FAQs: "What is an occupational therapist anyway???"

I do sincerely apologize to my blog readers for the very long break in blog entries. First came the holidays, then when the new year began I became very busy because I began a new job. I still am working full-time at the job I’ve had, but I’ve taken on an additional part-time job. In addition to my work at a pediatric therapy center (through which I work at a clinic every weekday afternoon/evening and am contracted out to a public secondary school two mornings per week), I am now also working two mornings per week at a special needs school. There, I work primarily with children in the school's preschool program. It has been a great experience so far, but it has taken a few weeks to acclimate to my new much busier schedule. So, once again, apologies for neglecting my blog.

I realize that a lot of my blog readers are not occupational therapists themselves. A lot you readers are people who do know me in real life, and kind of sort of know what it is I do, and have heard me try to explain it, but as readers who ARE fellow OTs know, summarizing what we do in any kind of concise way that can lead to any real understanding of our profession is almost impossible! I’ve been told many of my blog entries so far has contributed to my non-OT readers’ understanding of what OT is and what pediatric OTs do. So I decided to expand on that and write a blog entry giving my best description of my profession to help with my readers' understanding. I’ve decided to do it as a “FAQ”. These are real questions I’ve been asked when I’ve said to someone that I’m an occupational therapist. Most of these questions I’ve heard several times, as has basically every OT I know! Here are my answers.

The OT Slogan

Question: Is an occupational therapist someone who helps people find jobs?

This is one all OTs hear rather often, and always produces a collective groan from the OT community. A very common misconception is the meaning of the word “occupation.” In colloquial language an "occupation" refers to someone’s job, but an “occupation” refers to more than just a job. Occupations are what people do to occupy their time that is meaningful to them, and/or required of them. For you, your occupations likely include: activities of daily living (ADLs) (ex: dressing, eating, bathing and toileting), instrumental activities of daily living (IADLs) (ex: cooking, cleaning, pet care, and child care), your job, driving and/or navigating public transportation, and what you do for fun (such as participating in hobbies or meaningful leisure activities). Occupational therapists assist when people are unable to participate in, or have difficulty successfully participating in any of their occupations because of various barriers (including disability, disease, injury or mental health issues).

Question: What is an occupational therapist? What does an OT do?

Occupational therapists are professionals that assist their clients to overcome barriers to performing their daily occupations. This may involve assisting clients to: develop or improve necessary component skills for successful performance in their occupations; develop compensatory methods in the process of developing the component skills, or when these skills cannot improve (such as in the case of a permanent disability affecting the ability to develop the skill); adapt the task to accommodate for the client's current abilities; adapt the environment to promote the client's success; and most commonly occupational therapist use a combination of some or all of these methods for each client. An OT's overall goal with a client is to help him or her to become as independent and functional as possible, participate in meaningful occupations, and experience a high quality of life.

Question: What does an OT do with kids? Kids don’t have jobs!?

Children don’t have jobs, but children DO have occupations, For children, common occupations are: participating in ADLs (dressing, eating, bathing, toileting); being a family member and functioning within his or her family environment; playing/engaging in leisure; and being a student. Barriers to being successful in childhood occupations that pediatric occupational therapists treat include:

• Sensory integration/processing issues
• Developmental delay or disability
• Gross motor delays
• Fine motor delays
• Muscle tone abnormality
• Poor endurance
• Retained primitive reflexes
• Learning disabilities
• Cognitive impairment
• Physical disabilities
• Acquired injuries
• Behavioral issues
• Attention/focus difficulties
• Motor planning or praxis difficulties
• Visual perception and/or visual-motor integration difficulties
• Psychosocial issues

Question: Occupational therapy? Is that like physical therapy?

This is a question OTs get all of the time, likely because physical therapy has more mainstream recognition and most people understand the basics of what PTs do, but many people have no idea what OTs do. For those that can recognize a difference in the professions there is a stereotype that PTs rehabilitate from the waist down, and OTs from the waist up. Another stereotype that is out there is that PTs address gross motor skills, and OTs address fine motor skills. While these stereotypes aren’t entirely unfounded, they’re not entirely true either. Occupational therapy (OT) and physical therapy (PT) are both considered “related services” and often work in similar settings and with similar populations, but we are very different professions with different theoretical bases. Physical therapy rehabilitates a client when there is a physical problem that exists. Although OTs do that too, our treatment is always directly related to daily life functioning and ability to participate in daily occupations. OTs never have clients perform non-function based exercises merely for the sake of making a body part stronger or more flexible. We may do similar exercises as PTs if there is a physical problem limiting the client’s participation in their occupations, but the exercise will always only be a “warm-up” to working on a specific activity or developing or rehabilitating a specific skill required for the occupation. While both our professions help clients function, OTs treat all aspects of the person we are treating, not just the physical. Often we have overlapping caseloads (such as people who have had strokes or children and adults with physical disabilities). However, there are many settings where there is rarely overlap in cliental, for example OTs don’t often have a role a lot of strictly orthopedic situations where overall daily life functioning is not affected (such as a sprained ankle), and PTs don’t generally have a role in mental health or other barriers to occupation that don’t require physical rehabilitation.

The Occupational Therapy Domain

There, in summary are my answers to “OT FAQs”. Hopefully this contributed to my non-OT readers’ understanding a bit!

Rough life doesn't mean damaged for life

Yesterday morning before work, I completed a mandatory child abuse training online (as I am a mandated reporter of suspected child abuse, and am required to keep up to date on laws, policy, reporting procedures, ect). Spending several hours reading statistics about child abuse and case studies based on true stories, my mind couldn’t help but drift back to the summer of 2008, when I was completing one of my occupational therapy internships at a residential treatment center for adolescents diagnosed with Emotional Disturbance. Almost every single one of the teenagers I had worked with there had led very rough lives and had been either neglected, physically abused, emotionally abused, or sexually abused, and unfortunately most of them a combination of more than one (or even all) of the above. Even worse, many of them had been abused by multiple caretakers—taken from their biological parents by social services because of abuse and then moving in and out of foster homes where sadly, many of them were abused by foster parents and/or foster siblings.

I did a very different method of occupational therapy during that internship what I do now in my job. I did not work with the residents at the center individually, but instead in groups and on a consultative basis with the residential staff. One of the main areas addressed in the series of groups I ran that summer was instrumental activities of daily living (IADLs), which are activities that are not essential, but are necessary to live independently—including homecare, work, shopping and meal preparation. This was a focus of my groups because many of the kids ended up in the residential treatment facility after living very difficult lives with very little adult mentorship, and (although the goal is always short term stay) many of the residents end up calling the facility home until they age out on their 18^th birthdays. At that point they are legally adults, and many end up in adult group homes, where they're expected to be at least somewhat independent in most IADLs.  However, the system can sometimes set them up for failure after the transition because the residential treatment center is a bubble—the kids go to school there, live there, and only leave on seldom, supervised, and highly controlled special occasions. [Note: since my internship ended, I found out that the facility added a "transition unit" for the older residents getting ready to transition into the community to continue to combat this issue and give the transitioning residents more tools for community integration, but this did not exist at the time.] The groups I ran targeted self-esteem and team building in addition to hygiene, cooking, money management, and community skills such as grocery shopping. The summer culminated in assisting the residents in planning a dinner with their living unit which included looking up a recipe, making a grocery list of ingredients, going on a trip with me and other staff to the grocery store to purchase these items, and then cooking their meal and having dinner with their unit. Additionally, as my internship project, I created job descriptions for several jobs around the facility in order to help begin a job program for the kids. This program would allow the residents to hold jobs in the facility under the supervision of job coaches in order to gain real-life practical job skills. I learned so much about that summer. Although I work in a very different setting now with a very different population, the internship was invaluable to me as a therapist and a person. 

Yesterday, reading all about child abuse got me thinking about the internship. And then, as if that stirred something in the universe, I went to work and there was a new kid on my schedule at the clinic, diagnosed with Emotional Disturbance. As child abuse is unfortunately a prevalent problem in this country it’s almost impossible to work with kids and not come into direct or indirect contact with kids who have had it rough. However, this new kid I started with yesterday was the first kid that I’ve seen working in the setting I do now who’s IEP (Individualized Education Plan) gave a primary diagnosis of Emotional Disturbance. This boy, Alexander (once again all names of clients have been changed) is 10 years old. He is in the custody of the state, currently living in foster care. Upon reading over his IEP, I came to learn that he has a lot of attention and behavioral difficulties affecting his performance in school. According to his IEP, Alexander tends to be very angry, withdrawn, and distracted when he is in school. His home life has been unstable for a long time. [Yet, when I reached the section that included his occupational therapy goals, they related to his poor handwriting (hmm looks like someone seemed to make the common mistake and forget that OTs are so much more than just the Handwriting Ladies!) ]

Although the setting and method of service delivery is very different from my internship at the residential treatment center and Alexander is a few years younger than the residents, a lot of what I learned there will hopefully be advantageous to me as I begin to work with Alexander (and we will certainly be working on more of what is affecting his success in school than just his poor handwriting). One of the most important thing I learned at my internship that I will apply with Alexander is the importance of therapeutic use of self with this population. Of course, therapeutic use of self is important with every single child I treat. For example, I act very differently depending on the child I am working with at the time, constantly judging how to best use myself to benefit each child during each therapy session. Therapeutic use of self can be as simple as me being goofy and energetic with an eight year old boy who thinks he’s too cool for therapy, and then a few minutes later very quiet and soothing with a very shy and easily overwhelmed three year old girl. With children with Emotional Disturbance and other related psychosocial issues, however, therapeutic use of self is so very important in helping these children to be successful.  A child who has been in abusive situations may have had a very limited number of adults he or she could trust, who want to help instead of hurt. Because of the past, it is often hard for these children to get out of their own way and be wary of allowing another adult "in," even an adult with truly good intentions. Building a trusting, nurturing relationship is paramount if I have any hope of making progress with a child who has been through a lot of hurt in his or her life. This starts internally. This starts with me truly believing that these types of kids aren’t just “damaged goods.” That they are children who--although they may have been through unimaginable evil things in their young lives, although they may “fit the profile” of a future abuser or criminal themselves, although they may be little more than a statistic to many--still have a possibility of having a good quality of life, and still have a shot to become a functional adult, and that as an OT I have the ability and responsibility to give these children the tools to help make this possibility a reality.  It may take a lot of patience, kindness, and understanding, but getting through to kids with Emotional Disturbance isn’t impossible. I will always have a special place in my heart for children who have had difficult lives. Kids can be very resilient. Kids can overcome things that man people may have never thought possible. They can become functional members of society despite the odds. I am looking forward to working with Alexander, and hoping that I can use what I learned during the summer of 2008 to help benefit him.