What is Occupational Therapy?OT Services for Autism, ADHD, and SPD
If your child has received services for their autism, ADHD, sensory processing disorder, or many other things, you are probably familiar with Occupational Therapy. Collaborating with physicians, physical therapists, behavioral therapists, teachers, and resource specialists, Occupational Therapists are one piece of the big puzzle that comes together to show the picture of your child’s care team.
So, what does an Occupational Therapist do? Let’s first talk about the reasoning behind the name. No, OTs are not career counselors, even though that’s an easy mistake to make. In this context, the word “occupation” takes on a much broader definition. Instead of referring simply to careers, the word “occupation” describes any activity a person does to fill their time.
Let’s use a child as an example and list all of their occupations:
-eating breakfast, lunch, and dinner
-climbing on the jungle gym
-taking a test at school
-riding a bike
-going to the bathroom
-playing with friends
-so on and so forth for another 40 pages
We’ll stop there. As you can see, the list of occupations for any given person is long and vast. Essentially, we are always engaged in an occupation at every moment of the day, from getting out of bed in the morning to sleeping peacefully at night. The job of an OT is to help us engage in our occupations more effectively and productively. If I can’t tie my shoes, for example, my OT will help me learn and develop adaptive strategies that can make me independent and successful at that task of tying my shoes.
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Occupational Therapy Practice Settings
Occupational Therapists work in almost every setting imaginable. Here’s a rundown of the most common.
Private Occupational Therapy Clinics
Many kids interact with Occupational Therapists in private clinics. If you’ve done a Google search for OT services, or asked your pediatrician for OT recommendations, you’ve likely been referred to a private clinic. While they are called “private,” these clinics often take all forms of insurance and are open to all with a referral.
You’ll find private clinics that specialize in various conditions, with sensory issues being the most common specialization. OTs in private clinics will give children a series of assessments to determine their therapy needs and will use the equipment in the clinic to carry out any agreed upon treatments. Many kids see their OTs for a number of years, with treatment frequency ranging between multiple times per week to bi-monthly.
School Occupational Therapy
All public schools are required to provide therapy services to students that need them. This is usually determined through a series of assessments. Therapeutic progress is tracked on a regular basis in reoccurring IEP (Individualized Education Plan) meetings.
You may be asking, “If my child receives OT at school, why do I need a private clinic?” Well, the therapy services provided in schools often have a lot to be desired. This is no reflection on the therapists. School OTs are often some of the most passionate OTs out there. The problem is that schools are crowded and underfunded. Even within a well-functioning school system, your child will likely not receive the amount of treatment they need.
In addition, school OTs are focused on activities relating to school. As such, treatment sessions often revolve around handwriting, fine motor skills, and classroom behavior. While this is helpful, of course, it’s not a comprehensive treatment of your child’s needs. By pairing school OT with a private clinic’s services, you’re more likely to get a well-rounded treatment experience.
Psychosocial and Mental Health Occupational Therapy
While every Occupational Therapy setting addresses mental health, some Occupational Therapists work specifically in mental health facilities to address mental health conditions. In most cases, OTs in this setting will use a variety of activities to help individuals process their emotions, develop their mental and emotional skills, and build coping strategies.
Hospital Occupational Therapy
As the name implies, this is the OT that people receive when they are in the hospital. Whether recovering from an illness or an injury, there are daily tasks and skills that need to be relearned, refined, or rediscovered. In addition to helping individuals regain their skills while in the hospital, OTs help ensure that support systems are in place for when the individual returns home. This often includes training caregivers, performing home visits, and recommending adaptive equipment.
OT within a hospital context can often be intense for the individual. With the hopes of a short hospital stay, OTs often work with individuals for at least an hour a day to improve skills as quickly as possible.
Home Health Occupational Therapy
Again, as the name implies, home health refers to an Occupational Therapist going to an individual’s home to provide treatment. There are many benefits to home health, the biggest being the ability to use the individual’s home environment as a treatment setting. As you can imagine, there are big differences to cooking eggs in someone else’s kitchen as opposed to your own. Using an individual’s own space and equipment allows treatment to be highly specialized to the individual’s needs.
Early Intervention Occupational Therapy
When there are red flags in a child’s development, it’s important to get them started with treatment as soon as possible. Occupational Therapists in the early intervention setting often work with the youngest of babies through children outgrowing the toddler years. These services are often provided in the context of home health, with the therapist traveling to the child’s home one to two times a week.
The goal of early intervention is to help children reach any developmental milestones they may have missed. In addition, it’s important to help children prepare for any upcoming milestones as well. Missing important developmental milestones early on can result in delays as a child reaches school age and beyond.
Skilled Nursing Facility Occupational Therapy
Skilled nursing facilities (SNF) are for any individuals that need ongoing, long-term care. While the majority of individuals in these facilities are elderly, younger individuals with long-term disabilities may reside in skilled nursing facilities as well.
The work that Occupational Therapists do in SNFs varies widely. Some individuals come to SNFs to recover from surgery or injury. In these cases, OTs work to recover independence, gain skills, and prepare for a successful return home. On the other hand, OTs may be working with individuals who are at their final stages of life. In this case, OTs often work with caregivers to best optimize the comfort of the individual.
The most specialized form of Occupational Therapy is Hand Therapy. It is very challenging to become a Certified Hand Therapist so, if you ever come across one, know that you’re in good “hands.” OTs in this field are highly trained on the anatomy, structure, functioning, and recovery of hands.
Why are hands so specialized? You may ask. Hands are super complicated with many bones, tendons, muscles, and ligaments. As such, treating hand conditions is a tricky business. It’s fun though too!
Of all the forms of Occupational Therapy, Hand Therapy is the one that most resembles Physical Therapy. In fact, PTs can also become Certified Hand Therapists as well, so there’s a great crossover in professions as far as Hand Therapy is concerned.
Independent and Successful
Those two words are very important: Independent and Successful
The main goal of an Occupational Therapist is to help individuals learn to complete daily tasks on their own. If I’m working with a child who struggles to feed herself because of poor fine motor skills (ability to use her hands to put food on a fork and direct it to her mouth), I’m not going to tell the child’s father to feed the child himself for the rest of her life. Instead, I’m going to develop activities that we can use in therapy to help the child develop her fine motor skills. We may also incorporate some awesome thick-handled spoons, and other adaptive tools, into the child’s routine to make independent feeding easier. The goal is to have the child feed herself someday. Independent and successful.
Working in a wide array of settings, OTs work with a wide array of disabilities. An OT may work with a senior citizen on navigating the public transport system, guide a teenager with schizophrenia through the college application process, or help a child with autism say hello to the grocery store clerk.
An OT may help a young adult who lost his arm in a car accident learn to write with his left hand, support a child with cerebral palsy while standing for the first time to brush her teeth, or play a game of basketball with an adult who’s learning to direct a wheelchair for the first time. Overall, OTs are interested in improving quality of life by focusing on improving skills in the areas where individuals demonstrate deficit or need.
Improving Quality of Life
If the words independent and successful are important, the phrase “quality of life” is uber super-duper important. In most cases, completing a task independently and successfully leads to an improved quality of life. This is especially true for pediatrics, as kids have long lives ahead of them.
However, there are cases where independence and success don’t translate to an improved quality of life. Let’s consider the case of an elderly person in the late stages of dementia. An Occupational Therapist in this circumstance is less likely to focus on helping the elderly person cook for himself or clean the kitchen. Instead, focus is often placed on helping support staff learn how to best take care of this individual. An OT may teach caregivers how to administer showers, get the individual dressed in the morning, and arrange the environment for safety. In this case, independence can be dangerous and lead to decreased quality of life if the individual were to try to complete a task on their own and get injured.
Quality of life trumps all in an Occupational Therapist’s eyes. When evaluating a situation, we ask questions like:
–what factors are making life challenging?
–what will make life easier and happier for everyone involved?
–what is the end goal?
–what would make this end goal achievable?
–what are the long-term impacts of achieving this goal?
–what does the individual want? What do their parents/caregivers want?
There are many more questions that Occupational Therapists ask themselves as they work with individuals. The point is that every circumstance is different and must be evaluated given the unique factors that are in play.
This is why Occupational Therapy can be so confusing for people to explain and understand. An OT working with one individual may look completely different than that same OT working with another. Occupational Therapy was never meant to be a cookie cutter medical service providing cookie cutter outcomes.
Quality of life looks different for everyone and, as such, any strategies for improving quality of life will also look very different for everyone. This is what makes Occupational Therapy both challenging and exciting.
So, if anyone asks you what Occupational Therapy is, you can always say that it’s the job of improving lives. Not too shabby, eh?