Wednesday, December 08, 2010

One child's Christmas wish, as expressed to the OT

Lisa is ten years old and currently lives in a residential treatment facility for children who have emotional and behavioral difficulties. Her biological mother was addicted to drugs and Lisa was removed from her custody when she was four years old. She lived for a few years in several foster home placements and the most recent foster family had her for two years and intended to adopt her but they backed out at the last minute. There was a corresponding increase in uncontrolled behavior so she was admitted from another temporary foster placement to her current residential placement.

Lisa's current behavior is very erratic. Her everyday speech is laced with profanity. She is claiming that she was pregnant and just had a baby, but this isn't true. She is physically aggressive, sexually precocious and inappropriate, and has attempted suicide twice.

Lisa was referred for occupational therapy in her residential program because the previous foster family took her for a sensory-based occupational therapy evaluation that they pursued privately. The outside evaluation indicated that she had severe sensory processing difficulties and recommended the following:
  1. Wilbarger Brushing Protocol
  2. Listening to music, such as Mozart
  3. Diaphragmatic breathing exercises
  4. Early release from school so she isn't overwhelmed
  5. Increased intake of water
  6. OT Consultation to the entire residential program where she lives
The evaluation did not include any motor, cognitive, perceptual, social, or occupational measures. There was no developmental history and a scant social history.

I am calling this evaluation to people's attention because it represents such a horrific example of how we are not addressing needs. I would not be surprised to find out that this child does have some difficulties with emotional and behavioral regulation based on some sensory processing issues, but I do not expect that her gigantic problems will be fixed with a brushing program and a lot of water.

In fact, these kinds of recommendations are irresponsible and inappropriate. I am thinking of having the evaluator provide this intervention herself and see how much improvement is made.

Wouldn't it be interesting to listen in on that intervention session: "Gee, Lisa, it says here that you have been in 6 different foster homes, you were sexually abused when you were a toddler, and your biological parents abandoned you and were both addicted to drugs. Why don't you let me brush you and you can take a few deep breaths while we listen to Mozart. That should make it all better."

I am hopeful that some educators and practitioners and students will all read this and think twice the next time they talk about what would constitute an appropriate evaluation, what our scope of practice should include, and how we should be conducting ourselves as professionals.

Please keep Lisa's Christmas List in mind next time you think about how to identify a child's needs. The OT evaluator thinks that Lisa needs a brushing program, lots of water, and early dismissal from school to address her sensory needs. Lisa thinks she needs a car, a Christmas tree, a home, a dad, and a mom.

Which one is closer to being correct?

3 comments:

Brigette Joy said...

Thank you for the post. I totally agree and have seen similar things happen to a lessor degree. OT's have a lot to give, but we need to be honest about the situation, otherwise our credibility will be in question.

Matthew Occupational Therapist said...

Really interesting post - I think alot of OT's get detached from the personal aspect of our profession and involvement. Something to keep in mind when working with any client - don't lose touch with empathy!

TherExtras said...

I am thinking of a complaint to the state board regarding this 'evaluator's' inappropriate work.

Barbara Boucher, OT, PhD