066: Non-Traditional OT Practice

Good Fit Poor Fit
Good Fit Poor Fit
066: Non-Traditional OT Practice

Show Notes

Episode #65: Learned Creativity

Video of Rebecca’s Tedx Talk:

Article of Sarah’s feature on The Non-Clinical PT:

Instagram: @lovelyy_OT (Nancy) & @owltechpa

Other resources:


[00:00:00] Sarah: You’re Listening to Good Fit Poor Fit. A podcast that explores the interaction between people, design, and activity. Good Fit Poor Fit is part of The Universal Design Project, a nonprofit organization with a vision for every community across the USA to have a surplus of homes and opportunities for social participation that are universally and financially accessible.

[00:00:23] Learn more at universaldesign.org. 

[00:00:27] Rachel: Welcome to another episode of Good Fit Poor Fit. If you recognize a different voice citing that intro, then you would be correct! This is Rachel Melvin– We’ve met in a few podcasts– I’m an OT student who’s interning with the Universal Design Project for the fall semester. Today, I’m here with Sarah and Rebecca, and we’re going to discuss the dynamic shift in the occupational therapy profession and emerging areas of practice.

[00:00:52] Throughout the history of the profession, OT has changed to address the needs of people. As a student, who’s preparing to graduate, I’m excited to see these changes! I knew that I wanted to be an occupational therapist as a high schooler. So since then, I’ve had a detailed plan for how I was going to achieve my dream job. Now that I’m at the threshold of entering the workforce, I have found that my plans have been disrupted in the best way possible. My work with the Universal Design Project has ignited even more excitement about the future and has prompted me to be curious about other non-traditional areas of practice that are emerging.

[00:01:27] Non-traditional practice can take on many names, including non-clinical or unconventional. All of these terms can be described as work opportunities that don’t follow the typical path that most OTs pursue. The traditional trajectory for OTs is to leave their education and apply to the abundant clinical settings that are available. This mostly looks like hands-on patient care. However, we know that there are many facets that make up a person, and I think most professionals would agree that a core principle of OT is to approach a client holistically and provide services by taking into account the person as a whole. This leaves room for a myriad of opportunities in where and how to intervene.

[00:02:09] As a high schooler, that didn’t know much about the profession, the one thing that was always said to me was that a key characteristic of OTs was that they are inherently creative– Something that we discussed in our last episode podcast #65, Learned Creativity. With this out-of-the-box, thinking it’s no wonder why so many more OTs are looking for work outside of that traditional path.

[00:02:32] Sarah: I agree! OTs definitely have a mindset of creativity and resilience. This trend is most certainly something I’m seeing as well. I get many emails from students, just like you, Rachel, who are interested in this area of practice and learning more as they’re seeking out fieldwork opportunities and nearing graduation. The same shift is even being seen with current practitioners who are wanting to do something different with their careers, as they see their skills can be useful in other settings.

[00:03:01] Not that their skills in clinical settings aren’t valuable. It’s just that OT is so versatile, and I really think the world needs to understand how transferable our skills are to other settings and people in the community.

[00:03:14] When OTs have those light bulb moments and begin making connections for how they can advocate for their place in non-traditional jobs, that’s when the excitement and advocacy efforts tend to build. Rebecca, that’s kind of how we met too! When you applied to be a design advisor, you sent along your Ted Talk video– Which we’ll link in the show notes. After viewing that, I was like, wow, this girl really sees the connection OT has in the greater community and is really forward-thinking in her mindset. Then the rest was history! We began chatting about the variety of ways OTs contribute to our society and how we can collaborate here at the Universal Design Project and other opportunities.

[00:03:54] Rebecca let’s step back a bit though. Can you share a little about your shift and some of your feelings about non-traditional practice? 

[00:04:03] Rebecca: Yeah, of course! You may regret asking me to do that because I have a lot of feelings about non-traditional practice. It’s one of my favorite topics. Actually, probably my favorite OT-related topic ever, because I came to the field with the intention of being a quote “non-traditional OT.” 

[00:04:22] It really all started in college when I was studying engineering. I was constantly frustrated that engineers really don’t think too much, usually, about the people that they’re making things for in the design process. And this includes people with disabilities. So with the help of my advisor, I developed this vision of bringing a human-centered perspective into design. The way that I wanted to shape that human perspective was through the lens of occupational therapy. I knew that occupational therapists were focused on empowering all types of people to thrive in all types of environments, regardless of disability status. So essentially that’s what I do now! In addition to my work at the Universal Design Project, I work at a company called Disability Solutions. We work with fortune 500 companies to make their workplaces, everything from their talent acquisition, hiring, onboarding, to their physical workspaces and cultures and beyond, inclusive for all people.

[00:05:25] Our motto is “changing minds and changing lives.” Meaning changing the minds of employers by supporting them and hiring talented people with disabilities, thus changing the lives of those individuals who are hired. I’m definitely an anomaly and that I never really intended to be a straight clinician. But it’s really interesting because from OT school and into today, I’m often meeting OTs who are curious about non-traditional practice.

[00:05:52] The fact is a lot of the skills that we have as OTs for activity analysis, environmental observation, and modification, and things of this nature really make us very agile as OTs. We can use that agility if we’re willing to step out of our comfort zones a little bit.

[00:06:10] Rachel: Definitely. I feel like my awareness of this didn’t come until just recently. Like a true millennial, most of my information comes from social media. On Instagram in particular, I like the people I follow to be diverse and provide information regarding areas I am interested in, like occupational therapy! One account I follow is OT influencer and advocate Nancy or @lovelyy_OT. Nancy has used her platform to highlight the unique range of practice settings where occupational therapists can intervene and veer off the path of traditional practice.

[00:06:46] With a following of 13,900, she’s been able to gather feedback from her audience to share the desires and goals of OTs as it relates to their work. I was able to connect with Nancy and get her opinion on the subject she replied,

[00:07:01] “Non-traditional roles are paramount to our profession. It provides ample opportunities for us and gets us doing more outside-of-the-box business. Additionally, advocacy is always needed in every place we find ourselves, whether it’s social media, in-person, et cetera. This is how we continue to put OT on the map and let people know that we are here and that our services are needed. Any chance I get to work with my followers is absolutely amazing. I get to help them discover their purpose and find their way in this profession.” 

[00:07:32] As our inspiration for this podcast, we admire her advocacy and agree that it is a crucial piece in our role as occupational therapists. You can find Nancy’s account linked in our show notes– Go check her out!

[00:07:43] Rebecca: Yes! Nancy is yet another great demonstration of the shift that we’re seeing in the OT world. Just the fact that she has so many folks following her is testament enough. Now, if you’re not steeped in the OT community, you’re probably listening and wondering why is this and there are a number of reasons. As I mentioned before, OTs leave school with a really adaptable set of skills. And so even as a clinician, OTs are able to use their skills in a variety of ways and in a variety of settings. I’ve found that a lot of OTs are actually drawn to the field because they know they can make career shifts as they please, without much further education. For OTs, it can be tricky to navigate a rehabilitation world in which many people think we do the same thing as physical therapists and may not always see our distinct value. I’ve heard from a number of peers that this contributed to their decision to pursue non-traditional work.

[00:08:42] Another thing we have to recognize though, is that this type of non-traditional work is being increasingly supported by the OT world. In fact, in the most recent version of the OT Practice Framework, which is basically the document that explains what OT is and what an OT does, to OTs themselves. They’ve included pieces that address the use of OT skills in non-clinical and non-traditional settings. Personally, I was thrilled when I saw this because it’s validating for those of us breaking out of traditional OT roles and opening the profession itself up to more opportunity to truly define who we are and what we are capable of doing.

[00:09:27] Rachel: That’s awesome, and I agree! It’s nice to know that all paths of the OT profession are being supported. Like most things happening these days, we’re moving off the paper and onto the screen, current and future OTs have created this niche on the internet and are encouraging others to explore non-traditional and/or emerging areas of practice.

[00:09:48] But before we talk about the new age, let’s dive into a brief history of the profession first. 

[00:09:54] Sarah: According to a series titled the “Disability History Project” done by National Public Radio. The health profession of occupational therapy was conceived in the early 1910s as a result of World War I.

[00:10:07] During this time, the American Occupational Therapy Association describes that four women were sent to France as neuropsychiatry civilian aids to help World War I, soldiers recuperate from shell shock and war neurosis. And five women were sent as reconstruction aids to work with soldiers with physical injuries. Reconstruction aids provided diversions from pain and situation and worked toward recovery of function and specific deficit. In the post-war years, wartime injured and disabled veterans needed professional medical help, which led to the federal investment in rehabilitation services. Over the years, rehabilitation has come to mean many things from relearning the daily tasks of personal care to rethinking the physical environment in which people with disabilities live. 

[00:10:57] As it continues to develop occupational therapy still keeps its roots in the work where it started in world war one and has been an invaluable resource in helping people become more independent and skilled in their life tasks, for now over a century. 

[00:11:12] Rachel: In my first semester of OT school, I took a Foundations of OT course, which provided me and my classmates, with a professional understanding of what OT is and how it came to be.

[00:11:23] I loved learning the history and the background that you just mentioned, Sarah. These aids, as they were called, helped in a multitude of ways to rehabilitate veterans from physical to mental health and probably much more. I think the variety and the help they provided, supports the notion that occupational therapists can be valuable in a variety of settings.

[00:11:43] Occupational therapy is super unique in the way that people don’t normally think about their occupations in the way that we do, but when you rephrase it as, “things you do every day and what you deem meaningful,” it opens up the opportunity to really intervene within any sector of someone’s life. I think that’s super special.

[00:12:01] Rebecca: It definitely is special, Rachel! And that was one of the things that really shifted my perspective in OT school as well. Another thing that really helped me to craft my vision for non-traditional OT practice is the idea of occupational justice. I remember vividly reading about this concept for the very first time. The idea that we all have the right to be active and full participants in all parts of society, whether we’re currently disabled or not.

[00:12:31] Honestly, this was the idea that made me want to be more than just an engineer in the first place. I just couldn’t put it quite into words like that. I wanted to design a world in which all people could participate and enjoy every aspect of their community that they wanted to without barriers. And so the idea of occupational justice and enabling justice through occupation and participation has really been revelatory for me.

[00:13:00] I bring that perspective into my work now, Disability Solutions. I could soapbox about this for as long as you would let me, so I will leave it there with this concept of occupational justice.

[00:13:12] Rachel: I love it. And I think all of us appreciate hearing it too. I want to briefly go back to coursework– Depending on the curriculum of the OT program, there are typically courses that focus on particular traditional areas of practice. The American Occupational Therapy Association’s Workforce and Salary Survey from 2019 lists 10 primary work settings, including academic, community, early intervention, freestanding outpatient, home health, hospital, long-term care or skilled nursing facility, mental health, school, and other. In order to prepare students for entering the workforce, it’s easiest for the curriculum to focus on settings that are most common for an occupational therapist. However, I feel like this can create somewhat of a barrier for students and limit their options to traditional areas of practice. If we can work anywhere, why would we only work in the traditional settings already put in place?

[00:14:07] Personally, my OT path has always included opportunities in traditional settings. However, after learning and experiencing a non-traditional setting through The Universal Design Project, I have seen firsthand that there are other options available. 

[00:14:21] Sarah: I agree. I always saw myself working in a hospital and somehow I ended up as an OT considering the design of environments. Of course, most OT programs have to adhere to the standards that must be taught via the regulatory bodies and can run into a time crunch to get all of those requirements in, plus extra content.

[00:14:41] However, additional experiences and awareness of these non-traditional areas are important. I was in OT school over a decade ago, and I know I didn’t hear about universal design at all. We did have a Community-Based Practice course that required us to create programs for the community, but not really to explore non-traditional practice.

[00:15:02] I worked in a rehabilitation setting for three years and started to explore nontraditional options after attending a continuing education class on home modifications. My personal and professional experiences began to stir some of these passions, but my schooling didn’t include information on how to start your own business or link the skills you’ve learned in school to advocate for a place in another industry.

[00:15:27] Oddly enough, the tables are turning and I’m actually going to be teaching that same Community-Based Practice course in the spring semester at my alma mater. So, having the opportunity to connect some of those pieces for current students is definitely a possibility. 

[00:15:42] Rebecca: Yeah! I think that’s a great point, Sarah. And I do think that more OT programs, particularly doctorate programs, are recognizing the increasing popularity of non-traditional OT and therefore incorporating ways of providing experiences and knowledge to their students to support that. I’m certain that’s precisely what you’ll be doing next semester.

[00:16:04] I also know that in my program, we had numerous professors working in non-traditional arenas. From working with homeless populations, to refugee populations, to survivors of sexual assault and gender violence. We got to hear about their experiences and how, even though they weren’t necessarily doing occupation-based rehabilitation, that you’d see in a hospital or an outpatient clinic, they were using things like the COPM, which is a classic OT assessment or any number of environmental modifications to support their clients in personal and meaningful ways. Even just hearing about that from professors, how they were using the things we were learning in classes, in ways that were different than the way we were reading about them in textbooks was really eye-opening for us as students. 

[00:16:52] Rachel: I think this is exactly the message that Nancy, whom I mentioned earlier, was trying to convey by posting these, public forums with participating OT students and practitioners. Through her efforts, people are sharing that they want to pursue an emerging area of practice.

[00:17:09] Some of the options that were mentioned were telehealth, pain management, vocational independence, prenatal care, aging in place, lifestyle management, driving rehab, policy, hippotherapy, and home and community redesign. These opportunities are really just scratching the surface. I know that there are many other options out there.

[00:17:30] Rebecca, I feel like your unique timeline with occupational therapy gives you a perspective to think outside of that traditional practice, unlike most OTs. What other non-traditional practice areas have you heard about? 

[00:17:43] Rebecca: My two best friends from OT school actually are both doing some clinical and non-clinical work– Getting engaged with research, ergonomics, industrial design. I also have a lot of friends who, at various stages of their career, have left clinical practice to explore UX and UI, which are user experience and user interface design.

[00:18:04] I have friends working in research, at architecture firms, in hospice care, and with all different populations and in different realms that are ripe with possibility! People with whom I’m connected are always thinking creatively about how they can apply their OT lens in a new and innovative way.

[00:18:22] I mean, I didn’t even really think about workplace experience and workplace design as something that I could do, but I absolutely love it. And that’s what I do now every day! If you had told me in OT school, that that’s what I’d be doing a few years out, I would have shaken my head in disbelief. 

[00:18:40] Sarah: Right, Rebecca? It’s quite amazing to see how OTs are finding ways to advocate for their value in different industries and are in turn, providing so much value to everyone involved. I can definitely see a connection to the heart of OT practice and the work that you’re doing.

[00:18:57] After I graduated, I was in the mindset of getting a job in a clinical setting and never thought that over 10 years later there would be this shift of OTs getting into other fields. I’m in total agreement with your statement, Rebecca, that there are more job opportunities out there that are ripe with possibility for OTs to make a difference.

[00:19:16] It is a shift in thinking for everyone though. I often get asked if I’m going to go back to doing traditional OT. It’s definitely an opportunity for me to educate others in the path I traveled toward environmental design. If you listen to any of our Good Fit Poor Fit episodes you know, that homes are not designed to meet the changing needs of people in our community.

[00:19:38] Therefore, I decided to focus on the topic of universal design and how it relates to homes because I can see it truly making a difference for so many people. In regard to OTs being involved in home and design-related fields. There are so many opportunities! There’s a big need to make homes safer and easier to live in through home modifications, to existing homes.

[00:19:59] This could be small fixes here and there, or OTs can find themselves in larger home remodeling projects. Both of these are a great opportunity to add in more function into the home as they’re making the investment to update. Building new with universal design is even better, and getting involved with companies that are doing the design of those is a great place for an OT. 

[00:20:21] I’ve connected with other OTs who have a background in interior design, architecture, real estate, or product design– You should check out @owltechpa for that– and also integrated themselves into the concept of UD for learning in educational settings. I know of one OT, who was an advocate for herself in a position in a local library so programming and activities would be easily used by people of all ages and abilities. What a perfect fit for an OT! 

[00:20:50] PTs are also getting into the action here! I’ve had a spotlight with Meredith Castin at The Non-clinical PT, who has also been advocating for this direction in practice for all types of rehab therapy professionals. Things are gaining momentum here! We will link all of the folks I just mentioned in the show notes, so you can see for yourself.

[00:21:11] Rachel: Current OTs are carving out a path and paving the way for students to follow their passions. It’s validating to see that OTs from all over are expressing the same interest. As you mentioned earlier, Sarah, I have noticed quite a few other students, from all over the country, reaching out to the Universal Design Project to find ways to gain their own experience or even just volunteer.

[00:21:33] That’s just been in the short time that I’ve had here interning. So I know that there are even more people out there pursuing non-traditional practice options. It’s exciting to me as I prepare to move from my role as a student to a professional. I now have an awareness that other OTs want to work in this space, or are at the very least curious about it. This leads me to believe that the job market is going to be more expansive and inclusive of non-traditional areas of practice. I can’t help, but reflect on the history of the profession and think that this is the direction we should be pursuing. 

[00:22:07] Sarah: Right. Rachel, it’s definitely a parallel to how the profession started and this shift in where we are headed.

[00:22:14] I’m sure there were a lot of advocacy efforts to prove the value of occupational therapy when it originated to help returning soldiers during World War I. Even though it is currently recognized as a regulated and licensed profession with credibility, there are still some roadblocks to overcome.

[00:22:31] If you’re listening to this and don’t really understand OT or you’re an OT and are constantly having to explain what we do, you see the struggle and people understanding our profession. If people don’t understand OT and its value, then it’s going to be even harder to advocate for that outside the walls of the clinical model, where OTs are typically seen. Rebecca, you and I have talked about this before, and I feel like you might be itching to chime in here. Do you have anything else you want to add about this? 

[00:23:02] Rebecca: Of course I do, Sarah, you know that! I really couldn’t agree more. I think that as more of us start venturing out into non-traditional fields, we can best serve our OT community by demonstrating who we are, what we do, and making people understand our value as we provide meaningful contributions in these new spaces. I can’t honestly imagine a better way to advocate for our profession than by bringing our unique skillsets to new tables and using it to empower and enact change. It’s not easy, definitely not, but in my opinion, it’s really what needs to be done for the continued advancement and growth of our profession.

[00:23:45] Our profession has, as you’ve learned in listening to this episode, already weathered many changes through the years and it’s grown to adapt to the needs of the time. I personally think that we’re now at a juncture where it’s time to shift again and really embrace these new avenues and opportunities for OTs.

[00:24:03] So, if you’re sitting there listening to this and feel like maybe this sounds daunting, You’re right. It is, but I think it’s worthwhile. And if you’re sitting there listening to this and feel like, gosh, no, I want to be a clinician. I love clinical occupational therapy practice. That’s why I’m an OT school.

[00:24:23] We need you too! Diversity of what we do as OTs is our power and our beauty and our value. As I like to say, it takes all kinds of kinds. And that’s reflected in the OT world. 

[00:24:37] Sarah: Most definitely. And I do agree with you, Rebecca, that it is a little daunting, but also exciting to see this happening.

[00:24:44] There really isn’t a playbook for helping people understand our value in fields that typically haven’t heard of OT in the first place. I talked to an OT in Canada just last week about some tips on how to get started in a non-traditional practice setting. I told her one of the biggest things that she could do with any field that she’s looking to get into is to learn, to understand the other professional culture, language and process.

[00:25:09] Once you’ve shown that you’ve learned about how their field works, then you can find ways to advocate for OT, to be a part of their process and work out ways to collaborate together. People have learned how to do that within the medical field, between nurses, doctors, rehab therapists, and social workers. Although that’s still difficult, it’s more common. I think it’s possible for this to happen and other fields as well.

[00:25:33] And you’re right. If the clinical setting is your calling, that is amazing. Many people I’ve talked to venturing into the non-traditional route said that they knew they just wanted to do something a little different, and they felt that their OT knowledge was the basis for making that happen.

[00:25:49] Rachel: As a student with limited work experience, the Universal Design Project has provided me with another perspective on where the skills of an OT can be a real asset to people. Based on the conversations I’ve had with people regarding my placement in a non-traditional setting, I’ve been met with varying responses.

[00:26:08] Some are hesitant and don’t understand the value that OT brings to areas outside of traditional clinical settings. Just like you were saying, Sarah. Some are just as excited as I am by the opportunity to explore an emerging area. I actually had a conversation with someone this past week who works in healthcare and they recognized very quickly how important this work is and how it directly relates to the health and wellbeing of people and their families. This spectrum of opinions just tells us that there’s more work to be done. 

[00:26:37] Thanks for tuning in for another episode, I hope that you leave this podcast with a new perspective of the OT profession. Whether you find occupational therapists in a traditional or non-traditional practice setting, know that our education has provided us with the skills to implement in varying areas of life. For a group of professionals that are often characterized as creative, we encourage folks to look off the traditional path and pursue work opportunities that align with their passions. The possibilities are endless, and the ones we’ve mentioned today are making waves in the profession currently. I know that as I look towards graduation, I will continue to look for places that support people outside of clinical facilities, just in the way that the Universal Design Project is designing homes for people to live fully throughout their lifespan.

[00:27:25] Thanks again, and take care.

[00:27:26] Sarah: Thanks for listening to Good Fit Poor Fit. I’m your host Sarah Pruett, Program Director and Occupational Therapist at The Universal Design Project. Learn more about our work at universaldesign.org, and find more episodes and links to subscribe at goodfitpoorfit.com If you have questions or topics you’d like to discuss, email us at [email protected].

[00:27:57] Thanks for fitting us into your day!


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