I feel excited about going into the Pro Bono Clinic, especially since my experience with pediatrics is limited to my tutoring experiences and my one-week fieldwork experience in Spring 2025. I believe that the clinic will be a great learning opportunity, not simply as an occupational therapy student, but also for me as a person. I also feel somewhat nervous going into the Pro Bono Clinic because of my limited experience, and in combination with stories from individuals in my personal life who work with children with autism spectrum disorder, emotional dysregulation, and other needs.

1. Personal biases I have in working with pediatric clients include the following:

   1. Parents who seem uninterested in their children do not care about how their children behave.

   2. Children with diagnoses are easier to work with than children who do not.

   3. Children who have challenges with emotional dysregulation are typically aggressive.

2. I might address these personal biases by doing more research to learn more about the pediatric population, especially those with specific needs and who face various challenges. I may also seek advice and insight from individuals who have experience with the pediatric population, such as my sister (high school chemistry teacher) and my mother (classroom aide in an emotional regulation classroom). I believe that expanding my knowledge to diminish and eliminate these biases would be beneficial in my experience throughout the pediatric pro bono clinic. 

Personal strengths that I feel will assist my performance in a pediatric case are my ability to modify and adjust to various situations, past experiences with children, and my calmer demeanor. From my experiences, I know that pediatric clients may be unpredictable and may not want to engage in certain activities. My ability to adjust to their preferences will assist my performance in maintaining client-centeredness across sessions. Additionally, my past experiences have provided me with knowledge on how to redirect children and gauge their interest. Lastly, I believe that my structured and more calm demeanor may be beneficial in keeping myself level-headed in moments of high stress or tension.

Areas of Need:

Although I believe the above-mentioned characteristics can be considered my strengths, I also believe that they can inhibit my performance in a pediatrics case. My past experiences in working with children primarily involve tutoring, which is rather different from occupational therapy sessions. During my tutoring experiences, I have needed to utilize coping, emotional regulation, redirection, and other strategies utilized in occupational therapy; however, I am not sure if my ability to apply them will be as effective in the pediatric pro bono clinic. To continue, my client may not mesh well with my personality or the way I present myself, which may present a challenge for me act in a way that the client responds well to. 

I learned a multitude of things from the pediatric evaluation session. The most prominent information I learned was to be ready for anything to happen, and that what is written down on paper may not always present itself in person. Prior to the session, my partner and I anticipated that the client’s mother would be present for her younger siblings’ session and would not be readily available to answer our questions. Although our assumptions were correct, we adjusted appropriately and obtained as much information as possible from the client. From this, I have learned how much information you can gather from simple conversation, even with pediatric clients, and that you do not have to rely on their parent/caregiver for information. Overall, I feel that our pediatric evaluation session went very well. Our client was engaged in all of the activities, and I feel that my partner and I navigated the session appropriately.

Many things went well during the session. Our client was very engaged and content with the coloring and craft activity we planned, and shared that she enjoyed coloring at home. We also engaged in the Pop-the-Pirate game to assess her executive functioning and emotional regulation skills. This activity went much better than we anticipated. Our client was very interested in the game, so much so that we played multiple rounds of it. To continue, having conversations and building overall rapport went very well. Initially, our client was very shy, but she opened up almost immediately after completing the obstacle course on the way to our assigned room. I feel that once she engaged in one activity, she was continuously curious about what we were going to do next. We had some great conversations during our session, and my partner and I quickly learned that our client was quite talkative after opening up. 

In terms of things that did not go as well, I feel that we did not anticipate her behavior during interactions with her brother. It appeared that her emotions and behaviors were significantly influenced by those of her older brother, specifically during the obstacle course activity. Although I understand that obstacle courses are an opportunity for chaos and high energy, I feel that I was not anticipating the change of our client being alone with us versus being with her sibling. For me, navigating this change was a slight challenge, and is something that I realize I need to get more comfortable with. Next, I do not believe the cutting and handwriting components of the crafting task went as we anticipated. Per the developmental milestones, a child of our client’s age should have a sufficient grasp while using scissors and be able to spell, write, and recognize their name. Our client initially held the scissors incorrectly with the blades facing the body, which presented a safety risk. To continue, I was surprised that our client could not write or read her full name because it is typically a learned task by our client’s age. Lastly, although I anticipated that our client would have some challenges with transitions, I feel that encouraging her mindset regarding incomplete tasks may be a challenge, but it will be a great skill to address throughout the course of the pro bono clinic experience. 

We will incorporate this learning into our future sessions with our client by planning time for each activity to encourage smoother transitions, planning interventions independent from siblings, and utilizing fun activities. This plan may include a detailed breakdown of tasks, utilizing coping strategies for transitions, planning fun activities that do not have a lot of steps, and most importantly, collaborating with our client and her parent/caregiver. Additionally, I feel that the format of this session worked well for our client (physical activity/obstacle course -> fine motor activity -> organized game -> visual/physical activity -> physical activity/obstacle course). I believe that having a starting activity that opens up the client for the day, but also having calmer activities, is beneficial. On a personal level, I believe that this initial interaction with our client showed me how much patience I must have and that I am more than capable of giving that patience and the type of support that our client needs to be successful in her desired occupations.

1. How did you plan and organize today's session?

Unfortunately, our session was canceled due to client illness, which encouraged my partner and me to embrace the unpredictability of the pediatric occupational therapy setting. We planned to utilize our group intervention plan to plan and organize our first treatment session, in which we listed the activities in the order that we planned to complete them with our client. This week’s experience has taught me that plans do not always go the way you intend them to, and you may have to alter your plans last-minute to accommodate your clients. For next week, my partner and I will develop a second intervention plan; however, we will utilize activities from our first plan to aid in conducting a client-centered occupational therapy session. To continue, the session I observed appeared to be structured in a way that best fit the child’s needs, including both sitting and standing tasks to allow for flexibility and variability within the session.

2. What went well in terms of pacing and flow, and what would you adjust next time?

The session I observed appeared to have an effective pacing and flow for the client. The OTSs incorporated various activities within the session, while also completing them at the pace appropriate to their child, including an obstacle course, sitting activity, hula hoop activity, and another sitting activity. With this in mind, I intend to apply appropriate pacing and flow when conducting next week’s session by utilizing a clear plan, while also allowing our client to have autonomy within the session.

1. What strategies did you use to support the child’s participation and engagement?

Based on the session I observed, the OTSs used positive and motivational language, and remained patient and calm throughout the session. During moments their client did not want to complete a given task, the OTSs offered alternative options (i.e., completing kangaroo hops instead of bear crawls) that would address the same needs. For next week’s session, I plan to encourage our client to make decisions and use her autonomy within the session, while still being engaged in the planned activities. My partner and I planned various activities that allow for this practice of autonomy, including crafts and subjective tasks, to enhance our client’s participation and engagement.

2. Did you need to adapt or modify your original plan during the session? Explain why and how.

For this session, my partner and I had to adapt and modify our original plan due to the cancellation, and were given the opportunity to observe another group's session. I cannot specifically comment on how the OTSs in the observed session adapted and modified their original plan; however, they appeared to offer alternative tasks for their child to complete, as I mentioned earlier. For our client, we may adapt and modify our original plan to increase her engagement and optimize her performance. If our client finds an activity too difficult and is inhibited by potential frustration, we may grade down the task by requiring less components or providing more assistance (i.e., cues, physical assistance). We may also alter our original plan to challenge our client by grading up activities. This may include increasing the number or complexity of the requirements for a given task or selecting a back-up activity that was developed to be more challenging.

1. How did you address any unexpected behaviors, challenges, or environmental circumstances that arose?

   Unfortunately, my partner and I faced another cancellation, and completed our intervention session with our peers. When completing the planned activites, my classmate exhibited the following behaviors: non-adherence to directions and unsafe scissor use. I addressed her decreased demonstration to follow directions by verbally repeating the task instructions and utilizing short phrases, which “corrected” the behavior. To address her unsafe scissor skills, I asked her to pause the activity, and explained to point the scissor blades away from the body when cutting the paper. I also provided visual cues for where she should hold the paper when cutting to avoid harming herself.

   
   

2. What would you do differently if the same situation occurred again?

   If my client presented the same behaviors, I may utilize more visual cues to provide more concrete demonstrations, rather than verbal cues, which could be misinterpreted. I believe that the verbal cues I provided would be effective with my client, but I recognize that I may need to alter my tone or the way that I express the task expectations to better fit her needs. Even though I wish I could have experienced this session with my client, I am thankful for the curveballs my classmate threw at me and my partner, as I feel that the experience better prepared us for the unexpected.

1. Identify one activity you created or used in this session.

   One activity I created was a scooter pom-pom activity. This activity required the client to lie prone on a scooter to collect pom-pom balls dispersed across the ground one at a time, using training chopsticks in their preferred hand, and sort them by color into nine piles (i.e., black, blue, green, red, orange, pink, purple, orange, yellow). The activity targets various crucial skills, including fine motor strength and coordination, core/trunk strength and stability, gross motor coordination, sequencing, visual scanning, and color recognition.

   
   

2. Why did you select this activity, and how did it address the child’s occupational needs or goals?

   I selected this activity because it addressed multiple of the client’s occupational needs and goals. This activity aimed to develop fine motor skills and cognitive skills (specifically sequencing and recognition) necessary for handwriting to encourage full participation and engagement in school and related tasks. Two of the three established short-term goals focus on handwriting and scissor skills, both of which require fine motor strength and coordination. Although the activity was created to target handwriting skills, the fine motor skills utilized throughout the activity can also be applied to cutting skills and using scissors.

The OT would provide supervision to an OTA through direct or indirect means, as required by state laws and regulations. Direct supervision would indicate line-of-sight supervision, which would allow the OT to directly supervise the OTA throughout the session and other responsibilities in the outpatient pediatric OT setting. Indirect supervision may include phone calls and other non-face-to-face means. With regards to guidance, an OT may guide an OTA in administering assessments in which they demonstrate competence, carrying out interventions, and treatment session documentation. 

The OTA would contribute to the overall treatment process by administering assessments under the supervision of an OTR, contributing observations to the OT evaluation, carrying out treatment/intervention sessions, and completing documentation. OTAs play a major role in the intraprofessional team by contributing relevant information through documentation to aid in the development of a client-centered intervention plan, among many other contributions. 

An OTA can carry out interventions and complete documentation independently, without requiring direct OT input. Tasks and decisions requiring direct OT input include those that require clinical decision-making, such as evaluations (and re-evaluations) and evaluation interpretations, treatment plan development and modifications, goal setting, and discharge planning. In other words, OTs are responsible for tasks and decisions that involve the course and direction of treatment, while OTAs help enhance to the quality and effectiveness of treatment. 

1) What strategies did you use to support the child’s participation and engagement?

Throughout this session, I utilized the child’s interests to support his participation and engagement. As his aunt, I had some additional knowledge that my partners did not have. I also feel that being a familiar face helped him feel more comfortable in a new environment, especially in encouraging him to engage in various new activities with unfamiliar people. Additionally, I believe that my partners and I presented various activity options to allow N to make his own decisions based on his interests in given moments and situations.

2) Did you need to adapt or modify your original plan during the session? Explain why and how.

In the days leading up to the session, my partners and I developed an informal intervention plan with activities to address various skill areas. We set up various activities the day of the session, but not necessarily all of the activities that we had “planned.” On the day of the session, we determined what activities would be most appropriate and intriguing to our client for optimal engagement. During the session, we did not have a structured timeline of activities. Rather, we engaged in the activities that our client seemed to enjoy and most interested in, allowing for a more client-led developmental play session. Doing this encouraged our client to make decisions, and provided insight into his playtime preferences.

1) What did you learn about yourself as a developing occupational therapist through this session?

Since I was working with my nephew during this session, I felt that it was difficult to separate the aunt from the occupational therapy student side of me. I was not sure how involved I should have been in guiding the session, as I wanted him to come out of his shell and engage with my partners, who he was fully comfortable with by the end of the session. As a developing occupational therapist, I learned that I can be more lenient and have a “go with the flow” mindset during sessions. I’m a rather regimented person and I thrive off of schedules and checklists. I feel that this session showed me that I can still learn a lot about a client without “controlling” the session. Additionally, I learned how much I can expand in the activities I plan, especially with younger children. Just because a child is young, does not mean that they cannot do more elaborate activities. 

2) What is one goal you will set for yourself in the next clinic session?

One goal I will set for myself in the next clinic session is to take on more of my occupational therapy student role, rather than my aunt role. I believe that knowing that my newphew is more comfortable in the environment and with my partners allows me to feel more comfortable with stepping outside of the family member role to increase his engagement throughout the session. I hope to increase his engagement in various activities to enhance the developmental play aspect of our session, and to be more creative in planning activities to expand on his current and developing abilities.  

1. What did you learn about yourself as a developing occupational therapist throughout this entire Pro Bono Clinic?

   Throughout this entire pro bono clinic, I learned that I am more creative than I think I am. I found intervention planning very enjoyable because I was able to tap into my more creative side, and even surprised myself with all of the activities that came to mind during the planning process. On a more professional level, I learned how to better manage last-minute plan changes and the importance of communication in the real-world practice setting, especially with caregivers. The pro bono clinic taught me how to plan for the unexpected and that there is always room for improvement in my problem-solving skills. For my future career as an occupational therapist, I plan on working with the adult population. This experience has taught me that multiple aspects of pediatric occupational therapy can also be applied to various populations, when graded up and down appropriately. With this in mind, I feel that I expanded my intervention planning knowledge and how broad I can be in my creativity.

   
   

2. What skills did you develop during the Pro Bono Clinic?

   Skills I developed during the pro bono clinic were flexibility and more effective communication with children. With the various cancellations and no-shows, I feel that I learned to be better prepared for the unexpected and to not be thrown off by last-minute schedule changes. I learned how to be flexible during my level 2A fieldwork experience in an inpatient rehabilitation unit; however, I feel that this is a different type of flexibility than the type I developed throughout the pro bono clinic. To continue, I feel that I learned how to better communicate with younger kids, as most of my experience with children were with those in 3rd grade and above. This also includes non-verbal communication. As someone who is not extremely animated and bubbly, this was something that I anticipated I would struggle with during the clinic. I feel that my interaction with the client during the initial evaluation and my nephew outside of my family setting assisted in improving these skills. Finally, I believe that I improved on my written communication and critical thinking skills through documentation.

1. How did you go about discharge planning and creating the home program?

   Discharge planning was rather straightforward for our client. Considering we only saw our client for the initial evaluation and for no subsequent treatment sessions, our client was “automatically” discharged due to cancellations and no-shows. For our home program, my partner and I utilized information from the caregiver intake and the initial evaluation to establish focus areas. Our home program consisted of coping strategies (i.e., five finger breathing, “How am I feeling?” chart), task breakdown strategies (i.e., visual schedule, checklist), and tips for handwriting and scissor skills. These areas were identified during the initial evaluation session with our client, and were addressed in the client’s established goals and throughout the intervention planning process.

   
   

2. How did your family/ pediatric client (if appropriate) respond to your education/ instruction on the home program?

   Unfortunately, due to our client’s dismissal from the pro bono clinic, my partner and I were unable to gather a response from our client and her caregiver on the home program.