My Fieldwork Experience in Outpatient Pediatric Occupational Therapy

For my first 12-week fieldwork experience, I was assigned to a private practice outpatient setting. The practice offered OT, PT, speech and psychology services to children from birth to age 21. The OT area was designed with an OT gym for gross motor and sensory integration based activities. It was wonderful for introducing a social element into the therapeutic process as often there were many children in the gym at one time. Each therapist had access to his or her own space to provide one-on-one therapy, but the space was small so it often included table-top activities, fine motor skills, and assisted in developing the therapeutic relationship between the child and the therapist. Another area was available for working on activities of daily living such as toileting, grooming, bathing, etc. as needed. Occasionally, on a case-by-case basis, therapy was provided in the client's home.

Week one, as you can imagine, is all about absorbing the environment- learning everything you can about how the organization is run, personalities and preferences of colleagues and clients alike, and of course the little details like how to get to the bathroom. Ideally, you are slowly taking on a full caseload so that by the time you are into about week 6, you're ready to make decisions and be fairly independent.

This process can be very scary for someone who has never had to go through it before, but you can survive it- I'm living proof! So, here are a few tips that helped me through the process from day one to day done.

1. Always be respectful- to your clients, to the families of your clients, to your supervisor and to your colleagues.


2. Don't be too intimidated by your supervisor. He or she was once exactly where you are and they are only doing what they think will help you become a better practitioner. Listen to their criticism, ask for more if you're unsure of where you stand and appreciate honesty.


3. Learn how to direct your clients. Whether they are a child or an adult, you have to learn how to assume that authority role in order to be effective. This isn't to say you should be condescending or rude, but you are the expert and they need your services. They cannot receive the full benefit of your services if they are the ones running the treatment session.


4. Realize that there are exceptions to every rule and while some clients may not allow you to assume the authority figure in the session, there are plenty of ways to limit their options so that the behaviors and activities are therapeutic for them, while offering an important element of self-expression to the client.


5. While in your fieldwork assignment, regardless of what opinions or biases you may have, you must learn to adopt the preferences of your supervisor. As your work is technically occurring under his or her supervision, you are morally obligated to act in a manner which would be fitting with their therapeutic framework. It doesn't mean you cannot explore with your own style, but it does mean that you should probably avoid making waves in a pond you're just visiting... Remember though- once you're a licensed OT, you'll be the one calling the shots!


6. Learn from other disciplines. Humans are certainly occupational beings and OT covers a TON of things, but perhaps understanding what your clients speech goals or PT goals are could allow your time with them to be even more therapeutic! Plus, I've learned that there are several OTs-at-heart in other fields who will be able to teach you more than you could have imagined about your own field- maybe even more than your supervisor.


7. As a student, all of the staff will treat you differently than if you were full-time. Some of them will not invest in the friendship since they know your time is limited. Others will view you as a student who has a lot to learn. Some of them will even view you as a fresh face who can be confided in. Try not to take personally how others react to you. Instead try to focus your time there on if this type of position is a good fit for you, the pros and cons for working with this population, etc. Pay more attention to how the therapists treat each other than how they treat you as a student.


8. Most fieldwork sites require a presentation of some sort, a case study, a project, a proposal, etc. Don't be afraid to give the presentation. The likelihood of someone in the room asking a question is typically rather slim in most cases as they don't want to ask a stupid question in front of the other therapists. Most of the time, as long as your point is valid and you appear mostly confident, you'll do fine. Be prepared to answer basic questions if they do arise, but feel free to respond with "I'm not sure at this time, but I could get back to you on that" if needed.


9. Learn your clients well. Jot down quirks you notice, motivating factors, food preferences, performance deficits you notice, etc. Remember your conversations with their families, the tips you offer them, the questions and concerns they have, etc. This will assist in developing rapport with the client and the family, and help provide information to assist in the therapeutic process.


10. Use this time to test out all the cool stuff you learned in school. Put the theory into practice. Try out a ton of therapeutic approaches and find ones that work. Explore who you are as a therapist. Ask your supervisor questions about why they do things how they do them. Invest well into your time at the fieldwork site and the lessons you learned will go with you into your practice.

• I love kids, but they drain me! At least, that's how I feel right now. They were adorable though and walking away was the hardest thing to do even though they are tiresome!


• I'm not a huge fan of private practices. While it sounds like a great idea, they don't have the policies/procedures in place that a larger public company is required to have. It's also very difficult to have a small business where even small business decisions don't feel political, or worse, personal.


• To work in the outpatient setting, you have to be willing to see your clients for a LONG time. This is even longer when you are working with the pediatric population. This means that you are with them as they go through all of their rebellious stages, you invest into their life and see them change so much over the years you see them. But the change is often so slow (if it's there at all) that sometimes this can be a recipe for discouragement as a therapist.


• Some of these kids will never reach normalcy. So to work in this specialized area, you have to have a sense of humor and help them reach their full potential in spite of their difficulties.


• You have to get used to playing the bad cop. In order for your client to get better, he or she must do the work. Often, that means your client must do something that is difficult to complete successfully. While they want the end result, no one likes facing failure and so you have to be the encourager who takes no excuses at times when your client needs to perform.


• The outpatient setting is all about showing up. That is, when clients show up, you get paid. If they don't, you didn't offer your services and you don't get paid. Therefore, getting clients who show up is essential to your paycheck.

Unfortunately, in order to protect the rights of those clients and their families, I have to refrain from specific information which could reveal the identity of the clients. If you are curious about why I am saying this, I would suggest you google HIPAA regulations. I will state that the goals my clients worked on ranged from buttoning to handwriting to sensory integration. My youngest client was less than 2 years old and my oldest was 15. During my time at this facility, I became very familiar with the works of Jean Ayres, the Handwriting without Tears program and gained a better understanding of neurodevelopmental treatment theory as these were used with nearly every client on my caseload to some extent.