What do Occupational Therapists do in outpatient paediatric settings…

Occupational Therapists (OTs) in outpatient paediatrics work to restore and improve the participation of children and young people in basic activities of daily living (ADLs) primarily within home and community spheres. Many children also have services within the school setting and so, in outpatient, OTs focus on ADLs such as dressing, showering, and participation in play. OTs in this setting often work with families on feeding issues as well; this is a specialty within OT known as feeding or oral-motor therapy. We work to provide training, safety, and engagement for both the child and their caregivers which often includes involving the whole family in the treatment plan.

Describe a typical working day… 

I had just pivoted into to this setting in January 2020, after a year of being a locum OT in different roles. Meaning that I had just over two months of one kind of typical day before COVID-19 set in and has continued to evolve. These days I go to one of two locations; both are “free standing” units but are essentially attached to a school in my area. I work with a great team of Physiotherapists, one other OT, and a couple of office service Technicians. We are slowly rebuilding our in-person caseload after spending the past few months almost exclusively seeing our clients via telehealth. 

Each day has been a different combination of in person and virtual therapy. This includes preparing for evaluations or re-evaluations for our clients by searching through medical records and getting out the equipment or toys that we’ll use. Then suiting up with full PPE and keeping all items separate until they’re properly cleaned. Some days we then quickly switch out masks to go into a free room and attempt to complete a telehealth session, with often faulty internet connection, leading to frustration for families and providers alike. Next is completing documentation and calling families who are not able or have opted out of teletherapy for a check in. An afternoon might include creating an updated home exercise program (HEP) or calling a provider to follow up on a piece of durable medical equipment (DME) that needs to be updated or replaced. With down time going towards treatment planning for sessions, emailing parents what materials to have on hand for telehealth, and attempting to reorganise workflow with the help of my coworkers.

The challenges I face in my role are.. 

Telehealth and having a lack of equal access to technology, equipment, and a reliable internet connection has been a significant barrier for myself and coworkers since the start of the pandemic.  The lack of research on the various diagnoses with our population also makes it difficult to be as evidence-based as we would hope to be. Working within a system where equipment and diagnoses that qualify for services is highly influenced by the payer source is another challenge faced by my team and the families we work with. 

Many of the individuals and families that I work with have experienced trauma. Whether this is a physical trauma that occurred such as a birth trauma resulting in a diagnosis such as Cerebral Palsy or complex trauma such as a familial event on top of a physical disability. It is within an OT’s scope of practice to address all of these factors which impact our clients and their caretakers.

Many of our families, like all of us, are now having to find a new normal. The majority of kids we see at our clinic regularly have more than the usual amount of doctor’s appointments, therapy appointments, need for specialised equipment, etc. Over the past few months our families are having to juggle their job, e-learning with siblings and our clients, and deciding if it is worth the risk to bring their medically fragile child to therapy or to decline and risk regression or worsening contractures among other things. Recognising these factors, among many others, allow us to best serve our families by treating the whole person within their current environment. 

What I love about my job… 

The best part about my job is being able to problem solve and collaborate in the moment with my clients and their families. I find great joy in my role when a parent and I can work together over telehealth  to use ordinary everyday items from around the home or the child’s favourite toy to work towards the child’s goal. I love being able to show my clients a piece of adaptive equipment which can allow them to be more independent, or showing a client who is nonverbal how to do just one thing differently that makes all the difference, or providing active listening and empathy to a parent, even through a translator, who is often overwhelmed and who may feel as though they’ve run out of options.

It is providing hope where I can and creating connections with families and their communities. 

This blog is part of our ‘What do Occupational Therapists do…’ series to celebrate OT month.

Author: Emily Polovick-Moulds, MOT, OTR/L

Twitter: @Emily_VP 

Bio: My name is Emily and I am a United States based OT currently located in California. I work for a Medical Therapy Unit which provides outpatient services through the state to children (0-21 years old) with disabilities in my county.

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