Autism Review

I recall being a newbie occupational therapist and having a keen sense of "having to put my time in." It is probably a broad cultural value passed to me first from my family. My Dad was a hard working person who I saw go to work every day and sometimes even every night when he was assigned an evening shift.

When I graduated from college I gravitated toward home care and consultative occupational therapy; the freedom and responsibility of these settings matched my interests and work style. Since I was a newbie and trying to work for home care agencies all of the preferred geographic areas were taken by more seasoned occupational therapists. That left me with assignments in far-flung areas where I had to drive up to an hour to get the the patient's home. I figured that I would accept these cases and then after some time I would be offered cases that were not as far away.

So, during this time in my career when I was driving from Buffalo to Farnham and North Collins, dreaming of closer assignments, I met Peter Talty.

Peter was one of those 'more seasoned' OTs who I imagined I was competing against for favorable home care referrals. He called on the recommendation of Kent Tigges who was a mutual friend and said to me, "So I hear you are interested in some work and Kent tells me that I should call you!"

I already knew who Peter was although I never met him - and I was nervous and excited that he would call and offer me a job! Now being a newbie and most certainly not being in a position to turn away work and being flattered to have Peter Talty call me and definitely wanting to show my best for my mentor Kent I listened to myself reply, "Sure... definitely!" even before asking for any other details.

I'll never forget meeting Peter in person for the first time and I will never forget the first question I asked: "So... where did I agree to work and what kind of work will I be doing???"

Peter didn't hesitate a second in his response - he delivered the news to me in the straightest of terms. He deadpanned, "You know when you are driving along a major road like the Thruway and there is an exit for a town you never heard of? Then you look over and all you see is trees and maybe a gas station sign? You might wonder what is over there if you took that Thruway exit. That is where we are going to go!!!"

I noticed that he said "we" and that surprised me a little - after all, most "seasoned" occupational therapists only worked in places that were geographically close to their homes. I quickly learned that although Peter was very experienced he was definitely not like "most" therapists.

Although Peter lived near the Buffalo area he went with me to set up and deliver occupational therapy services in very distant places all over Western NY. We went to nursing homes in Salamanca and Machias. We went to community rehabilitation programs in Olean. We went to a residential program for children who had developmental disabilities in Bradford, PA. I will also never forget how Peter gave me directions to find these places: "Keep driving down this road and you will see a place called 'The Cow Palace' on your right. Keep on going and take the right fork in the road after that - but it won't have a street sign." Peter's directions were legendary.

While thousands and thousands of miles ticked off my odometer I never minded it at all. Peter was an amazing role model and I quickly dropped my preconceived notions of how far experienced OTs should have to travel for work. Peter Talty went the extra mile.

He didn't just go the extra mile in physical distance - he did the same for me, for the COTAs we supervised, and for all those patients including every child who had an IEP along the old Route 17 between Randolph and Belmont. In places where there was no occupational therapy, in places where occupational therapy needed to be, Peter Talty made occupational therapy happen.

I also recall Peter's phone call to me asking if I was interested in teaching some lab sections at a college. By that time I knew enough to ask "where is this college where we will be going??" Of course he was referring to Keuka College - a two hour drive for us both - but it was another tremendous opportunity to watch Peter 'go the extra mile' in so many ways for hundreds of occupational therapy students over the years.

A year or so ago Peter called me and wanted to spend some time in my private practice. Watching him work again was another amazing reminder of what he brought to patients, how he listened to their stories, and most importantly how he helped them move forward with their own recovery.

Peter Talty is retiring from Keuka College this year and I can think of no better way of honoring him than telling this story of how much good you can create when you are willing to 'go the extra mile' as an occupational therapist.

Whenever I drive along a road and wonder what is over the treeline I think of how important it is to care. I also remember that Peter showed me that you also have to care enough to actually put yourself into action. Sometimes the people who need us the most will be in places where we haven't been before and where we never imagined ourselves being. His example is one I will always aspire to.

From: A future OT student
Sent: Sunday, December 13, 2009 7:07 PM
To: chris@abctherapeutics.com
Subject: from a future OT student: wanted to say thanks

Dear Dr. Alterio,
I just wanted to thank you for all of the great stories you posted on your blog... I am writing to you because I have been searching for stories by occupational therapists where they actually help people, where they make a real difference. After going through prerequisites, applications and finally being accepted into two of my top choice schools- I have found terrible posts on [a website] posted by ex occupational therapists and some physical therapists which all revolve around how occupational therapy is an ineffective, terrible profession to go into. They warn people to stay away from the profession. Many people have written in response to those posts saying that because of them, they have changed their mind. You helped me to not change my mind.

I started looking into occupational therapy after having worked with special needs children as an aide for several years. I particularly remember enjoying work with an occupational therapist as she treated a girl with cerebral palsy. I also enjoyed working with children with autism and Downs Syndrome. I have a back ground in the arts (thought I haven't been able to earn an income from it).

I'm just glad to hear your real stories that reveal that you really do help people, and that its not all about getting reimbursed (for something patients don't need) and [providing personal care].

I wanted to ask you what you thought of skilled nursing facilities (if you don't mind).

I also wanted to ask you if you think it would benefit my future to go to a better school like [University A] versus [University B] (which is good, but not as good in some areas). Do you think people who go to more reputable schools have a better shot at a job they want?

I hope you don't mind my questions. Initially, I just wanted this to be a note of appreciation for the work you do, and for documenting it.

Thanks a million,
A future OT student

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Dear Future OT Student,

Thanks for your very kind note.

The Internet is a challenging place to get information because there is no guarantee that you are getting a balanced opinion and whatever you read may not always represent the true spectrum of opinion on any given topic. This even holds true for my own online writing. This does not invalidate anyone's opinions, but it is still important to remember!

As for skilled nursing facilities, I personally find them to be challenging places to work - but there is very important work to be done in those environments. I spent many hours in nursing homes early in my career, but this was before the so-called 'nursing home boom' of the 90s when the environment changed and became even more focused on reimbursement. My experience in nursing homes is that people in these facilities have incredible needs and that it is very challenging to meet those needs in that environment. The context is 'foreign' to most of the people placed there and in fact very few people choose to live in those facilities. In itself, this reality makes nursing home care tend toward tragic - at least when measured against the ruler of typical expectations of where people want to be in their lives.

There are exceptions, of course. Some skilled nursing facilities have re-engineered themselves into rehab facilities and people who reside there are only there on a short term basis for post-surgical or post-trauma recovery. Many skilled nursing facilities have sizable populations of people in this category. The problem happens when people who are elderly and experiencing declining health are determined to be 'eligible' for rehab beds or positions based upon someone else's formula. This causes unfortunate activity like rehab for someone who under other situations might not even choose it or might not even want it.

An exceptional skilled nursing facility situation I experienced was where the patients quite literally co-opted the occupational therapy room and created a 'culture' of work for themselves - they even went so far as to hang a sign on the door that said something to the effect of 'Let no one call another person's work inconsequential.' People who were long-term residents of that nursing facility came in and worked on things that they wanted to work on - some were functional activities and others were not! As a new graduate (at the time) I thought that it was my job to make sure all of their activity choices were respective of their occupational roles - any my naiveté almost prevented me from understanding that for many of these people the therapy was the environment and the culture - and not the activities! The people in this particular nursing home who created and participated in their occupational therapy routines were among the happiest residents of any skilled nursing facility I have ever seen in the twenty plus years since that time. These people, all with very broken physical bodies, represented a triumph of the human spirit that I have not again seen demonstrated - it was a rare and compelling experience.

My point is that even in desperate conditions there is hope, and hope is good when we can learn how to harness it for people who we are charged to care for.

Maybe the people who posted on those forums you refer to have lost some hope? I hope they can find it, somewhere - because spending your life doing something or being somewhere you don't want to be is not a way to spend a life.

Finally, regarding your question about schools - go to a place that feels like a match to you. Of course you should ask the school about their accreditation, graduation rate, and percentage passing the certification examination - but other than that your choice of a college has to match so many other factors in your life. Your future career as an occupational therapist will not be determined by the college that you go as much as what you choose to do with the college that you go to!

And I am very hopeful that you make all the best choices, for you!

Warm regards,

Chris