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Current procedural terminology (CPT) codes are used to designate services provided by healthcare professionals. As occupational therapists, we receive payment for our services depending on how we bill using these CPT codes. If we don’t properly bill for our services provided, we could be losing out on valuable income. This article aims to be a useful resource for new grads using occupational therapy CPT codes.

No one chooses to enter occupational therapy for the money, but it is still a huge factor in how we provide our services.

The payment we receive for our services is based on the resource-based relative value scale (RBRVS), which takes into consideration the work performed, the expense to the practice, and the liability and risk in providing the services or procedures.

When I was in OT school, I learned only a little about proper billing and reimbursement.

This is one of the topics that we are expected to learn on our own as during our Fieldworks and first jobs.

Depending on the occupational therapy setting in which you practice, and the site in which you are placed, you will find that people have different opinions on what constitutes proper use of these occupational therapy CPT codes.
Indeterminate billings

As a new grad OT, it can take several months to navigate your way through proper billing procedures. You have to be ethical while trying to please both the insurance companies and your employer’s expectations.

There is so much widespread uncertainty involved in such a vital part of what we do on a daily basis as clinicians.
  • How could this topic be so sensitive and debatable?
  • Don’t insurance companies want to clearly define what procedures they will be paying for?
  • How will I know how to bill for my patients’ time in the clinic if I don’t truly understand what the codes even mean?

The language is vague on purpose.

Those creating and modifying Medicare legislation and reimbursement know exactly what they are doing. Criteria for each CPT code must remain vague and undefined in order to give the insurance company the power to deny our claims if they feel our services aren’t necessary. Insurance companies don’t understand our role and the power of occupational therapy To them, if a patient is considered “functional”, they no longer require skilled occupational therapy intervention.

When it comes down to it, insurance companies are businesses. They aren’t in the business to provide occupational therapy to everyone who needs it. They are looking to provide as few services as possible so they can make a profit.

Despite all the griping from insurance companies, they have made a fortune since the passing of the Affordable Care Act in 2010.
Knowledge is power when it comes to occupational therapy CPT codes

It’s nearly impossible for us to spend our valuable time and energy thinking that everyone who requires quality rehab and OT services will receive the necessary funding. Our time is better spent working with our clients, so we need to be as efficient as possible with our billing.

We need to be informed of how to properly bill for our services to ensure small business success.

We need our private practice clinics to thrive so that they may continue to serve our communities and the clients who need us.

The future of reimbursement for occupational therapy services will depend on us. As new grads, we owe it to our profession to be knowledgeable about how to properly and legally submit claims for our services.
Know your value

For reasons mentioned above and the vagueness of the reimbursement language, we must write a detailed description of our skilled interventions that fall under each billing code we use to get reimbursed. It is imperative we demonstrate our skilled therapy, since that justification acts as an argument for what we are doing. It’s important we demonstrate the high quality of care for our patients, and not for the sake of trying to receive as much money as possible.

We must use the vague and barely defined codes to our advantage.

The truth is that we are underpaid for what we provide. We now have a masters or doctorate level of education. Let’s show the insurance companies how much we know and how valuable our skill set is.

Don’t let low insurance reimbursement or productivity rates dictate your self worth as a healthcare provider. Nobody else can provide the service you provide.
Simplifying the billing process

The main purpose of this article is to not only provide some insight on proper use of occupational therapy CPT codes, but to spark some motivation and eagerness on the topic among providers.

I want us to air our frustrations and help each other understand the topic by providing personal accounts and information regarding what these codes mean and the criteria for which they should be utilized.

While the topic of billing can be complex, the focus of this particular article is to provide basic information every occupational therapist should know about using these billing codes.
Billing terminology

With anything medical, there is always a jargon to understand. Here are some common phrases and terminology related to OT in order to understand how to use occupational therapy CPT codes.

Untimed codes: The OT is paid a predetermined fee regardless of the time of treatment application. These codes can only be billed once per treatment session. The time spent providing these services cannot be included in your calculations of timed units and are considered separate billing codes. It is also important to remember that your evaluations are untimed. So if you can spend 10 minutes completing an evaluation instead of 24 minutes, you can use that other 14 minutes to bill another CPT code.

Timed codes: These codes are based on the time spent one-on-one with the patient and include only skilled interventions. Time includes pre-treatment, actual treatment, and post treatment time. These are generally the interventions you are applying (versus the evaluation above).

Pre-treatment time: Includes assessment and management, assessing patient progress, completing a char review, analyzing results, asking questions, and using clinical judgment to establish the day’s treatment. All of the contact time is administered by the OT or OTA.

Intra-treatment time: This is the time spent providing a treatment.

Post-treatment time: This includes analyzing and assessing the client’s response to your treatment, client and family education, documentation, or communicating on the client’s behalf to other healthcare professionals. The patient must be present during this period of time in order to include it in the time calculation.

Medicare 8-Minute Rule:

  • 0 units of treatment time = 0-7 minutes
  • 1 unit of treatment time = 8-22 minutes
  • 2 units of treatment time = 23-37 minutes
  • 3 units of treatment time = 38-52 minutes
  • 4 units of treatment time = 53-67 minutes
  • 5 units of treatment time = 68-82 minutes
  • 6 units of treatment time = > 83 minutes 

Rule of mixed remainders: This is where things tend to get confusing. Try this example: You just spent 24 minutes on treatment in which you billed 1 unit of self care and 1 unit of neuromuscular re-education. Now let’s say you spent an additional 7 minutes performing manual therapy and another 4 minutes using superficial modalities.

According to Medicare guidelines (8-Minute Rule), you can combine this extra time (11 minutes total) into one additional unit of manual therapy since the sum of your remainders was more than 8 minutes (you bill for the service that you provided more of, hence, manual therapy in this case).

However, according to American Medical Association (AMA) guidelines, leftover minutes that fall into multiple categories with less than 8 minutes per category cannot be billed for. This is why it is important to know which insurance company follows what guidelines.

Now that we’ve got some of the important details out of the way, let’s start talking about what I believe constitutes each of the used occupational therapy CPT codes. After poking around the Internet, it’s clear that there isn’t much information available.

This information is based on my research and what I have learned from coworkers and Fieldwork educators in the past. Feel free to comment below to add your thoughts.

Common occupational therapy CPT codes and their usage

Evaluations: Starting in 2018, there are now three different evaluation codes you can bill that include low complexity (97165), moderate complexity (97166), and high complexity (97167). Now, there isn’t much for guidelines out there. Be sure to check out the CPT coding book for details. My facility considers 1-3 deficits low, 3-5 moderate, and 5+ as complex.

Therapeutic Exercise (97110): Includes exercises for strengthening, ROM, endurance, and flexibility and must be direct contact time with the patient. Functional mobility for ADLs or Mobility Related ADLs (MRADLs) are not included in here. Remember, differentiate yourself from other professions here and explain how the therapeutic exercise translates and will help your client with their ADLs.

Neuromuscular Re-education (97112): Activities that facilitate re-education of movement, balance, posture, coordination, and proprioception/kinesthetic sense. You would include activities spent focusing on stabilization exercises, balance, desensitization, bearing weight through an affected extremity, etc.

Manual Therapy (97140): Generally used when focusing on the upper extremity, OTs can bill this code when focusing on tissue mobilization, joint mobilizations, massage, and lymphatic drainage. Manual resistive exercise can be included in this category or in therapeutic exercise since it requires that resistance be applied by the therapist and may be performed with the goal of improving strength or endurance.

Therapeutic Activities (97530): Includes “dynamic activities” that are designed to improve functional performance for ADLs. This may include functional mobility, bed mobility, step-ups/stair negotiation, throwing a ball, golf club, car transfer training, and high/low reaching.

Self-Care (97535): I don’t need to explain this to you. This is our bread and butter. This training and improving performance in ADLs, working on compensatory strategies, using adaptive equipment, facilitating meal prep or self feeding, etc.

You can also use this to educate clients and families on wound care, edema control, activity modification, improving home environment for safety, or transfers (getting on/off the toilet or in to shower).

Cognitive Skills (97127): This is a new code. As of 2018, OTs can no longer bill 97352. 97127 is an untimed code for which OTs can only bill once a day. Medicare will also not reimburse 97127 but they have created a G code G0151 to help prevent fraud and abuse.

Prosthetic Training (97761): Includes fitting and training in the use of prosthetic devices as well as assessment of the appropriate device, but does not include fabrication time.

Other codes to look into:
  • Group Therapy (97150)
  • Physical Performance or Test Evaluation (97750)
  • Orthotic Management and Training (97760)
  • Developmental Screening (96110)
  • Sensory Integration (97533) 
Common billing blunders

Fixed rate payers: Medicare and other insurance companies have a capped, daily amount for payment. So, this does not mean they will pay you the same amount no matter how much you bill. Be sure you bill for the certain (and correct) amount of time to reach the capped maximum payment. Be sure to bill for your services and nothing less, but NEVER bill for the time you did not spend with your client.

Overusing certain codes: Not always, but insurance companies and others have been known to audit therapists who only use one billing code. If you are using one code more than another, they make ask you a few questions. To avoid this, be certain you are billing appropriately. For example, explain why and what you are doing that justifies neuro re-education versus therapeutic activity.

Under-timing the treatment session: Be sure to understand the definitions of pre-treatment, intra-treatment, and post-treatment. Also, be sure to keep track of your time. Often you may guestimate you spent 35 minutes with a patient when in fact it was 39. Those four minutes can make a huge difference.

Using the wrong codes: We sort of touched on this above, but make sure you are using the appropriate codes. Document correctly and be strong in your convictions. No one can argue the worth and value of OT better than you. You can almost always consider anything a therapeutic activity, but is it better suited as self-care or neuromuscular re-education? Just something to think about.

What questions do you have about billing? Do you disagree with any of the information above? Would you like to further discuss how we should be using these occupational therapy CPT codes? Please comment below!

ReferencesReferences

https://www.aota.org/~/media/Corporate/Files/Secure/Advocacy/Federal/Coding/Selected-Occupational-Therapy-CPT-Codes.pdf

CPT® is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved. 

The post The New Grad’s Guide To Occupational Therapy CPT Codes appeared first on NewGradOccupationalTherapy.

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Part 2: HOW OTs can continue their education and lifelong learning

Here at NewGradOccupationalTherapy, our mission is to empower new grads to maintain that initial excitement (and source of good nervous energy) that comes from being newly graduated in the field of occupational therapy. It takes a ton of commitment to become a newbie OT or OTA and keep your passion stoked throughout the beginning and continuation of your career. To that end, we try to supply you with articles on topics both clinical and career-focused, to give you opportunities to learn new things and spark discussion with your OT colleagues across the web!

Don’t forget to scroll to the bottom to enter our giveaway to win a FREE MedBridge subscription!

Previously, we delved into why lifelong learning is not only important to our personal and professional growth, but why it is lucrative and essential to our well-being and ability to fulfill purposeful roles in society. From that we can agree that the term “lifelong learning” is more than just a buzzword and there are reasons that support why we should embrace it . . . but HOW?

In the “How” of our duology on Lifelong Learning, we’ll fill in the gaps of how to incorporate lifelong learning into your daily life as well as provide you with some valuable resources to get the ball rolling.

1) Read more

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Reading provides us with opportunities to envision new worlds at the turn of a page — or push of a kindle button (haha!). Reading books of all kinds — fiction to nonfiction and everything in between (not just OT textbooks people) — can sharpen our ability to communicate or empathize with each other. Not everyone can afford an expensive membership to a continuing education site (or can you? scroll to the bottom for coupon code for MedBridge!) or to a fancypants weekend seminar, but an annual local library card is zero to little cost for a lifetime supply of books on multitudes of topics!

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Furthermore, reading daily is linked to increased vocabulary skills, improved written communication skills beneficial such as writing a marketing report or a resume (check out this NGOT post about how to nail writing a great resume), as well as at the very least giving you something useful and tangible to talk about!

2) Explore new passions

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Discover new passions and let the learning occur naturally in the context of the situation. Branch out to try different things and do them often. Leave your expectations and just be present. Travel and immerse yourself in new cultures to widen your horizons. Sign up for that computer technology course or that online Spanish course, or even better, study to become a Certified Specialist of Wine (no takers? Just me, well then . . . but it’s a real thing!). Allow the magic of neuroplasticity to occur as you exert your efforts in multiple contexts.

3) Attend conferences

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Yes, they can be expensive, but conferences with like-minded people boost creativity, promote practitioner excellence, and increase “buy-in” to not be one of those stuck-in-a-rut, complacent therapists. Presenting at conferences or attending presentations sparks our inner desire to engage and advance in our learning. Peer-to-peer interactions can facilitate new connections and translate to an increased sense of community.

Make it a goal to attend at least one conference a year whether it be at the state or national level. See you in NOLA for #AOTA19?? (We should have beignets and au laits together — seriously!)

4) Be a mentor and a mentee

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Nobody is asking you to know everything. In fact, that would go completely against the theme of lifelong learning — where, as the name implies, the learning is ongoing. Be vulnerable and meet up with eager interested preOT tract undergraduates. Give a brief presentation on your role as an OT practitioner in your setting. Go have coffee with a current OT/OTA graduate student. Arrange your schedule to volunteer to provide an inservice on fall prevention or whatever topic your interested in (OT is everywhere and includes everything) at your local gym or church.

Self assess how well you think you know a topic by teaching the concept or hands on skill to a therapist who may be newer to your specific practice setting. Putting yourself out there is an opportunity in itself to learn more.

Finally, seek mentorship because there is always someone who knows and is more experienced than you. If you are a new grad and are the only OT/OTA at your site, try seeking mentorship from other clinicians of other disciplines of course, but also make the effort to reach out to OT/OTAs in your community with experience in your setting. If that option does not suffice, you can at the very least listen to podcasts from experienced OTs (such as my personal #OTgoals Mandy Chamberlain’s “Seniors Flourish”) if you find yourself feeling on your own.

5) PodCAST your votes for your favorites

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Podcasts belong in the realm of lifelong learning tools and are a surefire way to boost productivity on those commutes to school or work. They’re especially great for auditory learners!

Check out our list of the 50 top occupational therapy podcasts for suggestions!
6) Engage in the present moment

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Mindfulness is all the rage these days but for good reason (My mind is blown, too). When we are anxious, worried, sleep-deprived, in pain, thinking about our endless to do list . . . the list goes on, we are unable to adequately concentrate on our current task which exponentially limits our ability to learn, engage, or thrive. The learned skill of mindfulness increases our ability to accept ourselves where we are in our present moment thereby improving our self-awareness and ability to be fully engaged in the current task. Thus, practicing mindfulness regularly can significantly increase our personal skill acquisition in our learning endeavors.

Interested in how mindfulness and OT truly goes hand in hand? Check out Kyla Salisbury’s article on how mindfulness can be an OT’s new secret power!
7) Lights, Camera, ACTION plan

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Commit to being actively engaged and write down your goals. It’s simple, really: you cannot surpass your goals or work toward your potential in life (and I’m not just talking about your potential when wearing your professional OT hat . . . ) if you do not define them.

Lifelong learning is about challenging yourself to continually give your best everyday. Strive for progress, not perfection.

Articulate a 5 year plan, identify manageable short term goals, and problem solve what actions need to be completed to achieve them!! Reflect and reassess often in order to resolve any barriers and self determine when you need help (this is where mentorship comes into play).

8) Continuing education and connection

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Check out:

The aforementioned sources are all websites (not an exhaustive list!) that provide opportunities for online education at the tip of your keyboard in the comfort of your own home (cue snacks and pajamas).

We at NGOT want to briefly introduce MedBridge, which perhaps needs no introduction!

“Our mission is to improve the lives of patients and medical providers while raising the quality of healthcare globally by creating the most impactful educational content on an innovative learning platform.”
—MedBridge Mission Statement

This online professional educational program serves several disciplines including occupational therapy in addition to physical therapy, speech language pathology, athletic training, and nursing.

Sooooo why MedBridge?

Learn from the Specialists

  • Online courses and live webinars are conducted by clinicians with expertise in a specific area of practice are a frequent occurrence paired well with a downloadable PowerPoint presentation and Q & A sessions to wrap up the session!

Surpass Your Continuing Education Requirements

  • MedBridge Continuing Ed emphasizes improving practitioner competence in the support to develop and nurture skills that promote eventual mastery. With almost 1,000 accredited online courses and interactive videos, you can fill your national and state CE requirements while maximizing your learning.

Say “NO” to Complacency and “YES” to Certification Programs

  • Yes, you could just go through the motions and allow a webinar run while you’re running errands, but what benefit does that provide to you or your patients? MedBridge offers certification prep to pass specialty board certification exams (although right now they’re only for PTs and RNs — cue our next topic in guidance in how to become a lifelong learner) in addition to offering certificates that represent holding distinguished knowledge.

Customized HEP and Track Outcomes with Mobile Patient App

  • Creating a home exercise plan just got a whole lot easier and much more streamlined. In addition to the ability to customize home exercise programs, MedBridge offers over 100 pre-made templates that are professional and can be tailored to the individual patient. These programs are easily printed or can be emailed or sent via text!
  • MedBridge also developed a patient app in which therapists can design home programs with just right exercise or activity challenges and patients can view and interact with their assigned home program. Videos in the app are looped and timed to mirror a patient’s completion of the assigned exercise. Therapists can track activity and interaction, and notification reminders can be set to increase adherence and ensure patients are carrying out their programs!
9) Demonstrate excellence with AOTA Board or Specialty certifications

Nine Certification Areas:

  • Board Certification (OT)
    • Gerontology (BCG)
    • Mental Health (BCMH)
    • Pediatrics (BCP)
    • Physical Rehabilitation (BCPR)
  • Specialty Certification (OT and OTA)
    • Driving and Community Mobility (SCDCM or SCDCM-A)
    • Environmental Modification (SCEM or SCEM-A)
    • Feeding, Eating, and Swallowing (SCFES or SCFES-A)
    • Low Vision (SCLV or SCLV-A)
    • School Systems (SCSS or SCSS-A)

In essence, we have the chance to stand out in our profession with Board or Specialty Certifications which demonstrates commitment, advocacy, and expertise in the area of choice. As a voluntary certification, these prestigious certifications through AOTA represent surpassing standard of care in effort to maximize knowledge, clinical skills, and ability level.

The certifications not only require extensive time and dedication to complete the application and requirements, but they are a surefire way to encourage lifelong learning in order to maintain the credentials provided. Certification is granted based on the results of a peer-review of applicants’ reflective portfolios which include a self-assessment, a professional development plan, as well as fulfilling the application itself. Most certifications require 5 years of clinical practice for eligibility.

There have been several excellent blog posts / podcasts that break down the certifications recognized by AOTA. See, for instance:

10) Rack up on AOTA Digital Badges

Meanwhile, as new grads AOTA fairly recently established a digital badging program which are designed as “web-enabled representations of a collection of learning achievements” that can be embedded to your resume, email signature lines, blog website or added to other social media sites such as Twitter or LinkedIn.

Basically, the thought is that if you are busting your butt, spending time and energy (not to mention money) to invest in your continued training as an occupational therapy practitioner, why not complete a few designated AOTA continuing ed courses in a practice area of your choice and receive an easily verifiable, concrete picture of your learning achievements? This program is free to AOTA members.

As of April 2018, the following Digital Badges are available through AOTA:

    • Autism
    • Cancer Rehabilitation
    • Driving and Community Mobility
    • Early Identification
    • Emerging Leaders Development Program
    • Falls Prevention
    • Fieldwork Educator
    • Fieldwork Educator Certificate
    • Home Modification
    • Low Vision
    • Lifestyle Redesign
    • Leadership Development Program for Middle Managers
  • Path to Leadership

To learn more information go to the AOTA digital badges webpage!

That’s a WRAP!!

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It should be duly noted this list like lifelong learning is meant to be continuous and will need to be added to and updated frequently.

In conclusion, lifelong learning looks a little different for every therapist (and any healthcare worker for that matter). Even new grad occupational therapists that work in nontraditional, non-direct patient care roles have new technologies, rules, regulations, and updated competencies that require continual retooling. We would love to hear in the comments what being a lifelong learner means to you and what steps you have taken to advance your learning opportunities!

Don’t forget to sign up for the giveaway! Enter to win a FREE year of MedBridge by filling out the form below. The giveaway will run until Monday, November 12th at 5PM EST and the winner will be contacted on Tuesday! Everyone who enters will get our special NGOT discount code, too!


The post Commitment to Lifelong Learning and Continuing Education for OTs: Part 2 appeared first on NewGradOccupationalTherapy.

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The Why; or, the benefits of lifelong learning for OTs

So you want to continue learning and growing in your knowledge scholastically, clinically, and personally? Two words: LIFELONG LEARNING.

What is Lifelong Learning?

Lifelong learning goes beyond the context of school, way beyond the typical lecture-style learning, and means actively pursuing self-initiated learning projects. Lifelong learning encompasses a broad range of formal and informal learning in addition to the behaviors, attitudes, and knowledge we acquire during our daily experiences.

Since we are occupational therapy practitioners, it’s quite lovely to know that our day-to-day occupations (or meaningful activities) contribute to our omnipresent opportunity to learn!

Lifelong learning looks a little different for every therapist (and any healthcare worker for that matter). Whether you are a new grad working in a familiar inpatient rehab setting or working in an assistive technology/switch toy adapter/amazing tech-savvy role, each field within the occupational therapy profession will have new technologies, rules, regulations, and updated competencies that require continual retooling on the job. This is where the importance of lifelong learning comes into play.

This is Part 1 of a 2 article series as part of “Why” (Part 1) and “How” (Part 2) lifelong learning and continuing education are a must for your professional and personal growth.

Now that we know a little about what lifelong learning is, let’s dive into 8 reasons why lifelong learning is essential!

The day you stop learning is the day you start dying.

Keeping up to date in the field helps us better treat patients

As new grads we have the advantage of completing the most up to date training in preparation toward becoming skilled evidence-based practitioners. But the learning does not end after a diploma. New literature and evidence is published daily and covers topics we did not learn in school, which leads to a need for the commitment to seek more knowledge and clinical understanding in order to best serve our patients.

Lifelong learning facilitates self-actualization

The principles of lifelong learning entail an intrinsic voluntary desire to creatively learn. Topics that are not taught in formal environments are awaiting exploration in your journey toward self-actualization — which, like lifelong learning, has no true endpoint.

“Self-actualization” refers to a concept created by humanistic psychologist Abraham Maslow. According to Maslow, self-actualization entails the growth of an individual through fulfilling needs in life, particularly those of meaning and importance.
You’ll have greater employment opportunities

First and foremost, just because you meet the qualifications and land an interview for your dream school or job, achieving that crucial acceptance or offer letter may require much, much more. In this era of advanced change, administrators or employers are highly interested in well-balanced individuals who demonstrate the aptitude and volition to learn and develop in multiple areas. Secondly, potential employers actually perceive your ability to self-reflect and determine you do not know something as a job trait that directly increases your competitiveness among other applicants for the sheer implications that you will be coachable and are willing to admit to failures.

Benefits of lifelong learning: improved self-discipline and reflection

Dedicating a couple of hours a week to diving into new ideas and exploring evidence-based interventions (hello continuing education — more on this in Part 2!) requires commitment and time sacrifice of more mindless tasks.

Take a moment and picture OT/OTA school as a gym membership and your professors as your personal trainers who guide you to reach your scholastic goals, much like a personal trainer guides you to reach your fitness goals. Neither the professors or personal trainers can complete the work for you to achieve your desired outcome. Moreover, in school we are provided with resources to help us reach a pretty standard goal: graduation, pass boards, become entry-level certified, and begin our careers — all of which require self-discipline. Lifelong learning requires this self-discipline skill to a greater extent and is more than meeting objectives on your syllabi. The extra sweat equity and time you carve out to build your skill sets, the higher likelihood of growth, satisfaction, and reflection.

You’ll decrease Impostor Syndrome and reduce burnout

When you feel competent in your work environment yet still feel challenged, odds are you will be happier than your fellow colleague who performs the same boring, repetitive, routine interventions day after day to every patient on their caseload in spite of the variety of diagnoses and levels of assistance needed per patient.

Challenging yourself to learn something out of your norm or engaging in enriching experiences are assets of lifelong learning that can directly reduce your risk of dreaded burnout. When workplace changes occur (changes in management or productivity requirements, etc) remember that you are able to embrace change and adapt to new roles!

Learning boosts creativity and stimulates enjoyment in multiple occupations

Learning for the sake of learning leads to the freedom to take up new interests or hobbies to enhance your life.

Ex: Take up pottery by joining a bimonthly pottery group. Better yet, do not limit your learning to the specific skill set of creating pottery; instead, make the conscious effort to allow the decisions you made during your creative construction of that pottery element to evolve in your intentional decision-making thought processes to other hobbies and routine tasks.

When you cultivate your mind with new skills, new foundations, and new thoughts, you are stimulating your brain to be the sponge that it is and wants to be, allowing it to absorb, sort, and piece together new ideas with old concepts leading to greater overall satisfaction.

Education improves our perspective and betters society

Skill sets change how an individual reacts to situational experiences. An active mind improves our ability to adapt to change and generalize skills learned to combating stressors in life, directly improving quality of life by giving purpose to a state of mind. The wisdom we gather from turning our trials to triumphs can be translated to real value that can act as a tangible benefit for others.

Technology is getting savvier

Upgrade ya (cue Beyonce)!! Can y’all remember when it was “cool” to have a flip phone? Yeah, it’s been awhile. There is a push for constant upgrading due to an immense growth in technological advancement around the globe. If we want to cope and succeed in our private and work life, it is imperative to open our willingness to the modern life.

In conclusion, lifelong learning is not going to become less important anytime soon. We have the obligation to ourselves as a community of up and coming practitioners to commit to learning throughout our lifetimes for the benefit of our patients, peers, and our personal well-being.

PSA: It should be duly noted that this article is not all-inclusive; just as we are supporting the idea that lifelong learning is lifelong, this list is ongoing, continuous, and will be expanded.

Next up, we will divulge into “How” in effort to clearly articulate how to complete the next steps on your journey.
Picture exploring different passions, seeking speciality certifications, achieving AOTA digital badges, navigating different continuing education sites such as MedBridge . . . also, GIFs and lots of them, and maybe even a MedBridge discount code . . .

The post Commitment to Lifelong Learning and Continuing Education for OTs: Part 1 appeared first on NewGradOccupationalTherapy.

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Interview season is upon us, causing thousands of potential occupational therapy (OT) students copious amounts of stress. From checking your email every 5 minutes in class or at work, to clearing your schedule when you finally nail the interview, there is a lot that goes into interview preparation and applying to OT school. Once you get the interview, you worry about what to wear, how to prepare for the weather (especially if you’re living in harsh winter climate), transportation and what to bring with you on interview day. Most importantly, how do you make an impression in the short amount of time that you are actually being interviewed?

Preparation! If you study up on your interview questions beforehand and practice responding to questions, this could potentially lessen the stress of an interview in the moment. You don’t have to worry about rambling or blanking when you have prepared or at least thought about how to respond to potential questions you could be asked. While you can’t possibly be prepared for every question that an admissions committee might throw at you, you can certainly prepare for some of the most common interview questions that many educators expect you to be able to answer. Here are 7 interview questions that YOU should be prepared to answer on interview day.

1. Describe yourself

Many people dread this question since it requires us to do some introspection and (admittedly) to brag. Once you nail your preparation for this question, you’ll practically be begging your interviewer to ask you to “describe yourself.”

So why is this a golden ticket question? The floor is yours. This is your chance to make yourself remembered. It’s your time to go from a name on a resume to a real person the admissions person can see as a student in their graduate program. Try to separate yourself from the crowd while also wrapping up your qualifications neatly into one response.

You want to sprinkle in references to your resume and qualifications, but don’t just talk about being a dedicated student or workaholic; talk about your passions and your values. In other words, tell your interviewer something that they wouldn’t know just by looking at your resume (which they may already have in front of them). Talk about some of your roles outside of LinkedIn (sibling, parent, caretaker, photographer, athlete, etc.). Try to find a balance between highlighting some of your best qualifications while also humanizing yourself with some tidbits that make you unique.

Pro Tip: make this short and sweet. You probably don’t want to sit there and talk about yourself all day anyways, so try to keep this response close to a couple of minutes.
2. Why OT? Why not PT?

This a pretty loaded question. First, the committee is looking to see that you grasp what OT actually is. They also want to see that you can articulate the difference between our cousin profession that many people struggle to discern. A common misperception is to claim that OT does upper extremity and PT does lower extremity. This doesn’t appropriately distinguish the two professions, nor would it appropriately explain why you would be passionate about OT over PT.

Use buzzwords such as client-centered, holistic, and meaningful occupations — and demonstrate that you understand the terms! This will show the committee that you have done your homework beyond just shadowing, which is often just a snapshot of what OT does without any real education on why. So, study up on the difference between the two professions and incorporate some examples from when you have shadowed.

Pro Tip: Even if you don’t get this question in your interview, you will likely be able to sneak this response in somewhere during your interview and earn some brownie points!
3. How would you define OT to someone who has never heard of it before?

This was one of the questions I received during interviews, along with “What is OT?”, which is essentially the same question. This is an important question to all interviewers because it is an incredibly common question that arises when you meet new clients and you will undoubtedly be explaining what OT is all throughout graduate school.

Keep in mind that interviewers know that you are not an expert in OT yet. You’re not expected to give the perfect answer as if you have been practicing your elevator speech for years, but it is important for the committee to see that you can confidently articulate a professional response. When defining OT to someone who has never heard of it before, you want to use everyday language that makes understanding OT seem simple.

Pro Tip: Practice your elevator speech with friends and family who might not understand exactly what OTs do. Ask them if they have any questions about your explanation or if anything was unclear and tweak your response from there.
4. What are some of your interests outside of school/work?

This question is similar to question #1, but it allows you to dig deeper into what activities you actually participate in when you’re not a full-time student or professional. This question might seem like it has nothing to do with OT, but admissions want to see that you are well-rounded and can cope healthily with stress. It also helps them individualize their applicants and look for stand-outs.

As an OT you will be looking at all activities of daily living (ADLs), so you can think of yourself as a client in this situation. To help reflect on this question, what are the things that you do when you’re not studying for class or working? How do you de-stress? What are some of your hobbies? Make a list and have this ready as you prepare to answer this question.

5. Tell me what (insert OT shadowing experience here) taught you about the OT profession.

Be prepared to share some of your experiences and observances that you made while shadowing. Admissions want to see that you can reflect on these experiences and that you were able to take something away from other OTs. If you have observed different settings, compare and contrast how OT looked similar or different. One of the great things about OT is that the field is incredibly diverse and can look very different in different settings, so use this to your advantage when talking about why you love OT so much!

6. What are your best and worst attributes?

This seems like a pretty straightforward question to answer, but you definitely want to be prepared to answer this question and don’t want it to be inauthentic. When thinking of your best and worst qualities, try to circle them back to how they would impact your future occupation as a graduate student. Even “negative” attributes can be spun to be something productive and positive or can at least be reflected on as something to improve upon. This is another question that lets the committee get to know you as a person and potential student and can be used to help you connect with the faculty member who interviews you.

Pro tip: if you’re having trouble of thinking of some positive and negative attributes, ask some of your closest friends – they won’t hold back!
7. Tell me about your leadership experience.

Being asked about leadership experience can be intimidating if you don’t have anything on your resume that explicitly says executive board. This is where you can be creative and draw on some of your life experiences that may not necessarily have been captain of your sports team or president of a club. Think about times you have worked in teams, situations that you took control of when conflict arose, or situations where you tend to take charge. A personal anecdote will make you even more memorable to the admissions committee!

Pro tip: consider bringing a padfolio with you on interview day and write some of your prepared notes to look at during your commute to the interview. You can also write down any questions that you have about the program so that when they ask what questions you have you are well prepared!
How to ace your OT school interview: preparation, preparation, preparation!

Preparing for interviews is always intimidating, but hopefully these questions help you feel more confident on your big day! Remember to remain true to yourself and try to let the conversation flow naturally. Don’t worry too much about looking nervous — interviewers understand that the process is stressful and nerve-wracking. Plus, nerves are healthy! They show the committee that this is a career and program that you care about.

Some people are more comfortable preparing for interviews than others. Whether you spend the night before skimming some questions or the week before going through mock interviews, make sure that you prepare just enough to calm your nerves. Regardless of how much you decide to prepare before interview day, have confidence in your ability to convey who you are during your interview. In a health professions career, evaluators want to see that you are a caring and compassionate person. You’ll convey this best when you can be yourself and honest in your interview process. By putting on the mask of someone you think you should be on interview day, you aren’t giving yourself a fair shot. At the end of the day, do what makes you and prepare for your new journey in OT school!

The post 7 Questions to Expect in an OT School Interview appeared first on NewGradOccupationalTherapy.

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Hello home health OTs! Aren’t we lucky? We get to work with clients in their most natural context; in the home or in the community.

However, there is a downside; sitting in our cars for long periods of time as we go from session to session. When sitting in a car, our upper body and low back round forward and our legs are kept in a flexed position that doesn’t really change. This posture causes tight chest and weak back muscles as well as tight hip flexors and hamstrings. These muscular imbalances often lead to low back pain as well as general pain in the muscles affected.

As OTs we know the impact that muscular imbalances and pain can have on participation in daily life, and we also know the importance of self-care, so we want to do something to counteract the effects of sitting in a car for so long.

One way we can address these issues is through yoga. And the good news is, you don’t have to commit to taking a full class multiple times a week! Just using a couple poses daily (or at least on the days you work) can be beneficial.

I have broken this practice down into two sets. The first set of poses is to be done while in your car; these I recommend doing between each session or whenever you’re starting to feel some discomfort. The second set of poses is to be done at the end of the day, when you’re at home. These poses you only need to do once or twice in the evening after a day at work.

Make these poses a habit and in no time, you’ll be feeling great!

Poses in the car

Please, don’t try this while you’re driving!

Seated Spinal Twist – This one is my absolute favorite. This pose is going to stretch your spine in a direction it doesn’t really get to move while you’re driving as well as build core strength, which helps to prevent low back pain. Sitting tall in your seat, inhale deeply. As you exhale, twist to your right (towards the passenger side of your car) using your core muscles. Then let your left hand rest on your right knee and your right hand rest on the center console. Maintain this twist for 3-5 deep breaths. Repeat on the other side, allowing your left hand to rest on the door of your car.

Seated Cat-Cow – This pose is going to move the spine, and chest and back muscles through both a stretch and strengthening sequence to counteract muscular imbalances. Again, sit nice and tall, really try to lengthen your spine. Place your hands on your knees and as you inhale, draw your shoulder blades together behind you and lift your sternum up towards the windshield. You can either bring your chin toward your chest here or you can lift your gaze toward the ceiling. As you exhale, push your shoulder blades forward, round your upper back, and draw your chin towards your chest and gaze towards your lap. (Note: You can also clasp your hands and push forward through the palms, whichever you prefer). Continue moving through these two poses with your breath for 5-10 rounds.

Neck Rolls – Time to stretch out those neck muscles. Sit tall (did you see that coming?) in your seat and gently drop your chin down toward your chest so that your nose is pointing at your lap. Take a deep breath here. On your next inhale, begin to draw your nose to one side and then raise it toward the roof of your car. As you exhale, begin to draw your nose to the opposite side and back down toward your lap. Really try to reach that nose as far as you can in each direction. Try to keep this movement fluid with your breath and continue with 3-5 circles in one direction before switching to move in the opposite direction.

Poses in the home

You can do these all at once or throughout your evening.

Camel – I usually do this one as soon as I’ve put my bags down. Stand tall, create a fist with each hand and place them on the low back on each side of the spine (note: you can also place your palms in the same location with fingers pointing down). Begin to draw the shoulder blades and elbows together behind you. As you inhale, lift from the rib cage and as you exhale, open your heart toward the top of your wall. Here, just as with Cat-Cow above, you can choose to keep your chin at your chest or you can lift your gaze toward the ceiling. If you lift your gaze, keep your neck strong to prevent your head from falling back — you know as an OT that is not good. Hold this pose while take 5-7 breaths. This pose is really going to work to stretch the muscles on the front side of the body while strengthening strengthen back and core muscles.

Warrior I – Standing tall, take a big step back with your right foot, you want a distance of about 4-6 feet between your feet. Bring your back heel to the floor at about a 45 degree angle. Inhale your arms overhead then draw your elbows down to the side, at about 90 degrees. From this position, gently begin to draw the elbows back (they won’t go far, but you’re strengthening your traps and opening your chest by doing this). Allow your hips to open a little bit, but you’re gently trying to draw your right hip forward and your left hip back to get a great stretch on those hip flexor muscles (Hint: Illiacus and Psoas). Take 5-7 deep breaths then switch sides!

Forward Fold – This pose can be done standing or seated. If you’re standing, I recommend doing it against a wall. I like to do one of each myself. If standing, place your back against the wall and let the upper body slowly sink down toward the floor. Have as much of a bend in the knees as you need, especially if you’re feeling some discomfort in the low back. Grab opposite elbows if it’s comfortable, otherwise hold onto the floor or your shins. You can gently rock side to side if you want. If you’re doing this pose while seated, sit nice and tall on the floor, bend your knees as much as you need so that your tailbone is not rolling under. Inhale and try to lengthen the spine. As you exhale, let the upper body glide forward over the legs. Relax the shoulders and let the head hang. Hold for 5-10 breaths in either variation!

Don’t you feel good now? And that was after only one set of the poses! Just think of how good you’re going to feel when you do this regularly! Remember, self-care is a vital part of continuing to be the best OTs we can be!

The post Yoga for Home Health Occupational Therapists appeared first on NewGradOccupationalTherapy.

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Stress is a physical or psychological factor that causes tension in the body. Anxiety is emotions or behaviors produced by perceived threat. Both are all too common symptoms of this fast paced, high expectation society in which we live. Common universal stressors in the United States today include money, family, work, health, traffic . . . the list goes on. Anxiety can be an intermittent feeling of nervousness or worry, or it can be a diagnosable disorder defined by a state of excessive uneasiness and/or apprehension. Historically, stress and anxiety were protective responses to promote survival. Too much stress and anxiety can actually have a negative impact on our health and bodies.

Chronic stress and anxiety are associated with a list of detrimental problems: immunosuppression and heightened inflammation, metabolic and cardiovascular issues, digestion problems including malnutrition, stunted growth and repair of cells, affective impacts, cognitive impairment, accelerated aging, sleep loss, and even pain sensitization (Dumas, 2018). Stress and anxiety can also develop into diagnosable psychological conditions. In any given year, 1 in 5 Americans will suffer from some type of psychiatric disorder. Approximately 18% of Americans have an anxiety disorder. Stress and anxiety are often comorbid with depression, and approximately 7% of the United States population has a current diagnosis of major depression (NIMH » Mental Illness, 2017).

Our patient population experiencing injury and illness is especially vulnerable to stress and anxiety. Furthermore, the aforementioned list of detrimental issues associated with long-term stress and anxiety can negatively impact our patients’ rate of recovery and overall health, subsequently negatively impacting our health profession’s outcomes. For this reason, it is imperative health practitioners begin addressing symptoms of stress and anxiety in out patient populations. As the profession of occupational therapy values a holistic, client-centered approach to medicine and as mental health falls within our scope of practice, I feel occupational therapists have great potential to address stress and anxiety in our skilled treatments — even in the physical disability or pediatric based settings.

Keep reading for a list of ways to help manage stress and anxiety for patients, caregivers, and even for yourself as a busy practitioner.

1. Improve Predictability and Support Behavioral Adaptation

There are several ways occupational therapists can improve predictability and promote behavior adaptation for anxiety management. Many patients experiencing stress from illness or injury have experienced a loss of sense of control and/or the inability to predict future events. Occupational therapists can work to promote an internal sense of control and improve predictability of events.

For example, at the start of a session, I often check in with the patient to see how they are doing, discuss goals for the treatment session that date, and work together to make a plan and expectations for the session. Before engaging in treatment such as manual therapy or exercises, I explain the procedure and the reasoning behind why we are working on this area. Addressing treatments sessions in this manner improves predictability and reduces patient apprehension and worry. By allowing the patient to be an active participant in planning therapy sessions, it promotes an internal sense of control, reduces stress, and increases self efficacy.

To facilitate generalization of anxiety management outside of therapy, teach your patient to plan ahead and anticipate life events. Instruct on energy conservation for patients experiencing fatigue and help them balance activity with rest for optimal recovery. Recommend patients use heat and ice modalities on a scheduled basis — that means preemptively, prior to experiencing pain! In the event that -inevitably – life does not go as planned, teach adaptability and promote flexibility.

I am constantly reminding my patients: Recovery is not a straight line.

2. Cognitive Reframing and Learned Optimism

Many patients who have experienced stress and anxiety for long periods of time may be experiencing cognitive distortions such as learned helplessness or fear avoidance for certain movements or occupations/activities. In these cases, additional time and treatment may be required to focus on identifying thought distortions and reframing cognitive thought processes. To help a patient with this, promote thinking in shades of gray, rather than all or nothing, black or white thinking. Teach your patients the “double standard method”: treat yourself as you would someone who you really care about (Dumas, 2018). Start small and increase activity over time. When a patient feels success, they will be ready and motivated to achieve the next level.

In your clinic and treatment sessions, reduce discussions of pain. Teach patients to use less threatening pain descriptors through word shifting. For example, word shifting might comprise of changing the words from “stabbing, burning pain” to “my arm feels not as comfortable and cool than it should.” Negative pain descriptors are threatening to the brain and can increase pain sensitivity. Using more positive words as descriptors (ie: not as cool, comfortable, loose, strong, etc) is less threatening to the brain and actually promotes a direct goal. The brain realizes, instead of being afraid, it needs to work harder to promote comfort, range of motion, and strength.

Support optimism. Use positive vocabulary with the patients. Similarly to reducing discussion of pain, decrease discussion of illness and disability. Then, increase use of positive words and emphasis on wellness, health, ability, and prevention. Your patients may benefit from using a gratitude journal, where they create daily records of things/people/events/accomplishments that they are thankful for. Remember to be enthusiastic and cheerful in your work. It is contagious.

3. Build Coping Skills

There are many coping strategies for stress and anxiety management. To identify the ones that may work for you patient, consider their hobbies and interests. Help patients identify strategies that distract or self soothe a patient when they are feeling stress and anxiety symptoms. Distractions can be watching funny videos or reading a book. Self soothing can include listening to their favorite music, drinking a cup of tea, taking a bath or sitting by a comforting, warm fireplace. Promote social support and opportunities to engage in social events within the patient’s abilities. For patients who are struggling, ensure a crisis plan is in place and that they have resources and numbers to call when needed. The National Suicide Prevention Lifeline number is: 1-800-273-8255.

4. Exercise

Exercise is a great way to expend nervous energy and reduce rumination on negative thoughts. Additionally, exercise combats obesity and increases the body’s ability to achieve homeostasis during anxiety (Dumas, 2018). Develop an exercise plan for your patients. This may be a sensory diet for a pediatric patient or a upper extremity work out plan related to a specific hobby for an adult patient. Make it fun!

5. Diet

Long term stress and anxiety can negatively impact metabolic efficiency. The body remains in a state of “fight or flight.” When the body is in “fight or flight” mode, the sympathetic nervous system is working: the heart rate increases, blood vessel constrict, and digestion is reduced. Sympathetic overdrive can lead to decreased digestive enzyme release, reduce smooth muscle contraction in the gut, impaired nutrient absorption, and disrupted protein synthesis from chronic elevated cortisol (Dumas, 2018). To counteract these negative problems, promote healthy eating. Support a diet high in antioxidants, natural food, and avoidance of highly processed foods. Interventions can incorporate meal planning and creating grocery lists that support a healthy diet. Consider a referral to a nutritionist if appropriate.

6. Mindfulness

Mindfulness is a mental state achieved by focusing a nonjudgmental awareness on the present moment. Outcomes of mindfulness include a reduced focus on past and future, reduced pain and anxiety, and reduced tendency for mind to wander. There are several ways to promote mindfulness both within treatment sessions and outside of skilled therapy.

7. Consider Complementary Medicines

Today, over 75% of health professionals are recommending complementary medicines (Dumas, 2018). Complementary medicines include: Massage Therapy, Yoga and Meditation, Acupuncture, Herbal Remedies and Aroma and Light Therapies. Survey your patient’s interests and consider if complementary medicine may be a great adjunct to your patient’s recovery process.

Use the aforementioned ideas to help combat symptoms of stress and anxiety in your patient caseload. The next time you have a busy week and feel symptoms of stress and anxiety, select one to trial on yourself! Let us know here at NGOT which ones are working for you and your patients. We look forward to hearing your feedback.

References:
  1. Dumas, T. C. (2018, May). Calming an overactive brain. Paper presented at Institute for brain potential continuing education course, Bozeman, MT.
  2. NIMH » Mental Illness. (2017, November).

The post 7 Tips for Reducing Occupational Therapy Patient Anxiety appeared first on NewGradOccupationalTherapy.

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[Trigger warning: if you have an active eating disorder or are in recovery from one, please pause to reflect and determine if you feel able to tolerate a discussion about treatment from a clinician’s point of view, as well as one reference to a specific number of calories.]

Don’t miss the very start of this three-part interview about eating disorder treatment and occupational therapy practice!

After discussing Bekah’s transition from grad school to Johns Hopkins to practice occupational therapy and eating disorder treatment, she shared details about the structure of the program, the overarching role of OT within it, and insight into her clients’ experiences. In this third and final section we’ll discuss some practical aspects of eating disorder treatment and how OT theory can be applied in this setting. The question that begins this interview came after Bekah described an emphasis on “real-life,” community-based interventions in her role as an OT on the Johns Hopkins eating disorder treatment team.

RO: Are the experiential sessions like grocery shopping and cooking primarily used as a time to practice coping skills and distress tolerance, or do you also process feelings and associations that come up during those activities?

BM: All of the above. So I think of it a lot as using the PEOP [Person-Environment-Occupational Performance] model because of the fact that, you’ve talked and talked and talked about how “I couldn’t go grocery shopping before” or “I haven’t been in a kitchen in six months,” and so now we’re saying, essentially, okay, we’re going to go do this and we’re going to do it together, and it’s going to be supportive and you’re going to have your peers there supporting you too.

So let’s go into the kitchen and you guys have to work together to collaborate to figure out what we’re going to eat because that’s how making meals at home sometimes works too you know, like what does everyone want for dinner? Okay, how do we make this work?

And life-wise that’s giving them the opportunity to actually “do” and engage in the process, and to talk about “hey this is really difficult for me, I’m struggling, I need help,” or they don’t ask for help and everything goes to shit and you’re like “okay, so how do we work through this to be supportive next time.”

Like, I have a patient currently who has severe anorexia with binge/purge behaviors as well, so she attempted to do two different meal activities with us but could not manage her behaviors to not binge on the cookie dough and desserts when we were making things, to the point where it was not helpful for her to come to the sessions. We had to have a chat with her and be like, “you know, you’re not going to be able to come to this next one because of the fact that it’s not supportive for us to put you in that environment. We need to work with you to build up some more coping skills before putting you back there because it’s unfair to you to be setting you up for failure.”

Then two weeks later she was able to do the full meal prep, and the amount of effort that it took then for her to be able to manage her behavior was definitely still high, but she was able to get through it with just redirections without engaging in any significantly inappropriate behaviors. It wasn’t perfect, but there was definitely an improvement, and part of that comes from the motivation of you know, “I have a choice when we’re doing meal prep, I get to have a say in what we’re having rather than whatever comes up on the tray.”

RO: That leads to one of the issues I talked about in the first article; from my understanding, some people in residential settings aren’t yet ready for the kind of experiential interventions you just described, but those interventions become harder and harder to access as a person moves down the levels of care. In your experience, have you found that to be true with your clients?

BM: Yes, it is. Ultimately that’s why we structured our program to be as multidisciplinary and supportive as possible, the idea being that patients get to do the majority of refeeding and stopping the cycle of behaviors while inpatient, while they have 24/7 support, and then as they’re able to be medically stable, then we start gradually stepping them down to lower levels of care with less supervision.

I can think of multiple people who – and you kind of expect this to happen– are doing really well and then they get a day off, and something goes wrong. I mean, there’s countless things that can happen – skipping meals, over exercising, purging, etc. – but we set up supports so that way it’s not just this “oh crap, I just got a day off and I just completely bombed it.” And that’s really why the step down is just so crucial, because without transitional care like that, you don’t have the opportunity to say “okay, I floundered, let’s get back on board, can you please help me figure out what to do next time differently, to make this a little bit less of a disaster of an experience?”

That’s why it’s so important, too, for people to have those opportunities to simulate things, to try and have the opportunity to fail before they’re out of treatment, because otherwise how in the world do we expect them to fully carry over those things, and how do we actually know if they’re able to implement the skills that they’ve learned?

But ultimately, I guess the answer to your question is [that] it really depends on the patient, and if they aren’t ready to do those real-life OT sessions that the day hospital really highlights when they’re discharged, then they probably shouldn’t have been discharged. Or they should have been discharged with a plan to follow up pretty closely with OT in order to be able to do those tasks in a successful, supportive manner.

RO: In your current workload do you run a mix of individual and group sessions?

BM: I guess it depends on how you look at it. With my two services, I have between 12-14 patients at a time. I theoretically see all of them in a group five days a week, but then I also see all of them at least one time individually. So I’m doing quite a bit of both group and individual therapy.

RO: For the individual sessions, do you mind telling me a little bit more about the goals you work on and how those sessions differ from the group work?

BM: The typical goals that I usually come up with are the basic health and illness management goals: being able to identify triggers to eating disorder behavior, anxiety, and/or depression. I separate all those out, identifying the warning signs for each, and identifying appropriate coping strategies.

Then the next step that I take with that is actually implementing those strategies. It’s one thing if you can list them, but you have to be able to be in a situation – which once again goes back to the PEOP and how having those simulation opportunities – where you can demonstrate them or at least trial them and see if they do or don’t work.

So, at first when I started here I thought it was kind of an odd thing for OTs to be doing – identifying triggers and warning signs and coping strategies – but that’s so foundational to not only your understanding of the patient, but also insight into the patient’s own awareness. It’s really hard to expect someone to just change their behavior if they don’t even understand what’s causing the behavior, or what’s triggering it – kind of unfair.

So, that’s usually one of the basic ones, I also work a lot on figuring out how do we improve people’s role performance, how do we specifically include leisure and socialization back into their life, since that’s usually one of the first things to get cut [by the eating disorder]. We do some leisure exploration, I do a lot with making a balanced schedule, to figure out – how do I balance work, play, sleep, self-care, and make sure that I actually allocate time for meal planning, meal prepping, and eating the food.

And then, as I mentioned, I do the meal planning, so we’ll make grocery lists, we’ll practice going to the store, we will make meal plans just practicing diversity, especially if people decide not to or can’t afford to go to day hospital, to at least get some of those things trialed before they leave so they can have a plan when they go home.

I do a lot of different things, but those are some of the main ones. Cognition also comes into play in this work too. I have to do a lot of figuring out “okay, now is this person struggling with x y or z because they have early dementia, or is it because they’ve only been eating 500 calories a day for the last 2 months?”

RO: Earlier you mentioned the issue of motivation, and I agree that it is so crucial for OTs to address in our work because, even in recently published textbooks, I have read descriptions that lump true motivation and eating disorder motivation together when they’re not at all the same, so our lens of trying to figure out what actions and choices and reported beliefs are coming from a symptom vs. their true values and motivation is so important. I’ve been really encouraged to hear you describe the program at Johns Hopkins and the way they embrace that approach.

BM: Exactly. If you look at the OTPF, it outlines everything we do in mental health and especially in eating disorders; [in order to treat eating disorders effectively] you have to look at values and beliefs, you have to look at the habits and the routines and the rituals, you have to look at the ADLs, IADLs, you need to look at socialization and relationships, you need to look at tons of activity analysis and real-life participation, you need to grade activities so that they can actually be supportive, you need to look at whether we’re in maintenance, and how do we either keep it going or facilitate things to promote recovery further. And that’s why OT is the perfect avenue for this work.

A note from the author: Since publishing my first article, Occupational Therapy and Eating Disorders: Bridging the Gap, I have been overwhelmed by the many responses from both students and clinicians, each full of interest and encouragement. That support helped me to make the decision to take my work from theory to reality, and open my own private practice offering the type of services that could reduce the “gap” in care. Thank you so much to everyone who read, shared, and responded to my writing, I am incredibly grateful!

The post Occupational Therapy and Eating Disorder Treatment: An Interview With Bekah Mack, Part 3 appeared first on NewGradOccupationalTherapy.

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[Trigger warning: if you have an active eating disorder or are in recovery from one, please pause to reflect and determine if you feel able to tolerate a discussion about treatment from a clinician’s point of view, as well as one reference to a specific number of calories.]

In part one of this interview on occupational therapy and eating disorder treatment, Bekah and I discussed her journey from grad school to her position at the eating disorder program at Johns Hopkins, as well as the structure of that program. In part two, we discuss the lived experiences of clients with eating disorders and key components of the OT role in this setting.

BM: One of the interesting things about eating disorders is that oftentimes individuals with them kind of want their support systems to give up on them, because they’re exhausted and just kind of want to call it quits and be done, especially if they’re struggling with anxiety and/or depression.

But there’s research that’s shown that people who have therapists/friends/family who keep on doing the dance with them for 10, 15, 20 years, still have a high rate of recovery. It’s just a question of whether you’re going to stick it out and do the dance with them for that long.

RO: By “do the dance” do you mean to stick around even when they’re telling you they don’t want you to?

BM: Right, so when they come in for help, we take the approach of “we want to help you get better even though you’ve left five times before [against medical advice],” and even though we know that we’ll probably see you again next year or the year after that.

For one of my current clients, this is actually my second time treating her but probably her fifth or sixth time coming to Hopkins. And each time she comes, a little bit more of her is ready and willing to change, so it’s especially crucial for us to say, you know, we don’t care how many times you’ve left and come back, because you’re willing to give it a shot again and we want to be there with you supporting you in trying to get back to those meaningful things in your life, actually find your identity in something else, to be that person you want to be, to have a real quality of life.

And seeing someone go back and forth like that can be really difficult and frustrating as both a practitioner and just as a person engaging with someone struggling with an eating disorder to that degree. We have to come and engage with them in a compassionate, empathetic, caring, client-centered manner without being like “dude, I know you’re going to leave early, I know you’re going to fall back on bad patterns.”

Sticking with it is part of the reason why OT is another important advocate here.

What things can we brainstorm through to overcome the barriers that led to relapse last time, or what things do we notice during our motivational interviewing that have improved or changed? I mean, even when someone is readmitted there is always something different from where we ended last time.

For example, this woman that I’ve been talking about: last time it wasn’t until her last week or two prior to leaving against medical advice that she was finally having real conversations with me about how to set herself up for success, and now this time within her just being here a couple days she’s like, “you know I’m so tired of the relationship I have with food, I’m so tired of the fact that it’s controlling my life and relationships, and that I don’t have an identity and I don’t even know who I am, I want to be able to leave here and not be so obsessed with food, I want to be able to leave here and actually be able to do the things I like and become a person again.”

Yes, it’s quite possible and even likely that within a week or so her eating disorder is going to be really pushing back against that mindset, but the fact that we started off on that note is a hugely significant improvement.

RO: Everything you just said is so encouraging to hear because that’s what the whole process is about: finding a little bit more of the self each time. It’s the eating disorder that is the motivation to leave AMA, not their “true” motivation, so sticking with them and saying “this part of the real you, I see that it’s here and I won’t forget, and when you come back that’s where we can start” is absolutely crucial.

I’m curious about what your role is specifically in the program at Hopkins; so few eating disorder treatment programs have OTs on staff so there doesn’t seem to be a standard role for us yet.

BM: In essence there are opportunities in all aspects of OT to provide interventions for this population, because the eating disorder can affect literally every aspect of their life.

So in the inpatient setting I meet with my patients once a week individually to work on the specific goals that we establish when I first evaluate them, and then we have a weekday group. The group includes a variety of things; ultimately I pick the topic based on what I feel the group’s needs are.

For example, one of my favorite groups for both of my populations addresses roles. We address the different roles they have, how each role has been impacted by their illness, and what they want that role to look like in the future. Then we brainstorm through the barriers of how do we actually make that happen. Because in treatment there can be an awful lot of talking about what’s wrong, and less frequently there’s problem solving as to how do we actually start tangibly fixing some of those things.

Another of my favorites is doing case studies with the patients where we have a made-up person who has stereotypical behaviors, which always ends up resulting in an interesting conversation. We usually have at least one person who is offended by the fact that we would even write a case study that’s so stereotypical, so that ends up being an interesting conversation because they’re like “I hate that you wrote down all these things that people just assume that people with eating disorders have”, and you’re like “well remember this isn’t about you this is about so-and-so, why do you feel like it’s impacting you to that level?”

And that usually opens up a lot of good group discussion as well because then you’ll have someone speak up and say, “Well, I know you said this is stereotypical but when I read this, this is me, this person is me.”

And from there we start to address questions like what environmental factors are continuing that disordered habit? What are practical coping strategies and changes that we can do to the environment to modify it in a way that’s going to be more supportive of recovery? What are things that we can start changing in that person’s routine while they’re in inpatient and in a safe but different environment, to carry over for when they go home?

How do we start making those practical small changes in order to make it more successful and easier for them to transition into the day hospital, where they’re going to have the opportunity to start getting time off and actually practice the things they’ve been working so hard to learn to implement while in inpatient?

RO: Is that focus on roles and transitions seen by the other professions on the team as an OT specialty?

BM: It’s hard to say for sure, but I feel like it’s something where they do recognize OT’s unique role.

In addition to those groups, something that I’ve begun regularly implementing since I’ve been working there is weekly meal prep groups. They have to plan the meal, and then we work together to prepare it, and so with that it gives them a lot of opportunities to begin figuring out, how do I do this without falling into the rigidity of the eating disorder?

We work on helping the clients learn how to estimate portions; the average person without an eating disorder wouldn’t measure out every piece of food – you would just plop what you wanted on your plate, eat what you wanted, and you would get enough nutrients without having to be obsessive about it. So to give patients real life practice of planning and eating meals in a healthy way, we do those OT groups weekly in inpatient and daily in the day hospital. And in day hospital they also go grocery shopping with OT, where they have to meal plan for the entire week.

Doing those OT sessions not only gives them the simulation of working through any anxiety and behaviors that may have occurred at the grocery store, but also getting real-life practice so we can address the questions, so how do I make this work, what was hard, what can I do to adapt this situation to make it more recovery based for me in the future, how do I work through this to be supportive?

And then we do all the meal prep, so they get practice doing breakfast, lunch, and dinner; we go and do a restaurant outing so they can have the opportunity to figure out how in the world do I utilize this recovery system when I’m not making my own food and I’m going out with people?

Nursing will also sometimes do take-out meals with them, but I would say that as far as the full meal-prep process, that is completely left to be done with OT, and our attendings definitely recognize that as a role that we play, along with figuring out meal planning supports for people when they go on days off.

Check back on Friday for the third and final part of this interview, where we’ll discuss some practical aspects of eating disorder treatment and how OT theory can be applied in this setting.
A note from the author: Since publishing my first article, Occupational Therapy and Eating Disorders: Bridging the Gap, I have been overwhelmed by the many responses from both students and clinicians, each full of interest and encouragement. That support helped me to make the decision to take my work from theory to reality, and open my own private practice offering the type of services that could reduce the “gap” in care. Thank you so much to everyone who read, shared, and responded to my writing, I am incredibly grateful!

The post Occupational Therapy and Eating Disorder Treatment: An Interview With Bekah Mack, Part 2 appeared first on NewGradOccupationalTherapy.

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[Trigger warning: if you have an active eating disorder or are in recovery from one, please pause to reflect and determine if you feel able to tolerate a discussion about treatment from a clinician’s point of view, as well as one reference to a specific number of calories.]

This article was written as a follow-up to the article Eating Disorders and Occupational Therapy; Bridging the Gap, which addressed the ways in which OT is uniquely suited to meet some significant needs in the field of eating disorder treatment. To give an inside view of one OT’s role with this population, I interviewed Bekah Mack, an OT on staff at the Johns Hopkins Eating Disorders Program — one of the few eating disorder treatment programs in the US that employs OTs. Bekah generously gave her time to share her path from grad school to Johns Hopkins, her approach to treatment, and her thoughts about our role as OTs with this population.

This interview has been edited for length and clarity.

RO: How did you start working in the eating disorder field?

BM: I knew that I wanted to work in mental health forever—well, for a long time, but it was kind of affirmed in school. There’s such a need for it and there are so few jobs available in [mental health], which is especially astounding given the fact that that’s where we started.

That said, I started my journey looking for any sort of mental health type things that I could get involved in, and I found out that [Johns] Hopkins has a residency program, and then ended up being offered a full-time job there instead of the residency, and the two services that I would be covering would be eating disorders and young adults with affective disorders.

Both are pretty difficult niches, so I was initially a little bit overwhelmed to say the least, but I liked the fact that it’s definitely an area where we have the opportunity to make a difference and make an impact in those people’s lives, and really give to them and they have a lot to give back to us.

So, while I’ve always found eating disorders interesting from the little I knew about them, I can’t say that I necessarily started by looking for a job treating them, and I didn’t really have a very firm grasp as to the depth and complexity of them until I started working here.

RO: Had eating disorders been covered at all in your grad program, or when you say, “the little I knew,” was that from life experience?

BM: A little of both. I have several friends who have struggled with eating disorders, and I was also aware of the stereotype versions of it just based on TV shows and movies and those sorts of portrayals; the “oh, they’re just afraid of food or have a bad relationship with food” idea that’s still unfortunately the stereotype.

My perspective and understanding is so different now, and when I hear people talk about this desire to find that one causal item that led them to end up with an eating disorder I just think, “It’s not about that; it’s so much more complex and akin to an addiction than it is to a fear that came from one event.”

It’s not about [causal items]; it’s so much more complex and akin to an addiction than it is to a fear that came from one event.

As far as grad school, we didn’t cover a whole lot. We had a biopsychosocial class that was really like the core foundation of my psych background, and then everything else mental health was [woven] into the program. My professors always said, “we really do have a really heavily based mental health program,” [but] we didn’t really talk a lot specifically about eating disorders other than kind of glazing over it as a DSM diagnosis and watching a couple videos from The Doctor or Doctor Phil or something.

RO: With that limited exposure, what was it like to start working at Hopkins?

BM: I was really blessed to have a mentor, who actually still works at Hopkins, who helped train me for it, and I spent probably a month and a half at least, if not two months, of getting to follow her around and get a better understanding of the culture, and then taking over bits and pieces with her there to support me if needed.

I’m very comfortable with the job now, but initially it was very overwhelming because — I don’t know if you’re familiar with Hopkins’ program at all — it’s very, very intense and a different culture — exemplified in the fact that we have a rule book that’s like 10 pages long. [The eating disorder program is] very structured in order to be able to address everybody’s needs.

RO: Would you mind telling me more about the program and how it’s structured?

BM: I work specifically in the inpatient [IP] unit, and then we have a PHP [partial hospitalization program], and then I occasionally take outpatients. But the inpatient unit is a locked psychiatric ward that’s shared with the adult affective disorder patients and the young adult affective disorder patients, which has pros and cons.

People who are significantly depressed may binge or restrict unintentionally without it actually being eating disorder behavior, which can have a complicated effect on the milieu, but it can also be good because patients are engaging and having the opportunity to socialize with people who are struggling with an illness that isn’t theirs. On top of that many people with eating disorders often have comorbidities of depression, bipolar, anxiety, so there’s a lot of good things that I see coming from those groups being together.

The biggest goal of having people inpatient is to do two things — the first is to break the cycle of the eating disorder behaviors, whatever they might be. Typically we see individuals struggling with various forms of bulimia, all forms of anorexia, and occasionally binge eating disorder. But because the people coming to the IP unit are going to be those who are more chronically ill and more acutely ill; most of them come with an anorexic diagnosis because they need to be medically stabilized before they can go through the refeeding process.

Check back on Wednesday for Part II of this interview, which covers more about the role of OT and the lived experiences of Bekah’s clients during their treatment at Johns Hopkins.
A note from the author: Since publishing my first article, Occupational Therapy and Eating Disorders: Bridging the Gap, I have been overwhelmed by the many responses from both students and clinicians, each full of interest and encouragement. That support helped me to make the decision to take my work from theory to reality, and open my own private practice offering the type of services that could reduce the “gap” in care. Thank you so much to everyone who read, shared, and responded to my writing, I am incredibly grateful!

The post Occupational Therapy and Eating Disorder Treatment: An Interview With Bekah Mack, Part 1 appeared first on NewGradOccupationalTherapy.

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As a fieldwork student or new grad, it can be overwhelming when you realize how much there still is to learn, particularly in an ever-changing and expanding field like health care. Without PowerPoint slides to study or a professor’s lecture to listen to, it’s hard to know where or how to even begin.

Previously, we’ve always suggested staying connected on social media or with blogs and websites. But it turns out that there is a thriving community creating occupational therapy podcasts!

Whether it’s during your next commute, while cleaning your apartment or during a much-needed self-care run, this free and easily-accessible ­routine modification opens up endless opportunities for continued OT education on-the-go.

Listening Hack: For longer episodes, I often increase the playback rate to 1.5x in order to get through the episode in one car ride and to keep my wandering mind focused

Time to get started!

If you are using your computer, you can use iTunes. Simply open up iTunes and in the top left corner, click what might say “music” and scroll down to “podcasts.”

Using your phone? You can use the Podcasts app on your iPhone.

Have an Android? No problem. You can use apps like Spotify and iHeartRadio to download your favorite OT podcasts.

Stitcher is a website and app, and it’s fun to use. You can sort by topics and subjects using #hashtags.

While there aren’t tons of OT-specific podcasts out there, podcasts exist all over the internet and you might be surprised to see how much content is relevant our field.

Next time you find yourself feeling curious, or just bored with the Top 100 on your commute, try listening to a podcast. Down below, you’ll see some of our favorite channels. While some aren’t OT-specific, you will find plenty of content relevant to you, both inside and outside the clinic walls. Keeping in mind that podcast preferences are unique, here are some suggestions to get you started:

The Glass Half Full

Jessica and Natalie bring a positive outlook to OT and their clients’ conditions. They are strong advocates for the profession, hoping to spread the word of how important occupations are to individuals. While they have a strong emphasis in neurological disorders, their podcasts covers a wide variety of occupational therapy topics.

Occupied

Brock Cook has started a new podcast dedicated specifically to occupation. With a fantastic radio voice and an Australian accent, Brock makes you feel like you are sitting across the table from him. He interviews OTs from around the world to discuss and explore what occupational therapy looks like in different regions, settings, and countries. Be sure to tune in to this OT podcast because Occupied is definitely up and coming.

Check out NGOT’s own Dominic Lloyd-Randolfi on episode 4!

FOX Rehab

My favorite part of this OT podcast from FOX is that it is run by OTs, for OTs. They are able to share some great insight into working in geriatrics including everything from intervention ideas to getting board certified. They also shine some light on how their business works on doing home health and billing Medicare B. It sounds amazing and I can’t wait for FOX Rehab to start up in my area!

Seniors Flourish

Mandy Chamberlain is changing the game for occupational therapists working with older adults. She has an endless supply of resources for interventions and activities for geriatric rehab. You can see this extend to her podcasts as she interviews clinicians and academics from across the profession. Be sure to subscribe and good luck listening to all her content. She has A LOT.

AOTA

That’s right! Your favorite professional organization is broadcasting straight to your device. Actually, they have several different podcasts you can check out. These are a must for anyone looking at OT podcasts. Why not? It’s the info you want, straight from the horse’s mouth! Given that Living Life to Its Fullest is produced with OT “consumers” in mind, this could even be used as a patient-education tool when appropriate. However, they aren’t very recent or updated.

Milestones: A Child Development Podcast

Allison Carter hosts this podcast that goes in-depth on Sensory Processing, Child Development, and other topics for children with special needs. An OT with over 15 years of experience, Allison does a wonderful job of detailing various areas of child development and other general information. Topics from Early Intervention to various areas of Sensory Processing and Sensory integration are all covered. Definitely a must-listen for those who serve this patient population.

wiredON Development Interviews

As another great option for the rising pediatric clinician, this channel hosts high-energy interviews with clinicians from around the world to explore various issues and treatments used in the pediatric setting.

On The Air

Easily one of the most active and high quality occupational therapy podcasts out there. Stephanie Lancaster is producing a new episode consistently every 1-2 weeks. If you look at her extensive list of episodes, you’ll see some familiar names and faces (and voices) as well as new content creators and sharers.

TED

You have two great options with TED; there are the classic TED Talks and there’s also TED Radio Hour.

While not a podcast, TED talks are amazing to listen and watch. Sarah at OT Potential put together an awesome list of talks that are relevant to occupational therapy. You can even learn more about OT and social media superstar, Bill Wong. He’s been known to talk at quite a few TED talks. Here is my favorite TED talk given by an OT. Everything Holly Cohen says resonates with occupational therapy, and it is really cool to see an OT on the big stage!

TED Radio Hour takes on the same concept of TED Talks of sharing inspiring messages, wise insights and experts’ opinions but in a solely audio format.

Occupational Therapy Insights

“What is occupational therapy?” A question we hear all too often. Frederick Covington and Occupational Therapy Insights is an educational series for parents, educators, and therapists that delves deep into the world of occupational therapy and breaks it down into a form that everyone can understand.

Lifestyle By Design

Lifestyle By Design is a series of interviews created by THE Karen Jacobs. She takes an interesting approach and interviews clients and recipients of occupational therapy to learn how they overcome the challenges of every day. This series is relatively new and Karen Jacobs is a busy woman so be sure to subscribe so you don’t miss her awesome work.

Trojans Talk OT

A podcast from USC that is on again, off again. The few episodes they have are excellent! They focus on everything occupational therapy, including entertaining practitioners, researchers, students, and friends.

The Medical Nomads

Dylan is a physical therapist who does a fantastic job educating and advocating for all healthcare professionals who are traveling or thinking about traveling. His website is great and he actually records his podcasts on Youtube as well so you can watch as well. He even puts in time stamps so you can hop around the video in an organized manner. This is definitely a go-to resource if you are thinking about traveling as a new grad OT.

99% Invisible

Now, this podcast isn’t created by OTs, nor does it even reference occupational therapy specifically; however, it’s included because you will find a lot of the content here will pique your interest as an occupational therapist. The 99% Invisible covers everything from history, to sounds, to cities. But they also include conversations on architecture and curb cuts and the design of products such as cans and holding cylindrical objects. Sound familiar?

RUSK Insights on Rehabilitation Medicine

Dr. Tom Elwood hosts interviews with top professionals in the field of rehabilitation, including those from the Rusk Institute at New York University’s Langone Medical Center and other world-renowned facilities. He covers the whole range of related topics, from “Samantha Muscato: Covering a Broad Range of Occupational Therapy Approaches” to “Dr. John Dodson: Exploring Geriatric Cardiology – Parts I & II.”

RehabCast: The Rehabilitation Medicine Update

Produced by the Archives of Physical Medicine and Rehabilitation (the official journal of the American Congress of Rehabilitation Medicine – ACRM) and hosted by Dr. Ford Fox, this podcast features in-depth interviews with the authors of published journal articles as well as relevant news briefings. Just reading some titles, like “Spinal Cord Injury Urinary Health, Falling Class and MoCa’s New Fame” and “Brain Injury, Guns, & D.C.; Neuromuscular electrical stim done right” might get you interested.

The Voice of the Patient

Founded by Dave Reed, a physical therapist, this podcast seeks to fulfill his mission, “to change lives, that is, to improve the quality of the lives we touch by improving healthcare through not only hearing, but truly listening to the voice of the patient.” Listening helps to remind us that no matter what our productivity requirements or payer expectations are, the patient is our purpose.

Kessler Foundation Disability Rehabilitation Research and Employment

As an organization dedicated to both rehabilitation research and promotion of employment opportunities for individuals with disabilities, we have a lot to learn from the Kessler Foundation. These podcasts give you an all-access pass to amazing opportunities like grand rounds and professional lectures, all from the comfort of your pajamas.

Shepherd Center Radio

People come from around the globe to be treated at the Shepherd Center in Atlanta, Georgia. Not only do they provide high-quality medical treatment and rehabilitation, they are also performing and publishing new research on a daily basis – some of which we learn about through their radio podcast.

Institute on Disability and Public Policy Podcasts

While not specifically focused on occupational therapy or rehabilitation, The Institute on Disability and Public Policy exposes us to crucial knowledge and understanding regarding the experiences, history and political issues affecting the daily lives of our patients.

Ouch: Disability Talk

Rather than solely focusing on data, facts, or history, this BBC Radio podcast uses a personal and sometimes-humorous approach to challenging issues surrounding disability and access. How could it be boring with topics like “How do you learn to trapeze if you’re blind?” and “Using chopsticks with your toes?”

Disability Now – The Download

What do you get when you combine a podcast presenter (Paul Carter), a business coach (Robin Hindle-Fisher), and a disability consultant (Phil Friend)? A very interesting conversation. Listen to Disability Now for inspiring, informative, and sometimes troubling interviews about the realities of people with disabilities in an majority able-bodied community.

But which occupational therapy podcast should you start with?!

Here’s my advice: Pick one that sounds interesting and give it a try. If it doesn’t suit you, try a different one! There are too many high-quality podcasts out there to waste time feeling bored. If you find success, let us know in the comments below! We’d love to add your suggestions to the list.

Happy Listening!

The post The Top OT Podcasts for New Grad Occupational Therapists appeared first on NewGradOccupationalTherapy.

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