Occupied with Service

Friday, March 30, 2012

Natalie Butz was in high school when her brother suffered a traumatic brain injury.

“I was with him in the hospital for three months and got to see him working with all the (care providers),” she said.

“(Occupational therapy) was the one—my heart connected with it,” said Butz OT ’13. “I saw the implications it had in my brother’s life.”

From high school through her undergraduate studies at Boise State University, Butz had a singular goal: a career in occupational therapy, or OT.

Today, she is in her second of three years in Pacific University’s occupational therapy program on her way to a master’s degree.

She dreams of working with people who have experienced traumatic brain injuries, like her brother, perhaps in an acute care center or a community group. Because of Pacific’s unique community-linked approach to OT training, she’s already getting a taste of the life of an OT. She has connected with Bridge to Independence, a Portland-based day program for traumatic brain injury survivors. She also has worked with elderly patients in Nicaragua and with rehabilitation services in Ireland—without even starting her Year 3 fieldwork experiences.

It’s that connection to the community and hands-on service approach that brought her to Pacific to begin with, she said. Butz and fellow second-year student Nicolé Wandell OT ’13 recently attended an enclave for occupational therapy students across the country. No other schools were as involved in serving the community as Pacific, they said.

“Nobody had that grasp of community involvement and nonprofit partners in OT. Some said, ‘We’re kind of working in a nonprofit,’ but Pacific sealed that,” Butz said.

“A lot of us were accepted to other programs. What drew us to Pacific was that community involvement.”

In its infancy a century ago, occupational therapy was concerned primarily with mental health—helping World War I soldiers deal with shellshock, or what today would be identified as post-traumatic stress disorder. Over time, the profession moved into the physical realm, and today only 2 to 3 percent of occupational therapists work in mental health, said John White, director of Pacific’s OT program.

The possibilities, however, are limitless.

“We define ‘occupational’ differently than the average person,” White said. It’s not about a job, per se; it’s about any way in which people constructively occupy their time.

“Our primary concern is the full lifetime of occupations,” he said. “That includes taking care of yourself—showering, brushing teeth, eating. It includes work—volunteering, schoolwork, taking care of friends and family. And all the leisure activities you pursue—games, socializing, playing sports—all the productive ways people spend their day.”

In other words, said professors Sandra Rogers and Sandra Pelham-Foster, it’s about doing. A family practitioner might tell a patient to exercise to lose weight, or a psychologist might talk to a client about strategies to avoid conflict; an occupational therapist helps people implement that advice.

“In many therapies, you come in for help and get instructions,” Pelham-Foster said. “It’s not that you don’t know you should do it, you just don’t know how to get it done.

“We help people integrate new techniques into their everyday life.”

And if ever there was an example of practicing what you preach, the School of Occupational Therapy is it. The focus for students is on doing, while learning.

Starting as early as the first year, classes are connected with a host of community organizations providing direct services for people. By the second year, students are more involved in fieldwork as part of their courses. And, in Year 3, students are expected to complete a large project, often including developing a business plan to sustain an occupational therapist in a new or existing program.

“Pacific is amazing, for its size, for all the things we do,” said Professor Rogers.

For example, she leads one of Pacific’s interdisciplinary, international service trips.

Last summer, she took Pacific’s second group of students and faculty to China to work in a pediatric rehabilitation facility. The project is a partnership between Pacific University, the international organization Fuling Kids International, and the Chinese facility, which includes an orphanage and rehabilitation hospital for children with disabilities.

OT, physical therapy and education students worked with the medical professionals who provide rehabilitation care in the hospital, as well as with the caretakers and educators at the orphanage.

“We’re giving them more tools, information and ideas. To the extent that they want that help, we’re trying to be helpful,” Rogers said, adding that she has been amazed by how the Chinese caretakers have taken ownership of the new ideas.

Meanwhile, second-year students Butz and Wandell were two of four OT students who visited Nicaragua this winter on another international service trip. Students and faculty from OT, physical therapy, physician assistant, pharmacy, dental health and optometry programs work in hogars, or homes for elderly individuals without family. For the first time this year, the Pacific group split in half, serving two different hogars in different parts of the Central American nation.

Butz said occupational and physical therapy students teamed up in the hogar where she worked to develop a chair exercise program for residents. One resident was so excited about the program that the students created a guidebook for her and taught her to lead the program after they left.

Butz also said she made a splint out of a water bottle for a person who couldn’t go to the hospital and, in another case, used a water bottle, a box and some foam to create a wedge to decrease a patient’s hand inflammation.

“You figure out how to adapt what you need without everything. You don’t have the fancy equipment we have here,” she said.

“It makes us better therapists, because we’re not thinking, ‘equipment, equipment, equipment.’”

Tiffany Boggis, the School of Occupational Therapy’s leader on the Nicaragua trip, said the efforts are making a long-term difference not only for the patients that Pacific students serve, but for the system of care throughout the country.

Pacific students work with one of the Nicaragua’s five occupational therapists, along with a local nursing school that traditionally hasn’t had the time or resources to focus on elder care, Boggis said.

“One result of our partnership with the nursing school is that they have included a whole portion in their curriculum on working with older adults and a lab portion where nursing students go out to homes for abandoned adults and work with individuals in hogars,” Boggis said. “That’s a really cool example of how our participation down there has really helped to spark some action in Nicaragua, for them to be able to take it on themselves.”

At home, the opportunity to serve and learn is even greater.

Pacific partners with Washington County Community Corrections, where students work with inmates in an optional drug and alcohol treatment program. The inmates spend 60 to 90 days in AA and other treatment, and occupational therapy students help them implement the lifestyle changes before and after release.

“That’s a key part of the program, because they go back to the community with the same people, the same problems with their family,” Rogers said. “How do they move their sincerity to stay clean and out of trouble into behaviors they can maintain over time?”

The OT program also partners with Old Town Clinic on Portland’s Burnside Street, working with professional occupational therapists to provide services such as pain management to homeless and underserved populations.

Students work with the Kiwanis Camp that provides summer camp experiences for people with disabilities. They have partnered with TriMet to help more people transition from driving or call-a-ride service to traditional public transit. They have interned with Our House of Portland, which provides healthcare and housing services to low-income people living with HIV/AIDS.

Pacific also partners with Portland State University in working with AgrAbility, an organization devoted to helping farmers return to the fields and continue their livelihoods after experiencing disabilities.

Students helped found and continue to work at AntFarm, a community center in Sandy, Ore., that uses outdoor activities such as trail-building to connect with at-risk youth.

On a Friday afternoon in February, Hannah Frankamp OT ’14, a first-year Pacific occupational therapy student, sat in a classroom, chatting with Karina Soriano, a senior at Miller Education Center in Hillsboro, Ore.

Throughout the school, about 30 other first-year OT students met one-on-one with middle and high school students in the alternative school. The meetings will continue every week throughout the semester, as the pairs talk, play games, learn new skills and work together on the younger students’ goals.

Most of the middle and high school students come from poverty, and many have a host of challenges outside of school that impacts their academic success. Though few have the severe disabilities that would trigger occupational therapy services through their public school, all could use extra help in finishing school, planning for college or finding

jobs, and establishing independent living skills to be successful as adults.

Soriano transferred to Miller Education Center from her traditional high school when she became a teen mother. She has some support from her family, and from Miller Ed, where she is able to bring her child to an on-site daycare. Still, the balance between school and motherhood is hard.

She talks passionately to Frankamp about the pressure of knowing that her decisions will directly affect her child.

She struggles to figure out the right steps after high school to build the best life for both of them.

She also talks about wanting other teenagers to know that parenthood isn’t a carefree babysitting gig; it’s permanent and it’s serious. She dreams of making a documentary in her school about the reality of teen motherhood, for her senior project—which she hasn’t quite started in February of her senior year.

These are the kinds of things that she and Frankamp will work on weekly until graduation.

“I think it’s really awesome to get a chance to actually get out of the classroom and start working on things we’re learning about in the classroom in real life,” Frankamp said. “I’m looking forward to just kind of learning more about Karina and what dreams you have that I maybe can help with—not necessarily fix or solve or whatever—but to just walk alongside you and be your cheerleader a little bit.”

Soriano nods and smiles, “Be there to help me up.”