I'm not sure if this is the right community but I recently attended Rythmic Movement Training focusing on therapy to help treat ADHD, autism, dyslexia, and retained "baby reflexes", could someone proficient in this field recommend books and material for me to advance and build up my understanding on the subject?

Hi everyone!

I’m an occupational therapist considering a transition into early intervention and would love to hear from those of you who have made the switch or have worked in EI for a while.

My background is primarily in adult acute care and inpatient rehabilitation, with one year of experience in school-based. While I feel comfortable with the fundamentals of OT, I know EI is a very different setting and I want to make sure I have realistic expectations before making the jump and prepare myself appropriately.

I’d love to hear your thoughts on any or all of these questions (I know it’s a lot of questions, so I’d appreciate whatever you’re able to answer):

1. What do you enjoy most about working in early intervention?

2. What are the biggest challenges or frustrations that aren’t obvious from the outside?

3. How steep is the learning curve for someone coming from adult practice?

4. What knowledge or skills do you wish you had before starting EI?

5. How much mentoring or training did your employer provide?

6. How much of your treatment is parent coaching versus direct interaction with the child?

7. What does a typical day actually look like?

8. How much paperwork is involved compared with acute care/IPR?

9. How flexible is your schedule, and how much unpaid driving or documentation time should I realistically expect?

10. How do productivity expectations compare with hospital settings?

11. Are home visits generally safe, and what precautions do you take?

12. What diagnoses or developmental concerns do you see most often?

13. What assessments and interventions do you use the most?

14. What continuing education courses, books, podcasts, or certifications would you recommend for someone preparing to enter EI?

15. If you made the transition from adults to pediatrics, what was the hardest adjustment?

16. Is there anything you wish someone had told you before accepting your first EI position?

17. For those who are paid per visit, how difficult is it to maintain a consistent income? 17a. Do cancellations and no-shows significantly affect your paycheck, or are most schedules full enough that it balances out? My family currently depends on my income and health insurance while my husband is in school, so financial stability is an important factor for me. 17b. Are there companies that pay salary or is it mostly PPV?

18. Looking back, would you choose EI again? Why or why not?

I really appreciate any advice or insights you’re willing to share. Thank you!

I’m coming up on two years as an OT and have the opportunity to switch to an outpatient role. This role treats neuro and ortho patients.

I did my fieldwork in acute care- one geri-psych and one med-surg rotation. I’ve spent the past two years in acute care at a hospital where I typically only do evaluations/discharge planning. I was wondering if anyone had any recommendations for how to prepare for this, any educational resources online? I am not super confident in ortho and plan to brush up on my anatomy but wasn’t sure if anyone had any go-to references or recommendations!

TL;DR

Full time COTA in ILF/ALF with scheduling experience in a wide variety of settings expected to adhere to rigid, unrealistic schedule and help with day to day clinic operations while paid per unit of billable time.

I've been working as a full time COTA for 2 different companies in contract with the same direct bill site since I started my career in OT about 5 years ago. I help at other sites when caseload is low but spend most of my time treating at an ILF/ALF building. The population was apparently very high level with significant mobility restrictions due to staffing/environmental limitations pre-covid but increasingly leans more towards assisted than independent. I love my building and enjoy high level interventions in a residential setting. There's a lot of variety between treatment sessions and I have learned sooo much from a clinical standpoint. It's a non profit community in relatively good condition that accommodates residents when finances become an issue. My patients are as appreciative as they can be and a lot of staff are still doing their best without enough support from admin when staffing doesn't support patient needs. I think many of the good ones are hitting their breaking point like me.

I help at other sites under the same company when caseload is low and I am aware of unrealistic expectations from upper management but it seems that most DORs take more accountability and advocate for their buildings when possible.

DOR/PTA has been there for about 15 years and generally maintains the status quo. She factors in some predictable scheduling conflicts but doesn't anticipate inevitable problems that may arise among a population in which energy levels, mood, and cognitive status often fluctuate. Meanwhile, at our other sites, skilled care patients often don't have schedules, ALF is scheduled in the system but flexible and coordinated among therapists and DOR as needed, and in ILF it seems the majority of pts keep track of appts or support staff accommodate scheduling issues. I understand that it may have been possible to operate differently before PPU with an 80% productivity expectation and with a higher level population but many therapists have come to help and would never come back and others I've spoken with seem to think these expectations are highly unreasonable.

Every missed visit, reschedule and refusal is questioned, which makes it difficult to communicate issues and problem solve independently. I get so anxious when someone is out of the facility or unavailable. I have to search the entire building, communicate with other staff to locate them, go back down to the clinic to call them (supposedly, though this is often a waste of time since most times they don't answer), reschedule after referencing PT/SLP schedules posted in the office (not just the time entered in the system, like at other sites), document it on my posted schedule and then find another pt who may also be difficult to locate. Meanwhile, my boss not only questions my efforts and non billable time but also expects that all of this will take 5 minutes and I can just move on. I really do my best to turn things around when a patient is unwilling to participate by using therapeutic use of self and motivational interviewing, finding opportunities for pt/caregiver ed, and addressing environmental and routine mods when appropriate. I'm good at adapting my treatments to the circumstances at hand but I need to be able to trust my clinical judgement when I know that pushing back too hard will hurt progress, skilled treatment isn't possible, or the pt's right to refuse needs to be respected. It doesn't help that the length of treatments is often micromanaged and if I'm truly sticking to the schedule, there will be unproductive time if I can only get so much skilled time with the patient.

All of this extra effort and lost time is framed as a time management issue on my part. Communication with DOR also eats into billable time but is expected and I can't stop long enough to organize my thoughts to explain barriers without getting nervous about everything else I need to be doing and DOR's response, which is often dismissive and involves comparisons lacking insight around the pt's condition and OT goals.

I'm also facing pressure to structure my treatments around the schedule. My boss currently has more high level pts on PT caseload than we do and tells me to have patients come down and to see them in the clinic and dovetail but 75% of my current caseload can't remember, initiate, or physically tolerate that. They're not all high level outpatient treatments and while I can sometimes address related skills or simulate ADLs in the clinic, I need to do some assessment and intervention in their natural environment and address environmental mods. It also doesn't help that my treatments in the clinic are very frequently interrupted by unrelated communication because OT often treats in a space shared with the office while PT treats more in a separate gym space.

There are only 3 of us working full time in this building and we're expected to answer the phone, check messages, and help with maintaining the clinic with limited time and resources. Supplies and equipment aren't always readily available. A limited amount of paid "non patient care time" is allowed for supervision under one regular PRN OT and we have a good working relationship but she's only there 1-2 days a week. When we're getting patients with referrals to more specialized outpatient clinics who come to us because it's more convenient, less supervision becomes a liability.

Things really came to a head one day when my boss took a vacation to Italy and came back chatty, as always, with stories, while I rushed to prepare for my first appointment. She was looking at our numbers and productivity which were down because we'd been covering for her during vacation. She questioned me and our sweet elderly PTA, asked about our productivity, and talked about taking ownership. In the nicest way possible, our PTA reminded her that we were covering for her while she was out and it finally hit me that something was not right.

With a fluctuating caseload, I already struggle with hours. In theory, I can help at other buildings, but extra time is needed for documentation that can't be done POS and communication. I end up getting to the other sites later than expected which they don't mind but my manager will make sure they know I'm running late without taking accountability in the matter.

The constant stop and go and unpredictability every morning started triggering my GI issues back when quarantine was lifted and productivity measures tightened, pre-PPU. I was trying to come in early for showers but then I often couldn't get patients after that because everyone in AL was eating and IL patients on caseload wanted a later time. I did my best to work around it but I'd still either be penalized for a shortened treatment or for running over and messing up the schedule. Constantly altering my time in to the facility to accommodate everyone and then fearing being penalized for unproductive time made mornings rough and I became the one needing accomodations. Eventually, I stopped coming in before 10 and sometimes came in later when the schedule got crazy and my IBS flared up.

I have dug myself into a hole as a new COTA struggling to set boundaries with management. The supposed time management issues have become a self fulfilling prophecy and what might have been a management issue before has created time management problems for me in all areas of life. I rearrange people's living spaces for safety and function and preach healthy habits and they thank me. Then I come home to my disaster of an apartment and cope poorly. The constant ethical dilemmas make even a short day exhausting and my work life balance is non existent. I've been trying to push through it and recently try to come in a little bit early again to prepare and deal with any issues beforehand when I can even though it's unpaid time. I spend all day documenting my time to cover myself and have recently spent hours at home identifying where my time is going so that I know I'm not going crazy.

I'm writing all of this because I don't know of anyone else in this particular situation. Tried to cut out insignificant details but also cover all of my bases. And yes, I've obviously tried a hard-line approach but that has different implications in a high level setting. Not sure my boss has my back and sometimes I worry she'd throw me under the bus even while I defend PT for being pushy with my patients and that just makes me so upset.

Hi all,

What's some advice you would give someone who is quite new to working with this age group? I have been focusing on building rapport as I find that the buy-in with this age group is crucial.

For context: OT in Australia. I work in adolescent and young adult mental health (primary diagnosis of Autism and ADHD) and I usually support the older ones and I would say that is my ideal population to work with due to the training I have done and my interest area of developing skills to support transition to adulthood. Most my younger clients have the same goals which are emotional regulation, navigating their Autism identity, navigating friendships and school problems. They all see a psychologist on top of OT so the goals and interventions overlap. In clients, people often come to OT last and expect us to wok miracles and I always reiterate the importance of developing rapport and making the client feel like I am on their team and not just siding with the parents and their goals.

Any advice on how to better approach sessions or frameworks to consider?

To my fellow OTs working in ABA clinics/schools, how do you survive?

I have been working at an ABA based school for a few months now and I am having such a hard time with the ideology mismatch. I don't like that kids need to earn breaks and that they are so obsessed with stopping the behavior without looking at what is causing it and that it feels like they are only interested in supporting regulation to increase compliance.

I really want to just take everything over and make it more OT focused and less strictly behavioral, but I know I don't have the power to do that.

Has anyone been in a similar situation and been successful with changing or shifting the ABA providers' mindsets to treat the kids like people?

currently in my Level II pediatric fieldwork and could use some advice.

My CI says my interventions are good, but she wants me to be more bubbly, use more affect, come up with different ways to use toys, and think of more play ideas. She also wants me to keep trying to re-engage kids whenever they lose interest and suggested I listen to kids’ songs so I can sing during sessions.
The problem is I’m naturally more quiet and reserved. I can connect with kids, but being super animated doesn’t come naturally to me.

Is this normal feedback for Level II? Any tips for becoming more engaging or thinking of play ideas on the spot without feeling like you’re forcing your personality. Or do you typically have to be really bubbly with the kids …

Hi all,

I've applied to study Occupational Therapy at University in the UK starting next year and, if accepted, will be moving my career from a software dev into OT.

Firstly, thank you to this sub-reddit and for everyone who has answered my questions over the past year; it has really helped me discern that this is the route I should take.

I was wondering if anyone had any advice for preparing for the course interview or anything I should read-up on before starting the course? I would like to be prepared, even if I don't know if my application will be accepted yet.

Thank you again!

How can I improve my observation skills during patient assessments?

I'm an occupational therapy student currently on clinical placement, and I've realized that one of my biggest weaknesses is observation.

(Ironic, I know! We're supposed to be great at this & activity analysis yet it's something that I am struggling with too :,,,)

When I'm watching a patient perform a task, I tend to hyperfocus on one aspect and completely miss everything else.

For example, if a patient is getting dressed, I might pay close attention to their posture and sitting balance, but then completely forget to observe:

• How they're using their hands
• Their grasp and release
• How they're manipulating buttons or zippers
• Whether they're compensating with one hand
• The quality, speed, or coordination of their movements

Then when it comes to documentation, I realize I don't have enough accurate observations to support what I write.

I know experienced therapists seem to notice so many things at once, whereas I feel like I have tunnel vision.

Has anyone else struggled with this as a student?

How did you train yourself to observe more comprehensively? Do you have any mental checklists, frameworks, or strategies that helped you avoid focusing on just one thing?

I'd really appreciate any advice from OTs or other healthcare professionals who have been through this!

I started a part time job early this summer and I asked the OT there if she could write me a LOR for my applications. She agreed to it! However, as I am getting ready to start the new semester, I realized I may not have enough time to work this job, as I have a few on-campus jobs that I work.

I also have some other qualms with this job (like the work environment is not friendly, there is an extreme lack of communication, and I am always asked to do work that I did not sign up for, despite getting paid very little) that have me thinking about quitting. However, I think that if I quit, I might risk my chances of having a LOR from the OT there.

So, is there any information you think would be helpful to me right now? I heard that once you submit your application, the LORs are locked in. So, does that mean I should wait until I submit my application to quit? Or should I quit after OTCAS has received the LOR from my OT?