For several years I was the occupational therapist at a residential treatment facility for children with severe mental health problems. Initially I was hired to provide school OT services for students with fine motor/handwriting goals. Clearly, these children had problems beyond poor handwriting. In fact, they were referred to as the “sickest kids in the state” by some of the staff and administrators. I eventually initiated a number of OT programs at the center, but the after-school OT activity program was my favorite due to its simplicity and amazing impact.

I was the school OT for at least a year when I started asking to expand into the residential units. Initially I hit strong resistance because there was no budget even though I offered to staff it with OT and OTA fieldwork students. We also were told it wouldn’t be safe, even though we all passed  crisis prevention and intervention classes. In addition, we were told the child-care staff would feel intruded upon, even though it turned out they wanted us. After months of persistent effort we were allowed to observe in the units and offer ideas. What we saw was very sad.

Although the center’s newly built living spaces were clean and bright, life in the units was occupationally sparse and monotonous. The children spent a lot of their after-school and evening hours waiting — waiting for dinner, waiting to take a shower, waiting for a turn at the video games. Time was largely spent quietly in their rooms or in front of the TV, with bursts of excitement when behavior escalated into arguments, tantrums or fights. No wonder they had incidents of misbehavior and aggression. Boredom is painful, especially when there’s no end in sight.

My OT and OTA fieldwork students and I initiated a rotating schedule of activities, so that each unit had one 60-minute session every week. We provided classical OT activities such as arts and crafts, active games, table games and simple cooking.

We quickly became rock stars! Staff members and kids would greet us with excitement as they wondered, “What are we doing this week?” Kids loved the sessions so much that they worked hard to avoid time-out all afternoon. Behavior improved because there was something to hope for.

Staff members loved having the kids safely occupied, and several were inspired to try their own activity ideas with the kids when it wasn’t OT night. We saw a visible shift in the culture and a decreased rate of behavioral incidents with just one hour per week of group intervention. The child-care staff and children consistently and unanimously valued our small presence in their units, and we treasured the opportunity to serve them so authentically.

Here are my take-aways from doing the after school OT activity program.

1) It can pay off to be persistent and unfailingly optimistic in the pursuit of providing OT services in the times and places they are most needed.

2) Relatively simple, low-tech activities that are pitched to fit the clients’ abilities, interests and needs can provide them immense satisfaction and joy, which is an antidote to boredom and frustration-based misbehavior.

3) OT sessions can be relatively brief and infrequent (once-weekly groups) and still pack a punch in terms of improving life on all of the days of the week.

Point No. 2 still causes me to tear up. How could such a little bit of effort have such an impact? Doesn’t it make you wonder what would happen if every child, teen and adult in residential treatment settings had an hour a week of real OT?

What’s your story of the transformative power of authentic OT? Please share it here.