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Blog Out in Healthcare

Out in Healthcare: Enrique Puentes, OTS

Name: Enrique Puentes

Pronouns: He/Him/His

Identity: Gay

Background: Both of my parents immigrated from Colombia, and I was born in Washington, D.C. I grew up in Northern Virginia but have spent the last fourteen years living in Central Florida. I have spent the past eight years working in catastrophe property insurance but have always had a longing for wanting to be in a profession that helped others improve. I finally decided to make the career transition and now am in my second term of my master’s degree.

Profession: Occupational Therapy Student (MOT)

Area(s) of Practice or Interest: I have huge interests in both Mental Health and Inpatient Rehabilitation but am unsure of where I may ultimately end up.

What does being ‘Out in Healthcare’ mean to you?: For me, being out in healthcare for me means inviting people to see my truest self. Representation of LGBT people in healthcare is important because not only does it create safe spaces for clients to feel they are being advocated for, but it also can help demystify misunderstandings that non-queer people have of the very community that I am a part of. I see being out in healthcare as a form of activism for anyone who has ever felt either marginalized in a society that has long celebrated heteronormativity.  

What is one thing everyone should know about your identity?: I want people to know that I am embracing the best possible version of myself by being out as an individual in healthcare. It is important for me to not be ‘discrete’ about my sexuality, because by me fully loving all aspects of my identity, I can in turn emanate the same level of love and care for others. 

How do you feel when your identity is included?: When my identity is included as both brown and gay, I feel included and seen as an equal amongst a group.

What does “taking up space” mean to you?: Taking up space means feeling pride about my own visibility and feeling the confidence in the fact that my visibility matters. I unfortunately did not always think/feel this way, so it’s empowering for me to live in this truth.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I think with any profession that involves interacting with all kinds of people (with varying cultures, backgrounds, political and religious beliefs, sexual orientations or gender expressions), we will almost certainly at some point, come to meet someone that we lack the education on, on how to honor and respect these individuals. Maintaining a sense of humility when engaging in these interactions is key to posturing yourself in a manner that is receptive to learning from these interactions. For healthcare professions in particular, it would behoove the practitioner to educate themselves on available resources that speaks on best care practices. Remember the importance of being client-centered in your approach and advocating for the client’s desires and wishes. 

Has your identity influenced healthcare that you’ve received?: My identity has impacted the healthcare that I have received. I have encountered practicing physicians who have not been aware of pre-exposure prophylaxis medications. It’s an odd feeling having to educate your own doctor on what this is and why you are requesting a prescription for this. I have also had experiences where healthcare professionals made assumptions of my sexual orientation. I greatly see the need for education of healthcare professions in working with LGBTQ clients.

Where can people find you?: Follow me on Instagram! (@ProudOTStudent)

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Blog Out in Healthcare

Out in Healthcare: Ryan Ellenbaum, MA CCC-SLP

Name: Ryan Ellenbaum 

Pronouns: She/Her/Hers

Identity: Cisgender Woman, Queer/Lesbian 

Background: I was born and raised in Philly, PA. I live with my wife and our two dogs. I love anything creative – lately I’ve been obsessed with weaving but I’ve dabbled in just about every textile craft. I also enjoy powerlifting and Olympic weightlifting. I studied Russian in undergrad which sparked my interest in communication sciences. Now I work with Russian-speaking families in early intervention and I’m co-owner of a private practice that specializes in gender affirming voice modification for the trans and non-binary community.

Profession: Speech-language Pathologist

Area(s) of Practice or Interest: Gender affirming voice modification, pediatrics, stroke rehabilitation.

What does being ‘Out in Healthcare’ mean to you?: The SLP field is full of compassionate and good hearted people but it can be a pretty homogeneous crowd in terms of race, gender, and sexual orientation. I’m proud to be a queer provider who is in tune with the issues that impact queer people seeking healthcare, especially working in trans voice. It’s important to me to make the services I provide a safe space that helps queer people access care that they might otherwise not feel comfortable seeking. 

What is one thing everyone should know about your identity?: I am generally “assumed straight” based on how I look and dress, which has been both a form of privilege and source of frustration since I came out when I was in high school. In my early intervention work, I am often subjected to unsolicited political opinions and people’s views on the LGBTQ community (while treating in families’ homes). This often forces me to make the split-second decision between being an advocate for my community and feeling safe at work. The message I would spread is not specific to me, but it is to never assume someone’s identity based on how they look. Challenge yourself to be inclusive and to provide space for people you meet to identify themselves as uniquely them, whatever the context.

How do you feel when your identity is included?: Safe and validated.

What does “taking up space” mean to you?:  Taking up space and being visible as a queer person is a form of advocacy. Queer people are everywhere, in every setting, in every town. The more visible we are, the more included we are in the conversation. The more included we are as healthcare providers, the more we can educate and guide our fellow providers to be more compassionate caregivers to patients. 

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: Take the time to thoughtfully educate yourself. Seek out positive, affirming resources – especially ones that amplify real voices and experiences of the population you are seeking to learn about. Don’t make assumptions about your patients, give them the opportunity to identify themselves by using inclusive language and questioning.

Has your identity influenced healthcare that you’ve received?: I’ve been fortunate enough to not experience any healthcare nightmares directly related to my sexual orientation, but I always consider queer-friendliness or referrals from queer friends who have had good experiences when seeking healthcare providers. 

Where can people find you?: You can find me on Instagram at @authenticvoicesllc, my website www.authenticvoicesllc.com, or reach out by email to authenticvoicesllc@gmail.com!

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Blog Out in Healthcare

Out in Healthcare: Oliver Hoad, OTS

Name: Oliver Hoad

Pronouns: He/Him/His

Identity: Queer Trans Man

Background: I’m 23 and grew up in a coastal town on the east coast of Australia called Coffs Harbour. I am currently in the second year of my Bachelor of Occupational Therapy. I came out as bisexual when I was in high school, but as I grew into my identity I realised that queer was a better fit. I came out as trans in 2018 which was a huge change for everyone in my life but luckily it has been a mostly positive one! Where I live is fairly regional, and there is not a lot of acceptance towards the queer community so unfortunately there are not many opportunities for interaction with other queer people, especially those my age. When I’m not studying I am a member of a group for LGBTQIA+ young people, a peer educator for a sexual health organisation and enjoy gaming, baking and going to the beach.

Profession: I am an Occupational Therapy student and I teach primary school (elementary school) kids how to create video games afterschool on the side!

Area(s) of Practice or Interest: Interested in sexual health and paediatrics/adolescents.

What does being ‘Out in Healthcare’ mean to you?: Australia is not very progressive when it comes to the healthcare of transgender people. After I came out and had to go to the emergency department of the hospital I told them I was trans and that my name was Oliver yet the doctor continued to address me by my deadname* and female pronouns. Being out in healthcare would allow me to reduce the chances of this happening to other trans people, particularly youth, and would increase attendance and inclusivity within spaces that cause so much anxiety for young people.

What is one thing everyone should know about your identity?: People should know that we are not all the same and we do not have to all be the same. Not all trans people look like the stereotypical trans man or trans woman that may be portrayed in the media, and a lot of us have values and beliefs that are different from each other. That is ok and it doesn’t make someone any less trans.

How do you feel when your identity is included?: I feel hopeful for the future. The inclusion of trans people in different conversations is so important. It shouldn’t be a question whether or not to include us in conversation whether it be political, health related, in sports, or religion, and when this occurs it feels like progress is being made.

What does “taking up space” mean to you?: As queer people, we are often told that we are taking up too much space. We are told that we are too visible within the media, we should be so “gay” in public, that our stories are being told too often and we are asked why we need a whole month to celebrate our community and their history when it “isn’t necessary”. These opinions of individuals are all such negative things that are brought up way too often! However, they bring about important conversations between two communities that may not occur if our presence wasn’t questioned so often. The space that we take up is so important even if other people don’t think that it is.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honour the identities of their patients?: Ask as many questions as possible. Ask what your patient they are comfortable with, what their pronouns are, and if they would like you to know anything about their identity. In saying that, also be respectful when asking the questions. Oh and don’t always assume that somebody fits into a binary gender simply because that is how they present!

Has your identity influenced healthcare that you’ve received?: It has definitely influenced my healthcare experience, probably being trans more than anything else. Finding a doctor who is LGBTQIA+ friendly and educated in transgender medicine is difficult in a regional area so you have to go in blind and hope for the best. There are also limited services available in these areas for transgender healthcare. In the past, I was often misgendered and called my deadname* even after telling doctors my preferred name and pronouns which is unfortunately a common problem for trans youth and people who are transitioning, especially in regional and rural areas like the one I live in. Luckily now I have found a good network of supportive doctors and allied health professionals that are educated in the needs of the LGBTQIA+ community.

Where can people find you?: You can find me on Instagram @onespicyegg or via email at olivermaxwellhoad@outlook.com

*Deadname: A deadname is the birth name of someone who has changed it. The term is especially used in the LGBTQ+ community by people who are transgender and elect to go by their chosen name instead of their given name. (Resource)

Deadnaming: Deadnaming occurs when someone, intentionally or not, refers to a person who’s transgender by the name they used before they transitioned. You may also hear it described as referring to someone by their “birth name” or their “given name.” (Resource)

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Blog

OT and Transfeminine Equipment: Breast Forms, Gaffs, and Tucking Oh My!

Transfeminine equipment or equipment for those with feminine gender expression among people assigned a male sex at birth, particularly transgender and gender non-conforming individuals may include: prostheses, breast forms, gaff, tape, tucking, padding.

Padding: Padding refers to the use of undergarments to create the appearance of larger breasts, hips or buttocks. Padding may also assist in minimizing dysphoria.

            Some padding-specific garments include:

–       Padded undergarments: Typically, useful for facilitating appearance of wide hips or full buttocks

–       Bras with pockets: Also known as mastectomy bras, they are designed to accommodate breast forms and other associated prostheses

–       Padded bras: May be preferable if breast growth is present but not at the desired size.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a breasts, penis, scrotum, or other anatomy.

Breast forms: Prostheses that have the appearance of breasts. Typically made of soft silicone gel and adhere to one’s body or are placed in a bra. Can be considered a form of padding.

Tucking: Tucking is the practice of arranging and supporting external genitals between the legs, including the penis, scrotum, and testicles so they are not visible in clothing. There are many ways to tuck, such as pushing the penis and other anatomy between your legs and then pulling on a pair of undergarments, to tucking the testicles inside of you. People tuck for many different reasons. One might tuck in order to feel more at ease in their body (minimize dysphoria), to feel more comfortable in their clothing, or to facilitate affirmation as one’s gender. There is minimal research on the safety of tucking.

Gaff: compression underwear that minimizes the appearance of a penis, scrotum, and testicles.

Tape: tape may be used with or instead of a gaff to “tuck” or minimize the appearance of the penis, scrotum, and testicles.

Important gaff considerations:

o Choosing the right size gaff is like choosing the right size underwear. One can also measure the circumference of their waist, just above the hips for correct sizing.

o Safe tucking/gaff techniques mirror those of binding:

o Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.

o Minimize duration of wearing, as in reducing the wear time throughout the years. Bottom surgery is an alternate to tucking, however it is important to note that not every individual that tucks will want bottom surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

o Unsafe tucking can affect the circulatory system, musculoskeletal anatomy, fertility issues, sex and intimacy, and skin integrity.

Gaff/ tucking garment maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. Pay special attention to skin folds, folding in the tucking garments (gaffs), bulging skin adjacent to the gaff or selected garment, redness, skin abnormalities, and prolonged indentations. Pay extra attention to the effects of the trans affirming/generally affirming care that you provide.  

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕥𝕦𝕔𝕜𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe tucking practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! Anotha time for the people in the back: we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe tucking practices.

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Blog

OT and Transmasculine Equipment: Binders, Packers, and Prostheses Oh My!

Transmasculine equipment or equipment for those with masculine gender expression among people assigned a female sex at birth, particularly transgender and gender non-conforming individuals may include: binders, packers, prostheses, and bandaging.

Prostheses: An artificial body part(s), typically made from plastics, lightweight metals, or composites. May be formed to represent a penis, scrotum, testicles, or other anatomy.

            Packers: A prosthesis with the form a penis

Binders: commercially produced binders designed for binding. Other options (usually less safe options) are sports bra, neoprene/athletic compression garments, plastic wrap, duct tape, and more. The benefits of binding far outweigh the risks, however 𝕥𝕙𝕖 𝕣𝕚𝕤𝕜𝕤 𝕒𝕣𝕖 𝕥𝕠 𝕓𝕖 𝕥𝕒𝕜𝕖𝕟 𝕧𝕖𝕣𝕪 𝕤𝕖𝕣𝕚𝕠𝕦𝕤𝕝𝕪.

Binding: Binding involves wearing tight clothing, bandages, or compression garments to flatten out one’s chest and/or other anatomical features. 

Safe binding practices include:

  • Donning neoprene/athletic compression garments or commercial binders. The limited research supports using neoprene/athletic binders over commercial binders.
  • Minimize frequency of wearing, take breaks throughout the week (although it may not be ideal, it is particularly important for involved anatomical and physiological systems). Reducing the intensity of wearing (daytime donning) can also reduce risk of negative effects, though not as significantly as reducing the frequency.
  • Minimize duration of wearing, as in reducing the wear time throughout the years. Top surgery is an alternate to binding, however it is important to note that not every individual that binds will want top surgery, nor will all individuals have access to the procedure (cost, access to healthcare, etc.)

Binding maintenance: First and foremost, follow the washing/care instructions on the packaging/garment. In general, hand washing is the best. Avoid using bleach and/or a dryer as they accelerate material breakdown/ reduce integrity of the material. A binder should never be too tight. Pay special attention to skin folds, folding in binding material, bulging skin adjacent to the binder, redness, and prolonged indentations. Pay extra special attention to the effects of the trans affirming/ generally affirming care that you provide.

According to research, some benefits of binding include:

– Increased self-esteem, confidence, ability to go out safely in public, positive mood

– Decreased suicidality, anxiety, and dysphoria

The research also notes the following risks and contraindications:

– Pain related to the musculoskeletal system and at times internal systems

– Musculoskeletal system changes including bad posturing, shoulder joint ‘popping’, fractures, and muscle atrophy

– Neurological system changes like numbness, dizziness, and more.

– GI system changes, decreased motility, and more

– Respiratory changes like SOB, coughing, and more

– Skin and tissue change like skin breakdown, wounds, and infection

𝕃𝕖𝕥’𝕤 𝕓𝕖 𝕤𝕦𝕡𝕖𝕣 𝕔𝕝𝕖𝕒𝕣

The risks and contraindications are 𝕒𝕝𝕞𝕠𝕤𝕥 𝕒𝕝𝕨𝕒𝕪𝕤 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕦𝕟𝕤𝕒𝕗𝕖 𝕓𝕚𝕟𝕕𝕚𝕟𝕘 and 𝕒 𝕣𝕖𝕤𝕦𝕝𝕥 𝕠𝕗 𝕒 𝕙𝕖𝕒𝕝𝕥𝕙 𝕤𝕪𝕤𝕥𝕖𝕞 𝕥𝕙𝕒𝕥 𝕗𝕒𝕚𝕝𝕖𝕕 𝕒𝕥 𝕞𝕖𝕖𝕥𝕚𝕟𝕘 𝕒𝕟 𝕚𝕟𝕕𝕚𝕧𝕚𝕕𝕦𝕒𝕝𝕤 𝕟𝕖𝕖𝕕𝕤. We need to have the knowledge based to educate our clients on safe binding practices as healthcare provides and 𝕖𝕤𝕡𝕖𝕔𝕚𝕒𝕝𝕝𝕪 as occupational therapists. HELLO!! ADLS!! DRESSING!! I don’t want to hear any of that “we don’t have room in our curriculum for LGBTQIA+ topics” anymore. Sis, honey, darling, we alllll know that our professors/we talk about dressing all of the time throughout our programs and throughout providing care 𝕒𝕔𝕣𝕠𝕤𝕤 𝕥𝕙𝕖 𝕝𝕚𝕗𝕖𝕤𝕡𝕒𝕟. That’s right peds friends, I’m calling you in on this too. You may have a child, adolescent, or young adult that is going to need 𝕪𝕠𝕦 to educate them on safe binding practices.

Sources and Citations:

http://www.phsa.ca/transcarebc/care-support/transitioning/bind-pack-tuck-pad

https://www.lgbtq-ot.com/terminology

Peitzmeier, S., Gardner, I., Weinand, J., Corbet, A., & Acevedo, K. (2017). Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Culture, Health & Sexuality, 19, 64-75. doi:10.1080/13691058.2016.1191675 

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Blog Out in Healthcare

Out in Healthcare: Wade Robinson, OTD

Name: Wade Robinson

Pronouns: He/his

Identity: Gay man 

Background: While completing my undergraduate degree, I became passionate about the field of sexual wellness while working with various non-profit organizations that provided HIV-related services and raised scholarships for LGBTQ students. Those experiences emphasized the importance of education around sexuality, and after beginning graduate school I was delighted to discover that sexual activity is included in the domain of occupational therapy. I was able to bring OT and sexuality education together and collaborate with @sexintimacyOT for my doctoral capstone project to create a continuing education course on LGBTQ0-inclusive practice.

Profession: Occupational Therapy

Area(s) of Practice or Interest: Sexual activity and education, pediatrics, hand/orthopedics

What does being ‘Out in Healthcare’ mean to you?: I believe that generally people have many misconceptions about what it means to be LGBTQ until they know that they know LGBTQ people. In my day-to-day life, I live by the mantra of “advocacy through visibility”, and I try to do the same in a professional setting by being authentic about my own sexual identity. I think this normalizes conversations about sexuality, models to colleagues how to respond, and indicates a safe-space to clients.

What is one thing everyone should know about your identity?: Overall I think that LGBTQ visibility is a good thing, but I’ve noticed that a lot of the mainstream media highlighting LGBTQ people are pretty narrow in their scope. I just want people to check themselves for implicit biases that are easy to subscribe to and know that being gay does not mean being into interior design, subscribing to a particular style of drag, or being into drag at all for that matter. Part of allyship is celebrating LGBTQ people for their identities, so just recognize that there are countless ways for identities to differ and each is as valid as the next.

How do you feel when your identity is included?: We [LGBTQ people] have gone so long without seeing proper representation or inclusion that I definitely notice when we are included in policies and media, even with little things.

What does “taking up space” mean to you?: To me this goes back to the idea of advocacy through visibility. It’s not like I always talk about being gay, queer culture, or anything like that, but I do think it is important to share my sexual identity with the people around me. I think its personal relationships that create allies. It’s so obvious to LGBTQ people how cisnormative/heteronormative everything is by default, and that creates a lot of marginalization that the majority never considers. I think that we can use that lens for the better to recognize how other minority groups could be excluded and erased, then aim for more inclusive, mindful practice.

What is one piece of advice that you would give to healthcare workers who aren’t sure how to honor the identities of their patients?: I know for OT in particular, there are not very many resources, which is why I created the LGBTQ-inclusive course for my capstone project. For healthcare professionals in general, I think the National LGBT Health Education Center is the best resource for practice guidelines. Time in the clinic is precious and the experience is often stressful for clients; it would be very unusual that that time would be best spent with the client educating the clinician about their sexuality. Being educated about sexuality before interacting with clients is best practice. If somebody finds themselves in a situation where they still are unsure, I think the most import thing they could do is approach the situation with humility. 

Has your identity influenced healthcare that you’ve received?: There are two instances that come to mind in which providers made assumptions about me after I disclosed that I am gay, and both instances were regarding sexual health interestingly enough. The first time I was just completing a routine check-up and getting some vaccinations to start graduate school, and the physician suggested that I complete a battery of STD tests. Even after I explained that I have worked in sexual health, am very aware of my relative risks, and was current on all my tests, the physician suggested that I at least get an HIV test. The second time, the nurse told me that they were going to ask me some questions about my sexual health, but once I said that I was gay, they moved on to ask me about other areas of health. Afterwards, without knowing any of my risk factors or sexual habits, they proceeded to try to administer a test that was completely inappropriate and did not apply to me at all. At this point, I said I would not be doing that test, explained that I previously worked in sexual health, and commented that I was surprised that they did not ask more questions to assess which tests were appropriate. The nurse brushed off my response and quickly said that there were more questions on the template but they were optional to ask and this was standard procedure. 

Where can people find you?: Hidden away studying for the NBCOT exam, hiking, or on Instagram at @Wad_the_robin

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Blog Travel OT

LSVT and Me

Picture property of https://www.lsvtglobal.com/
Citation

What is LSVT/ LSVT LOUD?: “LSVT LOUD is an effective speech treatment for people with Parkinson’s disease (PD) and other neurological conditions.  Named for Mrs. Lee Silverman (Lee Silverman Voice Treatment [LSVT]), a woman living with PD, it was developed by Dr. Lorraine Ramig and has been scientifically studied for over 25 years with support from the National Institute for Deafness and other Communication Disorders within the National Institutes of Health (NIH) and other funding organizations. LSVT LOUD trains people with PD to use their voice at a more normal loudness level while speaking at home, work, or in the community. Key to the treatment is helping people “recalibrate” their perceptions so they know how loud or soft they sound to other people and can feel comfortable using a stronger voice at a normal loudness level.” (LSVT GLOBAL)

While LSVT LOUD treatment has helped people in all stages of PD, the majority of research has been on those in moderate stages of the disease. LSVT LOUD has also helped people with atypical parkinsonisms, such as progressive supranuclear palsy (PSP), and has recently shown promise for adults with speech issues arising from stroke or multiple sclerosis and children with cerebral palsy or Down syndrome. Beginning your work with LSVT LOUD before you’ve noticed significant problems with voice, speech and communication will often lead to the best results, but it’s never too late to start. LSVT LOUD has the potential to produce significant improvements even for people facing considerable communication difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

What is LSVT BIG?: “LSVT BIG trains people with Parkinson disease (PD) to use their body more normally.  People living with PD or other neurological conditions often move differently, with gestures and actions that become smaller and slower. They may have trouble with getting around, getting dressed and with other activities of daily living. LSVT BIG effectively trains improved movements for any activity, whether “small motor” tasks like buttoning a shirt or “large motor” tasks like getting up from sofa or chair or maintaining balance while walking. The treatment improves walking, self-care and other tasks by helping people “recalibrate” how they perceive their movements with what others actually see. It also teaches them how and when to apply extra effort to produce bigger motions – more like the movements of everyone around them.” (LSVT GLOBAL)

Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in early or middle stages of your condition, when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.” (LSVT GLOBAL)

(Direct quotes from LSVT GLOBAL)

Method: Completed the online certification program (also an in-person program with same materials) I would personally would have done the in-class program if it were available to take around me and with the changes associated with COVID I was limited to the online course. I am a hands-on learner but still feel prepared to implement a LSVT program via the online certification course. Certification acquired by completion of LSVT Global’s LSVT BIG Online Course Modules (40) while achieving an 85% or higher on the final examination.

Time: 12.5 hours of course material with average of 16 hours of completion for clinicians, over 90 day period. If you need extra time, you can purchase extensions in 30 day increments. I used almost all of the 90 days (83 days total) to complete the course. Some barriers were working full time, traveling between multiple areas (travel therapy), and lack of motivation to start. Once I completed the first 5 or so modules, I was able to speed through multiple modules at a time. 

Cost: $580.00, $50.00 every two years for renewal. Fortunately, with a bonus from extending my travel placement, I was able to cover the cost of the certification.

Program: At least 4 1-hour sessions per week for 4 weeks, with daily exercises and tasks to completed outside of clinic time. If a patient requires additional time then you continue the program, with supportive documentation and assessment. Consists of 7 daily exercises, functional component tasks, carryover tasks, and hierarchy tasks. Facilitation of the program includes specific and simple cues from the clinician, with the use of modeling and tactile cuing techniques. There is daily homework for the patients that must be completed for the best outcome. 

Why I chose to pursue the LSVT BIG certification as an Occupational Therapist: I have always loved all thing neuro/neuro rehab! I have started the quest to enhance my knowledge in neuro-focused areas through continuing education unit courses (CEUs), certification programs, books, journal articles, podcasts, and research articles. In my year and a half long career thus far as an OT, I have worked with many individuals who live with a diagnosis of Parkinson’s Disease (PD). I briefly learned about the certification course (LSVT BIG) in college and also know friends/colleagues that had already obtained the certification. I have always heard positive reports about the LSVT program and decided to look into in further. An online course was the best option for me and I was in a financial position to purchase the course so I decided to go for it. I am also looking into the Impact OT (ITOT) certification and the Certified Brain Injury Specialist (CBIS) certification for the near future to continue on my neuro-focused journey!

Pros of LSVT Certification/Program: Set protocol to follow, but also individualized based on client’s goals and functional needs. Can be completed in multiple settings, and initiated by a LSVT certified OT in SNF and completed by LSVT OT in HH. The program is evidence-based. The exercises and task are modifiable to patient performance level, with multiple options on grading the activities up/down as absolutely needed. When the certification program is purchased, one receives an LSVT resource book with the modules, exercises, and handouts inside (also available online). I started with re-writing all of the notes from the modules by hand because I didn’t want to wait for the resource book to arrive, as I usually start with this method for studying. I would recommend just waiting for the book or taking online notes if that’s more your style, because re-writing by hand definitely slowed down my completion of the modules. The program has a ton of built in repetition so if you have to complete it in chunks like I did then this is really helpful. There is also a quiz at the end of each module to check for learning of objectives and course material. The repetition and quizzes made it so I had minimal final exam prep to do. The LSVT BIG program is able to be generalized to other neuro populations as long as they meet certain criteria. 

Cons of LSVT Certification/Program: A patient must complete at least 4 weeks, with 4 1-hr session per week, as the evidence only supports a program of this length or more. Program is more affordable than a lot of certifications, but cost is still a barrier to obtaining certification. Program not yet available via telehealth.

Overall, I think the LSVT BIG certification program for Occupational Therapists is worth it!

Categories
Blog Travel OT

Experiences as a Home Health OT in Multiple States

During my travel therapy career, I have worked in California, New York, and am also licensed in/planning to work in Colorado. So far, I have worked in subacute inpatient rehabilitation and home health settings, with more placements in home health at this time.

To be as transparent as possible, my time in home health in California was less than desirable. Not because of the setting itself, but because of the company I was working for. This was my first job after passing the OT board exam. My best friend and long time education partner, Sydney, and I drove from Rochester, NY to San Jose, CA to start travel therapy together.

The company I signed a contract with required me to cover two areas, including but not limited to: Antioch, Orinda, Vacaville, Vallejo, Rio Vista, Concord, Bethel Island, and Oakland. San Jose was a halfway point (or so we thought) for both Sydney and myself to commute to our respective work areas. Sydney was working in school-based pediatric, covering a county. Unbeknownst to the both of us, California traffic is no joke, especially in the Bay Area. I had to commute approximately an hour and a half to two hours to see my first client, and then repeat that for my drive home. I had to see six patients a day, with most of them being evaluations, revisits, and discharges. My orientation consisted of a three day in-class lecture series and no field training. At the time, I had no understanding of the coveted home health point system, from which your productivity is calculated. Thankfully, productivity was never mentioned for me, so I would be safe to assume I was meeting their requirement. We were provided with a bag including wipes, soap, sanitizer, barrier sheets, a laptop, a work cellphone, charging cord, theraband, and theraputty. Though I am thankful for the resources provided, the laptop was cumbersome to carry around and needed to be charged 2-3x per day. As a practitioner that is focused on providing quality, evidence-based, and client-centered therapy, I took most of my documentation home with me. Another part of home health is regularly scheduling patients, calling MDs or related providers, and coordinating with schedulers and office staff. So, with the daily commute to and from the areas, patient care, and documentation, I regularly spent 16-18 hours per day doing work or completing work-related tasks. In retrospect, I was in the perfect environment for burnout and that’s exactly where I landed. I specifically remember breaking down on the phone with my recruiter because I just couldn’t do it anymore. We were able to work a new system out with the OT supervisor due to an opportunity for me to move my area to San Jose. My commute drastically decreased and I was spending 8-12 hours per day on work and work-related tasks, though I was almost always behind on documentation due to a high-level of burnout. I made an effort to battle the burnout with weekly trips to various National Parks and hikes in Northern California, and completed daily documentation outside at parks or near the beach as much as possible. The contract was originally for 13 weeks, and we extended to 16 weeks to take us right up to Christmas time. There was an offer to return after the holidays, but I knew that my time with that company needed to end. Sydney also experienced burnout covering an entire county of under-served pediatric populations and decided to stay at home and not return to travel therapy. I am so thankful for having her with me for that journey, I really don’t know how I would have made it out of their with the little bit of energy that I had left without her.

A year later, I finally encouraged a close friend Sara to jump into the travel therapy world with me. We got lucky with an offer of two contracts with the same company, in the same area of NY. I was resistant to accepting another home health contract due to my previous experience, but I knew it was fair to give the setting another try with a new company. Due to gained experience both as a practitioner and interviewer/interviewee, I was able to determine that this company had an ethical outlook, manageable coverage area, and manageable productivity expectation. With the added bonus of working for the same company, Sara and I jumped on the opportunity and were both offered contracts with the company. Their orientation was a full week, with class time and field time. It was refreshing to have training under an OT preceptor, just to learn the ropes of the tablet and company operations. We were provided with the same protective equipment and bag, a balance pad, cones, a gait belt, a car charger, a tablet (instead of laptop), theraband, and theraputty. I covered one area that consisted of a cluster of 5-6 towns within a 30 minute radius, which seemed rather easy when compared to the 60 minute radius that I covered in California. I worked with a few COTAs in the area who took over a majority of my routine visits. Halfway through the contract, I moved to an area closer to where my partner and I were living and worked with one COTA, Shekera, who is out-of-this-world amazing. I extended my contract to mid-may with the company, though my contract was cut short due to PDGM. I was served a 30-day notice per my contract, and recently ended my contract on March 20th. The caseload was much more manageable, the scheduler and certain patient care managers were incredibly supportive. I was lucky to work with an amazing COTA, and didn’t have much experience with COTA supervision during my time in CA. The change to the Patient Driven Grouping Model (PDGM) did make working in the home health setting in general more difficult. The home health company I signed on with was bought out by a larger home health company shortly before my contract began. The company that shall not be named did continue to seek financial gain and stray from quality patient care in response to PDGM, in my opinion. The frequency of therapy visits was cut, there were conversations regarding cases being OT or PT only, and that OTs/PTs could cover each other’s scopes of practice, and OTRs became evaluation and discharge machines, while COTAs took over most routine visits. Through persistent advocacy and discussion, were were able to get the director to agree to providing the necessary visits per the practitioners discretion in order to meet each individual’s needs.

Pros: I enjoy the home health setting due to the fact that we get to evaluate, assess, and plan to provide interventions in an individuals natural environment. As an OT, what is better than that? I love the creativity that is required to use available resources and collaborate with a client to complete tasks they need to get through each day, with the greatest level of safety and independence. I love the change of environment throughout the day and ability to binge music or podcasts during the commute to each patient.

Cons: Even with a mobile tablet, I found that I continued to take work home with me. I don’t know about you, but when I get home I want to be completely done with work that is required of me. I found that I cannot compromise on maximizing direct client and face to face time during visits, as home health visits are not always lengthy in nature. If you own a car, expect to rack up some serious mileage. Though not an issue in California, hazardous weather can affect productivity and ability to see patients, especially in a state like New York during the winter months. The time spent on technology, whether it was my phone or tablet, was frustrating. In a time of technology, I found it difficult to step away from my phone or tablet and enjoy parts of my day. As someone who is 6’1″, the time in the car and looking at technology throughout the day definitely took a toll on my body.

Overall, I don’t think home health is my happiest place. I am thankful for my experience in the setting. As someone who strives to enter academia in the future, my experiences will allow me to share valuable information and speak on the reality of the setting.

References of OT practice guidelines and COTA Supervision:

California: https://www.bot.ca.gov/forms_pubs/supervision_faqs.shtml

New York: http://www.op.nysed.gov/prof/ot/part76.htm

AOTA:https://www.aota.org/~/media/Corporate/Files/Advocacy/State/Resources/Supervision/MSRSOTA.pdf

Categories
Blog

My story

I always found the idea of ‘coming out’ as strange or forced, but like many other LGBTQIA+ individuals I went through the same process on my journey to self-discovery and establishing my identity. I came out “officially” at the age of 17, or as I would prefer to say it, I started to let people in to who I am at 17. That is the same age that I decided to pursue an education in occupational therapy.

I applied to 9 schools originally and decided to attend D’Youville College in Buffalo, NY for my combined BS and MS of human occupation and occupational therapy. OT school was challenging, energizing, and fulfilling. I was fortunate to have incredible faculty, family, and friends who supported and challenged me with my crazy ideas like starting a community wellness clinic on campus or creating the official D’Youville OT instagram page – which is where the idea of @therainbowot grew from.

It was during professional development lecture in my final year of OT school where I found enough passion and frustration to start my lifelong mission for enhancing education, inclusion, representation, and advocacy for those within the LGBTQIA+ community, inside and outside of healthcare settings. I was so excited in class when we finally had a lecture where part of the class discussion was designated to address LGBT topics in OT. There was an objective to cover vast cultures including Korean and Latinx culture in a two hour span, leaving little time to cover all of the material, including LGBT+ topics. Without saying any names, it was clear to me that the professor was unprepared to answer questions about LGBT+ topics, especially those surrounding trans individuals – so the spotlight was turned to me (the token gay person). This wasn’t a new situation to me or the first time that I was placed with the responsibility to discuss LGBT+ topics in a class. I remember feeling powerful, frustrated, and concerned. There is a great amount of pressure when discussing topics and identities of the LGBT+ community, especially when my identity of being a white, gay, male (sex) does not come close to representing the entire community. It’s important to note that at the time of this class, I hadn’t really started acknowledging my non-binary identity, so I identified as a male. My concern came from the fact that I was one student, unable to represent or educate on all LGBT+ topics in only one section of the class. What did the other sections talk about? Did they discuss what it means to be trans? Did anyone validate the trans identity or provide definitions for the letters of the acronym? From there, the fire was lit to go on my own path of providing education and resources to anyone regarding these topics and more.

Where are we now? Well, The Rainbow OT has been running for just about a year. I launched my first LGBTQIA+ 101 series, a pronoun promise campaign, and have been a guest on two podcasts discussing LGBT+ related topics and occupational therapy’s role. With the support and safe space provided for friends that I owe the world to, I was able to let others in to who I am, a proud non-binary individual. I’m still in the beginning of my journey to self-discovery, but I am so happy with where I am when I look back at where I was. Where are we going next? You’ll just have to tag along and see.

XX,

Devlynn Neu

They/Them

The Rainbow OT

Categories
Resources

LGBTQIA+ and BIPOC Resources for Healthcare Providers, Clients, and Families:

 

BIPOC LGBTQIA+ Resources:

A comprehensive resource for BIPOC LGBTQIA+ individuals and LGBTQIA+ folx created for COTAD

Black Trans TV: A digital media platform used to promote unity and dismantle the idea that Black
queer/trans folx exist separately from the black community.

Zuna Institute: A National Advocacy Organization for Black Lesbians that was created to address the needs of black lesbians in the areas of Health, Public Policy, Economic Development, and Education. http://www.zunainstitute.org/

The National Black Gay Men’s Advocacy Coalition (NBGMAC): The NBGMAC is committed to improving the health and well-being of Black gay men through advocacy that is focused on research, policy, education and training. https://www.nbgmac.org/

The National Center for Black Equity: connects members of the Black LGBTQ+ community with information and resources to empower their fight for equity and access. https://centerforblackequity.org/

Black Transmen: A a nonprofit organization focused on social  advocacy and empowering trans men with resources to aid in a healthy transition. https://blacktransmen.org/

Incite!: A national activist organization of trans and gender nonconforming people of color working to end violence against individuals and communities through direct action, dialogue, and grassroots organizing. https://incite-national.org/

Know Your Rights Camp: Works to advance the liberation and well-being of black and brown communities through education, self-empowerment, mass-mobilization, and the creation of new systems that elevate the next generation of change leaders.

The BQI Collective: Black Queer & Intersectional Collective is a grass-roots community organization that works towards the liberation of Black queer, trans, and intersex people through direct action, community organizing, education, and creating spaces to uplift our voices.

UCSC QTBIPOC: Queer & Trans Black, Indigenous, People of Color Resource Page. https://queer.ucsc.edu/resources/qpoc.html

The Okra Project: Collective that seeks to address the global crisis faced by Black Trans people by bringing home-cooked meals and resources to the community. http://www.theokraproject.org

HBTW Fund: The Homeless Black Trans Woman Funs is a fund for the community of Black Trans women that live in Atlanta and are sex workers and/or homeless. gf.me/u/x3h8h

South Asian Sexual & Mental Health Alliance (SASMHA): SASMHA’s goal is to fight cultural stigmas, educate, and empower the South Asian American community by providing resources on issues most important to us, from sex and sexuality to mental health. They also have a podcast. http://www.sasmha.org

Queer the Land: A collaborative project that works towards the liberation of Black queer, trans, and intersex people through direct action, community organizing, education, and creating spaces to uplift our voices. Queertheland.org

Princess Janae Place: PJP provides referrals to housing for chronically homeless LGBTQ adults in the New York Tri-state area, with direct emphasis on Trans/GNC people of color.

Emergency Release Fund: Ensures that no trans person at risk in NYC jails remains in detention before trial. If cash bail is set for a trans person in NYC and no bars to release are in place, bail will be paid by the Emergency Release Fund. Emergencyreleasefund.com

Rainbow Sunrise Mapambazuko: A grass roots organization for African Indigenous Black trans and queer folx that is feeding those who have been made even more vulnerable by COVID-19. RSM is in need of donations. https://www.aedh.org/en/home/what-we-do/support-for-actors-on-theground/partners/149-africa/democratic-republic-of-the-congo/214-rainbow-sunrise-mapambazuko-rsm-en

House of GG: Creating safe and transformative spaces for community to heal, and nurturing them into tomorrow’s leaders, focusing on trans women of color in the south. http://www.houseofgg.org

The Starfruit Project: The Starfruit Project supports radical healing and brilliant growth through creative writing and performance programs that center queer and trans people of color. Offerings are for practicing artists, budding artists, and anyone seeking support on their journey toward healing and growth. https://www.thestarfruitproject.com/workshops

The Black Trans Advocacy Coalition: A National organization led by Black trans people to collectively address the inequities faced in the black transgender human experience.

The Marsha P. Johnson Institute: Defends the rights of Black transgender people.

National Queer & Trans Therapists of Color Network: A network committed to transforming mental health for queer and trans people of color.

Brave Space Alliance: A Black-led, Trans-led LGBTQ Center working on the South Side of Chicago. @bracespacealliance

SNAPCO: Builds power of Black Trans and queer people to force systemic divestment from the prison industrial complex and invest in community support. http://www.snap4freedom.org

The Brown Boi Project: a community of masculine center womxn, men, two-spirit people, transmen, and our allies committed to transforming our privilege of masculinity, gender, and race into tools for achieving racial and gender justice. Located in Oakland, CA. http://www.brownboiproject.org/

The National Black Justice Coalition (NBJC): A civil rights organization dedicated to empowering Black lesbian, gay, bisexual and transgender (LGBT) people. NBJC’s mission is to end racism and homophobia. http://nbjc.org/

Black Trans Travel Fund: Works on providing resources to Black trans women to be able to access safe transportation and travel alternatives.

TGI Justice Project: A group of transgender, gender variant, and intersex people – inside and outside of prisons, jails, and detention center – fighting against human rights abuses, imprisonment, police violence, racism, poverty, and societal pressures.

The National Queer and Trans Therapists of Color Network (NQTTCN): The NQTTCN is a healing justice organization that actively works to transform mental health for queer and trans people of color in North America. Together we build the capacity of QTPoC (queer and trans people of color) mental health practitioners, increase access to healing justice resources, provide technical assistance to social justice movement organizations to integrate healing justice into their work. Our overall goal is to increase access to healing justice resources for QTPoC. https://www.nqttcn.com/

Black Visions Collective: a trans- and queer-led social-justice organization and legal fund based in Minneapolis-St. Paul. https://www.blackvisionsmn.org/about

Black AIDS Institute: Working to end the Black HIV epidemic through policy, advocacy and high-quality direct HIV servicers. http://www.blackaids.org

National Black Justice Coalition: A civil rights organization dedicated to empowering Black LGBTQ+ people. http://nbjc.org/

The LGBTQ+ Freedom Fund: posts bail to secure the safety and liberty of people in jail and immigration detention. https://www.lgbtqfund.org/

Trans Women of Color Collective: A network of dedicated cultivating sustainable projects for and by transgender women of color.

For the Gworls: raises money to assist with Black trans people’s rent & affirmative surgeries. https://www.facebook.com/forthegworls

Black Trans Femmes in the Arts: A collective of Black trans women and non-binary femmes who are dedicated to creating space for Black trans femmes in the arts. @btfacollective

By Us For Us: A collective of queer, femme, and non-binary Black and POC artists and organizers. @Bufu_byusforus

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LGBTQIA+ Resources:

The Trevor Project: The Trevor Project’s Trainings for Professionals include in-person Ally and CARE trainings designed for adults who work with youth. These trainings help counselors, educators, administrators, school nurses, and social workers discuss LGBTQ-competent suicide prevention. https://www.thetrevorproject.org/education/

Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian gay-bisexual-andtransgender-health

Sex and Intimacy OT: Our mission is to dismantle restrictive norms related to sexuality and intimacy which limit clients and limit ourselves. We strive to promote understanding, respect, and empowerment for individuals as sexual beings. https://www.sexintimacyot.com/

Sex Love and OT: a sexuality, mental health, and OT advocate, writer, and practitioner. Dr. Tickoo works as a school-based OT in Mumbai, however her work is not limited to kids. Dr. Tickoo’s work explores the integration of sexuality in OT practices for people of all ages. http://www.sexloveandot.in

The LGBT OT: resource for LGBT+ specific OT practice and clients. By: Jadyn Sharber, MSOT, OTR/L. https://www.lgbtq-ot.com/

LGBTData.com serves as a no-cost, open-access clearinghouse for the collection of sexual orientation & gender identity data and measures. (By Dr. Randall Sell). http://www.lgbtdata.com/

Trans Justice Funding Project: Community-led funding initiative to support grassroots trans justice groups run by and for trans people. http://www.transjusticefundingproject.org

Transgender Law Center: offers legal resources to advance the rights of transgender and gender nonconforming people. https://transgenderlawcenter.org/

Reclaim: Resources for Queer and Trans youth. https://www.reclaim.care/what-we-do/resources-forqueer-and-trans youth.html

The Transgender District: The transgender district aims to stabilize and economically empower the transgender community through ownership of homes, businesses, historic and cultural sites, and safe community spaces. http://www.transgenderdistrictsf.com

CHANGE: Promoting gender equality by advancing the sexual and reproductive health and rights of women and girls worldwide. http://www.srhrforall.org/

National Center for Transgender Equality: advocates to change policies and society to increase understanding and acceptance of transgender people. In the nation’s capital and throughout the country, NCTE works to replace disrespect, discrimination, and violence with empathy, opportunity, and justice. https://transequality.org/

Youth Breakout: Works to end the criminalization of the LGBTQ+ youth in New Orleans to build a safer and more just community. http://www.youthbreakout.org

Trans Cultural District: The world’s first-ever legally recognized Trans district, which aims to stabilize and economically empower the Trans community. http://www.transgenderdistrictsf.com

LGBTQ+ Freedom Fund: Posts bail LGBTQ people held in jail or immigrant detention and raises awareness of the epidemic LGBTA overincarceration. http://www.lgbtqfund.org

The Network for LGBTQIA+ Occupational Therapists. http://www.otnetwork.org/

The National Resource Center on LGBT Aging (SAGE) Advocacy for LGBT+ Adult and Elderly Populations. https://www.lgbtagingcenter.org/

GLMA: Health Professionals Advancing LGBTQ Equality (previously known as the Gay & Lesbian Medical Association). http://www.glma.org/

NALGAP: The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies is a membership organization founded in 1979 and dedicated to the prevention and treatment of alcoholism, substance abuse, and other addictions in lesbian, gay, bisexual, transgender, queer communities. http://www.nalgap.org/

The Centers for Medicare & Medicaid Services is working with national and local organizations to endure the LGBT community get quality health insurance and health care information. https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/LGBT

Coalition of Occupational Therapy Advocates for Diversity (COTAD): The Coalition of Occupational Therapy Advocates for Diversity (COTAD) formed in 2014 through a collaboration that occurred between members of the AOTA Emerging Leaders Development Program. COTAD has grown tremendously since its early days and has added individuals to its Executive Board and general membership. Now established as a non-profit organization, COTAD operates as group of individuals from across the United States all working towards a common goal of promoting diversity and inclusion within the occupational therapy workforce and increase the ability to occupational therapy practitioners to serve an increasingly diverse population. COTAD’s new Ignite Series: https://www.cotad.org/ignite-series 

COTAD-logo-v01 copy

LGBTQIA+ Educational Podcast Episodes:

https://otafterdark.com/

https://ot4lyfe.com/35/

https://seniorsflourish.com/sexuality-identity-occupational-therapy/

www.occupiedpodcast.com/074