Sunday, July 31, 2005

on private practice

Hm, perhaps my postings over the next little while will be restricted to text only. I wanted to talk about private practice, and perhaps talk a little bit about what I went through in the last 36 hours, and perhaps talk about a broader desire to help other people get involved in private practice - but now that I can't upload my picture I am feeling a little deflated.

It was of Thelma and Louise, flying over a cliff, preferring to face death than capture. That is kind of what entering private practice is like.

I don't mean this in a negative way whatsoever, despite what the last 36 hours was like.

Now that I am here on my slow dial-up connection I don't have motivation. I might read instead. I think that I am just tired. The sun set around an hour ago. The waves are pushing quietly but insistently at the beach outside. All is right with the world.

Saturday, July 30, 2005

Reasons for working late


OK everyone... make sure to visit here... This will take you to the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC). Yes, this is a wonderful new assessment I am currently enjoying, but it is also why I worked 18 hours today.

The CAPE provides data on an individual’s day-to-day participation for the purpose of intervention planning or measuring outcomes. CAPE scores provide information about the diversity (number of activities done) and intensity of participation, as well as children’s enjoyment of activities and the context of children’s participation (with whom and where they participate in activities). The PAC may be used to assess an individual’s preference for activities.

Both measures are appropriate for clients with or without disabilities between the ages of 6 and 21 years. CAPE and PAC may be used independently or together. Activity types addressed in both measures include: recreational, physical, social, skill-based, and self-improvement.

If I had unlimited time I would create some EXCEL sheets that would do all the crazy calculations that are necessary to score these tests. From the best I can figure, the people who wrote it assumed that they could pass off the data to some hapless graduate student who would pore over the numbers until their eyes crossed. Something must be done.

Anyway, wouldn't it be fun to gather scores on kids who have discrete conditions, and compare them to other groups? Talk about easy, and talk about interesting.

Well, to some of us anyway.

Friday, July 29, 2005

Of birds and toilet bowl flanges and need for vacation


I talked a little about the thinking I do while driving yesterday... and I failed to mention that my absolute best thinking is accomplished while mowing the lawn with my John Deere tractor.

There I was, driving around in established circles in my back yard when I approached my MacGyver-like birdfeeder. I never imagined myself to be overly creative with constructing or building things - I remember frustrating my OT 'media' teachers with my lack of creative skill. But I really redeemed myself with my birdfeeder.

It used to be a pole for the satellite dish, but I removed the dish and capped off the solid steel pole with an (unused) 3" toilet bowl flange, and then attached the bird feeder to the flange. It was ingenious, if I do say so myself. Actually, I probably got the idea to do that while riding on my John Deere. See?

Anyway, there I am driving around and I get to the bird feeder and I see a bird stuck inside the feeder. My first thought was to capture the bird and keep it as a pet, but then I remembered that I wasn't ten years old anymore. Then I thought... 'Look at that stupid bird, stuck inside the very thing that was designed to give him sustenance.' Suddenly, in a flash of insight, I considered how good it would be to go on vacation.

See, my best thinking is accomplished on the seat of my tractor.

Thursday, July 28, 2005

Life Management by Driving Around



Tuesday and Thursdays are traveling days this summer... most of my work on these days is in the homes of families all over Western New York, providing early intervention and home-based preschool services.

  1. There isn't much to do in a car by yourself, so I spend a lot of time thinking. Here are some things that crossed my mind while driving around today:

  1. I thought about buying a Hybrid vehicle to save on gas.
  2. I thought about my newest niece.
  3. Because I am alone in the universe I considered submitting an article to OT Practice on virtual contexts and Blogs.
  4. I checked the Power Vista and Lewiston-Queenston bridge for signs of terrorists. What a world we live in.
  5. I wondered if there was a web site that had lists of what students (i.e. my son) need for college (A google search tonight solved that problem).
  6. I wondered if all my daughters have strep throat (oldest does, younger ones pending).
  7. I thought about my grandmother.
  8. I mentally designed a brochure to advertise a staff member's expertise and certification in lymphedema management for the Lockport office.
  9. I wondered how long it would take me to operationalize my mentally designed brochure.
  10. After seeing a bunch of kids I stopped in Lockport and had an unsuccesful fight with the motors in the Fluidotherapy machine. I decided that I didn't want to be the resident electrician. Expenses be darned - I want someone else to fix these things for me.
  11. I thought about how good it feels to get paperwork done, so I spent the afternoon writing notes.

This is just a small sample, of course. I remember reading an article in an undergraduate management course about 'MBWA' or 'Management By Walking Around.' The idea is that you could keep tabs on 'things' by walking around the worksite and interacting casually along the way. 20 years later and I find that I have modified the concept into 'Life Management by Driving Around.'

If I didn't have my drive time, when would I get anything done?

Wednesday, July 27, 2005

randomly connected thoughts

I was looking for other blogs today that are written by occupational therapists (because I have so much time on my hands). I couldn't find any, and that was a little disappointing.

I am relatively certain that there are a lot of people out there who would have many interesting things to write about.

But relativity breaks down at the point of singularities - and this is where space-time has zero volume and maximum density. Sounds like my mental state at the end of the day.

If I wasn't an OT, I would want to be an astrophysicist - but I lack the mental capacity.

Today I saw a young fellow whose mental capacity far exceeds my own - but he can't tie his shoes yet and he develops unassailable arguments about the methodologies of learning how to print.

He said to me today, "If I am supposed to start my letters at the top, then how come an 'e' starts in the middle?"

My brain, as dense as any singularity in the universe, could not generate a reasonable response.

Tuesday, July 26, 2005

That overwhelmed feeling...


I was asked to go to Amber’s home to complete an evaluation. She is almost two and lives with her mom, grandparents, three aunts, and one uncle. "Her Dad lives with his parents," the mother told me, nonchalantly. She told me as if it was almost the norm.
Their small apartment was in a very poor neighborhood. The walls were streaked with a greasy residue. It was distributed at adult level, and not just on doorframes. I wondered how many years of dirt were accumulated on those walls. Flypaper strips hung obscenely from the doorways, dotted with the remains of insects that couldn't seem to escape the traps.
Amber was a beautiful child, by any measure. She was slight, and her hair curled in casual twists and turns outlining her perfectly symmetrical face and deep brown eyes. She had a microphone buried halfway into her mouth, making humming noises that were distorting terribly over a toy karaoke machine. "She doesn't talk yet," the mother reported, "but she loves playing with that microphone. The mom took it from her so we could begin the evaluation. I winced as I saw exposed wires come out of her mouth with the remnants of foam glued around the edges of the microphone that once made the toy safe. Thankfully, the toy is run on batteries so I doubted it would do too much harm if it short-circuited.
The mom was very concerned that Amber might have some developmental delays. "I had seizures when I was younger; do you think she might have them too?" I listened carefully as she spoke to me, but I focused in on the mom's mouth. Her gums were overgrown and her teeth were misaligned. Her face was very coarse and she had a speech impairment. I wondered if she was beautiful as a child also, and I considered that this might be what her seizure medication did to her. "Oh, I would hope she doesn't have seizures," I said in an honest and positive and hopeful voice. That satisfied the mom, who didn't seem to notice that I didn't answer the question.
I completed the evaluation and as I expected Amber qualified for early intervention services. As I explained this to the mom, I wondered what would be the best way to help. My mind raced through asking permission to adopt the child myself, or recommending parenting classes, or perhaps recommending a center-based program to expose Amber to a different environment... In early intervention it is the parent's choice on how to best meet the needs of the child. I wondered what the mother would choose.
During this last part of the assessment Amber occupied herself with books. As she became bored with a Winnie the Pooh book she reached under the table and grabbed for an old high school social studies textbook. I looked toward the mother, asking if it was ok, and the mom answered, "She can look at those books; I don't mind."
As the mom and I talked I watched Amber flip pages. The book belonged to mom at some point. There was writing on the inside of the cover about pop singers and the mom's name was written all over the book. As we continued to talk, Amber turned to a section of the book that had two facing pages of flags from around the world. Written across the top of the page in red marker was "Contries that I no about." The United States flag was circled boldly, as was the Canadian flag. That kind of made sense, since we were in the US and you could practically see Canada from the location of the mom's apartment. No other flags on the page were circled. As we talked, I thought about the apartment, the flies on the flypaper, and how small this family’s world must be.
As we talked and as I mused, I heard a loud ripping sound that re-oriented me to Amber. She tore out the left facing page that had the two circled flags on it. The mom didn't seem to mind too much as she balled up the page in her hands and said to Amber, "Now you know that books are not for ripping."
My eyes focused on that torn and crumpled page in the mom's hand, and all I could think was that Amber's world had just gotten a little smaller.

At the end of the day, there are still the tomatoes


What a wonderful and busy day we had today.

Getting ready for vacation is always the most stressful part of going on a vacation to me. I always feel a big push to catch up all the paperwork, get all the billing out, make sure all the little pieces are well organized.

I have one pressing problem that I don't know how to solve yet: what do I do with my garden when I am away?? Today I picked my first tomato. It pleased me, but raised the large question.

Then I remembered, there will always be tomatoes left on the vine. Maybe the rabbits will eat them, and that wouldn't be so bad.

Sunday, July 24, 2005

Welcome!

Hi everyone...

This is the ABC Therapeutics weblog. We are occupational therapists in Western New York.

More coming soon...