How to Get OT Observation Hours during the COVID-19 Pandemic

Although most states are now easing restrictions related to the COVID-19 pandemic, many prospective OT students are left with few options for ways to gain observation hours. Many medical facilities like hospitals, skilled nursing facilities, and outpatient clinics are suspending volunteer services, strictly limiting visitors, and postponing, shortening, or canceling student placements. Additionally, schools have been closed for months and many OT practitioners have transitioned to telehealth settings with varying degrees of interaction with their students. Community-based settings have also been impacted as home-based providers have had to modify the ways in which they interact with and provide interventions for people in their homes or other communities.

If you’re a prospective occupational therapy (or other allied health profession) student, the situation may seem hopeless. Volunteer positions you lined up in OT clinics may have been canceled, volunteer programs suspended, or shadowing experiences shuttered – and with them your plans for earning the observation hours and experiences required by most programs. Fortunately, all is not lost!

The difficulties created by the COVID-19 pandemic have created a unique opportunity to highlight how your ability to think creatively and overcome unforeseen challenges in order to achieve your goal makes you even more prepared to work as an occupational therapy practitioner who will be doing the same with future clients.

Additionally, many if not all OT programs have modified their admissions requirements for the 2020-21 review cycle that takes into consideration barriers students face to getting observation hours during the pandemic. If you are currently applying to OT programs, it is absolutely crucial that you carefully review each program’s website for the most up-to-date information about program-specific modules/books/etc. that are required in addition to or in lieu of traditional observation hours.

If you are struggling with the loss of opportunities to obtain observation hours but you are still determined to become an OT or OTA, read on to learn how you can use creative avenues to learn about the profession and gain useful insights that will strengthen your applications!

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Black OTs Matter: Changing Your OT Practice to Combat Racism, Address Racial Trauma, and Promote Healing

BLACK OTs MATTER

 

As I sit here in the quiet of a Sunday morning in the comfort of my home, I’m in quite a state. A state of numbness, a state of shock, a state of anger, a state of resignation, a state of…wonder.

 

Wondering if things in America will ever be different for black and brown people. Wondering if this morning is the last time I’ll talk to my dad on the phone and tell him I love him before getting That Call. Wondering if there’s any hope for a world in which black and brown people are treated as if our lives really do matter. And wondering if the people who know and love me know that I’m not okay.

 

For the past week, I’ve been going back and forth to work and keeping it together because I’m “essential” and that’s what I have to do. For myself, for my husband, for my patients. I’m one of two black people in my office, and one of a few black people in the rehab department at the hospital where I work. For those of you who don’t know, I work in a mental health setting serving people with a wide variety of mental health conditions. People always ask me how I keep from bringing my work home with me, wondering how I can keep all of the sadness and pain and trauma and heartache from saturating my life and affecting how I go about it.

 

What they should really be asking, to me and every other black practitioner out there, is how I keep all of my own struggles and trauma and emotional distress out of my work life.

 

The truth is, I’m crying for the first time since hearing the news about Ahmaud Arbery, Breonna Taylor, George Floyd, and remembering Philando Castile, Eric Garner, Trayvon Martin, and all of the other black and brown people whose lives have been cut short by forces outside their control as I write this right now.

 

After every tragedy, I find that I am unable to really process what I’m thinking and feeling to the full depth because I have to keep getting up and giving strength to other people and being strong for other people who are suffering. I just don’t have the mental resources to cry all the way to work and all the way home and still keep doing my job. Because if I started crying on the way to work I’d never stop.

 

Unlike my white colleagues, I live with the burden of being black in America every day. When I go to work, I often face microaggressions and assumptions about my abilities, backgrounds, interests, and experiences from when I walk in the door to when I walk out. On top of that, I go in with worries about whether my brother or my uncle or my dad or my cousins will be stopped on their way into work or while doing their jobs and have their lives cut short. I wonder if the black patients who I see will be restrained, ignored, marginalized, or judged based on the color of their skin and not their physical, emotional, or mental health challenges. I wonder if the black and brown teens who I work with will be around in five years to be able to change the world in the wonderful and wild ways they tell me they want to. And yet I still have to create groups, attend meetings, write documentation, and go about my business the same as everybody else. But I’m not the same.

 

Everyone keeps talking about “occupational injustice” and “occupational apartheid” like they’re these big, fancy concepts that only apply to people in prison or low income communities or war zones. The fact is, these concepts apply to me too! As a black OT, it’s an injustice for me to come to work and listen to people talking about their fun weekend or their sleep issues or their plans for the future while I’m struggling to reconcile all of the emotions and hatred that’s happening and have nobody check in and ask how I’m doing or consider how it might be impacting my occupational engagement and quality of life.

 

This week, I’ve gotten texts and phone calls from people I’ve known for all of my life and just a few years asking how I’m doing and wanting to know what I think about everything that’s going on. I’m thankful that I have people who care and who are willing to brave the awkwardness and brace themselves for an onslaught of emotional instability when they ask “How are you?” It’s honestly more than I’ve gotten in any place I’ve ever worked.

 

I don’t know if it’s because people feel like it’s not “appropriate” in the workplace to check in with their black and brown colleagues and patients or because they themselves don’t want to deal with what happens next. But that’s just another luxury that I don’t have – I don’t get to ignore what’s going on. I get to relive the generational trauma and endure another day of institutional racism in a place that doesn’t have room for the answer to be “I’M NOT OKAY!!!!”

 

A lot of people are mad about how AOTA isn’t putting out a statement or doing anything else to acknowledge everything that’s going on, but I honestly couldn’t care less about what they’re doing. Anyone can write up a stupid statement to slap on their website and claim that they are “with you.” Anyone.

 

What anyone CAN’T do is meaningfully engage and push others to engage with their friends, family members, colleagues, managers, subordinates, team members, and others who are black and living through a time when our legacy of pain is laid bare for all to see and even more to avoid.

 

So if you’re not satisfied with AOTA’s response, why don’t you take a look in the mirror and look at your own response? Who have you checked in with? How many black patients have you asked this week about what’s going on in their heads and hearts? How many people have you cried with, have you marched with, have you called, have you written to, have you hugged, have you held, have you held space for? Versus how many social media images have you shared, posts have you written, videos have you watched from the comfort of your own home? Think about it, and then let me know who’s really in the wrong.

 

If you are an OT practitioner or anyone else out there reading this, I want you to know, and I need you to know that I’m not okay. We’re not okay. We haven’t been okay for a long time and we probably won’t be for an even longer time until you start to speak up and share the burden. Until you understand that I can’t be productive when most of my day is spent avoiding my own mind and finding ways to stay busy and keep from crying in the bathroom for 8 hours straight until I can go home and do it all night. I can’t do my best work when I’m listening to a bunch of ignorant coworkers talking about riots and looting and ignoring the millions of ways in which they marginalize and bully and oppress and ignore the people in their “care.” I can’t achieve my full potential in a workplace that refuses to acknowledge or even ask about whether or not what’s happening in the world and in my life is affecting me. Answer: IT IS.

 

I need our profession to understand that we as black and brown people don’t have the same occupational rights as you do! I don’t have the same right to walk down the street, to go shopping, to go jogging, to drive my car, to go to work, to live, to love, to laugh without experiencing alienation and maybe even violence. I don’t even have the same human rights as you do. And the sooner you acknowledge it, the sooner we can start a dialogue and start making change.

 

As an OT, I know that context is such an important part of what is happening in anyone’s life and how they are able to engage in occupation. Why would that be any different for black OTs right now? The context of my life is different than that of a white clinician. Currently, my context is one of pain, misery, trauma, anger, defeat, confusion, and despair. And as a result, my occupational performance is suffering. My energy levels are down, my cognitive functioning has changed, my emotional resources are bottoming out, my spirits are weak, my motivation is low, my mood is grim, and yet…I’m expected to go and do the same as a white clinician who isn’t facing this barrier? Worrying for their family’s and their own safety every day? It’s insane that a profession that prides itself on caring about context is so blind and yet here we are.

 

Right now, I’m supposed to be participating in my typical Sunday routine of attending church, spending time engaged in spirituality, and communing with friends. But I can’t do that because I have too much emotional distress brewing to even focus on anything else. Consider that on a wide scale, and then think about why the people you work with as an OT might be having difficulty doing what you and everybody else is asking them to do.

 

You’ve probably noticed by now that this isn’t the type of thing I normally write, but that’s OK. At least, it is with me. Maybe it’s food for thought or maybe it’s just another link to share or skim or ignore, whatever. It’s what I needed to do for me, and maybe what somebody else needed too. I don’t know, and I won’t know.

 

What I do know is that as I continue to do work in mental health, physical rehab, or wherever else, I am not going to ignore the big, black elephant in the room. The experience of trauma is embodied, and impacts occupational performance. As best practice, I’m going to write about it, I’m going to document it, I’m going to talk about it, I’m going to acknowledge it, I’m going to cry about it, I’m going to scream about it, I’m going to do my best to provide interventions and support and resources and referrals for it and all this is so that I can do something about it.

 

If you’re a boots on the ground therapist, make it part of your everyday practice to stop ignoring the obvious and doing the difficult thing. Make an emotional check in part of your session and make space to listen and learn from your clients of color. Challenge the assumptions of your coworkers and other people who don’t see “why it’s a big deal” or say “it’s so sad” and change the subject. Acknowledge the pain of your black and brown coworkers and do your best to share the burden or allow them to stop pretending and unpack their minds for a few minutes or as long as it takes. And if you’re in leadership, make it your job to engage meaningfully with people of color in your workplaces and communities to understand their frustrations and learn how to make changes to make their lives more bearable.

 

I’m committed to being more open with the people around me, to allow them to be supports and to challenge them to be better and do more.

 

I hope you’ll join me.

How To Take a Virtual Tour of Potential OT Programs

FINAL Acute Care OT Series

If you are a prospective OT student, applying to degree programs in the middle of a pandemic probably isn’t the exciting experience you were envisioning. You may be stuck at home and unable to visit the programs of your choice due to travel restrictions, financial strain, family obligations, or other factors.

If that’s you – fear not! After reading this post, you will learn how to get the information you need from the comfort of your couch. Taking a virtual tour of prospective OT programs is a fun, flexible, and cost-effective way to get important information about the place where you might be spending the next two to four years.

By using my Four P’s of Virtual Touring and focusing on the Program, People, Places, and Payment for each academic institution, you can get an excellent sense of whether a program is a good educational, cultural, and financial fit. Start by reading the questions below to learn more about what to keep in mind when comparing each program using the Four P’s system. Then, highlight the questions that are most important to you, based on your personal needs and goals. For example, if your primary concern is saving money, focus on the financial aspects of each program. Or if you enjoy travel, consider choosing programs in areas near major transportation hubs rather than those in more rural settings. Would you rather attend a top tier program that will require you to live in a studio apartment with four roommates? Or would you rather attend a lower-ranked institution in a location with a more affordable cost of living? All things to consider as you coordinate your virtual tour! (If you REALLY want to get detailed, you can assign a point value for the responses to each question based on your preferences and tally the scores for each program to get a more “objective” look at how each one stacks up.)

Finally, use the infographic that follows to guide your virtual search through each program’s website, social media, LinkedIn, YouTube, and other resources. Good luck, and happy touring!

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Earth Day Ideas for Occupational Therapists

Earth Day OT

Although many OT practitioners are providing services via telehealth, working reduced hours, or not working at all during the COVID-19 pandemic, there are thousands of therapists (including me) who are still going to a physical place of work every day. We are still seeing patients who expect us to come with a plan and a purpose, and to continue helping them to get well. And what better way to foster wellness than with a day of fun, non-pandemic-related treatments?

I love incorporating holidays into my treatment sessions because I LOVE themes and getting creative! (Seriously. My husband bought me one year’s worth of holiday-themed socks for a wedding gift and I wear them ALL. THE. TIME.) With Earth Day approaching on Wednesday, April 22, OT practitioners have the opportunity to bring a joy, foster skills development, and provide education by using earth-inspired occupations as interventions.

Read on to learn how you can celebrate Earth Day with occupational therapy clients of all ages!

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Book Review: Yoga for Amputees

FINAL Acute Care OT Series (1)

Wondering how you can mix up your OT practice, improve your clients’ health and wellbeing, and learn something new? I was able to accomplish all of this after reading the book Yoga for Amputees by Marsha Therese Danzig. Read on to learn more about why this book is a wonderful find for OTs.


Background

Marsha Therese Danzig, the author of Yoga for Amputees, is an amputee herself. In the early pages of the book, she describes how she lost her lower left leg to bone cancer in 1976. Danzig was a teenager whose main concerns were “boys, clothes, and getting into a good college” when she became an amputee and the devastating impact it had on her mentally, physically, and socially. She also describes how she eventually found yoga, which helped her develop a new sense of self, continue her recovery, and grow to become a skilled yogi and educator. As an OT, reading her story gave me fresh insight into how challenging it can be to live with limb loss or chronic impairment – and the powerful impact that interventions such as yoga, meditation, physical mobility and strengthening, and spirituality can have on a client’s life.

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Expanding Occupational Therapy’s Role in Acute Care

Acute Care OT Series 2

This is the second post in a series about occupational therapy in acute care. Read the first post in here.


One of the constant refrains of my occupational therapy program’s faculty was that we were all “change agents” with the power – and responsibility – to see and do things differently in order to achieve optimal outcomes for our patients and our profession. As a change agent, I make an effort to give my best and make positive change wherever I work, even when it’s easier to stick with the status quo. This is especially true in the acute care setting, where time, financial, and resource restraints can be huge barriers to holistic, occupation-based OT practice.

To be perfectly honest, I’ve had more meetings with management than I care to admit during my brief tenure at the hospital, typically to discuss my goals and plans of care for patients with needs that were deemed “not appropriate” to address within the acute care setting or goals that other team members “wouldn’t be able” to address after my initial evaluations (apparently because they weren’t BADL or exercise-based goals…). It hasn’t been easy, and each meeting is a valuable learning opportunity for me to learn what others think OT is or should be – and a platform for me to provide education and advocate for my profession and scope of practice. Without going into too much detail, I’ll simply say that I think there is a long way to go before truly holistic, progressive, and occupation-based occupational therapy is the norm – rather than the ideal – in most hospital settings.

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Acute Care Occupational Therapy: A Dying Art?

This is Part 1 of a series about OT’s role in the acute care setting.

Acute Care OT Series.png

In August 2018, I had my one year anniversary as an OT working in an acute care hospital setting. If you’d asked me two or three years ago where I thought I’d be working, I NEVER would have thought I’d be in acute care! Ironically, my first-ever OT fieldwork experience was with an acute care OT at a large teaching hospital, and while I enjoyed the learning experience I was certain that the setting was not for me. I disliked the hectic pace, limited opportunities for occupation-based practice, and short time spent treating clients. Ultimately, I felt that I was better suited for a setting where I would be able to do things with clients that initially drew me to the profession – such as cooking, leisure activities, home modification, and community outings – and acute care didn’t seem conducive to any of these goals.

 

Fast forward three years, and I found myself working with a small team of OTs and one OTA at a 650 bed community hospital on an interdisciplinary acute rehab team. Initially I spent much of my time on the ortho floor, evaluating and treating patients after hip, knee, and shoulder surgeries. From there, I branched out into providing care for patients on the neuro, general medicine, oncology, bariatric, intensive care, and cardiac units. It has been a whirlwind experience, and I am learning something new every day – including what my managers, coworkers, and teammates believe is “within the scope” of OT practice in the acute care setting. I don’t always see eye-to-eye with them about what types of OT interventions are appropriate in the acute care setting, but our ongoing discussions and my desire to learn more inspired me to dig into the literature, talk with professional mentors, and reach out to other acute care OTs to learn how how I could serve hospitalized patients while still practicing in a way I know is skilled and demonstrating my distinct value as an occupational therapist.

Read on to learn more about the precarious position of acute care occupational therapists in today’s demanding healthcare environment.

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Evidence Based OT Practice, Part IV: Fact or Fad? A Case Study with Bal-A-Vis-X

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This post is part of a series on evidence-based practice in OT. Read the previous posts in the series here, here, and here.


Many rehab therapists have fallen prey to using fad treatments that have little or no evidence to support them. There continue to be many lively Facebook debates and polarized opinions about various occupational therapy interventions. Those who believe the intervention is effective make a point of highlighting the many clients they’ve treated who have experienced significant gains, and non-believers turn their noses up and ignore on any evidence presented by those on the other side. As I’ve stated in previous posts about evidence-based practice, the issue in these cases is not whether to use new interventions without a ton of research evidence behind them, but the lack of clinical judgment and application of evidence-based practice principles when choosing and using OT interventions.

 

For example, in one setting where I worked I witnessed a department of over 50 experienced and intelligent clinicians buy into the promises of an intervention with only weak evidence to support it due to its extreme popularity in the pediatric professional sphere. No matter that this intervention required costly trainings and materials, was unlikely to be generalizable outside of a highly specific context, and was barely occupation-based – therapists wanted to learn it anyway! I was shocked that the department was spending limited continuing education funds on a popular pseudoscience program rather than a well-researched, evidence-based training that could help clinicians obtain better functional outcomes for young clients. Unfortunately, this is the case in many settings and with many practitioners.

 

The goal of this post is to closely examine one such program and break down how principles of evidence-based practice can be used to help make a determination about the validity, clinical applications, and utility of this program for occupational therapy practitioners. Read on to learn more about whether the widely-used Bal-A-Vis-X program is an evidence-based intervention or a highly-flawed fad!

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Evidence Based OT Practice, Part III: How to Become an Evidence-Based OT Practitioner

Evidence Based Practice Series (1)

Current literature indicates that many healthcare practitioners – including OT practitioners – are failing to identify or utilize high-quality, up-to-date sources of evidence and are instead relying on personal experience, popular media, and outdated treatment protocols to provide intervention.

 

I have observed firsthand the difficulty of integrating evidence into practice during my OT education and employment experiences. During one of my fieldwork placements, a veteran fieldwork educator with 15+ years of experience gave the same home exercise program (HEP) to every client she saw, despite their diverse diagnoses and abilities. Although one could argue that upper body strengthening may be generally helpful for any person who is recovering from illness or injury, I began to wonder whether or not giving the same handout and Theraband to every client was actually benefiting them. In short, what was the evidence supporting this practice?

 

The fieldwork educator certainly wasn’t harming any of the clients by giving them a generic home exercise program. But not causing harm isn’t a particularly good reason to use a treatment or intervention. By that logic, you could provide any treatment whatsoever as long as you aren’t hurting your patients! It seemed to me like this supervisor had simply included “home exercise program” as part of her routine, rather than carefully considering each person’s condition, learning style, or level of health literacy and incorporating this information into her plans of care.

 

I don’t fault my fieldwork educator for her actions; since joining the workforce I’ve experienced firsthand how challenging it can be to ensure that the interventions I provide are evidence-based. It’s exhausting to spend all day treating patients, answering emails, talking with interdisciplinary team members, documenting, and going to meetings – some days it feels like Googling an unfamiliar diagnosis is the most than I have the time or energy to do. Despite this, I push myself every week to read an article, pick a coworker’s brain, talk with a mentor, or find another way to continue incorporating evidence into my everyday practice. And I’ve found that while it’s not always easy, it is always worth it to find evidence to support the interventions I provide and grow my knowledge base and clinical skills.

 

Why Is It So Hard to be an Evidence-based OT?

There are a plethora of reasons why many occupational therapists struggle to consistently utilize evidence within their daily practice, such as:

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