anticipate the obstacles and dodge most of them. I still need a lot of support and am not able to do as much as I would like in the real world, but that’s slowly changing.

The singer Ingrid Michaelson has a song called “Keep Breathing” with a lyric in it that says “I want to change the world…instead I sleep.” See the video below.  That’s been me for a long time.  Now I’m ready to change that lyric to “I want to change the world…and I have started the process.”

This link goes to the song on Youtube. I couldn’t figure out how to embed it because the code kept showing up rather than the video.

Keep Breathing by Ingrid Michaelson

Imaginative play is cognitively enhancing

I saw this status on my Facebook feed and it made my day. It was written by one of the 3rd grade teachers at a school I previously worked. She had overheard her daughter, a vibrant and enthusiastic elementary schooler, exclaim, “Yay! A free box!” I LOVED THIS. We have so many children now who get exactly the toy they desire, rather than having to use sticks as swords, or use their imagination with empty boxes. Imagination and creativity are vital to a mentally flexible and entrepreneurial, problem-solving mind. Play-based learning, especially with items that require imaginative thinking, is so important, and so many caregivers forget that.