What do Occupational Therapists do within a Residential Treatment Centre (RTC)…

I’m Emily, an American-based OT, and right after graduating with my Master of Occupational Therapy degree I worked in a residential treatment center for pre-teens with complex developmental trauma for just over two years. Our students came from all over the county and each had a unique story that had led them to us. 

OT’s Role… 

In my experience, OTs working in residential treatment centers often work with clients’ sensory preferences, body awareness, emotional regulation, coping strategies, roles within school, friends, and home, and establishing healthy routines. 

Weekly Routine…

The programme I worked with had five teams of approximately ten kids each; I was responsible for one group per week with each team as well as individual sessions for the majority of kids on a rotating basis. There were several students who had IEPs (Individualised Education Plan) from their school district and I worked with the teachers at the middle school to implement strategies and spent targeted time with them for this purpose. In addition, I spent time consulting for and collaborating with various departments within the RTC. Additional duties included: 

  • Treatment team meetings for each child monthly
  • Clinical meetings (including all the therapists and neurotherapy technicians)
  • Supervisory meetings: both with my supervisor as well as with my OT Aide 
  • Monthly “town hall” meetings with all staff
  • Quarterly seminars with parents and other professionals on campus: this would include giving updates to families and giving educational presentations 

What are the challenges of your role?

Having been lucky enough to attend a few conferences during my time working within this setting I was able to meet a few other OTs who also worked in this area. Here are a few challenges that seem to be universal: 

  • Staff turnover and burnout: Working in this setting is difficult. Whether you have an office to yourself or you are working directly with the kids for an entire shift there is a higher-than-usual turn over rate for those working in an RTC setting. There are a myriad of reasons why this happens as well as a slew of issues that predictably occur as a result. The why of this as well as the solutions to it seem to have been debated for as long as the setting has been around. In short,  individuals with complex developmental trauma often have an  inherent lack of trust in caregiver figures. And so it follows that there is a domino effect when a student’s regular direct care/floor staff or therapist is not consistent; they do not feel safe and so they in turn may act out in a way which makes staff feel unsafe or uncomfortable.  This is only one small part of the puzzle but it is clear that building trust with students is pivotal in this setting and frequent staff turnover often leads to additional barriers for progress. 
  • Lack of research/mentorship as an OT within this role: there is a scarcity of evidence-based protocols for working within an RTC with focus on trauma and mental health. 
  • Setting boundaries: Working with individuals with complex developmental trauma may test your ability to hold  boundaries, particularly when not working in a place which is staffed 24/7. In my experience, it was exceedingly difficult to leave work at work and to not feel guilty when needing to take time or space to take care of your own needs. It is difficult not to be overwhelmed or guilted into feeling as though you need to fix things in the reality of the endless fires that need to be put out when working in this setting. Many OTs get into this profession because we are helpers, problem solvers, and want to make a difference; which can make it difficult to step back and find the occupational balance you may need. 
  • Lack of support from co-workers: I was lucky to have many supportive co-workers within my immediate setting; however, there was also a feeling of constantly battling other departments/coworkers or having to prove my worth. It was exhausting to continually be telling others what OT could offer, what was within our scope, and to be treated as a valued part of the treatment team.

What I loved about this role

This was a truly unique role where I got to build a program from the ground up. When I started I was the only OT and only the second OT that had worked with the organisation; I was a department of one and department head by default. By the time I left I had gotten to train an amazing staff member to become an OT Aide and our office was in the sensory gym which I had gotten to plan and see to fruition (pictured below). I was able to be a part of a talented group of individuals which made up a comprehensive unit of therapists (LPCs and MSWs), our neurotherapy department, case managers, animal therapy team, adventure therapy, teachers, and our residential staff. 

Being able to work with our students where they lived, played, learned, and healed was an amazing experience. I also made lasting relationships with co-workers and have benefitted from  the wisdom that the students I worked with, and their families, taught me. Additionally, this role provided invaluable lessons about the nature of trauma and its effects on the body (highly recommend Bessel van der Kolk’s book: The Body Keeps the Score). This role provided a learning curve I didn’t know I needed on how to create boundaries, both at work and personally, and how to be a confident leader. 

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 

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