Student Blog
Daniel

Everything Coming Full Circle This Summer ⟩
August 6, 2020, by Daniel

Fieldwork

This summer began with a lot of uncertainty due to the COVID-19 pandemic. Finding out I would be completing my entire summer fieldwork from home was not what I had planned for. Even after starting fieldwork, I still had hope that things would get better during the summer and that I would be able to work in person at the primary care clinic. However, that day never came and as I write this I find myself completing my last fieldwork week, and the last official week of the Master’s program. After 12 weeks of fieldwork, doing 40+ hours on most weeks, and working as an OTD Student Ambassador, I am ready for a break! Yet, I feel grateful that I was able to continue my education and work from home during this time because that is a privilege.

A big part of writing these blogs is to inform you about my personal experience to help you think about what career path to take after the Master’s program. Reflecting back on this summer at the Primary Care Adult West Clinic, I can honestly say that I feel like I made the right decision by pursuing this OTD Residency. When I was applying to OT school, I remember writing my statement of purpose and having this innate desire to eventually be in a position to help the communities that I grew up in. Below I share with you a piece from my personal statement that has served as my personal motivation throughout the entire OT program and especially during these 12 weeks of fieldwork.

“People from low-socioeconomic backgrounds often do not have income, time, nor access to the health education necessary to receive treatment for various conditions. Even when members from my community are aware of healthcare resources, factors such as work, lack of transportation, immigration status, language barriers, and no insurance prevent them from addressing their health needs. For example, during my introductory experience completing occupational therapy volunteer hours, I became a de-facto translator for Latino families who admitted that they felt more comfortable receiving care from someone with whom they could clearly articulate their health concerns.”

Reading this now and thinking about my clients at the primary care clinic brings me a lot of joy. I feel very lucky that every day I get to work with the communities that I dreamed of helping while applying to OT school. Like any other person, there are days where I feel tired, less motivated, or just out of rhythm, but then I will have a conversation with one of my clients from the clinic and it reminds me just how much they appreciate the support OT provides. When talking to clients, they often remind me of my parents, my grandma, my aunts, and my neighbors. People that are trying to navigate such a complex healthcare system, simply trying their best take care of themselves and their families, while they are impacted by social, political, and economic factors. As someone that grew up in a low-income, Latinx immigrant family, with parents trying to make ends meet, the experiences of many of my clients hit home for me. This helps me push through on those difficult days and motivates me to always do my best to connect them with any resources that can help them. 

This summer has helped me learn a lot about myself and as I mentioned it was a good reminder of the reason why I came to OT school and decided to continue with the OTD. I am excited about the future as I look forward to learning and collaborating with others to better serve this population at the Primary Care Adult West Clinic. Lastly, I just want to give a special shout out to the entire Adult West clinic team, Dr. Diaz, Dr. Pyatak, Dr. Granados, and soon to be Dr. Elissa Taylor, who supported me this summer and prepared me with the necessary skills to take over the caseload at the clinic as the new OTD resident.

My advice to students applying to the OTD is to think about the things you are passionate about. If needed, take a step back and think about why you applied to OT school in the first place, what do you want to get out of the OTD, and what do you see yourself doing in the future. Remember that your OTD does not necessarily define what settings you end up practicing in. However, you want to make sure that adding an extra year to your education will be a pleasant experience, and an opportunity that will motivate you to want to show up every day and do the work to help others. Finding the right fit will be essential when looking at potential OTD residency opportunities, whether they are Chan affiliated or not. And if that takes a little bit longer than you expected, than that is totally okay. Don’t be afraid to reach out, be curious, take your time, and ask questions!

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Communication is Key!!! Especially in Telehealth! ⟩
July 15, 2020, by Daniel

Fieldwork

Good communication is an important skill that all occupational therapists need to develop and continue to improve as they continue to practice. As a student completing my final level-2 fieldwork at LAC+USC Adult West Primary Care Clinic, I’ve had the opportunity to practice my communication skills every day. Especially now that most settings are providing telehealth, communication is vital to making things work! The most difficult part about working remotely and communicating is that you may have never actually met the person you are talking to. My time at fieldwork this summer has consisted of communicating with patients over the phone, and communicating with the primary care team via phone, email, video camera, and messages.

Communicating with patients:
One of the hardest things I’ve had to do as an occupational therapy (OT) student is facilitate a one on one, 1-hour appointment over the phone with someone I have never met before. Whether it’s an initial evaluation, progress phone visit, or discharge, asking someone to answer all your questions and trust you over the phone is a lot to ask! Furthermore, if patients have had previous negative experiences in the healthcare system, they may be reluctant to opening up to you. Neither of you are able to see each other’s body language or pick up on cues that people rely on when having a conversation. The way you frame questions, your tone of voice, and your ability to listen will be key to communicate effectively! When I think back to all of the courses I have taken at USC, I have to say that OT 578 Therapeutic Communication: Facilitating Change in Clients (Motivational Interviewing) with Dr. Diaz is one of the most valuable courses I have taken in my entire college career. This class taught me the importance of simply listening to someone and showing them that you care by using reflections, affirmations, summaries, etc. in order to build that trusting relationship with your patient. This may be the first time a healthcare provider is actually taking the time to listen to them and agreeing with a lot of the frustrations they may be expressing. Additionally, the structure in the primary care clinic allows OT to spend up to an hour talking about making lifestyle changes with a patient. This client-centered approach of focusing on the patient’s needs and wants is the unique value of OT. The reality is that motivational interviewing may not work for every single one of your patients, but it is an evidence-based approach that I have personally found valuable during my time in primary care. 

Communicating with your team:
Again, communication, communication! At the clinic our interdisciplinary team consists of primary care providers (medical doctors, physician assistants, nurse practitioners), clinical pharmacists, certified medical assistants (CMAs) community health workers (CHWs), care managers, nurses, medical case workers (MCWs), 1 occupational therapist, and 1 occupational therapy student (me). Working within an interdisciplinary team can be challenging at first. My first couple of weeks in fieldwork I spent learning how to use the communication systems used by LAC+USC County, which was frustrating at times with IT or technology issues. In the beginning, every electronic medical record (EMR) message or email I would send to a patient’s primary care provider (PCP) would make me nervous because I would be talking to doctors or specialists that have been practicing for a long time. Furthermore, I am communicating sensitive information that can affect the patient if it’s not communicated properly. Once I became more comfortable and got over my fear of “messing up”, I was able to better understand the value of OT and how to effectively communicate patient concerns with the interdisciplinary team. For example, while working with patients diagnosed with uncontrolled diabetes and/or uncontrolled hypertension, we may communicate patient concerns such as hypoglycemia episodes (really low blood sugar levels), not taking medications, reported pain that is limiting their function, and needed support for food and/or housing insecurity as well as financial support. This communication allows us to catch things that the patient may not have reported during their appointments with other providers and help the team provide the best possible care to the patient.

You will make mistakes and that is totally okay! As a student, this is the time to learn from your mistakes and develop those skills that will help you become an amazing OT in the future! As students we are often too hard on ourselves and are afraid to mess up, but remember to take a step back and remind yourself that you are still learning! As long as you are following safety precautions and working with your team to improve your skills, you will become more comfortable communicating with your patients and your team. As many of you begin to go back to fieldwork in the Fall and then begin level-2 fieldwork next year, you will have the support you need from the fieldwork educators, your clinical instructor (CI), and the rest of the team (wherever your setting is) you are working with! I have been fortunate to have such a supportive team at the Adult West primary care clinic with helping me transition into working remotely and providing feedback to develop the necessary skills to work in this setting. I hope this provides some insight into the importance of communication in the world of telehealth! This is a skill that you will be able to develop during the Master’s program and further enhance if you choose to pursue the OTD as you will have additional mentorship from faculty! I hope that no matter what route you choose, that you feel competent when applying to jobs in the future that require great communication skills and telehealth experience.

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Meaningful Occupations and Routine Changes During Quarantine ⟩
July 1, 2020, by Daniel

Fieldwork Life Hacks

During the COVID-19 pandemic many of us have lost our normal routines and had to either adapt or stop engaging in certain daily occupations. Occupations are activities that we need to do, want to do, or are expected to do in our everyday lives. Everyone has a different definition for what a meaningful occupation is, for example, going to school, working, taking walks, interacting in the community, etc. Social distancing has changed the way we work, socialize, and how we take care of ourselves. Right now, more than ever, occupational therapy plays a crucial role in guiding patients through the process of creating and/or adjusting habits and routines that are personally meaningful and health promoting. Occupational therapy has the ability to address the physical, mental, and spiritual wellbeing of individuals. 

During my remote fieldwork at the LAC+USC Adult West clinic, I have had many conversations regarding increased levels of fear, anxiety, anger, and depression. These are completely normal feelings to have during a time of so much uncertainty. People are worried about their health, financial responsibilities, food insecurity, their loved ones, social injustice, etc. Furthermore, the inability to engage in their usual daily occupations has taken a toll on many of the patients at the clinic. Yet, it is important that we do not let these feelings control our lives, and instead, find healthy ways to cope with these feelings and find ways to begin to engage in meaningful occupations. For example, many people are worried about not being able to work which leads to stress and anxiety about how they will provide for their families the longer this continues. To many this is an extreme change in their lives and are not able to engage in what they have considered a meaningful occupation (working) for the last 10-20 years. Often, our phone visits will focus on exploring coping strategies to manage stress or anxiety, and connecting them to resources that may support them with basic necessities. Without the ability to take care of their basic needs, patients have difficulty focusing on managing their health. Furthermore, we support patients by finding ways to increase activity level and engage in safe/appropriate socialization.   

Below are some resources that you can use with your future patients and for yourself:

Patient Resources:

• My Therapist Aid: A tool for mental health professionals that includes worksheets, audio, videos, guides, interactive activities, and products. Resources can be searched by topic to tailor activities to client’s needs (i.e. stress, anger, anxiety, depression, grief, self-esteem, relaxation, substance abuse, etc.).
• Mindful USC: free app with guided meditations, as well as information about mindfulness classes, retreats and events in the community.
• UCLA Guided Meditations: different types of free meditations in English and Spanish, that can be played as audio or read using a transcript. The meditations can also be accessed via the “UCLA Mindful” app for free.
• YouTube meditations: YouTube is a great resource for many of our patients because it is free and it has so many options! Patients can explore different types of meditations such as guided meditations, sleep meditations, meditations with music, etc.
• Deep Breathing: a relaxation technique that focuses on taking slow deep breaths to provide relief from stress and anxiety. This reminds you to breathe, bring that heart rate down, and relax your muscles.
• 211LA: A hub for community members and community organizations looking for all types of health, human, and social services in Los Angeles County.
 

Personal Coping Strategies:

• Music/Lo-Fi Music: Music has always been a coping strategy for stress and anxiety for many years. More recently, I really enjoyed simply playing lo-fi music, which is a type of music that is mostly beats.
• Exercise: Strengthening exercises and running have been one of my biggest coping strategies during moments of stress. Since gyms began to close, I had to re-invent the way that I exercised at home. I started to do more bodyweight exercises and lots of stretching!
• Reading: I know this probably sound exhausting because we usually already have so much to read for school or work! However, I have found it therapeutic to spend at least 20 minutes per day reading books I have genuine interest for and does not feel like more work. A strategy I have been implementing is setting a timer for 20 minutes to read every day.

As I reflect back on the first 7 weeks of fieldwork, I have learned a lot from hearing patients’ personal experiences under these life-changing circumstances. This has been a challenge as I try to support them through a computer monitor and phone. However, this experience has also improved my problem solving, communication, and collaboration skills as the clinic team finds ways to better support patients. This experience has served as a reminder that occupational therapy provides the adequate training to help with challenges that occur when a person is confined to home and is unable to engage in their meaningful occupations.

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A Busy Day in Primary Care Fieldwork — from Home! ⟩
June 11, 2020, by Daniel

Fieldwork Life Hacks

This summer I am doing my level 2 fieldwork with my OTD residency site under the Lifestyle Redesign for Chronic Conditions Lab (LRCC) in primary care at the LAC+USC Adult West Clinic. This OTD residency is designed to expand occupational therapy (OT) services in primary care, focused on addressing chronic condition management among patients with diabetes and/or hypertension, using a Lifestyle Redesign® approach. This summer I am being trained by the current OTD Resident in preparation to take over the full caseload this Fall.

Currently, the primary care clinic does not have a video platform and we are not allowed to use Zoom to interact with patients, thus all of the appointments are three-way phone visits using Doximity (HIPAA compliant) with supervision from my clinical instructor (CI) through the phone and Zoom. I am able to lead appointments in English and Spanish, which is valuable for our predominantly Spanish speaking community at the clinic. The phone visits can be beneficial for some patients as they don’t have to travel far to get to their appointments and can talk to their providers from the comfort of their home. However, there are also barriers for our patients such as not having a quiet space at home or disconnected phone lines due to being unable to pay their phone bill as a result of the pandemic. We do our best to contact all our patients and provide as much support as possible to help them navigate these barriers and be able to manage their health.

Each day can look very different when doing telehealth in primary care, and below I wanted to share an example of a typical busy Wednesday! On this particular day, I started my day with an OTFP in-service learning about mental health when utilizing Lifestyle Redesign® approaches. Next, my CI and I started calling patients since we had done chart reviews the day before. During our phone visits, we discussed topics such as healthy eating, physical activity, stress management, medication adherence, habits and routines, resources, etc., to support their diabetes and/or hypertension diagnosis and overall health management. In the middle of the day we had consecutive meetings to discuss patient progress and how to better support them (care management); fieldwork/residency updates, logistics, and an opportunity to ask for guidance with clinical approaches (fieldwork supervision); and daily clinic updates and projects (daily brief). And perhaps you are wondering . . . when do you eat? Well, there are days when we don’t get an official lunch break, so we do our best to get food in between meetings! Thereafter, we began calling patients again for the rest of the day and documented in between appointments and during our assigned admin/documentation time at the end of the day.

Typical Wednesday

• 8-9AM – Occupational Therapy Faculty Practice (OTFP) In-Service
• 9-11AM — Patient Phone Visits
• 11AM-12PM — Care Management Meeting
• 12-1PM — Fieldwork Supervision Meeting
• 1:05-1:30PM — Clinic Daily Brief
• 1:30-4PM — Patient Phone Visits
• 4-5PM — Admin Time/Documentation

Tips for working from home

• Take stretch breaks: This is one of the most important things you can do for your body. Taking stretch breaks is important to prevent pain, aches, and cramps later on! You can even do stretches while sitting down.
• Snacks & water: Don’t forget to stay hydrated and have snacks in reach to have energy throughout the day!
• Ergonomics: Posture, posture, posture! Please take care of your bodies and follow proper posture and chair tips when working from home. This can easily be overlooked and if you don’t have fancy equipment, there are ways you can get creative! Your body will thank you later.
• Prepare meals: This can save you time on days when you may have a short lunch break or none at all!

I hope this paints a picture of what a busy day of telehealth primary care may look like! My intention is to be transparent with you all and share the good, the bad, and the busy days. I am often exhausted at the end of the day, but I am excited to continue to learn and the patients make it all worth it!

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Why I Chose the OTD? ⟩
May 31, 2020, by Daniel

Diversity First-Gen What are OS/OT?

For me, pursuing the OTD means much more than just pursuing an education. It represents years of overcoming systematic barriers and paving the way for more first-generation Latinx students. Along the way, I have been fortunate to have a support system that believed in me, which I call my village (family, friends, mentors). As a first-generation Latinx student, pursuing an education comes with many other responsibilities. Personally, my entire college career I’ve had to work almost full-time, financially help my family, deal with imposter syndrome, and felt lost along the way since I am the first in my family to pursue higher education. My dream has always been to earn a doctorate degree, however, I never thought it would be financially possible. During Fall 2019, I began contemplating my options and whether it was possible to pursue the OTD. I struggled with constant questions of, “How can I pay for this?”, “Should I just start working after graduation to help my family out?” This was a time full of emotions and feeling stuck. Fortunately, I was able to ask questions, lean on my support system and this provided clarity. I reflected on my future goals of wanting to teach someday, starting my own non-profit organization, and promoting Latinx representation and leadership in OT, and decided the OTD would better prepare me to pursue these goals. Furthermore, I reflected on the communities I seek to make an impact on and decided to pursue a USC Chan Residency in primary care. Now that I am starting my residency training at the LAC+USC Adult West Primary Care Clinic, I truly believe I made the right choice. I am excited to continue to grow working along my faculty mentors Dr. Beth Pyatak and Dr. Jesús Díaz, and learn the necessary skills to expand OT services in primary care. I look forward to sharing my OTD journey with you and helping you find yours!

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