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Fieldwork

Let’s Talk Fieldwork — Part II: School-Based Pediatrics ⟩
September 28, 2017, by Caroline

Fieldwork

In my previous blog post I explained how Level I and Level II Fieldwork experiences work in our program at USC, and shared about my previous Fieldwork placements. As promised, this blog is devoted to my current Level I Fieldwork experience!

I am in the Pediatrics Immersion, which means that my Fieldwork is also in a pediatric OT setting. I’ve been placed in a local school district, so I get to see school-based pediatrics. I was really excited when I first got my placement, because I had observed pediatrics before, but not in a school-based setting, so this would be a new experience for me! I spend most of my time at an elementary school, but my Clinical Instructor (CI) and I also go over to a local high school to treat some students there as well.

I just had my 3rd day at my Fieldwork site, and I have already gotten to observe and assist with so many different things! Because my CI has a pretty consistent schedule, I get to see the same kids each week. This allows me to see growth and change in the clients, helps them to become more comfortable with me, and gives me the opportunity to begin planning and leading treatments with them as I become more familiar with them, their goals, and their interests.

The elementary school where I’m placed has a pretty unique setup, because my CI has an awesome OT clinic room all to himself — mats, obstacle course, swings, and all! With all of the materials and resources, there are so many possibilities for treatment and intervention, which is so exciting!

A Typical Morning at my School-Based Fieldwork Site

8:15 — Arrive, plan for the clients that day, prepare any materials needed.

9:00-9:30 — Pull a client out of class for an individual OT session. We used play-doh to work on hand strength, bilateral coordination (using both hands at the same time in a controlled manner), and pre-writing (by using the play-doh to spell out the client’s name).

9:30-10:00 — Pull another client out of class for an individual OT session. We used a three-step obstacle course in the clinic room to work on gross motor control (coordinating the large parts of your body, like legs, arms, and trunk to move) and task sequencing (progressing smoothly through a multi-step activity).

10:00-10:30 — Time for documentation and planning.

10:30-11:30 — We run an OT and Speech group with one of the Special Ed classrooms. We led the students through a song with choreographed dance moves (jumping, running in place, spinning) and then completed a craft activity based on the song that worked on fine motor skills (activities that require the use of the smaller body parts, such as the hands and fingers) like handwriting, cutting, coloring, tearing paper, and squeezing glue.

11:30-12:00 — Time for documentation and planning.

12:00-12:30 — Lunchtime (in the teacher’s lounge! It’s definitely not as mysterious as my elementary-school aged self thought it was 😊 ).

The mornings are pretty consistent, but the afternoons have a little bit more variability. Sometimes, we have meetings with parents and the rest of the team at school (Speech Therapists, Teachers, Psychologists, etc.) to address concerns or for an annual Individualized Education Program (IEP) meeting. At these meetings, it’s really cool to see the inter-disciplinary team working together to best support the individual child in the school environment. Other afternoons, we’ll go over to the nearby high school and work with some of the clients over there. I’ve enjoyed getting to see what school-based OT looks like for elementary-school aged children compared to high school students.

I’ve only had 3 days of Fieldwork, but I’m seeing individual clinic sessions with elementary and high-school aged students, group sessions, IEP and parent meetings, and more! My CI is also very open to me jumping in, taking charge, and planning and implementing some sessions with the kids. As I continue to learn more in my pediatrics class and am exposed to more at Fieldwork, I expect I’ll get more and more comfortable taking on more responsibility at Fieldwork!

My full week of fieldwork is coming up in a couple of weeks, so I’m looking forward to seeing even more clients! If you’ve observed OT in a school-based setting or have any questions about my experience, leave a comment below!

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A Summer of Lessons From Master Wu ⟩
September 28, 2017, by Bryan

Fieldwork Life Hacks

I never liked kids. Maybe it was growing up as an only child, or not liking loud noises or when things get too messy (sensory sensitivities . . .), I always distanced myself from having to interact with a child more than a quick smile or wave.

With that said, this past summer I spent my 12 weeks getting to know and treating children ages 4-11 at Stepping Stones Therapy Network, a pediatrics clinic in Seattle, WA. I took advantage of the out-of-area fieldwork request and took the opportunity to work in one of my favorite cities.

While I am planning to elaborate more on the process of securing an out-of-area level 2 placement and tips throughout the process in a future post, I wanted to share a few ways in which I grew as a clinician, student, and person after completing my Level 2 FW.

1. I was so prepared! I cannot stress this enough. If you put in the work throughout the semester to learn the material and listen to faculty’s tips and tricks from their own practice, you will be ready for all that comes with Level 2 FW. The hardest part about Level 2 was not the clinical reasoning needed to observe and assess a client from the multitude of OT models of practice (Sensory Integration, Biomechanical, etc.), rather the ins and outs of learning how the clinic operates and becoming more proficient with administering and scoring assessments. One of the major encouragements my clinical instructors gave me was regarding my documentation skills which I directly attributed to the fact that I was taught the OT lens in class through the case studies we discussed and from faculty’s own stories and reflections.
2. The learning does not stop. Even though I had no examinations or quizzes to study for, I spent each evening looking up treatment ideas for my clients the next day, documenting on the clients I saw that day, watching YouTube videos of BOT 2 administration for my evaluation later that week, reviewing Handwriting Without Tears, all the while trying to learn the names of Ninjago characters to better connect with the kids. Fieldwork is definitely full time!
3. I learned to have a BLAST on the weekends! The good thing about fieldwork is that you do not have to feel the dull (sometimes sharp) pressure of an upcoming exam that impedes your ability to just hang out and chill. I went on a lot of fun hikes and really explored Seattle which only helped me focus and perform better when I was at fieldwork during the week! I loved having a routine throughout the week: working, gym, meal prep, treatment planning, reading, and enjoying the city and friends I had during the weekends.
4. Make it a priority to build a relationship with your clinical instructors and coworkers. I guess this point was easy for me this summer because I was truly blessed with amazing CIs and coworkers who were not only skilled OTs, but also mindful instructors, carefully pacing my growth as a student and clinician. I wanted to be intentional with asking them about treatment ideas and career advice moving forward. What steps should I take to go into inpatient pediatrics? What do you like about working at a peds clinic? What certifications should I pursue?

Seattle summer weather is unreal . . .

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Let’s Talk Fieldwork! ⟩
September 14, 2017, by Caroline

Fieldwork

I can hardly believe it, but this is week 4 of the fall semester, which means that all of my classmates and I are starting our Level I Fieldworks this week! In my next blog, I’ll tell you all about my first couple days of Level I Fieldwork in Pediatrics. Before I do that, I want to use this blog post to give an overview of fieldwork in general, because many prospective students have a lot of questions about it!

Fieldwork is our chance to go out into the field and see first-hand what we’re reading in our textbooks and learning about in class. In our entry-level Master’s program here at USC, we have Level I and Level II Fieldwork experiences.

Level I Fieldwork is tied in with our 3 immersion courses: Adult Physical Rehabilitation, Mental Health, and Pediatrics. Once per week, instead of going to class on campus, we report to our Fieldwork site for a full day of clinical experience. Then, in the middle of the semester, we get a week off from class and report to our fieldwork all week long. Level I Fieldwork is a great way to get exposure to a particular practice setting, make connections to what we’re learning in class, and develop some clinical and interpersonal skills!

Level II Fieldwork is a more beefed-up, immersive experience than Level I Fieldwork. While Level I Fieldwork occurs in tandem with classes during the fall and spring semesters, Level II Fieldwork is a full-time 12 week clinical experience which takes place during the second and third summers in the program. Level II Fieldwork begins with observation, but as the summer progresses, we are gradually given more responsibility, until the end of the summer, where students usually have their own caseload that they are evaluating, treating, and writing documentation about. At the end of Level II Fieldwork, the goal is to practicing at the level of an entry-level practitioner in that setting.

My first Level I Fieldwork experience last fall was during my Adult Physical Rehabilitation immersion. I was placed at St. Mary Medical Center in Long Beach. At this hospital, my Clinical Instructor (CI) and I evaluated and treated patients on the acute and ICU floors. I had never seen OT in a hospital setting, so managing IV lines, oxygen cannulas, and blood pressure monitors was totally new for me. Also new to me was working with individuals in critical conditions. I was surprised by how much I enjoyed the population and setting! I had a wonderful experience at St. Mary’s, and left feeling more comfortable working with patients in the hospital, and with a better understanding of OT’s role in an acute setting.

The following spring semester, my Level I Mental Health Fieldwork placement was at Gateways Forensic Community Treatment Program. This was an outpatient mental health setting that provided court-mandated services for individuals following release from prison or inpatient mental facilities. I had a lot of autonomy at this site: I got to lead groups and facilitate one-to-one OT sessions with my own caseload. Erika wrote a whole blog about embracing fieldwork sites without an OT as your CI, and I couldn’t agree with her more! I had a lot of responsibility, but I think this push was exactly what I needed to gain confidence in myself, my knowledge, and my therapeutic use of self. I was also totally unfamiliar with OT’s role in Mental Health prior to that semester, but I definitely saw the value of occupation and OT’s approach for the individuals I was working with.

Then came summer, where I had my first 12-week Level II Fieldwork experience. I was placed at St. Barnabas Senior Services (SBSS), a center for community-dwelling older adults. This site fell into the category of primary care and health promotion and wellness. My fellow-classmates and I were the first students to have our Level II Fieldwork at this site, so it was up to us to do a needs assessment, market our services, and establish OT’s presence at the site. While that’s hard to accomplish in the span of 12 weeks, we did establish new groups (allowing seniors to engage in new occupations), met with individual clients (that we recruited ourselves!), and led health education and literacy presentations (I provided education on fall prevention and diabetes management). A lot of things about my summer were challenging, given the nature of the site, but I definitely grew as a person and as a future OT. I enhanced my Spanish skills (75% of the time I was speaking with the older adults, it was in Spanish), learned about program development, gained familiarity with common chronic conditions commonly experienced by older adults, sharpened my clinical observation and reasoning skills, and practiced with different evaluation tools and practice models. I wasn’t sure how I felt about working with older adults at the beginning of the summer, but I could definitely see myself working with older adults in the future!

So now I have one more Level I Fieldwork placement left, this time in Pediatrics, and then one more Level II placement next summer. As I said before, my problem (albeit a “good problem”) is that I haven’t yet found a population that I didn’t enjoy working with. I love OT because it allows me to connect with a diverse range of individuals, meet them where they are, and help them work towards getting to where they want to be. In class, we talk about how to do that, and we simulate that with case applications. Fieldwork, though, is my chance to really apply that and have a hands-on learning experience. How valuable that is!

Now that you’ve heard about my prior fieldwork experiences, stay tuned for my next blog, where I’ll tell you how my Level I pediatrics fieldwork has been going so far!

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Aloha Assistance Dogs of Hawaii!: My First Level II Fieldwork Experience ⟩
September 6, 2017, by Kaitlyn

Fieldwork

Hawaii, dogs, and OT . . . if this sounds like the ultimate dream trifecta of a Level II Fieldwork then let me be the one to tell you that it is actually real (because I lived it!). This past summer, I am grateful to say that I spent 3 months in Maui with Assistance Dogs of Hawaii for my first Level II Fieldwork experience.

This journey began in March of 2017, when I first underwent an application and interview process. By the end of that month, I began to mentally prepare myself for what would be a life-changing, temporary move across the Pacific Ocean to work with one the most inspiring non-profit organizations!

Assistance Dogs of Hawaii, founded by Mo and Will Maurer, is a fully accredited, 501(c)3 non-profit organization that provides people with physical disabilities specially trained dogs to help them live more independent lives. I was lucky enough to work under the supervision of my clinical instructor, Dr. Cate Dorr, who is a certified dog trainer and occupational therapist. Between Assistance Dogs of Hawaii and working alongside Dr. Cate Dorr, I knew that it was going to be a summer full of growing and learning.

In the 3 months that I was in Maui, I was exposed to a multitude of experiences and learning opportunities. Just to name a few, I learned how to care for and train service dogs (my preview to motherhood), participated in Team Training Camp where I learned the skills of a hospital facility dog handler, conducted therapy visits, created and implemented a week-long camp dedicated to children with limited mobility called Camp Bow Wow (which was featured in Maui News!), and of course, worked with patients of all ages and diagnoses implementing occupational therapy and Canine-Facilitated Interventions (a term coined by Dr. Dorr herself!).

Towards the end of the summer, we were even provided with the opportunity to visit foundations and hospitals such as Kapiolani, Queen’s, and Shriners, all of which are located on Oahu with our (at the time) 10-week old puppies! During that same trip to Oahu, we also met with Catia Garrell, one of the founders for Thrive for Life (and an USC OT grad!) to see a home modification project in progress. At the site, we got to see how accessible home modifications are made through an OT lens, which is just another piece of evidence that since the OT scope is so broad, we should never be scared to think outside of the box!

When I wasn’t working or with the dogs, I explored the island and really immersed myself in the beauty of Hawaii (and became really tan while doing so).

Out of all the amazing things that I got to do while I was in Hawaii, I will say that working with patients alongside my four-legged friends proved to be something that has profoundly changed my heart. For example, one of my patients broke dog treats in order to improve strength in his hands post incomplete C5-C6 spinal cord injury and another patient with spina bifida took steps alongside one of our service dogs in training to help him engage in tabletop ambulatory level activities. Seeing the motivation and intrinsic desire to do better in therapy sessions with the presence of dogs really opened my eyes to how beneficial and essential this emerging practice is to the profession of occupational therapy.

All in all, I have learned so much about dogs, occupational therapy, Canine-Facilitated Interventions, people, and myself from this Level II Fieldwork experience. Here are a few:

1. Be open to every Level II Fieldwork placement possibility. Prior to receiving an offer from Assistance Dogs of Hawaii, I was looking into rehabilitation hospitals and clinics across the country, ranging from places like Nebraska to the Bay Area to New York. I knew that I wanted to expose myself to the best learning experience while being in OT school and for me that meant opening my mind to every option out there. While those did not necessarily work out for me at first, the opportunity with Assistance Dogs of Hawaii followed soon thereafter. When one door closes, it just means that there is a better door waiting for you.
2. Allow yourself to make mistakes and learn from them. I am so far from perfect and I know it. The beauty of being a fieldwork student is that it is okay to make mistakes . . . so long as you learn from them and have a positive attitude about it! Your clinical instructor is there to teach and support you through these learning curves, so don’t be too hard on yourself when you don’t know everything.
3. As much as you teach your patients, let your patients teach you too. I met the most inspiring individuals during my time in Hawaii and I can confidently say that I am a changed person because of them. My patients, my patients’ families and friends, and the people of Hawaii have taught me the true definitions of what it means to be resilient, compassionate, and happy. Despite any hardships they were facing during that time, they always managed to have a huge smile accompanied by a huge heart.

I’d like to end this post with one of my favorite quotes from a patient that I worked with that had ALS. During our last session together, she told me, “Kaitlyn, sometimes life will not treat you kindly. When this happens — because it will — just be strong and be kind back regardless. You will be doing amazing work as an OT, and you will change so many lives whether you know it or not.”

Mahalo Mo and Will Maurer, Dr. Cate Dorr, USC, Assistance Dogs of Hawaii, and the beautiful islands of Hawaii for the adventure of a lifetime.

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No OT to shadow? No worries! ⟩
September 6, 2017, by Erika

Fieldwork Life Hacks

To those of you who are currently in or still need to complete the mental health immersion, this blog post is for you. Many of you have concerns about not having an OT to shadow during your level I due to the limited number of mental health facilities that have OTs available. That’s a fair concern, I had the same one! Fear not, I’m here to say that I had a great experience in my level I even without an OT to shadow. It took a bit of a perspective shift but once I was able to allow the experience to reveal itself naturally, what I ended up gaining exceeded any expectations and fears I had going in.

During my first fieldwork placement during my first year, I was placed at Verdugo Hills Hospital’s geriatric psychiatric unit called Stepping Stones. I had the opportunity to observe both inpatient and outpatient settings which was quite a privilege. As with most mental health settings, there was no OT to shadow. Therefore, I was placed under the supervision of two recreational therapists and an art therapist in the inpatient unit as well as two social workers in the outpatient unit.

Here is what made my mental health experience so valuable even without an OT to shadow:

1. I learned what professions are already well established in mental health, what they do, and how OT can provide additional value. Before this fieldwork, I didn’t know much about mental health. I just assumed that if someone had mental health issues, they’d see a psychologist. Through this fieldwork, I had the opportunity to observe interventions done by recreational therapists, an art therapist, and social workers and how they played their parts in assisting patients across the progress of their illness. I learned that in art therapy, you would choose mediums (markers vs. paints vs. colored pencils) according to the patients’ cognitive levels and abilities as well as the psychological significance of certain colors! I learned that social workers have the authority to diagnose and observed how they engaged clients in group talk therapy. Best of all, I was able to execute OT sensory and cognitive interventions and inform the other professions on what value we could bring to what they were already doing. It was a beautiful exchange of thought across professions and a shared passion of service to this population.
2. I was able to get exposed to all mental health settings through the experiences of my peers and in turn, reduce stigma that I personally associated with mental health. Since there are few OTs to shadow, mental health is the only immersion in which weekly fieldwork debriefs are set up with peers and a faculty member during class time. I think that most of my classmates would agree that this served as being one of the most helpful resources. We were placed with the same group all semester in which each member was placed in a different mental health setting so we got firsthand experiences of what each setting entailed. What a way to learn! It provided an open platform to not only share in each other’s concerns and successes but gave us a deeper lens into the mental health community. These debriefs equipped us with awareness and compassion, and in turn, helped debunk any stigmas that we initially came into the course with.
3. USC faculty support is top notch. Even with the lack of OT in my settings, there was never a time that I didn’t feel supported by USC faculty. With such breadth of experience, you are bound to find a faculty member that has practiced in the setting you’ve been placed in (inpatient, outpatient, full service partnership, wellness center, clubhouse, etc.). I was able to reach out to faculty members and pick their brains about possible interventions to try out, success stories, horror stories, etc. just to feel a bit more comfortable in understanding OTs role in my specific setting. This experience opened doors to forming relationships with faculty who I now see as mentors that I feel comfortable reaching out to for guidance throughout school and my future career.
4. Developing my therapeutic use of self. Even without an OT, this fieldwork placement was a great opportunity to observe the variance in how my supervisors, as therapists, utilized their own therapeutic uses of self. Everyone has their own gifts, ways of communicating, and backgrounds that contribute to how they practice and work with clients. It was fascinating to see how one recreational therapist Carl*, who I called the Zen master, would engage patients vs. another, Yuko*, who was bubbly and charismatic. They were so different and yet, their concern and care for every patient was expressed and equally well received. This made me really reflect on the fact that there is no one way to be a successful therapist. I began to observe my own therapeutic use of self and develop my own style of practice utilizing my own authentic experiences and gifts.

I know this post was a bit of a big boy but thank you for reading. Hopefully, I’ve been able to alleviate some fears or at least provide a change in perspective on what else you could look forward to during your level I mental health fieldwork placement. At the end of the day, with all your fears, questions, or concerns, know that there is faculty close by, peers going through the same thing, and new and interesting perspectives that lie untapped with your supervising mental health professionals that might provide more insight into your own value and practice with this population. Level I placements are meant solely as a means to observe so OPEN YOUR EYES — you may be surprised by what you end up learning.

*All names mentioned in this blogpost are pseudonyms.

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