One third of the way through this experience (4 weeks out of 12).. that is shocking and nerve racking because I still feel like such a newbie. Is 12 weeks enough time to learn the skills I need to be an OT in any setting?
It takes time for children and parents to warm up to a student. In an adult setting, I imagine the clients are more goal-driven and willing to participate in tricky tasks, even with a stranger, if they believe it will help their independence. Trust building is a huge part of therapy - being client centered, having empathy, bringing yourself into the client's world. No doubt about it. You will get more out of your patient's if they trust you. Regardless of practice setting or population. But adults can communicate their concerns, their doubts, their frustrations.. you can talk it out and reason with them (sometimes..).. you can explain why it is important to do x, y, z.. Kids don't care about your schooling, your treatment goals, or why you're in their house. If you can connect with them, you're in. If they see you as a threat, you're out. And it takes time! So my supervisors and I have been respecting children's time to warm up to me, which is different for each of them. Some kiddos have a more adverse reaction to change, due to their experiences, and could not tolerate me being less than 5 feet away. Some children find eye contact too intense, and if I would look them in the eye and invite them to play with a toy, they would shrink back. Some children are used to having many people in their homes and could care less. Some greet me with smiles or coos and I can interact with them no problem.
Then there's the parents. They are our clients as well. They have different comfort levels with people being in their space, with their children receiving services, and with a student fresh out of school working with their child. We have helicopter parents and distant/absent parents. My supervisors prepped me on the situations we were entering at most of the homes, and I read charts and take notes to try to remember names and tidbits about the kiddos medical or family history so I can better interact with the parents. I've found that my supervisor's already established relationship with a caregiver sets the tone for my relationship with them: if they communicate well, it's easy for me to chime in and ask relevant questions and make small talk; if it's rocky, I tip toe and hope for the best. And some are all for my learning and don't mind at all if my supervisor explains to me what they are doing during the session. Basically this involves pointing out abnormalities in the child.. you see how they move their head, how they don't track objects, how they hold one side of their body tighter, how they are floppy, how their head is asymmetrical...
Some parents are able to hear these things because they have accepted their child's status or are intrigued to learn more about the child's movement patterns and behaviors. Others are in various stages of grief, pain, or denial about their situation, and this sort of dialogue would be difficult to handle. So most of my questions or observations are discussed in the car rides between visits.
When you are surrounded by children who are delayed in their development, it's hard to remember what is "normal." The textbook or child development resources have bullet points about what to expect at each month. It seems very cut and dry. Simple - just memorize the facts! But in reality, everything is a range and each child has their own timing. A child who crawls or walks later than expected may very well catch up in all areas of development and it may be no big deal. But if other signs do or do not occur within a certain period of time, stronger red flags are raised. It can be hard to remember what is what when a parent asks questions. Is this the thing I tell the parent I'm concerned with or is this the thing I tell them it's going to be fine, he just needs some more time? I mean we're concerned with all of the kids we're seeing - that's why we're involved. So I am becoming a little numb to major delays, because the majority of our children have major delays. It's not uncommon to see a one year old who cannot sit without help, crawl, or walk. That's not good!!! But it's easy to compare children who are about the same age and start thinking child A is doing fine because child B is so much farther behind. Really they both need serious attention and we must keep educating the parents on the gravity of the situation! I was more confident on baby milestones before this internship.. now everything is wishy washy.
Then I got my hands on the kids and led my first treatments and wrote my first progress notes in the moment on the real documentation paper... and it was NOT a piece of cake! They make it look so easy - one motion segues into the next; one activity is followed by another.. A child refuses and they set limits. A child is inattentive and they pull them back in...
I enter the home and forget the child's name. Mom's name is out the window. "Hi guys! How's it going?" Haha... When the child isn't understanding what I'm asking them to do, I try a few ways and then sit there blankly.. forgetting that hand over hand prompting is a big strategy we use. When I stare at the blank progress note at the end of the session, it stares back. We do maybe 5 -8 activities in each hour session, with lots of the same toys hour after hour. What did we just do? Which toys? And what skills did we address? Overhead reaching, cause and effect toys, identifying shapes and colors, imitating sounds? What kind of redirection did the child need? How do I say that in words? How do I write this in a positive way?...
With each experience, these things are getting easier. Words are closer within reach in the word bank in my head. Moms and siblings and pet names are starting to be packaged together. And along with it, there's an ever increasing awareness at how much growing I must undergo. How many parent questions I am ill-equipped to answer. How much I rely on my supervisors to know what to do next. How intense some of the needs in some of these families really are...
Warming Up
It takes time for children and parents to warm up to a student. In an adult setting, I imagine the clients are more goal-driven and willing to participate in tricky tasks, even with a stranger, if they believe it will help their independence. Trust building is a huge part of therapy - being client centered, having empathy, bringing yourself into the client's world. No doubt about it. You will get more out of your patient's if they trust you. Regardless of practice setting or population. But adults can communicate their concerns, their doubts, their frustrations.. you can talk it out and reason with them (sometimes..).. you can explain why it is important to do x, y, z.. Kids don't care about your schooling, your treatment goals, or why you're in their house. If you can connect with them, you're in. If they see you as a threat, you're out. And it takes time! So my supervisors and I have been respecting children's time to warm up to me, which is different for each of them. Some kiddos have a more adverse reaction to change, due to their experiences, and could not tolerate me being less than 5 feet away. Some children find eye contact too intense, and if I would look them in the eye and invite them to play with a toy, they would shrink back. Some children are used to having many people in their homes and could care less. Some greet me with smiles or coos and I can interact with them no problem.
Then there's the parents. They are our clients as well. They have different comfort levels with people being in their space, with their children receiving services, and with a student fresh out of school working with their child. We have helicopter parents and distant/absent parents. My supervisors prepped me on the situations we were entering at most of the homes, and I read charts and take notes to try to remember names and tidbits about the kiddos medical or family history so I can better interact with the parents. I've found that my supervisor's already established relationship with a caregiver sets the tone for my relationship with them: if they communicate well, it's easy for me to chime in and ask relevant questions and make small talk; if it's rocky, I tip toe and hope for the best. And some are all for my learning and don't mind at all if my supervisor explains to me what they are doing during the session. Basically this involves pointing out abnormalities in the child.. you see how they move their head, how they don't track objects, how they hold one side of their body tighter, how they are floppy, how their head is asymmetrical...
Some parents are able to hear these things because they have accepted their child's status or are intrigued to learn more about the child's movement patterns and behaviors. Others are in various stages of grief, pain, or denial about their situation, and this sort of dialogue would be difficult to handle. So most of my questions or observations are discussed in the car rides between visits.
The More I See The Less I Know
Getting My Feet Wet
Weeks 3 & 4 are dangerous and confusing. I am at a place where I know enough, in general terms, but can't answer much about specifics, so it feels safer to keep my mouth shut. I rely heavily on my supervisor to lead the way during treatments. But the treatment with "Johnny" this week kind of looks the same as our visits with him the last 2 weeks, so I'm starting to get a little bored observing and have this feeling that I got this. Piece of cake. It's so obvious what comes next when my supervisor does it... I was starting to think it was pretty easy and wondering if we are even providing a skilled service, just playing with kids and all.Then I got my hands on the kids and led my first treatments and wrote my first progress notes in the moment on the real documentation paper... and it was NOT a piece of cake! They make it look so easy - one motion segues into the next; one activity is followed by another.. A child refuses and they set limits. A child is inattentive and they pull them back in...
I enter the home and forget the child's name. Mom's name is out the window. "Hi guys! How's it going?" Haha... When the child isn't understanding what I'm asking them to do, I try a few ways and then sit there blankly.. forgetting that hand over hand prompting is a big strategy we use. When I stare at the blank progress note at the end of the session, it stares back. We do maybe 5 -8 activities in each hour session, with lots of the same toys hour after hour. What did we just do? Which toys? And what skills did we address? Overhead reaching, cause and effect toys, identifying shapes and colors, imitating sounds? What kind of redirection did the child need? How do I say that in words? How do I write this in a positive way?...
With each experience, these things are getting easier. Words are closer within reach in the word bank in my head. Moms and siblings and pet names are starting to be packaged together. And along with it, there's an ever increasing awareness at how much growing I must undergo. How many parent questions I am ill-equipped to answer. How much I rely on my supervisors to know what to do next. How intense some of the needs in some of these families really are...
Being Present
But I've found ruminating on all these "issues" if you will, was decreasing my confidence. My hyper-awareness of how little I knew was slowing my ability to learn and be present, to absorb and take in. It's hard to be present when you are trying to bring someone's name to mind, or worry about what kind of a future this child and family will have. And it's hard to connect with a family when you are being quiet, reserved, and worried. The kids connect through silliness (MUST BE SILLY!), through leaving pride at the door, through sounds and faces and energy. My supervisors aren't worried about what I don't know - they just want me to do my best. And when worried about a family, really the best thing I can do for them is connect, model behaviors we hope to see in the parents, and model play skills we want the kiddos to imitate. It's so much more fun this way - to connect through play - and laugh at my mistakes. Now's the time to make them! It's kind of the point.. this is a safe place to flop and grow :)
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