What is up my friends?! Long time no type. Life has been hectic for me as of late for a few reasons – mainly starting my new job (!) as well as moving to a new city and then moving from an apartment in that city into a house! Regardless of the craziness of the last couple of months, I am excited to be back on here to share about my new job and what I’ve learned as the only occupational therapist at a pediatric speech therapy clinic!
I also opened up a questions box over on Instagram the other week to see what you all wanted to know about new grad life in addition to how I am handling my new job! So first, as usual, I will outline more of the specifics of my job, and then I will jump into all of the questions you all asked me.
My New Job
If you didn’t already know, I started my new/first job as an official OT at a small, private outpatient pediatric clinic. The wild part is that I am the ONLY OT on staff as the clinic has always been a speech clinic (serving adults and children). I was brought on to start expanding the clinic and to help with providing feeding therapy as this is a huge need in pediatrics right now (every job interview I had prior to accepting this position asked about my interest in feeding therapy as all of the clinics had a major need for this). Luckily I had some feeding therapy experience during fieldwork!
What I love about this job right now is that I started without a caseload and have been slowly building it. So I have essentially been working part-time, giving me a ton of down time to do research and prepare for sessions.
This will be my full-time schedule once my client base has increased (right now I am working about 20 hours/week, but am getting new referrals all the time!)
The clinic I work at contracts with Early Steps in Florida (Early Steps is early intervention, ages birth-3 years), so the majority of my client base so far is around 2 years old.
I also see some older, school-aged kiddos who I love! And I see one adult client!
Since I don’t have a waitlist, I also get referrals for infant feeding from local pediatricians offices – i.e. I saw a 1 month old (born 1 month premature, so basically a newborn) for latching and weight-gain difficulties.
Diagnoses I See So Far:
- Developmental Delay
- Feeding Difficulty
- Anoxic Brain Injury
- Aphasia (I have one adult client)
- Prader Willi Syndrome
- Sensory Processing Disorder
Loan repayment hasn’t started yet (it will in September) so I honestly have not even been thinking about it hehe. I am definitely very privileged to not have to think about it though – and this is because of my small business! I have a well-stocked savings account that gives me a lot of comfort knowing that I will be able to handle loan repayments once it starts even if I am not working full-time once the first bill comes in.
What resources do you use for intervention ideas?
I use a lot of the resources that my clinical instructor let me photocopy (worksheets, research), but I also love using a lot of the blogs that I reference in my post about OT websites + blogs from a while ago!
My Top Books for Feeding:
- Pediatric Feeding Disorders: Evaluation and Treatment
- Just Take a Bite: Easy, Effective Answer to Food Aversions and Eating Challenges by Lori Ernsperger, Ph.D. and Tania Stegan-Hanson, OTR/L
- Food Chaining: The Proven 6-Step Plan to Stop Picky Eating, Solve Feeding Problems, and Expand Your Child’s Diet by Cheri Fraker, CCC-SLP, CLC, Mark Fishbein, MD, Sibyl Cox, RD, LD, CLC, Laura Walbert, CCC-SLP, CLC
How to write good goals using the SMART method?
Goals are definitely my weak point, I will have to write up a whole blog post just to get into good goal writing. But I do a lot of googling while I’m writing my goals, I try to keep it simple by sticking with the basics – i.e. milestones and ADLs!
How does being a new grad OT affect the interaction with parents?
I don’t think it has really affected any interactions with parents (yet). I do my best to prepare before I see my patients and I know that they trust me to provide them with accurate and helpful information for their kiddos. There has only been one instance where I didn’t know what to do during an evaluation and I simply told the parent that I was a new grad and didn’t have much experience with cases like theirs but reassured them that I would do as much research as possible, and ended up bringing in my boss (a very experienced SLP) to see what she thought of the case (it was a feeding case) – we ended up solving the problem right then and there!
How do you organize your materials?
This is something I am still working on as the clinic is changing constantly (I just had storage cabinets put into my treatment room!) As far as printable handouts and research materials, I keep all of those in organized files on my laptop.
Tips for treatment and evaluation planning to make clinical days easier?
I dedicate a few hours at the end of the week to plan for the following week’s treatments and evaluations, I create a “to-do” list for all of these things with the date/time that they are coming, and have that printed out and attached to a clipboard that I carry with me throughout the day.
Every morning I arrive at the clinic at least 30 minutes early to prepare activities for the day and to make sure I am organized!
How did you negotiate pay?
So for this job I did not negotiate my pay ($36/hour) because I am a new-grad and my boss set up the rates. Once I have a full caseload I will transfer to a salaried position, so I will need to do some research on new-grad rates in outpatient pediatrics in Florida!
Tips on dealing with anxiety and imposter syndrome:
The best was that I deal with this is through organization and preparation. I will never walk into a session without a plan + plus plan A-Z. And even then I know that I need to be able to adapt as we go.
I don’t really like the term “fake it til you make it,” because that implies that you have no idea what you’re doing – if you don’t know what you’re doing, then maybe you should take a step back and ensure that you are providing evidence-based care! By putting in the work and doing the research or seeking out mentors with more experience, this can help alleviate that sense of anxiety and imposter syndrome and make sure that you are providing your clients with the care that they deserve.
What do you wear, what do you bring in your bag, and how do you bill your patients?
I wear scrubs (hallelujah)!
In my bag is always something new. I created an Amazon wishlist for supplies and toys, so I get new things weekly that I bring into the clinic. But other than that I have my planning binder (where I write all of my plans for every day, and hold any printouts/laminated sheets that I create for the sessions, snacks, lots of pens, and my laptop.
I do not do anything with billing or scheduling. My clinic is contracted with most insurances, so I just do my treatment and notes, and my boss handles all of the billing.
How is the transition from learning material in OT school to applying that knowledge to your job?
This transition was actually harder than I thought it would be – because every kid reacts differently and is motivated by different things. I can come up with the most fun and creative treatment ideas, but the best thing you can do as an occupational therapist, is learn to adapt to changes and allow your client to lead while giving them their just-right challenge.
When it comes to more medically involved treatments and knowledge, I follow the research and what I learned in school. An example of this would be applying thumb splints to one of my clients with cortical thumbs. I did as much research as possible to figure out what would be best practice in this case and found that McKie thumb splints would be our best option. When sizing them, I ensured to follow all of the guidelines I learned in school during my splinting class, as well as the guidelines provided by the splint company.
Biggest challenge, and some treatments and evals you have done so far:
My biggest challenge so far would have to be my more medically complex patients that I don’t have any experience with. These cases take more out of me because I have to do a ton of research and preparation to ensure that what I am doing it evidence-based and will create a positive impact on the client and their families.
Some evaluations I have done include using the PDMS-2, SPM-2, BOT-2, REAL and also one adult evaluation where I completed an occupational profile.
Some treatments I’ve done include lots of sensory processing and messy play, activities that work on core strengthening to support upper extremity functioning, fine motor tasks, and ADL tasks (like tying shoes!).
How much time do you spend outside work prepping/writing notes?
The goal is not to do any documentation out of work, which I’m pretty good at besides with evaluations (because I like to take my time on those). I do all of my treatment notes either during the session, in the last 5 minutes of the session hour, or during my lunch hour/for a little bit after my last session.
With evaluations I do my best to type as much as possible before, during and after the session, and will usually only bring the assessments home to score, and write down my impressions + goals, and then submit it all once I get back to the clinic.
Do you feel like the older OTs are critiquing everything you do?
I am the only OT…….. I wish there were other OTs critiquing me! I will occasionally text or call my CI with questions about treatments and certain patients, but other than that I just do a loooot of research!
If you are interested in more treatment ideas and resources please feel free to check out my Instagram page! I post pretty regularly on my stories and I always share new things that I find have been successful in my treatments sessions!