USAHS Doctor of Physical Therapy program alumna, Dr. Cameron Brown is the Physical Therapy Coordinator at Center for Developing Kids, a private outpatient pediatrics clinic in Pasadena, CA. She helps provide intervention for various diagnoses and disorders to improve pediatric clients’ functional abilities and promoting overall health, wellness, and fitness.
When the COVID-19 pandemic gripped the nation, similar to many other healthcare businesses, the Center was forced to take its therapy services to a telehealth setting. The shift created many challenges, including the inability to use the wide array of equipment available at the clinic. But, Dr. Brown said this experience has allowed herself and fellow therapists to better communicate and get feedback from parents and caregivers.
Dr. Brown gives us a glimpse at the rewards and struggles in the healthcare provider community brought on by the COVID-19 pandemic.
You mentioned the shift to parent-coaching model. Could you give an example or two of what parent-coaching looks like for your clients?
Parent coaching means much more detailed explanations of HOW to carry our specific tasks versus just why we are doing it, which is the parent education part that we have always incorporated for our sessions. For example, in the clinic I may be able to set up a specific activity with my own logic behind what I use for set up, how I prompt or guide the child, and even where I stand or guard them. We often have parents present in our sessions to see what we do, but even then, it’s hard for them to re-create things on their own. For example, I may suggest an activity for stepping over a hurdle but I have to coach the parent on exactly how tall it should be, where to put their hands on the child to facilitate the right weight shift, and even sometimes where to stand so that they are not offering too much support. Parent coaching comes up a lot when doing stair training, because many adults lift a child’s hand in the air in order to help pull them up, but because we want to challenge the child to be more independent, I have to coach them not only on where to stand on the steps, but where to have the child’s hand or how to prompt them and pace them. Every child is different so it’s really helpful to be talking to the parent step by step while they are actually practicing so we can see what might need to be adjusted.
What challenges does this model create and how have you worked through them?
The biggest challenge moving to a complete parent-coaching model is just that some things are tough to describe without modeling or demonstration. Similar to how it takes students weeks of hands-on time to really learn the best ways to facilitate certain movements, the parents have a learning curve too. Sometimes parents can get frustrated or feel like they are not as helpful, but they are learning more each session. It has been helpful to use dolls when possible to demonstrate specific motions, but not every therapist has that at home. I’ve been able to use my son to record videos of certain things, because he is developmentally at the same level as some of my patients. For example, I made a video of me helping him to jump down from a low step, because I had a few parents that were confused on the timing and the best place to offer support.
Can you give an example of an activity that gets the whole family involved when working with clients?
Most of my home activity suggestions have been open to involving siblings, because with school’s closed most parents are juggling everyone at once and I know that the buy in will be greater if my activity is practical and can keep everyone busy. For example, I have been creating small chalk obstacle courses for my kids with outside space and I will suggest that older siblings can help draw the course with chalk or model/demonstrate as the “leader.” I’ve also suggested having younger siblings follow along, allowing the patient to be the “leader” so they can gain a sense of confidence. I will also give activity suggestions with instructions on how to make the tasks easier or harder, so it can be graded up or down for siblings with different ability levels. For example, I may have a sibling balance on one foot during the “freeze” part of a freeze dance game, while the patient balances with their foot on a ball or stool. Freeze dance has been very big for me as a balance game since I have the parents create a “freeze station” to work on static balance (stand on a throw pillow, stand on a rolled yoga mat, etc.).
How are you feeling during this time? Have you been able to balance work life and home life while working remote?
This is of course a question with multiple layers of answers! But overall, I’m feeling grateful that I have the option to work in a more flexible manner and to adapt to telehealth along with my patients and families. There is definitely a level of job stress and uncertainty because our caseloads have decreased significantly, and all of our staff has had to move to working part-time and hourly based. I know this has impacted so many levels of our business and I’m hopeful that we can make it through this as a small privately-owned clinic. I was initially very overwhelmed by the new work format and adjusting to come up with new ideas and to work with more limited resources but now I am grateful for how much this has challenged my own creativity and how much more caregiver involvement I have been able to see. The work/life balance game is never easy but working at home with a young toddler definitely poses challenges and it mostly means that I have to jump back and forth from being a PT and being a mom with very little time to adjust mentally. I’m working odd hours and during naps and at nighttime, and I’m trying to stay organized without my usual routine. I’ve been able to adjust better now that we know this is not just a temporary situation and I’m figuring out more every day, so the stress has been decreasing. I’m now able to appreciate the extra time with my family and I’ve learned what things I can control and change and what things I need to let go of because they are out of my hands. It’s been helpful to stay connected with family and co-workers through social media and calls/videos/chats to remember that we are not alone in this at all.