Saturday, July 18, 2009
After spending quite a few years working with adults helping them return to work post-injury, I decided to allocate one day a week to working with kids with developmental difficulties. The change in focus came from my growing interest in child development, a need to 'make a difference', and the sudden opportunity to move into private practice.
Working with adults is challenging. Their issues are numerous and complicated. Their needs are great and urgent. See my Blog on 'My First'.
Working with adults within the Worker's Compensation system is even more challenging. Not only do you need to address barriers to return to work affecting the client, there are many stakeholders involved whose needs you also have to consider - the employer, the insurer, the doctor and other health professionals.
Because of the stakes, everything you have done, and plan to do, must be documented. This is a requirement of the insurer and of the provider you are working for. Every conversation, email, fax must be recorded and filed diligently. Reports must be written frequently. Paperwork is 90% of your job.
So when I first met with the owner of the new paeds practice where I would be working, I was amazed at how little was actually written.
How much do we charge for reports?
"We don't often need to write reports".
How long do you give yourself for writing progress notes in between therapy sessions? I asked.
"We just write them" *puzzled look*
I quickly realised that the focus for practice was not to document every little action. The action itself was important. Paediatric therapy was all about the client and not the process!
My first client was a darling little child, not quite 3 years of age, who had Autism. I chatted with his Mum as we played. We spoke about his current difficulties with communication and sensory issues. We chatted about his inability to play with toys appropriately, and we set goals around these problems. This little man loved his cars and would sit for ages just spinning their wheels. No vroom! vroom! or other behaviours typical of this age group. Our main goal for future therapy sessions? To help this little boy play well with his cars.
After the appointment ended, I sat to reflect. I had taken notes during the session, and made a point of writing out our goals and plans for the next session. There was no report to write because there had been no insurer, doctor or teacher involved in the referral. There were no forms to fill out, or boxes to be ticked. The therapy session had been all about that child and not on the paperwork. I stil enjoy my vocational rehab work, but working with these children has reminded me why I became an OT in the first place.