Making an Impact Early

How Occupational Therapy students help clients of local agencies—and vice versa

By Judie L. Kinonen

Five middle-aged men and women gather around a large, square table, their faces firm with concentration as they gingerly paste shiny heart-shaped stickers and brightly colored plastic beads on picture frames fashioned from Popsicle sticks. It’s a cloudless November day, and these clients at Sunshine Center, Inc., in Galveston—an agency that provides training and socialization for developmentally delayed adults—fill the window-lit classroom with cheerful conversation. One woman announces an upcoming plane trip. Another says her favorite color is brown. In a momentary silence, one man lets out a long, guttural belch, followed by a lusty, “Excuse me!” Everyone chuckles—including four UTMB occupational therapy (OT) seniors seated among the group to guide them through their activities. These students are conducting the last session of a ten-week series that fulfills their required course work before graduation. After they pass their certification exam, the young OTs can work in hospitals or clinics, schools and community agencies like this one, teaching people to do the things they want to do or need to do for a more fulfilling life.

At Sunshine—as it’s familiarly known—the UTMB students have learned how to transition from one project to the next; how to manage their allotted time; even how to keep from flinching when someone burps. These are all lessons a good textbook or professor might touch on in the classroom, but they are lessons best taught from experience with the clients. This is why a high-quality community-based training program is absolutely vital to occupational therapy education—and becoming more vital all the time, says Loree Primeau, chair of UTMB’s Occupational Therapy Department.

Primeau says that while, in the last sixty years, OTs have become best known for their work in hospitals—rehabilitating people to their daily activities after an injury—OT has its roots in community agencies like Sunshine. “We started as more of a social work-type profession, and now we’re shifting back to this community-based practice,” says Primeau. UTMB’s Occupational Therapy Department has braced for this shift.

In the last six years, Primeau and her faculty have taken a simple hands-on course assignment and turned it into a sophisticated blend of service and education known as “service learning”—a model calling schools to give as much thought to the needs of the community as to the needs of its students. Beginning with grants from the Harris and Eliza Kempner Fund, and enhanced through a $417,000 grant from the Health Resources and Services Administration, Partnerships for Healthy Communities has provided 174 UTMB OT students with a rich, hands-on curriculum, while ten Galveston-area agencies, including ADA Women’s Center, Discovery Club, and Our Daily Bread, have received some of the year-round help they badly need. Today thirty-two UTMB OT students are working in four local agencies, and Primeau says the agencies are “buying into” this unique program, two of them even committing some of their limited budgets to sustain it after the grant runs out.

Agency “buy-in” was weak before the Partnerships grant, and for good reason. Elicia Cruz, assistant professor and project co-director, recalls having students design a marketing proposal in her management class. The plan was supposed to be implemented by students in a local agency the following semester, under a professor’s supervision. The project functioned, but complaints were justified on all fronts. The professor felt overwhelmed as she struggled to schedule student observations while carrying a full class load. The students felt scared. Their only previous experience had been working with patients in a hospital setting, so community-based occupational therapy was uncharted waters; and with too little support from their faculty mentor, they were sailing without a compass.

As for the agencies, they simply felt used. “We’d come in for a stretch, learn from them, and then leave,” Cruz says. “They didn’t get much out of it.”

So in 2001, Cruz and Primeau designed an ambitious new plan—Partnerships for Healthy Communities—and applied for the funding that would get it off the ground. They now have a full-time occupational therapist who is paid to rotate among the participating agencies. Debbie Heater, project therapist, acts as faculty mentor to occupational therapy students in the fall semester, but the grant takes her job a step further, paying her salary to work at the facilities year-round—to conduct group therapy, counsel individual clients, and do whatever the agencies need her to do, whether UTMB happens to have students in these agencies or not. Meanwhile, Primeau and project manager Tina Esparza maintain weekly communication with the agencies’ staff and directors; Esparza assesses potential partner sites and constantly reassesses existing sites to ensure the therapy UTMB offers is the therapy the agency needs.

Sunshine director Rhonda Gregg says she is well pleased with the arrangement. The agency’s insurance will not allow Sunshine to use volunteers because the clients are so vulnerable to abuse. But by opening the facility as a laboratory to train occupational therapists, Gregg has greatly increased her staff size and given the clients a group of fresh faces to work with. As for Heater, Gregg has received approval from her board of directors to pay her part-time salary when the grant money is gone. With support like this, the Partnerships program may soon be self-sustaining, Primeau says. Says Gregg: “It’s a marriage made in heaven for us.”

At their last session at Sunshine, the students and clients seem quite comfortable with each other.

The program has exceeded the students’ expectations as well. No longer are they thrown into the deep end of the pool to sink or swim—in Cruz’s rehabilitation course, now they have an introductory, “get-your-feet-wet” community-based project in the spring semester. Then in the summer management course, they observe clients in their chosen agency, consult with agency staff, and design a detailed marketing proposal to “pitch” to the agency’s director; for example, the students at Sunshine proposed a series of projects designed to increase their clients’ self-esteem. Finally, during the fall semester, students use their laboratory time to conduct group therapy sessions under the supervision of either Heater or Esparza, who guide the students through an hour-long critique after each session. The instructors make well-informed reflections; at Sunshine, Heater praises student Christina Trinh for the way she redirected her client when she kept seeking her approval about which beads to use on her frame. That client often has trouble working independently, according to Heater—who knows, because she’s her client, too.

This student group at Sunshine had developed activities for increasing their clients’ self-esteem. But this beautiful marketing proposal took quite a beating over the weeks. In the most striking example, the proposal had called for the clients to undertake several short writing assignments. But the OT students discovered during the first session that many of their clients could not even write their names. Trinh recalls a distinct shift in approach after that first day—from what the proposal said to what seemed best for the clients.

Heater says she sees this kind of professional growth in all the students. “At first they’re rather stiff and scripted,” she says. “But over time they relax and recognize this is a rich environment for learning, for both the clients and for themselves.”

At their last session at Sunshine, the students and clients seem quite comfortable with each other. When the Popsicle stick frames are complete, the students present their clients with a group photo as a memento. The clients grin widely as they closely study the photo and ask about the students’ future plans. One woman interjects, “We’re going to miss y’all,” and a student echoes the sentiment. As the clients file out the door amid a flood of warm handshakes, “good-byes” and “good lucks,” it’s evident that both clients and therapists embody the spirit of partnership this program is working to engender.