The vast majority of OT students complete their Level II fieldwork placements in traditional settings such as schools, hospitals, outpatient clinics, and home-health programs*. Fewer will complete fieldworks in mental health facilities, community-based settings, or even more non-traditional practice areas such as vocational rehabilitation or criminal justice systems. With a quick Google search, you can read about OT students’ fieldwork experiences in schools, hospitals, and mental health institutions across the country and around the world.
But what about the few, the proud, the mostly-forgotten OT students who are not working in these places? As far as I can tell, we don’t really have a voice in the online community and there is little information available from AOTA, individual programs, or other sources to support students who aren’t in traditional fieldwork settings. A recent literature review I conducted in an attempt to find resources for myself demonstrated that while there are multiple studies touting the benefits, opportunities, and possibilities for with OT students who complete non-traditional or “innovative” fieldworks, there are virtually no resources or studies examining the student experiences in these settings. As is often the case, the focus of most OT research and knowledge development is not focused on or developed from the student perspective.
While I think it’s great that many OT students are being encouraged and given opportunities to practice in non-traditional settings, I am disappointed and frustrated with the lack of resources and support available for students (like myself) in these placements. For example, two of the more common non-traditional settings are criminal justice systems and community-based mental health organizations. Although there is research discussing the challenges and opportunities for clinicians in these settings, I believe it is also important to know what issues students face when working with current or newly-released inmates or clients receiving community-based mental health services (for example). How are students preparing to learn, meeting education standards, providing services, and “doing OT” in these settings? These are some of the questions I have, but it seems that nobody has the answers. I believe that students should be as well-equipped as possible to enter these and other non-traditional settings in order to ensure that the educational experiences they receive and the services they provide are both of high quality, but this has not been my experience. And while many students entering non-traditional settings are “debriefed” by their program’s fieldwork coordinators, future fieldwork instructors, or previous students, this may not be sufficient to prepare students to succeed in these placements.
Although I can say that I don’t have any regrets about my fieldwork placement in vocational rehabilitation and I value the opportunity to learn about the clients, health conditions, and pros and cons in this setting, I’m not going to pretend I’m 100% aware of how to develop my practice skills here or that I’ve been well-supported with resources from my professional associations or even my program. In all fairness, I have sought advice from my supervisor and academic fieldwork coordinator (AFWC) and conducted research online (all of which have been only moderately helpful), but I would appreciate having other supports available online or elsewhere for students in situations like mine.
The goal of this post isn’t to make myself a martyr for the non-traditional placement cause or to say that students in traditional settings have it easy. As always, I’m simply looking to provide information for students in a similar situation to mine who may be struggling with it like I am. This post may also be relevant for students in any setting who are struggling to find success during fieldwork or how OT fits in with their practice setting.
Read on to learn how you can get the most out of your non-traditional OT fieldwork experience, wherever you may be!
10 Tips for OT Students in Non-traditional Fieldwork Settings
- Develop your knowledge. Although I have not yet provided many “OT services” to clients (in my opinion), I am learning a great deal about working with clients who have mental illness, low literacy levels, and problems such as substance abuse and homelessness – things I have not experienced in-depth before now. As a result, I’ve spent a great deal of time conducting research into best practices to use with clients with these conditions, and I spend much of my time picking my supervisor’s brain about how to best serve these types of clients. Even if you are uncomfortable in your setting at first, taking time to learn more about what to expect can help you settle in.
- Communicate early and often. If you feel that your experience is not giving you the skills you need to be a successful clinician, SPEAK UP! Your supervisor is not a mind reader, and he will not always know if you feel like you’re missing something. Find a time to meet with your supervisor and voice your concerns. You should also keep in contact with your AFWC and keep him or her apprised of your situation; it’s likely that she or she will have had students in similar situations and can offer you helpful advice.
- Accept what you cannot change. One of the frustrations I have in my setting is the length of time between when clients are referred to the agency and when I get to actually see and work with them. However, being annoyed about it isn’t going to change it. I’ll see clients when I see them, and this is just something I’ve had to learn to live with. By letting go of unproductive thoughts, you’ll free up mental space for more useful work.
- Make your own way. Work with your supervisor(s) to identify specific clients, cases, or programs that you feel will benefit your learning and focus on these. For example, in my setting there is a lot of “wait time” between when clients are initially seen and when they can start receiving services. So although I spend much of my time completing intake paperwork, I am also actively seeking out opportunities to do things like shadowing job coaches when they work with clients on the job, observing vocational evaluations, and visiting the state assistive technology center to support my learning and interests.
- Own your OT identity! Being the only OT in a setting can be nerve-racking at first, but you can use your fieldwork as an opportunity to advocate for why an OT is necessary where you are and provide a different set of skills and perspectives to your clients and coworkers. I also make it a point to educate others about what OT is and the unique, client-centered, and effective services OTs are able to provide (our distinct value!) whenever I can.
- For example, during a group workshop for people trying to find or retain employment, I led a mini-discussion about stress management strategies with an OT twist. I focused much of the lesson on sleep (the forgotten ADL!) and how too much or too little sleep affects every part of a person’s life (all their occupations) at home and at work. I described how a lack of sleep can increase stress and make a person perform poorly during a job interview or have a negative attitude at work. I also had clients tell how many hours of sleep they typically got and offered suggestions for altering sleep habits and routines to help educate clients about this important occupation.
- Reflect on your learning. It may be difficult to parse out the things you are actually learning during your fieldwork in the heat of the moment throughout the day. However, if you take time every week to think about the different kinds of skills you are developing, you may notice that you are learning a lot more than you think and you’ll likely feel better about your fieldwork placement! Some of the skills I’m currently developing are:
- Client interviewing, including active listening and collecting required information while gathering information about the client’s background, interests, skills, and challenges
- Self-advocacy, when speaking with my supervisor about my goals and learning needs
- Redirecting conversations when they veer off track or to inappropriate topics
- Maintaining a poker face when listening to client stories that are sometimes very difficult to hear or (honestly) kind of shocking
- Being client- and family-centered in situations where the client may not be as able to speak for himself (i.e. addressing and including both the client and his parent/caregiver in the interview, evaluation, and application process)
- Handling workplace interpersonal dynamics
When I’m sitting in my office filing paperwork or sending yet another fax, it can be hard to see all of the things I’m actually working on. But when I think about my day during the drive home or in the evenings, I can see all of the things I’ve learned. As a budding OT, your experience as a fieldwork student is kind of similar to what many of your OT clients will be doing – learning skills without even knowing it!
- Keep things in perspective. Even if you feel like you’re floundering or have a lot of regret or negative feelings about your placement, do the best you can every day and realize that it’s only 12 (or so) weeks of your life! A month after your fieldwork, you’ll be back in classes, looking for a job, or doing a million other things – keep in mind that your fieldwork situation is not where you’re going to be for the rest of your life.
- Sharpen whatever skills you can. In my setting, I simply do not have the opportunity to provide physical or hands-on interventions with clients at this time. However, I am responsible for interviewing many clients and writing accurate, detailed client meeting notes for every encounter I do have. As a result, I feel that I have significantly improved my interviewing, therapeutic use of self, note-writing, and active listening skills. Even if you feel like your opportunities for skill development are limited, make the most of whatever every experience you do have.
- Focus on the positive. Even if you are uncomfortable or even unhappy in your non-traditional fieldwork setting, you can make a choice to focus on the ways in which your experience is benefiting you and your clients. For example, consider how your presence as a student is allowing clinicians in your setting (and you) to work with more clients than they would typically be able to. Or think about how hard you worked in the past few years to get to where you are! By keeping a positive mindset, you can help keep negative thoughts at bay and make the most of your experience.
Finally, remember Tip #10: Comparison is the thief of happiness. If you’re spending all of your time talking to your classmates about what they are doing on fieldwork, reading about settings you wish you were in, or comparing your experience at a site to students who came before you, you’re never going to be able to be truly successful.
Just know that you can learn something wherever you are, and even if you aren’t necessarily developing a “standard” skill set, think broadly about the skills you have gained. Have you become an organization master? Have you gotten over your fear of cold-calling clients? Have you learned how to interact with people of diverse skills sets and backgrounds? Then you’ve done a good thing, and you’re on your way to being a great OT!
How did you find success in your non-traditional OT fieldwork placement or job? Share your advice in the comments!
*Unfortunately, I was unable to find actual data about the distribution of OT students across fieldwork practice settings, so these statements are from my experience in my OT program, talks with my instructors, and a survey of recent and older OT blogs. Although I searched thoroughly, there does not appear to be hard numbers for current or past OT/A student fieldwork distributions readily available online.