A Day in the Life | School-based OT, Part 3

Today, I'd like to welcome my OT social media idol, Cheryl of OT Notes! If you enjoy reading blogs like mine, then you have Cheryl to thank! As one of the original OT bloggers (in fact, I remember when her blog was the only OT blog I read), Cheryl was a big inspiration to me when I was thinking about starting my own blog, and she continues to inspire me today. I'm so honored to have Cheryl here to share a "typical" day as a school-based therapist.

 

I work as an occupational therapist in the school system, and literally no day and no week are the same! My days can even be wildly different than that of my coworkers, just by the nature of our caseloads.The educational model is different from the medical model in how and why services are provided. OTs in the school system provide direct services and consultation to help students access their Free and Appropriate Public Education. These services are mandated through the Individuals with Disabilities Education Act for students who go through the IEP process, and through Section 504 of the Americans with Disabilities Act for students who do not qualify for special education. You can check out AOTA’s fact sheet on OT in the school system for more details.

My school district employs about 5 full time OTs and 3 COTAs to cover about 45 schools across our county serving about 20,000 students. I have what I consider a fairly large number of schools and students, but the majority of my students are on consultative services, and I do have assistance from the COTAs at some of my schools to help cover direct services. I do my best to keep my schedule similar from week to week. I’m usually at the same school every Monday, for instance. However, if there are meetings, evaluations, or other reasons that services are missed, the schedule will get reworked. I also try to not make multiple trips per week to my farthest away schools, and instead try to sneak in time to see those students if I have to be out at the site for a meeting.

I have a preference for front-loading my day and my week so I have time for paperwork and catch up as the week goes on. The beginning of the year is absolutely CRAZY trying to find all of my kids and find the best time in their schedule to provide their OT. I try avoid all encore/special classes (art/music/PE/band/library), lunch, recess, core classes, scheduled transition times, and other interventions (speech and sped pullouts). I can’t always do it, but I try!

Monday: I head to a local elementary school. This is a Title I school which serves a lower-income population than some of the other city schools. There are two classrooms for students with autism or developmental delays. I absolutely love the staff here and they are really committed to a lot of positive projects to build their school and community. They also treat me well- I have a mailbox, case managers are quick to inform me when there is a change, teachers frequently fill out screening forms when they have a concern, and everyone is friendly.

8:00 - I meet my COTA buddy in the parking lot and we lug in a variety of tools and activities. We get set up in the case manager office/intervention area. We communicate before the day about which IEP goals we will address in which way. There are a couple of slots of individual kids where the other practitioner will type notes to catch up, screen new students, or observe consult students. We try to plan this out at the beginning of the day. We are trying to do a once monthly push in session to the autism classroom, and we work on ideas for this also.

8:30 - we see a pair of preschoolers with IEPs for speech impairment. They are getting OT as an early intervening service (EIS, also known as Response to Intervention) to address fine motor concerns.

9:00 - we see a kindergarten student working on basic skill acquisition as part of his IEP. Sometimes we will pull a peer from a first grade class for EIS at this time as well.

9:30 - The case manager runs a reading intervention group and we write some notes.

10:30 - The COTA sees a life skills student who is working on basic prewriting and self-help skills. This is also the time we will do a once monthly push in group in the autism classroom. Most recently, we did a Dr. Seuss theme where we made puppets and oobleck. We used the oobleck to trace letters and shapes, and the puppets to promote social interaction.

11:00 - We see a pair of second graders who have made great progress. Both have attention difficulties and one has an orthopedic impairment. These kids always make us smile, so we end the morning on a high note.

11:30 - we take a lunch either with the case managers in their room or in the staff lounge with the first and second grade teachers. Occasionally someone will ask a question about a kid but usually it’s pretty relaxed.

12:00 - after lunch, we move our materials to another room so that we can continue to have a space and not interrupt other services. This is better for seeing individual students with autism who need additional structure of the smaller room.

12:30 - I see a student with autism with a lot of supports in place. We use a visual schedule, tangible rewards, and multisensory activities to try to get his best participation. The COTA and sometimes the speech therapist will join me for sessions on occasion to help facilitate the readiness skills we are addressing.

1:00 - I’ve just started seeing an older student who was referred for EIS. We are working on perceptual skills and improving handwriting spacing and sizing.

1:30 - The COTA sees another student from the autism classroom. She has made great strides in readiness skills since the beginning of the year and responds really well to the COTA’s ebullient personality.

2:00 - We finish with our final pairing of IEP students. Both have an orthopedic impairment and so we have a more intense focus on hand skills- opening containers, completing multi-step activities, and becoming speedier with classroom tasks.

2:30 - I spend this time catching up on documentation for the day. I fill in the times or absences on my lesson plan sheets for each student. I write notes for the individual sessions. If I have time or pressing deadlines, I may work on upcoming IEPs or writing reports.

3:30 - done for the day! I pack up my car and go get my son from daycare. Unlike jobs I’ve had before, I don’t ever worry about email or notes at home.

About Cheryl:

I got my Master in Occupational Therapy degree from West Virginia University in 2007 and have been writing the OTNotes blog since 2008. I have literally worked with clients across the lifespan- Day 1 to 100+ years and love the flexibility of OT. I’m loving the speed and stability of a full time school system job in Maryland. I have presented at 2 state conferences and twice at AOTA conferences on online and social media tools related to OT as well as other topics. I will be hosting #otalk2us this fall on school system issues.

Connect with Cheryl:

Blog: OT Notes

Twitter: @otnotes

Pinterest: http://pinterest.com/otnotes/

OT Connections: http://otconnections.aota.org/members/cheryldotot

A Day in the Life | School-based OT, Part 2

It's day two of getting a peak into the life of a school-based occupational therapist! Today, please welcome Heather Brohm! Heather's caseload is unique in that she works with students of all ages, ranging from kindergarten through high school. Read on to see what a typical day is like for Heather!

I am an occupational therapist, working in the public school setting. In public schools, occupational therapy is provided to children who are benefiting from IEPs, or Individualized Education Plans, or, in some instances, 504 Agreements, which refer to the Americans with Disabilities Act. OT falls under the category “Related Services” and, along with physical therapy, speech and language therapy, visual or hearing therapies, is focused on increasing independence and participation in the child’s role as a student. However, the students are not my only client in the schools. I work with adults in the schools as well, including paraprofessionals, nursing staff, other therapists, and teachers, including regular, special education, and special subjects (art, music, etc). 

My days are busy and long! I work with both secondary students – grades 9 to post-graduate, and elementary – Kindergarten to 5^th. I can see both 5 year olds and 21 year olds in the same morning. In both of my schools, I see students in the Life Skills classroom, a self-contained room for children who have moderate to severe disabilities. I also see students who benefit from Learning Support, who need less intensive supports and may be included in regular education for all or part of the day. A typical day for me looks something like this:

7:30 – A whole class group with a Life Skills classroom at the secondary level. We do yoga together 1-2 times a month. I have observed benefits in self-care skills – donning and doffing shoes, vocational skills – wiping down mats, moving furniture, relaxation and self regulation, following directions, as well as the opportunities to stretch and move functionally.

8:00 – Pack up my stuff and move on to the elementary school, as I have an IEP meeting at 8:20. The student’s mother is attendance, as well as the special education and regular education teachers, principal, and speech and language therapist. We review the student’s progress made since the previous meeting, and discuss any concerns, changes in programming/placement, and new goals.

9:00 – An individual session with an older elementary student. We practice a strategy to support self-regulation and self- control, and trial a new, simplified method for recording homework assignments, to increase his self-efficacy and independence.

9:30 – Another older elementary student, this time working on keyboarding and improving his knowledge of basic computer skills.

10:00 – A group of younger elementary students – working on bilateral coordination, visual perception, and visual motor coordination. Today we practice tying shoe laces – what a way to address all 3!

10:30 – A pair of older students from the Life Skills classroom. They are making great progress in OT this year, improving self care skills to button small buttons independently.

11:00 – A younger student from the same classroom. He attends with his 1:1 aide, and we work on his emerging skills – zipping a jacket, writing his name, with lots of positive reinforcement and yoga poses in between.

11:30 – Kindergartner this time – addressing motor planning and bilateral coordination difficulties that impact his independence opening lunch containers.

12:00 – Making sure that I am incorporating suggestions from the vision therapist when designing this second grader’s therapy activities.

12:30 – I grab a quick snack while I finally jump on email. I may have invitations for IEP meetings, notifications of evaluations/permissions returned, questions from parents or teachers, or all of the above.

1:00 – I pop into another student’s speech and language session to check in. She uses AAC (Augmentative and Alternative Communication) and I use this opportunity to consult with her support staff and problem solve as necessary.

1:15 – I run down the hall to consult and check in on other students in Learning Support classrooms.

1:30 – I pick up another student from the Life Skills classroom – beginning our session with sensory input, moving on to practicing clothing fasteners and prewriting practice.

2:00 – Another short break – this time I’m writing my weekly notes home for the children in the self-contained classroom.

2:30 – Another pair of students and a classroom aide from Life Skills for yoga poses and finger plays!

3:00 – Last kiddo of the day, and we are working on a “How to Draw” activity of a popular cartoon to support motor planning, and fine and visual motor skills.

3:30 – I don’t have another IEP this afternoon, so I pack up and wipe down the table and mats. Some weeks I check in with the teachers I work with to see if there is anything they need or if there are successes to share.

It’s a long day, but full of little accomplishments and successes. I usually spend time each night, or on a lighter day, writing notes, IEPs, progress reports, and evaluations. I really enjoy being able to see my students take pride in their work and gain confidence, and working with such a wide range of students, in both ages and abilities, helps keep me on my toes and the big picture in mind. I love OT because it lets me be creative and a problem solver.

About Heather:

Heather Brohm, OTR/L, has been an occupational therapist for 6 year, working in the school setting with children from ages 4 to 21. She creates products for school OTs in her Teachers Pay Teachers store, The Organizing OT. Heather is interested in furthering the occupational therapy profession through a strong evidence base, and is the founder of AValidOccupation.org, a website designed just for occupational therapists. A Valid Occupation is a database of OT resources and references, enhanced with a professional social network of therapists from around the world.

Connect with Heather:

Teachers Pay Teachers: www.teacherspayteachers.com/Store/The-Organizing-Ot

Website: www.avalidoccupation.org

Facebook: www.facebook.com/avalidoccupation
Twitter: @ValidOccupation 

A Day in the Life | School-based OT, Part 1

Today I am excited to kick off a week of school-based OTs sharing what a day in their life is like. What I love about this is you'll see that every school OT has a different "typical" day. Thank you Claire for getting this week started!

Even before I started OT school, I knew that I wanted to work in pediatrics and that I would most likely want to work in a school-based setting.  Our professors urged us to keep an open mind, to consider working with aging adults (most likely because there are many jobs for OTs in skilled nursing facilities, rehabilitation facilities, and hospitals), but I was always knew that it was my calling to working with kids and that I loved being in a school environment.

When I think of occupational therapy and pediatrics, I automatically think of schools...the place where kids spend a huge chunk of their day, the place where they are expected to navigate their surroundings, demonstrate independence and autonomy with learning, interact in a healthy way with their peers, access their tools and belongings, and much more.  This is the stuff occupational therapists’ dreams are made of!

I work in a preschool and primary school building and hardly a day goes by that I don’t see the clear and lasting impact of my work on the way my students are able to participate and function in their classrooms and around the school building.  From the bus to lunch time to recess to circle time - school-based OTs are able to touch kids’ lives in a unique and positive way.

Now, before I get too carried away...there are some things about being a school-based occupational therapist that I didn’t bargain for.  

First off, I work in a closet.  While it is a larger utility/storage closet, it is a closet nonetheless, making it really hard when you want to get kids up and moving for some sensory or gross motor fun.  But not to worry, this is where my other “office” comes into play...the hallway!  We school-based OTs, PTs, and SLPs are well-versed in practicing therapy in school hallways, corners, nooks, and crannies - and we do it with style! Yep, the life of a school OT isn’t all glitz and glamour. But it’s all worth it!

Here’s what a typical day looks like for me:

8:00 - 8:15 Check emails and respond to teachers/administrators/other therapists regarding meetings and collaborations/consultations for students .

8:15 - 8:45 Plan treatment sessions for the day and pull supplies from storage

8:45 - 9:30 Begin treatments for the day with students who need support during the arrival routine (getting off the bus, hanging up their belongings in the coat rooms, starting the day with morning work).

9:30 - 11:00 Treatment sessions with preschool students.  These sessions can be one-on-one with a student, in the classroom with all of the student’s peers, or co-treatment groups with other therapists (PT, SLP).

11:00 - 12:00 Lunchtime treatment sessions with students who are working on goals related to feeding, managing containers and packages, and/or navigating the lunch line/lunch room setting.

12:00 - 1:00 Treatment sessions with kindergarten students or students in the classroom for children with multiple disabilities.  Again, these can be one-on-one sessions, sessions in the classroom with all of the student’s peers, or co-treatments with other therapists.

1:00 - 3:00 Afternoon treatment sessions with preschool students.  

3:00 - 3:30 Treatment sessions with students who need support during the departure routine (putting on coats and backpacks, packing up at the end of the day, changing shoes/boots, etc.).

3:30 - 4:00 Paperwork (writing IEPs and MFEs, billing Medicaid, etc.) and returning emails

Things to note…

Yep - there’s no lunch time.  It is what it is.  Somewhere in there, you have to inhale a granola bar while running down the hallway to see your next student.  I usually bring lots of little snacks to eat throughout the day, but typically don’t get to my lunch until 3:30!

There is also no scheduled time to consult with teachers and parents regarding students’ progress or to pass along strategies and ideas.  And yet, this might just be the most important part of the job!  Most consultation time happens on the fly - before school at the copy machine, after school in the staff lounge, or as you’re running down the hall in between treatment sessions (are you sensing a theme here? :)  Most of my parent phone calls happen in the car on the way home from work or in the evening.

Above all, consultation and collaboration requires building strong relationships and being open to chat whenever you can (even if it’s not the most convenient time)!

There is no scheduled time for evaluations or meetings.  This can get tricky and requires some creative juggling of your schedule.  Many times when things get busy, we create co-treatment groups between speech therapy, physical therapy, and occupational therapy.  This helps open up our schedules a little bit to fit everything in!

The keywords when it comes to school-based therapy are flexibility, creativity, and independence. All of this creative scheduling takes place without anyone telling you where to be or when to be there.  You definitely have to have your ducks in a row (and a steady supply of coffee and chocolate doesn’t hurt either).

Here are some of my favorite ideas for helping kids get ready for school.  And if you’re looking for quick, easy ideas for helping kids with developmental skills - check out these quick tips for child development!

About Claire:

Claire Heffron, MS OTR/L is the co-creator of The Inspired Treehouse, where she and Lauren Drobnjak (PT) write about child development and creative activities for kids that promote healthy development and well-being.  Claire is mom to two funny, rambunctious boys and has worked for 9 years as an OT in a preschool/primary school setting.  

Connect with Claire:
Follow The Inspired Treehouse on Facebook, Pinterest, Twitter, and Instagram to get great ideas for supporting healthy development in your kids!

A Day in the Life | Skilled Nursing Facility

Today I am so excited to have Bill Wong here to share a day in his life as an occupational therapist. You might already be familiar with Bill from his strong social media presence. Today, Bill is sharing what a typical day in his life as a per diem occupational therapist working in a skilled nursing facility looks like. Oh, and he shares his experience of being an occupational therapist with autism. Please read on to learn more!

I had many of my current co-workers ask me, “Bill, you are a young person. You are capable in working full time hours now. But, why are you choosing to work per diem?” My professional reply has been, “I just want some time to do the extracurricular stuff that I want to do.” While this is 50% true, the other 50% is that I want to avoid burning out, like I had in my first job in OT in pediatrics.

Start of the Day

I wake up at about 7:00 a.m. every day that I am working. My goal is to leave my house between 8:00 a.m. to 8:30 a.m. to get to my work place for the day between 9:00 a.m. and 9:30 a.m. Depending on the day, I will spend 35-75 minutes on the road to get to my work. To keep my times relatively consistent, I often don’t go on freeways unless there is a stretch where I can go with little traffic.

Usually I will know where I go for the day from the Friday (or sometimes earlier) of the previous week. However, I will keep my cell phone to my side in the event that I have a call from my staffer at my SNF company. After all, it is possible that I may need to go to another building for the day instead, or have a schedule change due to something emergency come up.

Once I come to work, I clock in and receive my schedule for the day. I looked over my patient’s list to see if there are patients that I am unfamiliar with. I will also check on assignment board to see if these patients also have physical therapy for the day. This is important because there maybe some patients where co-treating is the only option. After that, I will prioritize who I should see for the day. For me, I will do evaluations first, and then complete them right after. I choose this option to work around my working memory deficits. After that, I will try to look at the rehab gym to see if there are patients already there. If so, I will try to work with these patients also. If not, I will go with whoever I can find that are available.

Throughout the Day

How much time I spend with the patient will be the suggested intervention time minus 15 minutes. If the building is bigger, I will subtract another 5 minutes. The reason are because- a) I spend an average of 8-10 minutes per daily note. b) since I am an OTR, I might be expected to write some recertifications, progress reports, and discharge summaries, which can take anywhere from 8-12 minutes per report. c) the patient might want to be seen for a later time than I planned. d) the elevators at these buildings are slow. After all, as a per diem SNF occupational therapist, I am expected to get the daily notes done at the very minimum. If I can get any other reports done, that is a bonus.

If I were to have at least one evaluation, I will go through the patient’s medical chart in about 10 minutes so that I can know important details about the patient- for determining possible appropriate goals, appropriate billing codes for physician orders, and any other vital details for the rest of the occupational therapy team to know. After all,

As for my documentations, to compensate for my short term memory issues, I will do my documentation once for the patients I have seen before lunch, and once after lunch. This compensation strategy has worked well because I know I am minimizing my chances of messing up patients’ daily progress documentations.

Meanwhile, I have to be on my toes until after 2 pm, especially on days where I anticipate there will be many hours of needs in facilities that I can reasonably drive to. After all, I will not be surprised to receive calls regarding working overtime on these days.

If it were a Friday, I will be proactive in calling my staffer to know the buildings I will work at for the following week. By being reliable (yet knowing my limits at the same time), I am able to build a great relationship with my staffer. In turn, I get more preferable places to go for work, especially due to me being proactive. This is important because per diem practitioners are lower down on the packing order for available hours, though they are higher than the practitioners on registry. I am thankful that I don’t work on registry because I would have gotten working hours at facilities that I might not desire as much.

End of the Day

On a good day, I get to start going home by 6 p.m. However, on a long day, I might not start going home until 8:30 or 9 p.m. This will depend on whether I work overtime or not, as well as the number of reports I am expected to finish. In some facilities, it can be a lonely feeling when I am the last person to leave on the rehab team. In other facilities, I might be accompanied by some other rehab team members who stay late. After my work is done, I will drive anywhere from 30 minutes to 2 hours home, depending on the distance and traffic.

Back to Home

I will go home for a home cooked meal. After that, I might either crash straight to bed, or spend an hour or two on social media. The latter is important because I know it is important to continue to grow my social media presence in occupational therapy globally.

What I Have Learned

As an occupational therapist who is autistic, I have learned early on in my career that I might need more mental breaks than my neurotypical counterparts. Yes, I am to a point where I am more than capable to work full time hours. In fact, there are days I am capable to work overtime, which I did not have this ability previously. However, having known what burnout feels like, that is why I choose per diem instead of full time or part time for my career.

I also have gotten past the point of worrying how people might perceive me- as someone with strong knowledge in autism, but choosing to work at SNF. After all, I realize that I need to work with my strengths and weaknesses, as there is no such thing as a perfect occupational therapy job. The fact that I can work in occupational therapy successfully and competently after some initial struggles is a testament of my work ethic and desire to succeed.

About Bill:

Bill Wong was born in Hong Kong and came to the United States with his family as an 11 year old in 1996. Bill received his bachelor’s degree in statistics from University of California, Riverside in 2007, master’s degree in occupational therapy from University of Southern California in 2011, and clinical doctorate degree in occupational therapy from University of Southern California in 2013.

Bill was diagnosed with Asperger’s Syndrome in August 2010. After a year in trying to find his identity in occupational therapy, he decided to establish his specialty in autism. Since receiving his diagnosis, Bill has presented at occupational therapy conferences at state, national, and international levels. Bill has also guest lectured at 8 different occupational therapy masters programs on autism.

Bill’s passion for his occupational therapy career is to be able to deliver occupational therapy presentations to Chinese speaking countries in Chinese and to continue to establish himself as a leader in occupational therapy and autism communities.

Connect with Bill:

Twitter: @BillWongOT
Facebook: www.facebook.com/redshirtpilgrim
Pinterest: www.pinterest.com/bw1628/
TEDx Grand Forks: youtube.com