Outpatient Pediatrics with Anastasia

Hi! My name is Ana, and I am a new grad OTR/L from the University of Wisconsin-Madison. I recently accepted an acute care  position in Chicago, where I am originally from!

What setting are you sharing about today and can you give a brief description of it? What qualifies a person to receive therapy in this setting?

Peds peds peds! Pediatric occupational therapy can occur in a wide variety of settings. During my Level II, I worked at a company that provided outpatient services through clinic-based, in-home therapy, and telehealth modes of delivery. Clients in the pediatric setting most often include children with gross motor, fine motor, visual motor, visual perceptual, cognitive, and/or sensory processing barriers, leading to difficulties engaging in typical childhood activities such as play, handwriting, dressing, and interacting with peers. 

What is OT’s role in this setting?

In the pediatric setting, occupational therapists use a collaborative and family-centered approach to address infant, toddlers, children, and adolescent’s barriers to function and to improve play, self-care, academic, and social skills. Caregivers are the experts on their family’s routines, rituals, culture, and values, so empowering parents to be active members of the therapy team is key! 

Did you feel prepared going into this setting based off of your classes? And how did you prepare before starting?

I prepared by emailing my CI to introduce myself and ask about common conditions, evaluation tools, and interventions that it would be useful to review! Based on her response, I ended up looking over pediatric fine motor, gross motor, and self-care developmental milestones in addition to reviewing the assessment tools and diagnoses she advised. 

What resources were the most helpful during your time there?

My clinic had a dropbox of resources, including research articles and treatment activity ideas that were super helpful! I also frequently used Tools to Grow, Case-Smith and O’Brien’s “Occupational Therapy for Children and Adolescents” textbook, and notes from my pediatric course! 

How did you stay organized and manage your time?

I used a planner to keep track of my to do list for each day, which included notes, treatment planning for future sessions, and writing parent emails. I also found it helpful to use a binder to organize print-outs of intervention ideas and materials by the skills they addressed.  For example, I had a section for in-hand manipulation skill activities, bilateral integration activities, postural stability, etc. 

What was your schedule like?

My schedule varied week to week! Partially due to COVID-19 and partially due to the nature of pediatrics, I saw clients via telehealth, clinic-based, and home-based modes of service delivery. Although the location of therapy varied day to day, I maintained a pretty consistent 8AM to 5PM schedule including evals, treatment sessions, documentation, and weekly department meetings. 

What assessments did you use most?

Peabody Developmental Motor Scales (PDMS-2), Bruininks-Oseretsky Test of Motor Proficiency Ed. 2 (BOT-2), Beery Visual Motor Integration (Beery VMI), Test of Visual Perceptual Skills (TVPS) and the Sensory Profile. Another important component to each assessment was skilled observation of each child’s relevant occupations, preferably in the child’s natural home environment. 

What conditions/diagnoses did you see most often?

Most frequently Autism spectrum disorder (ASD) and related disorders, ADHD, sensory processing disorders, executive functioning and developmental delays. Other common diagnoses included Cerebral Palsy (CP), muscular dystrophies, Down syndrome, generalized weakness, decreased coordination, and upper extremity injuries. 

What did a typical session look like?

Sessions would begin with a 5-10 minute preferred activity. We would then transition to play-based activities, targeting areas such as fine motor, visual motor, sensory processing, postural stability, and self-regulation skills. I liked to go into each session knowing the skills I wanted to address and having a couple of options for activities that the child could choose from. If we were targeting self-regulation or a non-preferred activity, I liked to alternate between activities using the “first-then” technique.   

How did you stay client-centered and occupation-based?

I stayed client-centered and occupation-based by taking the time to really get to know each kid, their likes and dislikes, their favorite toys, movies, and characters so that I could come up with play activities that were fun and motivating for them! Because children’s preferences and performance factors can vary day to day (or minute to minute) I was often working on the fly to grade activities. I really liked to go in with lots of ideas to make sure I could meet each child where they were at and provide the “just right challenge” each day. 

Did you have to do a project or in-service? Could you share what topic you chose? (if you can)

For my project, I created two caregiver education guides in collaboration with the company Therapy Materials Vault. My first guide, “Welcome to Our Team: A Guide to Family-Centered Practice,” was created to empower parents to view themselves as leaders on the therapy team and to provide them with connections to family-focused, accessible, and sensory-friendly activities and facilities in the community. My second guide, “Self-Care: A Quick Guide” was created to educate parents on the importance of taking time to address their own needs and recognizing when self-care is needed. 

What was your favorite part of this fieldwork experience?

My favorite part of this fieldwork experience was getting to work with so many amazing children, families, and therapists. There is so much joy in pediatrics, and I truly loved getting to watch my kids achieve milestones and grow. I still miss the people that I worked with. They will always have a special place in my heart!

What was your least favorite part of this fieldwork experience?

The most difficult part of this fieldwork experience was learning to turn off my work brain. In the beginning of my rotation, I was learning so much and meeting so many new children that I felt like I could always be planning for future therapy sessions or reading up on OT-related things. Maintaining a sense of balance truly does make a positive impact on your well-being and it reflects in the quality of care you provide. 

What is something you learned that you will take with you for the rest of your career?

I am a great OT with a strong client-centered and holistic approach to care! One of the most difficult things (at least for me) of being a Level II Fieldwork student was overcoming the self-doubt that can come with being new to independently providing services. It’s a transformative moment when you realize that all of your hard work in OT school, your personal strengths, and your experiences have made you into a skilled clinician with your own unique and valuable style! That confidence will shine through in your interactions with future colleagues and your care for your clients and their caregivers. 

What advice do you have for a student about to start in this setting?

My advice for any fieldwork student about to start in pediatrics is to embrace the opportunity to grow in a fast-paced, dynamic, and fun environment! Regardless of whether your future goals involve pediatrics, you will gain so many transferrable skills including providing clear and concise verbal cues, creating motivating intervention activities that fit your client’s unique interests and needs, upgrading and downgrading activities on the fly, managing client behaviors, communicating with caregivers, working on interdisciplinary teams, and so much more!


Social Media: 

LinkedIn:Anastasia Bormann, MS, OTR/L  https://www.linkedin.com/in/anastasia-bormann/

Instagram: @anabormann

Resources: 

AOTA Practice Section for Children and Youth

CDC Pediatric Milestones

Tools to Grow

Therapy Materials Vault

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