#299 - When is the Right Time to Discharge from OT?
Mar 13, 2024
Rachel Harrington, COTA/L, AC & Jessica Hill, COTA/L
Our goal with OT when working with pediatric clients is to help the children and their families get through the day easier, learn the skills necessary for ADLs and IADLs, provide emotional regulation tools for all environments that the child is in, and ultimately be successful in all occupations of life that the child wants to participate in.
Success is different for each child and each family which is why there’s no one-size-fits all approach when it comes to treatment or discharge.
In this episode, we discuss what to look for when discharging a client, the downsides of clients becoming dependent on OT services, home exercise programs, and more!
Our goal with OT when working with pediatric clients is to help the children and their families get through the day easier, learn the skills necessary for ADLs and IADLs, provide emotional regulation tools for all environments that the child is in, and ultimately be successful in all occupations of life that the child wants to participate in.
Success is different for each child and each family which is why there’s no one-size-fits all approach when it comes to treatment or discharge.
In this episode, we discuss what to look for when discharging a client, the downsides of clients becoming dependent on OT services, home exercise programs, and more!
One thing that I like to do with my clients is make sure the families know that I'm going to give them suggestions and tools to take home with them and that's where they're going to see the biggest amount of progress. And I mean, I've been very honest with some families I've worked with where I've told them, hey, I don't want to see your child forever. I don't want you guys to be coming to OT for several years. We should try to give you guys the tools and build the confidence and build the skills so that your child can get discharged from OT and go live their best life. And sometimes just being very honest with the families in that way can be helpful.
Rachel:
I'm Rachel.
Jessica:
And I'm Jessica. And this is All Things Sensory by Harkla.
Rachel:
We are both certified occupational therapy assistants and together with Harkla, we are on a mission to empower parents, therapists and educators to help raise confident and strong children of all abilities.
Jessica:
On this podcast, we chat about all things sensory, diving into special needs, occupational therapy, parenting, self care, overall health and wellness and so much more.
Rachel:
We're here to provide raw, honest and fun strategies, ideas and information for parents, therapists and educators as well as other professionals to implement into daily life.
Jessica:
Thank you so much for joining us.
Rachel:
Hey there, welcome back to All Things Sensory by Harkla. You are listening to your good friends, Rachel Jessica.
Jessica:
Hi, welcome. Welcome back.
Rachel:
We are both certified occupational therapy assistants. We are also certified primitive reflex clinical specialists.
Jessica:
That's hard to say.
Rachel:
And we are here today talking about discharging your clients from OT.
Jessica:
We don't often talk about discharging clients in OT because, at least in our experience working in an outpatient pediatric clinic, where treatment was heavily dictated by insurance, discharge doesn't happen as often as with other professions, like physical therapy. Llike you go in for physical therapy and within a couple of months you're usually discharged because the issue was remediated. But for a variety of reasons, we don't often see that in occupational therapy and we don't, we'll talk about this later, but we don't always agree with the idea of keeping ot clients for years and years and years.
Rachel:
Yeah.
Jessica:
We want, like our goal when getting a new OT client, should be to discharge them at some point.
Rachel:
Yeah, and really OT in a nutshell, if you're not familiar, or if you're just like needing a refresher, our goal with OT with pediatric clients is to help the kiddos, help their families, help the caregivers get through the day easier, learning the skills necessary for activities of daily living, instrumental activities of daily living, provide emotional regulation tools and strategies for all environment that the child is in, and just really, ultimately, to help them be successful in occupations of life or whatever activities that the child wants to participate in.
Jessica:
And success is different for each client and for each family. So there's really no one size fits all approach, where like, I just I look at PT, and a client goes in because they broke their leg and so they've healed and now they need to kind of relearn the skills to walk and build up that muscle on the one side. It's like they have that one goal. They work on it in therapy for a couple of weeks, and then they're good to go. But in OT, because we're looking at the client as a whole, we're looking at the child as a whole, we're looking at everything they do all day long from the moment they wake up to the moment they go to bed. And because each family is different, each child is different, our approach and our treatment plan is going to be very different for each clients and our discharge plan is also going to be different for each client.
Rachel:
And I just I think it's so important to remember that when we're trying to work with a child or get a child to discharge, I mean, as OTs we can, it makes sense why you can see a client for years and years and years because there's so many things to work on, right? We really want them to thrive and so there's a lot to work on, right? But from a functional standpoint, it just doesn't seem like it's in the child's best interest to or the family's best interest to see them for years and years and years despite insurance paying for it, right?
Jessica:
I mean, you think about sports, if your child plays baseball, and they love baseball, so it's the only sport they want to play. There's an offseason. They're not playing baseball every week, all year long. They do it for a couple of months and then there's an off season before they go back into it, right? And I almost feel like that should be the way it is with OT as well of like, you get into OT, you work on some goals, you make some progress, and then you take a break. You go into the offseason, and you engage your child in something else that's functional for them and then maybe you find new things that you want to work on. So you bring them back into OT, to work on these new things and it's like an on season off season kind of like sports almost.
Rachel:
I love that. Yeah. And I think that's what we have to remember with our clients is that, I mean, a lot of our kids get burnt out with therapy.
Jessica:
The families get burned out.
Rachel:
They've been coming for so long, and the kids are plateauing and we're like, Well, what's going on? It's like, well, you've been an OT for seven years. That makes sense, right? So this isn't to like, bash on the current like OT model, because there's so many different practices out there. There's so many different clinicians. There are so many different experiences that we can't say this is a one size fits all thing that happens all the time, right? But this is just from our clinical experience. This is something that we've seen happen often and we just kind of want to raise the question and to just look a little deeper and challenge yourself, challenge your co-workers and just see if we can maybe do things differently and we'll make more progress that way.
Jessica:
So if we're looking at discharging a client, there are some different things that we want to identify and see if they're ready to discharge or if they just need a break. But the first thing we need to ask is have they gained new tools to use in different situations? So many of our clients come to us with emotional regulation difficulties, sensory processing challenges, and we want to provide the family and the child with the tools to help with those challenges in all environments. At home, at school or daycare, at the grocery store, at the playground, all of the different environments they're engaging in. So if we're going to discharge a client, we need to make sure that we've given them as many tools as possible.
Rachel:
We also want to look at is the family seeing progress and success in areas outside of OT? Are they seeing progress at school? Are they seeing success at home in the community? Are we having fewer meltdowns? Are we able to complete daily activities with more independence? So that's another thing to look and check into.
Jessica:
You also want to find out if the family feels confident in their ability to help their child. So oftentimes, we'll have clients come in, and the family is just desperate for help. They don't know what to do to help. They've tried some different things that didn't work, and they just don't know what to do. And so our job as therapists is to provide them with the tools and the confidence to help their child. So that has to be a factor when looking at discharge.
Rachel:
And another thing, like we mentioned, is looking if they've plateaued or if they're burnt out, or if they just really aren't making progress anymore and it's really no one's fault. It's just, maybe they need a therapeutic break, and they need a good home exercise program sent home with them.
Jessica:
Yeah, I think we just need to make sure that we are on the same page as the family as well and make sure that we set realistic expectations for the family from the start from the very start.
Rachel:
Yes.
Jessica:
And I think one thing that I like to do with my clients is make sure the families know that I'm gonna give them suggestions and tools to take home with them and that's where they're going to see the biggest amount of progress. And I mean, I've been very honest with some families I've worked with where I've told them, hey, I don't want to see your child forever. I don't want you guys to be coming to OT for several years. We should try to give you guys the tools and build the confidence and build the skills so that your child can get discharged from OT and go live their best life and sometimes just being very honest with the families in that way can be helpful.
Rachel:
And just making sure that you are sending home realistic activities, suggestions, home exercise programs, that the families, the caregivers are capable of carrying over. We've talked to about this in the past before, but we might as well bring it up now. But back when Jess and I first kind of we were pretty new as new therapists, and we were struggling we both Well, Jessica, you had Logan but I didn't have kids at this point. And we were like, like, why is it so challenging for carryover to happen and we made a little mock home exercise program. I gave it to Jessica. I said, Alright, here's your home exercise program, go do it with Logan. Good luck, let me know how it goes. And Logan's a neurotypical kiddo so really there are there weren't like real things to work on with him. It was just like activities and little things to do during play and a month goes by, two months go by, and I'm like, Hey, how's your home exercise program? She was like, yeah, we've done it maybe once or twice and she's like, we're just busy. Like, there's just always so much going on. And I know now having my own kids, I have so much more empathy as a therapist, because I'm like, yeah, it is extremely hard to get toddlers, kids, anyone to do these activities as their parent, right? It's so different when it's a different person saying, Alright, let's do some jumping jacks together. So I personally have so much more empathy now. But that being said, I still think that there are ways that we can support caregivers to be able to carry over realistic activities and giving them the control of like, okay, what can you carry over at home? Like, what do you feel is feasible in your current routine? Do you feel like you could do yoga at night before bed? Okay, then we'll start there and we're just going to do that. We're going to focus there. So really checking in with the caregivers on home exercise programs is important. Yeah. And I think too, when we're looking at how long do we want these kids to be in OT for, we also want to look at the other things that the child can be doing in the community. What other sports can they be involved in? Is there an adaptive sports program available? Here in the Treasure Valley, we have game changers, I recommend game changers to many of my families as a thing for their child to go participate in that will build skills similar to what we're working on in OT. Trips, where it is a little game changer short today, actually.
Jessica:
Perfect. You know, or is there a swimming class that the child can take? Is there an art class that the child can participate in?
Rachel:
Can they volunteer?
Jessica:
Can they do some volunteer work, some community service work? I think just looking at all of the other things that the community has to offer for the family and for the child to build a variety of different skills out in the real world is very important. And if the child is coming to OT, and speech two to three times a week, chances are the family is not going to have the time or the energy to go do those other things. So maybe we need to give them a therapy break for three to six months so they can go explore these other areas for their child to learn these different skill sets in real life.
Rachel:
And don't get us wrong, there are definitely certain cases, certain diagnoses that do require more intensive therapy for longer periods of time. We're not saying that's not beneficial. But looking at intensive therapy like that could be something to try coming three to four days a week for a month, and then taking a break or three days a week for three months, and then taking a break. Where it's more intensive and we can see more positive results faster, and then they get to go be like Jessica said, try those skills in the real world and actually put those skills to use. But if they're in OT for seven years, they're never going to really have much of an opportunity to go out and practice what they're learning in OT.
Jessica:
And I think from an ethical standpoint, as therapists, we have to look at that situation and say, is it ethical to keep a client on the caseload for this amount of years when we are slowly making progress? The family is seeing progress at home, at school in the environment, but we as the therapist are going to continue to say yes, but they also need to work on this. Yes, but they should also work on this. And it's like, but do they really need to?
Rachel:
Yeah.
Jessica:
Do they really? Is this really the best place for them after they've already been in OT for five years?
Rachel:
Yeah. And thinking about we do progress reports every six months. We do.
Jessica:
We do them every three months.
Rachel:
Oh, every three months?
Jessica:
Every three months.
Rachel:
Wow. Okay. Thanks. Yep. So we are required to do progress reports.
Jessica:
Thank you Medicaid. We're required to do revaluations and if we've met goals instead of changing them and increasing them, why don't we just say, Hey, we're making progress. Let's test these out. Let's see how we're doing. Let's carry over some things at home, and then come back and touch base. And also, I think, to a little bit of that scarcity mindset is a factor because it's so hard to get into OT. It's so hard to find help that once you've solidified a spot with a therapist that you like, and you have rapport with, if you take a break, how are you going to get your spot back? How are you going to come back? Which sucks, like, it's terrible. But Darn, I wish that we had, like, golden lightbulb moment of this as the answer.
Rachel:
Yeah, this is more of like, just food for thought.
Jessica:
And you know, I think about this frequently with the clients that I work with. They're coming one to two times a week. We're working on a lot of different goals, a lot of different areas. Maybe one thing that we can do as therapists is to have fewer goals. Maybe we just condense them a little bit and say we're going to work on these five areas instead of these 10 thing and maybe that provides a better way to create a treatment plan because it's more specific and then it helps us create better home exercise programs for the family. Because we're not trying to work on 10 different things, we're working on five. So we can address those specific areas a little bit easier. We can see progress a little bit faster, because we've kind of condensed it. It's like make sure you're doing three things really, really well, instead of 10 things just okay.
Rachel:
That's the mantra of my life.
Jessica:
Right? So maybe we just break it down, have fewer goals that we can really focus in on, and potentially discharge a little bit quicker. Because discharging a client should be like a celebration, like, hey, guess what, you worked really hard. You and your family worked really hard to improve these areas so that you could feel more confident, so that you could move easier, so that you could get through your day easier, and you did it. Let's celebrate that.
Rachel:
You know, there's definitely things like PT that we can definitely adjust and yes, I know, in OT, we're working on the whole child. There's a lot more to work on than just a broken leg.
Jessica:
Right, that was probably a poor example.
Rachel:
But we do we need to celebrate it, we need to make it a big deal for these kids when they are getting discharged. We need to give them the opportunity to do something well and move on to the next skill. You just think about their confidence, you know. If their their confidence could potentially be so low because they've just can't do any other activities because they go to OT twice a week and it's too much or it's too exhausting and there's too many things and, you know, let's just try something new. Try something different here.
Jessica:
So I think key takeaways from this episode is, as therapists, we should definitely be trying to discharge clients, because that means that we are helping them meet their goals. We're helping the family meet their goals. Let's help to discharge more clients by focusing in on a few specific areas, providing really good easy to implement home exercise programs, providing really good education to the families so that the families feel confident in helping their child, and providing families with resources for other things to do in the community. Those are kind of my takeaways here.
Rachel:
If you have like any comments that you want to add to this, or if you want to start a discussion, we invite you to come chat with us on Instagram at All Things Sensory Podcast, and share this episode, especially, if you're a therapist. Share it with your co-workers. Share it with whoever you feel could benefit and should benefit, which is honestly everyone just let's have this conversation and open it up.
Jessica:
Okay, I think that's all we have for you.
Rachel:
Okay, we'll chat with you next Wednesday.
Jessica:
Okay, bye.
Rachel:
Thank you so much for listening to All Things Sensory by Harkla.
Jessica:
If you want more information on anything mentioned in the show, head over to Harkla.co/slash podcast to get the show notes.
Rachel:
If you have any follow up questions, the best place to ask those is in the comments on the show notes or message us on our Instagram account, which is at Harkla_family or at All Things Sensory Podcast. If you just search Harkla, you'll find us there.
Jessica:
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Rachel:
Head to Harkla.co/sensory to use that discount code right now,
Jessica:
We are so excited to work together to help create confident kids all over the world. While we make every effort to share correct information, we're still learning.
Rachel:
We will double check all of our facts but realize that medicine is a constantly changing science and art.
Jessica:
One doctor or therapist may have a different way of doing things from another.
Rachel:
We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties, and what we have found to be beneficial that will be as evidence based as possible.
Jessica:
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Rachel:
Consult your child's pediatrician or therapist for any medical issues that he or she may be having.
Jessica:
This entire disclaimer also applies to any guests or contributors to the podcast.