I N S I D E RI N S I D E RTHE

TEAMWORK!VOL. 9 NUMBER 4: November 2013

Engagement Survey Results

Success Story

Week in the Life

The Magnetic Life

Coordination of Care

A Project ManagementReview

OT in India

PLUS:..

IN THIS ISSUE:

THERAPY2000

We improve lives.

THERAPYTHERAPY

Also: Survey Says | Buddy Walk | Chari-T2000 Update

• Can't Whistle a Symphony. .......... 3

• Engagement Survey ................... 5

• 2-D/3-D Care .........................6-7

• Project Management ................. 8

• Magnetic Life .............................. 9

• Functional Performance ...10-12

• TM Model ................................. 13

• Buddy Walk .........................14-15

• Chari-T2000 .......................16-17

• Change the World .............18-19

• Week in the Life ................20-21

• OT in India ................................ 22

• Survey Says ............................... 23

• Advocacy Update .................... 24

Inside This Issue:

HHaappppyy AAnnnniivveevvevv rrssaarryyrryrr

ANNIVERSARIESOCTOBER

Kristy Winiger.............................. 10/17/2002

Sandra Ordaz ............................... 10/04/2004

A’Donna Corbin ......................... 10/16/2006

Tara Wisdom ................................ 10/09/2007

Julie Walker ................................... 10/20/2009

Anne Pinkenburg ......................... 10/26/2009

Vicki Prouty .................................. 10/28/2009

Darla Grant .................................. 10/01/2010

Risa Grace .................................... 10/04/2010

Kerri Bennett ............................... 10/11/2010

Suomi Gandara ............................ 10/11/2010

Emily Johnson ............................... 10/11/2010

Theresa Mai .................................. 10/25/2010

Carissa Tracy ................................ 10/25/2010

Mercedes Pina .............................. 10/24/2011

Atisha Parbhoo ............................ 10/01/2012

Meredith Kapchinski ................... 10/22/2012

Monica Silva .................................. 10/22/2012

Alexis Vo ........................................ 10/22/2012

Mary Michelle Fleckenstein ........ 10/29/2012

Angela Nelson ............................. 10/29/2012

Robin Perkins ............................... 10/29/2012

NOVEMBER

Guillermo Monjaras.................... 11/08/2001

Areti Hadjigeorgiou .................... 11/30/2001

Jennifer Riley ................................ 11/07/2005

Karen Vardiman ........................... 11/13/2006

Ashley Tarrant .............................. 11/05/2007

Patricia Gurinsky ......................... 11/09/2009

Joanna Littler ................................ 11/30/2009

Georgina Suick ............................ 11/08/2010

Jean Belcher.................................. 11/10/2010

Juan Richard Martinez ................. 11/15/2010

Michael Shane Basham ................ 11/29/2010

Melissa Smith ............................... 11/29/2010

Christina Wrightsman ................ 11/05/2012

Joshua Hubbard ........................... 11/19/2012

Gwen Cassel ................................ 11/26/2012

Mary Crompton .......................... 11/26/2012

Tiffani Johnson ............................. 11/26/2012

Trisha Thorne ............................... 11/29/2012

DECEMBER

Rhonda Gayle ............................... 12/01/2003

Jennifer Barbee ............................ 12/14/2004

Bradley Jeffery .............................. 12/01/2005

Cynthia Lynette Fountain ........... 12/20/2005

Michael Nieto .............................. 12/05/2006

Jessica Martinez ........................... 12/03/2007

Theresa Hill .................................. 12/01/2008

Jorge Marquez .............................. 12/17/2008

Edward de la Cruz ...................... 12/06/2010

Stacey Willmon ............................ 12/07/2010

Andrea Beach............................... 12/20/2010

Karen Cannon ............................. 12/20/2010

Michelle Adams ............................ 12/05/2011

Martha M. Gutierrez .................... 12/05/2011

Crystal Zamora ........................... 12/12/2011

Jamie L Lombardo ........................ 12/19/2011

Tiffany Neal .................................. 12/03/2012

Jennifer Tebo ................................. 12/03/2012

Diane Wallace .............................. 12/03/2012

Katharina Rosas ........................... 12/17/2012

Kathleen Leeper .......................... 12/20/2012

Emily Trof ...................................... 12/31/2012

Editorial Staff

Jerre van den Bent, PTEDITOR-IN-CHIEF

Kyle ButlerMANAGING EDITOR

Alex ParisEXECUTIVE EDITOR

STAFF CONTRIBUTOR

Ira KirkleySTAFF CONTRIBUTOR

Belinda Williams, OTRSTAFF CONTRIBUTOR

Katie NealSTAFF CONTRIBUTOR

Josh FlorenceSTAFF CONTRIBUTOR

Jennifer Lawson, OTR, MSSTAFF CONTRIBUTOR

Steve Tate, SLPSTAFF CONTRIBUTOR

Nick FlorenceSPECIAL CONTRIBUTOR

Melissa Smith, OTSTAFF CONTRIBUTOR

Haley Hilton, OTRSTAFF CONTRIBUTOR

Few great things have ever been accomplished apart from a great team. And though the public often heralds individuals for their contributions to everything from art to governance to invention, it doesn’t take much digging to discover an effective team that col-laborated to make those contributions a reality.

THERAPY 2000 is no different. Our disciplines are built on effective teamwork. There is no effective therapeutic inter-vention apart from the teamwork of an engaged patient, sup-portive caregiver, knowledgeable physician, and skilled thera-pist. There is no meaningful service to the community apart from the teamwork of a therapist, management, and support staff. Throughout 2013 we have invested heavily in fostering a work environment that promotes and supports teamwork, because we believe that teamwork makes a difference when it comes to the Absolute Ultimate Quality of Care (AUQC) for our patients and Absolute Ultimate Employee Experience (AUEE). We plan to further that investment in 2014.

Absolute Employee Experience

I have always believed that the best way to improve the lives of children is by providing employees with an enriching experi-ence. Along those lines, we will be rolling out several new tools in 2014 to make our work easier, more effective, and more collaborative. These include:

• Clinical Competency Model (Q1) – a profile of behaviors de-scribing critical competencies key to a clinician’s professional de-velopment.

• Clinical Program Discussion Boards and Resource Centers (Q1) - dedicated spaces within the company intranet to foster collaboration and support for each discipline and specialty pro-gram.

• T2K Reference App (Q4 2013) – an iPhone and Android app that offers remote access to important company resources and guidance in the field.

• Clinical Learning Tracks (Q1) – expanded learning opportuni-ties focused on improving the transition of classroom knowledge to skilled interventions in the field.

• ClinicalCertificatePrograms(Q3) – learning tracks that can result in official company certification on important clinical top-ics.

Absolute Ultimate Quality of CareThe home health setting offers tremendous treatment benefits

to our patients because of its natural integration with their everyday environment and most significant relationships. We want to partner those inherent benefits with new levels of skilled intervention in order to change the face of pediatric therapy across the State of Texas. I am excited to announce that we will also be piloting multiple programs to improve our patient’s quality of care in the upcoming year. These include:

• Clinical Home Health Treatment Protocols for each disci-pline and specialty program (Q2) – access to evidence-based treatment protocols adapted for the home health setting.

• Patient Outcome Tracking (Q2) – a program to monitor and improve the effectiveness of pediatric interventions across a wide-variety of disciplines and diagnosis.

• A New Autism Program (Q2) – leadership, learning opportuni-ties, and tools to support the effective treatment of a growing segment of our census.

Expanding Our Impact

Not only will we improve the quality of our AUQC and AUEE, we will also bring our services to more areas and different industries. We will be launching a new division in the first half of 2014, the Panhandle Division. Our current Dallas Division Director, Crisann Skinner, will serve as the Division Director for an area extending from north of Amarillo to as far south as Midland/Odessa. We will be able to impact the lives of more kids and provide support to other healthcare entities. THER-APY 2000 will also start an educational services company in early 2014. This company will provide online and face-to-face learning experiences integrated into the social context of ca-reer enrichment. That means that we will take great pains to connect an individual’s learning to their ongoing responsibili-ties in their day-to-day job and their network of fellow practi-tioners. Learning never occurs in isolation, so we don’t think that teaching should occur in isolation either. This new compa-ny will offer consulting services to peer providers in order to share the benefits of our innovative work with children served by other agencies.

These programs will be wildly successful because they rely upon our collective efforts. I believe that the therapists, staff members, and managers that make up THERAPY 2000 can achieve anything if we work together. Undoubtedly, we will all be stretched at times. Collaboration and innovation are dif-ficult skills. They require the ability to listen, to compromise, to see things from a new perspective, and put old assumptions to the side. These things do not always come easily. But when I look back at the accomplishments of 2013, I know it will be well worth it. I predict that 2014 will be a break out year for THERAPY 2000.

YOU CAN'T WHISTLE A SYMPHONY JERRE VAN DEN BENT, PT, ADMINISTRATOR

4

RESULTS OF THE T2K ENGAGEMENT SURVEY BY IRA KIRKLEY, PHR, EXECUTIVE DIRECTOR OF STRATEGIC DEVELOPMENT

THERAPY 2000 recently wrapped up its 2013 Employee Engagement Survey. First off, thank you to the nearly 86% of employees from across the agency that contributed their thoughts and opinions to the survey. It was exciting to see

and reflect on the positive experience shared by so many employees on a daily basis. While there was an abundance of encouraging feedback, there was also very constructive guidance on ways to continue building the quality of every employee’s AUEE (Absolute Ultimate Employee Experi-ence).

What is employee engagement?

Employee engagement is not a simple concept to define. While we all have a sense of our own degree of engage-ment in the workplace and the engagement of our peers, it can be difficult to tease out the various components that lead us to our perceptions. Fortunately, a lot of work has been done in the industry in an attempt to create some clarity. Researchers have devoted their careers to this top-ic for one reason in particular: people that are engaged are more effective in their jobs.

THERAPY 2000’s definition of engagement is made up of seven components:

• Setup for Success – Do employees have the necessary training, equipment, resources, and coaching?

• Career Enrichment – Do employees have opportunities to pursue profes-sional development and promotions?

• Total Pay – Do employees feel they are fairly compensated for the time, expertise, experience, and demand of their position?

• Confidence in T2K – Do employees feel confident about the agency’s direc-tion and its senior leadership?

• Quality of Relationships – Do em-ployees feel good about their work-place relationships?

• Performance Focus – Do employees feel they are encouraged and expected to be successful?

• Personal Fit – Do employees feel like they are a good fit for their current job? Do they enjoy it?

These seven components were explored for four different groups:

• T2K – The agency as a whole and its senior managers

• Manager – Each individual employee’s manager

• Peers – Individuals in the same position within the company

• Self – E ach individual employee’s self-perceptions

Why does it matter?

When these seven components come together for the above four groups, employees demonstrate an enthusiastic willingness to contribute to the success of the people that surround them in the workplace. This willingness can be expressed in a variety of ways, including the following:

• A willingness to go above and beyond expectations to be successful

• Improved ability to utilize change ef-forts for growth

• A desire to help others• The ability to seek out areas of oppor-

tunity and contribute to improvements• A willingness to share the agency’s suc-

cesses with others in the community for recruiting and marketing

Engaged employees are willing to do these things, because they believe that their positive contribution results in the development of a work environment that they highly value.

What does it look like at THERAPY 2000?

Not surprisingly, THERAPY 2000 has many things of which we can be proud. We have each helped fashion a unique and positive workplace experience. As a whole, THERAPY 2000 averaged higher than a 4 (Agree) on all but one com-ponent.

5

RESULTS OF THE T2K ENGAGEMENT SURVEY BY IRA KIRKLEY, PHR, EXECUTIVE DIRECTOR OF STRATEGIC DEVELOPMENT

Some of our obvious strengths include Quality of Rela-tionships (4.48), Performance Focus (4.38), and Personal Fit (4.31). These paint the picture of an agency in which the majority of employees are in a position they enjoy, sur-rounded by people they like, in which they are striving to be successful. These strengths provide us with great tools with which we can continue improving the lives of our patients and one another.

The one clearly identifi ed area of opportunity is Total Pay. THERAPY 2000 has been actively working to address this area over the past year through a number of strategies. These strategies include:

• The creation of over 100 paid career enrich-ment opportunities

• Merit based increases for the fi rst time in 3 years

• A 2013 matching HSA contribution• A 2014 reduction in PPO premiums for full-

time employees• And the development of a Performance Based

Profi t Sharing system

However, we are not done yet. Total Pay requires constant attention as our agency grows and our industry changes. We will continue to develop plans for improvement to our

Total Pay Package in 2014 by improving our educa-tion benefi ts, clinical sup-port, bonus opportunities, and premium pay for select visit times.

On average our therapists earn nearly $3.60 of ad-ditional compensation per visit because of the manner in which we have chosen to compensate for Admit, Eval, Re-Eval, Mentor, and Shadow Visits. That means a therapist with a Per Visit Rate of $55 actually aver-ages an estimated $58.60 in compensation when com-pared to other agencies.

When you combine base compensation, medical care, fringe benefi ts, and bonus opportunities, it is our goal to offer the best Total Pay Package for pediatric therapists in Texas. De-spite ongoing challenges to our reimbursement rates, we will continue to strive to fulfi ll this goal in the most sustain-able way possible.

Next Steps

The Dale Carnegie Institute has identifi ed an individual’s re-lationship with their immediate supervisor as one of the most important drivers of workplace engagement. As a re-sult, we have equipped each manager with a summary of their team’s engagement scores and a process to action plan for improvement. It is very important that we invest in agency-wide solutions and team-specifi c solutions. As a result, each manager has begun assessing their Engagement Score Summary to identify areas of strength and opportu-nity. They will follow-up their assessment by talking to their direct reports about their impressions to better understand the data presented in their summary. Finally, they will work with their team to create an action plan that results in im-proved employee engagement. This process will be occur-ring over the remainder of the year and throughout next year.

TEAMING WITH FAMILIES: 2-D vs. 3-D CARE BELINDA WILLIAMS, OTR, EXECUTIVE DIRECTOR OF TRAINING AND COMPLIANCE “Hi, I’m your OT/PT/SLP…I will be evaluating and treating "Little Johnnie" for develop-mental delays.” Sounds profes-sional enough, but is it enough? This statement defines what is typically expected in tradition-al treatment strategies. The

traditional intervention model is most often based on the dyadic relationship between the therapist and the child. The therapist communicates with the parents/caregivers (P/CG), but spends the majority of treatment time engaged directly and solely with the child. The primary mode of instruction of home programs or other helpful carry-over activities is primarily verbal or by demonstration while the P/CG watches.

However the evidenced based philosophies embraced family centered care (FCC) and participation based care which define early intervention in both community-based and medical home settings are hinged upon the family’s right to be involved in their child’s care. AOTA, APTA and ASHA have each published position statements supporting family centered care and the intent is that all therapists embrace this philosophy as a functional framework for pe-diatric care.

Researchers of the Pearson group in 2007 used the Home Visit Observation Form to measure time spent in thera-pist-led parent-child interactions vs. therapist-child inter-actions and concluded that, “Providers spent more than half their time solely interacting with the child and less than one third their time engaged in parent interactions..." In fact, when providers used strategies that incorporated direct interactions (vs. conversation) with the caregiver and child together, engagement levels of mothers consid-erably increased. According to Bellin, et al., 2011 starting off on the right foot is the key: “It would be important to include questions ex-ploring parent’s concerns related to raising CSHCN (Chil-dren with Special Health Care Needs) and their goals and

expectations for service delivery.” This includes their pref-erences for how the communication would be provided, i.e., verbal, written, demonstration, or guided practice.

Family centered care demands at a minimum, a three di-mensional exchange between the therapist, child AND the family. In order for therapists to hone skills in the FCC arena, approaches such as family-guided activity or routines-based intervention, & participation-based inter-vention must rise to the level of intentional inclusion in goals and interventions. Each requires the clinician to assume the role of teacher within the 3D model. In order to promote participation and learning for the whole family two approaches are recommended: “(1). Adapting the envi-ronment, materials, or the activity/routine, including assis-tive technology, and (2) embedding individualized learning strategies within family routines." (Colyvas, J.L., et al 2010)

Dyadic Service Delivery Model (2D)

Therapist

Therapist

Family

Family Centered Care Service Delivery Model (3-D)6

TEAMING WITH FAMILIES: 2-D vs. 3-D CARE BELINDA WILLIAMS, OTR, EXECUTIVE DIRECTOR OF TRAINING AND COMPLIANCE In order to facilitate these strategies, coor-

dination of care must also be emphasized.

The 3D model then expands to include any

other care providers involved: other ther-

apy providers, physicians, orthotists, men-

tal health specialists, service coordinators,

vendors, case workers, etc. Very often the

therapist becomes both the educator about

available resources and facilitator who di-

rectly engages key professionals on behalf of

the family. THERAPY 2000 is proud to have

both RN & SW Case Managers that provide

critical support to our families and thera-

pists in the execution of care coordination.

References

AOTA, http://www.aota.org/

ASHA, http://www.apta.org/

APTA, http://www.asha.org/

Bellin, M. P.-V. (Nov 2011). Parent and Health Carves on Professional Perspectives on Family-

centered Care for CSHCN: Are We on the Same Page? Health & Social Work, pg. 281.

Colyvas, J. S. (2010). Identifying Strategies Early Intervention Occupational Therapists Use to Teach

Caregivers. American Journal of Occupational Therapy, 64, 776-785.

When therapy goes fl at (2D), the impact of intervention is lessened and upon discharge, families are left feeling helpless and unprepared to carry-over and sustain activities and routine strategies as well as new skills that Johnnie just attained. No wonder some parents panic with the mention of discharge. Taking time to refl ect on our dimensions of intervention is just a starting point. Stay tuned for 50 ways to make P/CG involvement rich and rewarding in the next issue! If you would like to contribute to the list of ideas, please email me at: Belinda.Williams@T2000.com. Credit to all contributors will be cited.

Child

Child

The Information Exchange: Your Are Central to Effective Coordination of Care

Your Are HERE!

PCP/Specialists

Vendors

Family/Client

Co-Providers

7

CELEBRATE THE TEAM! KATIE NEAL, HR GENERALIST

A Review of Franklin Covey ProjectManagement Essentials online Course

Have you ever been assigned to a project or assignment where you felt that you had maybe one or two tools in your tool belt, but you were mostly fumbling around in the dark? Well that’s how I felt when I was assigned to a big work project this summer. I

knew I needed something to help me get started, to give me a direction, and to keep me on track, but I just didn’t know what. In my initial meeting with my supervisor, he suggested that I look into the Franklin Covey Project Man-agement Essentials Course. This is a comprehensive, full-day webinar on the planning, executing, and closing processes of projects. It gives you tools to use and a step-by-step approach to planning and executing a project that can be tailored to or used in any setting. The biggest benefit that I saw was that this type of training would be invaluable to my career - it would be something that I could take with me and use, regardless of where I was or what I was doing.

The day after I took this course, I could not stop talking about it! I really liked the way the course was delivered. I get distracted easily during webinars, but this one was so interactive. The facilitator continually asked for our feed-back, asked for our opinions, and kept us engaged by using a mix of video and slides with discussion. We followed a fic-tional character throughout the process of project manage-ment which really put it into real world context and helped me grasp just how to use these tools and strategies. And speaking of the tools, I was very impressed with the tool kit that came with the course. Along with the book we re-ceived a flash drive that was loaded with all of the tools we discussed during the course, so I didn’t have to start from scratch when I began my project. The great thing about these tools is that they are customizable, so you can take the basics, and customize it to your organization or proj-ect. Another part of the course that really resonated with

me was the part about leading a team. The course gives you strategies for leading and managing a team through a project. Not only does it give you the tools necessary, like a project schedule and a risk assessment form, but it intro-duces you to basic leadership skills like approaching and coaching a team member when they haven’t fulfilled their duties. I also learned how to facilitate a project progress meeting with a team.

One of the most valuable things that I learned through this course is that really focusing on the project before it actu-ally gets started is what really drives the success of the project. Then you can utilize the project schedule and other tools to help keep you on track. I also found the last stage of the process to be very important – closing the project. In this stage, they teach you to look back at the project once it’s complete to see what was done well and what could use improvement in the future. I really like how they tell you to CELEBRATE - celebrate the project’s success with your team, acknowledge the hard work put into the project, and celebrate those who went above and beyond. In the fic-tional example, their project team had an actual celebration with cake and awards! I feel like this step is so crucial and often gets forgotten or is not even acknowledged because it can seem so trivial, but it’s not. You need to let your team members know when they did a good job and that you ap-preciated their contributions. This will only drive success in your next project. Lastly, this training is so valuable because it can be used in any type of project – planning for changes in a company, planning events, even planning a family vaca-tion! These skills will stay with me and I am excited to put them to use on future projects.

For me, this training is currently being put to use. We have some exciting improvements to our employee experience that will be coming soon, so this training has helped me get started, and will continue to help me stay on track and ensure that nothing is forgotten or left out of the process. Even if you don’t know just yet what you will use these skills for, I still recommend that you take it. I promise you will have a use for them in your work or home life. And remember, T2K reimburses for CEU credits!

Interested in this course? Go to www.FranklinCovey.com and search for "Project Management Essentials for the Unofficial ProjectManager." This classmaybe eligible forCEU reimbursement (with supervisor’s approval).DownloadtheCEUReimbursementFormfoundonMangrove.

THE MAGNETIC LIFE JOSHUA FLORENCE, PT

Joshua Florence will be writing a recurring column from his unique perspective. Not only is he a pediatric PT but he also has a daughter with special needs. He see patients in the San Antonio region of THERAPY 2000.

I would like to start off with a quick lesson in physics (please do not tune me out just yet because I said physics). By defi nition, a magnet is a ma-terial or object that produces a magnetic fi eld.

The magnetic fi eld is an invisible force that is responsible for the attraction of objects like iron and opposite poles, as well as repelling other magnets with the same pole. The life of a magnet is full of what are called magnetic moments. Without getting too far off track, we will defi ne a magnetic moment as an action that occurs between the poles causing an attraction or repelling.

I have learned many lessons over the past three years as a parent of a child with special needs. There are many things in our life that shape who we are but are kept hidden in the depths of our hearts and minds. Disability is not usually one of them. It’s hard not to notice the person in the wheel-chair, the little girl who is walking “funny,” the boy who is drooling everywhere or the kid that is yelling and scream-ing like a two-year old having a tantrum but is clearly in his teens. Yes, disability is something that we often have to wear so that all can see, sometimes by choice but often not. It is this exposure that allows what I like to call magnetic moments to occur.

Elle had only been out of the NICU for a couple of days, but as her father, I had made my mind up that I was not go-ing to let her “special needs” stop us from doing anything, so we ventured out. Sharon was much more hesitant, she wasn’t sure if it was the right time to be getting out. You see, Elle had a G-tube placed two weeks prior and we were on an every-three-hour feeding schedule. After fi nishing a few errands to pick up some medications, we decided to go to one of our favorite lunch places. It was time to feed

Elle as well. No matter how discrete you are trying to be, it is hard to hide the fact that you are hooking up a tube to another tube that is coming out of your baby’s stom-ach. Once everything was hooked together, Sharon sat in the booth and held Elle while I stood next to her holding the syringe pouring formula into it. All of a sudden the sy-ringe came out of the extension and the formula dumped all over Sharon and Elle in the booth. Sharon sat there, soaked and almost in tears as she said, “I TOLD YOU THIS WAS A BAD IDEA!!!!” I replied, “Everything is okay, we are fi ne.” As I started to clean up the mess, Sharon whispered, “Now those two ladies are just staring at us!!” I turned and looked over my shoulder, there sat two older ladies across the way watching us. We quickly fi nished eating, packed ev-erything up and began to leave. As we walked out, one of thetwoladieswhohadbeenstaringatusreachedoutandstoppedSharon.“Ma’am,”Ifrozeandthoughttomyself,ohcrap,herewego.Justastearsbegantowellupinthelady’seyes,sheshared,“Ijustwantedtotellyou,thatyouhaveabeautifulfamily.”Iwasspeechless,and did not know how to respond. I looked over at Sharonasshesaid,“Thankyou.”whilecrying.

Over the next few months I would often think back to that day. It was in that moment that I realized that not every-body that is staring is staring for the wrong reasons. You see, that day we had a magnetic moment. It was a moment, we were placed in a situation and realized we had put our "negative" side out. Instead of pushing us further away with another negative, that lady recognized that we needed her "positive" side. It was something so small, something she probably will never remember, but I will remember it for the rest of my life. Our life is full of these moments, times were we see someone and realize they could use an en-couraging word, “Hey- look at how awesome you walking!” or, “I love your wheelchair!” Or something as simple as, “Your daughter is beautiful.” can impact a life and change the way they see world. You get to make the choice. Am I going to repel them away by not saying anything, or do I pull them closer, making them stronger? Life is full of these mag-netic moments; why not focus on making them positive?

THERAPY 2000’S FUNCTIONAL PERFORMANCE MODEL FOR CLINICAL APPLICATION BY JENNIFER LAWSON, OTR, MS

Learning on the Living Edge of NowTHERAPY 2000’s Fri-day education oppor-tunities have been a hallmark of the or-ganization’s commit-ment to learning and professional growth (as well as our desire to community build, network and enjoy good food). These events, other clinical

discipline specifi c opportunities, and T2K training materials have allowed us to explore what it means to provide high quality OT, PT, and ST services at THERAPY 2000. They have allowed us to gain skills and knowledge about a variety of therapy-related topics , from the nitty gritty of speech language assessments to the ins and outs of seating and positioning, to the logistics of becoming a therapist certifi ed in VitalStim®.

THERAPY 2000 is now ready to take these ideas to the next level. We are in the process of streamlining content and adding an emphasis on process and teaching/learning methodology. This will give our therapists the opportunity to plug in exactly when and where they need to, based on interests, preferences, and current professional profi le (for example: new grad vs. experienced clinician). Our goal is for our therapists to gain confi dence and knowledge and deliver services to children and families with quantita-tive and qualitative outcomes. THERAPY 2000’s Clinical Program Directors (see page 12 for list of Program Di-rectors & Managers) will be leading these efforts through the development of a new, comprehensive model of clini-cal competence and application. This model will address varying levels, types and modes of learning. It will measure outcomes so that we can ensure we’re on the right track in meeting the varying needs of T2K professionals, patients and families.

Based on review of current literature and existing avail-able materials and models, much of the work being done in terms of clinical competence and education in the medical and therapy realms appears to be incomplete. In general, missing is a focus on creating the best experience and out-comes for both the professionals involved as learners and the clients. THERAPY 2000 wants to change that. We want to do something different, something better, and something more! Does that surprise you?

You may have noticed these ideas begin to unfold within our new T2K Competency Profi le. As you completed your self-assessments and performance reviews earlier this year, you may have discovered a new emphasis not just on what you know and the skills you may have, but what does it mean, what does it look like when it is put into action? This is where the real magic happens. It also is a new way of thinking for most of us in terms of looking at clinical competency.

How do we learn best? David Boulton , an organizational learning theorist and technologist uses the phrase "learn-ing on the living edge of now.” This concept speaks to that beautiful process that takes place when learning is interwo-ven with context, timeliness, just right challenge, relation-ship, and meaning. It is at this nexus that everything comes together and falls into place. This is our vision for the Clini-cal Programs at THERAPY 2000. We want them to provide you with learning opportunities and experiences that are, "on the living edge of now" so that you can offer the same experience for the children and families with whom you work.

What do you think of when you hear clinical com-petencies?

As our Clinical Program Director team brainstormed about this term/phrase, this is what came to mind:• A long list of tasks and skills for every area of what

we do as therapists• A process that organizations go through to "check

10

THERAPY 2000’S FUNCTIONAL PERFORMANCE MODEL FOR CLINICAL APPLICATION BY JENNIFER LAWSON, OTR, MS

people off" as a “CYA” measure• A process that often doesn’t feel meaningful or

connected to real world learning and performance

We’ve all seen exhaustive lists of skills and knowledge required for different aspects of our jobs; these lists are common in the healthcare industry, and you are likely to have experienced this process if you have worked in set-tings other than at THERAPY 2000. Many of us have been ‘checked off ’ on skills demonstrated, often in an isolated setting lacking the contextual factors present in the real world of the work we do. Many of us have had the experi-ence of gaining a new skill or new knowledge in an isolated educational setting, only to find that when we are back out in that real world, we revert back to what is familiar and comfortable, because we can’t quite assimilate the new in-formation when it really matters.

What do you think of when you hear terms like functional performance, reflectivepractice, and clini-cal application?

This phrase functional performance in particular reminds me of some of the terminology we use when we talk about best practice in working with children and families. It is about providing services in a way that is powerful, mean-ingful, relational, reflective, and most of all about "perfor-mance." It is about being able to show up in the world in a new way, about being able to learn and participate to the best of one’s ability so that the quality of one’s life is en-hanced. This is what we want for the children and families with whom we work. Might we consider that it is what we want for ourselves as growing professionals as well?

Here is the solid foundation that has been created in terms of our current clinical programming at T2000:

• Educational opportunities through our Friday ed-ucation events in all regions

• Some written material for clinical programs and advanced care programs, primarily based on a re-quired skills and knowledge framework

• Program Directors, Program Managers and Men-

tors available to support you in the field for brain-storming and more challenging situations

• Recent move toward having the majority of thera-pists with a Team Manager of the same discipline, allowing for ongoing relationship based mentoring and support

The functional performance model that is currently in de-velopment for THERAPY 2000 is all about performance, action, application, outcomes, and how we grow, learn and change as therapists throughout the trajectory of our ca-reers. Skills and knowledge are, of course, important. How-ever, without process and context, without tuning into the nuances of how clinical reasoning develops over time, and without deliberate practice/performance, our outcomes are insufficient and incomplete, limiting the impact we can have on children and families.

Here is what is currently expanding and/or is on the horizon for clinical programming (Functional Per-formance Model for Clinical Application):

• Clinical program resource materials available in a systematic format, and these materials will serve as the foundation for T2K training materials, as well as revenue-generating materials that can be sold to other agencies/therapists in order to sup-port our diversification

• A variety of training modules (workbooks, eLearn-ing, classes, mentoring, etc.) to further develop the competency of Program Managers and Mentors, Team Managers, and field therapists of all levels, with an emphasis on action, behaviors and out-comes, rather than primarily skills and knowledge

• Greater level of involvement and leadership from Program Managers (vs. Program Directors) in each region/division, as materials, guidelines and processes are developed

• Learning pathways and systems to support your professional development in a systematic and ef-fective way, for the greatest benefit to you as a therapist at the different stages of your career

• Programming and processes that support mean-

(continued on next page)11

THERAPY 2000’S FUNCTIONAL PERFORMANCE...(continued from previous page)

ingful learning and development that directly impacts outcomes for the children and families with whom we work

This is a new and different way of imagining professional growth and development for many of us in the healthcare realm. By envisioning ‘competence’ in this more grand way, this Clinical Program Director team is most definitely "learning on the living edge of now," under the guidance of Ira Kirkley, Executive Director of Strategic Development. Let’s be honest, it isn’t easy…but it is worth it, and some-thing about it feels right.

So what does all of this mean for you?

First and foremost, keep up the amazing work you are do-ing! Stay tuned for details about how education and train-ing will be shifting in 2014 to better reflect this developing vision of a functional performance model for clinical appli-cation. Keep an eye out for additional tools, resources and measures that will accompany this shift in practice. Last but not least, give some thought to who you are as a profes-sional here and now. Consider what’s next, what inspires you, where you see yourself six months from now, three years from now, five years from now. How do you see your-self learning on the living edge of now?

Clinical Programs

Speech Language Pathology• Program Director: Jenny Katz, CCC-SLP (Fort Worth)

Occupational Therapy• Program Director: Jennifer Lawson, OTR, MS (Dallas)

Physical Therapy• Program Director: Alice Anderson, PT, DPT, PCS

(Dallas)

Advanced Care Clinical Programs

Hearing Program• Program Director: Ashley Farleigh, MS, CCC-SLP

(Austin)

High Risk Infant & Toddler Program• Program Director: Alice Anderson, PT, DPT, PCS

(Dallas)• Program Managers:

• Joshua Florence, PT, DPT, CIMI (San Antonio & Austin)

• Trisha Thorne, PT, DPT, C/NDT (Houston)

• Lisa Chance, PT (Tyler)

Feeding Program• Program Director: Cuyler Romeo, OTR, MOT

(Fort Worth)• Program Managers

• Lizzie Norlander, MS, CCC-SLP (Tyler & Houston)

• Evangelina (Vangie) Moncayo, OTR/CCC-SLP (Austin & San Antonio)

• Chessa Jones, MS, CCC-SLP (Dallas)

Assistive Technology Program• Program Director: Mayra Perez (Austin)

• Program Managers• Carol Kretchmar, MS, CCC-SLP

(Fort Worth)

Autism Spectrum Disorder Program(in development)

• Program Director: Jennifer Lawson, OTR, MS (Dallas)

** Note: With the shift to T2K’s Program Director, Program Manager, Team Manager models, the mentoring program is being re-imagined and re-launched. There is local support available in your area, even if not specifically noted on this list. Please contact the corresponding Program Director or Program Manager for guidance.

12

TEAMWORK — THE KEY TO THE TM MODEL

LOOKING FOR A GOOD READ?

In the past OTs, STs and PTs out in the field reported to a District Supervisor. The District Supervisor might or might not have been the same discipline. District Supervisors in larger areas could have as many as twenty reports. In managing thera-pists’ day-to-day work needs little time was left to foster rich employee relationships, provide clinical mentorship or offer guidance on a therapist’s career path. The size of the group was hindering communication and career potential.

In order to foster more of a team atmosphere, THERAPY 2000 rolled out a new direct report model this year. Smaller, same discipline teams report to a same discipline Team Man-ager. TMs are more available to the therapists, helping them to grow clinically and within the company. We checked in with some TMs and therapists across this great state to see how the system was working for the team.

Both therapists and TMs felt strongly about the same discipline pods fostering positive solutions, creative brainstorming and more open communication. Feedback shared included that hav-ing a TM in the same discipline helps therapists get answers to therapy related questions quicker and that they receive better clinical guidance. Having team members of the same discipline can lead to quicker solutions to therapy related issues. It is eas-ier to ask questions and get good clinical guidance when you are working with people in the same discipline. Teams can also brainstorm and help one another with tough cases or diagno-sis. One TM shared, “Having the same discipline TM can support meaningful dialogue for my team.” It appears that everyone brings something great to the table in this type of reporting

structure. Another TM shared, “My team asks me for my clini-cal opinion which opens up discussions about their own clinical skills and fosters new ideas and strategies for treatment. “

Both TM’s and therapist expressed that they felt there was more understanding working with the same discipline. TMs have been in the same shoes so they feel they can relate to the issues, good or bad, that a therapist might currently be experiencing. They are better able to analyze documentation and explain important points within. One therapist shared her thoughts, “I feel like there is a better ‘connection’ when working with a same-discipline TM or supervisor. I feel like they understand my clinical needs better than a supervisor from another discipline. Also, when they review my work, they have a better under-standing of what is reported in my documentation. “

Communication lines have opened with smaller same discipline teams and they use many ways to communicate that might not have been as successful with larger groups. Meeting at the of-fice, Starbucks or even a restaurant is easier with the coordina-tion of less people on the team. Emails back and forth, texting and good old fashioned phone calls keep the lines of commu-nication open.

The TM structure continues to hold incredible potential for the future. In 2014 we will continue to incorporate group learning, patient outcomes, process improvement and recogni-tion systems into the TM structure. By moving in this direction, we have the opportunity to foster small cohesive and effective peer groups that can leverage the significant resources of a state-wide agency.

A patient’s mom, Brandie, wrote a book to teach children more about autism. She hopes the book will, "open dialogue between children and their caregivers about autism and, ultimately, re-duce bullying of children afflicted with the disorder.” “Tricia” (T2K therapist Patricia Gurinsky) plays the role of a speech therapist who works with Koby, a child with autism spectrum disorder. The book is was published by Tate Publishing, Chil-dren’s Division at can be bought here https://www.tatepublish-ing.com/

A synopsis of WhyWon’tHeLookatMe?ABookforChil-dren Struggling to Understand Autism:

“Laura is nervous for her first day at her new babysitter’s

house. All she wants to do is make a friend. But one of the boys acts differently than anyone she has ever met. When Laura learns that he has autism, she doesn’t know what that means. Join Laura as she learns all about autism and her new friend in the book, Whywon’tHeLookatMe?

Right: From page 19 in the book. "Mrs. Tri-cia" arrives for a visit.

Far Right: Book cover

Did you know?• Downsyndromeisthemostcommonlyoccurringchromosomalcondition.Oneinevery691babiesintheUnitedStates

isbornwithDownsyndrome.• There are more than 400,000 people living with Down syndrome in the United States.• Down syndrome occurs in people of all races and economic levels.• TheincidenceofbirthsofchildrenwithDownsyndromeincreaseswiththeageofthemother.Butduetohigherfertil-

ityratesinyoungerwomen,80%ofchildrenwithDownsyndromeareborntowomenunder35yearsofage.• LifeexpectancyforpeoplewithDownsyndromehasincreaseddramaticallyinrecentdecades-from25in1983to60

today.• AllpeoplewithDownsyndromeexperiencecognitivedelays,buttheeffectisusuallymildtomoderateandisnotin-

dicative of the many strengths and talents that each individual possesses.• Quality educational programs, a stimulating home environment, good health care, and positive support from family,

friendsandthecommunityenablepeoplewithDownsyndrometodeveloptheirfullpotentialandleadfulfillinglives.

It was a beautiful, crisp morning for the 2013 Tarrant County Buddy Walk. About 2, 500 walkers gathered for the stroll

created to celebrate Down Syndrome Awareness Month and promote acceptance and inclusion of people with Down

syndrome. Along the one mile pathway were signs with large headshots of North Texas kids with interesting accompany-

ing facts to raise awareness about Down syndrome. $140,000 was raised for the DSPNT (Down Syndrome Partnership

of North Texas) with a portion of the proceeds going to NDSS (National Down Syndrome Society) and the Green Oaks

School in Arlington, Texas. The Green Oaks School is for children and adults with Down syndrome and other developmen-

tal delays. It teaches academics at the level of ability and interest of the students and gives older students job training and

instruction in the community.

In addition to raising funds and awareness, the walk is a great place to meet other families with something in common. We

TARRANT COUNTY BUDDY WALK RAISING AWARENESS ONE STEP AT A TIME

DOWN SYNDROME FACTS:

walked with Tim of “Tim’s Troopers” and his family. Tim has been a patient of THERAPY 2000 and is currently in Kindergar-

ten. One of Tim’s strengths and passions is reading. After reading with Tim all summer his mom was happy to report that

according to his teacher he is currently the best reader in her class! She shared, “I recall how when Tim was born I was so

overwhelmed by his diagnosis and all of the ‘unknowns’ of his future. I soon became aware of all of the things that could

‘go wrong’ with him and of all of the things that he may never be able to do. But year by year and day by day I am realizing

that many of the surprises that Tim's life holds for us and what he can do. I now find my awe and amazement coming at his

accomplishments; his ability to cut a straight line with scissors, to feed himself and open a container of yogurt on his own,

to put on his own socks and shoes, to pull a shirt on and take it off without assistance, to wear ‘big boy underwear’ and

keep them dry (most of the time), to ride a bike, play a game of ‘memory’ with us, the list goes on and on.” Buddy Walk is

the perfect venue to share the accomplishments and show just how valuable kids like Tim our to society.

TARRANT COUNTY BUDDY WALK RAISING AWARENESS ONE STEP AT A TIME

16

CHARI-T2000 UPDATE

Seating System to the RescueKevin is a pleasant, happy-go-lucky, five-year-old boy with devel-

opmental delays. He needed a more stable seating system. He is

very active and curious, to the point of sometimes causing harm

to himself and others. His mother had tried all she knew to keep

him from getting into things, even strapping him into a high chair

when she left the room. Kevin had either broken or fallen over

in at least five different high chairs. His mother was at her wit’s

end. Enter physical therapist Tran Tran, who helped the family find

an appropriate seating system for Kevin, the TumbleForm2 feeding

chair with straps and a tray.

Since his insurance wouldn’t pay for a feeding chair, Chari-T2000

stepped in to provide the primary payment for Kevin’s system. The

newly-arrived seating system now provides Kevin with the means

to remain safely strapped in, as well as to have a flat surface on

which to play, when his mother goes in another room. Kevin’s

mother was very appreciative for this donated gift. It now allows

her to leave the room for a minute without fearing that Kevin is going to harm himself or others. She no longer has to

worry about him knocking over another high chair over and landing on the floor again. Thanks Chari-T2000!

— Steve Tate, SLP

It’salmosttimeforthe4rdannualChari-T2000auction(online)!Bidding begins November 29th and goes through 10 PM December 14th.

This year we are taking it online so everyone can participate. We are still accepting auction items so get your goods in so we can raise money for a great cause. Don’t forget your donated items are tax deductible.

Visit to http://c2k.silentfundraising.com/ to register and bid beginning November 29th - December 14th.

• Signed Cowboys football• iPad air• 32 inch flat screen• jewelry

• gift cards• crafts• photo packages• gift baskets

And much more, all below retail prices!

CHARI-T2000 AUCTION IS COMING!

17

CHARI-T2000 UPDATE CHARI-TEE OFFSeptember 27th was a beautiful day for the inaugural Chari-T2000 golf tournament. About thirty golfers grabbed their clubs and headed out to the Woodbridge Golf Club in Wylie, Texas to play a round with friends for a great cause. Special thanks to our celebrity golfer, Nick Florence, for playing in the tournament. Chari-T2000 would like to thank Holly Swannie for bringing her golf tournament expertise to the table. A huge thank you to tournament co-chairs Sara Wilkerson and Christin Christopherson for their tireless preparation and hard work that ensured our first tournament was a success. We could not have done it without you! Way to go!

Thank you to our amazing volunteers for making the tournament a success:

Holy SwannieSara Wilkerson

Christin Christopherson Eileen Wade

Milford Roque Amy BihlAlex ParisKyle Butler

Shannon Anderson

Teri SpeerErin BellueEmily Chow

Jan DulayTacey FerraroBecky BurgessKimmy Gibson

Jerre van den Bent

Thank you to all our sponsors of the inaugural Chari-T2000 golf tournament

DIAMOND SPONSOR ($10,000)THERAPY 2000

GOLD SPONSORS ($1000)KidsCare

Live Oak State Bank

SILVER SPONSORS ($500)CFO Advisory Services

Innovative Seating and MobilityLift Aids, Inc.

OG2 Network Services

BRONZE SPONSORS ($250)Colin Kugelmann

Cotter & CompanyFinishing & Mailing Center

John Larrimer, Attorney at LawKimmy Gibson

Marshall Wilkerson Sr.Mincey-Carter, P.C.

Singer & Associates P.C.Sync Yoga and Wellbeing

HOLE IN ONE CONTEST SPONSORBoardwalk Audi

Special thanks to Nick Florence for your support!Thank you Celebration for donating dinner.

Thank you Jason Cole from GolfTEC Plano for donating your time.

Swag bag

"Superstars" Sara and Christin

Let's do this!

Nick's Team

Hole in one contest

CHARI-T2000 UPDATE

Nick Florence, Baylor’s 2012 star quarterback was Chari-T2000’s inaugural golf tournament celebrity player. In addition to playing

in the tournament he wanted to share his personal story and about why he supports Chari-T2000.

Change the World with Your Story

Each of us are born into a particular family, at a particular

time, in a particular place. It is these differences that make

each of us unique and different. Our differences shape who

we are and what we do. They set a foundation for our sto-

ries. Moving forward, we each have the opportunity to begin

writing our own stories. And while we intend for our stories

to playout in very specific ways, our stories often take a

different path. So when our stories don't turn out the way

we planned, is there still hope? Yes, there is hope. If we each

realize that our story is unique and special, our lives and

stories will not only be fulfilling, but impactful and inspiring.

My story began in Dallas, Texas where my twin brother and I

were born into the Florence Family with three older broth-

ers (Yes, five boys and no girls). We had so much fun grow-

ing up and were introduced to sports at an early age. As

brothers, we would play football games in the front yard,

which turned into all of us playing sports of different kinds,

including football, golf, pole vaulting and soccer. Fast forward

nineteen years and I found myself headed to play collegiate

football, following in my older brother Josh's footsteps.

I was taught early on by my parents and authority figures

in my life, that our individual stories and lives are meant for

greater purposes than ourselves. In everything we do, we

will be given some sort of platform to be a part of some-

thing bigger than ourselves. The place that we find our plat-

form in, or even the size of our platform, is irrelevant. What

permeates through all different platforms is the fact that

we must take the opportunities that we are given to make

positive, life-changing, impact on the world around us. Little

did I know just how big my platform

would be.

As a freshman on Baylor's football

team, I was unexpectedly thrown

into action and started seven

games. Our starting quarterback,

Robert Griffin III, tore his ACL, and

the backup quarterback, a senior,

separated his shoulder. I think we only won two of the seven

games I started, but I learned a lot and got a taste of what

playing D1 football was like. In the two years following my

freshman season, I was a backup to the eventual Heisman

Trophy Winner, RGIII, until he went on to be the 2nd pick in

the NFL Draft. Then it was my turn.

The media couldn't resist asking how I was going to fill the

shoes, or socks (RGIII was known for wearing crazy socks)

of the Heisman Trophy winner. I had to look deep within my-

self to realize and learn just who Nick Florence was. Would

I choose to be defined by what I do on the football field?

Would I crumble under the pressure of having to perform in

the most praised and critiqued sport in America?

"What was so inspirational about

them was they were all focused

on the victories his daughter, Elle,

had accomplished. Elle's first vic-

tory was being born alive."

CHARI-T2000 UPDATE

Ultimately, I realized that not many people get the oppor-

tunity to play sports. Even fewer people get to play quar-

terback. Fewer than that get to play at a D1 school in the

Big XII. And only seventy-seven get to replace a Heisman

Trophy winner. Wow! I was given an opportunity not many

people get. I have been blessed with gifts and abilities many

people only dream to have. I was now given a platform big-

ger than most people can imagine. I knew, though, that I was

called to use my platform for something beyond myself.

As the year began, my brother Josh began texting me differ-

ent inspirational messages. What was so inspirational about

them was they were all focused on the victories his daugh-

ter, Elle, had accomplished. Elle's first victory was being born

alive. Knowing that if she were to

be born alive she would be born

with multiple severe disabilities,

the doctors advised Josh and Sha-

ron to terminate the pregnancy, as

her chances to live would be slim.

Therefore, Elle's first victory came

thanks to her parents, who decided

to continue the pregnancy. You see,

it is important to realize that our actions don't always exist

in a vacuum - our actions can actually provide opportunities,

hope, and victories for the people around us, as well. While

Elle's first three years of life haven't been the easiest, the

choice her parents made have led to victories that doctors

said were impossible. Elle's victories became my inspiration

throughout my senior season at Baylor.

The night before the final home game of the season, I had

to the chance to speak to my team at our chapel time. That

week, my brother had sent me a necklace that he had bought

when the doctors told him to make funeral arrangements

for Elle, before she had even been born. He asked me to

wear it in honor of Elle, but also to show that life is more

than about ourselves. At that chapel, I shared with my team

about Elle, and about the necklace. I focused on the fact that

I was dedicating my final game to my niece, Elle, and chal-

lenged my team to dedicate the game for someone else, too.

You see, when we live life for others and move beyond the

"Me" attitude, life is so much more fulfilling. It brings more

joy than you could imagine and allows you to live beyond

yourself.

Additionally, at this last home game, THERAPY 2000 had the

opportunity to bring kids to the game. This was my first

interaction with THERAPY 2000. Walking out of the locker

room after the game, I had the privilege of meeting several

of the children that attended the game that day. The smiles

on their faces were the most pure, joyful grins that I have

ever seen. What an inspiration it was to see children, who

culture says are imperfect and “not normal”, with more joy

and life than most people experience in a lifetime. The kids

from THERAPY 2000 are truly living life to the fullest. They

are using their stories and their choices to impact many

people's lives, including mine.

I have had the privilege to be a part of Chari-T2000, the

charitable arm of THERAPY 2000 through Josh and be a

part of their first ever golf tournament. It was a wonderful

event but an even better cause. I had the opportunity to get

a few of my friends to come play with me and see firsthand

all the amazing things that Chari-T2000 is doing.

I have shared with you my story and how I have been able

to use my platform of playing football for something bigger

than me. As I move on with my life after football, my plat-

form will change and most likely get smaller, but that’s OK.

What matters is that I am using my platform to be a part

of changing and making an impact in the world around me.

We all have our own story. What's your story and how will

you use it?

"What was so inspirational about

them was they were all focused

on the victories his daughter, Elle,

had accomplished. Elle's first vic-

tory was being born alive."

20

A WEEK IN THE LIFE MELISSA SMITH, OT

Meet Melissa Smith:I have been an occupational therapist for seven years. I be-gan my career working with the adult population in the rehabilitation setting and then at the Burn Unit here in San Antonio. I quickly found my way into the pediatric world and have LOVED it ever since. I am married to my won-derful husband, Hunter and we have two beautiful children Sydney (4) and Caleb (2). I started working part-time for THERAPY 2000 almost three years ago and became a Team Manager a little over a year ago.

Monday Oct 21st I start my Monday mornings checking DARs for my OT team and then head off to my first patient at 10 AM. I am prepared for a rough start this morning because this little guy recently had surgery and has been on hold for a few weeks during his recovery. Surprise, surprise he runs straight to me with a big hug! What an awesome way to start off my day and week! I have back to back patients for the rest of the morning before making a quick stop by the office to grab some supplies and an assessment. While I’m there I check in with the office staff, our awesome staffer and AOS, to make sure there is no new news for the OT team. We discuss a few patients that need to be staffed and the upcoming CEU event. Then I’m back on the road for my afternoon kiddos. Whew… I saw 8 kids today and I’m ready to go pick up my two kids and head home!

Tuesday, Oct 22nd 9 AMHave a fun visit planned! I’m going with an awesome patient and her family to get her fitted for her power wheelchair. Now I know typically PTs will go on these types of visits but I get to go because she requires a specialized joystick that needs to be positioned just right so she can independently drive her chair due to her severe physical limitations. Although I am not an expert in Assistive Technology, I have an awesome team member who is and has agreed to come out and do mentor visits with me. Now we can make the best recommendations for this patient to get what she needs to be successful. This is one of the best aspects of the Team Model.

Tuesday, Oct 22nd 2:15 PMEvery Tuesday at 2:15 PM the Team Managers along with our Regional VP/DD have our weekly WIG (Wildly Important Goals) call. We have a great team and these calls give us a chance to share ideas, and discuss ways and strategies used to make each of our teams successful.

Caleb and Sydney

Patient with new power wheelchair

HOME HEALTH ESSENTIALS:

• Sunglasses

• Car Phone Charger

• Snack Cooler with water and snacks

• Knowledge of where to stop at for the

cleanest restrooms!!!

21

A WEEK IN THE LIFE MELISSA SMITH, OT

Wednesday, Oct 23rd Wednesdays are usually, one of my busiest days but unfortunately had several cancellations so I decided to call one of the other OT TMs and see if she was free for lunch! What a great way to fill the gap in my day, great lunch and good conversation. After lunch I head out to do some mentor visits with some of my team members. This is really a great way to collaborate with other OTs and get new ideas and information to use with your own patients. Although I don’t always have the time to schedule several mentor visits in a day, it is nice when it works out. We have an AWESOME OT Team in San Antonio!

Thursday, Oct 24th

I woke up bright and early this morning to head to the gym at 7 AM and then head out to my first patient at 9 AM. Every day I spend several hours on the phone between patients or in the evenings with other Team Managers and/or with team members to discuss any difficulties or concerns that may have evolved during the day or week. We are get-ting close to the end of the month so scheduling and completing re-evaluations and meeting deadlines are a large part of my end of the month conversations including difficulty scheduling visits and evaluations, getting team members to help cover make up visits, and the latest changes for insurance requirements for re-evaluations.

Friday, Oct 25th * 8 AMTypically, Friday is my make-up day and today I have quite a day scheduled. I usually try to make-up all missed visits within the same week, especially at the end of the month to make sure my patients receive all their visits. Although, Friday is not my favorite day to work who wouldn’t be happy when you have such wonderful patients!

Friday Oct 25th, 4pmNow that work is done, it’s off to the Pumpkin Patch for some fam-ily fun! Have a great weekend!

22

I was recently given the opportunity to join nine other members of Northwest Bible Church of Dallas on a two-week mission trip to India. We stayed at Asian Christian Academy (ACA), which is about a two-hour drive from Bangalore. The ACA campus has a small hospital, a school for kindergarten through 12th grade, a seminary and an orphanage/student hostel. We lived on campus and served in various capacities de-pending on each of our areas of ex-pertise. Many of us worked as sub-stitute teachers at the school, and in the evenings led chapel and craft activities for the children living on campus.

Seeing the almost overwhelming masses of over 2,400 school children everyday reminded me of the Bible story about Jesus walking through Jericho with a crowd of people seeking his attention. Jesus singles out one man, Zacchaeus, and chooses to spend the day with him. I asked God to show me my “Zacchaeus” among the children at ACA.

I saw Abigail the fi rst day at morning assembly, standing at at-tention with her classmates and singing the songs along with them. Because she lived on campus, I was able to meet with her after school. She was eager to work with her new auntie from America (the children called us aunties and uncles). Abigail (Abby) is a sweet 7-year-old girl, born with Down syndrome. She is a hard worker and motivated in school. She loves to sing and dance and play with her friends. Her

mother is the house mom for all the girls living at what is known as the House of Joy, a dormitory for orphaned chil-dren and children from underprivileged homes.

I noticed while watching her copy her letters, Abby hummed, and constantly moved her tongue as if searching for some-thing, her eyes watered, and she quickly fatigued. There are not a lot of quick fi xes in my profession as an occupational therapist, but God reminded me of one in this situation! At one of the THERAPY 2000 hosted CEUs, I had learned how the neurological functions of suck, swallow, breath, oral motor sensory, posture and alertness are all linked. The fol-lowing day, I gave Abby some gum to chew, and what a differ-ence! She completed three writing pages quickly and easily, asking for more work afterward! I bought some more gum at the campus store and gave it to the family, explaining the purpose and use of the gum of less of a treat and more of a

learning tool for Abby. Visual motor processing and oral motor go hand in hand!

It is easy in our profession as thera-pists to become burned out and bogged down with the over-whelm-ing needs of our patients and their families. It is easy to be discouraged when my interventions feel like a tooth pick chipping away at the gi-gantic boulder of problems my pa-tients face. Abby reminded me that I can make a difference, and among the endless diffi cult trials there can

be that occasional simple solution. These are times I trea-sure most, they encourage me to keep plugging away!

I had more opportunities to work with and get to know other children at the school and at House of Joy, but Abby will always have a special place in my heart.

IMPACTING LIVES, ONE CHILD AT A TIME HALEY HILTON, OTR

Children from the ACA and their "aunties".

Children from the ACA. Say cheese!

Haley and Abby

Survey SAYS...

Our therapy team consists of parents/caregivers, nurses, therapists and office staff…among many more! Since we work in-home we face some unique teamwork challenges. Often, you might never see the other part of the team that is working to improve the life of the same child. Below are some challenges therapists shared and some tips to overcome them.

What is the biggest challenge you find working as a team (with members not all in one place at the same time) in a home environment?

• Communications amongst all disciplines.• Trying to get time to do shadow visits to coordinate care, with-

out having to rearrange my schedule. • The convenience of getting a hold of everyone at the same time. • Coordinating care when we all work different days. • Coordinating when making up visits for whatever reason. • Making sure all documents (copy of progress notes, re-evals,

etc) that are needed by outside disciplines (ie. case w workers, managers, and schools) are communicated and authorized and received through the office...

• Coordinating times with other team members. • Getting to know all the employees.

What are some tips you utilize and can share to better

work as a team within a home?• If there are other disciplines from other HH companies, I try to

get cell numbers to text if needed. Sometimes, I will create a notebook to facilitate communication in the home.

• Group emails are great- that way everyone is getting the same information. Also, communication with the primary caregiver & requesting they communicate that info to other members of the team.

• Sometimes emails are not enough....pick up the phone and call if needed!

• Text, e-mail and meet in person when possible. • Open communication.• Sending emails to all parties involved in the care, when there is

a change or issue to resolve.• Communication and willingness to compromise. Within the

home if a child receives more than one discipline, I try to keep

in contact at least once a month with the other therapist most of the time to share generalizing techniques that we can both implement during our TX sessions to support another therapist goal. Also for time scheduling, ESP when it comes time for re-evals. As an assistant I have 3 schedules to work with the patient, my supervisor, and myself so when other disciplines are in the home scheduling flexibility and communication is helpful. Send-ing a nice "text msg" can work MAGIC! Get family, caregivers, and patient involved in their rehabilitation. Provide knowledge and tools needed for carryover of therapeutic activities.

• Write notes to help me remember to send communications to other team members.

• Have team building "fun" time. Meet up with your team some-where to have coffee and talk, or do something fun together.

How do you mobilize to make “teamwork” work better?• Keeping in contact, knowing their schedules with the patients

we share.• I try to document well, so that others coming behind me can

see easily what we are working on. • I try to keep some time open at least once in awhile so I can

text, e-mail or shadow other therapists. I also take advantage of the times when I do see other therapist, like 2nd Fridays. Use every form of communication: text, email and call. I try to be as proactive as possible. Use the phone, texting and conversation when we bump into each other. Communication with choices.

• Try to show appreciation for their help and knowledge that they shared to help me do a better job.

• Provide teaching and training on therapeutic activities addressed

by my discipline to all those in the home involved in the patient's care so that when other disciplines have questions they are able to relate that information to them.

• My supervisor and I are in constant contact whether that is face to face, email, on the phone, or with text messages! We have tried to set up deadlines for re-eval progress reports, monthly summaries, etc. to be turned in by the time of the re-eval so the SLP is not waiting on input from the assistant. We also priori-tize kids that I as the assistant need more guidance and direc-tion with for supervisory visits vs. kids that are making more progress or are less challenging. We try to coordinate any "off" school or half days to our advantage with AS kiddos. We also coordinate our "off" days around each other.

WE GOT FORUMS, YES WE DO!

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ADVOCACY UPDATETHERAPY 2000 is expanding its advocacy efforts this fall through the T2K Advocacy Initiative. The objective of this initiative will be to strengthen our relationships with key legislators in order to gain support for our industry and to preserve services to children with developmental delays and disabilities in Texas. The desire outcomes of our efforts include:

• Rate restoration and increases• Advances with Managed Care Organizations• Proactive input in bills which affect our industry• Legislator involvement on critical issues with Health and

Human Services Commission• Development and involvement in quality based outcomes,

utilization standards and payment• To accomplish these outcomes, a committee is in the early

stages of development. The committee will begin small and increase in size and impact each year by developing:

• T2K Key Contact program• T2K Legislative Priorities• Participation in the Texas Association of Home Care and

Hospice (TAHCH) and Home Therapy Advocate for Kids (HTAK) advocacy efforts

Committee volunteers will develop metrics, timelines and deliverable and report to company at regular intervals. There are a few spots left on the committee. If you are interested, please contact Advocacy@T2000.com.

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