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Fieldwork

Calvin

Fighting Feelings of Imposter Syndrome During Fieldwork >

by Calvin

Fieldwork What are OS/OT?

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Just last week, I completed my first Level II Fieldwork at Prototypes: A Program of HealthRIGHT 360! I was placed with the agency’s Adult Full Service Partnership (FSP) Program and Children’s Program where I was able to provide individualized occupational therapy services to clients across the lifespan who struggle with mental health concerns, needs, and barriers.

This was my first full-time fieldwork placement. I was expected to be there every day from 9:00 am to 5:30 pm, whereas my previous Level I Fieldwork placements did not require me to come as often. Although I had heard amazing things about Prototypes from previous fieldwork students, I knew that things would be different given the pandemic situation, and also just that everyone’s experience is different. I was feeling anxious about taking on telehealth services, potentially meeting clients in-person, documentation, and more. I wasn’t sure how I would fit in with the team or if I was going to represent OT well enough in the mental health field. The imposter syndrome was real. However, after my first few weeks of fieldwork, those feelings of impostorism gradually began to fade away. I was able to build my confidence to thrive in what turned out to be a beyond-stellar fieldwork experience.

My clinical instructor (CI) was the only occupational therapist at my site, but they truly advocated and raised OT awareness within our client and provider population. I am so fortunate to have had their supervision because they helped further my understanding of what occupational therapy’s role in mental health is. I also appreciated how they always challenged me to ask questions and tested my clinical reasoning and critical thinking skills. At first, I was nervous about making mistakes, but I kept reminding myself that it’s okay and that I should take those as opportunities to learn and grow. Additionally, with the rest of the agency team (inclusive of case managers, clinicians, administrative support and program directors), I felt very well supported and empowered to make an impact as an occupational therapy fieldwork student. It wasn’t long after the beginning when I started to more confidently plan clients’ treatments, document my sessions, present cases to my fellow colleagues, and really highlight the unique capacity of occupational therapy within the mental health community.

It was this sense of community and appreciation for OT that made me feel like I belonged, and uplifted me to bring my skills and knowledge of resources to the table. I was able to creatively collaborate with my caseload of clients to address hygiene management, budgeting their finances, accessing resources, accountability with task completion, social participation, engaging in habit change, and building and maintaining routines so that they can independently participate in their daily lives. I realized that this is the beautiful work of occupational therapy in mental health (and of course there’s so much more to it)! These are meaningful occupations that may be difficult for individuals to participate in because of their mental health needs and barriers. As occupational therapists, we have the power to use occupations as a means and as an ends, as well as to support our clients with health promotion and education, holistic interventions, and our therapeutic use of self.

Team Picture

The OT Team with our farewell paintings 😢 Best team ever!!!

Overcoming self-doubt and persevering through my own imposter syndrome enabled me to come out of this fieldwork with a wealth of insight, about OT and about myself. I’m grateful for My Mental Health Immersion Experience for providing me with such a solid foundation that prepared me well for this experience. Also, the interprofessional collaboration that I experienced here was extraordinary, and I am incredibly thankful for all the mental health practitioners that I was able to collaborate with. Finally, thank you to my CI, my new West Coast University OT student friends, and especially my ambassador teammate, Bethany Yew, who was placed there along with me — WE DID IT, BETHANY!!!

I am very much looking forward to transitioning into my next, and final, Level II Fieldwork for the Summer 2021 semester, and I can’t wait to continue translating everything I’ve learned through my experiences! Whether if it’s our first or last, or if it’s Level I or Level II, good luck to all of us going into fieldwork. Let’s continue to support one another and make the most out of our experiences!

Daniel

Mixed Status Families >

by Daniel

1 comment

Admissions Classes Diversity Fieldwork Life Hacks

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According to the National Immigration Law Center, “a mixed-status family is a family whose members include people with different citizenship or immigration statuses. One example of a mixed-status family is one in which the parents are undocumented, and the children are U.S. born citizens”. The state of California has the largest number of U.S. citizens in mixed status families filing taxes, at 1.5 million people. This is a topic I would like to bring more attention to because many people may come from or know someone from a mixed status family, this includes students at USC and clients seen during fieldwork or residency, and this may not be something that is often brought up in the classroom. Personally, I live in a mixed status family, which includes DACA recipients and people without any documentation, with some extended family having other statuses as well.

Source: Migration Policy Institute, “Mixed-Status Families Ineligible for CARES Act Federal Pandemic Stimulus Checks,” (May 2020), migrationpolicy.org/content/mixed-status-families-ineligible-pandemic-stimulus-checks

Source: Migration Policy Institute, “Vulnerable to COVID-19 and in Frontline Jobs, Immigrants Are Mostly Shut Out of U.S. Relief.” (April 24, 2020) migrationpolicy.org/article/covid19-immigrants-shut-out-federal-relief

This past year has been really tough financially for my family and me. The multiple stimulus packages that were passed came with a lot of limitations for mixed status families. For example, as a USC student who is undocumented with DACA status, I was unable to apply to the CARES Act financial assistance for college students. After doing some research and waiting for the final relief bills to be amended and passed, I was fortunate to receive the stimulus check because I have a temporary work permit via DACA. However, not all undocumented students are DACA recipients, and many undocumented people did not qualify for anything, even though they pay taxes every year with an Individual Taxpayer Identification Number (ITIN) number. In the last year, I saw many people be excluded from federal assistance simply because of their immigration status, personally at home, with friends, and at residency. My parents and many of my clients in primary care were impacted by the exclusions in the COVID-19 relief bills, including the most recent under the Biden administration.

During this time, many families continue to rely on food banks, are behind on rent, and are surviving on the little help they can get. For example, I helped my parents and some of my clients apply to local and state specific relief programs which provided some financial assistance, but not nearly enough. And for many it’s not an easy process due to technology access, literacy levels, social support, etc. Last fall, I helped my parents write a letter and email it to a rent relief program that provided $500. I was appreciative that non-profit organizations and certain school departments took it upon themselves to be more inclusive and provide some type of financial assistance for students that may have not qualified for the CARES Act. As a current student, I was able to apply for the USC Ostrow Emergency Fund, the USC Graduate Student Government Emergency Assistance, and Immigranted (non-profit organization) for financial assistance to get through the year. Most of that assistance and my stimulus checks went to home expenses that my parents were simply unable to cover.

I believe this is an important discussion we need to have or at least consider in the academic setting and occupational therapy world. As I stated earlier, this impacts students at USC and in the OT programs, as well as clients being seen by occupational therapists/residents and/or fieldwork students. It’s important to consider how students may be navigating their own experience within a mixed-status family or perhaps have family/friends, clients, or colleagues that are experiencing this. As the Chan Division continues to push for more diversity and students from different backgrounds come in, it’s important to consider how prepared we are to support their education and clinical experience within the context discussed above.

No matter your political views, from an occupational therapy lens, we all have a responsibility to promote occupational engagement and occupational justice. This may include supporting clients navigating access to resources. As I found myself doing with my family and clients in primary care, I was that person that supported their own resource seeking as a means for survival during the pandemic. The reality is that not everyone has access to OT services or a family member who can help them seek resources. This is a very complex topic and there are many layers to it, perhaps many terms you may not be familiar with. I am always available for any questions (.(JavaScript must be enabled to view this email address)). I ask you to be open minded and encourage you to have these uncomfortable conversations. It is never too late to start learning and getting involved in the discussion. The COVID-19 pandemic revealed and exacerbated many of the disparities and social inequalities that have been there for many people in the United States, especially the undocumented population. I want to leave you with the questions below to reflect on:

  1. As a current or future occupational therapist, how are you going to support clients experiencing occupational injustices due to their immigration status?
  2. How are the needs of students within mixed-status families being met? How can we best support them in reaching their educational and professional goals?

Feel free to comment below as well!

References:

Liz

Level II Fieldwork Part I: Almost Complete! >

by Liz

Fieldwork

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I am so bummed that level II fieldwork is almost over—one week to go! 12 weeks literally flew by. If you read my previous blog post about my level II fieldwork placement, I’ve been having a blast the past 3 months. I can confidently say that I feel prepared to practice in a hand therapy setting! Here’s a little bit of what I’ve learned these past three months:

How to complete an initial evaluation
This is so important y’all. Not only is it key for knowing why the patient is coming in/what their primary complaint is, but it is the first interaction that you have with them. This is your chance to begin creating that relationship. At first I was a little nervous. I was so grateful for masks because it made it that much easier to hide how nervous I felt! But, I’ve done so many initial evals that now it’s a piece of cake. There’s so many important questions to ask: have you had surgery? Any steroid injections? How does this affect your ability to do things every day? Do you currently own a splint? Take measurements as needed. And yes, these are all super important, but so is the impression you make. This will determine how comfortable the patient will feel with—can they trust you?

How to explain to patients what in the world is going on
A lot of times patients will come in and have no clue what’s going on. This is why knowing your anatomy and familiarizing yourself with diagnoses is critical. You also have to keep in mind that patients will not usually know what in the world extensor carpi radialis brevis is. Explain in a way that the patient will actually understand! Practicing this is super helpful for when patients say “what is tennis elbow, I don’t even play tennis!”

Prioritize occupations!
I’ve seen folks who come in post surgery and also those who are trying to take care of their condition conservatively. In both cases, I’ve had people ask if they need to stop doing things they love. In some cases, the goal is to get them back to doing those things. I had a client who fractured one of his carpal bones and hasn’t been able to surf for months. Attempting to surf right now probably wouldn’t be the best idea. But, what we’ve been working on is getting his range of motion back and slowly working towards weight bearing so he can push off on his surfboard, wax it, put on his wetsuit, etc. 

Documentation
We learned a little bit about this in the hands electives and in adult rehab as well. This is super important for noting what you did with the patient, how they responded to treatment/modalities, what happened, why do they need to continue coming to OT. This looks differently at each site, but to date I’ve written so many SOAP notes I already lost count! SOAP notes are used in several OT settings. It stands for: Subjective, Objective, Assessment, and Plan. These provide information about what the patient said/what they’re reporting, what you observed/measured as a skilled clinician, why they still need to continue seeing you, how are they progressing?, and what the plan is for the next session. You’ll learned more about this when you practice writing SOAP notes in class. 😊 


How to actually treat people
Anyone can Google what a trigger finger is. But, what do you actually do when a client comes in with one? This is when I was super grateful for my fieldwork educator. There’s a reason why practicing in a hands setting is considered advanced practice. There’s so much! There’s a lot to know, and everyone’s conditions may present similarly but also be very different. I’ve had the chance to independently treat so many diagnoses including: trigger fingers, wrist fractures, Dupytren’s contractures, carpal tunnel, rheumatoid arthritis, osteoarthritis, cubital tunnel, tennis elbow and even a couple folks who have had amputations—to name a few. I am very happy to say that I’ve felt completely comfortable treating these conditions.

Splints 101
Making splints is tough y’all! It is literally art. For one, there’s different materials to choose from. Some cool faster than others, some are more comfortable for night wear, others are more restrictive. I had the chance to make a couple short opponens splints and a few trigger finger splints as well. My fieldwork educator has so much experience and I’ve seen him create some amazing splints for different people. Making splints is great, but with that comes some client education. Can they bathe with it? Should they sleep with it? Skin checks! Tip #1: Don’t leave it in your car—it might lose its shape with the heat!

Being confident in myself
It’s okay to not know everything. It’s literally been only three months! At first it was rough to come to terms that I wasn’t an expert. But, now that I’ve really got the hang of everything I am so sad that this placement is coming to an end! I’ve learned that it’s okay not to know everything and asking questions is fine. My fieldwork educator once told me, “You might not know it all, but you definitely know more than the patient so believe in yourself”.

So, this is all just a fraction of what I’ve learned so far. After nearly a year of learning from behind a screen, I am so grateful for this experience. It exceeded my expectations of what level II fieldwork would be like. If you have any questions about my placement or want to know more about my experience please feel free to shoot me an email!

Savi

Fieldwork II: Saying YES to Taking on New Challenges >

by Savi

Fieldwork

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As I enter into the third week of my level II pediatric fieldwork at Hiller Therapy, I am shocked by how much I have already grown as a practitioner. I was extremely nervous coming into this fieldwork placement because pediatrics had been the most difficult practice immersion for me. I never felt fully comfortable with the material and I didn’t believe that I had the right character traits to work with kids (creativity being an important one!).

Now I am sitting here, writing this blog post and realizing that I had underestimated myself. I feel as though I can create fun and engaging treatment sessions, help children meet their goals, and develop appropriate goals after doing an evaluation. All of this after just two weeks! You might be thinking…Savi…how is that possible? All it took was saying YES to any opportunity to be hands-on with clients and leaning on the professionals around me to look over my work and give me honest reviews.

In the first week, I said yes to taking on half a client load filled with children of all ages. This forced me to quickly pick up on developmental milestones and differing interests. After a few days, I became familiar with my resources and began developing more and more creative treatment plans. I said yes to running evaluations I had never tried before and taking on new projects – such as developing a school-based OT assessment. These were not things I was comfortable with initially, but by being honest with my OT about my perceived skillset and having her there to help me if I ever became confused or overwhelmed, I felt more confident taking on challenges in my first few weeks.

By saying yes to these opportunities, I quickly realized that I knew more than I thought I did and that I was WAY more competent than I had initially believed.

Do I have a ways to go to become a proficient pediatric OT…Yes of course I do! Although I have a lot to work on and a lot more to learn, I am now excited and not nervous walking into the clinic each day. I am becoming more comfortable with treatment planning and going with the flow because kids can be kids and you can’t always micromanage and control each session.

I say yes to opportunities I have time for and I am honest with my OT if I am feeling overwhelmed. This has taught me how to communicate openly with my co-workers and to learn from their years of pediatric OT experience to become an asset to them whenever I can.

If you are reading this before a Level II fieldwork experience in a setting that you might not be extremely comfortable in, know that it is ok to feel nervous and maybe even scared to fail. This is a learning experience so take advantage of the opportunities presented to you, say YES to taking on challenges you may not feel capable of overcoming, and lean on the brilliant OTs (or other healthcare practitioners) around you to get a few words of wisdom and support whenever you need it. You are more capable than you believe…trust yourself and enjoy the ride!

Daniel

You Don’t Need to Be Perfect, You’re Still Learning >

by Daniel

1 comment

Admissions Classes Fieldwork Life Hacks

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Over the last couple of weeks, I have been talking to students that find themselves at different points in their OT journey. This is a busy time as many wait for updates from admissions, some still deciding whether to pursue the OTD, and others wondering what field of OT to pursue as they find themselves in the final year of their program. Being able to connect with students from different backgrounds is my favorite part of this position and it is a privilege to learn all your stories. Around this time in 2018, I was waitlisted for the Entry-Level Master’s program, and to be honest I did not have high hopes that I would get in because of my GRE scores. At the same time, I was working a lot and still trying to finish my Bachelor’s degree while struggling to do well in Chemistry (I know, what a fun last semester!). When I have these conversations with students it takes me back to these days, the good and the bad times. This is a time in my life when I thought I had to be perfect in order to be successful. Whether you are waitlisted, deciding on an OT program, just discovering OT and not knowing if this is the right choice or feeling overwhelmed with the overload of information coming at you, remember that you are not perfect. None of us are.

Make sure you are taking the time to breathe and engage in things you love to do, even if it’s a few minutes of your day. Take those minutes to spend it with loved ones, call someone, and eat! Remember to practice what we preach and try to find a balance. You cannot control everything, so focus on the things you can and take care of yourself. We want you to be at your best during class, when studying, at fieldwork, and with clients. You should always strive to give it your best, but it’s okay to not be perfect. When you know you gave it your best despite the circumstances, I believe you can be at peace with the results. This way of thinking and restructuring my thoughts has helped me cope with the demands of grad school. Remember that part of learning is to fail and try it again. Dwelling on it will not change anything, but what you can do is learn from those shortcomings. Maybe you had a practical that didn’t go as planned, perhaps a rough fieldwork or residency day, you know, it happens! And often those are the times that stay with you the most, when you make a mistake, when you failed at something, or when you didn’t know what to do.

I recently read a quote from my assigned class reading about an immigrant woman that says, “I may not remember everything I have learned, but it has made me who I am today”.  This is the quote I needed last week as I found myself struggling through my busy days. The long days and nights, assignment deadlines that feel impossible to meet, back-to-back meetings, the endless information introduced every week, etc. At times, it may feel like you’re just on autopilot, going through the motions. We can get so caught up in not knowing enough for an upcoming exam, for fieldwork, or for your residency setting. And of course, I do not know every single thing that was ever taught to me in school, but I have learned lessons from it all along the way. The Master’s program and now the OTD program, they have both challenged me in different ways. They have both made me question my abilities and have tested my motivation.

If you are reading this now and find yourself with doubts about what to do next, remember that you don’t need to be perfect. As you proceed to the next step in your journey, remind yourself that perfection is an unrealistic expectation that should not be put on anyone, you are a person and student that is still LEARNING. Take the necessary steps to learn from the particular experience you find yourself in, and with a little perseverance just keep going. Use the resources available to you, reach out for help, and don’t ever be afraid to ask questions. Lastly my virtual door is always open for those that may relate to this notion of perfection or if you have questions about OT and higher education (.(JavaScript must be enabled to view this email address)). I also invite you to make comments below if you would like 😊

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