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Recognizing then Fulfilling a Need in the Community | NEWS-Line for Occupational Therapists & COTAs
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Recognizing then Fulfilling a Need in the Community

Toby Joanne Black, MA, OTR/L, began her career with another field in mind. "I began volunteering as a candy striper at age 14. My plan was to go to nursing school and work with children. I worked at Shriner's Hospital in Philadelphia as a nurse's aide for three summers following high school graduation," Black explains. "I was introduced to occupational therapy and my career plans took a sharp turn. I met the ‘play therapist,' who was an OT, and became interested in the profession. I started in a pre-nursing program but the next summer I was able to work with the OT at Shriner's and my life plans were changed!"

Black graduated from Washington University with a Bachelor of Science in OT, and went on to earn her master's in Education and Counseling from Western Kentucky University. "I pursued a Master's in Counseling since I realized that I was not meeting the needs of the families. Parents tend to talk freely to therapists working with their child and I need to listen to their conversation because it tells me how they are coping. I also train parents to be advocates for their child as they change programs. They need to be independent of the healthcare professionals that they have come to rely on," Black explains. "I feel that I am a better listener and I no longer focus on just the child. I take time to really talk about the medical condition and how the child should develop. I feel better about my interactions with parents."

Black began her career as a staff therapist, and then forged her own path after six years. "When I graduated, I did not realize that OT lacked credibility and acceptance outside of larger cities. When we moved to Bowling Green in 1976, OT was not an organized profession. I arrived with a baby on the way and thought I would retire for a couple of years. That lasted about three months! OT was an unknown by the medical community. I decided that I would have to make my own contracts since no one was jumping up and down to hire me part-time. I began out of my home and slowly added equipment. As my name became known, referrals came from pediatricians and parents. I eventually contracted with several programs."

Black's clients included the city schools, which began as a part-time situation, but eventually the need warranted more OT time. "The local schools were not interested until 1987. As teachers began to see our role, referrals and the caseload increased," Black says. "Head Start changed as the children with disabilities entered the program. I have worked with Head Start since 1982. My role is clearer and I feel that I am no longer the outsider coming in but part of their team. I have office hours after school."

In addition, Black sees clients through an organization called First Steps. "I only do home therapy for First Steps. First Steps began to evolve in Kentucky in the early 1990s and OT was one of the professions. It was in opportunity to show what we can do and how we work with teams. I was lucky to be on the ground floor and watch it grow. There are still growing pains, but it has been a great experience for me." This program aids children in their developmental years, and the setting, Black's home, has abundant stimuli for the children. "We see children from birth to three and it is a transdisciplinary approach. I have a long flight of steps into the lower level of my house. Many children have learned to walk down those stairs," Black says. "When they enter the building their attention is drawn to my barking dogs (behind a gate). It makes for an interesting discussion about dogs. I also have a cat who may allow herself to be seen. I start with mat activities with the sensory diet and move to the ball for vestibular movements. Depending on the age, I have a table for the older kids and a bench and tray for the little ones. The activities depend on the age and needs of the child but I offer developmental appropriate activities. At the end of the session the child has free time to choose a toy. I do use music, which is either calming or upbeat depending on the child. It plays in the background. I also talk to the parent during the session as well as allow time after the session."

When school isn't in session, Black continues her work with young children who need help with their motor skills. "During the summer, I offer motor groups for four- to nine-year-olds. I started motor morning or motor afternoon out groups for children who need to work on their fine motor skills and social interactions," says Black. "I have been doing this since 1980 and I have had to change with the times. The children are grouped by age and we start with gross motor games, then a floor group game, then the fine motor table activities (writing, manipulation of letters). I have added computer games since that is the current interest (mine are educational). I am into assistive technology. I also have two groups during the school year for five- to six-year-olds. These are social, writing, and motor groups."

Black focuses on children with sensory and learning challenges. "I was introduced to sensory integration in 1973 and spent three years learning as much as possible. I took the Southern California Sensory Integration Test training, and have continued studying and videotaping children to offer the most up to date therapy programs for children diagnosed with sensory processing disorder. My office is equipped with vestibular equipment (tunnel, swing, balls, rocking board) to add to the experiences of my clients. I am using several writing programs and videotaping the children to determine if one approach is more preferred."

By opening her own practice and contracting to the local schools and programs, Black filled a void in Bowling Green. She has also been a witness to the growth of her profession in that area, which presented new challenges. "The community I live in was behind the times in regard to OT. For a number of years I was the only practicing OT. When the rehab center opened in 1992, we began to see new graduates first interning and then taking jobs. Some of the therapists were interested in pediatrics and saw a source of experience and income with First Steps. I began to see a trend of therapists without pediatric experience trying to evaluate and treat children, so I decided to offer mini courses based on their interests to give them resources and teach treatment approaches. It was a great way to network and exchange ideas."

Black enjoys training and mentoring and would like to do more of it in the future. "I would like to teach in a transdisciplinary setting," she says. "To me, transdisciplinary is several professionals working together and interacting to discuss the approaches and brainstorm. I worked at a center offering this and I was sold on the concept that the whole child is what we are trying to develop (not talking, walking, etc. as separate goals). I would like to be part of a team. Working alone limits brainstorming! I spend time researching topics, diagnoses, testing materials. I have to do my own public relations and I use brochures I designed for mailings to the medical community. Plus, I have a networking community."

As with many, Black's greatest concern about her profession is medical insurance. "I am now required to bill insurances which I never did before. I had difficulty collecting private fees resulting in asking for payment at the time of service rather than billing. We have to be business professionals and that's difficult for us to accept."

Rewards, however, far outweigh the problems in Black's profession. "I worked with a two-and-a-half year old just diagnosed with autism. His grandmother was determined that he was not going to be autistic. He is Aspergers and went from an out of control, non-verbal child to a verbal, bright, interactive young man. He is now in first grade and has lots of activities to keep him busy. Certainly, he is still autistic, but he is no longer the unhappy aggressive boy I first met. His grandmother tells the story of how he didn't say ‘mama' when he first came to me. His mother and grandmother were so uptight when he cried that I asked them to wait upstairs. He was very upset and I told him that when he stopped crying he could go to the stairs and call ‘mama.' To my surprise he did! He also liked the sensory headphones and he asked me to keep them on so he didn't have to listen to his grandmom talk!"

Black's advice to new or prospective OTs is to get involved. "Attend workshops and explore the areas of interest," she recommends. "Network with more experienced therapists. You can learn a lot."

"I spent my entire career talking about the value of OT in education and early childhood," she reflects. "We are certainly a respected profession and the demand for OTs is very encouraging. We are no longer just rehab. We are offering certifications and technical trainings. We are specialists in the medical community."

Black has undoubtedly learned plenty in the years since she first devoted herself to the field, and has changed with the needs of the profession to continue providing life-changing therapy. "I have to remind myself that I graduated 34 years ago. I love this profession and the daily challenges. A lifelong commitment to my chosen profession and NO BURN-OUT! Yes, a lot has changed, but we still focus on the clients and their special needs. It is very satisfying to see them grow up and be active in their communities."

Toby Joanne Black, MA, OTR/L, has a Bachelor of Science in Occupational Therapy from Washington University in St. Louis, Missouri, and a Master of Arts in Education and Counseling from Western Kentucky University in Bowling Green, Kentucky, where she currently lives.

Jeneane Brown is a freelance writer for NEWS-Line for Occupational Therapists & COTAs. She resides in Miami, Florida.

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