Mental Health FW 1 Experience: Recounts & Thoughts

Hey guys, so as of Tuesday, July 14th,  I wrapped up my MH FW 1. To give you some background the FW took place at an psychiatric facility for short-term crisis stabilization. I was in a group with 2 other classmates. The FW was a total of 7 weeks with group once a week. The first week, we got to observe the current therapists at the facility conduct a group. I was kind of disappointed because the group we were able to observe was just a physical education group. They played "HORSE" -- not much to see. I was really looking forward to observe a psychoeducational group, but that didn't happen.

Every other week we were required to write a SOAP note on one of the group members. The most common diagnoses that we saw were bipolar, major depressive disorder, schizophrenia, and schizoaffective disorder with corresponding substance abuse. In order for the clients to participate in group they had to at least be yellow status. Red status clients were only allowed to participate in group if it was held in the outdoors part of the unit. We hosted 2 physical education groups, 2 media/craft groups, and 1 psychoeducational group. One week of our group got cancelled due to a newly admitted patient unknowingly having chicken pox.

Postive Affirmation Shoe Box

Waterballon Obstacle Course

Plastic Container Staining 

Ceramic Box Painting 

Foosketball

Piñatas 

We did a water balloon obstacle course, positive affirmations shoe boxes, ceramic box painting and plastic container staining, foosketball and knockout, and piñata making and hitting. Our best group was probably the water balloon obstacle course. The group members seemed to really enjoy it. Our least successful group was probably the piñata making and hitting. Don't get me wrong, it wasn't a bad group, but it was a little chaotic. For one, there were wayyyy to many group members for this particular session (16 group members). The room that craft activities and most groups take place is super tiny, with not a lot of room to navigate. Also, the members didn't have enough time to finish their piñatas, which I already anticipated. I had expressed my concerns to my group members prior to the session but they thought it would be fine so I was like okay. Also, the bootlegged piñata we made for them to hit was burst on the first hit. So 1/16 group members got to hit the piñata lol HOW FUN! The group with the worst turn out in terms of attendees was the foosketball and knockout games. There were only 4 people for foosketball and about 6 people for knockout. The staff decided to join in since participation was so low. Fortunately, those who decided to participate seemed to really enjoy it. I joined in during knockout and actually won the second game -- yay Bemo! ha Also, our large dice was complete crap lol -- it didn't roll effectively and it tore apart in less than 6 rolls. It was kind of embarrassing.

In my opinion, our sessions were not the most creative. I'm horrible with coming up with activities that I think others will enjoy, so I didn't contribute to coming up with the main ideas. My biggest role was making sure that whatever my group members suggested were realistic and could be completed within the 30-45 minutes or would actually last the 30-45 minutes we usually had to hold groups. Some of their ideas were pretty cool, but not realistic to last for an entire session. Some of the other groups that hosted sessions were MUCH more creative! Unfortunately, I don't have access to their pictures so I can't share.

My evaluation on how I did is Thursday, July 16th. I think I will be rated pretty average. I don't anticipate that I will be rated as exceeded expectations in really any category. I felt like I did a good job interacting and connecting with the members and my documentation was pretty good, but I don't feel like I did anything spectacular. I also didn't really ask any questions. One of my group members consistently asked the supervisor about their diagnoses after group. I'm not particular fond of labeling people so I never felt like I just NEEDED to know their diagnoses, especially not for the purpose we were there. Now, if I was actually establishing real goals for the members to meet, then yes knowing their diagnosis would be more important. I guess I just didn't feel like it was my business, since we weren't their to actually "treat." Probably a mistake on my part. I did ask one question about how to respond to when group members become visibly upset. The second group we held, a man was just sitting there. Since he came to our first group, I knew that it was not like him to be sad like that during group. I asked him if everything was okay, but that seemed to make it worse and he shook his head no and started tearing up. I didn't know if it was my place to keep at it, so I told him that I hope he feels better and backed off. The supervisor said it would have been okay to see if he was willing to step out of the activity room and talk about what was bothering him. I kept that in the back of my head for a next time, but there was no next time.

Update (07/16/15) -- So, I got my eval today and I -- am -- SHOCKED! I mentioned that I anticipated that I would be rated average. For our FW scaling that would equal a 3, which is "meets standards, performance is demonstrated 70-89% of the time when behavior is necessary." However, I was rated a 4 in all categories except for "discusses/selects/implements interventions that demonstrate knowledge of characteristics of client/population." Wow! The supervisor's comments were "[Bemo] is a highly dedicated and conscientious learner. She exercises good judgment in treatment planning and interactions. Documentation skills are outstanding and demonstrate good observation and assessment skills. She will need to work to control occasional anxiety that appears to be related to a desire for perfection." Her feedback is similar to the constructive feedback that I typically get...my feedback seems to always be related to either my lack of confidence or my anxiety. I know it's my biggest area of weakness and I'm not quite sure how to address it, but I will continue to work on it!

Anyways, that about wraps it up. All-in-all, I'm proud that the supervisor thought I did a good job. The first round of FW 1's are all done! Yay.

Assistive Technology Seminar Day is tomorrow (July 17th, 2015) so I will be taking tons of pics to share with you guys! Look for that post in the next couple of days!

<3 Bemo

Pediatric FW 1 Experience: Recounts & Thoughts

So, woah, talk about missing in action!

To give ya'll an update, I'm completely finished with my pediatric FW 1 rotation. I finished the last week of June -- and yes, I passed! :) My mental health FW 1 rotation will be over next week.  I'm going to go ahead and sum up my experience with my peds rotation!

So, in my last blog post, I mentioned how unorganized and frustrating the rotation was. The frustration subsided as the days went on, but our role and purpose was still unclear. So to give you some background, the rotation was 2 weeks M-W -- so a total of 6 days. We were expected to be there around 7:45am on those days (unless it was "our day") and we left around 12pm (unless we needed to set up for the next day). When we got there, we would assist the leaders of the day with any last minute things they needed to set up. At 8:25am, we all gathered together for a "walk through". The leaders would tell us the behavior regulation activity for the day, the name tag activity, the script study activity, the word study activity, the sound study activity, the OT graphic station, and what the snack for the day would be. Then we went outside and waited for our "little friends" to arrive. At the end, before we headed out, we had a debriefing and discussed what went well and not so well. 

The group that I had was what they called the "higher level group." I worked with them in collaboration with one SLPS. I honestly wish that I would have had a more "lower level group." Although the kids in my group had several deficits in speech related areas, for the most part, they were developmentally appropriate in fine motor and gross motor skills. Their only deficits were in things like attention, behavior regulation, and sensory processing (two were sensory seeking and were unable to achieve the appropriate amount of vestibular and proprioceptive input). The two things that made it difficult working with this group were 1) we haven't had our pediatric class yet, we have it in the Fall and 2) it was hard finding a way to meet my "OT" goals, when the rotation had such a strong speech emphasis. 

This particular fieldwork rotation started as a "camp" put on my the SLPS. This year they tried something new by allowing OT students to assist with the "camp." However, because our role was never thoroughly established, the activities catered to speech's goals (remember when I said word, script, and sound study...yeah all speech). I guess their attempt of incorporating OT was by adding the OT graphics station. However, unless your child had fine motor deficits or sensory defensiveness, which mine didn't, it was just more for creative expression or any opportunity to work on attention and behavior related things . So, for my kids, it was hard to implement interventions to address their needs. For my counterparts that had lower level kids, they had more opportunities to work with their kids on handwriting skills or fine motor skills, which worked out great because handwriting meshed well with speech goals and fine motor skills could be worked on during OT graphics. Are you understanding? 

Anyways, so although I enjoyed interacting with my kids and everything, I don't really feel like I did much. I tried to work with them on following directions and turn taking. I also tried different transition activities between stations to try to increase attention like bear walks, stomping, big steps, etc. We also implemented a wiggle seat cushion because two of the kids were constantly rocking and fidgeting (the wedge seat worked better for them than the round one). I also took one kid aside and worked on his words for the script because I noticed he was really struggling and not getting the proper attention to be successful (not really OT related, but he ended up beasting his script by the end!). Other than that, that's about it. I didn't really feel like a valuable member of the team to be honest, but it was a unique experience. 

So in the end, I passed my fieldwork and received positive feedback from my supervisor. Even though I don't feel like I did anything special, she and the SLP clinicians that all contributed to my overall rating saw something in me that I didn't see in myself. We were also able to give feedback about the rotation and I expressed my thoughts on the form. 

Take away lesson: So, as with any experience whether bad or good, there is always something to take away from it. For this fieldwork, we had to write a daily SOAP note each day on the same kid. On the first soap note, we had to establish at least 2 goals for the kid based on our observations. It is always emphasized that your goals should be measurable, so I made my goals measurable -- I thought. However, what I realized is that you have to make sure that your measurable goals are realistically measurable. Are you actually able to measure your goals as written and will there be enough opportunities available to meet your goal as written. For example, if you say that the client will do something 4 out of 5 times within two weeks....will you actually be able to provide those 5 opportunities or will those times naturally occur? Also, are those opportunities expected to be given in one day (i.e., five opportunities each day) or over the course of two weeks (i.e., one opportunity for at least five of the days).  As another example,  if you say that a client will do something 80% of the time, will there realistically be enough opportunities for the client to meet that goal? Say that a client did something 3/4 times...There were 4 times the client could have done whatever but they only did it 3...that's pretty good right...right, but that's only 75%...goal not met.  Do you get what I'm saying? Also, with everything that goes on during a session, can you realistically keep up with the goal you have established...I didn't realize how hard one of my goals would be to track over a 2.5 hour period. A lot of things happen in 2.5 hours and my job was to help all kids, not just one, so my attention was being pulled in multiple directions the entire time. 

So my biggest lesson was to make sure I'm writing and establishing measurable, measurable goals. The more specific, the more realistic, the better. Think...if you had to miss a day of work and someone took your place, would they understand how to continue tracking your clients' goals based on what you wrote and could they effectively measure them? If the answer is yes, you are on the right track. If your answer is no, you may want to rethink how you are writing your goals. 

Helpful Resource: https://funandfunction.com/habitat/https-funandfunction-com-blog-wp-content-uploads-2015-06-activity-guide-june2015-web-pdf.html

I used this downloadable resource to help me come up with ideas for sensory breaks and transitions between stations. 

<3 Bemo

FW 1 Summer Experience: Day 1/2

Alright so I'm already off to bad start with meeting my goal of posting a daily update, but so far I'm still within the weekly goal.

There really wasn't much to say about yesterday, so I didn't feel compelled to write anything. I will have to be mindful of what I say in this post because I'm not sure who all will read it. So, this week is primarily focused on "training," planning, and set up. As mentioned in a previous blog post, I am currently in a pediatrics and mental health fieldwork.

If I can be completely honest my experience with the pediatric fieldwork has not been that enjoyable. So far it seems unorganized and incomplete meaning that essential details seem to be missing. I have been confused since day 1 and that confusion has not subsided much since then either. We are told what we are supposed to do, but not exactly how we are supposed to do it and sometimes not even when. On the first day, it was emphasized what things could cause you to fail fieldwork. There were many things mentioned and much of them were mistakes that could easily be made. Therefore, when things are unclear I find that I get really frustrated in fear that I will miss something and fail fieldwork. In my younger days, I was more of a "go with the flow" person, but since I have gotten older...not so much. I'm trying to work on it, but so far, no good.

Continuing on with pediatrics, when I heard "training" I thought we were actually going to be trained on the skills necessary to successfully plan and implement activities/interventions for these summer programs. However, so far, that has not been the case and today was really our last day of training. We went over the syllabus, our general role in the summer program, and discussed TEAMSTEPPS which is an evidenced-based model designed to optimize team performance.

Today was little bit more exciting, we did much more activities and such. Since we are working interprofessionally with speech language pathology (SLP) students we did an activity where we had 5 minutes to write on a large piece of poster paper what we thought the other profession did (e.g., SLP wrote what they thought OT did, and OT wrote what they thought SLP did). Then we did a campfire activity where one student acted as the "client" and sat on a wiggle seat cushion or an exercise ball and had to follow the woman in the front's directions using pretzels, hot tamales, and marshmallows. After the activity, we had to label the SLP components (e.g., receptive language, articulation, sensory components, protesting) and OT components (e,g., balance, posture, stability, attention, problem solving, fine motor skills) of the activity. Then a lady came and talked to us about behavior regulation and some of the activities we will be doing with the students. After that, we were broken into our programs where we discussed a bit more about the specifics and then had to plan all 8 days of the program. We were split into about 4 people per day and were responsible for planning the activities and snacks for that day. The planning was a little rocky, but it went smoother than I anticipated so that was good.

Overall, today was a good day. The issues didn't come about until it was time to wrap up and it was announced that X, Y, Z was due and that shopping was going to be done Friday. However, outside of shopping, it was not clear (and it still not clear) how Friday is going to go with setting up and everything. Right now i'm just playing the waiting game and seeing if there will be a clarification email of some sort sent out. If not, I'll have to ask my classmates and see how they interpreted everything. I'm hoping that once the planning phase is over and we actually start the program everything will fall into place. **fingerscrossed**

In regards to the mental health fieldwork, it is much more organized and clear. I'm looking forward to my mental health fieldwork much more! We toured the inpatient psychiatric unit today. It's a small facility, but I look forward to sitting in on one of the group's next week!

I could say more, but I'll end this post here.

<3 Bemo

Summer Semester 2015: Fieldwork I, Classes, Books

Alrighty, so right now I'm on a short 2.5 week break. I finished classes on May 6th, headed home on May 7th, and am expected to return back to school by May 26th (the first day of the summer semester). On May 26th, the 2nd years (us) are hosting an MOT BBQ for the first years. I'm responsible for tracking RSVPs and tallying up the counts for hamburgers, hot dogs, and veggie burgers. If ya'll remember last years blog post "First Day: Orientation (Summer 2014)," I talked about going to the BBQ, meeting my "big", and leaving pretty shortly after. Last year, I really didn't socialize much, but this year I'm going to try to be a little more interactive.

Yesterday, I was assigned a "little." I really don't care for the "big/little" titles. It comes off very condescending to me, but whatever that's just me lol. Anyways, I got her information yesterday so I will be going to the store when I get back on the other end and buy her a gift, just like my "big" bought me one.

Also, on May 26th, we will start classes and the first Fieldwork I rotations: Mental Health & Pediatrics.The two classes I will be taking are "Clinical Reasoning for Fieldwork" and "Assistive Technology."

My Mental Health rotation is at an inpatient psychiatric unit where we will be responsible for hosting therapeutic groups that provide just right challenges for the patients. There are three main types of groups: physical activity, psychoeducation, and therapeutic activities. We will be rotating between these 3 groups throughout the semester. The groups last about 45 minutes and usually contain 10-18 members. The groups will be held weekly for 7 weeks. We will be separated into groups of 3 I believe. I'm not sure who my partners are yet. Continuing on, the main diagnoses seen at this particular inpatient psychiatric facility are major depressive disorder, schizophrenia, schizoaffective, bipolar, and corresponding substance abuse or personality disorders. The other mental health rotation options were with a Program of All-Inclusive Care for the Elderly (PACE) and at a children's home, which while great options were not my top choices.

My Pediatric rotation involves working with students in grades Kindergarten through 5th on building social skills as well as language and literacy skills needed for children in elementary school. I will be in a group with 5 other individuals and we are working interprofessionally with Speech Language Pathology students. We will be responsible for planning themes and activities for 1-4 programs days, adding fine motor/sensorimotor components to activities, providing consultation in regards to fine motor, developmental, positioning, and other OT-related areas, and documenting sessions.  The pediatric fieldwork only lasts about 1.5 - 2 weeks. The other pediatric rotation options include the same program, but with ages 3-6 years old, a handwriting camp, and a program designed to work with children with food selectivity.

Now that that is all out of the way, let's take a look at the required books. If you read my last blog post these books should look familiar! We will also be using a previously purchased book called "Occupational Therapy in Mental Health: A Vision for Participation." The "Assitive Technologies" book you see on the right is actually the 3rd edition. A month after sending out the original book list, the professor recommended that we instead purchase the 4th edition. I will just be asking a classmate of mine to look at there's if necessary. Too much time has passed to try and hassle with getting a refund and the 4th edition is around $100.

Left to Right: Stepping Into Handwriting: For Students Studying Elementary Education by Handwriting Without Tears,

The Wheelchair Evaluation: A Clinician’s Guide  by M. Batavia, and Cook & Hussey’s Assistive Technologies Principles and Practice by A. Cook & J.M. Polgar

This is not set in stone, but my plan is to post AT LEAST a weekly blog post keeping you updated with my fieldwork experience! A daily update would be optimal, but I don't know if I can commit to that! lol

Well I will talk to y'all next blog post!

<3 Bemo