Communicating the power of goal-directed therapy gives young clients autonomy in their treatment.
Recently, the AOTA published a blog titled “Perfecting Your ‘What is Occupational Therapy” Elevator Speech.”
In April 2015, to help commemorate Occupational Therapy Month, our pediatric practice perfected their own “What is OT” speech to the people for whom it matters most — our clients.
Positive Steps is a private pediatric occupational therapy center in New Jersey. Founded by Dana Blumberg, OTR/L, Positive Steps believes that a child’s OT program is a collaborative effort initiated by the therapist and carried out beyond OT sessions, throughout the child’s daily life. Each therapist works closely and in conjunction with parents, teachers, caregivers, and schools to achieve a child’s highest potential.
Positive Steps is not a doctor’s office, and not just another after-school activity. The work done here helps children in a myriad of ways. By giving the children this knowledge, they gain autonomy in the process, and therapy becomes intrinsically motivating. Therapy shifts to something more than a fun place mom and dad take them to after school, without much understanding of why.
So how does one communicate the intricacies of sensory processing, motor skill development, and core strength to children? And how does one make the connections between how helping a child’s body in a sensory gym can help participation in the classroom, at home, and in the community? Blumberg enlisted the help of assistant director Jan Pett and office administrator Emily Ripps to devise weekly waiting room activities and themes to begin the process.
Waiting room themes started in late March. The first week kicked off with “OTs Helping Hands.” Children had their hands painted and stamped on construction paper. Handprints along with each child’s first name were displayed in the waiting room. Children showed their work to their mom, dad, siblings, and whomever else attended therapy with them.
This began to involve the children in waiting room activities. Like in therapy, getting a child to be intrinsically motivated by having fun is a huge element of success.
Picture signs about what is “learned” in OT were hung around the room. Examples included write, eat, button, dress, color, cut, build, create, climb, feel, and manipulate. One child even asked where the proprioceptive system sign was!
Next, themes shifted the focus to the therapists. Each therapist answered what being an occupational therapist meant to them. A picture of the therapist and their answer was hung around the waiting room. Children would point out “their therapist.”
Everyone in the clinic got to know each other a little bit better. It forced us all to think about why we as therapists come to that “fun gym” as well. We all can get stuck in patterns of just doing what we do. This exercise brought the meaning behind our practice back home to us as well.
Themes rounded out with “What OT has done for me.” During sessions, children were asked what OT has helped them with, and they wrote a few sentences and drew a corresponding picture. If they were not able to write or draw, their therapist would help.
These response sheets were hung around the waiting room, and communicated to everyone how children perceived their therapy sessions. Some were quick and simple — “I learned to climb” — while others showed more awareness of implications outside of the clinic: “I can wear clothes with tags now.”
It gave clients a voice, a way to communicate how they perceive their occupational therapy sessions. Often, I will ask clients how their body feels, or allow them to choose a toy to work for or to incorporate into a session. This theme illuminated the value in asking a child, “What is this activity doing for you? Why are you here?”
Waiting Room Games
In addition to rotating themes, there were different activities in the waiting room. Children could play while waiting for their sessions, and siblings could play while their brother or sister was in therapy.
Waiting room games included a “snow bucket” filled with cotton balls, an ice cream scooper, and tongs. Toilet paper rolls were ice cream cones, along with cut-up pipe cleaners as sprinkles and a red pom-pom for a cherry on top.
Next was a tactile bin, a bin of rice with 10 hidden small objects. A picture sheet with photos of the objects was provided for a tactile hide-and-seek game. Another game was a tactile board with a crazy road of different textures from a car to a garage to be followed with a finger.
Play-dough writing was another option. Children placed small pieces of straws into letters that were imprinted on pieces of play dough.
The therapy team at Positive Steps in Livingston, N.J., had young clients draw pictures representing what OT means to them (photo courtesy Positive Steps).
Waiting room games held many purposes; most importantly, they got parents and siblings involved. It showed parents carryover activities to do at home. It communicated with siblings a small piece of what occupational therapy is, and how they can be involved. This increased involvement from family members can help remove the stigma.
Goal Attainment Scaling
Therapists are constantly sharing their knowledge. In school-based settings, this may look like a communication book, in-service with teachers, or
Therapists are constantly sharing their knowledge. In school-based settings, this may look like a communication book, in-service with teachers, or parent-teacher conference.
In early intervention, therapists work hand-in-hand with families to educate them to carry out therapeutic interventions outside of sessions. In private clinic work, therapists discuss outcomes at the end of a session. Evaluations, progress reports, and discharge summaries are further avenues of communication.
However, things can get lost in the shuffle. All therapists have experienced the glazed look of an overwhelmed parent, or the parent who simply answers “no” when you ask whether they have any questions.
In a recent discussion, I discovered that a parent was not following through with home recommendations. The reason? She was entirely overwhelmed. Her child received a lot of therapy, and each therapist was providing a plethora of recommendations. We decided to only work with one recommendation per week, and the parent would let me know when she was ready for more. This was an eye-opening discussion; it really showed how it feels to be in the parent’s shoes.
Goal attainment scaling (GAS) was originally developed for adults in mental health. Goals are generated and monitored based on an interview process with family members and/or the client during goal setting and post-treatment. GAS captures individual progress, what is truly meaningful to the family, and projected outcomes.1
Left to right: Jessica Addeo, OTR/L; office administrator Emily Ripps; Dana Blumberg, OTR/L, director and founder; and Jan Pett, OTR/L, assistant director.
One of the greatest elements of GAS is its ability to measure progress outside of standardized assessments. It measures what’s not easily measurable, but usually what matters most — the “I can wear clothes with tags” and “I can climb” elements of therapy.
One of its greatest advantages is increasing the motivation of the client and family to achieve goals. It shifts everyone’s perspective of “that fun gym we go to after school” to something more meaningful, and to the reasons they sought services in the first place.
We want our children to understand why they are coming to therapy, and how it helps them beyond having a good time. We also want our parents to feel that therapy was worth the time, money, and effort.
In the end, this elevates the profession of occupational therapy, and lets everyone involved know why we do what we do, and why it is so powerful.
Sustaining the Power of Knowledge
The Occupational Therapy Month waiting room themes and activities showed the power of knowledge for every participant in the therapy process.
Therapy sessions are only one piece of the puzzle. Children, parents, siblings, friends, teachers, community leaders, and other health care professionals all need to collaborate to truly impact a child’s ultimate course of development.
As the saying goes, it takes a village to raise a child, and the power of knowledge themes is one more way to contribute to that village. But why stop here?
In today’s world, therapy blogs are plentiful. Positive Steps plans to have a weekly therapy blog and forum for parents to discuss their experiences. Blog topics will be driven by parents’ concerns and what’s really relevant to them in the moment.
Our Occupational Therapy Month exercises showed how powerful sharing information and opening the doors for conversation can be in the therapeutic process. For therapy to be truly successful, real communication must be as important as our treatment plans and interventions.
Occupational therapists have a wide breadth of knowledge. But let’s not keep all we know a secret, even as we are trying to communicate with patients and families. Let’s share the power of our knowledge, support our “village,” and make a real impact on the children and families we treat.
1. Mailloux Z, May-Benson TA, Summers CA et al. Goal attainment scaling as a measure of meaningful outcomes for children with sensory integration disorders. Am J Occup Ther. 2007;61(2):254-259.