Occupational Therapy in its Truest Form – An Occupational Therapy Student’s Perspective

by | Oct 26, 2020 | Occupational Therapy, Outdoor Play

When my fieldwork coordinator first explained a potential placement at TimberNook to me, I had many questions. One of the very first being, “Is this even occupational therapy?” After speaking to Angela Hanscom, my very knowledgeable clinical instructor and founder of TimberNook, I knew that TimberNook was a program that I wanted to be a part of. I saw the therapeutic value that it holds and recognized the widespread need for this service among the pediatric population. 

I was still struggling, however, to understand how this could be considered a level II fieldwork experience when TimberNook did not seem anything like my pediatric occupational therapy classes and labs (which often simulated traditional clinic or school-based settings). It was only after observing for a day at TimberNook that it “clicked.” After weeks of involvement in programs and time spent educating myself on TimberNook’s guiding principles and philosophies, I realized that the more important question that I needed to ask myself was, “What is occupational therapy?”

I stopped trying to fit TimberNook into the occupational therapy “box” that I had created in my mind. Instead, I started re-familiarizing myself with the definition of occupational therapy. According to the AOTA (American Occupational Therapy Association) Model Practice Act, occupational therapy is defined as “the therapeutic use of occupations, including everyday life activities with individuals, groups, populations, or organizations to support participation, performance, and function in roles and situations in home, school, workplace, community, and other settings. Occupational therapy addresses the physical, cognitive, psychosocial, sensory-perceptual, and other aspects of performance in a variety of contexts and environments to support engagement in occupations that affect physical and mental health, well-being, and quality of life.” 

With this definition in mind, I broke both occupational therapy and TimberNook down to their fundamental cores and made an important realization:  TimberNook is not only a form of occupational therapy, but it is occupational therapy in its truest, most meaningful form. 

In a traditional clinic-based setting, it would be difficult for an occupational therapist to create a single treatment session that addresses all of the aforementioned aspects of performance in a truly meaningful way. During TimberNook, however, it is difficult to find instances where this isn’t happening. While I was sitting under a tree observing play at TimberNook, I saw children simultaneously challenging themselves and their peers physically, cognitively, socially, and emotionally. Undertaking these challenges during meaningful play experiences naturally guides development in a positive direction. And isn’t healthy development exactly what all us occupational therapists are working so hard to help our kiddos achieve anyway?

In class, my professors emphasized the importance of making our treatment sessions meaningful to our clients, but would then pull out something trivial like a pegboard as an example of a fine motor intervention. I found this same kind of disconnect when I completed my first level II fieldwork placement at a skilled nursing facility (SNF). I knew that we were supposed to be making our treatments meaningful for the patients; however, I found that many therapists relied heavily on rote exercise and other therapist-led activities that had little to no value to the patient. 

I remember having discussions with other occupational therapy students at this time regarding the juxtaposition that we observed between the idealized form of occupational therapy that we learned about in school and the reality of occupational therapy once you enter the “real world,” a world governed by money, time, and productivity. At TimberNook, however, the children’s experience is not constrained by these factors. They have the time and space to fully immerse themselves in self-directed and meaningful play; the developmental benefits of this play seem to be a desirable byproduct. TimberNook is always meaningful to the child, because they are guiding their own participation, rather than being subject to an adult’s intervention. 

TimberNook has no formal evaluation process, predetermined goals, or treatments. It is by no means occupational therapy in the traditional sense and I think that is exactly why it’s so effective. I remember Angela Hanscom telling me a story about a little boy who had been working on going barefoot with an OT for over a year with little success. That same little boy came to TimberNook and was splashing around barefoot in the mud by choice. I’ve come to realize that “traditional” does not mean right, just as “different” does not mean wrong. Whether or not an insurance company validates a service through reimbursement should not dictate the therapeutic value of that service. In my opinion, the occupational therapy services that TimberNook provides to its kids is invaluable.