In any year outside of 2020, if I had to pick between a teacher and an occupational therapist for the “most-likely-to-fly-by-the-seat-of-their-pants” award, I would choose the occupational therapist every time.
I won’t say that all occupational therapists operate their day-to-day with this mentality, but I will say that planning was definitely not a skill that I brought to my first OT job. Sure, I made sure that my treatment sessions were inline with the goals I had written for each patient, but as far as a detailed, written, day-to-day plan for how we were going to get from point A: evaluation to point B: discharge? Nope. Not at all.
My day-to-day intervention planning looked more like an impromptu brainstorming session on my way to the patient’s room. And sometimes, even on-my-feet thinking while my patient completed some routine therapeutic exercise.
Adapting and ‘making-do’ are simply in our nature as occupational therapists. We do what we have to, when we have to, and we make what we can work. We use canned goods for weights while we work in patients’ homes. We simulate our patients home environment the best we can while we work out of a facility. We are creative with the limited materials we have in our gyms.
Sometimes we have no choice than to ‘fly by the seat of our pants.’ I know some days are like this for our teacher friends, too, as they make-do with their limited resources. But imagine if a teacher walked into her classroom of 20 students and thought, “mmm, what should we work on today?”
Y’all. Therapists do this all. the. time. (I am especially guilty).
How much more efficient and end-goal oriented can we be if we have a true “intervention plan?” I don’t mean an evaluation with short term and long term goals—though a well-written evaluation must be the place we start.
I mean an intervention plan that spells out the exact steps we will take to meet those short term and long term goals.
The plan would have to be repeatedly modified, of course, to account for regressions and rapid progressions, ‘good’ days and ‘bad’ days, medical changes, and flat unexpected events. But I guarantee, we would have better outcomes and better patient/caregiver communications. Imagine how much of a breeze walking into work would become when you know the plan for each patient rather than walking in thinking, “what are we going to do today?”
Teachers do a beautiful job of the planning game. They have yearly themes. They have a day-to-day, hour-by-hour plan for their students. They have clear and specific expectations for outcomes. Teachers have a lot they can share with therapists.
1. Teachers make time to plan.
Teachers generally have a scheduled planning hour. And I know that many spend even more time planning outside of that given hour. Our teacher friends realize the importance of a plan and subsequently, the importance of scheduling time out of their day to make the plan happen. We can do this too.
If I don’t schedule it, I’m not doing it. Are you the same?
I won’t pretend to know how the planning period really works for teachers, but I imagine for therapists, taking a few minutes to an hour a week to dedicate to intervention planning will improve your efficiency from the few seconds in passing that you devoted to this task before.
Make planning part of your weekly routine. I like Monday mornings. Jot down your plans for each of your scheduled patients for the week. Think about what needs to be accomplished, what you can progress on from last week’s status, and how to effective and efficiently guide your client to meeting their goals. You should be checking in on those lovely goals you wrote at least weekly if not at the beginning of every session.
2. Teachers have a clear endgame.
Teachers have specific outcomes that they want their students to meet by the end of the year. They call them learning objectives. Therapists, of course, have these outcomes too. We call them short term and long-term goals.
If you are going to have a well written intervention plan, you need to start with well-written goals.
I’m not talking about a foo-foo, therapy jargon, “let’s make this just confusing enough to pretend we made progress in two weeks” type of goal. I’m talking about a clear, concise goal that can be understood by your patient and their family and gives a clear description of the journey from point A to point B.
Here’s a tip: ask your patient what they want to look differently for them in a given time period—I typically use 6 to 8 weeks. The answer(s) to that question can serve as your long term goals. If your patient needs a more specific question, ask, “In 6 to 8 weeks time, how will we know that we were successful in therapy?”
To have a plan, you must know where you are going!
3. Teachers streamline the planning process
Teachers don’t (typically) start from scratch for each of their lesson plans. They use their previous lessons plans as guidelines. They brainstorm with their coworkers. They share across their profession.
Therapists do an excellent job of this with the protocols for rehabilitation of orthopedic injuries—particularly after surgery. In these cases we have a week-to-week plan of how to progress our patient through the rehabilitation process.
I suggest making a similar template for the non-orthopedic diagnoses you see. Of course, that template will then be modified for each of your patients, but you will at least have a starting place. You will combine that template with the patient’s personal and spe