Episode 1 - Let’s Talk Therapy: We did a thing!

Jennifer and Stephanie discuss starting the podcast, their individual therapy specialty, and hopes for future podcast episodes. 

Transcript

Jennifer Morgan: [00:00:00] Welcome to Let's Talk Therapy. My name's Jennifer Morgan and I'm here with Stephanie Hill and we are going to podcast. It's our first podcast and we're super excited. So Stephanie Hill, you're an occupational therapist. Tell us a little bit about that. 

Stephanie Hill: Sure. So, um, and did you say what you are? 

Jennifer Morgan: Oh, probably not.

I'm a speech language pathologist, 

Stephanie Hill: so we're both therapists in pediatric home health. We are able to do the podcast today through Viva Pediatrics, an agency that we both work with that does all three therapies, O T P T, and speech therapy as well as private duty nursing. So, uh, we appreciate the opportunity.

So, um, I am an occupational therapist and I've been in pediatric home health for a long time, and I can get into what OT does. However, before we. Start, I wanted to just talk about why are we doing a podcast? Because you approached me about this, uh, several months ago and my first response was, uh, no way.

Not doing that. However, [00:01:00] um, I do think it's a great opportunity. So why did you want to do a podcast? 

Jennifer Morgan: So, there's a couple of reasons. One, I had been exposed to podcasts because my daughter wanted me to podcast with her so that we could start like talking kind of. I dunno. It was helping her like get through those like middle teenage years.

Right. And then I did a podcast with my um, church and it was easy cuz I was just a speech therapist and talked about speech therapy stuff. And then you always send out a list of. Goals for our department around December-ish, January, November, and I usually have no goals and I'm like, text you back. And I feel shamed because I'm like, I don't have any goals.

But this year I, it popped in my head. I was like, this was something fun that I did and I feel like our community could benefit from it. I feel like it's a good way to share people's stories and kind of educate the community on what we do and [00:02:00] how we can help and assist, but also I think our families need it.

I think our therapists in the field need the connection and that's where. That's where it originated. So how did I get you to say yes and sit in the chair? 

Stephanie Hill: Yeah, so I, I hadn't really gotten into podcasting. I've been hearing about it. Uh, know a lot of people who listen as they're driving in their car, going places.

And when you approached me, I was a little scared because I thought, well, I can't just sit and talk and, and here we are, but for the same reasons you mentioned, I thought it was a great, uh, opportunity to educate for anybody who might be interested in the field of pediatric home health or therapy or nursing in the home.

I thought it might also be helpful for our current therapist, um, as you said, Be connected. Um, in home health, you are out there, uh, mostly by yourself, not in the homes, but as you're driving between places. And [00:03:00] it helps you feel part of an agency also for our families, if they don't know if they've been referred for, uh, therapy services or nursing in the home so that they have an opportunity to learn.

About what we do and how we work together. Finally, you and I have known each other for a really long time and we've worked together on and off at a variety of agencies, sometimes in the field, sometimes in the office, or vice versa. So, uh, we enjoy, just generally. I enjoy talking to you about therapy. I love what we do.

I think it's just a very, uh, special career path. Plus you have lots of fun stories and I have fun stories. There's lots of conversations. 

Jennifer Morgan: Yeah, I was thinking about this on my way over here. Or maybe like this week when I was worried about doing that. Doing this today when we first met, which was 14 ish years ago.

Yeah. Something like that. And I think about the people, the group of therapists that we worked with, cuz we were at a pretty good size agency at that point. Yep. And I think out of everybody in the room, if we [00:04:00] had to vote on who would've done a podcast in that room at that time, you and I wouldn't even have been allowed to vote or be in the room.

No. Because we would've been like, what is a podcast? Yeah. Not us. So this is crazy that we're here and we need lots of grace. 

Stephanie Hill: Absolutely. In, you're going to school, you come out and there's lots of different environments that you can work at. Right? So, um, somehow you and I both ended up in home health and in pediatrics, uh, specifically.

So I'm just curious, uh, when you got started, got outta school, uh, what did that look like for you? Did you start in home health? Did you start elsewhere? How did you get all away to home health? And then now that you're here, why have you, why have you stayed? 

Jennifer Morgan: So, I feel like my entire profession, I've just kind of fallen into the right.

Spot. Mm-hmm. At the right spot, at the right time. So, um, even going through college, like I just kind of ended up in the school of speech therapy. Mm-hmm. So you have to get your master's degree. And then the first year, which is unique to our discipline, it's kind of different from everybody else's. You have to have, they call it a [00:05:00] clinical fellowship year, which is a year out in the community, out working, paying taxes.

But you have somebody assigned to supervise you for a certain number of hours for a duration. So I went into the schools to do that cuz I. I really felt like either you go work with old people in a nursing home or you work with children in a school like I did not know. That there were hospital I, you knew that there were hospitals and things like that cuz you did clinical rotations there.

But I really didn't feel like that was an option for me cuz those were for uber smart people. So I went to the schools, I did a year and I did my CF year and it, the ladies that I with, Was with, they were wonderful. They, they had all kind of started teaching at the same time and they were now being grandmas at the same time.

So they taught me how to be a really good coworker and to love each other and to help an assistant collaborate. And it was really a fun, it was a good experience. I stayed there for about three years in the schools and then I was at a dinner party and one of the people at the dinner party was [00:06:00] in home health.

And he explained to me that home health, you go into the homes and you provide therapy with the family present. There's one child, you, most of the time there's one child. Sometimes they're siblings, but. But you're just in the house and it just kind of breaks to me. It breaks therapy down to a very true natural, mm-hmm.

Um, holistic type form. Mm-hmm. And I quickly got on the phone and I started calling home health agencies, or actually just the one that he worked for, cuz I wasn't real adventurous. And I finally got a call back and we started, and I worked in the schools during the day. And then as I drove back home, I saw patients on the way and I fell in love with it.

So over the summer I built up my caseload and I've been here ever since. Yeah. How about you, Stephanie? 

Stephanie Hill: We're lucky to have you in in home health. So my path is a lot different. Um, just start out with, and. Pediatrics for occupational therapy, that's considered a specialty area of practice. And so to get into pediatrics you have to really work at it.[00:07:00] 

Um, so before I went to school, I worked at a private pediatric clinic and it was uh, kind of a sensory-based clinic. I worked with an OT and a physical therapist, and then down the hallway there was a group of speech language pathologist. And so it was a great opportunity to see how all three of the therapy dis.

Plans work together. My position wasn't obviously as a therapist, but it was as the office manager and a therapy aid or, um, kind of a tech is sometimes what it's called. But in that position, uh, on the, on the office side, I learned about orders and authorizations and therapy codes and, you know, Things that, um, help us do the job that we do when we treat patients.

And then on the flip side, I got to be the extra hand for all the therapists. And so it was really fun because, you know, I got to engage with patients and I gotta help the therapist and I gotta kind of learn about what it is I wanted to do and go to school for. So, so I went to school. And during school, the instruction was [00:08:00] don't go into home health when you get out.

And we heard that over and over and over and over. And so I was a little really afraid of home health and there was purpose behind it in the sense that in home health, you are very much independently performing your job. And so, but when you get out as a, as a new novice therapist, there's still a lot of learning to do.

You do have a, um, An internship for which you, you are gonna be with supervisors, um, and learning, but it's not quite enough. And so those first few years you need to be around other, uh, therapists and continue to be a sponge and just learn as much as you can. But you're also making connections with colleagues in the field because when and if you go into home health, you're gonna, you're going to wanna reach out and connect back to some of the therapists that you've worked with.

Previously, uh, cuz you never know what you're gonna encounter when you're doing home. Do you ever 

Jennifer Morgan: feel like in home health that you're like, oh, I got this, I got this day, I got this new patient. I can, I can do [00:09:00] anything. Do you ever feel like Wonder Woman out there? I 

Stephanie Hill: don't think so. I don't think so. I, you know, you can be a year out or you can be 20 and you.

Still are going to just approach every, every, uh, session, every patient, uh, with kind of renewed what's, what am I gonna do today? How can I advance those skills? What activities could I do? And then separately, you know, what's going on with that patient or in that family dynamic that's gonna change your approach once you get to that home and you start going.

And so 

Jennifer Morgan: I feel like someone along the line told me, after three years of working, you'll feel like a pro. Mm-hmm. And I feel like. That cycles. Yeah, like maybe every third year I feel like a pro, but then my fourth year I'm knocked back down and I'm like, oh, I don't know. This job is is totally new. Nothing's working.

Yeah, let me call my 

Stephanie Hill: friends. Oh, it's so true. Just kind of again, once I got outta school, afraid of home house. So I went back to the pediatric clinic and I'm glad I did. And then from there I [00:10:00] wanted to just advance my skills because I was kind of stuck in a, not a rudd, if you will, but. It's a sensory based clinic.

I love that area of practice, but I did kind of feel like I was missing out on other skills that I needed to utilize. I learned a lot. I had a lot of tools and I didn't want those to go away. So at that point, I signed up to go to a big hospital system, and that was a little bit. Scary. But I worked in a float position where I, uh, did outpatient and inpatient and whatever was needed.

So I would cover maternities and vacations, or if they were opening a new clinic, I would, uh, start that. And so in, in a lot of ways, that float position, which was constantly changing in terms of the environment, but also the kind of patients I saw helped prepare me for home health. And so I was thankful.

Um, I call that my bootcamp before I got to Home Health because, uh, you know, getting to work with pediatric patients and in, um, [00:11:00] inpatient where I had to, you know, feel a little bit more comfortable with a lot of different equipment and so forth. And then, and in the outpatient, uh, being able to travel from place to place and between treatments, uh, is, is somewhat similar.

To moving into home health. So like you, I initiated actually going into Home Health. I call the agency. So I So did you 

Jennifer Morgan: have to wait forever for them to call you back or did they call you right back? Uh, they 

Stephanie Hill: didn't call me right back, you know, and it, it, you know, um, it was an interesting situation at this, uh, agency, which we were both ended up at.

They had very few. Occupational therapist and PTs. Actually you have one or two. Uh, it was very heavy speech language pathologist. And so, but, but again, it, it, it worked out well to, uh, get to start there. And you were my first supervisor in home health, so there you go. Yeah. 

Jennifer Morgan: I remember, and I, one of my jobs as a supervisor was to read the OT reports and then decide if they were like a, If they had this stuff, they needed to get [00:12:00] authorization.

Right. I just remember reading my first OT report and I'm like, I don't know. I'm not an ot. So then I started, that's whenever I started calling you and I was like, Hey, Stephanie. Yeah. What is about this? Does this make sense? Because remember we were contracting with another agency. Yes. And those reports were crazy.

That would come in. They weren't good. They were interesting. Um, but it was fun. It taught me a lot. Yes. Taught me a lot about what to look for. Yes. And, um, gave me insight. 

Stephanie Hill: So we're talking about our two professions. I don't wanna neglect talking about, um, physical therapy, which is another part of our, the therapy team.

And we will be talking to one of our PTs, uh, in one of our future podcasts. So, uh, didn't want anybody to feel like we're neglecting them, but so again, we're, you know, talking about. Speech language pathology and occupational therapy. But I guess we should tell people a little bit about, 

Jennifer Morgan: and nursing of the nursing agency.

They're the ones that got us our microphone. We're so thankful for Viva. 

Stephanie Hill: We absolutely are. But I thought maybe we would talk about like what it is. What does [00:13:00] speech Lang language pathologists do? Like what areas do you cover? Like when you are evaluating or treating a patient, like what are you looking at?

Jennifer Morgan: Well, if I asked my mother, she would. Tell me that I was a teacher. Well, because this week when I talked to her on the phone, I think three times, she told me, she was like, it's teacher appreciation weekend. I'm so thankful for you. And I'm like, well, Yeah, I'm a speech language pathologist. Mom, you paid for a master's degree and it's a different state board state exam.

I cannot teach anybody to read or write or any of that stuff, but I work on talking and talking is what we do a lot. So we work on receptive information, what you hear and what you take in and what you process. So you can follow directions, complete daily routines, but also on actual like expressing communications, thoughts, ideas, feelings, and then, You have more with communication.

You have the pragmatics part, you have the actual like sounds that are produced in words so you can [00:14:00] understand, and the ity and the rate and the voice. Um, so that's a pretty big umbrella. But then speech also tackles along with ot, the feeding side. Mm-hmm. So, um, some of my friends were like, what do you do with that baby?

And I'm like, well, you know, they've got to eat. They've gotta reland to touch. That's what we work on. So that's kind of like the whole speech. Area. I'm sure there's more that I'm missing out on. Well, just, 

Stephanie Hill: just a general overview, but I do think it helps people to know, you know, the, the speech part is in your name.

Right? Right. But not necessarily the feeding. And for all of our therapists at Viva Pediatrics, all of our speech language pathologists, we also want them to have experience in feeding. Mm-hmm. And so it's a very, it's a very big part of that home health practice in your profession, which, uh, we're all very grateful.

I was 

Jennifer Morgan: watching the show Take the Lead the other night that was talking about food. It was Top Chef. One of the ladies was telling a story about how she had immigrated to [00:15:00] another country and like feeding. And when she cooked, she felt like her mom was present with her when she cooked. And then this other lady started crying and I don't think we realized how.

Tied with emotion and language. Mm-hmm. That feeding takes on because like, as a mom to be able to feed your baby, you like, know that they're safe and secure during those months and years when they can't really talk to you and express and say, Hey, my toe hurts. You know? Mm-hmm. They can tell you, you can tell from the way they look and they respond to you that their tummy's full.

So if you don't have that aspect whenever mm-hmm. You, you've got this new baby that you're already anxious about, it can really like it, it gets in your head and it can mess with the way you think and, and. And move forward when really like it's just a basic, we get to deal with that side, right? That basic side, that nurture side.

Absolutely. Which is kind of nice. Yeah. Long way to get there. Yep. So tell me the occupation of a child, Stephanie, the 

Stephanie Hill: occupation. Thank you for phrasing it that way. So that's in my, uh, profession's name, occupational therapy. Sometimes people don't know what it is we do. So I'm gonna give [00:16:00] you a quick overview and just as you said, I might miss a few things, but when you think about occupation, it's how someone occupies their time.

So how does a child occupy their time? Will they, Play. They learn how to become independent and, and grow, grow up to be, you know, little adults. And they interact, um, they interact with people, they interact with objects, they interact with, you know, the intangibles around in their world. And so, in particular, OTs are gonna really focus on fine motor skills.

So anything you might do with your hands, if you grasp something, pick up something, push a button, turn a knob, um, you're. Interacting with your environment and also, you know, anything you might do with your eyes and hands together. We call that visual motor eye hand coordination. So if you're reaching out to graphs something, or if you're putting a simple puzzle together.

We're gonna look at that. And then a [00:17:00] big area of practice is self-care skills. So, you know, in your everyday life you get up and you likely take a shower and you brush your teeth and you eat a bowl of cereal and you drive to work. So all of those things are kind of related to that self-care. And so for little ones, you know, we're going to be working on how do they learn how to dress, how do they learn how to groom themselves?

How do they do with, um, taking a shower, taking a bath, maybe sitting on the potty using tools or utensil. So, uh, you know, eating with a spoon or fork, uh, drinking with a cup. But those are all very important skills and even if a child maybe doesn't have that skillset, and we can kind of help them be as involved as they can to help their caregivers perform those things for them, um, sometimes.

And well actually a lot of times in our environment we're working with those more home bound, medically fragile kids. And so we want [00:18:00] them to, to be as involved in their daily routines, in their daily, uh, life task as possible. And so OTs gonna take the lead on. Functional skills, those everyday skills. And then one other big area of practice, you heard me mention earlier that I used to work at a sensory clinic.

So this area of practice is kind of one of my favorites. But you know, if a child can maybe overreacts or underreact to anything sensory in their environment and it impacts them so much that um, they can't maybe learn or socially engage, um, then OTs probably gonna be, uh, something. That needs to be, um, looked at.

So you know how a child responds to sound, to sight, to movement, to touch, taste, and smell. So some kids who are, um, maybe. Don't like to wear certain kind of clothing or the tags or the seams in their socks, or [00:19:00] maybe they don't like to walk in the grass or the sand. It's, it's too overwhelming for them. Or maybe they're just like, have to touch everything and they're constantly fidgeting and they're constantly doing, uh, same way with movement.

Very fearful of having their feet off the ground. Maybe they're afraid to sit on the potty cuz they're, they're. Feet are dangling in the air or they're afraid to take the stairs or steps or something like that. Or it's those kiddos who are like spinning nonstop. They gotta be moving all the time. Right.

Uh, you know, we could talk about the other areas, but again, if it is impacting them so much that they. Kind of don't, aren't able to or don't want to, or are not available to engage in their world, then OT may be an appropriate referral for that child. So that's the overview of what, uh, we do. I do wanna mention a little bit about pt.

So, I am obviously not a physical therapist, however, I wanna just paint the [00:20:00] picture, speech therapist, a physical therapist. But I do wanna just paint a little bit of the picture about what they do. And then again, we're gonna have a PT come and, and they'll be, uh, you know, better equipped to kind of cover all the bases, but, So the difference for physical therapy is that they're gonna look at those big motor skill movements, so gross motor skills movement in particular.

So for our littles, being able to roll, being able to sit up, stand, uh, take steps if they require some equipment that might help support them in doing those. Things then the PT is gonna be involved in helping to obtain and order those things for them, but strength and balance, coordination, stability so that they can help both of us do our goals.

Absolutely. So huge big part of, uh, what we do, um, in the therapy program is we need our PTs and we need our speech therapists. And I 

Jennifer Morgan: think they're kinda like the best out of all three of us. Because they get to do those big movements where I'm like, sit in a chair, [00:21:00] and you're like, oh, touch this gooey stuff.

Yes. Well, and they're like, yes, let's go to the park and go up and down the stairs. Yeah. 

Stephanie Hill: Well, and, and then on the flip side, they'll probably say that about us. Right. You know, it's just all about perspective. So, um, but that's a good overview of the different therapies. So let's just talk about home health, like.

Why home health? Like what are some of the positives for, um, going into that area practice? Like why do you like it? 

Jennifer Morgan: I love home health because the families, I love the families. And like when you were talking about, when you were talking about like teaching a child to play with toys and engage with their environment, it made me think about.

We did a c U a long time ago, I think you were in there with me, where this lady like literally labeled all of her toys according to the age month that, that it was appropriate for. And I think about that, like, you know, even rolling a car, like the skills you need as an adult that you have to get from rolling a car or even like mm-hmm.

Hold back to sleep. [00:22:00] That kind of created the movement where kids weren't crawling as much. Mm-hmm. And how that skill is so needed to maintain good stability and support like whenever you get older. So you can throw a ball, you can engage in middle school. Yes. I mean, not just middle school. Like it helps you keep a better course so your body can stay healthy in your joints.

And so I think home health allows. Me to break those skills down mm-hmm. That are needed in the home. And then I get to see the family dynamics with it as well. Right. So you have your developmental milestones. Mm-hmm. And then you have activities that make a house function and be specific to them. Right.

And that's what you get to focus on when you're in the schools. You kind of have the school curriculum that you're kind of trying to blend in. When you're in a clinic, you have, you know, clinic stuff that you can easily see, community things, right? But in the home you get the input from the family. 

Stephanie Hill: Yep.

And the parents, I agree. The natural environment, we'll, obviously on the OT side, as [00:23:00] I was talking about self-care skills, so you can practice those skills in a clinic in the school setting, but how great is it if you're working on dressing that you know, You can get them to their dresser and they can help pick out their own clothes or Right.

Cuz 

Jennifer Morgan: every dresser is different. You don't realize that until you're doing therapy that every dresser and dresser handle is different. 

Stephanie Hill: Right. And, and, and just seeing the layout of the home makes such. A difference, not only just how it's structured, but as you mentioned the family dynamics. And so I used to tell this story and I still tell it when I worked in the clinic, particularly in the private uh clinic, I used to make these beautiful two, three page home programs.

And I was so proud cuz I thought, look, I'm giving them a blueprint of everything they do all day long. And then when I got into home health, I thought, wow, how sad was that? Because that family may only have five, 10 minutes in their daily routine to even focus on some of these things. [00:24:00] Or they may not have access in their environment to the things you might see in a clinic or a school.

Do you feel like you to go 

Jennifer Morgan: write an apology 

Stephanie Hill: letter to those parents? Well, listen, I did think about it because I, I was so proud and my, my ego was so big about it. Mm-hmm. And, um, but that's not real life. And so home health is real life. That's, I feel like that was the 

Jennifer Morgan: school stuff. Like I remember writing these.

Jane, beautiful lesson plans. Yeah. Like beautiful, beautiful lesson plans. And like, I would take in like two or three bags while I still take in two or three bags, but I would bring in all these activities, right? And, and I'm like, that's that's not it. 

Stephanie Hill: Yeah. That's not it. It's, it, it, it wasn't always practical, right?

Mm-hmm. And, and then your families who actually tried you were like, Wow. They really did all, you know, as much as they could. Yeah. But just again, and I think that when you're in the natural environment and you're adapting to that environment and you're adapting to that kind of family, you're also get more carryover, right?

Mm-hmm. It's, it's, it's real. And, and you are asking them to do things. That are already maybe in play, you're just enhancing them or [00:25:00] you're complimenting them, or you're giving them some things to just make it just maybe a little bit tougher or challenge that child a little bit more, or you're changing it up to make it easier for that caregiver to engage in that, um, that kind of home programming activity.

So there 

Jennifer Morgan: was one therapist a long time ago that said what she loved about home health was the fact that, you know, she had a consistency. Schedule. So every Tuesday or Thursday at three o'clock mm-hmm. The little girls were peeking through the blinds, waiting for her to show up and. That was the one true consistency in their life.

Like, they may not have food, their electricity may not be on, but every Tuesday and Thursday at three o'clock, their therapist showed up. Yeah. She had a smile and they did fun stuff. Yeah. And that was her rewarding moment. And I think that's kind of, you just integrate into the family in that sense. 

Stephanie Hill: Yeah. I, I love that.

Um, and, and it's very, very true. I mean, you hope that you're not pulling up and they're like, oh no, it's the therapist. But [00:26:00] also I think, For clinicians so to consider home health. So great for patient care. First and foremost, we care about quality and we care about the families. But just as a clinician, when you're in home health, typically your schedule is a little bit more flexible because you're making it so the agency oversees it, tip.

Most of the time, but the therapist is determining, um, what days and, and, and the length of that session. And 

Jennifer Morgan: almost like an individual, individual contract with that family. Like when you say yes and you go through the eval mm-hmm. You're like, okay, this is what we're committing to. Right. Um, And the other 

Stephanie Hill: thing, you know, we, we talked about it, you're much more independent, right?

Like use that term autonomy. Mm-hmm. So, uh, you are determining your plan of cares and you're determining what kind of activities and you're determining your approach. And so some therapists really enjoy that. And if you get to, [00:27:00] you know, a certain point in your career, you feel a bit more confident. Also, mm-hmm.

To be more independent. But the other thing I wanted to mention, and this may be just true for me, but when I worked at the hospital, for instance, um, and this, these were the dayss when we still had 30 minute sessions for o t and p t. Now they're longer. But when we were on a kind of a 30 minute, uh, treatment interval.

I literally in a 10 hour day saw 16 or 17 patients and it was nonstop. And it was sort of like assembly line therapy, if you will. Mm-hmm. And I'm not knocking that, uh, setting. I'm just saying that that was, that 

Jennifer Morgan: was that setting just allows for that. Right. Because the parents bring you, you drop one off, you pick one up.

Yes, 

Stephanie Hill: exactly. They're coming to you and so you're just back to back to back. But in home health, you get a little bit of a break between kids because you've got that drive time. Right. And for me, it's sort of like, Okay, let me think about what I did last time or last session. Let me think about maybe some activities I wanna try today.

You know, what did, [00:28:00] what did the caregiver mention to me that I need to be aware of? Maybe the environment. Uh, maybe I work in the living room, but that is too crazy and TV going and siblings and pets and so forth. So maybe we could move to another area, you know, this time to make it more successful. So, at any rate, just having that little bit of a breather.

Was also really helpful for me, and I felt like it made me a better therapist because I could actually process and think about and plan for what I was gonna do. I think it's 

Jennifer Morgan: great, like it's a great positive, but then it's a great drawback too, because then like whenever you're at a clinic, you clock in, you have that visual like clock out, right?

Mm-hmm. But when you're in home health, You start your drive in the morning and you go and you do your first visit, and then you're in your car and you go to your next one. And so yeah, during that time, your radio may be on or off, whatever you need to make it to your next one, but you're thinking about it.

Mm-hmm. And then at the end of the day, when you drive home, it's no. See you [00:29:00] later, alligator. You can still be thinking about that and you may still have paperwork at home and you, I mean, it's still like if you're somebody who sits and marinate and processes on something, you have to be able to self-control that and be like, okay, between these hours I marinate about work and then here I'm going to be home and I'm going to be family.

Stephanie Hill: It's very true because you can, uh, and, and I know that's one of the challenges, and so I think it's helpful to talk about some of the challenges and maybe some of the strategies. Mm-hmm. Right? Mm-hmm. But. Sometimes it's difficult to turn it off, right? Mm-hmm. And if you are not disciplined enough to make sure you're doing your notes.

So for me, when I was full-time in the field, if I had a break, so you're gonna get cancellation cancellations sometimes, and occasional no-show. Hopefully not very often, or you're gonna build in a lunchtime. So that you can catch up. We're gonna on your morning notes. 

Jennifer Morgan: We're, cuz we all know we drive an eater sandwich.

Yeah, we do. 

Stephanie Hill: We we totally do. But, but [00:30:00] it, you've, you also have to be disciplined on your schedule. Mm-hmm. Because when you set a plan of care, the, the goal is that you meet that plan of care. So if it's twice a week, it's twice a week. And so if you miss for whatever reason, maybe you know that child had a doctor's appointment or there was something going on or on the clinician side, maybe you had.

Some family event that was gonna impact your schedule, but you still need to try to make up those visits and so you've gotta be able to juggle your schedule. You constantly 

Jennifer Morgan: have to be flexible. Yes, yes. And willing to, like nego, I mean, not negotiate, but you know, just like last week, like I knocked on one door and they were walking out to an appointment and I was like, oh, well somebody else is three minutes away.

I'm just gonna go knock on their door or call them, or you know, whatnot. Right. So you have to be available for that because you're gonna need that other time slot to make up the one who just wasn't home. 

Stephanie Hill: Exactly. Exactly. So, and I guess, you know, just we've talked about some of the other challenges, right?

Uh, they're like, They're like [00:31:00] challenges, but also good things. So being able to adapt to a variety of environments and families and diagnoses and ages and so forth, 

Jennifer Morgan: and just rules. Like I always walk into a house, especially with feeding, and I'm like, what's the rule? And they're like, what do you mean?

What's the rule? Like we feed them. And I'm like, I know, but like. Once a thing of yogurt is open, can we reuse it the next day? Or it's like it's tossed and gone. Or everybody has their own like home norms and you have to blend according to what house you're in, into those norms to a degree. Yes. 

Stephanie Hill: And you know, and that goes back to even different cultural, um, beliefs.

You have to be very respectful because I mean, you're going into their home and they may have some very specific. Ways of doing things and whereas you may have an idea say how to address. Behavior, they may have a very different approach. And so you can't just come in with just what you think [00:32:00] a family should do.

You've got to learn what, how that family functions and what their beliefs and what you know their rules are. And then you have to adapt and then somehow kind of meet in the middle as you're working towards a. Agreed upon goals. So it's not, it's not really about just our goals, right? It's about what are, as a partnership with the family, what is 

Jennifer Morgan: everybody's goal?

So I love it whenever the grandma and the grandpa are like peeking beside the door, like looking in at you throughout the whole session, and mom's just sitting there and like everything you say, then she looks back at the door. Because you know, grandma and grandpa are running that house. Oh, yes, 

Stephanie Hill: yes. Just making sure it's okay.

Jennifer Morgan: So making sure you're not hurting their baby. 

Stephanie Hill: Right. And and then the other thing, and we touched on it, when you're walking into a household, they may or may not have this. The same things that you might have an idea of what you're gonna work on. So, You know, if they don't have stairs or steps, you know, what are your options for working on those same movements?

You know, [00:33:00] if they don't have a particular toy with a button and I wanna work on activating and pointing and you know, all of these, you know, kind of fine motor and eye hand coordination, how can I try to utilize. Other things that might mimic those similar activities. And of course, you know, there, there definitely are times where we might bring things in and, uh, show a family and that, you know, this is, you know, the skills we might be working on.

And these are some things that might be helpful. We're not asking a family to go out and buy a bunch of things, but we want to be able to buy the toys that we bring in. No, we just, we just wanna be able to model and, uh, give them a visual of what it is that we're trying to do. So, but, but with that, I guess challenge is also pushing you to be very resourceful and very creative, and so that's kind of some of the fun things.

Pieces. 

Jennifer Morgan: Um, yeah, we get to be crafty without actually being crafty. Yes. We don't have to make a wreath for the door, but we get to constantly 

Stephanie Hill: be. Yes. [00:34:00] Sometimes you're like, I don't know how I'm gonna do this, but you figure it out. And so it's, it's like, on your feet, go, go, go. And so it does stretch your skills.

It, it does. Um, but it also, I think it just, it strengthened you. As a clinician. Mm-hmm. And so, um, that's where you have 

Jennifer Morgan: to be observant in reading the child too, cuz I think so many times our little ones, like if we can give them the support mm-hmm. Like they're wanting to do those skills mm-hmm. Just their body and space won't let him.

Right. So, um, if we can just like, maybe he just has to lean into you while he stands at the table and plays or mm-hmm. Whatnot. Like those little bitty tiny touches are what we're there to help the parents see. 

Stephanie Hill: Absolutely. Absolutely. And the other thing I think of, and, and we talked a little bit about it earlier in the discussion, but because you are going into that home and you're not necessarily around other providers, you've got to be able to utilize your resources in terms [00:35:00] of not being afraid.

To ask questions, to reach out to colleagues who maybe they have encountered something that you haven't, or maybe you've been working with a child for a while and you're kind of like, I'm, I'm, I feel like I'm maybe stuck. I'm stuck. Yeah, exactly. And so you want to feel comfortable to say, Hey, uh, other, uh, speech therapist or OT or pt, what do you think about this?

Or, you know, I've tried this and this is not working, or, Wow, this is actual diagnosis that I've never seen before. Have you, and what do you think? Mm-hmm. So, you know, where autonomy and independence is very, very, uh, something that people would like. You're really not that if you're a truly, uh, And that's gifted 

Jennifer Morgan: home health therapist really have to seek in home health because it is possible, especially if you've never done another setting and didn't meet anybody other than what you graduated with.

Right. Like you really have to seek that out cuz [00:36:00] one, we're not doing therapy on top of each other. Right. So we don't, we're not doing a session with an OT there or with a PT there that you might get in a clinic. Mm-hmm. Or in a school. And then, so that means you have to have made friends that you have their phone number so that you can call, right?

And if you have quarterly meetings, monthly meetings, whatever your company offers, then during that time is the time where you can collaborate the most. But there's so many times that I'm like, oh, this therapist, she's great at co acom. I'm calling her because, I don't know. I don't know what I'm doing here or this one.

Like we're working on feeding and mm-hmm. She's not sucking like she will suck when there's no bottle around, but as soon as you put something to your lips, she won't suck. So, um, just that collaboration. But you're gonna have to be the one who reaches out to do that. Absolutely. Which is either a strength or a drawback according to.

What you feel comfortable doing. Right, right, right. And connections that you're willing to make. 

Stephanie Hill: Very true. And as we're talking, uh, we're talking about, you know, just, uh, reaching out to fellow therapists, but I do wanna mention that for those, uh, families and [00:37:00] patients where there is a nurse in the home with, uh, a lot of our patients, we do have nursing, you are collaborating with the PDN nurse, uh, and the family members because, you know, they're spending the most time.

With this child. And so they, they're gonna pick up on things. They're gonna know things that maybe is going on with their, uh, their health status, or maybe they've discovered that this child has a new preference. And then as a therapist, you're like, awesome. We're doing Mario next week, or whatever, you know, whatever character or whatever activity has gotten their attention and their engagement.

So again, uh, you are just utilizing all the. All the people who are involved with this child to help them make progress. And so, uh, it, it is a partnership. And so you're, you're not technically all alone. You really are working with other people, but you are going into a variety of environments and, and I think 

Jennifer Morgan: the longer you stay in the industry and you have your areas that you are so familiar with, [00:38:00] you start to know the therapist in those areas.

Yeah. And it's. It becomes a connection whether you're all with the same agency or not. You, you know them, you call them, you coordinate. 

Stephanie Hill: And for the record, it's a small community, so it's so small. Um, even in DFW and in Austin, you might work for different agencies, but uh, it's going in pediatrics in particular, you're probably gonna know someone.

Someone else who you've worked with before? Someone else has worked with them before? No. Wasn't it 

Jennifer Morgan: like two weeks ago where I was like, Hey, I walked in and there was a nurse that I worked with at this other company. Yes. And then I had to ask you what her name was. Right? Right. And then I went into another one.

I was like, I just saw another one. You guys just hired her? Yes. Choose to work at this other agency. So, yeah. Um, yeah. It's interesting. You never know, like when you knock on the door, right. If you're gonna recognize the face or not. Right. Or even out in the community, sometimes you'll see a little one run by and you're like, 

Stephanie Hill: Ooh, I might have treated that one before.

Right, 

Jennifer Morgan: right. And then all of a sudden mom's like, Hey, how are you? And you're like, hi. 

Stephanie Hill: [00:39:00] Yes, yes. We forgot, uh, to talk a little bit about, uh, professional boundaries and working in the home. And I don't wanna let that little piece go by because, you know, we talked about in the school and in the clinic and people are coming to you.

And so you may or may not have that caregiver in your session. Uh, sometimes you might not even see. That caregiver. But when you're going into a home, you are intimately involved. You are in, in that family's world, and, and there's pros and cons to that, right? Mm-hmm. Because as a therapist, you do it because you love it, and you want that connection, but you're also a medical professional in which you have to set some professional boundaries.

And that's important because I mean, Sometimes you're gonna have to have some tough discussions and the end goal of therapy is that eventually you are gonna discharge that patient. Mm-hmm. So there will be an end to that professional relationship. So it is, [00:40:00] uh, it is wonderful and it's hard not, it is hard cuz you're there, 

Jennifer Morgan: you're, you're there watching their child go through stages.

Mm-hmm. You're there when mom couldn't get the laundry done and she's complaining that, or not complaining, but she's apologizing cuz her house is a mess. Then, then you're like, oh no, not here for your house. I'm here for your child and you, you know? Right. And it's, and it's hard because I remember when I had, I.

When I've had children and I was working with a home health agency, but I also had some private practice, and I remember calling one of my moms because I just couldn't, I couldn't keep up with it anymore. I was too much being a new mom and working full-time, and so I called her and I'm like on the phone crying, telling her that I'm gonna have to find her another therapist and sh before I can even get out.

She was like, I know Jennifer. Oh, you need to take care of your baby, and it's okay. We'll be here for when, whenever you're ready or whatnot. Yeah. And it was hard cuz I'm like sitting there crying and I'm like, oh, well this is a good time to practice professionalism, you know, like clearly. But I mean, she was able to help me grow through that [00:41:00] situation.

But you do like, right, you, you get connected. It's hard. You really have to have like a clear boundary of where. It stops. 

Stephanie Hill: We you do. And, and on the flip side, you may walk into a home and that parent, um, may not have as many resources. And so they're home with their child, you know, day in and day out, and they don't have a lot of social contact.

Mm-hmm. And so guess what, as a therapist, you are their social contact. And so they may disclose to you a lot of personal things that you're like, Oh, this is really uncomfortable, right? Because I'm really here, you know, to focus on, on treatment. And so you're gonna still be supportive and kind because obviously you're treating the whole family.

You're really in the end not treating just that child. But you also need to be careful because, you know, it would not be appropriate, uh, to engage in talking about and sharing even from your own personal life with this caregiver. And so, but some of the dynamics, right, of working in home health. Lots and [00:42:00] lots of positives.

And of course other settings have their, have their pros and cons too. But I'm thankful to work in home health at this point in my career. I can't imagine doing anything else. And so, um, and I, you know, obviously I've worked in different settings. I even did e c I for a little bit and I'm glad that I had those experiences.

I learned from them. But this is, this is where I wanna be and hope that I can continue for as long as my body allows me to work in home health. And so, 

Jennifer Morgan: This is where our heart is at home health. 

Stephanie Hill: It it is. And in pediatrics and so, 

Jennifer Morgan: and people, right? It's all about 

Stephanie Hill: people. It is about people. So we are thankful that you all have taken the time to listen to our podcast today.

Jennifer Morgan: So let's talk about what we're gonna do this season, cuz we've got a great season. I feel like you do, in my opinion. We do. Do you 

Stephanie Hill: want me to just 

Jennifer Morgan: kind of, I might be able to read it on your notes across the table. Just so you guys know, I have like, A half page of notes and Stephanie has two full on 

Stephanie Hill: pages.

Okay. But difference in personalities. I'm just saying so. Right, 

Jennifer Morgan: because But if I had that much, I would not be able to even [00:43:00] read it right now cuz I'm so nervous. So we will be having pha, our pt, come on. Mm-hmm. And talk to us about just how we can all collaborate and work together and then we'll have. One of my favorite nurses, Ms.

Kim, come on and we're gonna talk about a case we kind of had together and how we worked. And then our wonderful owners who bought us microphones, Efram and Erica will come on and share their story. And I'm so excited to hear about that. And then we have somebody from the office, Elda coming on and we're gonna just talk about work-life balance and mm-hmm.

All of us we're working and trying to be humans and have families and things outside. Mm-hmm. And it's tough some days. Mm-hmm. And then lastly, we will have one of our moms come on that, um, has a chi, a child with special needs, and we're gonna talk about how she balances that, having nursing services and therapy services and mm-hmm.

Everyone in and out of her home and she's. Always so welcoming all the time. Yeah. I'm, 

Stephanie Hill: I'm, I'm so excited to hear, uh, we, you know, we have these planned, we [00:44:00] hope that people will find value and our discussions are just, uh, listening and have some fun or maybe some connection, uh, to something that we've said.

So we hope that you'll join us again with Let's Talk Therapy again. We're with Viva Pediatrics. That's, uh, v i v a, pediatrics. We're home health agents. C in Dallas, Fort Worth and in Austin we have all three of the therapy services as well as private duty nursing. And if you have any questions or wanna explore a little bit more about Viva Pediatrics, you can find us@www.viva peds.

That's V I V A P E D s.com. And we look forward to talking to you again on our next session. Thank you. Bye.