Sunday, December 2, 2018

How to Determine Frequency and Treatment Durations of Occupational Therapy services in ACUTE CARE

Triaging who gets seen first for evaluation typically is driven by both joint commission standards (we address OT consults within 24 hours of receipt) AND how fast it is predicted for clients to leave the hospital setting.  

More likely, clients will not stick around the hospital long; that is why we need to be strategic about HOW we triage evaluations.

In acute care, we know evaluations are king…but what about frequency of treatment and the duration at which we should spend time with clients?

Here are the basics to get you started. 

Let’s first take a look at the five basic components of determining frequency and duration of clients seen in the acute care setting: 

Skilled client needs
Discharge placement security
Length of stay
Readmission risk

All of these work alongside each other and not as one or the other.  Each is a puzzle piece to a triage formula for determining who, how often and how fast.

Skilled Client Needs

Q: Who determines this?  

A: We do as OTPs as in any setting!  As the OT practitioner, we determine duration and frequency based on the client’s skilled needs (not a supervisor, manager, director or caseload number).

Questions to ask ourselves:

Do they have skilled needs?

“Is the client appropriate for OT services at all or are they at baseline?” 

“Do the standardized assessments we have done shown their skilled needs?”  

“Does the patient have goals?”

Determining whether we sign off at OT evaluation, select 5x/wk treatment, or choose 2 follow up sessions before the client discharge is influenced by skilled need.

Whether clients stay 2 days or 2 months; what the client needs is what matters.

That is why we indicate the true frequency needs. Even if the caseload is so slammed and you know you will not get to them for that 5x/wk for treatment, that treatment  frequency represents what the client will require to recover in occupational performance when they leave us. 

Q: What are some cases where treatment may be minimal to no needs?

A: Client is going toward a comfort care approach (with no hospice measures indicated). When the client does not tolerate therapy for the duration we anticipate to see them that day.  Or, we may be trialing our services for 2x/wk before determining a greater frequency because of poor tolerance for treatment or uncertainty in client ability to meet goals.  

There may also be times where we may sign off the client case completely when they do not have goals at all.  Despite our attempts made over the course of their stay with us in acute care, we together (OT and client) cannot come up with any additional goals to progress occupational performance.

Q: How about evaluation complexity codes. Do we factor those into skilled needs determining treatment frequency?: 

A: The evaluation complexity codes are chosen based on the clients number of occupational performance deficits, extent of occupational profile and overall complexity criteria.  When it comes to determining treatment frequency however, code choice actually will play less of a role when the length of stay, discharge placement and readmission risk influence the circumstances.

We may find a client only has a few things to be assessed for with more detail treatment to follow…or lots of things on evaluation to assess are found with less detailed treatment to follow.  

So many factors determining skilled needs.  Truth is, it takes many years of practice to work alongside your client and determine skilled need frequency and duration of treatment (give yourself grace with this).  

Discharge placement security

Questions to ask ourselves to determine how secure discharge setting is (with or without OT services) for our client:

Does the client have a caregiver?  Does that caregiver have the time, availability and amount of assist level necessary for this client’s physical, cognitive, psychosocial needs at discharge setting? 

This will influence what we recommend (and may be necessary information to determine how involved we are in treatment during the client’s stay for training or justification to a higher level of care)

Will the client be returning to skilled service at prior discharge setting?

No acute or infrequent acute needs until their return back.   Example: coming from and going back to a skilled nursing facility.

Does the client have a discharge setting to go to and will they be functional for that setting by the time they discharge?  

The client may be in limbo as to where they will go.  When we do find out, we have to determine if they have enough caregiver assist there and whether they need OT when they go. 

Examples of this:

#1: Client will be going to an assisted living facility (ALF) but, they do not have 24 hour hands on assist (it is supervised level of assist).  We find now after their hospital admission that this client needs physical assist to prevent a fall.  We may be more involved in training the caregivers, or having increased contact with care coordination, to help facilitate their treatment needs going forward when they discharge the hospital.

#2: Client is homeless and there is question as to whether they can discharge back to the streets with those multiple fractures they just sustained.  It is uncertain if they can get home health OT at a shelter but, we would be prioritizing their treatments to maximize their skilled therapies while we have them in the hospital.

Is the client going home with or without OT services?:

We may need to download all we know into the client and caregiver’s brains to best prepare them for their functional well being with a new diagnosis if no OT service is accessible to the them.


Client is medically ready to leave the hospital on post op day #1.  They will not be getting home health OT services. Acute care OT needs to evaluate and provide treatment intervention all in the same day!  Even though the client’s occupational performance is graded at a low complexity - 30 minute anticipated evaluation - we may be with them for a whole hour total to cover all the basics in treatment before the client discharges.

Are we trying to justify for acute rehab services?:

This may require us to see them more often to justify tolerance for therapy and prove it to be beneficial in a critical rehab recovery time. 

Does the client have a good discharge plan for after they receive acute rehab services?:  

If they do not have a set discharge plan in place after rehab, this may play a role as to whether the client is accepted to an acute rehab. 

Sometimes we have to play the role of being their acute rehab services (even though we function like an acute care setting) because the client has a critical functional recovery window (such as in an acute stroke or acute TBI.  It may be time sensitive where the more frequently we can see the client, the better the functional outcomes.   


Speaking of critical functional recovery windows…

Q: What diagnosis may indicate more frequent or longer durations of treatment in acute care setting?

A: a client who has sustained an acute neurological incident (TBI or stroke), cardio-pulmonary type surgeries, or clients who are on early mobilization protocol (ventilator weaning), may require prioritization for frequent treatments to maximize neuro, cardio-pulmonary and functional recovery.  

Benefit from greater frequency of OT services in acute care setting can also support discharge placement through our justification. 

Beyond functional recovery windows, seeing these clients more often proves their tolerance for therapy.  To fulfill the skilled need to be accepted into that LTACH or acute rehab, we up the frequency of treatment to better the client’s chances in getting into settings recommend for them.  

Also, those diagnosis that are known for not receiving our services (for example a client on observation for a pelvic fracture), may benefit from our visits more frequently and for longer durations of time during their hospital stay.

Q: What about diagnosis where the condition is terminal?

A: Some terminal diagnoses may have us determining less frequency for clients who are set for hospice or comfort care measures; this may lead to the client being signed off from OT services completely.  We of course have a role in a client’s trajectory of palliative care, however, those needs can be best met at the next level of care/setting.

Additionally, if we know what diagnoses are notoriously known for receiving OT services at the next setting, we may not prioritize them altogether and recommend they receive that upon their discharge.

Length of Stay

Knowing how long a client will stay in hospital will vary.  However, it plays a critical role in determining frequency of treatment.  This will help us prioritize treatment follow up.  

The first questions I ask myself are:

Is this client on an observation status, outpatient in a bed, or ambulatory status of care?

Is this client someone who typically goes home after their medical scans are clear but likely to be predicted to have critical self care and functional retraining needs?

While considering the discharge setting and follow up of OT services available to the client at the setting they leave us for, treatment duration may vary and more reliant on frequency need before they go.


The shorter the stay in the hospital = the more frequent they will be seen for ADL retraining. 

The more frequent you need to see your client may also be a predictor in how long you stay for the duration of treatment on the first few sessions.

Some exceptions for short stay clients:

When you know they will be going back to skilled nursing with skilled OT services (or back home to resume already-in-place home health therapies).

Another component that is critical to consider in treatment is education.  Assume the first time you see your client will be the last. Ask yourself: 

Did I educate the family on the critical points for their loved one to be successful at the next level of care?

Did I go over and have them return demo (if able) all the critical points I can think of that may be impacted by their current diagnosis and acute stages of recovery?

Anything they should know to anticipate during their journey of recovery (to be able to advocate along the way?) 

Readmission Risk

Let’s first ask ourselves: 

Who is at risk for readmission?

1. Clients with acute on chronic conditions.  

Example: client with acute on chronic Congestive Heart Failure (CHF) admitted to the hospital due to fluid overload.  

The physician will take the fluid off of their body with medical treatment and send them home once medically stable.  

These clients may be back sooner than later if their symptoms are a result of client behavior, perception of medical treatment being a disruption to their daily occupations or other circumstances we find out in OT evaluation.  

We as occupational therapy practitioners get to figure that out and decrease their risk of being readmitted.  That is why our interventions with them on day one will be so critical. 

Sometimes our treatment are the resources we provide to them that are available to the client in the community.

2. Complex medical cases. 

With these cases, I sometimes find myself in unknown and uncharted territories as an acute care therapist.  This is because their readmission risk factors are more dynamic than one diagnosis need; think of it like PEOP model on steroids (the environment influences the person and the person influences the environment.  Both influence their performance and the occupation.   Also, the place at which they occupy space is influenced and interchangeable).  

Some examples include:

  • co-morbidity of significant obesity (including beyond BMI and standard scales)
  • homelessness
  • frequent alcohol intoxication with withdrawal
  • social admissions (family can no longer care for their loved one) 
  • psych diagnosis
  • history of falls
  • dementia without placement into a memory care

In our own implicit biases or uncertainties of how to assist these clients, we tend to defer these cases for a variety of reasons.  However, these clients are still at risk for readmission.  

I wonder and ask you:

So how do we play a role in their recovery to decrease their incidence of returning to the hospital?  

How frequent do we get involved in interdisciplinary care for these clients?

When do we wean down our treatment frequencies?  

These clients tend to stick around the hospital for a while due to barriers in discharge; it is a question I ask myself regularly but know in my OT heart we have a role.  

I begin with an occupational therapy profile to get started on what treatments and interventions should be addressed.  

The interventions take time to build upon themselves to truly make an impact on clients with these chronic circumstances.  That is because our interventions in acute care are not overnight fixes for this client population.  We are used to treating with one to few sessions in this setting ( such as training the client on how to use of a sock aid for that posterior hip replacement).  With complex medical cases however, there are many years of layers we need time to pull off to get to the client’s ability to perform self care well.  When the client leaves and it is a question as to where they can receive those treatments and interventions elsewhere, what can we do in the short to help them with the long term outcomes?

If you have ideas, I would love to know myself.  Write them below in the comments.

Hope this breakdown of determining frequency and duration of treatment in acute care has served you well to get you started.  There are many more factors to consider beyond this post.  If you have additional questions you would like me to talk about, email me at 

Until then, see you in my IG stories or live video feed

Thursday, October 25, 2018

Occupational Lessons About Head Injury

Once upon a time, in a suburban acute care hospital, there was a client walking and talking within the four walls of their hospital room. Their supportive family sitting all around the client's bed; awaiting the rehab team to come evaluate their loved one.  Their beloved family member sustained what appeared to be a "very mild" brain injury.  

The OT arrived to assess and provide treatment intervention.  The OT thought the client was doing well (based on observation and by what the client self reported).  The OT believed the client could go home; that conclusion was so wrong.  That OT, once upon a time, was me.

At the time of this encounter, I rationalized that the client was "just tired."  

I remember the speech language pathologist (SLP) asking me to watch their treatment session with the client. I wasn't sure why it would be necessary; I had already shared with the SLP that I thought the client could go home because of how well they had been doing. 
I gave it the time and watched the next few minutes go down.  

It was in those few minutes my perspective and OT practice shifted forever.  

It was that moment that took me from what I thought 5 years of OT experience looked like, back to feeling like I had ZERO years of skilled experience and then back to what 5 years of experience is supposed to feel like.

It was embarrassing; to admit to myself I was acting more like a bystander; seeing the client from a superficial lens.  What I thought I was doing was being compassionate and respectful of the client's experience in the hospital.  I was not using my clinical or skilled eye to make a lifelong impact for my client.

So how do you shift from bystander observation to skilled OT practice assessment? 

If you see your client agitated and irritated and "tired" you want to leave them alone out of respect right? The thing is, we aren't doing them any favors by letting them rest.  We are actually creating the barrier to the meaningful occupations they are expected and desired to return back to in the home and community. 

After the SLP elicited the client's true deficits, a lightbulb went on for me. 

Witnessing the client's rationale showed me it was apparent they would not be able to safely take care of their young children...or manage multiple errands in the community...or tolerate conversation in social gatherings...or have a meaningful relationship with their spouse.

Although the client was physically able to do ADLs, including demonstration of getting on their knees (of the hospital floor) to simulate pulling out a broiler drawer of an oven (they used it often to cook for their family); independence with this dynamic activity was not enough for daily activity success.  

To get a perfect score on a MOCA screen does not mean they are safe from the real-life struggle ahead of them (and ahead of their family).

While I felt drenched in humility, the situation convinced me that the client should go to acute rehab (ARF) before returning home.

Then, I came across my next battle:

Convincing the Physical Therapist out of their recommendation "independent; home." 

The PT said: "_____ should be able to go home to recover; you shouldn't want them to be stuck in an acute rehab!  They walk fine; let them go home to spend time with their family."

After multiple discussions we were able to get the PT on board to recommend acute rehab, begrudgingly.  Encouraging them to use other assessments that were going to challenge the client at a higher level was a strip from their ego.  To ask them to observe the client's reactions, comments and behaviors when participating in the assessment was an easier feat.  After this advocacy, the client did get into acute rehab (whew). 

Skipping forward two years (2018):

One of the things about working in acute care hospital is we do not see (or always hear) about the outcome of the client's rehab recovery at the next setting they go to.

When we do not see the benefit of our work because of lack of closure, we may convince ourselves that what we do must not work or be of that much benefit.

Truth is, we get to be first on the scene of their life changing event.  We get to start our clients on the right track of recovery and cross our fingers what we did or recommended to them worked or made a difference in their lives. 

I got my closure recently on this particular case.  

Two years from the time I saw this client and their family, the client's spouse and I run into each other unexpectedly at a local coffee shop…at an ungodly hour of the morning by the way (I never wake up this early but, I wanted to get a head start on my department’s next competency project before the rush of colleagues came flooding into the office…that’s for another story).  Standing in street clothes, grabbing a straw for my coffee, the client’s spouse remembered my name and what therapy discipline I was. They said to me "Alexis, what you did for ___ and my family made a huge difference in our lives.  We will never forget it. The only trouble they have now is ___.  I have my ____ back again. Thank you."

Two things came to me in that moment:

1. I asked "What did I do?" I shifted attention to thanking the profession of Occupational Therapy for reminding me of the meaningful components that impact our life.

2. I picked myself up off of the floor after knocking myself down. This client's restoration, return to meaningful daily activity and family wholeness could not have reminded me more of why the challenges we face in our day to day practice are worth battling.  

Have you ever had a time where you were able to be facilitate your client's access to meaningful occupation after their traumatic event because of your advocacy efforts?

Have you ever had a situation where you experienced a lesson you will never forget in practice? 

I want to hear from you and your story; you are not alone. 

Monday, October 1, 2018

How Listening to my Client Improved My OT Skillset

I remember that day when I was told by nurses and physical therapists that client X was "in a mood" "upset" and "not participatory."

I was told they were "independent" because they could navigate their oxygen and intravenous lines themselves; demonstrates untangling them around their body to transfer to a chair from the nearby hospital bed.

So I did a chart review to screen to see if I would evaluate one time only, based on the report I received from my colleagues.

When I walked into the client's room, I didn't introduce my name or discipline.  I first greeted them hello and asked "how are you doing?"

They proceeded to tell me "I'm fine; what do you want?"

I followed up by saying "I want to find out more about you.  I see you were admitted to the hospital for exacerbation of symptoms associated with cancer.  I would like to get to know you a bit more to see if  there is anything I can do to support your recovery to compliment what you are already doing now for coping with symptoms. Would that be okay with you?"

They began to tell me their story: long they have had the diagnosis
...what they have been able to do and not able to do in daily activity because of fatigue and pain
...what roles and responsibilities they played in the community and to family

Then they began to share their concerns the more I listened:

...their difficulty delegating tasks they didn't like to do in their day to day
...their difficulty organizing tasks in the day and feeling overwhelmed easily
...their report of finding themselves irritated often
...their report of forgetfulness
....their upset with doctors, nurses and therapists stating "they don't hear me. They listen but they don't hear me.  Instead, they tell me what they want from me."

After hearing all the client's thoughts, perspective and concerns over a 45 minute period, the client turned it back to me to state "thank you for hearing me; what can I do for you?"

I paused for a moment: all I wanted was to help them fill in the gaps they perceived as the obstacles, barriers or stumbling blocks to accessing meaningful activity.

So we worked together to identify all the things that we could work on.  Two things came out of it:

Identifying what we have control over
Asking what can we take action on now

I felt slightly out of my element that session because I walked in thinking I would interview and discontinue from OT services...maybe see if the client needed energy conservation and work simplification strategies for an exacerbation of respiratory related symptoms and fatigue.  Instead, I was taught the lesson that when you truly hear your client, you pick up on what they really need.

In this client's case it was two things:

1. a way to let go of some of the responsibility they took on (having too many occupations that weren't serving them well).

2. how to get organized and keep on the tasks they identify as important or of value.

It turns out the client had an pre-existing brain injury as well that was not identified in their medical history; the client told me that 40 years prior they sustained a TBI and never received any OT services for this.

So we worked on cognitive strategies to address the client's needs (not my plan or the other staff's plan, my client's plan).

The client expressed significant gratitude to have an intervention that fulfilled her request.  Not only could she plan a better system to be less hindered by fatigue emotionally and physically, she was heard.

Wednesday, August 15, 2018

From RUGs to Patient Driven: 4 Ways to Prepare for What's to Come

Writing today because you just never know what is coming around the a week, a month, a year.  Time travels faster than we know what to do with it.  That's why I want to give you options when change is on the horizon.  Change can be annoying and scary. We can sit back and take a "wait and see" approach to change or shift how we do things; including how we practice OT.  Either way, it is important to:


Stay in the know of changes and knowledge. Knowing all details of the good, bad and ugly gives you power to make decisions.  ...and in this case with shift from RUG driven payment models in skilled nursing settings to a patient driven one (in just over a year from now), it helps us best prepare for how we desire to practice OT.

You can do so much in one year; preference of how you want to practice is in your hands: 
--> to practice OT while abiding by (and advocating OT's inclusion for) what is coming in Oct 2019 
--> you have the choice to prepare to transition out if this isn’t what you truly want to do.

Ultimately, the decision (and actions) are up to you.
Here are some different routes you can chose from:


Daily; this is an investment to be certain you will be utilized
(if you decide to stay, each of the over 365 days, each day counts to make this effort... to sustain your utilization, the time and energy to speak to be heard is non-negotiable)


ask of each (the DOR, the administration, the owner, the supervisor and managers) of their perspectives (separate from one another) regarding the upcoming changes...
this will help you make an informed decision about whether it’s the facility (and setting) you want to continue to work at.
If they don’t know how they feel about it yet, give time to continue to gather their developing perspectives.


Start studying for that different population or service setting. Learn about the ins and outs of something unfamiliar. Pick up per diem work. Get a trusted mentor in those settings.
Remember: just because you have little to no experience in another setting, does not mean you do not know how to practice OT. It’s just a different shade of what you do (it’s not easy but not impossible. It takes practice, exposure and willingness to try).


research what it is like to start your own; this is actually the wave of our future.
(and to be honest, it’s where we would thrive being our creative selves).
Where there is more control over our circumstances...where our hands are tied by rules and restrictions of insurance...and what feels like it dictates how we practice, the more you will see OT practitioners stepping into their own businesses.
There are so many opportunities to develop your own thing. 

Service, invention, product.

Don’t be mistaken; those who do it started afraid (or will be when they do).
They will do it unprepared but will learn and grow overtime.
They may start off inexperienced but they will grow in skill with practice and time.
One important thing, they will be happy.

We get so bogged down by the limitations in front of us that we miss the opportunities there as well.   It’s just a matter of believing you deserve it more than believing you can’t do it.

To sum up, there are always options in uncertainty:
* Do OT, show OT, be OT - AlexisJoelle
* Stay informed.
* Research, investigate, explore.
* Do something that aligns with your OT spirit and do it scared anyways
* Be limitless

Appreciate you for stopping by.  
To stay informed of upcoming resources, courses and support to decrease barriers in your day to day activity of practicing OT like those mentioned above, be sure to sign up with to stay informed

To review the article referencing the Oct 2019 change from RUGs to Patient Driven Payment Model:…/CMS-SNF-PPS-Patient-Driven-Payment-M…

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Wednesday, July 18, 2018

What Do Nelson Mandela Quotes Have to do with Occupational Therapy?

A single centennial celebration for our profession of Occupational Therapy does not stop in 2017; it signifies a legacy building upon itself.  In this proactive "journal entry" of mine, I want to take you on a journey of celebrating Nelson Mandela today (as today would have been his 100th birthday).

He is a historical landmark for what it means to be a peacemaker; for human and social rights.  Everyday as Occupational Therapy practitioners, we face circumstances where we advocate for our client's human and social rights to participate in meaningful day to day activity.

That is why I would like to question and break down how these top Nelson Mandela quotes relate and teach me about our practice in occupational therapy:  

(P.S.  I replaced all the "man" or "men" references to "person/people" cause I don't do rules)

"Difficulties break some people but make others. No axe is sharp enough to cut the soul of a sinner who keeps on trying, one armed with the hope that he will rise even in the end."

Hitting roadblocks, obstacles and circumstances telling us "no" in practice is familiar to many; it comes from administrators, peers, our own colleagues, and even our clients when they don't want to work with us. When we use those roadblocks as fuel instead, we rise and grow.  

Every time I use the very thing pushing me down as fuel, I gain greater momentum and strength to stand up again.  


We will fall.
We will fall many times. 
Just like when little ones learn to walk.  

Then they try again after hitting their bums on the floor more times than not.  

...but isn't that the foundation of what we encourage our clients to do?: 

they are handed a barrier (or a wrench is thrown in their plans of life) and we assist in filling in the gaps along their journey in finding their footing?...isn't that the very thing to facilitating access so they can move, do and be in their meaningful activity?  

Question #1 I want you to answer for me:
Instead of defeat: How can we use our barriers as fuel for our soul?

"It always seems impossible until it's done."

If we haven't tried it yet, we will not know what will come of it.  

Instead of giving up...instead of giving it a label like "not being accessible" or "it's impossible," try embracing the journey one baby step at a time. 

We make it this big thing that if we snap our fingers, it will magically appear and be what we expect the results to be. 

Again, we must learn to take the small steps before walking, crawling, stumbling, and losing our footing.

We will never know what it is like until we get in the mix of it. 

As I say: 

"The first step is to take one"  -Alexis Joelle

in other words...

"Can't couldn't if it didn't try" -Alexis Joelle

That said, Question #2 asks you:
What baby step will you take first right after reading this post to embrace the impossible?

 "If I had my time over I would do the same again. So would any person who dares call himself a person."

When we own our lifestyle, we accept ourself for as we are.  This is a valuable professional lesson to live by.  If we live someone else's life, we disregard our own.

Question #3:
To ensure you have no regrets or missed opportunities: How will you live your life exactly as you are? 

 "I like friends who have independent minds because they tend to make you see problems from all angles."

Without diverse perspective, we live in a limited world subjected only to our own knowledge of it.  We will also feel isolated in our problems. When we expand our understanding of what we think we already know plenty about, we actually grow solutions rather than problems.

Question #4 for you:
How will you broaden your friend circle?  Who will you hang out with and ask questions of to gain a more well rounded understanding of the topic you struggle with?

 "Real leaders must be ready to sacrifice all for the freedom of their people."

When we signed up for this profession, no one told us we would need to be leaders; the truth is we are.  The moment we get that "L" to state we are licensed, we gain a responsibility to lead.

Question #5:
How will you lead in order to free your clients from their be able to access their meaningful activity?

"A fundamental concern for others in our individual and community lives would go a long way in making the world the better place we so passionately dreamt of."

Plainly speaking, we care a lot! We do. 
No matter how you show it or phrase it for others to understand, we care and show concern for our clients and community.

However, I ask this in Question #6:
Do we live our world dream in the practice of OT?

"Everyone can rise above their circumstances and achieve success if they are dedicated to and passionate about what they do."

We are passionate about our work but, sometimes our passion does not lead us to being "successful."  So with that,

Question #7 asks you:
Do we do the work? Do we do OT?

[Now a bit of an explanation for this question 

- I didn't say these questions would be easy to answer or sweet and considerate of your particular circumstances.  

-They just come from my authentic self...real thoughts that run through my headspace about real circumstances...

-when I journal, I actually ask myself the hard questions I don't want to hear sometimes. I answer back to them to grow in learning! 

-If I ask myself these questions, I should ask them of my #OTtribe as well because it means you too are reading this to learn and grow yourself in life and in your OT practice.  

-When you get vulnerable and face the tough stuff (the stuff we don't talk about or admit to) I am here to support you when you are in that's because you gave yourself permission to be vulnerable and it's in my blood to be sure you NEVER feel alone in that

...okay now back to our regularly scheduled blog entry]

"Education is the most powerful weapon which you can use to change the world."

We know education is huge!  We must pass along the knowledge to serve our clients.  However, it's less about what we can educate our clients on and more of what we can learn instead; that is where change happens.

Question #8:
What will you educate yourself about today to change the world?

"I learned that courage was not the absence of fear, but the triumph over it. The brave person is not those who do not feel afraid, but those who conquer that fear."

I feel we conquer a fear every time we are brave enough to step into the patient's room, space, or environment to offer our services to them.  

Confession: I get nervous every time I step in; shaky and gittery...and I've been practicing since 2011!!! 

Fearing that they will reject what we have to offer is the very thing that drives us to serve in our best efforts.  We want to provide a meaningful therapeutic relationship with our clients.  We want them to succeed. When we let fear take over, we miss the opportunity to truly serve our clients.

Question #9 for you is:
How will you face fear head on to serve in your purpose?

"For to be free is not merely to cast off one's chains, but to live in a way that respects and enhances the freedom of others."

We feel free when we succeed in getting our clients what they need. Freedom to me is feeling like my clients can access independence in their daily activity.  I feel free in my purpose when I achieve this.

Question #10:
How do you release the chains, holding you down, to free your clients from their burdens?  The burdens stripping them of their freedom to access meaningful activity?

"Resentment is like drinking poison and then hoping it will kill your enemies."

We can feel demoted from our position when a client prefers to walk instead of do daily activity with us... or we feel treated unfairly in being included as a part of the team....and we hold grudges towards our own clients and other disciplines.

The thing is: it's not worth losing sleep over it at night.  We do become poisoned over our own grudges.

Question #11 for you is:
How will you let go of resentment?

"Lead from the back — and let others believe they are in front."

Oh em G: this is our bread an butter.  We facilitate others to be able to lead their own lives; through independence in accessing meaningful tasks.

IT'S NOT JUST BELIEVING!  Our clients actually will take the front if we allow the opportunity.

Question #12: 
How will you allow your client to lead, not just believe?

"Do not judge me by my successes, judge me by how many times I fell down and got back up again."

We very well do this with our clients in encouraging them to fall because it means they are moving forward.

Question #13 is: 
Will you give yourself permission to trip, slip and fall, many times in the day, to be successful?

"I hate race discrimination most intensely and in all its manifestations. I have fought it all during my life; I fight it now, and will do so until the end of my days."

The physical characteristics of clients we serve (their race) is judged by many unintentionally.  They will be assumed to be a certain way when it comes to their health and well being. 

The healthcare services provided to them will have gaps unintentionally; there is no question of that.  

OTs do advocate on the regular for health literacy efforts; to bridge these gaps for our clients due to unintentional biasing treatment but, we forget to acknowledge the OT race.

Our physical OT characteristics are judged by others.  

The equipment we carry around in the halls.
The way we carry ourselves to others.

Truth is, we need help from those who can advocate for us to be as we are. We need support; we need a community to fight for and a community to fight on our behalf.

Question #14 is:
How will you fight for your OT race? 

"A good head and a good heart are always a formidable combination."

We toggle between listening to our head and listening to our heart; I always listen to my OT heart. 

Why you may ask: 

because it is a feeling greater than logic or knowledge.

That feeling creates deeper connections to myself in what I do and a deeper connection to what my clients need from me as an OT practitioner.  

Truly, no one cares about your 4.0 GPA or highest level degree.  

All they care about is if you spoke and acted upon your heart.

Final Question #15:
How will you live with a good heart in your OT practice?


about 1% of you will actually answer ALL of these questions and get back to me

3% will answer a few

about 20% will answer 1 question  

What percent will you be?  

I personally would love to expand my knowledge by hearing your thoughts.  If it's too personal to share in the comments below, shoot the responses to me in an email.  

That is your assignment for the week. :)


Want to take on the assignment because you know you want to boost your OT growth but, need more time to answer? They are hard questions for me too...and you don't have to answer them all in one day!  Do one each day of the week and get back to me in 15 days!  (If you need friendly reminders, I'll post the question of the day in my instagram for the 15 days). Challenge accepted: let's do this.

-xo, Lex

I live for and teach fellow OT and OTA practitioners how to embrace "your best OT self"; no matter the barrier in your way. To stay up to date with resources and upcoming courses to support you in this, go to: 

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