Week 2, Day 3, OT Pediatric Level II fieldwork placement

Is it sad that it is 8:15pm and I am so ready for bed?

Today was somewhat of a stressful day. There was some miscommunication going on yesterday that I feel I contributed to, involving the OT tech and some expectations about a chore, long story, but the bottom line was that it stressed out the boss, which meant it stressed out my OT, which means it stressed out me, LOL. I got to see four kids back to back today which was a little challenging. I saw the two girls of the triplet set for 30 minutes and we made french fry people (what I meant to do with them Monday but they couldn't come), to practice coloring, cutting, and gluing. Then we worked on some other table-top fine motor stuff. At one point I let the girls up for a minute and it was a mistake because it took longer than I would have liked to get them back settled. The little things you learn!

Then it was time for the little boy who is nonverbal with gravitational insecurity. He is very low level. We spent a lot of time in the ball bath and did a few tabletop activities, but he is easily frustrated, and honestly his gravitational insecurity is his biggest issue, so it was okay to do a lot of gross motor things that work on building up his sense of self. I challenged him several times VERY mildly by putting him in my lap to swing or bounce on a ball. In all cases he would tolerate maybe 15 seconds but it's a start. Near the end when another girl came in (my next client), he actually did AWESOME….the OT was doing some cleaning and had found a tunnel that the boy wanted to play with and it ended up in the ball pit. Now I personally have claustrophobia issues and the thought of being in a tunnel PANICS me….especially a tunnel in a ball pit. Like it seriously makes me sick to think about. But oddly enough this little boy had a great ol' time in the ball bath in the tunnel, throwing balls around and peeking. I was hovering nervously in case he got scared in the middle of the tunnel and needed help getting out, because I personally would have gone PSYCHO…but he did great. Very surprising considering his issues. He's only been coming a few weeks but there is already a big difference in his ability to tolerate things like the ball bath – at first he was scared to even get in it.

Then the girl client had her turn with the ball bath and tunnel thing and then we did a lot of table-top fine motor, which she hates. She has Down syndrome and has classic work avoidance behaviors and can be quite challenging. I have a hard time discipling firmly and threatening things like homework/time-outs but when the OT interjected, she ended up with homework and it REALLY pissed this little girl off. She was horrid for the next few minutes and got threatened with a “spanking with a spoon” several times by her mother, since it was the end of the session. Anyway, with the exception of the last little girl, it went well, and I really really need to work on my firm disciplining behaviors.

Then we left for the tiny town in Mississippi. Those of you that know me know that I ***HATE***** driving other people's cars, ***HATE*** driving in unfamiliar locations, HATE driving in the rain, and more or less hate driving period. Well, due to several odd events, I ended up driving my OT's car to this town, so everyone of my hated events occurred. Luckily it wasn't that bad, straight roads with little traffic. It was the director in one car, me and the OT in the other. We ate at a tiny place on the square and then went to do our home visit with the baby that is deaf-blind. This time the director didn't join us as she had other errands, and so she directed us. Unfortunately neither the OT or I realized her directions were slightly vague until we were lost..we didn't have a street name or the name of the projects or anything…just a vague recollection of what it looked like from the last visit….so we ended up going down each street in this one area and the director wasn't answering her phone and it was like AUGHH lol. Eventually we stopped a policeman and the OT fumbled with asking him about um, the projects. She was like um…I'm a therapist and I need to work with a kid who um, lives in some projects….there are apparently 3 projects in the area and we got it narrowed down…turns out we had just barely missed the right place to go because it was a little confusing. It was funny, trying to figure out what to call the housing projects. Neither of us were sure if projects was a derogatory term. I'm pretty sure the cop thought we were insane, not having the name of the projects or a street or anything…but since we had been there before we didn't realize we'd have so much trouble. LOL.

We walked in with all our toys and my OT did therapy with the deaf blind baby, who tolerated a lot more sensory stimulation than before…a lot of vibrations and oral motor desensitization. It's important to stabilize this baby carefully so that she feels secure boundaries and can focus on other things like sensory stimulation. Like I'd cuddle her in my arms giving her as much feedback as possible on her body so she could be assured of her position while the OT worked on her mouth with a toy.

Then it was time for a chaotic evaluation involving the early intervention social worker + the director + me and OT. The woman had brought two 1 year olds, cousins, and they were a MESS. One of them basically ran around with his pacifier, falling down and throwing things. The other one had a slightly greater attention span, but both only screamed as their form of communication, both were easily frustrated, and both were delayed in their skill levels. It's amazing the various abilities of kids – just in the few minutes we were there the second kid with the attention span learned to pick up small toys with tongs as well as unzip a zipper. At one point one of the cousins got near the other cousin, and that cousin pushed him down into a table. As the child screamed, the woman said mournfully “You have to learn to fight back”…ack. Probably the toys we use most in order to determine skill level are crayons/paper, blocks, a basic puzzle with peg pieces, and a ball.

Then it was time to head back to the clinic, in the rain…the office drama of the day was rehashed some and finally we left around 5:20pm. Phew. I'm tired! Tomorrow is an 830 to 7pm day, augh. I'm not sure I'll survive it. Plus I think I have a bunch of kids scheduled tomorrow. Luckily Friday is a short day, which is good since I have a hair appointment and a babysitting job. 🙂

I've heard some stories from my fellow OT students about their fieldworks and they are all mostly really hilarious, with a few really sad stories as well. One of my friends is in a pediatric psychosocial setting and she talked about how this one child, who had been sexually abused, would freeze and look down with despair whenever they tried to work on basic dressing skills. 🙁

Other stories were more along the lines of veterans saying or doing funny things (like wandering in for groups just for coffee, then claiming a restroom break to avoid actually joining the group, multiple times a day). One girl has a really awesome but really hard OT who gives her hours of homework nightly.

I'm trying to think of some of the funny stories we've heard but honestly my mind is blank and/or they were the type of story where “you had to be there” facial expression wise for it to be amusing. Hmmm.

I guess that's it for today…seeing a bunch of patients back to back was hard but I think I try too hard to do lots of things – tomorrow I'll try to be a little slower and maybe not end up getting so hot! And then if I can just get through tomorrow, I can handle Friday easily and then can recoup this weekend, phew. That will mean two weeks down, 10 to go. 🙂 I like my placement and I like my people, but I don't like wanting to go to bed at 9pm every night! LOL.

OT was asking me today if I feel like I'll learn a lot. The answer is mostly yes –  learning office dynamics, Medicaid basics, billing/insurance, juggling back to back patients, dealing with parents, interdisciplinary communication, etc are all great skills to learn about…and I'm definitely gaining tips and tricks for dealing with kids in terms of discipline and/or things to do/not to do (although i feel I had a really strong play therapy background compared to most after years of doing it 2-3x a week with a special little girl)….so yeah overall I'll learn a lot overall I guess. 🙂

Okay, good night!!

Jul 10, 2008 | Category: Occupational Therapy | Comments: none