Using Occupations As Means- My Experience

I am sure a lot of us are familiar with Gray's article on AJOT about Using Occupations as Means and Occupations as Ends from about two decades ago.  So, I decided to write a blog entry on how that really helped me, as I talked about myself using an occupation as means approach.

Back when I started my first level 1 fieldwork in Pediatrics almost 2.5 years ago, I looked lost.  Aside from getting used to the environment sensory wise, I never really had any experience with little kids.  Of course, growing up in a completely different culture also didn't help.  So, aside from troubles of reading the little ones' social cues, my main problem was how I react to the various changes in the environment.

Upon hearing that feedback, I knew I must improve my "kids skills".  So, the OT in me said, "You need to work with kids more.  That's the only way to help you- in regards to interactions as well as knowing what kids might want to do (whether they are able to or not).  It's not easy to start with relative nothing.  But, hopefully you will see some signs of improvement at the end of each Sunday school section you teach."

For the first two Sunday School sections I signed up in spring 2010 (which I taught for about 10-12 weeks because I did this back to back), it was very difficult because I didn't know the kids that well and the kids didn't know me that well either (even though their parents know who I am).  I mainly just focused on the reading and leading the story.  I could care less about what's going on around me.  After these sections, I felt that I did the bare minimum.  I knew that if I were to take it to my fieldwork then, it won't cut it.

So, I decided to sign up for three sections in the 2010-2011 school year.  Aside from my diagnosis, I knew I must work hard so that I can be comfortable with at least one potential OT setting, which became my main motivating factors.  As I was doing the three sections, I did a little better as I tried to interact a little bit more.  However, when I took it to my independent study courses (or bridge classes that are designed to help me to prepare me for level 2 fieldwork), I still encountered some bumps along the road.

After doing another set of task analysis, I made some more adjustments to make sure I have a great PEO fit.  Meanwhile, I also did another section of Sunday School during the time in my recent level 2 FW.  That section (as well as the section I am doing now) really helped because I am able to use what I learned in the OT settings and applied it at my church's Sunday, and vice versa.  Overall, it was really night and day, as the kids got to enjoy me more now, too.

What can be taken away from this experience?  There are several things.

1. Getting to know the client's end goal(s)- such as required skills, client's baseline level, client's assets and limitations.  Most of the work in the Aspie context will be done while obtaining the Aspies' occupational history.  However, there can be things teased out once you have some sessions with the Aspies.

2. Depending on the nature of the end goal(s), it can be a process and there will be some bumps along the road.  It's important to help Aspies to see things in perspective, even when things don't turn out as well as they hope to be.  Sometimes, it can be a long process and the Aspie might not know that.  Hence, positive reinforcement could be needed.

3. Set some goals in occupation(s) that the Aspie will be engaging, even in no-lose situations.  Although I didn't really set them, but here are what would have been.

For first 2 Sunday School sections (in 2009-2010 school year)

STG- Get comfortable in an environment with little kids- to complete at least the minimum required responsibilities as a Sunday School teacher.

STG- Spend 5-10 minutes to reflect on what I did well/what I need to improve on at the completion of the back-to-back sections.

For my next series of Sunday School sections (in 2010-2011 school year)

STG- Try out at least one different activity with the kids.

STG- Build rapport with at least one child.

For this school year's Sunday School sections (in 2011-2012 school year)

STG- Interact with the kids for at least 5 minutes when I am not teaching.

STG- Build rapport with all the "regulars" (which would be around 3-5)

4. Being client-centered is important, but finding a good occupational fit is also important.  In this instance, I used church because it's part of my occupation I will engage on almost all Sundays anyway.  Also, considering that I am a young adult leader at church, so teaching Sunday School is a good occupational fit that will also build my confidence in kids skills.  Last but not least, I am in a setting where learning from my "mistakes" is OK.  All in all, it was a just right challenge for me.  As present and future OT's, this is where collaborating with your Aspies and/or their caregivers can be handy.

5. Reassessment- this is very crucial because it is important to know where the Aspies are to their end goal.  From time to time, you have to see whether they are on the right track, or whether you need to offer other suggestions or change the occupation altogether (if it turns out to be not constructive).  Aside from that, it maybe a good idea to help them apply the "transferable skills" they have just acquired or still in the process of developing.

That's all I have for today.