Level IIA Fieldwork: Outpatient Pediatrics

I spent nine weeks in a private outpatient pediatric clinic for my level IIA rotation and had the BEST time. “Nine weeks?” you may ask. Yes. Just nine. Because a pandemic decided to happen so that I couldn’t finish the entire rotation… My CI did pass me though, so I am very excited about that.

Those nine weeks were jam-packed with so many learning experiences, opportunities to grow as a student and future clinician, and connecting with some amazing people. During this fieldwork I learned that I’m more prepared than I thought I was, that kids are more forgiving than you think, and that being gentle with yourself is the key to getting through difficult sessions.

In this blog I will outline the basics: my schedule, the various diagnoses and ages I worked with, the assessments I used, etc. In another blog I will list out the specific interventions I used and what each of them worked on!

Schedule

Tuesday-Saturday: 9am-5pm with a 1-hour lunch

Assessments Used

Peabody Developmental Motor Scales – 2

• Ages birth through 5 years
• Assesses:
  • Reflexes
  • Stationary skills
  • Locomotion skills
  • Object manipulation skills
  • Grasping
  • Visual-Motor Integration
• Though I love the information the assessment gives, I really hated using it lol. Getting the ceiling and basal scores were annoying and the assessment would drag on forever sometimes!

Bruininks-Oseretsky Test of Motor Proficiency – 2

• Ages 4-21 years
• Assesses:
  • Fine Motor Precision
  • Fine Motor Integration
  • Manual Dexterity
  • Bilateral Coordination
  • Balance
  • Running Speed and Agility
  • Upper-Limb Coordination
  • Strength
• I loved using the BOT-2, you can make it as quick as you want and the way that the assessment is structured and the amount of detail given makes it pretty straight forward to score!

Sensory Profile 2

• Ages birth-14 years
• Assesses:
  • Sensory processing
    • Auditory
    • Oral
    • Tactile
    • Visual
    • Body position
    • Movement
  • Behaviors associated with sensory processing
    • Conduct
    • Social Emotional
    • Attentional
• We gave this to every parent to fill out during our evaluations, even if the child wasn’t coming in for sensory processing difficulty. It was good to have as much information as possible!

Pediatric Evaluation of Disability Inventory (PEDI)

• Ages 6 months-7 years
• Assesses:
  • Functional skills
  • ADLs
  • IADLs
  • Functional mobility
• Assessed through interview with caregiver
• I used this assessment for a child who was blind and non-verbal, I completed the interview with their parent to get as much information as possible about the child’s functioning and skills.

The Print Tool

• Grades K-4+
• Assesses handwriting
  • Memory
  • Orientation
  • Placement
  • Size
  • Start
  • Sequence
• I had never seen this assessment before and it was so easy to catch onto – though scoring it was pretty tedious!

Diagnoses Seen

• Autism
• ADHD
• Oppositional Defiant Disorder
• Tic Disorder
• Obsessive-Compulsive Disorder
• Anxiety/Depression
• Cerebral Palsy
• KBG Syndrome
• Lamb-Shaffer Syndrome
• Sensory Processing Disorder
• Limb Deficiency
• Moebius Syndrome
• Arthrogryposis
• Blindness
• Unspecified motor/cognitive/developmental delay
• Feeding difficulties
• Traumatic Brain Injury

Tips

Assessments/Evaluations

• The BOT-2 doesn’t have a script, so make it fun for the kids!
• Triple check your scoring, it could make a huge difference
• During evaluations, don’t just note whether they can or cannot do something, note how they attempt it, what their body position is like, whether they are giving the task attention, their frustration tolerance, etc.
• It is also important to note whether they are actually putting effort into the assessment – I found that engagement decreased when I was doing the BOT with teens (embarrassed by some of the activities)
• When the kid is sitting at a table, make sure their feet are touching the floor, and if they aren’t give them some type of platform to rest their feet on!
• It was helpful for me to have a blank sheet of paper to write as many notes as possible during the evaluation, even the most minuscule of observations were helpful when I was writing up the evaluation on the EMR.

Documentation

• Use a small notebook to write down notes during sessions and note the important things – like how they held their crayon, whether or not they crossed midline, how they worked through a problem, or anything else you observed that you don’t want to forget
• I also used this small notebook to write down my patient’s goals before I saw them and any ideas I had for their session, so that I had a plan to fall back on/always had their goals readily available
• When writing your documentation, make sure to be concise – fluff is unnecessary
• Try not to get behind on documentation (I know it can be hard), but be firm with the amount of time you have to get things done
• Get familiar with terminology that your facility (and insurance companies) likes – this will vary so ask your CI

Treatment Sessions

• Make a plan but don’t expect to follow it
• SMILE – kids can sense your emotions and will feed off of it
• Know if your child has a low or high threshold for sensory information, and base how you interact with them off of that.
  • I noticed with some of my higher threshold kiddos, I had to be way more animated to get them engaged, rather than being more reserved with my lower threshold kiddos.
• If they have a preferred task, try to make it therapeutic and work with their goals (unless one of their goals is to complete non-preferred tasks, then switch it up)

Research

• I would research interventions for specific skills the day/night before my sessions and adapt them to the supplies I had available to me at the clinic, or stop by the dollar store/Target beforehand
• If I was going to be working with a kid with a diagnoses I had never heard of (which actually happened a few times) I would research that diagnosis, common functional limitations, and scour the literature for evidence-based interventions
• When did I have time to do this? During my lunch hour, and on the weekends.
  • MAKE TIME for research – OT is an evidence-based profession!

Resources I Used:

Occupational Therapy for Children and Adolescents 7th Edition by Jane Case-Smith and Jane C. O’Brien

The Out-of-Sync Child by Carol Kranowitz

American Occupational Therapy Association

American Journal of Occupational Therapy

Research Databases:

• PubMed
• ProQuest

 

I hope that this gave you an adequate view into my experience in outpatient pediatrics. Every clinic will be different, but it is always nice to have a heads up of what it could be like. If you have any questions or would like me to dive further into any of these concepts, feel free to message me here or on my instagram @carolineb_ot.

And if you take anything away from this blog, take this: Be gentle with yourself.