A Day in the Life of a Pediatric Outpatient OT
For today’s post, we’re sharing Jamie Schreckler, OTR/L’s day in the life as a pediatric outpatient OT. For our full Day in the Life series, featuring so many occupational therapists in a wide variety of settings, find the whole series here.
Working in the outpatient pediatric occupational therapy clinic setting is a fun and fast paced learning environment. The clinics I have worked in across three states all were in sensory integration gyms, working alongside several other OTs, PTs and SLPs.
My Caseload and Schedule Overview
Working in the pediatric clinic setting, I have carried various levels of productivity requirements. I could be scheduled anywhere from 6-8 treatment hours per day, depending on other responsibilities/roles I have at the time.
At some clinics, no shows and cancellations can be common, so the schedulers try to keep the therapists booked as many hours as possible. In other clinics, I would have scheduled documentation time built in.
A Typical Day as a Pediatric Outpatient OT
No matter what clinic I am working in, I try to arrive to the clinic an hour ahead of my first scheduled session, to catch up on emails, evaluation write ups, and think through my plan for my first few sessions.
Once sessions begin, I see each child for 50 minutes, with a 10-minute time between clients to wrap up, clean up and do any set up for the next client. Most therapists at the clinic share a lunch hour, so that ends up being a great time to chat through any cases informally for ideas.
Then the remainder of the day is the same, with 50-minute sessions. I try to squeeze in some note writing if a family is running late or if there is a last minute cancellation throughout the day.
On evaluation days, which can be anywhere from 1-2 times weekly, typically the evaluations will be in the morning and then regularly scheduled clients in the afternoon. The evaluation time frame can be anywhere from 1-2 hours, depending on the stamina of the child.
What a Typical OT Treatment Session Looks Like
I personally prefer parents and family members to participate in sessions, to facilitate carryover at home. In addition, when you do any email follow ups to explain the rationale of your interventions, they have been there to see and participate to understand the therapy best.
A typical session begins with greetings either in a waiting room or specific area designated with the child or family that would work best. For example, some children with sensory challenges may become overwhelmed in a busy waiting room, so meeting them in the parking lot or even in a hallway away from other people would be arranged.
I always feel that the greeting is one of the most important parts of the session, as it can set the stage for regulation and is the opportunity for us to first connect with the child.
From there, we create our plan of action together, typically with use of some type of individualized structure that is most supportive of the child and their sustained engagement and participation. Most often, the session happens in the sensory gym with time in smaller sensory spaces, as needed.
All the clinics I have worked in had multiple therapists, so there were always other sessions going on. This would allow for social opportunities and collaborative play. I love how the sensory rich environment and engagement with an attuned therapist allows for play and fun to be the modality for change and growth in the kids I serve.
Transitions are another key component of each session, typically well thought out and supported. The transition at the end of the session is one that can be particularly challenging for children with developmental, emotional, and/or sensory differences. Believe it or not, I often mentally plan for that ending transition at the beginning of the session, in order to give ample time and space for the child to maintain regulation during the transition.
A Comment on Shifting Pace
In sessions with the child, we want to maintain an engaged and even pace of play. It is all about the process and being in the moment with the child, while keeping my 50 minute mental time clock in the back of my mind.
This is an interesting challenge for outpatient occupational therapists working with children who have a variety of “engine speeds”! We are trying to slow the pace of the fast movers and increase the pace of the children who are more hesitant or process more slowly.
Then, once the session is over, we must shift ourselves into high gear to regroup, clean up and get ready for the next friend coming (whose pace may be different still!). An awareness of the need to shift pace in this way is an essential part of my day when working in outpatient pediatric therapy clinics.
For new clients, evaluation write ups are a requirement to justify services and goal writing is required prior to beginning services. Most clinics I have worked in allot 1-2 hour time frames for evaluation write ups, which includes scoring assessments and integrating parent provided background information with the clinical findings in your evaluation.
Having families participate in goal writing by identifying their priorities for their child is best practice. Some clinics allow for parent meetings, allowing time to explain evaluation findings as well as to develop client centered goals.
In terms of daily notes, documentation requirements vary in style between clinics, however, it is a part of the day that takes time to do well. It also is the place to document clinical reasoning which informs treatment decisions for the next session. I find that thorough note taking throughout the course of intervention allows for more efficient progress notes and discharge summaries!
One of the many benefits to working in a clinic setting with other therapists is the opportunity for in-house mentoring and supervision. At each clinic I have worked in, there were scheduled team meetings and/or supervision mentoring time on a weekly basis.
In addition, oftentimes we would meet informally over lunch if we shared a client with PT or Speech, to collaborate and brainstorm.
Another feature I love about working in the outpatient clinic setting is the opportunity for continuing education through colleagues and co-workers. Having monthly in-services where special topics are presented by different therapists who attended a conference or training and could share some key information is a way to stay fresh with ideas as well as to stay informed on current therapeutic trends.
Depending on the population of clients that I was serving at the time, I was occasionally asked to join IEP meetings to support a child receiving services in the schools. Additionally, parent meetings to go over evaluation results, set goals, or review progress are a part of the weekly routine as well.
The End of the Day: Feeling Exhausted and Energized
Somedays I leave the clinic in awe of how tiring play can be!
But the varied tasks and learning opportunities in a pediatric outpatient OT setting, along with all of the play, is also so energizing and inspiring. Working with children and families along with other therapists in a clinic setting is a truly unique growth experience for all involved!
To learn more about Jamie or about pediatric occupational therapy, you can contact her via her website, Gnarly Roots, here. We want to thank her again for providing such great insight into the world of pediatric outpatient OT!