A lot of life has happened since my last post (3 months ago oops)!

Turning 23 and watching little brother walk across the same stage that I did in 2011 to preparing for “studenting” outside of the OT school classroom to switching from girlfriend to future bride   (f o r e v e r      j a m m e n)     to learning that kids are exhausting but rewarding to finishing my fieldwork with a sense of fulfillment and more.

 

What is Level 1 OT fieldwork?

Well, for starters Level 1’s are definitely not created for the student to achieve independent performance such as the expectation of  Level 2. Rather, Level 1’s are for increasing the comfort level between student therapists and clients with an emphasis on…

“experiences designed to enrich didactic coursework through directed observation and participation in selected aspects of the occupational therapy process” (AOTA.org).

These experiences vary from school to school but typically include about 5 settings in which a student will observe and participate in intervention planning/implementation to a wide variety of clients (developmental delay, Autism Spectrum, Down Syndrome, amputees, war vets-God Bless them-, physically/mentally impaired, survivors of strokes, spinal cord injuries, traumatic brain injuries, motor vehicle accidents… the list goes on and on-in all sorts of settings ranging from inpatient rehab to acute care to neuro/lymphedema to outpatient pediatrics to skilled nursing facility (SNF) to schools based. Some occupational therapy schools may choose to send their students to one site for 5 consecutive days and then complete coursework the following weeks. My school –University of South Alabama

(***I am speaking only about the time frame from which I attended OT graduate school there***)-
Go jags– sends their students to a site once a week for 5 weeks between semesters 3 and 5. The student continues to receive graduate level education in a regular classroom 3 days a week in addition to 1 day of clinical fieldwork.

For example, I attended the following 5 settings for my Level 1 experiences: acute care, SNF, outpatient pediatrics, schools-based, and hands/orthopedic.

What is Level II OT fieldwork?

First things first, this is the realist-no matter if you were an all A’s student or if you barely inched your way through OT school, your success in fieldwork is dependent on your work ethic, interpersonal skills, ability to handle stress, personal research, flexibility, among other characteristics– this in addition to applying the knowledge learned through curriculum work and previous Level 1’s. In my opinion those aforementioned qualities are much more important than your book smarts. There is none of the 89.99 nonsense that makes you angry at school when you receive a B when you worked your bum off the whole semester instead of an A-whereas the classmate next to you with an 81.0 receives a B without half the stress (or hard work) you put yourself through >>type A problems<<. In OT Level 2 fieldwork land it is simply Pass or Fail. If you happen to achieve 170 out of 170 so be it, but that does not earn you a GOLDEN STARand you aren’t cooler than your peers even though that is the ideal score.

For Level II Fieldwork, the American Occupational Therapy Association Standards requires a minimum of 24 weeks full-time (my school requires two 12-week rotations in totally different settings) for occupational therapy students. All students must complete the fieldwork (both Level 1 and Level 2) required by their school program.

In a nutshell, you can think of Level 1 fw like an opportunity to observe and then treat with less emphasis on the “why” you chose specific interventions and much more emphasis on learning through example. Level II fw is like Level 1 fw on steroids; by the end of it (actually more like by the middle of it…) you should be taking the lead and acting basically like THE therapist.

Perhaps the first week is more laissez-faire, but after that it is time to apply your knowledge gained from school and previous observation/treatment and truly transition from the “academic” mindset to the “application and adapt interventions as you go” mindset.

See more information on Level II fw here.

 

 

Prep Prior to Pediatric Level II

After 2 years of going, going, gooooing in the classroom (including 5 Level 1’s), it is pretty natural to feel a little burnt out. With that being said I didn’t touch a book or read anything OT Practice/AOTA/Pinterest anything occupational therapy related for the first week after the conclusion of my fifth semester.

After I enjoyed a little leisure time (important area of occupation!!!), I was well-rested, nervous, and excited for my quickly approaching rotation. At my school our main Early Childhood Development course was in our first semester, which felt like an eternity ago. I definitely had to brush up on infant reflexes, developmental milestones, age appropriate grasping skills, and interventions as well as a multitude of other topics. The fact of the matter is that in OT WORLD pediatrics is a specialty area.

And so it begins…

The first week flew by and I remember being amazed by the fast-paced expectations. In contrast to adult outpatient rehab where you may have an easier time communicating and coaxing your clients into performing an important skill (by reminding them that they need to do these interventions to get well in order to perform activities of their interest again or to get back to work or even in order to increase their independence in personal daily skills), in pediatrics you have to truly incorporate the child’s favorite toy or game in addition to communicating at their level to accomplish client-centered therapy. Peds OT is all about manipulating or adapting a game or a toy to address an array of skills. And don’t get me started on handwriting (who would have known there is literally like 10 different types of writing paper…)and appropriate grasp on a writing utensil because that is a skill you learn to incorporate during treatment (tx) sessions on the job—aka have stickers or something awesome to bribe a child with to complete this portion of therapy–or think multisensory and have the child don (place) his/her 1st digit or a q-tip into shaving cream, paint, or tactile sand!!

Always aim to address multiple goals!

OT is synonymous for bringing craftiness and creativity and aligning interventions to theory! Below are a few different “toys” I made to address multiple needs at the OP clinic.

The Hungry Caterpillar

 

 

As a child I really loved The Hungry Caterpillar. On Pinterest I saw many different button snakes that pedi OTs and preschool teachers made to help their kiddos learn to button. Once again it is all about how you can take an activity and adapt it to address numerous skills. For my Hungry Caterpillar button snake I bought all of my craft materials at Michael’s (felt paper, button, string, hot glue gun), and went to work… some of my food items came out a little better than others but the kids loved it!!

So what’s so cool about a book and a button snake??

It addressed the following skills depending on how I presented it to the child…

1. ADL/Unbuttoning/buttoning medium sized buttons –> to decrease caregiver burden in this self-care dressing task
2. 2 step directions (verbally give directions to retrieve 2 felt food pieces) –> to improve auditory processing, memory retrieval, recall
3. Simple figure ground (spread the felt pieces out in front of the child and have him/her find a specific piece) –> to improve ability to find a specific object in a busy background such as independently retrieving a desired clothing item in a messy drawer full of clothes at home
4. Pattern imitation/color matching or identification –> to improve sequential memory skills
5. Gross motor skills(indirectly) –> Spread the pieces out on one side of the room and have the child frog jump, crab walk, army crawl, etc to the other side of the room with the pieces–> to increase age appropriate balance, body posture, endurance, ability to wear bear for hand strengthening.

Visual Schedule Board

 

Naturally, I feel better when I have a tentative schedule for my day in mind. I’m quite certain I am not the only individual who feels this way. I keep my planner handy in my purse for this reason; however, without my planner I can still perform my tasks for the day in the correct sequence and timing (but I feel anxious not being able to physically scratch it off my never ending to do list). That is not as easy of a feat for child with a disability such as a child with Autism Spectrum Disorder. For this reason, I decided to revamp the clinic’s visual board with the following simple materials (clothespins, paint brush, felt paper, icon pictures, sturdy board).

Reasons to use a visual schedule board…

• Visual processing with pictures rather words eliminates reading comprehension demand
• Provides predictability and structure
• Provides a point of reference for a child to know when is the next break or “recess”
• teaches organization and improves transitioning between activities
• Increases inclusion in regular ed classes
• Helpful in task analysis

Sensory Bottles

Firework Sensory Bottles

If you are in need of a quick sensory calming strategy that can be used in a variety of contexts (such as in a car, in the grocery store, etc), a sensory bottle may be the just-right option for you. These are cheap and are made by upcycling bottles and filling them with a multitude of different items such as colored sand, pebbles, water beads, sequins, and glitter. If a child is having a behavioral outburst or mini meltdown and you aren’t in an environment that provides you with the atmosphere to apply deep proprioceptive input or other calming input, this may be an easy and effective solution in effort to improve one’s ability to self-regulate by providing an outside calming source (similar to newborns that learn to regulate their breathing and body temp through skin to skin contact with their mom).

After completing my 12 weeks in an outpatient pediatric setting I firmly believe (and so does my CI) that if the opportunity to work in peds presents itself, I can do it wholeheartedly and effectively. After completing 16 6-8 page evaluation write ups (and those are the ones I wrote by myself), 36 intervention plans weekly, a few reassessments, multiple mini projects, 10 progress notes, and countless detailed daily notes later, I am thankful and relieved!

When you treat/”play” with a kid, you get the opportunity to impact the kid and the parent’s life and that’s truly special.

 

Nevertheless, in the middle of my fw two awesome life events happened…

1. James and his classmates finished their first year of medical school!!! So proud.

Curious about medical school?? Not sure if it’s for you or not?? Did you know there are two routes to becoming fully licensed physicians that can treat, diagnose, and perform surgery?? Allopathic vs. Osteopathic (and no this is not referring to naturopathic “doctors”…). MD vs DO and their pros and cons—-> MD vs. DO: DO your research

2. James proposed!!!! I get to be his forever bride!

 

 

Literally up to an hour before he proposed with the most romantic plan ever, I was writing evaluation write ups and intervention plans for my kiddos.  I live a blessed life and he is the best part of myself.

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Next rotation begins Monday in a SNF/inpatient rehab facility. Wish me luck!!!

With love,

SHANNEN M.