#251 - Home Health Occupational Therapy with Jessie Given, COTA/L

by Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC April 12, 2023

#251 - Home Health Occupational Therapy with Jessie Given, COTA/L

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Home Health Occupational Therapy with Jessie Given, COTA/L

Jessica Given is a pediatric Certified Occupational Therapist Assistant with 6 years of  intensive experience in the outpatient clinic setting with an emphasis in sensory integration. She is currently serving in the home health setting and has been since 2021. Jessica has completed certification as a Therapeutic Listening Program provider and Clinical Anxiety treatment professional, in child and adolescents. She has extensive experience working with a variety of diagnosis and rare genetic disorders specializing in Autism and Sensory Processing Disorder.

She is incredibly passionate about learning all evidence based therapeutic interventions and programs to best reach goal outcomes and highest level of functioning for all children. Some of her favorites include: Beckman Oral Motor Protocol, Pediatric Rock Taping, Bal-A-Vis-X, Movement and Therapeutic Listening Program, Primitive Reflex Integration, and Yoga and Mindfulness.

Throughout her practice, Jessica always felt drawn to the effects of mental health and behavior and the impact it can have on treatment and goal outcomes. She pursued her certification in anxiety treatment  to improve her holistic approach and empower her clients and families to achieve optimal performance levels and highest function.  Jessica served for 6 years in the Idaho Occupational Therapist Association Board in the roles of Legislative/Reimbursement Chair and as Co-Chair Outreach Coordinator.

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Home Health Occupational Therapy with Jessie Given, COTA_L

Jessie Given, a certified Occupational Therapist Assistant, worked at a sensory integration clinic outpatient pediatric facility in Eagle, Idaho for six years before transitioning to the home health setting in the Treasure Valley where she has worked for two years. She will talk about her experience of working in the home health field with pediatric patients, and provide tips and insights for individuals interested in this career path.

How does providing healthcare services at home differ from providing them to children in a clinic?

Both clinic and home health have their advantages and disadvantages. In a clinic, you have a supportive team and access to various therapeutic techniques and equipment. However, in a home health situation, it may be challenging to utilize certain techniques or equipment due to limited space or lack of resources.

When selecting a setting for their child, parents should consider the child's challenges and the family's feelings. To assist parents in supporting their child at home, both settings should provide opportunities for education and guidance.

At the clinic, we may not have sufficient time to demonstrate the exercises that need to be continued at home. However, in the home environment, we can provide real-time modeling using the available resources.

It is common for children to have difficulty using the skills they learn in our clinic in real-life situations or showing their abilities in a natural environment. Although we may use activities that resemble real-life situations to promote success in our clinic, it does not always lead to success at home.

Advantages Of Receiving Occupational Therapy At Home Compared To In The Clinic

Some kids may benefit from going to outpatient therapy outside of their homes where they won't be triggered or struggle with their environment. The therapy will focus on direct sensory preparation and functional stimulation.

During therapy, we will do various activities such as gross motor sequencing, enhancing sensory processing and regulation control, accomplishing ADL, and engaging in fine motor tasks. The holistic approach we use for each child involves utilizing their whole body, which enables them to make significant improvements. 

At home, we only have 30 to 45 minutes to spend with our children, so we often focus on setting rules and doing practical tasks. However, our children may have a strong attachment to their routines, and our arrival can disrupt their plans.

There are some kids who may resist any changes we make, even with interventions. If that's the case, they may need a different environment to be successful. In this situation, I have referred families to outpatient care. 

Is It Possible To Receive Occupational Therapy Both At Home And In The Clinic?

Although providing occupational therapy in both clinic and home settings may be the most effective approach for children, insurance companies usually do not cover its cost. As therapists, we should still inform parents about community resources, no matter our workplace.

While clinic-based settings provide an opportunity for socializing with other kids and therapists, they may only emphasize specific daily living skills. To work on these skills more effectively, it is recommended to practice them at the child's home. For instance, the skill of bathing or showering can be better mastered at home.

At the clinic, we can help the patient by breaking down the necessary steps and guiding them through each one. We can simulate a complete activity in which the patient completes multiple steps, and provide a visual chart to help them remember each one. 

Additionally, we will ensure that the patient has the necessary physical skills such as gross motor skills, functional postural control, trunk rotation, fine motor skills, dexterity, and grasp strength to be able to wash their own body. However, it's important to note that although we can provide this guidance and support at the clinic, the actual act of washing must be carried out by the child at home.

At home, children are given all the necessary tools and functional skills in real-time to ensure their success without the need to generalize what they learn. They are able to apply it because they are in the same environment where they shower.

Carryover is easier to achieve at home because parents can see the modifications, sensory strategies, and outcomes in real-time. Seeing the success of their child builds the confidence of both the child and the parents, and can lead to improved independence.

Typical Day Like As A Home Health Occupational Therapy Assistant

To provide effective support, it's essential to be well-prepared and organized. You cannot assume that all the necessary equipment will be readily available. It's crucial to plan your treatment ahead of time and divide each step of the session to avoid exceeding the 30-minute time frame.

Prior to beginning the session, it's crucial to converse with the parent. Topics to discuss include any challenges they are experiencing, their objectives for the session, and whether any pressing matters require immediate attention. Additionally, it's necessary to have a full comprehension of the daily regimen of each child and their capacity to complete tasks autonomously.

Jessie uses a bag filled with different items to make the children excited for our session. The bag's contents are regularly changed, and the children call it the "Mary Poppins" bag because it feels magical. This method helps the children prepare their senses before engaging in a multi-sensory activity that stimulates both their body and mind.

Before moving on to the next family, it's important to tidy up the workspace and provide the parents with the necessary materials for them to work on until your next meeting. Additionally, share any progress made during the session with the parents and give them time to clarify any questions they may have.

Type Of Clients Typically Seen In The Home, And How Often

Jessie works in home health with clients ranging from birth to 18 years old. She provides care for various conditions like autism, ADHD, ADD, rare genetic disorders, missed developmental milestones, and developmental delays. 

The frequency of visits depends on the severity of the client's condition or their eligibility determined after an initial evaluation, typically once or twice a week. The home health sessions last for 45 minutes, which is similar to the 60-minute sessions in clinics. 

Occasionally, clinics may offer extended sessions that can last up to 90 minutes, which is not usually possible in a home setting since the billing codes are different. Since the home health environment is more intimate, there are more opportunities to build an effective rapport with both the children and their families. 

You tend to get to know the child on a much deeper level due to the extended time spent in their homes. It can often be easier to determine what works best for each child since she knows their home environment, family dynamics, and their daily schedule.

Is The Home Environment More Flexible Than The Clinical Environment?

We provide excellent therapy services in the comfort of your own home. We offer helpful guidelines and tools to help you achieve your goals and make progress. However, if the child is not making progress toward their goals, we may need to explore different treatment options or end our services.

Our commitment to providing ethical care to our clients remains unchanged in both settings. However, we focus more on assisting the child in achieving maximum independence in daily living tasks in all aspects of their life. Although the goals are generally consistent, it is possible to simultaneously offer speech therapy and physical therapy in a home setting even though these may not be the primary focus of the therapy provided.

Home health occupational therapy is a good option for those who struggle to travel or access clinic care due to its flexibility. For children, it is better to receive therapy at home as they perform better in their familiar environment.

Compared to the clinic setting, the home setting is more comfortable, which leads to greater involvement from the child and their parents. This promotes success and leads to better long-term outcomes.

Does Documentation Differ In Home Occupational Therapy Compared To Clinic?

The program used for documenting a child's progress is the same in both the home and clinic settings. It allows you to track their goals and document their progress. Additionally, the process of documenting is similar in both settings.

Before the session begins, make sure to note the child's progress, such as positive developments and complaints, as well as their readiness for therapy and their parents' experiences during the week. After the session, document the activities, strategies, and protocols used, along with any modifications made and the level of assistance provided to ensure success.

Jessie advises documenting the session immediately afterward. Before heading to the next family, she takes a moment to debrief the parents and takes brief notes or records a voice memo in the child's file. However, the majority of the documentation, home program creation, and resource research for families and children is completed on her own time at home.

Which Activities Do You Typically Use In Home Health?

Stomple is a game that people of all ages enjoy playing. It uses rainbow-colored marbles and has several adjustable difficulty levels that allow players to use their creativity. The game can be an ideal activity for children to improve their fine motor skills and visual-motor coordination with the objective to reproduce a given color pattern.

One way to enhance your child's working memory in an enjoyable way is by engaging them in speed games using a deck of playing cards. By matching the cards quickly, they can improve their ocular motor function. 

Moreover, this game can help them develop good sequencing habits, as they learn to control their impulses and wait their turn. Additionally, card games such as Go Fish can promote fine motor dexterity and bilateral integration, as both hands get used.

Finally, one of the best activities is creating an obstacle course using items from the child's home that they enjoy playing with, and incorporating movements that align with their goals. This is both functional and fun, and the child won't even realize they're working on their skills.

Sensory-Based Interventions Using Items Found in the Home

Many families cannot afford sensory equipment or are unsure where to begin when trying to help their children. As a home health occupational therapist, Jessie demonstrates that you can use everyday household items instead of purchasing expensive equipment.

Families can improve their child's skills by finding household items for fun and productive activities through practice. Below are some ideas to jumpstart your home activities.

  • Create courses using various items found in your house.
  • Engage in vestibular activities, try using couch cushions and blankets to swing the child in a blanket and gently lower them onto the pillows.
  • Get outside: incorporate nature whenever appropriate. 
  • Grab a table, some chairs, and blankets to make a fort. Let's do this under you know, so yeah, it's just figuring out what works for each family in the space they have.

Parents who already have access to a sensory room or equipment can still benefit from the provided tips. However, it's important to recognize that not all families can obtain or afford these resources, and are not always essential for success.

Tips for Occupational Therapists Considering Home Health Employment

If you're a new graduate and interested in working in a home setting, Jessie recommends finding a mentor in your area and building a team of therapists for support. They can share ideas, activities, and treatment options for various diagnoses, as well as provide valuable knowledge and skills.

The new therapists have requested additional practical training experience. Unfortunately, there isn't much time as you are meeting with clients back-to-back and then going home. The workload is heavy and there are frequent scheduling conflicts. 

Obtaining approval on certain strategies from other therapists in real-time can be difficult resulting in delays, and sometimes it can take weeks to receive responses. To overcome this challenge, it is recommended to continue educating yourself and becoming certified in specialties to directly meet the needs of your community.

As a therapist, working in a home setting can be a great option. You have the opportunity to work with children directly in their own environment, with their own rules. It's fulfilling to support families and witness real-time progress, as children can make impressive strides even after just a few sessions. This approach provides a unique perspective on therapy and demonstrates how it can facilitate success and growth.

Advice For Parents Starting Occupational Therapy

Jessie obtained certification and training in childhood and adolescent anxiety not only for the children but also to provide complete support to parents. Parents often come to us feeling anxious about their child's development and may not have much support.

She likes to help parents understand the root cause of their anxiety about seeking services for their children. Her top recommendation is to trust your instincts.

If you sense that something is wrong, what is preventing you from pursuing therapy or other services for your child? Try to prepare yourself mentally for therapy and talk to your pediatrician for recommendations or look for support groups in your community to find help for your child.

Final Thoughts

Jessie Givens obtained certification to facilitate the therapeutic listening program both at home and in clinics to enhance treatment interventions. Being updated in education and having the latest interventions is crucial and therapeutic listening is an incredible tool.

If you work as a therapist in home health or are considering this path, we hope this message has encouraged you. It's clear from her experience that Jessie finds fulfillment in the connections she makes with her clients and the progress they achieve.

 

 

BORING, BUT NECESSARY LEGAL DISCLAIMERS

While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.

Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC
Jessica Hill, COTA/L & Rachel Harrington, COTA/L, AC

Rachel Harrington, COTA/l, AC, CPRCS, and Jessica Hill, COTA/L, CPRCS are Harkla's in-house Certified Occupational Therapy Assistants (COTA) and Certified Primitive Reflex Clinical Specialists. They have been working with children for over 6 years in outpatient settings. They specialize in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica and Rachel are the in-house experts, content creators, and podcast hosts at Harkla! To learn more about Jessica and Rachel, visit the Harkla About Us Page. Make sure to listen to their weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.


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