August 1, 2025 • 28 mins
Cultural humility isn't just a buzzword—it's a transformative force that reshapes how healthcare professionals approach treatment. As Dr. Gus Schlegel shares in this deeply moving episode, a simple moment watching a family eat their traditional meal completely changed her understanding of occupational therapy.
When milestone charts indicated a two-year-old child from an African immigrant family should be learning to use utensils, Dr. Schlege initially saw the mother's questioning response as resistance. Then came the breakthrough: witnessing the family's cultural practice of eating with hands—forming rice patties with meat inside—revealed how irrelevant the standardized recommendation was to this child's daily reality. This profound realization became the foundation for a more contextual, culturally-responsive approach to therapy.
The conversation broadens as both speakers share humbling experiences from home visits that revealed clients' true circumstances. One particularly moving story involves discovering a mother who carried her 17-year-old son with cerebral palsy up two mountains—a 2.5-hour journey—to reach appointments, which prompted the implementation of home-based care. These moments underscore how entering clients' environments unveils realities impossible to understand from clinical settings alone.
The episode explores occupational therapy's unique contributions to mental health treatment, from helping clients develop essential daily living skills to implementing structured group therapy using protocols like Cole's Seven Steps. The "relative mastery" concept emerges as particularly powerful—therapy success defined by clients' own standards rather than textbook examples. A compelling illustration is the photo-based customized patient education materials being developed, which use images of clients performing exercises at their current ability level, respecting their dignity and autonomy.
Whether you're a healthcare professional seeking to deepen your cultural responsiveness or simply interested in more humanistic approaches to care, this conversation offers transformative insights into how understanding context creates more meaningful human connections. Share your own "aha moments" that have changed your perspective, and subscribe for more thought-provoking discussions about bridging gaps in healthcare and human services.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello everyone.
I'm Dr Beatrice Ippolit andthis is your World.
Speaker 2 (00:15):
So way back when I was working in an early
intervention, it's a birth tothree program.
So before children go intoschool, where the municipality
really takes over the fundingand the programming for children
, they're eligible for birth tothree and it's really a federal
program.
(00:35):
So from zero to three, itvaries depending on the state,
but it's generally from zero to36 months and there might be
that bridge.
If a child turns 36 months inMay and school doesn't start
until September, the birth tofeed program will cover the
expense of sending the clinicianout if needed until they start
(00:58):
school.
So I was working with awonderful family.
I've worked with a lot ofimmigrant families, but this
family came from a country inAfrica and I always loved those
experiences because I learned somuch.
I love people and so just thatjust enriches my understanding
of people.
(01:19):
But I was a young clinician andhad just really started.
I was maybe three years into mycareer.
And I was a young clinician andhad just really started.
I was maybe three years into mycareer and I was looking at
milestone charts and so therewas a two-year-old, this
two-year-old boy, and so Isuggested to the mother one day
we really need to start workingon utensil use Fork, spoon and
(01:43):
the mom looked at me why?
And I said well, that's whatthe milestone chart says, it's
right here, look.
And I showed it to her and shegoes oh okay, wasn't convinced,
and I left there thinking whatcan I do to convince her?
Because there wasn't buy-in,and so that was my line of
thinking, right.
A couple of sessions later Icame back and I happened to
(02:04):
catch the family.
They were still enjoying theirmeal, their family meal, and
they were sitting on the floorsurrounded.
There were two pots in themiddle, one was a big pot of
rice and the other one was a bigpot of meat.
And they were, and they invitedme to come and sit down and
participate.
And then you reached in withyour hand and you made yourself
(02:25):
a rice patty like a big patty,and then you took some meat and
you put it inside, rolled it uplike a ball and you ate it.
And there were no utensilsinvolved, and so in that child's
everyday use, at least untilthe child went to preschool or
to school, that child wouldn'teven have been exposed to a fork
(02:47):
or a spoon.
It just didn't make any senseBecause that was not part of her
culture.
It wasn't part of their culture,and so that's where really
understanding the context becameso important to me, and that
was one of those.
You know how you have those ahamoments.
For me, that was a big ahamoment and that just really
(03:07):
changed the entire way that Ilooked at my work.
That humbled me tremendously.
So that's what I mean by.
Speaker 1 (03:18):
You know what Many of us can relate to some level, so
I may not have the sameexperience you had.
That humble you, but I had myexperience that humble me.
I remember I was working withan agency which I'm not gonna
mention the name, and I had aclient and went to see that
(03:41):
client.
In the chart it says client was26.
But upon visiting the client,client was laying in a crib and
I went there play with the babyfor a while and after maybe one
or two minute I looked towardthe caretaker at that time and I
(04:03):
said, oh, where is my client?
And that was my client in thecrib.
Yeah man.
I look at the chart, look atthe caretaker, look at the child
.
I'm like 26 years old, weightedless than 40 pounds.
All the health condition in theworld, you name it, that child
(04:29):
has it.
So could not see, could nothear, could not walk, and that
moment really was like a wake-upcall moment for me.
And that moment had reallyhumbled me.
Personally, I'm not acomplainer, but that moment I
(04:51):
said you know what?
I should be grateful foreverything that I have Instead
of complaining for things that Ishould have and I didn't have.
So it's like that was a ha-hamoment for me.
That moment really had humbledme.
So I completely understand whenyou said you know, you got your
ha ha moment I had it very,very important.
(05:15):
And that's the beauty of beingin the community, being in
people lives, being in peopleyou know like home, to see their
living condition, theircomforts.
I've visited clients wholiterally didn't have anything
you see what I mean but the joythat they always have on their
(05:39):
face.
You're like wait a minute.
So you will have thought that.
You're like wait a minute, soyou will have thought that
client will have a differentattitude.
But you're like, okay, somebodywho basically don't have
anything can carry that smile onher or his face.
What about other people who areblessed with a little of
something?
(05:59):
So that's very important.
Speaker 2 (06:02):
I'll tell you another aha moment that I had.
That just occurred to me too.
So, working in Haiti andthere's a real you've heard of
Paul Farmer, who he helped startPartners in Health, and so
Zamni La Sant, which is thesister organization in Haiti he
(06:29):
led that up until his passing.
One of the things that he saidwas that if clients don't come,
then go and find out what's upwith them.
If they were supposed to showup, then go and find them.
And so it was really importantin Haiti too, with our partners,
those that we were working with, to have this clinic, this
fixed facility.
(06:49):
That was a sign of status, andyou have to come to our clinic,
regardless of how far you haveto travel.
That makes sense to me, becausethat's where you have your
equipment and there's a questionof safety and so on.
But one of the things that wesaid well, when our patient
because we would go down and wewould treat patients didn't show
up, we said to the people thatwe're working with, can we go
(07:12):
visit them?
And so they looked you reallywant to leave here and go out
and walk?
And I said, yeah, and so that'swhen we started going on home
visits, and our first home visitwas, and it really just we
(07:32):
became aware of what this lookslike.
So it was this young, was 18 or19 years old, and he had
cerebral palsy.
So that's when there's someoxygen deprivation that occurs
during the birth.
So the child is typically okay,the fetus, but then during
birth, some complications, sothat part of the brain doesn't
(07:56):
get oxygen for a period of time,and so that leads to some
physical conditions and alsothere could be some cognitive
impacts.
So this child well, I call hima child, but he was a late
teenager wasn't able to walk, hewasn't able to speak, and so
his mother had to carry him.
(08:17):
We wondered well, where arethey?
Let's go?
And so we said let's go visitthem.
They lived up two mountains over, and so in order to get there,
we had to climb up one, two andthen up the next third mountain
to get to them.
So, valley up, valley down, andit took us two and a half hours
(08:40):
to get there and we were justwalking with our light backpacks
, hours to get there and we werejust walking with our light
backpacks.
But then you consider thatthere, whenever the mom had to
take the child, her child, to anappointment had to carry the
child on her back, this17-year-old.
That was just amazing to us.
So then that's when we said youknow what we're really going to
(09:02):
start coming to people's homesand doing visits.
That's where the home carevisits started, just because,
also just understanding thecontext, how people live, that's
what's really appealing to me,and I also, aside from being an
educator, I still work and seeclients in their home, so I go
(09:24):
and visit them.
Speaker 1 (09:25):
Yeah, it's amazing, and I do love home visits
because you know, sometimes youhave people who may be in need
for certain things but will notbe comfortable to ask the OT
person, the social worker orwhomever may come.
You know so over the phone.
But as an occupationaltherapist, a social worker or
(09:49):
whatever the title may be, whenyou get to visit that patient
you get to see what the clientneeds, what the client doesn't
have, what the client shouldhave.
So based on your own assessment, you can put recommendation.
So I had a client I will neverthought that she didn't have
(10:12):
enough to eat until I visitedthat time and I'm like now this
is a client that need to be onmillion wheels you know.
So it's like because we have theservices out there, so if there
are people in need, they maybenefit from it.
But some people they may notknow how to look for the
resources, or some people, forwhatever reason, they don't feel
(10:35):
comfortable to go and ask.
And I'm like, no, if you havethe needs for the services and
it's there, so you may as wellapply for it.
Yeah, so that was the joy thatI used to have when I used to
come back home visit with uh, myprevious employment.
Yep, it's very important, soI'm gonna with like few one or
(10:57):
two benefits of uh ot.
On mental health According toresearch, ot helps individuals
develop skills for daily living,such as self-care, productivity
and leisure activities and whencopying mechanisms.
(11:18):
Ot also teaches individualscoping strategies and techniques
to manage stress, anxiety andother mental health challenges.
Will you agree?
Speaker 2 (11:31):
Yes, and that's a lot .
There's a lot there, and OTreally does touch on all of
those.
So let me start with self-care.
And so that's really just afundamental component of what we
call activities of daily livingADLs for short.
(11:51):
And so, as occupationaltherapists, we focus on helping
clients either develop thoseskills or return to engaging in
them successfully.
And so, with clients who havemental health conditions, we
know that there are mentalhealth conditions like
depression or schizophrenia,where those activities, they
(12:15):
become disrupted and so theclient doesn't engage in them
effectively.
And so we work with our skillset of being able to break down
activities and coaching to beable to bring that person back
to being able to engage in themsuccessfully.
Tell me some of the others.
Speaker 1 (12:34):
OT helps individuals with techniques to manage stress
, anxiety and other mentalhealth challenges.
Speaker 2 (12:45):
Yeah.
Speaker 1 (12:45):
To meaningful activities and accomplishments.
Social participation OTSI alsoencourages or assists with that
and really helps clients intopromoting social connection and
relationships.
Speaker 2 (13:02):
Yes, and so one of the things that we as
occupational therapists doreally well is have a beautiful
protocol for running groups.
It's called Cole's Seven Stepsand it was developed by Madeline
Cole.
She was a professor atQuinnipiac University in
Connecticut, and so Cole's SevenSteps it's pretty, I would
(13:22):
would say, pretty much used byby most most schools or in some
form, and there's there's a realfound foundation.
There.
We learn about the, the rolesthat different people take on
within a group environment.
We learn how to leverage groupsto to be able to elicit outcome
(13:44):
, and, and so those outcomes canbe group goals, they can be
individual goals.
We leverage social learning, solooking and learning from each
other too.
So peer learning, that's reallyimportant.
Speaker 1 (14:01):
What size, normally between 6 to 12, or what's the
size of the group?
Speaker 2 (14:09):
So it can really depend.
It depends on how manyfacilitators you have.
If I were running a biggergroup, then I would want to have
another facilitator, too, tosupport me.
So the way that they wouldtypically run is there would be
some warm-up, right?
So just something to just youknow, start, and it might be
(14:33):
what's your favorite movie, orsomething like that, and then we
, as clinicians, will talk aboutwhat the lesson is or what the
focus of the group session is,and it might be some activity to
further enhance someunderstanding.
It might.
It could be, honestly, it couldbe something that's not mental
(14:54):
health related.
It could be being able to usewe use sock aids to put on socks
, and so educating and providingthat block of instruction about
how to use the sock aid, whatits purpose is, and then we take
and we give them somebackground.
(15:15):
This is important so that youcan be independent.
Then we practice it and we'llgo through steps.
Okay, now take this and youmight take turns with the person
next to you or within a group.
Well, the important part, then,too, is the processing part,
because during processing, we gothrough and there's a group
(15:37):
dialogue where we talk about whythis is important to me as a
group participant and why thisparticular activity that we
engaged in is relevant, what welearned today and how we're
going to then use it orgeneralize the skill.
Speaker 1 (15:54):
Okay, so when running those groups, so the group
leader will be chosen from thegroup participant or it will be
the OT person.
Speaker 2 (16:03):
You know it would be the OT, we could have a
co-leader.
So and that's a really goodpoint too, if I've had, so in
inpatient settings very oftenthere's one or two patients that
just in inpatient settings veryoften there's one or two
patients that just they're notdischarged, there's no safe
discharge plan, and so they tendto stick around, and so because
(16:23):
we have patients come in andout, it might be that we run a
similar group maybe maybe two orthree or four weeks later, and
so that person that's been therefor a while, they might have
had exposure to that.
We've worked with themindividually to develop that
(16:43):
skill, and so we, we give themthat opportunity to really
showcase hey, this is what Iknow, and and that's and they
engage in in educating theirpeers, other patients.
Speaker 1 (16:56):
And they can relate to each other as well.
Absolutely, Because it's likethat's one of the beauty of
group, so it's like to know that, hey, I'm not on the world
alone.
Whatever that I'm dealing with,there are other people who are
facing the same situation and asa group, so it's like we can be
helped to work things out.
So group is very important.
Speaker 2 (17:20):
And, as you know too, when I teach something,
sometimes it becomes clear forme too, and so I know that
giving those that have beenaround, those patients that have
been on the unit for a while,the opportunity to teach their
peers, that helps them reallysolidify that skill too and it
(17:40):
might get them closer todischarge.
Most certainly they'redeveloping self-esteem because
they did something that was veryuseful that day.
And so I know in some unitsthere's different levels, status
levels, right, they call themdifferent things level one, two
and three.
I know in the military it hadto do with you had to stay on
(18:05):
the unit if you were level oneall the way up to level three,
where you could wear youruniform and weren't in a
hospital gown, you couldactually wear your shoes and go
out and go around the hospital,go to the mess hall, the
cafeteria and eat.
So that really helps preparethe person that's been on the
(18:29):
unit for a while for dischargeand that could be part of their
care plan too, being able toeducate others.
That really translates to intowhen they're out in a community
setting, at a community mentalhealth facility, they can be
really, they can feelcomfortable being in a
leadership role at times to helpeducate others.
(18:50):
This is I know a lot about thisand that all would go with them
and they can let the staff knowand that, hey, you know I've
gone through this, I've donethis.
Speaker 1 (19:02):
That's good.
Those who work in the KSACfield.
They have a similar approach.
Speaker 2 (19:07):
Okay.
Speaker 1 (19:08):
And I think you know so they let other peers who have
experience, who have struggledwith drugs and addiction, who
over time had overcome theaddiction and now they use them
as peer specialists to go andhelp other people through their
life's challenges.
(19:28):
So it's very important when youcan use other group members to
educate one another, it'swonderful.
Speaker 2 (19:39):
And a real parallel to that too is the AA, the 12
Steps with the sponsors, thosesponsors that have been sober
for a period of time.
They, they have their struggles, but in in them, being a
(20:02):
sponsor for someone else reallyhelps reinforce their
determination and and theirwillpower to to continue on.
So it can be very validating,rewarding and in a practical
sense too, it's yes, yes, indeedyes indeed my next question how
do you measure theeffectiveness of your
(20:23):
occupational therapy services?
ah.
So if you were to ask me thatit would be.
And so, after the theevaluation process, I really
include my patients in helpingunderstand what it is that they
want to accomplish.
(20:44):
And so there's this, there'sthis idea, there's this concept
called relative mastery, whichmeans that tying your shoe or
frying an egg there might bethis textbook example of this is
(21:05):
how you fry your egg or youmake a breakfast or iron a shirt
, but I can't impose what thetextbook says or what everyone
else says about this is how.
This is what a shirt should looklike.
It has to come from the client.
(21:27):
It's really important for themto know how to use an iron and
how to iron, but really theoutcome is really it has to be
important to the client.
And so that relative mastery isthey complete the ironing task
(21:47):
or they fry the egg to theirspecifications, and so when I
flip my egg, I would dreadbreaking the yolk.
To them it might not beimportant, so I can't impose on
them don't break the yolk or youwere not successful with frying
this egg.
Speaker 1 (22:00):
So the service is kind of like client-centered.
Speaker 2 (22:03):
It's very client-centered, yes, and that
even comes to play when we talkabout exercises.
And so there's this program thatI've been developing, that
Sheila's been helping with too.
It's photo-based, customizedpatient education material, and
(22:24):
so very often when you receivetherapy you're undoubtedly given
some instruction sheet.
So a home exercise programprogram HEP we call them and
there's very often a picture ofa 20-something year old right
doing some exercise and they'rethey're able to raise up all the
(22:48):
way up and full extension or goout, and they might be able to,
or go out, and they might beable to whatever our patients
might not be able to do that.
So if they can't reach all theway up, all the way up to the,
to the, to the ceiling, extendtheir, their shoulders 180
degrees, then by look, based onthe picture, they weren't
(23:11):
successful in that activity,right, because that's what the
20 something was doing so with.
With our photo based customizedapproach, we really take that,
that concept of relative mastery.
Let me see how high you can getthat up, and then I use their
customized picture and I embedit in the instruction sheet so
(23:32):
that they know, based on thepicture, that that shows their
success in the exercise or theactivity.
So it's very, very clientdriven because it cannot be your
treatment.
You're not the one dealing withthe issue exactly and and the
people love see them seeingtheir themselves on the
(23:52):
instruction sheets too I've'vegotten we both have, we've
gotten really good feedback.
Speaker 1 (23:58):
You know, that approach, you know really shows
a sense of respect and dignityfor your patients.
Speaker 2 (24:08):
Yes, absolutely too.
Speaker 1 (24:09):
Because people want to feel that, hey, you know what
I'm capable of making thechange that I need in my life.
So as a professional, you maysee the need, but you don't come
and just impose your own walls.
So you make sure that whateverthe treatment plan gonna be is
(24:31):
gonna be based on the clientdecisions.
Speaker 2 (24:34):
That's exactly right.
Speaker 1 (24:35):
That's powerful.
My next question what role doyou think occupational therapy
plays in promoting overallhealth?
Speaker 2 (24:49):
So because we're very client-centered, we very often
are kind of the person and we'realso team players.
We're the discipline that kindof pulls the team together and
gets everyone talking and makesthose connections, and so we
(25:09):
might not have the skill set ina particular especially when it
comes to medication, for example, we engage with the nurse who
knows about medication.
Do you think that themedication is impacting the
patient?
Maybe a side effect orsomething is impacting the
patient's performance?
What other alternatives arethere?
(25:30):
And so we are collaborators,which is really, really
important.
Also because we can spend thetime with our clients.
We also get to know them.
We get to know the family.
I love going to my clients'homes on the weekends and the
(25:50):
evenings because I run intotheir caregivers, they're
visiting family and so and I'lldo that deliberately sometimes,
oh no, you can't come, then myson's coming.
I don't want the son tointerrupt the session and I say
you know what it would be.
Does your son come?
Does your son help yousometimes?
Yes, I would love to meet yourson, if that's okay with you,
(26:10):
and maybe we can show your sonwhat you do, what we do during
the sessions Okay, and those,and maybe we can show your son
what you do, what we do duringthe session.
Okay, and those sessions theyturn out to be sometimes the
best sessions, because I'mengaging them and if we're doing
some task, I have the familymember there working with us
(26:31):
together, especially if it's acooking task.
Maybe the client will make sometoast, some butter toast for
all of us, right?
And then we sit down and weenjoy it together with a cup of
tea.
Those are the special sessionsthat I really appreciate, so
that's really valuable.
Speaker 1 (26:52):
I assume that oftentimes you will see the joy
on your client face.
Oh yeah, you know because,knowing that, oh, you know what,
I toasted those two slices ofbread by my own, so I was able
to do it my way and so havingpeople enjoying eating those
slices of bread with them, withtea, so that can bring a lot of
(27:14):
joy.
Speaker 2 (27:15):
Absolutely, you know so.
Absolutely.
It really touches on the socialpiece too right.
Mm bread with them, with tea,so that can bring a lot of joy.
Absolutely, you know so.
Absolutely.
It really touches on a socialpiece too right yeah, exactly,
yeah, exactly, yeah.
Speaker 1 (27:22):
So it's like the way that I've seen ot people may
think helping somebody.
You know, fry some eggs ortoast to slices of bread, some
eggs or toast to slices of bread, people who have the capability
(27:42):
of doing it.
Speaker 2 (27:43):
They say it's not a job.
What's the benefit, what's theimportance of it?
Believe it or not, it's verypeople who are in need of autism
services.
Yes, I agree, I agree.
Hello everyone.
I'm Dr Beatrice Ippolit andthis is your World.
Speaker 2 (00:15):
So way back when I was working in an early
intervention, it's a birth tothree program.
So before children go intoschool, where the municipality
really takes over the fundingand the programming for children
, they're eligible for birth tothree and it's really a federal
program.
(00:35):
So from zero to three, itvaries depending on the state,
but it's generally from zero to36 months and there might be
that bridge.
If a child turns 36 months inMay and school doesn't start
until September, the birth tofeed program will cover the
expense of sending the clinicianout if needed until they start
(00:58):
school.
So I was working with awonderful family.
I've worked with a lot ofimmigrant families, but this
family came from a country inAfrica and I always loved those
experiences because I learned somuch.
I love people and so just thatjust enriches my understanding
of people.
(01:19):
But I was a young clinician andhad just really started.
I was maybe three years into mycareer.
And I was a young clinician andhad just really started.
I was maybe three years into mycareer and I was looking at
milestone charts and so therewas a two-year-old, this
two-year-old boy, and so Isuggested to the mother one day
we really need to start workingon utensil use Fork, spoon and
(01:43):
the mom looked at me why?
And I said well, that's whatthe milestone chart says, it's
right here, look.
And I showed it to her and shegoes oh okay, wasn't convinced,
and I left there thinking whatcan I do to convince her?
Because there wasn't buy-in,and so that was my line of
thinking, right.
A couple of sessions later Icame back and I happened to
(02:04):
catch the family.
They were still enjoying theirmeal, their family meal, and
they were sitting on the floorsurrounded.
There were two pots in themiddle, one was a big pot of
rice and the other one was a bigpot of meat.
And they were, and they invitedme to come and sit down and
participate.
And then you reached in withyour hand and you made yourself
(02:25):
a rice patty like a big patty,and then you took some meat and
you put it inside, rolled it uplike a ball and you ate it.
And there were no utensilsinvolved, and so in that child's
everyday use, at least untilthe child went to preschool or
to school, that child wouldn'teven have been exposed to a fork
(02:47):
or a spoon.
It just didn't make any senseBecause that was not part of her
culture.
It wasn't part of their culture,and so that's where really
understanding the context becameso important to me, and that
was one of those.
You know how you have those ahamoments.
For me, that was a big ahamoment and that just really
(03:07):
changed the entire way that Ilooked at my work.
That humbled me tremendously.
So that's what I mean by.
Speaker 1 (03:18):
You know what Many of us can relate to some level, so
I may not have the sameexperience you had.
That humble you, but I had myexperience that humble me.
I remember I was working withan agency which I'm not gonna
mention the name, and I had aclient and went to see that
(03:41):
client.
In the chart it says client was26.
But upon visiting the client,client was laying in a crib and
I went there play with the babyfor a while and after maybe one
or two minute I looked towardthe caretaker at that time and I
(04:03):
said, oh, where is my client?
And that was my client in thecrib.
Yeah man.
I look at the chart, look atthe caretaker, look at the child
.
I'm like 26 years old, weightedless than 40 pounds.
All the health condition in theworld, you name it, that child
(04:29):
has it.
So could not see, could nothear, could not walk, and that
moment really was like a wake-upcall moment for me.
And that moment had reallyhumbled me.
Personally, I'm not acomplainer, but that moment I
(04:51):
said you know what?
I should be grateful foreverything that I have Instead
of complaining for things that Ishould have and I didn't have.
So it's like that was a ha-hamoment for me.
That moment really had humbledme.
So I completely understand whenyou said you know, you got your
ha ha moment I had it very,very important.
(05:15):
And that's the beauty of beingin the community, being in
people lives, being in peopleyou know like home, to see their
living condition, theircomforts.
I've visited clients wholiterally didn't have anything
you see what I mean but the joythat they always have on their
(05:39):
face.
You're like wait a minute.
So you will have thought that.
You're like wait a minute, soyou will have thought that
client will have a differentattitude.
But you're like, okay, somebodywho basically don't have
anything can carry that smile onher or his face.
What about other people who areblessed with a little of
something?
(05:59):
So that's very important.
Speaker 2 (06:02):
I'll tell you another aha moment that I had.
That just occurred to me too.
So, working in Haiti andthere's a real you've heard of
Paul Farmer, who he helped startPartners in Health, and so
Zamni La Sant, which is thesister organization in Haiti he
(06:29):
led that up until his passing.
One of the things that he saidwas that if clients don't come,
then go and find out what's upwith them.
If they were supposed to showup, then go and find them.
And so it was really importantin Haiti too, with our partners,
those that we were working with, to have this clinic, this
fixed facility.
(06:49):
That was a sign of status, andyou have to come to our clinic,
regardless of how far you haveto travel.
That makes sense to me, becausethat's where you have your
equipment and there's a questionof safety and so on.
But one of the things that wesaid well, when our patient
because we would go down and wewould treat patients didn't show
up, we said to the people thatwe're working with, can we go
(07:12):
visit them?
And so they looked you reallywant to leave here and go out
and walk?
And I said, yeah, and so that'swhen we started going on home
visits, and our first home visitwas, and it really just we
(07:32):
became aware of what this lookslike.
So it was this young, was 18 or19 years old, and he had
cerebral palsy.
So that's when there's someoxygen deprivation that occurs
during the birth.
So the child is typically okay,the fetus, but then during
birth, some complications, sothat part of the brain doesn't
(07:56):
get oxygen for a period of time,and so that leads to some
physical conditions and alsothere could be some cognitive
impacts.
So this child well, I call hima child, but he was a late
teenager wasn't able to walk, hewasn't able to speak, and so
his mother had to carry him.
(08:17):
We wondered well, where arethey?
Let's go?
And so we said let's go visitthem.
They lived up two mountains over, and so in order to get there,
we had to climb up one, two andthen up the next third mountain
to get to them.
So, valley up, valley down, andit took us two and a half hours
(08:40):
to get there and we were justwalking with our light backpacks
, hours to get there and we werejust walking with our light
backpacks.
But then you consider thatthere, whenever the mom had to
take the child, her child, to anappointment had to carry the
child on her back, this17-year-old.
That was just amazing to us.
So then that's when we said youknow what we're really going to
(09:02):
start coming to people's homesand doing visits.
That's where the home carevisits started, just because,
also just understanding thecontext, how people live, that's
what's really appealing to me,and I also, aside from being an
educator, I still work and seeclients in their home, so I go
(09:24):
and visit them.
Speaker 1 (09:25):
Yeah, it's amazing, and I do love home visits
because you know, sometimes youhave people who may be in need
for certain things but will notbe comfortable to ask the OT
person, the social worker orwhomever may come.
You know so over the phone.
But as an occupationaltherapist, a social worker or
(09:49):
whatever the title may be, whenyou get to visit that patient
you get to see what the clientneeds, what the client doesn't
have, what the client shouldhave.
So based on your own assessment, you can put recommendation.
So I had a client I will neverthought that she didn't have
(10:12):
enough to eat until I visitedthat time and I'm like now this
is a client that need to be onmillion wheels you know.
So it's like because we have theservices out there, so if there
are people in need, they maybenefit from it.
But some people they may notknow how to look for the
resources, or some people, forwhatever reason, they don't feel
(10:35):
comfortable to go and ask.
And I'm like, no, if you havethe needs for the services and
it's there, so you may as wellapply for it.
Yeah, so that was the joy thatI used to have when I used to
come back home visit with uh, myprevious employment.
Yep, it's very important, soI'm gonna with like few one or
(10:57):
two benefits of uh ot.
On mental health According toresearch, ot helps individuals
develop skills for daily living,such as self-care, productivity
and leisure activities and whencopying mechanisms.
(11:18):
Ot also teaches individualscoping strategies and techniques
to manage stress, anxiety andother mental health challenges.
Will you agree?
Speaker 2 (11:31):
Yes, and that's a lot .
There's a lot there, and OTreally does touch on all of
those.
So let me start with self-care.
And so that's really just afundamental component of what we
call activities of daily livingADLs for short.
(11:51):
And so, as occupationaltherapists, we focus on helping
clients either develop thoseskills or return to engaging in
them successfully.
And so, with clients who havemental health conditions, we
know that there are mentalhealth conditions like
depression or schizophrenia,where those activities, they
(12:15):
become disrupted and so theclient doesn't engage in them
effectively.
And so we work with our skillset of being able to break down
activities and coaching to beable to bring that person back
to being able to engage in themsuccessfully.
Tell me some of the others.
Speaker 1 (12:34):
OT helps individuals with techniques to manage stress
, anxiety and other mentalhealth challenges.
Speaker 2 (12:45):
Yeah.
Speaker 1 (12:45):
To meaningful activities and accomplishments.
Social participation OTSI alsoencourages or assists with that
and really helps clients intopromoting social connection and
relationships.
Speaker 2 (13:02):
Yes, and so one of the things that we as
occupational therapists doreally well is have a beautiful
protocol for running groups.
It's called Cole's Seven Stepsand it was developed by Madeline
Cole.
She was a professor atQuinnipiac University in
Connecticut, and so Cole's SevenSteps it's pretty, I would
(13:22):
would say, pretty much used byby most most schools or in some
form, and there's there's a realfound foundation.
There.
We learn about the, the rolesthat different people take on
within a group environment.
We learn how to leverage groupsto to be able to elicit outcome
(13:44):
, and, and so those outcomes canbe group goals, they can be
individual goals.
We leverage social learning, solooking and learning from each
other too.
So peer learning, that's reallyimportant.
Speaker 1 (14:01):
What size, normally between 6 to 12, or what's the
size of the group?
Speaker 2 (14:09):
So it can really depend.
It depends on how manyfacilitators you have.
If I were running a biggergroup, then I would want to have
another facilitator, too, tosupport me.
So the way that they wouldtypically run is there would be
some warm-up, right?
So just something to just youknow, start, and it might be
(14:33):
what's your favorite movie, orsomething like that, and then we
, as clinicians, will talk aboutwhat the lesson is or what the
focus of the group session is,and it might be some activity to
further enhance someunderstanding.
It might.
It could be, honestly, it couldbe something that's not mental
(14:54):
health related.
It could be being able to usewe use sock aids to put on socks
, and so educating and providingthat block of instruction about
how to use the sock aid, whatits purpose is, and then we take
and we give them somebackground.
(15:15):
This is important so that youcan be independent.
Then we practice it and we'llgo through steps.
Okay, now take this and youmight take turns with the person
next to you or within a group.
Well, the important part, then,too, is the processing part,
because during processing, we gothrough and there's a group
(15:37):
dialogue where we talk about whythis is important to me as a
group participant and why thisparticular activity that we
engaged in is relevant, what welearned today and how we're
going to then use it orgeneralize the skill.
Speaker 1 (15:54):
Okay, so when running those groups, so the group
leader will be chosen from thegroup participant or it will be
the OT person.
Speaker 2 (16:03):
You know it would be the OT, we could have a
co-leader.
So and that's a really goodpoint too, if I've had, so in
inpatient settings very oftenthere's one or two patients that
just in inpatient settings veryoften there's one or two
patients that just they're notdischarged, there's no safe
discharge plan, and so they tendto stick around, and so because
(16:23):
we have patients come in andout, it might be that we run a
similar group maybe maybe two orthree or four weeks later, and
so that person that's been therefor a while, they might have
had exposure to that.
We've worked with themindividually to develop that
(16:43):
skill, and so we, we give themthat opportunity to really
showcase hey, this is what Iknow, and and that's and they
engage in in educating theirpeers, other patients.
Speaker 1 (16:56):
And they can relate to each other as well.
Absolutely, Because it's likethat's one of the beauty of
group, so it's like to know that, hey, I'm not on the world
alone.
Whatever that I'm dealing with,there are other people who are
facing the same situation and asa group, so it's like we can be
helped to work things out.
So group is very important.
Speaker 2 (17:20):
And, as you know too, when I teach something,
sometimes it becomes clear forme too, and so I know that
giving those that have beenaround, those patients that have
been on the unit for a while,the opportunity to teach their
peers, that helps them reallysolidify that skill too and it
(17:40):
might get them closer todischarge.
Most certainly they'redeveloping self-esteem because
they did something that was veryuseful that day.
And so I know in some unitsthere's different levels, status
levels, right, they call themdifferent things level one, two
and three.
I know in the military it hadto do with you had to stay on
(18:05):
the unit if you were level oneall the way up to level three,
where you could wear youruniform and weren't in a
hospital gown, you couldactually wear your shoes and go
out and go around the hospital,go to the mess hall, the
cafeteria and eat.
So that really helps preparethe person that's been on the
(18:29):
unit for a while for dischargeand that could be part of their
care plan too, being able toeducate others.
That really translates to intowhen they're out in a community
setting, at a community mentalhealth facility, they can be
really, they can feelcomfortable being in a
leadership role at times to helpeducate others.
(18:50):
This is I know a lot about thisand that all would go with them
and they can let the staff knowand that, hey, you know I've
gone through this, I've donethis.
Speaker 1 (19:02):
That's good.
Those who work in the KSACfield.
They have a similar approach.
Speaker 2 (19:07):
Okay.
Speaker 1 (19:08):
And I think you know so they let other peers who have
experience, who have struggledwith drugs and addiction, who
over time had overcome theaddiction and now they use them
as peer specialists to go andhelp other people through their
life's challenges.
(19:28):
So it's very important when youcan use other group members to
educate one another, it'swonderful.
Speaker 2 (19:39):
And a real parallel to that too is the AA, the 12
Steps with the sponsors, thosesponsors that have been sober
for a period of time.
They, they have their struggles, but in in them, being a
(20:02):
sponsor for someone else reallyhelps reinforce their
determination and and theirwillpower to to continue on.
So it can be very validating,rewarding and in a practical
sense too, it's yes, yes, indeedyes indeed my next question how
do you measure theeffectiveness of your
(20:23):
occupational therapy services?
ah.
So if you were to ask me thatit would be.
And so, after the theevaluation process, I really
include my patients in helpingunderstand what it is that they
want to accomplish.
(20:44):
And so there's this, there'sthis idea, there's this concept
called relative mastery, whichmeans that tying your shoe or
frying an egg there might bethis textbook example of this is
(21:05):
how you fry your egg or youmake a breakfast or iron a shirt
, but I can't impose what thetextbook says or what everyone
else says about this is how.
This is what a shirt should looklike.
It has to come from the client.
(21:27):
It's really important for themto know how to use an iron and
how to iron, but really theoutcome is really it has to be
important to the client.
And so that relative mastery isthey complete the ironing task
(21:47):
or they fry the egg to theirspecifications, and so when I
flip my egg, I would dreadbreaking the yolk.
To them it might not beimportant, so I can't impose on
them don't break the yolk or youwere not successful with frying
this egg.
Speaker 1 (22:00):
So the service is kind of like client-centered.
Speaker 2 (22:03):
It's very client-centered, yes, and that
even comes to play when we talkabout exercises.
And so there's this program thatI've been developing, that
Sheila's been helping with too.
It's photo-based, customizedpatient education material, and
(22:24):
so very often when you receivetherapy you're undoubtedly given
some instruction sheet.
So a home exercise programprogram HEP we call them and
there's very often a picture ofa 20-something year old right
doing some exercise and they'rethey're able to raise up all the
(22:48):
way up and full extension or goout, and they might be able to,
or go out, and they might beable to whatever our patients
might not be able to do that.
So if they can't reach all theway up, all the way up to the,
to the, to the ceiling, extendtheir, their shoulders 180
degrees, then by look, based onthe picture, they weren't
(23:11):
successful in that activity,right, because that's what the
20 something was doing so with.
With our photo based customizedapproach, we really take that,
that concept of relative mastery.
Let me see how high you can getthat up, and then I use their
customized picture and I embedit in the instruction sheet so
(23:32):
that they know, based on thepicture, that that shows their
success in the exercise or theactivity.
So it's very, very clientdriven because it cannot be your
treatment.
You're not the one dealing withthe issue exactly and and the
people love see them seeingtheir themselves on the
(23:52):
instruction sheets too I've'vegotten we both have, we've
gotten really good feedback.
Speaker 1 (23:58):
You know, that approach, you know really shows
a sense of respect and dignityfor your patients.
Speaker 2 (24:08):
Yes, absolutely too.
Speaker 1 (24:09):
Because people want to feel that, hey, you know what
I'm capable of making thechange that I need in my life.
So as a professional, you maysee the need, but you don't come
and just impose your own walls.
So you make sure that whateverthe treatment plan gonna be is
(24:31):
gonna be based on the clientdecisions.
Speaker 2 (24:34):
That's exactly right.
Speaker 1 (24:35):
That's powerful.
My next question what role doyou think occupational therapy
plays in promoting overallhealth?
Speaker 2 (24:49):
So because we're very client-centered, we very often
are kind of the person and we'realso team players.
We're the discipline that kindof pulls the team together and
gets everyone talking and makesthose connections, and so we
(25:09):
might not have the skill set ina particular especially when it
comes to medication, for example, we engage with the nurse who
knows about medication.
Do you think that themedication is impacting the
patient?
Maybe a side effect orsomething is impacting the
patient's performance?
What other alternatives arethere?
(25:30):
And so we are collaborators,which is really, really
important.
Also because we can spend thetime with our clients.
We also get to know them.
We get to know the family.
I love going to my clients'homes on the weekends and the
(25:50):
evenings because I run intotheir caregivers, they're
visiting family and so and I'lldo that deliberately sometimes,
oh no, you can't come, then myson's coming.
I don't want the son tointerrupt the session and I say
you know what it would be.
Does your son come?
Does your son help yousometimes?
Yes, I would love to meet yourson, if that's okay with you,
(26:10):
and maybe we can show your sonwhat you do, what we do during
the sessions Okay, and those,and maybe we can show your son
what you do, what we do duringthe session.
Okay, and those sessions theyturn out to be sometimes the
best sessions, because I'mengaging them and if we're doing
some task, I have the familymember there working with us
(26:31):
together, especially if it's acooking task.
Maybe the client will make sometoast, some butter toast for
all of us, right?
And then we sit down and weenjoy it together with a cup of
tea.
Those are the special sessionsthat I really appreciate, so
that's really valuable.
Speaker 1 (26:52):
I assume that oftentimes you will see the joy
on your client face.
Oh yeah, you know because,knowing that, oh, you know what,
I toasted those two slices ofbread by my own, so I was able
to do it my way and so havingpeople enjoying eating those
slices of bread with them, withtea, so that can bring a lot of
(27:14):
joy.
Speaker 2 (27:15):
Absolutely, you know so.
Absolutely.
It really touches on the socialpiece too right.
Mm bread with them, with tea,so that can bring a lot of joy.
Absolutely, you know so.
Absolutely.
It really touches on a socialpiece too right yeah, exactly,
yeah, exactly, yeah.
Speaker 1 (27:22):
So it's like the way that I've seen ot people may
think helping somebody.
You know, fry some eggs ortoast to slices of bread, some
eggs or toast to slices of bread, people who have the capability
(27:42):
of doing it.
Speaker 2 (27:43):
They say it's not a job.
What's the benefit, what's theimportance of it?
Believe it or not, it's verypeople who are in need of autism
services.
Yes, I agree, I agree.
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