Episode 2 - Let's Talk Therapy: When we all 3 get together

Today’s episode invites a physical therapist to discuss the rewards and challenges of providing therapy in the home setting. 

Transcript

VIVA Podcast Episode 2  -  Let's Talk Therapy - When we all three get together!

Jennifer Morgan: [00:00:00] Welcome to Let's Talk Therapy. My name is Jennifer Morgan and I'm here with Stephanie Hill and we are going to talk with our friend Peisha today. She's a physical therapist and she works for Vipa Pediatrics with us. Uh, our open air question is, what was your high and your low for the week? 

Stephanie Hill: Is that coming my way?

Jennifer Morgan: It's coming your way first, Stephanie. 

Okay. So because she's our guest. Absolutely. Hi for the week. If I'm thinking about work specifically, because you know, you have highs at home and highs at work, but highs for me, uh, we are going to hire a few therapists out of our Austin office and it's a really big deal because therapist, pediatric therapists for home health are hard to find.

So we are super excited about that. Goodness, alo. Still work. Authorizations are getting a little bit harder, so things are changing for the better related to covid and the emergency period. However, all the flexibilities and all of the, uh, allowances are kind of going away and so all of a sudden our authorizations are [00:01:00] getting, uh, really looked out more closely.

We're getting. Them denials we're giving changes. And so that's a bummer because you know, our goal as a pediatric therapist is just to get out there and treat as quickly as we can and with no hiccups. But we have a great team and so we will work at doing appeals and whatever it takes so that we can see our little ones.

So, How about you, cia? Well, my high for the week was one of my little kids. I said I was packing up, ready to go. I said, I'm gonna go see some more of my friends. And he said, but I thought I was your best friend. Aw. And I was like, excuse me, why? My heart melts just a second. Um, I feel like I've done my job if they see me as their friend.

My loaf for the week was the rain. I just don't like home health and rain. Yeah. I like rain at home on a patio. I don't like having to get in and out of it. It's just not fun. One of the challenges, Jennifer, you're up. Okay, so my high for the week was, I have a little one that has a trach and he, I [00:02:00] think he's actually one of my first patient, like the earliest I've ever seen a doctor give us a pap er valve.

'cause he's like one-ish and that's kind of early and he's still cuffed like most of the day. Which for those of you out here, who there that don't know what a, what it is. Whenever we say a child's cuffed is they have a trach and then there's this little. My words are like a little balloon above the trach that you kind of inflate, so they can't aspirate into their lungs or anything.

So, um, he no longer, like during therapy, we can decoff him so that's not there. And we can put on a papier valve, which is a valve where he can take in oxygen to his lungs, but then he has to expel it through his mouth, which allows him to vocalize. So today he, or this week, he tolerated it. Me taking it off during the session, not him having to have it off because he couldn't maintain respiration.

So that was cool. That is awesome. Do you have a low? I always have a low, so this week was rough. I think if you had asked me on Tuesday, I'd have had like a ton of 'em because [00:03:00] Monday was a holiday for a lot of our little ones. So that inevitably leads to cancellations and then you're like, what do I do with the time?

But then also the rain and then I felt like my. Exploded in the backseat of my car a couple of times, my therapy bag with all my toys, and they go everywhere, and that's just never easy to recoup after that. If someone can gimme a good organizational. Tip for the trunk, I would gladly take it. Oh yeah. Yeah.

Because I'm always changing it up. Yeah, yeah. I always have like the Ikea baby bag Uhhuh. The IKEA toddler bag. The ikea, yep. High sensory bag, and it just still seems to always be a hot mess. I know. Because they have those trunk organizers and there's never enough, and then there needs to be some type of like, Good trash can that we can have in our car.

Well, I was gonna say, because there's a, there's a toys I can still use and the toys, you gotta clean, right? Mm-hmm. And so you come outta a session and you're like, get getting ready for the next one. And so you gotta go, okay, this toy I can use again, this toy, I need to clean this [00:04:00] toy I can use for this age or that.

And then from week to week you might change it. So there's always movement of the toys in. In the trunk or wherever you have it. So, um, or the, they transition to the backseat when it's raining because, you know, then you can just like maneuver in your backseat Sure. And get your toys out and then climb out one door instead of opening like two or three and getting totally soaking.

We, yeah. Yes, yes. Well, let's welcome Peisha again. So she is a physical therapist. She works in pediatrics with us at Veeva Pediatrics. And, uh, we are so glad to have you. Okay. Because, uh, just our. A reminder, Jennifer is a speech language pathologist. I'm an occupational therapist, and the third member of our therapy team is physical therapist.

So we are super glad that you're here. Uh, we wanna get to know you a little bit. We wanna find out a little bit about your background. How did you come about, uh, being a physical therapist? Did you start out in pediatrics? Did you work your way to it? And then ultimately, how did you get to, uh, [00:05:00] pediatric home health?

So I do feel like I was a little bit of the minority in my class as a PT because I feel like, I don't know how it is with OT and speech, but as a physical therapist, it feels like pretty much everyone in there HA was an athlete and had some sort of sports injury that they went through rehab and they're like, this is great.

I wanna do this. That was not my story. Um, I was a nanny in high school for a little boy, and so I had to go with him to his therapies. And I remember when he first started walking with this miniature walker, uh, that is the cutest thing I've ever seen. And just having to do the therapy with him at home, I, that's when I decided I definitely wanted to go into physical therapy.

However, it wasn't that I wanted to go into pediatrics. It just, I knew I wanted to go and help people. And so then when I started PT school, I. When I did a couple pediatric just observations, I thought, I'm not sure I can do pediatrics. This is too sad. I can't do this. And then it shifted after I got my first job [00:06:00] into home health.

I cannot imagine doing anything else. Yes, but that's how it started. But even, okay. Stephanie talked about in our first episode how occupational therapies kind of, it's a specialty to work with peds, where I feel like with speech therapy, We see them in the schools. I mean, it's not so unusual to visualize a speech therapist as somebody working with pediatrics where Stephanie was like, that's a specialty.

Is, would you say that's the same thing with pt? Physical therapy? For sure, because we don't, I would say, you know, if you were to ask me what I learned in school for physical therapy, it would be the anatomy, the body parts. I mean, I don't think we did a whole, we maybe had a three month sliver on pediatrics in that.

That was about it. I dove into pediatrics as a young therapist, did not have a family, so I could go on these week long, you know, to Chicago and these week long retreats basically, and learn so much and I really, that's where I gathered the bulk of my information and just really. [00:07:00] Taking the patient from start to finish, looking at gait, looking at the gait cycle, then I would go to an orthotics.

What is an orthotic? What start to finish? And I really still lean on my professionals, but in the orthotist world and in the D M E world, but I at least know what they're talking about. And then also, same thing with seating. I went to a ton of seating. Seminars on ride molding and getting, um, licensed in that.

And then just looking at everything, every type of child, whether it be the low tone, quote unquote clumsy child as they would call it, to the high tone child, to the just developmental delay. Did the NICU handling, um, N D T training? It just, I really used those first, I would say five years of being a young therapist and not have being a mom and.

Utilizing that extra time to dive into, do you feel like, um, coursework is still the same? Because whenever I went through school, like we had a lot of, obviously [00:08:00] child development, those type of things, clinicals, but there wasn't a huge focus on feeding, which now feeding therapy is huge in the speech world.

So do you feel like maybe now the curriculum for college work has changed or do you feel like it's still the same? I would probably say it's still the same. When I was in PT school, you definitely knew which schools focused more on what, where I went. We were way more of an orthopedic school. Yeah. San Antonio was more of a neuro school.

So you kind of knew your I'm, I would doubt they have one that's super pediatric biased. But, um, I think really pediatric being the specialty that it, that it is, you have to go out in the field and learn that. One on, you know, hands on. Mm-hmm. And I appreciate you said that first five years because I shared in the very first episode how someone had told me when I was in school, don't go into home health at least.

Do you have five years of experience? Like don't even try because you have to gain so much more knowledge in order to be out in that setting. But I'm curious, when you started working, did you start in home [00:09:00] health? You did start in home health. Mm-hmm. Wow. Okay. It's interesting. That's unusual, right? It's because usually you're in a setting with other, uh, therapist clinicians, so you, you're continuing with your learning.

So tell us about that. So my very first job out there, um, worked for a wonderful home health company that really, um, they helped build the therapist. They, they did a lot of continuing ed. They knew they were bringing on new grads. I also, I look back on it and just the other day I was having a conversation with someone and I was like, wow.

I mean, I feel so blessed that I was able to go out on some of those first evals when you're just a brand new baby out there. And that they trusted me with their children and the families listened, and I had the confidence to do that. I don't know how that worked out, but it did. Um, and I just, I've had such a great experience.

In home health, I will tell someone when they first started following me, and I still had [00:10:00] students, home health is not for everyone. It's a hundred percent where I'm supposed to be, but it is not for everyone. If you're not the type of person that wants to just move around your schedule all day long and be here and be there and doesn't like that.

Mm-hmm. And they want super stability, like their job is never gonna change. We're gonna wake up, we're gonna go to the office, then it might not be the best. Setting, but I absolutely love it. So I hear you say you love it and obviously we love it. We've been doing it a long time as well. But what specifically, I heard you say maybe the schedule's flexible, but are there other parts of the pediatric home health that you really like and that you would tell other people maybe who were coming from a hospital setting or an outpatient clinic?

Like how would you differentiate that to say, this is really special about this area of practice? I think being in the patient's home and being able to observe them in their environment and just that [00:11:00] organic interaction that you have with them is probably what makes it and sets it completely apart from a clinic or a hospital.

Learning all the dynamics of that child, like everyone can go into a clinic. I say everyone, most people can go into a clinic or a hospital setting and act one way for 30 minutes. That is not going to happen when you're in their home two to three times a week for 45 minutes to an hour. And I think that in pediatrics, one thing that is different from other areas of pt, when you start with a patient, you might be with this child for a very long time.

So just being able to understand them and see where they're coming from. You know, sometimes you show up and that child is not having the best day. You know, other dynamics that go on in the home. So you think, okay, today is a day we're gonna quietly sing songs and you know, do imitation play versus let's go out there and run an obstacle course.

So I think just being able to see the patient as a whole. [00:12:00] Yes. Yep. I like how you mentioned, you know, like when you first started you were learning, and I think that's something that Home Health allows us to do is we are in the home, the parents are learning. A new way to interact with their child. And then at the same time, we're learning and growing our skills.

'cause each little one that we see, mm-hmm. Our basic skills. We may have the same basic techniques that we use with each child, but you have to grow and learn those skills with each child in each environment. And, um, That's what Home Health allows for, I think, is that you get to, you have to manipulate the skills you learned at school and were taught to work in the home environment and I was blessed.

I had some phenomenal mentors, you know, very early on I would go to, you know, PT one and say, this is what I have going on, and they would set me up with A D M E that was willing an A T P, that was willing to come out to the home and really go. Through all of the things with me. And then I started out with a really good orthotist who I, I no longer use her anymore, but she was great and she [00:13:00] really worked through the whole gate cycle and told me the pros and cons of different orthotics.

And again, I used a ton of books back then. Now I would probably use Audible or podcasts, but then I really did a lot of reading. And so I just had some good mentors that gave me some good, um, things to look at and helped me get through those first couple years. And I hear you saying just your, uh, ability to reach out and feel comfortable and confident to, you know, get the information that you needed.

I. And there was no reservations of, well, I should know this, or I'm just on my own. We, we talk about in home health, sometimes it does feel like you're on island by yourself, right? You're on an island. That's a good way to put it. However, as long as you've made these connections with other professionals or the providers in your life, you just reach out and you say, Hey, this is what I've got going on.

What do you think? Or you know, uh, I know you mentioned ATPs and DMEs. Some of our listeners might not know what that means or what you're talking about. So if you could just kind of share a [00:14:00] little bit about some of these other people that you work very closely with as a pediatric pt, because I know that, you know, equipment things are kind of your specialty, right?

Mm-hmm. And being able to help with, um, some of the mobility. So can you give us a little background on that? Yeah, so the D M E, the durable medical equipment companies, they do everything from supply, the diapers and the formulas or the medical supplies all the way to our equipment, like our specialized wheelchairs, our customized standards gate trainers.

And so working with someone that is very knowledgeable about all of the equipment out there, not just the old, old school equipment, because it's always changing, it's always evolving. I have, again, some great ATPs and they're the, um, The actual professional that works with the D M E and then works alongside the therapist to kind of come up with a plan for that child and what's gonna be the best piece of equipment I have.

It's not just about picking an A T P and picking a piece of equipment. It's also [00:15:00] about knowing which of these companies have contracts with which insurance comp, you know, insurances. Mm-hmm. So for example, Amerigroup with company A is gonna pay for this gate trainer that I love. Amerigroup with company B.

Sorry, that's out of our contract. We're only gonna give you X amount of dollars, so I know I have to go with company A. So knowing those kinds of things. Also knowing as insurance has changed, everything has evolved, we have to know what to put in those medical necessity letters. Sometimes it's not just the child can't walk, it's that we need to put a safety.

Claws or we can't say it's about making it easier for the caregiver. It's about making it a safe transfer for the child and just really knowing all those ins and outs. It's not, it's not black and white. Yes. And then the other people we work with is the orthotist, and they're the ones that provide the small everything from hand splints to helmets if the child hits their head while they're walking all the way down to things on their [00:16:00] feet.

All kinds of orthotics out there and knowing what's best for that patient. I, um, my orthotists are wonderful and work with me and know I'm very specific about what I want my, myself. It is so important. Right. And I know on the speech side, I mean you work with the augmentative communication device. So we are very, we have very minimal D M E equipment that we would, I mean, ours is pretty much the, um, talking devices or, you know, a lot of it we can do ourselves or, you know, we may go through a company.

Or those devices that'll help someone talk, facilitate communication. So it's not just about like what we learn in school and just treating the patient, right. It's, it's also connecting with a lot, a lot of other people to be able to provide that holistic care. And you know, obviously the three of us have our own disciplines, our own role with that child and with that family.

However, we also work very closely together, right. So depending on that child's needs, there could [00:17:00] be a case where they're gonna access all of us. So we wanna talk a little bit about how we coordinate care and so any one of you guys can take the lead on this. Oh, I'll start because I think with speech, I rely heavily, I feel like I rely heavily on my OTs and PTs because whenever I do have somebody that you know, I need positioning.

For my respiration. And then if I am doing a device or getting in something to help facilitate communication. Lots times I need help with positioning with their hands and like what are they able to do? What can they reach out? So that's where, where I'll go to my ot. So I feel like I rely on you guys heavily between everything I do.

I'm always like, oh, can I come in at the end of your session and just you can get them set up for me to do this activity. Because you know, as speech we. We deal more with like language model and feeding and things like that, but we don't, we don't spend a lot of time, we haven't, we didn't even have to do an anatomy and physiology course.

Like I took one on my [00:18:00] own in college, but that wasn't like necessarily required. Mm-hmm. We know may do a neuro for like the brain. Mm-hmm. But like when it comes to big body, like you guys are my specialties. I didn't know that. Yeah. I, I can go. So, but however, um, I kind of steal a little piece of both speech and PT, if I'm honest.

So I'm looking at more sometimes higher level skills in my sessions. I might be looking at fine motor and upper extremity, and I might be looking at. Self-care skills or sensory, but I also want to have some functional communication in there while I'm doing the activities I'm doing. And so I'm gonna try to pull in some engagement with my, uh, with my child and see, you know, and that communication may be verbal or non-verbal.

You know, on the PT side, I think you all really specialize in the equipment. It's not that OTs can't do it, and some of them are very, you know, capable of doing that. But if I'm focused on the, my primary roles, I'm gonna go, Hey, pt, can [00:19:00] you help me with, you know, again, some of the, uh, mobility equipment, maybe some of the, you know, ordering of a hospital.

Little bed or ordering of some of the adaptive equipment. And so we're always working together. You know, even, you know, can, can I stand and then I wanna use my hands to brush my teeth or, you know, comb my hair, you know, what's the tolerance of putting 'em in the stander? You know, because then if they're in the sander and I've got a flat surface, Then I can engage with some of those fine motor skills.

And so there's too many ways I think to, to uh, go into how we coordinate, but I think that we kind of help each other in the sense that we wanna learn about that child. And if PTs doing something or speech is doing something, I wanna know so that maybe I can do some complimentary practice of those things in my session.

So you get that carry over throughout the day. So, In the beginning we did a lot, um, more co-treat. Mm-hmm. Than that kind of got shut down and understandable because I'm sure there [00:20:00] was some gray areas there, but it was very helpful and I still think it's helpful even if you're just there observing, because like you said, learning what they're working on in speech, if it is colors or the w h question clauses or whatever, then I incorporate that with the child while we're working on the shape, you know, the yellow triangle or.

Where did you go today? Or what did you eat for lunch? So just knowing those kinds of things. And then also with my OTs, knowing what, what am I supposed to be looking at? 'cause I truly don't know. I mean, I, as long as they pick up that toy and put it in the where I need 'em to go, I'm happy. But they'll say, no, I need them to have more of a pincher grasp or, To whatever they're asking.

So, and then also I think with pt, I mean, no one wants to sit and do lunges and squats and core work. So just I, I really have to bring in those other fun things. So if it's just songs and imitations while we're working on core work on a therapy ball, perfect. If it's bilateral integration moving from [00:21:00] the right to the left in coordination that they're working on an ot, then I can.

Throw that into my obstacle courses. So the child has no idea that they're working on lunches and squats. Well, and that's such a key thing, right? Just generally. Mm-hmm. I appreciate you expressing that because just generally we're looking at skills that we wanna build, but we kind of mask it in play. And so sometimes families are like, My therapist just comes and they just play for 30 minutes or 45 minutes, like they're not really doing anything right?

So sometimes we have to really help our families and our caregivers understand what's behind what we're doing, and because we've gotta get that child involved to practice, we want to use play as our avenue or as our resource to do it. So very much if you don't like to play, If you don't like to get down on the floor, if you don't like to, you know, just really be silly sometimes then pediatrics may not be your niche, but I, I think every pediatric therapist just loves to get in there with the [00:22:00] kids no matter what age they are.

I remember my son doing fluency therapy and he. He had made a a therapist, that wasn't his experience and she was actually going through school, graduate school. They were working on the R sound, which is hard. Like if you can't pull your tongue back and make that R sound, it is hard. And so he was saying the word, she was correcting him.

He was saying the word, and then finally he just kind of blew up at her and he was like, I keep on saying the same thing over and over and over again, and I'm doing what you want me to do and this isn't the way it's supposed to work. I'm supposed to do it. Four times and then we do something fun and then we can come back and try again.

And the um, I felt so bad for a little grad student 'cause she like, was like, oh, okay. And he did, as soon as like she went into that rhythmic, made it fun pattern. Like she got a totally different kid. Yes. But, and it made me think, I was like, oh my goodness. You're right. We are sitting there. Four 30 minutes, 4 45 minutes, 4 53 minutes, however many minutes you're there for.

And you're asking this child to do the hardest thing. Yes. [00:23:00] Hardest skill that they can at that point, because that's what your goal is, is to fix that one skill. Yep. Very true. I mean, we're, we're really pressing on them to advance their skills. Mm-hmm. Not just maintain sometimes, but actually, you know, increasing.

Changing. Yeah. We're not asking 'em to do something that they can do already at 90%. They're already, they're doing it at. 20, 30, 40% and we're trying to get them practice done. Ironically, in the beginning of my career, I had many parents say, you know, you're just coming in here and playing. Like you get paid way too much for this.

And it used to be so offensive. But now I'm like, then my goal has been met because you shouldn't know what I'm doing. Your child's getting better and I'm having fun. And the child's having fun. Yes, absolutely. Cool. So, all right, so let's talk about what's in our therapy bag, guys. What's in your bag? My bag.

Um, I always love books and puzzles, but lately we've been doing some Legos. Legos has been, I love a good Lego set thing, and I agree. I so therapeutic. Never done Legos before, [00:24:00] but. It's been in there for a month now and the kids are still asking, so we still keep on bringing them out every week. I'm literally going and buying a new Lago set this weekend.

I feel I, it's therapeutic for me. Yeah, I love it. In fact, I have a little feeder and he's got to, he's supposed to drink Boost and I think he would drink anything else in a volume of eight ounce, but he will not drink Boost because it doesn't taste good. Sorry. Boost people. It doesn't taste good. He doesn't like it, and he gives me a face so, I've probably been bribing him with Legos.

Like if you can drink Boost, like you do these five mls and we'll do a piece of the Lego and if you can finish the whole Lego set by the end of the session, you can have it. So super fun. Yeah. Today he reminded me I need to go buy a new Lego set. Oh, how funny. Well, but Legos translate from, you know, toddler.

Depending on whether you have big Legos or little Legos. Mm-hmm. And then are you just stacking or are you actually trying to match a pattern? Trying to get a higher level design. So it's [00:25:00] one of those things that can translate, which is what we look for. Right. And pediatric. Activities, any kind of toy, you know, what can translate from little to big that you get the biggest bang for your buck, right?

So my bag is always changing because, you know, as an OT, manipulatives of every kind and they, everybody gets bored. So, I mean, I can't have just one pencil or colored pencils. I gotta have colored markers and I gotta wiggle pen and I have to have a scratch pad and you know, so, and that's just, Just for maybe scribbling or learning letters and so forth.

And so certainly blocks and puzzles. I always have bubbles. Like bubbles I think is universal. You can use that. And even here in the office, we turn on the bubble machine. Everybody goes nuts as adults. I mean, like it's, it's just bubbles are fun. They're very calming. It is, and it's, it's great not only just for skills, but also as a motivator, right?

Because sometimes, What, when you're doing something hard, you're like, Hey, let's do this, and then you get [00:26:00] a bubble break. Mm-hmm. You know? So I always have a lot of fun stuff, but always changing it out. Rarely blocks balls of any kind, and then of course, lots of little stuff that we can pick up and put in containers.

So containers of every sort, right? Mm-hmm. That you can make it fun, make it target point. I have one little guy that likes to just dump things right now. Mm-hmm. And he dumps literally everything. Like everything he dumps. In fact, the mom the other day, she was like, no, don't dump that. It's the trash. And it like it was dumped.

It was gone. Yes. If you had to tell me I can only take one thing in my therapy bag, um, to every patient for that day, eight patients on my schedule, you have one thing you can take. It would be my therapy peanut ball. Oh, because I can put any size child. Any level child, we can have a newborn on that therapy.

Peanut, not a ball, but the peanut, yes. And we can now all the way to an adult. Engaging that core [00:27:00] is important for everyone. Mm-hmm. For the basic function of breathing. So, yeah, that would be my one point. And then the core is like, I have a lot of babies on my caseload now, and I keep on telling the parents, you've gotta have a good pt.

I can't do anything else if I don't have the core. I need the core and I can't do it myself. You know? I mean, yeah. I just, I don't think people realize how, you know, even as an infant, your core has to be there, but even. As you age up to be an adult, like if your core is not there, that's when your body breaks down too.

I, I'll say bruise a rib one time and you'll realize how much you use your core. That's very, very true. You know, we're talking about things that we have in our car, things that we potentially bring in to that environment, but there could be a time where you have a family that says, I don't want you to bring anything into my home.

You gotta switch gears pretty quickly and say, okay, I'm gonna walk into this home and or maybe. Which I have done before. You forgot your therapy [00:28:00] bag at home because you cleaned up your car and you didn't put it back in and you arrive and all of a sudden you, you're there to do treatment. So what are some things you might do if you have nothing to bring in?

And I'll just say if you've ever worked in early childhood intervention, that is something that is required that you do not bring anything into the home, that you use that natural environment in what's there. So just gimme your thoughts on that. Once upon a time there was a pandemic and we couldn't take things.

Yes. Was. So we learned all these cute, colorful, fun toys that we had in our trunk could no longer be taken inside. Um, so that's when we really had to use our, um, creative minds and balance beam became a folded a towel. You know, my Dina discs that are the little fun, wobbly discs that every kid loves. Were now the throw pillows from the couches.

Yeah. We, and we. Really had to bring in all the home stuff. Instead of having balls, we would roll up socks and [00:29:00] toss them into the laundry basket. Making targets on the floor. Mm-hmm. Um, using chalk that the child may have in the home, 'cause I could leave it there. So that's, I'm a big obstacle course person.

If the child is able bodied enough and they don't have to be fully independent, but using just all those kinds of things, balance beams, step stools, lots of throw pillows from the couch. But that's how we, I usually do my therapy sessions and then always singing. Music. Oh yeah. Singing So easy. I was gonna say, you can do anything.

You can wash your hands to sing it. You can just sit in your chair and wiggle and sing. Okay. But just even from an OT standpoint, all those songs where you can do, if you're happy, you know it and you're clapping. Right? Yes. And then you can add all the actions to it. I can't tell you how often I would use that.

Or Wheels on the Bus, or even Baby Shark, which, sorry to even mention the. The name because it gets stuck in your head. But there's so many things that you can do just through songs and a lot of times, again, then you're pulling in not only [00:30:00] movement, but you're pulling in some of that functional communication.

You're hopefully getting not only the upper body, but lower body. So yeah, that would be, that's my first go-to is let, let's sing some songs and let's do some things to move your body. You know, and then I have a little bit of an advantage on the self-care side because we're already using what's in the home.

So, but, uh, but it works. And, and you mentioned couch cushions or throw pillows. I can't tell you how much we would use that just to toss it as if it were a ball or sit on it because it gives you a little bit of a wiggle and you're trying to pay attention to something. Manipulatives, you can always go to the kitchen.

You shouldn't find hiding things underneath the sofa. Pillows is always fun. Yes. Or hiding your body underneath a pile of. Pillows if you need that sensory. Mm-hmm. Deep pressure. So, but there's, you know, things in the kitchen, you can use utensils, you can use pieces of food, you can use the containers. So, you know, that just kind of like reinforces for all of us as pediatric home health therapists is that creativeness, that [00:31:00] resourcefulness that.

And, and while it might sound like it's kind of hard, it's also kind of fun. Because it's a big challenge, right? Mm-hmm. I mean, you're like, okay, here we go. We're gonna make this work. You know? And you, you don't want to show to the family, like, you're like, I have no idea what we're gonna do. Or could you imagine just canceling a session because you don't have your things?

I don't think that's an option for us. You know, we're gonna figure it out. So, One thing I would say for a parent out there that might say, you know, I really just don't want things brought into my home. Mm-hmm. I get it. I understand. But if we are, um, properly sanitizing, yeah. It really gives the child something new and exciting.

All the kids love to look into the therapy bag and then the key would be afterwards letting the families know, okay. I. It's not important for you to go out and buy these toys. In fact, don't go out and buy the toy because then the child's not gonna wanna play with it when I come. But then finding what they have in their home that will mimic that same activity that you're doing in therapy.

So you do have a good carryover, right? But that new toy and fun, exciting thing to do is [00:32:00] super helpful for me. It is for me too. And I, I experienced that when I did a short period of time where I did some, uh, virtual or some telehealth visits with one of my patients. And, um, and I had, uh, planned it out and upfront I said, here's the container of the OT things we're gonna do.

And uh, and I had. Similar things on the other side of the camera. And we did this for a few weeks and I, and I have to say, even the mom at that point was like, can you please just come back? Because it's just not the same. Like, please, can you just come? And by the way, I'm okay if you bring a few things, but, but with that, I appreciate you saying that.

We always sanitize, you know, so I bring it in my wipes. I certainly wash my hands when I start. We're still wearing masks at this. Point, but at the end of my session, that's part of my showing the family I'm cleaning up. And depending on the child, they might be part of that process because we're putting away, right?

We're ending that task and so everything gets cleaned, goes back into the bag and so forth. So, big things like a big ball or be honest or [00:33:00] something where we might need to clean it outside of the home, you know, it means a lot to us to, uh, you know, because not only are we gonna go from patient to patient, but we also have to go home to our families.

We may come to an office with other people. So, you know, we are very, very conscious about being very, very careful to do the right thing and make sure everybody's safe. And especially with Covid, reinforce that. But just know that, you know, that's just part of, uh, what we provide and what we think is most important.

One thing I did well, there were many things I learned during covid, but one thing that I really learned as a therapist was, um, When I first started to do the virtual therapy, this might be a child that I have worked with for two plus years, three plus years, and done very similar things. And then when I asked the parent to do it, it was completely foreign, even though that parent has observed every one of my sessions.

So learning to now ask the parent to do return activity. Return, yeah. Um, has been a very big [00:34:00] learning experience for me because the. We do it's second nature to us to use all of our muscles and bodies and everything like that, and then we ask them to do it, and it is a different feel and handling and all of that.

So I think that was a really big lesson for me as a therapist. I think my takeaway from doing Teletherapy was that I didn't realize, you know, we see our little ones on devices all the time. Yeah. And we think that they're engaging and engaging well with that device. But when it came time to like, Hey, I'm on this little box screen and I'm moving, or I'm even playing, like there wasn't.

They, they weren't able to attend, they weren't able to look. So it's, it wasn't the same because I guess I'm not making mouse clubhouse. I know I'm not that entertaining, but I, it was unique 'cause it was some things, you know, like I felt like we had eye contact down. I felt like we had, um, the ability to track on the screen and stuff, but we really didn't.

I'm laughing because I had one child say, when are you gonna get outta jail, [00:35:00] sweetheart? I'm not in jail. I'm at my house. I'm not in jail. You are. You're the one stuck at home. Yeah. That's hilarious. You know, that, that really was, um, just such a transition for us. And, um, again, for our population here at Veeva Pediatrics, you know, we tend to see more medically complex, more medically fragile kids.

Being able to truly, uh, facilitate and to provide that care tele through telehealth. It didn't work very well. It certainly, we didn't feel as a company that it was safe to do feeding, uh, to ask the parent to feed, 'cause they might miss some of the cues to do some of the handling with some of our very involved kids just against.

Safe transfer safe movement. And it's not that we didn't want to show our parents how to do that, but it's so much easier to do it in person and then help Correct. Than it is through the camera because you can't quite see everything. And uh, and then as Jennifer [00:36:00] said, sometimes the kids just wouldn't engage.

Right. I think there's a population that it's okay for. Yes, I do. There definitely is a population that it's okay for. It's just maybe not the area that I like to focus on doing therapy, so I, I think that's for me, I like the. Patients that ha we have to be more hands-on. Like, you know, I maybe have to feel the swallow or position the head or tilt and maybe even change how I'm tilting the head as they're swelling, you know?

Right. Like, um, I kind of like those more involved. Mm-hmm. Kids, not that I think articulation as therapy would probably be great. Um, yeah, I, I think for our sensory kids and speaking on that side, um, again, you do wanna train the families, uh, in the home, some things to do. But if you're doing it through telehealth, you know, you can so quickly get overstimulated.

Uh, if. You are not watching for the signs. And sometimes you really have to trial some things like directly with the child and watch how they're responding. And that's just difficult to do, you know, through [00:37:00] that avenue. So we're not knocking telehealth, we're just describing just some of our transition, uh, to and from it.

Trial trials and tribulations through it. Exactly. And uh, and then just considering kind of our nursing slash therapy patients that may not have. Been appropriate or adequately benefited from that kind of therapy. So I think when we did do telehealth and like during Covid, we did rely on our parents a lot more.

Mm-hmm. Like, not that we shouldn't, but So what are some tips that you all y'all gave to your parents for engaging, like even now that you give them to engage with their children to help with those carryover skills? Uh, not only with the parent, but also the therapist or whoever's trying to, the caregiver, the nurse.

It's just really reading, um, your child in that moment because all of us have good days and bad days and good moments and bad moments. And so if you feel the child's getting frustrated or starting to stem or something's happening, take a deep breath, stop. [00:38:00] Redirect, come back to it. Might not be at that session, might be another day.

But I think forcing something over and over, it just becomes a negative feeling around the whole thing. And you, that's the last thing I want, right, is for me to leave a child in the home crying like I I crying makes me cry, so I can't do it right. I know it's terrible, but I don't do it well. So if we start crying, we stop and we redirect and we play and we find some fun.

It, I love it if we start crying. 'cause I'm a sympathetic crier too. You it, it's not good. I don't like it. And so we stop and we redirect and we play because I never wanna leave that child crying. Not only because I don't think that's a positive thing, but also because our children are super smart. Yes.

And if they learn, if I cry, then we stop therapy. And so then it becomes a behavioral cry. Yes. So there's. It's multifaceted and I just don't like, I don't like my sessions to be filled with crying. Yeah. I remember one time I went to CU and the guy [00:39:00] leading it, he was like, you have to be the most rewarding thing in the room, otherwise, why would they even come and hang out with you?

And I'm like, you're right. And it, but it's gotta be not only your bag, but you too. Like there has to be that relationship there. Like my friend who said I was his best friend, I know I'm jealous now. I've never been called a best friend from therapy session. I. I don't think I have, but when there's an absence, you know, over time like Uhhuh, when I did telehealth and when I came back to that home, I got a hug.

Oh wow. That was huge. Like, and this is not a hugger kind of kid. And even the nurse and the parent who's was like, everybody was lined up, they were like excited. And so I was like, oh. This is great. This is awesome. You know, so somebody loves me. I know, I, I know, you know, if everybody in this world greeted me like my patients, oh yeah.

Wouldn't it be amazing? They just welcome you with open arms and a big smile and kicking, and I'm like, oh my gosh, I love you too. I just wanna hug you. Okay. But to be fair, sometimes [00:40:00] there are some negative behaviors, so. I love that we, we talk about the positive, but sometimes there can be some challenges.

Like you're, you're trying Yes. I have an example of a challenge. Yes. The other day we had this hammock swing. This chair was swing and so the kid, we'd swing him. You sent me a picture of it. Yes. Oh yeah. I think I told you. And then he, he's just getting like, it's not calming him. It like, Escalating. And I'm like, okay, let's move.

Let's move. And so he jumps outta the hammock hammock swing. He grabs this little tight plastic bat and he just starts whacking everything, toys go flying. And I'm like, oh no, let's do a big hug. Right? And so we did a big hug and we came back together. Yes. I was like, mom, put that away. We needed some deep pressure and maybe the hammock goes away, but literally, yeah, we had just played Legos.

So he's crashed that Lego set and it went flying. Yeah, it was hilarious. Well, I have one that just absolutely hates to practice putting on socks or putting on a jacket, any kind of self-care, [00:41:00] right? We could play puzzles and all kind of manipulatives all day long. You bring out the self-care and he is like, shut down.

So for me, I always have to plan for something really fun. Right after that really tough thing. And I show it to him at the beginning and I say, Hey, guess what? We're gonna do socks today. And I immediately get, uh, you know, shaken of the head and we're not doing this. Okay, well if we're gonna do socks, then you get to play with my marbles.

The marbles are like golden right now, so marbles. And so as we're doing some of the other fun activities, I still get the shaking of the head and pointing at the feet. Like, I'm not doing socks today. I'm like, marbles. And so by the end, We're doing our socks. And so we still get to practice those skills and it's something that again, he can look forward to, but there's still that working through the nose, like, I am not gonna do that.

Or maybe sometimes it's a fear, like, I'm not gonna sit on that ball that's moving and no thank you. Like I, that's new to me. And so you gotta kind of put something fun [00:42:00] with that, something that's kind of hard, um, to manage some of those behaviors. And then, you know, also check in with the family, like, What are their favorite things, right, right off the bat?

What are those things? Characters or, uh, you know, manipulatives or some activity, or maybe it is some song, and you're gonna save that for those really tough times where you're gonna have to get through that next thing. Not that I'm happy to hear you have these struggles, but I always feel like PT is not always the favorite.

'cause OT gets to come in and play games. Speech is usually feeding, and I'm like, yay, let's go work out. So I'm glad to hear you have a few little challenges in there. Really, I kind of feel like the other disciplines are the fun ones. Because remember, like it's, I'm feeding em something. They don't want to grass on the other side.

I think it, I think that's what it is. Do you guys get to move and y'all get to go walk stairs outside? See, I'm like, it's so great. You have them contained in a container and you don't chase them around the house. See, it's just about, it's true. And I get all the fun toys, so I do have this one little kid, he's got this, he's 13 and he's [00:43:00] got this.

Big seating device. I don't know what it is, but it's like big. It's almost, I don't know if they still have rift in chairs or not, but, um, it's big. You can angle it forward or back. Well, first he always like lazy boys. It instead of backwards forwards. And then as soon as we are done and right after his musical notes video, he does this twist and he jumps out the side.

So they're only, that's fun. Kind of contained 'cause they're willing to sit there. Well, I'll bet that our time is getting a little bit low, but this has been really fun to talk and have all three of us in the same room, uh, talking about pediatric home health, um, getting the opportunity to kind of work together and.

I would say that this is similar to when we get a case where we're reaching out and we're coordinating care, right? So, you know, I'm gonna reach out to my PT or my speech therapist, um, if I'm have some challenges or just talking about the dynamics of the family, the scheduling piece that we, you know, obviously have to coordinate so that we're not showing up at the same time.

But it's so important. That we are [00:44:00] able to reach out to one another. It, it staves away some of the isolation that you might feel and it's best practice for that kid, right? If we're, we're all working to towards the same and same goals, we're all communicating and supporting the family in the same way it makes.

All the difference in the patient making progress. And I'll throw nursing in there too because we all have the opportunity not only to work with other therapists, but with our nursing team, which we very much appreciate. Yeah. So is there anything else you all wanna share before we end for today? I think I'm good.

We're good. So we look forward to continuing on with our discussions through Let's Talk Therapy. Again, we are with Viva Pediatrics and if you all have questions for us or uh, wanna learn more, we're gonna leave you with our website, which is www.veevavvapedspeds.com, and we would look forward to hearing from you and we will be.

Back with another podcast. We have some more exciting things coming. We [00:45:00] will be talking to our co-owners of our company soon and hear their story. We will be meeting and talking with a mom of, um, some children with special needs. We'll get an opportunity to, uh, talk to some of our internal office staff who help us with orders and authorizations and how it all works together.

And of course, we have a recording scheduled with one of our P D N nurses and how they work closely with therapy. So thanks everyone for joining us. We appreciate you taking the time. Bye bye.