Occupational Profiles: Long term & Residential Pediatric Care Facility

I am very happy to introduce a new series, Occupational Profiles, with a guest post from Meredith Daly. The hope of the series is to expose readers to different occupational therapy settings, perhaps to spark interest in pursing a specific speciality or perhaps to find commonalities between seemingly very different practice ares. Afterall, as Meredith writes below, we are all working to give clients as much control over their lives as possible.

Q&A with Meredith  

What is your current practice setting?

I work at the Massachusetts Hospital School in Canton, MA, which is a long term & residential pediatric care facility. It’s a really unique model in that a majority of the patients live on campus for a traditional school week; they go home to their families on Friday afternoon and return on Sunday evenings.  I work on the hospital side of the facility (vs the school side) and so get to focus on pediatric physical disabilities without being bound by IEP goals. It’s the best of both worlds!  

Who is your typical clientele? 

MHS services children aged 8-22 years old with multiple physical & cognitive disabilities. There are 5 OTRs on site and we each have our own unit.  We have 2 COTA/Ls that share responsibilities across units as well! My unit is home to 19 patients aged 14-21 who have severe cerebral palsy, spina bifida, seizure disorders, mitochondrial disorders, various chromosomal abnormalities and/or genetic conditions. All but two are non-verbal and five are AAC device users!  

How did you land in this practice area? 

I have always loved working with kids. For a long time I thought I’d be a teacher, but I always had an interest in physical disabilities & rehabilitation. I ended up volunteering at MHS as a high school student in the therapeutic recreation department.  Once I was in, I never left (even while in NYC for grad school!).

How are you specifically poised, as an OT, to help clients in your practice area? 

Really what these kids want to do is have as much control over their lives as possible… luckily that is something that we, as occupational therapists, specialize in (not to mention get joy & satisfaction out of)! Simple things like choosing which book to read next, participating in turning the page, and choosing nail polish colors are a HUGE deal! The training that we got at NYU with focus on client-centered practice, activity analysis, & assistive devices/tech has prepared me with the foundation & confidence I need to help these little guys out.

OT is such a great profession because it allows you to collaborate with your patient to find areas that are motivating & special to each individual.  Since these kids really just want to do “typical things” my goal is to create opportunities for them to make choices & direct their care as often as possible. Obviously as an OT in a hospital setting, many interventions are centered around ADLs & grooming. One of my favorite activities with one of my favorite little chickies is having her use her Dynavox to direct a grooming task. Without doubt she always chooses “paint my nails” or “pick out clothing”. These tasks allow her to work on finger & wrist extension without the use of her very stylish black & hot pink Beniks splints, so while she feels great & proud of herself, she is simultaneously (and secretly!) refining communication skills, directing care, establishing a sense of self/personal style, AND working on upper extremity coordination goals.

What advice would you give to someone interested in your practice area?

Become familiar with wheelchair seating, assistive tech, and AAC devices! When working with kids with severe physical disabilities, it’s important to be educated on current assistive technology approaches! Become as comfortable and familiar as you can with these devices, and then remember that the kids are just kids!  

What areas of growth would like to see in the profession, with regards to your practice area? 

Many standardized assessments are motor based & difficult to administer to students who are wheelchair users, particularly those with all limb involvement. Some of the motor free assessments are difficult due to the communication skills require. I would also love to see more advanced course training for assistive technology as it relates to access & participation in daily life especially at group homes or day programs! Tools for transition preparation & assessment!


Photo of Meredith and a client by the Massachusetts Hospital School