Outpatient Pediatric Mental Health with Haley

My name is Haley Hoffman and I am a recent graduate earning my MS in Occupational Therapy in December 2020. I recently accepted a job offer and am currently practicing in a private outpatient developmental therapy-based pediatric clinic in the Chicagoland area. I am from a small town outside of Rockford, IL with only 3,000 people! I absolutely love my new position as a pediatric occupational therapist and my clinical interests include sensory processing, emotional regulation, adaptive yoga, social skills, and all things ADL. I utilize a trauma-informed and strengths-based approach to my practice. 

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?

I completed my 2nd Level II fieldwork at an intensive outpatient mental health treatment center for children and adolescents ages 5-17 years old. Services provided include occupational therapy, psychiatry, case management, nursing, and clinical counseling. The program consists primarily of group sessions and 1:1 counseling and family sessions. A person qualifies to receive therapy in this setting by having a mental health diagnosis that impacts their safety, wellbeing, and daily functioning.  

What is OT’s role in this setting?

OT’s ultimate goal for treatment is to enhance the client’s occupational engagement, wellbeing, sense of belonging, and promote self-care. Exploration and engagement in leisure and healthy self-regulation activities such as painting, making stress balls, yoga, mindfulness, meditation, journaling, dance, and various other sensory-based strategies was the focus of OT.

Often times, engaging in occupations allowed the individual to open up and process things in a way that otherwise could have been missed. OT provides a unique perspective to the interdisciplinary team including the impact of trauma on the sensory system, I/ADL independence, and the importance of occupational engagement for one’s mental health, wellbeing, and quality of life. 

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

Overall, I felt prepared going into this setting based off of my classes along with my prior experiences before grad school including my BA degree in Psychology and my job as a Case Manager at a day program for adults with disabilities. I also took the Trauma Counseling I & II electives in my grad program which helped me tremendously for this setting by giving me a deeper understanding of trauma and the implications of it on occupational engagement and participation.

I prepared before starting by reviewing common mental health disorders, my class notes from the Trauma Counseling I & II electives, the assessments that would be used at the setting, and AOTA’s mental health section on their website.

What resources were the most helpful during your time there?

Therapistaid.com (includes tons of free resources and worksheets for mental health)

Pinterest, here’s my mental health fieldwork board!

The National Child Traumatic Stress Network

AOTA Mental Health tip sheets and fact sheets

The Body Keeps the Score by Bessel Van der Kolk

SAMHSA

How did you stay organized and manage your time?

I used this clipboard storage box which helped me stay organized day to day. I kept my weekly schedule on the front and inside of the storage box I kept helpful resources, the group protocols I planned, etc. I prepared group sessions ahead of time by treatment planning in the evenings when I got home and making sure I got to the treatment center early enough to print off any resources I needed and gathered supplies. Once the day started, I was usually in back-to-back groups or assessments so I liked to gather all of my supplies and be prepared at the start of the day.

What was your schedule like?

I typically arrived around 7:30am, assisted with transportation while the participants arrived from 7:45am-8:00am, led groups or took group notes as secondary leader from 8:00-11:00am, lunch/documentation time 11:15am-12:45pm, led groups or took group notes as secondary leader 1:00pm-4:00pm, and finished the day with any documentation I needed to catch up on and treatment planning. The adolescents were at the center in the mornings and the children were at the center in the afternoons. 

What assessments did you use most?

The Sensory Profile and the REAL. 

What conditions/diagnoses did you see most often?

Typical diagnoses seen at this setting included PTSD, ADHD, suicidal ideation/past attempts, anxiety disorders, oppositional defiant disorder, depression, dual diagnosis (primary mental health disorder complicated by use of drugs or alcohol), reactive attachment disorder, and history of trauma.

What did a typical session look like?

A typical session included group therapy with around 2-8 participants for 1 hour. I usually began with a preparatory/relaxation/grounding activity including a guided meditation or deep breathing with music. After that we would begin the main activity including topics such as emotional regulation, self-care, time management, problem solving, gross motor movement, and boundaries. After the activity, we had the participants share with the group and had discussion regarding the activity.

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

I continually made sure to seek the participants’ input regarding activities they would like to do and making sure I was staying client-centered by providing options that best suited their interests and needs. For example, one day I had a movement-based activity planned however through observation and discussion with the participants they were seeking a more relaxation, art-based group that day.

Meeting the clients where they were at was crucial in this setting in order to be trauma-informed and provide them a sense of empowerment and safety. I stayed occupation-based by providing activities that were hands-on and encouraged occupational engagement and participation, along with ways to make the clients more successful in their day-to-day roles as students, friends, siblings, etc. One group I led was having the clients think of themselves as occupational beings and draw themselves on a piece of paper with their occupations surrounding them and what these occupations meant to them. 

What was your favorite part of this fieldwork experience?

My favorite part of this fieldwork was building rapport with the clients and seeing them progress over the 3-month time frame I was there. It was incredible to see the power of occupation and how engaging in activities gave the clients an opportunity to open up and share their internal experiences in a safe, healthy way. Being able to walk into a room where a client is showing flat affect and exhibiting depressive symptoms, and while engaging in occupations seeing glimmers of hope and happiness in their eyes was one of the best feelings of this fieldwork experience.

What was your least favorite part of this fieldwork experience?

Something a bit difficult in this setting is the limited amount of communication you have with the caregivers and family as the OT. A lot of times the clients were experiencing additional traumatic experiences on top of prior ones at home and/or at school, and this is something you cannot control when providing services solely in the outpatient setting.  

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

As OTs, trauma-informed care is not something that is solely practiced in a mental health setting, but across ALL settings whether that be inpatient rehabilitation, the ICU, or the school system. There is a level of trauma that all of our clients have experienced such as suffering from a stroke, living with a disability in an able-bodied world, or recovering from a TBI. No matter what setting I am in throughout my career, I know I will carry forth the knowledge I gained about mental health diagnoses and trauma-informed care throughout. 

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

It’s important to be mindful of compassion fatigue and burn out in this setting, as you are often hearing heavy stories of trauma from the clients. Practicing self-care, having conversations with your CI and colleagues, and reflective journaling were all helpful strategies for me. Don’t be afraid to ask questions and utilize your resources, professors, and classmates. Give yourself grace and know that you are in the processing of becoming an incredible OT and will carry forth this unique fieldwork experience into your entire career!


Social media handles: 

Instagram: haleyyhoffman

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