What do Occupational Therapy Assistants do in paediatric outpatient clinics…

As I am driving up to the clinic, I do my best to savour the last few seconds of peace and quiet before I enter the organised chaos that is a paediatric outpatient clinic.

I don my facemask, grab my morning coffee and walk into the clinic. I am usually greeted by our Receptionist and she kindly reminds me to take my temperature and sign the COVID-19 self-assessment log. As I settle in, I glance over my schedule for the day and make sure there are no cancellations or changes. In this setting, my weekly schedule is typically reoccurring apart from rescheduled or new patients; I always have the same kids on my schedule as this helps with consistency and creating a rapport with my patients. It is also helpful because it minimises the time spent for chart reviews and allows me more time to review new patient’s goals or consult with my colleagues regarding my caseload. 

My caseload for the morning usually consists of working with a range of children, with varying social contexts and physical and psychological needs. I may spend the morning working on sensory regulation, activity tolerance or transitioning; this is why I need to make sure I enjoy the peace and coffee before I enter the clinic! One child I recently worked with did not sleep well the night before and needed all the input I could give her to keep her alert during my session. We bounced on the physio ball and completed an obstacle course before we started working on her tactile aversions. The next child was a rowdy three-year-old who eloped to the platform ramp with every chance he could manage, just to get out of any sit-down activity I offered him. This is the child I will usually start the session with heavy work and proprioceptive input before I even try to tackle any structured activity. My last child of the morning is self limiting with everything a typical four year old enjoys like colouring, playing games with peers and swinging on a swing.  I will spend the morning filling up her cup with love and encouragement, showing her she can draw a pretty picture and complete a scooter board race with a peer trying to keep the appropriate social distancing protocol. 

I am fortunate enough to have an hour and half lunch break, which will consist of catching up on notes, case conferencing and prepping for my afternoon kids all while sneaking in a bite every now and then. At 1:30pm I hit the ground running, I will see six kids in the afternoon for 45-minute sessions. I do my best to wash my hands as often as I can with soap and water since the sanitiser dries out my skin so badly. On top of keeping up with the kids and keeping them engaged in meaningful activities, I have to keep up with sanitising every piece of equipment the kids touch. I do my best to contain my elopers from running around the gym and touching every piece of equipment we have. In the past, I may have let it slide and get to wiping things down when I get to it but with an active pandemic going on I cannot take any chances! 

Since most of my after-schoolers have fine motor and attention goals, I’ll usually have some kind of fun craft activity planned. This is where I like to use activity analysis and grade the craft according to each kid’s specific goals.  It also helps me remember what I did when it comes to writing my note, everyone did the same craft, I just need to document how they did and what accommodations were provided. At the end of each session I hope the parents remember to be available 5 minutes before their time is up so I can provide parent education and feedback on our session. During this time, we are currently only allowing one parent to go back into the gym with the child or encourage parents to wait in their vehicle during our session to limit the number of people in the therapy gym  so we can social distance appropriately, this can be frustrating. 

Since COVID-19 was declared a global pandemic, it feels as if everyone in our clinic has been doing some sort of damage control. We have been offering teletherapy, increased therapy frequencies and even offered therapy on days the clinic used to be closed; all in hope of giving our kids some kind of routine and normalcy. In our area all schools and public playgrounds were closed taking away opportunities of play that all of our kids need. With the break in routine, I noticed an increase in maladaptive behaviors, I started doing check ins with parents and kids to see what I could do to help them more not just in the clinic but at home as well. Yes this is within our scope of practice but this goes beyond OT. This is being a kind human being connecting to my kids and their families in a way I may have not been able to do before. I shared with the families my own personal struggles during this pandemic and what I have done to cope. 

At the end of the day, I complete my documentation, help scrub down every inch of the therapy gym then I wash my hands and head home. As I walk through the door, I’m greeted by my two crazy kids, reminding them to wait until after my shower before I can hug them. We end the day with some imaginary play, thanks “Bluey”, eat dinner, relax then go to bed. All to repeat it all over again the next day.

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

Author: Marissa Cabaza 

Bio: Marissa Cabaza has been a COTA for 5 years. She is currently in a Masters of Occupational Therapy Bridge program at University of Texas at Tyler. She is married with two children. When she is not at work she enjoys family time playing in their backyard and watching movies.

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