Waiting Room Chaos in Pediatric Therapy

Waiting Room Chaos

Ah yes, the waiting room: The very bane of my existence.

Parents? Kids? Therapists? Are we all in agreement here? It’s just the worst.

The concept itself is crazy- Here kids, sit in this chair, be quiet, and wait patiently for your turn. Ha!
It gets loud, it gets busy, and it gets challenging to walk around without knocking someone over. And that’s just at 10AM… wait until the afternoon rush hits!

The waiting room has been an issue everywhere I’ve ever worked- whether the clinic was tiny or huge. However, one clinic had the unique opportunity to move into a bigger facility. There was much debate about arranging the waiting room in the new place. Should there be more space? Perhaps an “L” shape for extra nooks and crannies? We could stagger the therapists’ schedules so that everyone isn’t in the waiting room at the same time. Or, how about no waiting room at all?

The consensus was that the waiting room is horrible regardless. More space = kids literally running around. Less space = louder noises. More toys = more of a mess, kids fighting, and germs spread. It’s a lose/lose situation.

Within the first week at the new facility, a parent looked at me as the tornado of children and parents surrounded us, hands over her ears, exclaiming… “I thought this was going to be better!?” Or at least that’s what I think she said… It was awfully loud in there.

So what exactly makes the waiting room such a stressful experience? Here are just a few things I’ve noticed…

-Lack of proper adult supervision.  

Of all the places in the world, a therapy clinic should be a safe place for parents of children with special needs. I completely understand that and want people to be comfortable with their children.

However, there have to be some rules or expectations in order to keep the situation from getting out of hand or causing other children to meltdown in a horrific domino effect.

I often see parents allowing their children to knock the chairs over, rip books apart, or throw things from one side of the waiting room to the other. (And most of the time it’s the sibling that is the guilty party here as they wait for their brother or sister to be done with therapy.)
These kids can get out of control, and will even get into fights or scream at each other as a parent sits silently on their smartphone. I even had one parent that was so sick of other kids being out of control that she yelled at them from across the room. Awkward.

Now, I hate when parents feel overwhelmed in the waiting room, so if their child is having a particularly hard time, I tell them to take the child back to my office immediately upon arrival, or to arrive right at their scheduled time so they don’t have to wait around.

– Getting a little too cozy in the waiting room.

Hey, therapy is a big time suck for a lot of families. They have to drive there, wait around, and then drive back home. They have things to do, and I totally get that. However, there is a point when the activity you’ve chosen to complete is inappropriate in the waiting room setting.

One parent dragged an end table in front of her chair, set up a laminator and large paper cutter (you know, with the giant blade that chops large stacks of paper) and seemed annoyed when I had to step over her.

There are other instances when siblings bring bags full of toys, Legos, or whatever, and spread them all out on the floor, only to be upset when others come to play and check out the fun. Just know that if you have something cool, other kids are going to be interested. If you don’t think your child will be able to share, you might want to think of another activity to bring along. (Oh, and if you bring a video game or some electronic device, make sure to bring headphones or keep the volume waaaay down.)

I’ve also witnessed several parents attempting to home-school in the waiting room, and I have to say, some can pull it off well. Others? Well, it seems to end up to be a bit counterproductive and they get frustrated by other people making noise in the waiting room.

 -A complete loss of “inside voices.”

Wow, the noise of a waiting room. It’s a therapist, child, siblings, and parent, all talking over each other, times ten. Most of the time I can’t even process what I’m saying to a parent due to the noise level, so how can I expect them to understand what I’m telling them? The worst part is trying to move to a new location, only to be bombarded by other therapists attempting to do the same thing.

 -Judgement and stares from other parents.   

Remember how I said a waiting room should be a safe place for a parent of a child with special needs? I really dislike when some parents sit and openly stare or gawk at another child with autism as they make a strange sound, or possibly hand-flap or “stim” off of something. I can get really defensive when I see this happening, as if they are comparing their children’s challenges. We’re all here for the same reasons, people, so please calm down the judgmental stares.

-Finding a new client in the crowd.

Why does this hardly ever seem to go smoothly with me? You can either walk around to every group of people you don’t recognize and creepily ask if they are there for an OT evaluation, or call out a first name to a crowd that just stares back at you. Sometimes another therapist can describe the child or parent right beforehand, or maybe the receptionist can point me in the right direction if she has a spare moment. Regardless, I apologize if this is a strange situation.

-The transfer of the child from parent to therapist, or back again.

Here’s a fun situation. Maybe it’s only me, but when I take a child back out to the waiting room, as soon as the mom or dad is in view, I assume that the child is back in their care. If your child runs out the door into the parking lot, runs into an adjacent office building, or starts hitting the child next to them in the waiting room, please step in. I’ve chased my share of kids out the front door before, and will continue to do so in order to keep them safe; however, I do appreciate it when the parent steps in to try to help.
Now, if you have your hands full with other children or are trying to load everyone in the car, that’s a different situation all together, and I am more than glad to help. This is mostly an issue when the parent seems to ignore a situation that calls for their attention.

-Attempting to have a meaningful conversation with a parent.

There is this little thing called HIPPA that all therapists and medical professionals must abide by. These laws protect you and your child’s private health information. So ideally, you wouldn’t be talking about a child’s therapy in a crowded waiting room. While most parents give consent to talk openly in the waiting room, it can still be challenging to do so in a meaningful way when there is a circus surrounding you. I feel so terrible when a parent is trying to tell me something important, and my next client is literally tugging on my arm. Or perhaps I am so excited to tell them what their child did in therapy, but the sibling is having a meltdown. In these situations I try my best to find a quiet place to talk in the back or at the car, or I’ll ask to call the parent at another time.

-Keeping things clean.

Please don’t judge a clinic by the cleanliness of the waiting room. I promise, it’s really the hardest place in the world to keep clean. People throw trash on the ground, leave toilet paper all over the floor, spill drinks, vomit, you name it. Again, I know it is a challenging place to keep everyone happy and on their best behavior, but man, I’ve seen some gross stuff left behind.
The worst part is that typically many small or private clinics can’t afford to hire someone specifically to clean. It’s usually a duty that is spread between therapists and other support staff. And throughout the day it’s hard to keep things clean and well stocked when you have a full caseload. However, I will always stop what I’m doing to make sure you have toilet paper. That’s kind of like life’s necessity.

-Finding a waiting room alternative.

So when the waiting room is just too much to handle, what else can we do? For many parents, I recommend taking the child to the car and talking there. The downside to that plan is that I often end up sweating in the heat, or freezing in the cold or rain.

Also, without the watchful eye of the next parent staring you down, people can get lost in the 5 minutes or so allotted to talk before the next session starts. I’ve been stranded in the parking lot on more than one occasion, looking for a pause in the conversation to say, “I gotta go!”
I admit, there’s a point when I stop listening and start thinking, I’m late, I’m late, please stop talking, I’m late… But that’s hard to say when a parent is opening up about something personal or difficult for them, or even just chatting about their day. I would advise bringing up big problems before the last few minutes of the session because you’re more likely to have the full attention of the therapist. Or, if time is running out, suggest having the therapist call you later when they have more time to talk.

And yes, I’ve been yelled at for being late because a parent kept talking to me. (Probably why I’m so paranoid about being late to my next appointment.) One parent literally watched the clock to make sure I wasn’t “stealing” any of her child’s session. Or, how about watching one parent yell at another parent for making their therapist late to their child’s session. Yikes. I have to say, never a dull moment in this job!

So to parents that hate the waiting room, just know that a lot of therapists are right there with you. And if anyone has come up with an amazing solution, please feel free to send it my way.

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Posted in Insider Information, Lessons Learned, Occupational Therapy | Tagged , , , | 5 Comments

Therapy Carryover in the Home: Issues and Barriers

Therapy Carryover in the Home

The copies run through the machine, one after another, using paper, toner, and a few spare moments I found before my first client. I’m printing out handwriting practice sheets as homework, but can’t help wondering… am I wasting my time?

I used to assume that people followed all of my instructions back in my idealistic “I can fix everything” phase of practice, fresh off the grad school wagon.  But it doesn’t take long to spot a parent that brushes you off, expecting the change to happen in your time together with their child, not at home.

There are some people that are apologetic about it all, like a babysitter that came in week after week- “I’m SO sorry we didn’t do the homework this week, time just got away from us.” Her honestly was refreshingly surprising; after all, it’s not often that someone will fess up to blowing off assignments.

Others are sneakier about it, like one parent that asked every session- “What are we supposed to do at home this week?” I loved it, and felt like she was really on board. I copied handwriting sheets and sent home fine motor ideas each week. We were a team, therapist and parent, conquering letter formations!

That was until one week that the mom was running late. She had to pull up really quickly as her son jumped in the front seat. And that’s when I saw them –  weeks and weeks of homework sheets, crumpled, stepped on, uncompleted, and strewn about the car floor. What should I have done? Pointed my finger accusingly, “Hey! You didn’t do those worksheets! Liar liar pants on fire!” Or what I actually did – avert my eyes and pretend to see nothing. Maybe that day I just needed to pretend like what we were doing was important.

So here is the question of the day: how do we get carryover in the home?

I like to introduce the idea of therapy to parents with a scenario: Would you go to the gym for one hour a week with a personal trainer, never return between sessions, and then gripe at the trainer because you don’t have a six pack? No, because that sounds ridiculous. However, the expectations of therapy are practically that high. “Why can’t he tie his shoes?” “Why isn’t he writing his name?” “His teacher says he still runs around the classroom, this sensory stuff you do isn’t working.”

For many of these situations I respond with a question of my own, “Have you tried my suggestion to do ________?” Parent responses range from “Well… no, not yet.” Or a quick brush off of, “Nah, that didn’t really work.” So many times I find that I bang my head against the wall trying to scour my brain for answers, only to realize the ideas aren’t even attempted.

When I had a string of clients with tricky sensory processing issues, I realized I needed to try something different. The parents were saying, “He hasn’t changed.” or “He is still all over the place.” each week and I was feeling hopeless. One mom admittedly did nothing at home, so I decided to send home a journal for her to track what she did and how the child responded. I tried a very strict approach with her in attempt to get her on board, clearly laying out the rules that she needed to bring back a completed entry every week.

The result? I never saw that journal again.

I’ve seen the same thing with fine motor practice; some therapists attempt to send home a binder of work to be returned and reviewed each week, or perhaps a simple checklist or grid sheet with room to chart exercises. While there are parents that thrive on this approach, I have to wonder if they are the ones that would have been doing the homework regardless.

It becomes frustrating as a therapist when you spend the money and time to create something special for a child, knowing very well that: a) it might never be used, and b) you might never see it again. I have found that even when homework is considered a “requirement” of the therapy program, there isn’t always follow through.

But what makes the difference between a parent that follows through and a parent that doesn’t? Sometimes it boils down to money; those that are paying a LOT for therapy seem very interested in homework, mostly because they want to be done with the added expense ASAP. Others don’t blow off homework intentionally, they just barely have time in their schedules to get their child to and from the office. Then there are still some people view therapy as a break from their child, or perhaps they simply feel like the therapist should be doing all the “work.”

I get it though. Lives are busy, especially when families have more than one child. They have work, school, and extra curricular activities. But if a parent invests in coming to therapy, they should invest in the time to make the most of it, if they really want to see progress.

That’s why I feel that it is critical to make sure the parent knows exactly what is being worked on and WHY. I have found that if a concept or task doesn’t make sense to someone, they are more likely to just not follow through at home then to ask for clarification from their therapist.

There is obviously a delicate balance between becoming an authoritarian that says, “You must do this for your child!” and creating that therapeutic bond. The trick is to find the middle ground. Maybe I should just say “pretty please” and see what happens?

Posted in Lessons Learned, Occupational Therapy | Tagged , , , | 11 Comments

DIY Therapy Putty

DIY Therapy Putty 1

The majority of my test pins have a common theme: how to make therapy products that don’t cost a ridiculous amount.

In my latest quest I set out to find a recipe for DIY therapy putty. I use this stuff all the time- hiding objects inside, pushing pegs into it, cutting it with scissors – It’s a great (and always entertaining) way to develop hand strength for kids. My only issue is that it costs more than it probably should, so I figured a homemade recipe would be worth a try.

While searching on Pinterest, I found a link to this website with the recipe I was looking for: DIY Studio: Homemade Therapy Putty

It looked easy enough, just liquid starch and school glue in a 1:1 ratio, and then food color for added pizzazz. I ended up using about 8 oz. (2 small bottles) of glue and 8 oz. of liquid starch. A batch was under $3 total, with plenty of liquid starch left.

First I added the liquid starch and glue in the bowl (1), and started mixing it together with my hands. It started out very stringy (2), and I thought I had done something wrong already. However, the more you mix it, the more those fibers start to stick together (3). My biggest mistake was waiting too long to add the food color. I guess I had little faith that it was going to work out or something. Anyway, adding it at the end was a bit like mixing food coloring into a mostly done omelet (4).

DIY Therapy Putty

Side note #1: I gagged several times while mixing this little project together, and I didn’t even think I had tactile issues. The consistency in the beginning can be a bit gross, and might be something to consider if you are going to make this together with a child that has sensory processing issues. Even with the finished product there were a lot of children that wouldn’t come close to touching this, even if they didn’t mind regular therapy putty.

Side note #2: I thought it would be fun to play with the ratios of glue to liquid starch to see if I could make the mixture a bit firmer, like regular therapy putty. Adding more starch made the putty a bit more dense, but then chunks would simply rip off instead of being pliable, essentially rendering it useless for what I wanted to use it for. After a few tries, I decided to stick with the 1:1 ratio.

Once I had mixed it all together, I decided to compare my creation to actual therapy putty. The result? No comparison.

Putty comparison

Notice the difference in the overall stability of the two globs of putty? The DIY putty eventually spread out to fill the entire paper plate, while the regular putty (medium resistance) kept its shape. The DIY putty reminded me more of that Nickelodeon Gak I used to play with when I was a kid. Even Silly Putty is firmer than this creation.

However, since I had braved the gagging and messy hands, I decided to see what I could do with this putty.
-I hid some small beads in the mixture, but they were only hiding under a thin film. Not too much digging required here.
-I then tried to stick some “Lite Brite” pegs into the mixture, but they barely stayed in place. It was more fun just to take the pegs and poke a bunch of holes in the putty.
-This eventually just became more of a sensory task with the children. They liked the feel of playing with it and squishing it in their hands. While it could still be used for some fine motor strengthening, you aren’t going to get the resistance of the real therapy putty.

DIY putty activitiesSo no, I didn’t find a substitute for therapy putty. However, I will still say that I found a recipe for a fun sensory “goo.” I might not be making this for myself again any time soon, but I will definitely recommend it as a good activity to try at home.

Posted in Occupational Therapy, Pinterest Test Pins | Tagged , , | 9 Comments

Making Sense of Occupational Therapy Goals

Making Sense of OT Goals

Therapy revolves around one central theme: meeting goals.

It seems straightforward – goals are the way therapists track progress and determine necessity of services. They should be objective, measurable, and attainable. However, a lot more goes into the goal making process than you may realize, and it can be complicated by a number of factors.

Step 1: Determine areas of skill development that the child needs to work on.
Therapists will look at evaluation results and determine which skills need to be addressed.

Complications with this process:

Parents don’t agree on skill areas to be worked on:
Just because I want to work on a goal doesn’t mean the parent wants to, and that can cause tension with some therapist/family relationships. I had a colleague that lost a client on her schedule simply because the mother thought that her goals were inappropriate.
This particular therapist was gung-ho on working on core strength as a foundation for fine motor skills, posture, and stability. The mother felt it was irrelevant to her child’s issues and they just couldn’t agree.
While I think it’s critical for parents to be on board with the goal writing process, there is always going to be a delicate balance. If there is an area that the therapist thinks must be addressed, it’s up to them to fully explain their reasoning to the parent. However, if the parent refuses to work on something, the odds of the goal being met have just been greatly lowered. In this example I might have removed the formal core strength goal and incorporated this foundational skill area in our weekly sessions without blatantly spelling out.

Parents don’t agree on the skill level of the goals:
Yes, some 10 year olds still need to work on pre-writing strokes like vertical and horizontal lines. This can be challenging for a parent that wants their child to be working on things that they just aren’t ready for. Underlying skills have to be built up before progress can be made. A child that can’t imitate a vertical line most likely doesn’t have the motor skills to be able to copy their name.
This gap in expectations can also cause a struggle between therapist and parent goals.  One parent told me “Well, he should be in first grade this year, so I want to work on more challenging things.”
My knee-jerk reaction to statements like that are that we need to work on the level that the child is functioning, and hopefully one day we will get to where we need to be. Unfortunately the changes in the calendar don’t automatically change what we should be working on.

Step 2: Writing out the goals.
It’s more difficult than it sounds: going from “they need to work on promoting a more mature grasp” to an actual goal that can be measured and tracked.

Complications with this process:

Therapists can’t find an objective way to write goals:
Sometimes it’s just challenging to word what you are working on in a measurable way. Especially when you are an OT working on sensory processing issues. How about: “Child will demonstrate improved sensory processing skills to tolerate transitions with minimal distress in 75% of opportunities.” Sounds measurable, right? Not quite… poor parents are left trying to estimate how much of the time their child is melting down in a “minimal” way. Therapist have to try very hard to set their parameters in a way that makes goal tracking easy.

Therapists cram way too many skill areas into one goal:
“Child will utilize a tripod grasp to copy pre-writing shapes (circle, square, and triangle) with good formation and consistent sizing in 4/5 trials with an appropriate seated posture and minimal verbal cues.”

Yikes. The sad thing is that I’ve actually seen this goal and goals like it way too many times. Sure, it sounds fancy and important, but how in the world are you going to track that goal? What if the child copies a circle and square with good formation, but not the triangle? And what about moderate cues for posture, but the functional grasp is spontaneous?
The worst part is when a therapist inherits a child on their caseload from a colleague that has written goals like these. (Can I just discontinue this goal and write three more in its place??) There is nothing wrong with writing several simple, easy to track goals that address all of these areas. A goal doesn’t need to make the therapist look like a super-hero.

Therapists write too many goals:
I believe the longest list of goals I saw was around 46. FORTY SIX. As I’ll touch on later, the therapist essentially wrote a goal for every single testing item that the child was unable to complete upon initial evaluation. That means if a therapist saw an average of 25 clients a week and they all had 46 goals, they would have 1,150 goals that they need to track. Not possible people. There is a beauty in prioritizing.

Therapists only write goals related to testing items:
Therapists: Please, PLEASE, don’t simply write a goal that states, “Child will imitate a bridge design in 3/4 trials.” (A testing item straight from the Peabody assessment.) This drives me insane and makes it look as if no thought was put into goal attainment.

Now, there are some areas on a standardized assessment that can be generalized into appropriate goals. For example, when the child can’t copy a circle or other pre-writing shape. But when it is a super specific, standardized test related item, I question the motive behind the goal. Can the therapist say why they want to work on that? In this block goal example, if the therapist was worried about the child’s imitation skills, then they could potentially write a goal to imitate simple 3-4 block designs. But if they sat there and taught the child one block design until they finally mastered it, they essentially taught them the test. So next year when they are re-tested, did their visual motor integration really improve, or did they “cheat” into a higher score?

Step 3: Track goal progress in weekly notes.
Therapists have to keep diligent notes during sessions to make sure we track progress towards goals.

 Complications with this process:

Therapists work on activities related to goals:
Sometimes I envy my speech therapy friends that keep these beautiful, consistent percentages in their notes. “Child imitated /r/ in 80% of trials.” That’s it, easy to track. But if I’m trying to work on pencil grasp, one day I might write that the child manipulated therapy putty, transferred items with tongs, or inserted pegs with a tripod grasp. It can be difficult to track a goal when you supplement with other activities. Then I end up hating myself when it’s time to write a progress note and can’t find what I want in my notes.

Therapists get side tracked by unexpected areas of concern:
Say I made a goal for feeding this quarter, but all of the sudden we realize the child is reversing their 6’s and 9’s consistently at school, and that becomes the new priority. It’s an appropriate skill to work on, but then when I go to write the progress note I realize we didn’t even touch that lovely feeding goal. Whoops. Once again, as long as a therapist is working on something appropriate, it shouldn’t be that much of an issue.

Step 4: Write a progress note demonstrating progress towards goals.
Therapists must report a child’s progress in a document for both the parents and their insurance companies.

Complications with this process:

Difficulty guessing the rate of progress:
It is really challenging to guess how much progress someone will make in three or six months. Not every child is the same, and not every rate of progress is the same. Yes, it happens to the best of us- we write some goals that a child meets in two sessions, and some goals that get carried over for way too long. While therapists always need to determine how appropriate their goals are, I wouldn’t get bent out of shape over a few that just don’t make the cut as expected.

Parents aren’t aware of their child’s goals:
I won’t judge if you can’t recite your child’s goals from memory, but hopefully parents know the general areas of intervention. I know several parents that would have absolutely no idea what their child is working on in OT. This also means that there isn’t a whole lot of carry over at home, and therefore, progress is going to be slow.

So while the process of writing goals seems simple, there can be many complications along the way. While it might not be a perfect system, the master plan is to promote progress and change in a positive direction for the child.

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Testing Your Child’s Therapist

Testing Your Child's Therapist

When I was handed that diploma in my cap and gown I figured I was done with tests forever.

Boy was I was wrong.

All too often parents come to me under pretenses that I’m not aware of. Perhaps they are looking for a second opinion, or maybe they just didn’t get along with their previous therapist. They might have been scorned in the past and want to ensure that they get what they are looking for. I can’t blame them for wanting the best of the best, but sometimes I wish I could take a look at this secretive therapist rating score sheet that some people seem to have. Regardless of the reason, it seems like many parents are out to “test” their therapists, and I’ve noticed a few ways this happens…

Withholding Previous Evaluations:

I think some parents view this as the ultimate “test;” withholding another therapist’s previous evaluation as to “avoid clouding your judgment.” Or, to be completely blunt, one parent said that she just wanted to compare the quality of work between two different therapists. No pressure.

No, I don’t need another therapist’s evaluation in order to complete my own, but sometimes it helps to see where the child has come from. However, once I know the parent is intentionally looking to compare my work to someone else’s, I suddenly become ultra paranoid, double checking that my Peabody directions are spoken verbatim. “Build a bridge like mine!”

Does the parent gain anything from this? Well, it might weed out some really terrible therapist that can’t make any judgments on her own. However, I think that might be blatantly obvious in other ways as well.

However, from my perspective, I’ve got my own set of credentials that allow me to make clinical judgments based on what I see. So if someone else says that there are no sensory issues and I say that there are, am I right? Not necessarily, it’s just my opinion, but it’s the opinion that the parent is paying for.

Seeing Two Therapists at the Same Time:

When are we going to go steady already? Yes, seeing two different therapists at the same time can be a weird situation if the parent is trying to keep them a secret from one another, or if they are going between two different clinics.

One of my awesome co-workers related this situation to The Bachelor, asking, “Am I going to get the rose?” Although I’m not sure if you want to win that battle when you know the parent is going to continue to analyze you under a microscope. (Although, dang, it feels good to win sometimes, right?)

Does the parent gain anything from this? Perhaps initially, because they get to see two different styles of therapy and decide which one is the best fit for them. However, I wouldn’t do it for too long, because in my experience parents have a hard time completely following through on anything if they are too busy comparing and contrasting what they think is better about each session. I’d rather a parent goes all in with one therapist rather than secretly juggling two relationships.

The Question Ambush:

It can be rough to be put on the spot. Let’s be honest, we don’t all do our best thinking when the pressure is on. I find this especially true as an OT, because I am asked all sorts of bizarre questions that might require a bit of pondering. However, some parents choose to save a bombshell question for the last two minutes of the session, expecting a solution to what might be a very big issue.

Does the parent gain anything from this? No, not really. It’s perfectly fine if your therapist needs a minute to think, or even a day or two; we don’t have to have all the answers that second. Besides, the answer I come up with on the spot might not be nearly as good as what I come up with as soon as you walk out the door. (That always seems to happen to me…)

Yes, therapists are different people, and we are going to have differing opinions and different ways of doing things. Just because his previous therapist did the platform swing to start every session doesn’t mean that I have to as well. Just because one therapist presents her data in one form doesn’t mean that I have to do the same either.

We can be different without all being “wrong.” That might mean resolving to be comfortable with the therapist that you have, or finding someone that works for you. It is so important to feel at ease with your therapist, and the therapist needs to know that you are invested in their opinions.

Related Posts:

Therapist vs. Therapist

Therapist Vs. Therapist: Who Should a Parent Trust?

When Does an OT Have the Right Amount of Experience?

When Does an OT Have the “Right” Amount of Experience?

Posted in Insider Information, Lessons Learned, Occupational Therapy | Tagged , | 2 Comments

Therapist Burnout

Therapist Burnout

“Why isn’t he making any progress?”

“He has completely regressed this week.”

“I tried that… it didn’t work.”

Burnout.

It can happen to anyone – therapists, parents, teachers, caregivers, students, clients, stars in the solar system…

People get tired as they are pulled in every which direction. There might be too many kids that don’t listen, too many clients that don’t make progress, too many parents that don’t follow through, or too many people that don’t seem to care when you have cared way too much.

Every once and a while I’ll feel the wave of burnout moving in; I won’t realize it’s coming until one little event pushes me over the cliff into the land of “I’m done.”

Our jobs as occupational therapists are challenging… mentally, physically, and emotionally. I don’t think that everyone realizes that. We aren’t medical robots programmed to “fix”. It hurts when a child bites, it’s depressing when a parent yells, and it’s amazing when even the smallest goal is achieved. We are people with bad days, good days, and everything in between. Don’t tell me you haven’t had a day that you just wanted to pull your hair out, quit, and never think about OT again. What, only me?

Don’t get me wrong here, we have an amazing profession that I love; however, it can take a toll. So many OTs out there are beyond amazing. They treat patients, they blog, they advocate; living, breathing, and embodying OT. Thank goodness there are people like that out there, those little OT Super Heroes. (I’m talking to you, Mama OT, Miss Awesomeness, Tonya at Therapy Fun Zone, Notes from a Pediatric OT , Dr. Zachry’s Pediatric OT Tips, and probably several others that I haven’t even had the proper time to check out.) But that day comes when you need a break, a reprieve, an attentive ear to listen and say, it will be OK. You are making a difference.

Starting this blog began as therapy for me; a way to express my opinions in a way that I couldn’t normally do. For those that have been following, you may have noticed that I took a solid month or so off. (And thank you to the ones that sent messages of encouragement while I did so.) I didn’t tweet, Facebook, pin, or write a single word related to OT. I came home at night and just relaxed. I needed it.

Because as the wave of burnout passes, either with time, a new job, or just a really good day, you realize the joy of being the one to teach a parent or child something new, and it pretty much makes it all worth it.

With that in mind I wanted to share a short story that was sent to me that seemed to embrace the daily rigors of a therapist and child interaction. Check it out below and see if you can relate.

A Second Opinion

(Submitted by an OTR)

           We stop in front of that place again; the place Mom always brings me. I don’t want to be here.

They’re here. And only seven minutes late this week. Please God, let it be a good day. I force a deep breath as he emerges from the van.

“No, no, no, no, no!” I use the strongest words I have; the ones that let me go home.

He just screams at his mother as she drags him by the hand. Her eyes glaze over, the focus clearly set on getting inside the building.

That’s when he’s my responsibility.

His shrieks are all too familiar, yet they still command my stomach to clench in protest. I don’t want to do this today; I can’t do this today. But instead of giving in to my reluctance, I contort the muscles of my face to create some semblance of a smile. After all, he is only my first patient of the day. “Hi Johnny! Let’s go play!” My voice is a direct contradiction to the situation; a false hope that it will somehow change the outcome of our session together.   

The words aren’t working. She is taking me back there. I want to go home. Don’t make me stay here. I want to see Animal Adventures. “Animal Adventures! No! Animals!”  I pull my hand away.

It’s escalating quickly today. Already with the Animal Adventures requests and we haven’t even made it out of the waiting room. “No Animals, Johnny. First work, then Animal Adventures.” I say the words out of habit, ignoring their lack of gravity.

Work? No Work. I said I wanted Animal Adventures. I said it. I see it in my head. I see Dave the Forest Ranger and his map. He has work to do too. “Ranger and map and let’s go!” I can see him crossing the bridge and he has to choose the right way. “Which one?”

I am a broken record in every sense of the phrase, repeating the same question over and over and over. “What do you want, Johnny? Say ‘I want’…” I stare, searching into the glassy reflection of his eyes. The cues do nothing- he is gone. Autism is boasting its control now, locking him into his own head to script the words of some television show. At this moment he has no idea that I’m even here. I scrap the questions, accepting a sliver of defeat. Instead I hold up two pictures, giving him one last chance. “Swing or trampoline?” I raise his hand to touch each picture, forcing him to interact in some way with his environment. His eyes transfix past me, seeing a world that I can’t. His arm is heavy and limp as I let go.

He needs to get across the bridge. “That way! Good choice!” Dave the Forest Ranger smiles at me. He is happy. My arm falls down and I look at it. I am in that room again. The girl is here and I don’t like it. I push everything away.

“Great! You chose the trampoline!” I am over the top in my enthusiasm, desperate to reinforce anything, even if it’s incidental contact with a picture card. I place my hand under his arm, pulling up with intention, but he doesn’t budge. “Let’s go to trampoline. Stand up.” This time he sets himself in motion.

I want to see Dave the Forest Ranger again. He bounces on a trampoline with the kangaroos. He is in a race to win! I jump too. I am just like him. “Jumping on the trampoline!”

“Good using your words! You are jumping on the trampoline. Jump, jump!” Maybe this is what he needed; he seems more tuned in. I press my luck by reaching for a puzzle. “Look, let’s sit on trampoline. I see a puzzle.”

I don’t want that puzzle. The letter “M” is gone. Get it away. I want to go home. “No, no, no.” I want to go home.

Of course, the second I place a demand he withdraws. How am I supposed to document progress from thirty seconds of structured activity a week? “First work, then home.” I point to the visual schedule I spent ten hard-to-come-by minutes piecing together. More wasted energy. I get that feeling a lot these days.

I don’t want to work. I want to go home. Why doesn’t she stop? I said no. I already said no. The list has lots of pictures. I see home at the bottom. I reach for it.

“No, stop. Not yet. First, puzzle.” I point to the first picture on the list. He keeps reaching to tear the pictures off, so I toss the whole thing to the side. He is about to lose it, I know, but I can’t let him have it on his terms. He will never learn if I back down. So I stand strong, holding my ground. “First. Puzzle.”

She takes the picture of home away. It’s gone. Home is gone. I am mad. Like Henry the Grumpy Groundhog. He is mad. “No Henry Groundhog!” Home is gone, so I reach for the puzzle and throw it far away. She tries to bring it back, so I squeeze her arm. I squeeze and I pull. I don’t let go. She yells. It will be done soon. I will go home.

I let my guard down for a second and pay the price. My arm burns on fire along with my barely caged anger. The sensation boils over as his fingernails break the skin, tearing down the meaty flesh of my forearm. I pry his hand away, taking a leap backwards in self-preservation. He will not win on his terms. I choke back the tears so he won’t see me in pain. I don’t even look at my arm, the throbbing ache already alerting me to the damage. He won’t see me cry. “Johnny, no! No scratch!” As he registers my voice, firm with a hint of tremble, I take an instant to collect the puzzle. I hold up a piece in declaration. “First. Puzzle.”

It didn’t work. I am still here. I am Grumpy Groundhog. “NO!” I yell so loud that they have to hear me this time. I yell until it hurts.

I am losing him again, but I cannot give up. I am the therapist here. He will never progress if we can’t get through this. The clichéd mantras continue as I swallow hard around the knot in my throat. The pain fuels anger, but I push it down. Not now. I have a job to do. I take another step back, letting him flail around on top of the trampoline. I let him scream it all out. A luxury many of us can’t afford.

I kick, I scream. I want to go home. I don’t want puzzles. I don’t want letters. I don’t want jumping. I want home. I kick, I scream. I kick, I scream. I stop. Did she go? I sit up fast, but she is there. She is still there.

“Nice job calming down.” I take an apprehensive step forward. He didn’t think I would wait him out. I remove all of the pictures from the schedule so only two remain. I point slowly, speaking with as much authority as I can muster. “First. Puzzle. Then. Home.” Another step forward; I set the schedule down.

Home. She said home. I see the picture.

Taking advantage of his momentary distraction, my unsteady hand reacts. We quickly place the puzzle piece in the board together– hand over hand. He pulls away in protest, but it is too late; he complied without even realizing it. “Good work, Johnny! You did puzzle!” The Velcro rips loudly in celebration as I pull the picture away. “Now home!” I glance at my watch: forty-two minutes for a single puzzle piece. What am I doing here? As we head to the waiting room our roles are abruptly severed. Both of us are now content to walk as equals. I take the moment to examine the deep purple bruise, wincing as I accept the mark. I have to believe we accomplished something or I will collapse in self-pity. Today I’ll say that I won.

I am going home. I am happy Dave the Forest Ranger. He wins.

Posted in Insider Information, Lessons Learned, Occupational Therapy | Tagged , , | 7 Comments

Can You “Cure” Sensory Processing Disorder?

Can you "cure" SPD?

Here are some of the most common questions I hear when discussing a child’s sensory processing skills with their parent:

“Is he going to be OK?”
“Will he make a full recovery?”
“Will he eventually just grow out of it?”
“Is OT the cure?”

These parents are all essentially asking the same question: Are we going to “cure” their child’s sensory processing disorder?

Short answer: “Kind of…”

Long answer: Keep reading.

Here’s the thing- we ALL have sensory preferences. I can’t stand dry sand under my fingernails and I happen to be highly distracted by auditory input.
But do I have sensory processing disorder?
Not so much.
And how do I tell the difference between a sensory preference and SPD?
Sensory processing disorder interferes with daily functioning.
Any other questions I want to ask myself?
Eh, not right now.

So sure, I love the beach, but I’m probably not going to dig a sand castle with my bare hands. I also know that if I want to read a book or type a report, I either have to have complete silence or listen to a white noise app on my phone. With these simple strategies I can adapt to be a (somewhat) typically functioning adult.

However, what about the child that can’t sit still in their chair because they crave vestibular input? They might be missing out on fine motor skill development because they aren’t appropriately participating in school work.

What about the child that can’t stand the touch of a tag in their shirt? Refusing to wear clothing can make it kind of challenging to get out the door in the morning and participate in life.

Another issue that makes sensory processing disorder different is that I know that I can’t sit still at a conference for 8 hours straight. I bop my leg up and down or I chew gum to keep myself alert. A child doesn’t always have the reasoning skills to say, “Hmm, I had better just chew some gum rather than bite through my neighbor’s pencil.” Their nervous system is driving them to find the input they need, and they might not know the most appropriate or effective strategies to use.

That’s the point when OT comes in handy. We teach children and parents the strategies that are most effective. Essentially, how to get the most “bang for your buck” when it comes to sensory input. A child that pings around from activity to activity might just need some assistance to choose something more appropriate, and stick with it long enough to receive the benefit of the input.

Now, say that OT teaches the child what they need to know, and the parents follow through with appropriate sensory activities at home. Does this mean the child will be “cured”? Not essentially. It means that they will have more control over their bodies. We are working with the idea that the brain is “plastic”, meaning it can change and make new connections. The theory behind sensory integration supports the hope that the nervous system will become better able to handle and modulate sensory input to the point that a child can function appropriately.

However, will a child that is extremely under-responsive to movement input choose a desk job when he grows up? Probably not. This is the child that might choose snowboarding as a hobby, or something that provides the input he still craves. Or on the other side of things, a child that is sensitive to most input is probably not going to pick a job in a factory with a lot of loud, unpredictable noises.

So throw the words “cure” or “fix” out of your vocabulary when it comes to sensory processing disorder, and think more along the lines of “adapting”. Hopefully a child’s sensory processing disorder becomes manageable sensory preferences that allow them to lead their lives the way they want.

Related Posts:

Sensory Processing Disorder: Is it Real?

Sensory Processing Disorder: Is it Real?

Sensory, Behavior, or Both?

Sensory, Behavior, or Both?

Posted in Lessons Learned, Occupational Therapy | Tagged , | 8 Comments