2020 Essay Contest - First Place - OT: Occupational Therapy and Childhood Trauma by Meaghan Kennedy
“Childhood trauma is defined as a psychologically distressing event involving ‘exposure to actual or threatened death, serious injury, or sexual violence… Such events involve a sense of fear, hopelessness, and horror.” (The American Occupational Therapy Association [AOTA], 2015, pg. 1). The effects of trauma have been studied and have been shown to affect individuals’ stress reactions, more specifically their fight or flight reactions. When a child’s stress response is effected, this can present in a variety of behaviors and difficulties. Many of these children lack adequate resources to develop skills to overcome their difficulties which results in decreased participation in their daily lives including but not limited to: school, play, participation with family, sleep and self-care, sports, leisure time, etc. All of which are considered to be a child’s occupation. When these essential opportunities are missed, they may lack the building blocks of coping, resilience, and stress management in order to become productive members in our society. More importantly, they do not have the opportunity to engage to their full potential in their daily lives which is everyone’s intrinsic right.
Occupational therapy engages their clients in meaningful activities to promote physical, mental, and emotional health and well-being. OT focuses on their clients’ participation in areas such as: education, play, leisure, self-care, social activities, ADLs, IADLs, sleep, rest, and work. Occupational therapists receive extensive education on mental health as well as physical health in relation to development and aspects of everyday life. This places OTs in an excellent position to fully understand how a child is affected by trauma, how their development has been affected, and what needs to be addressed in order for these children to meet their developmental milestones, mentally, socially, and physically. As aforementioned, the areas that can be greatly affected by childhood trauma all fall within the realm of occupational therapists. Therefore, occupational therapy practitioners find themselves in a perfect position to assist children, adolescents, and adults who may come from hard places with skills to build resiliency, self-efficacy, and increase their participation in their daily lives.
Despite occupational therapy being highly educated in the areas that individuals from hard places face difficulties, we are rarely seen in settings that serve these children, adolescents, and adults. My question is why?: Why do other practitioners and professionals working with this population not know the benefits of OT in these settings? Why do individuals only believe OT can rehabilitate adults after a stroke or shoulder injury? In regards to working with children, why does OT receive the reputation that we can only help in facilitating better handwriting and pencil grip? Of course, all of these aspects of occupational therapy are imperative and extremely important, but we possess the ability to reach more populations and change more lives. We are not advocating for ourselves. In turn, we are not advocating for the individuals from hard places who can benefit greatly from our expertise as occupational therapists and do not have the abilities to advocate for themselves.
I believe that continued education within our OT graduate programming on trauma and trauma-informed care is essential as first steps to finding a solution for this issue. Trauma-informed care (TIC) implies that you can coming from a place of understanding when you approach every individual, no matter their background. It is replacing “what is wrong with you?” with “what happened to you that is causing this pain/suffering/difficult you display.” It is the simple understanding that behind every behavior there is a need that the individual is unable to convey to you. Is it the understanding of the effects of trauma on individuals, families, societies, institutions, etc. TIC is the ability to recognize those at higher risk of trauma and taking the necessary steps to mitigate those circumstances. This education is imperative for every OT student as they enter the professional workforce. Regardless of whether they desire to practice in a setting specifically focusing on children, adolescents or adults who have experienced trauma, these practitioners will see the effects of trauma everywhere. The ability to come from a place of understanding for every individual that we serve is beyond imperative within our practice as health care providers. Trauma-informed care allows for us to understand and build our therapeutic rapport and serve our clients in a more holistic approach.
Occupational therapy programs should consistently engage within their communities to advocate for the profession and allow for a deeper understanding of all that an OTR/L can accomplish. This might include presentations at local elementary, middle and high schools to demonstrate the vast field of practice that OT provides. This may also increase the diversity within our field which is another large issue in OT. Community outreach can also come in the shape of fieldwork opportunities. The main reason I was drawn to Temple University for their Masters of Occupational Therapy Program was their commitment to the community of Philadelphia and the fieldwork placements within the community. We are often placed for our Level I B Fieldwork in sites that do not have an established occupational therapy program/therapist. Within these sites we aim to broaden the practice and share the expertise with those who may not realize what we are capable of as practitioners. This has opened many doors for future practitioners and aided in building resources for our community partners.
Although there is no simple solution to this issue that I hold dear to my heart, I believe that these steps will begin to open doors and allow more settings to see the value of occupational therapy. It only requires a conversation. However, that conversation requires knowledge and perseverance to clear a path that has not been cleared for you. As Dr. Mona Hanna-Attisha states in her novel about the Flint, Michigan water crisis, “The eyes cannot see what the brain does not know” (2018). We cannot expect individuals from various professions to understand the vast depth of our professional abilities if we are not advocating for ourselves. We deserve a seat at the table for children, adolescents, and adults from hard places and they deserve the knowledge and insight of an occupational therapist. It is our responsibility to bridge the gap and form a path into those community sites to aid in the service of these individuals who deserve the best health care they can receive.
- Hanna-Attisha, M. (2019). What the eyes don’t see: A story of crisis, resistance, and hope in an American city. New York: One World.
- The American Occupational Therapy Association [AOTA]. (2015). Childhood trauma. School Mental Health Toolkit.