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Day in the Life: Outpatient Pediatrics

Ever wonder what a typical day looks like as a pediatric occupational therapist in a clinic setting? Well, today I’m here to answer all your questions and give you a rundown of what a "typical" day looks like! It’s important to keep in mind, every clinic operates differently and sets various expectations/productivity standards for their therapists. The information provided is simply to serve as a general guideline for those wondering what an average day looks like in a peds clinic, with the hopes that this information can be helpful for either an OT student with upcoming outpatient peds FW rotation or for a fellow practitioner interested in pursuing a career in outpatient peds.

How long is a typical workday?

Assuming you work full time, a typical workday is between 8-10 hours. You will most likely work 4-5 days during the week and may possibly work on weekends pending your clinic's hours of operation. Start and end times will depend on the clinic's hours and family availability, but will typically begin sometime around 7:00 am-9:00 am and end around 3:30 pm-6:30 pm. You may choose to take either a 30-minute or 60-minute lunch break, pending personal preference.

How many clients do you see in a day?

Depending on the length of your sessions (i.e. 30-minutes vs. 60-minutes), you can estimate to see around 8-16 clients during a given day. It is important to remember, cancellations and no shows are a common occurrence in an outpatient setting due to a number of factors (i.e. sick, vacation, conflicting schedule, etc.) and you can almost always guarantee at least 1 cancellation in any given week (sometimes more, sometimes less). However, if cancellations occur, it is either the front desks or your responsibility to reschedule a makeup session for the absent client, which is typically completed the following week.

How long are sessions with clients?

Typically, clients are seen during a 30 or 60-minute session somewhere between 1-3 times a week, per therapist discretion/ recommendation and coverage from insurance. For clients seen during a 30-minute session, the rule of thumb is to provide 25 minutes of direct services & 5 minutes of indirect services. What this means is that 25 minutes of the session is spent working directly with your client to address various goals/skills and 5 minutes spent (typically at the end of the session) indirectly providing information to families regarding skills address during today’s session, discussing home exercise programs the family can implement into their daily routine in order to address various skills during the upcoming week, collaborating with families, etc. For clients seen during a 60-minute session, the rule of thumb is similar, except it is 50 minutes of direct services and 10 minutes of indirect services.

What do my responsibilities entail?

Responsibilities vary pending your clinic but may include the following:

  • Creating individualized treatment sessions daily to target goals/ areas of need for each client.

  • All documentation including, but not limited to, daily notes for each client seen (these may be handwritten or completed on a system pending clinic), progress reports, re-evaluations, discharge reports, initial evaluations, referrals for other therapy services, letters of medical necessity to insurance companies or physicians.

NOTE: It is your responsibility to submit update reports according to authorization expirations. These reports are typically submitted a minimum of three weeks prior to the authorization expiration to ensure insurance companies will have an ample amount of time to review the report, provide any corrections or clarifications if needed, and provide a re-authorization for continued skills occupational therapy services.

  • Billing/productivity/timecards for the week

  • Setting up, cleaning, and sanitizing treatment areas and equipment

  • Scheduling ( clients, makeup sessions)

  • Creating handouts/home exercise programs to provide families based on various skills targeted during treatment sessions

  • Attending/ collaborating during team meetings

What skills are addressed during sessions?

Working with pediatrics, there are SO MANY SKILLS that can be addressed during sessions. In an outpatient setting, you are given more flexibility in regards to areas you can address during your treatment sessions. With that said, you must always remember to target areas within your scope of practice. Some skills address during sessions include:

  • Self-care skills (i.e. donning/doffing shoes/sock/shirts, toileting, brushing teeth, hand washing, feeding, sleep, etc.)

  • Fine motor skills (i.e. grasp patterns, scissors, shoe typing, puzzles, fasteners,etc.)

  • Gross motor skills (postural control, balance, coordination, muscle strength/endurance)

  • Visual Perceptual/motor skills (i.e. figure-ground, visual closure, visual memory, form consistency, spatial relations, hand-eye coordination)

  • Sensory Processing (tactile, vestibular, proprioceptive, olfactory, gustatory, visual, auditory, interoceptive).

  • Oral Motor Skills (oral motor awareness, jaw stability, lip closure, tongue lateralization)

  • Praxis (ideation, motor planning, execution, feedback, feedforward)

  • Executive functioning skills (Initiation, Sequencing, Prioritization, Planning, Impulse control, working memory, organization)

  • Social Skills (emotional regulation, frustration, positive behaviors, safety awareness)

  • Bilateral coordination (Contralateral movements, crossing midline spontaneously)

What are the most common diagnoses of clients you work with?

  • Autism spectrum disorder

  • Attention Deficit Hyperactive Disorder

  • Sensory processing disorders

  • Developmental delays

  • Learning problems

  • Mental health or behavioral problems

  • Down syndrome

  • Multiple sclerosis, cerebral palsy, and other chronic illnesses

  • Birth injuries or birth defects

  • Traumatic injuries to the brain or spinal cord

  • Traumatic amputations

  • Burns

  • Juvenile rheumatoid arthritis

  • Post-surgical conditions

  • Spina bifida

  • Cancer

What are some commonly used assessments?

Assessments greatly vary pending what your clinic has available but you can almost always guarantee they will have the PDMS-2 and BOT-2. Other assessments commonly used include either The Infant/Toddler/Child Sensory Profile OR Sensory Processing Measure (SPM), The Pediatric Evaluation of Disability Inventory (PEDI), BEERY VMI, and/or The Wide Range Assessment of Visual Motor Abilities (WRAVMA).

What CPT codes are most commonly used to bill for services?

The most commonly used CPT codes include:

  • 97530: Therapeutic Activities

  • 97167: Evaluation

  • 97168: Re-Evaluation

Other codes less frequently used include:

  • 97533 SI/Sensory processing

  • 97535 Self Care/safety

  • 97537 Community Integration

Can you provide an example of a “typical” workday schedule?

8:00am-9:00am Client A

9:00am-10:00 am Client B

10:00am-10:30am Client C

10:30am-11:30am Client D

11:30am-12:30pm Client E

12:30pm-1:00pm Lunch

1:00pm-2:00pm Client F

2:00pm-3:00pm Client G

3:00pm-3:30pm Client H

3:30pm-4:30pm Client I

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