Empowering occupational therapy practitioners with a playbook of functional tasks to use with their geriatric clients

Why a playbook?

Why a playbook?

When I finished graduate school, I debated about what exactly to do next. I thought very seriously about staying at the university to complete my PhD and I was being encouraged to do this by the professor who supervised my research assistantship. On the other hand, I wanted to get some clinical experience before I returned to school to give me credibility as a teacher and find out what questions most intrigued me as a researcher so I contemplated applying for an opening to be a therapist at a local children’s hospital, which was my dream job before and during OT school. Also factoring into my debate was missing my family. I had moved away from them to go to school and I wanted to be near them again, especially my first niece who was born a few months after I started school. Ultimately, I packed everything I owned in my to Toyota Corolla and made the move closer to family.

I didn’t realize at the time that my job prospects would be significantly different there than they would have been closer to school. For starters, I moved from a city with 4 major children’s hospitals to a city with 1 major children’s hospital. Also, I moved from an area with numerous sensory integration clinics to an area with just a handful. Pediatric OT jobs weren’t impossible to come by, but there weren’t a lot of them, the people working in them generally liked them and stayed in them for long periods of time, and they paid significantly less than other practice areas. As if the first two issues weren’t enough, this last consideration was more important than I wanted it to be since I had decided to go to an expensive private school instead of a reasonably priced state school and I had the student loans to show for it. After some job searching and exploring different companies, I was offered a job working in a skilled nursing facility. I had not envisioned myself working with older adults and I imagined that as soon as a pediatric job became available, I would switch positions. (As a side note, I’ve now spent nine years in 4 facilities as a staff therapist as well as a DOR and I can’t imagine working with any other population and loving it as much.)

Because I didn’t envision myself working in geriatrics, I was not prepared as I should have been and that led to a rough transition. When I arrived at work on my first day, my director handed me a list of my clients, showed me where to find their documentation, and introduced me to the aide as well as the physical therapist that also saw each of my patients. Because I was now a therapist, not a student, he expected me to be able to complete their interventions without someone telling me what to do, checking my notes, or making sure I was doing it quickly enough. Although I had gone to school for two years, done 27 weeks of fieldwork, and passed my board exams, I really wasn’t sure what to do with my clients that day. What I really needed help with was understanding how to translate the OT Practice Framework ideals I had learned about in school into 30- to 75-minute sessions with clients in a way that was meaningful and also fit within the practical constraints of the setting. It took a patient PT colleague, a sharp aide, and many clients good-naturedly tolerating my trial and error interventions as well as endless hours of studying and completing continuing education outside of work for me to start to figure it out.  Slowly, I progressed from needing the physical therapist to introduce me to a client, tell me that they had just asked to go to the bathroom but needed help, and let me know that the occupational therapist usually helps with that to feeling confident managing OT services for the entire facility when the other OT on staff left to go on maternity leave six months later.  I value the hard-earned knowledge and experience I gained during this time, but I regret that the clients I saw didn’t able to benefit from the quality of occupational therapy services that I could have given them if I had better a playbook back then.

So, let’s talk about the idea of a playbook. I grew up playing sports. As my peers and I moved from casual neighborhood and schoolyard games to playing on organized teams, we were introduced to the idea of plays. Plays are a coordinated set of actions that a team can take during a game to achieve their goals. These plays can be defensive, offensive, or for special occasions. There are plays that are vague and others that are highly specific. Some plays are used often; others are saved for special occasions. The goal is to develop a whole book of plays is that will help you coordinate with your team and accomplish your goals over time.  You have confidence in your plays because they have been developed by coaches or players with experience and knowledge of the game, because they have worked in the past, and because you have taken the time to learn them and practice them until you can run them effectively. A good playbook will give you structure and a plan but is flexible enough to adjust as you assess the skills of the players and the specifics of the situation.  

Just as a playbook can improve the performance of a sport team, a good playbook can help an occupational therapy practitioner to most effectively facilitate interventions with their clients. It can allow you to have confidence that you are choosing effective interventions, allow you to coordinate your interventions over time and with other team member, allow you the flexibility to adapt interventions to meet the specific needs of your client and situation, and give you access to creative ideas and suggestions for intervention you might not have the time, knowledge, or resources to develop otherwise. As you observe the structure, mechanics, and underlying theories of the plays, it can also provide you a guide to help you to develop plays yourself.

The goal of this blog is three-fold. First, I want to share clinical insights about assessing and developing skills necessary for occupational performance in a way that facilitates clinicians using them regularly in their practice. Second, I want to provide specific plays you can run in your practice to help your clients become more independent. Third, because I have learned over time that narrative is powerful, I want to share my stories (from getting started to what happened when I ran some of these plays). My hope is that you’ll find something of value for you and your clients in this playbook.

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