Voices of Discernment

Yesterday provided a unique opportunity to meet with an "occupational therapist" who works with adults with mental health issues (a co-worker of Madalin's).  While occupational therapy as we know it does not exist in Romania, many people practice similar principles with a variety of populations.  Right now a group of occupational therapists is working towards creating a national association to gain recognition and developing a professional degree-- the process is inherently slow.

During the sessions with his clients (they just come freely and interact as a group), he works on a variety of craft/woodwork projects that provide a sense of accomplishment and purpose.  His clients love coming to see him everyday because of his warm, encouraging attitude, his sense of humor, and his genuine instillment of self-worth in his clients.  After explaining the general concept of occupational therapy in the US and how we specifically work with mental health issues I couldn't help but wonder what the long-term goal of his sessions were.  He replied that the goals of therapy would theoretically be similar to what I mentioned-- independence, productive living, and community integration.  However, many barriers exist in the current system.  Most of the clients live at home and cannot find employment simply due to their diagnosis.  Many of the limitations placed on these clients are socially constructed due to misconstrued biases, fear, and misunderstanding (and tend to be more blatant than those still in existence in the US).  Additionally, the therapy sesssions are funded by the European Union that demands specific projects to be outlined with the inclusion of their ideals, standards, and expectations.  Unfortunately not many of these principles align with the improved performance and participation of the clients served. 

While discussing these issues I couldn't help but relate my current situation with the language barrier to that of the clients with mental health issues.  We all have a voice, but depending on who is listening we are not always understood.  And so we stumble through our current situation, making the most of what we can, using our resources to the best of our abilities, in hopes that something will change.  Fortunately as occupational therapists we have the ability, nay responsibility, to serve as a translator for our clients so that they can be heard and their participation can be augmented.  When we better understand the needs and situations of our clients, as well as the perceptions and inner-workings of organizations that influence our practice, only then can the current standards of practice be influenced.  Advocacy in our profession is not an option-- there are too many voices that remain suspended in the air.

This first meeting marked the beginning of many interactions and opened the door to a new area of work while I'm in Romania.  I hope to shadow the therapist, learn more about his work and ideologies, and provide foundations towards the future of occupational therapy in Romania.  Already he has shared ideas of developing camps/programs for adolescents with mental health concerns, primarily social deficits, that open a door of opportunity for me to collaborate with him.  Excitement abounds with this new relationship!

Oh, I cannot neglect to mention a wonderful strategy he uses that every therapist should employ on a daily basis:  to prepare his mood and sense of humor he watches 2-3 humorous videos on YouTube.  Try it someday and you might be amazed at how much it improves your relationship with your clients.

Today I finally met with the caregivers for the first time to discuss (interactively, of course) the principles of occupational therapy, how we work with children and caregivers, the basic concepts of the practice model I developed, and to get their feedback.  Using PowerPoint, I composed a variety of slides with roles and occupations that might encompass them, asking them to raise their hand if it was true of them.  Then I showed them slides of some assistive technology we teach clients how to use, again asking them if they had seen the devices before (a reacher, ACC, universal cuff, TTB, and commode were some of the devices they did not know).  Finally, while I went through the practice model I gave them handouts that had blank spaces for them to write as they followed along.  Most of them seemed to like the visual representation of child development and how they can influence the outcomes of a child. 

After the lesson I wanted to gain their insight and opinions on various topics.  Several groups have been here in the past year that taught Montessori methods to the caregivers, but not many of the methods lasted long-term after the instructors left.  To prevent from making similar mistakes I wanted to gain an understanding of the challenges of using the methods, as well as what they didn't like about the way they were taught the methods.  They, too, have a voice that deserves to be understood.  Luckily the one lasting impact made was the notion that the children need to be encouraged to do activities independently-- they will not learn if the caregivers constantly do things for them (even if it gets done faster).  Also, knowing what difficulties they face on a regular basis and their opinions on the needs of the children serve as a valuable starting point for the development of my programs.  I assured them that we will work as a team, teaching each other, and that it will require give-and-take from both ends.  Change is difficult.

Overall they tend to be eager to learn effective strategies that will benefit the children and themselves alike.  Some topics include: behavioral interventions, development of empathy amongst the children, and teaching rules/responsibility.  Other topics that I feel would be beneficial include: introducing sensory modulation, relaxation techniques for the caregivers, and discussing developmental concerns in adolescence.  Many concerns that I hope to address align with those Iulia (a psychologist) would like to address as well.  This will serve the children and caregivers well-- working in the same direction is always easier.  My next steps are compiling a needs assessment, creating my next lesson plan (probably regarding the development of empathy), developing activities for the children to learn different skills (again, starting with empathy/social interest), and continued observation/communication.  Stay tuned!