Frequently Asked Questions of a Pediatric Occupational Therapist

In honor of Occupational Therapy Month, we sat down with Allison Fullam, Occupational Therapist at Connecticut Children’s to learn all about this very important medical profession and how it helps both adults AND children.

ot_jpeg 1What is an Occupational Therapist (OT)?
An Occupational Therapist works with people who have disabilities, deficits or injuries. Occupational Therapists help to increase functional abilities and independence in performance of meaningful activities.

Why do you work with children, they don’t have an occupation?
A child’s occupation is to play, learn and interact with his/her environment. Through play a child develops motor skills, sensory awareness, cognitive skills, social skills, and self-help skills. These include eating, dressing, toileting, bathing and other hygiene/grooming activities.

How do you work on these skills with children?
Through use of therapeutic activities and exercise, OTs use toys and play to address the areas of concern to meet the child’s and family’s goals. There is always a purpose for the toy and activity that is chosen.

For example, an obstacle course can work on strength, motor planning, following directions, regulation and social skills. A feeding session may include interacting and having fun with foods, such as kissing food items or playing with foods with their hands to get messy and feel comfortable around foods. ..Or a child may be asked to pick up small items, using tweezers or tongs, to work on fine motor coordination and grasp fine motor tools for writing and cutting.

ot_jpeg 2Why did you choose to be an Occupational Therapist?
I knew that I wanted a career that included the study of science and helping people; and Occupational Therapy was a perfect fit. Through my training, I learned that I loved working with children and their families.

Nothing is more rewarding than seeing a child perform a skill for the first time and the joy from the family as they watch their child achieve their goals.

Advancing Kids: Dr. Paul Dworkin Joins CDC Grand Rounds

By Paul Dworkin, MDexecutive vice president for community child health at Connecticut Children’s, director of the Connecticut Children’s Office for Community Child Health and founding director of the Help Me Grow® National Center

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(Shown in photo left to right) Ross Thompson, PhD, Paul Dworkin, MD, Mary Ann McCabe, PhD, and Georgina Peacock, MD

On March 15, I was honored to participate in Public Health Grand Rounds, which is a monthly activity of the Centers for Disease Control and Prevention in Atlanta. The session focused on the important issue of “Addressing Health Disparities in Early Childhood.”

During my presentation, I was able to share the story of Help Me Grow®, which I developed as a pilot project in Hartford in 1997 and then successfully advocated for statewide expansion in 2002. The program has since expanded around the country through the Help Me Grow® National Center, which is a program of the Connecticut Children’s Office for Community Child Health that provides technical assistance to affiliates in 25 states and territories.

As part of my presentation, program organizers asked that I identify the key strategies by which Help Me Grow® addresses health disparities. I emphasized three key aspects of our work: a focus on vulnerable children who often elude early detection and typically do not meet the relatively restrictive eligibility criteria of state early intervention programs; support for interventions that strengthen protective factors and enable families to mitigate the impact of early adversity and stress; and the imperative of cross-sector collaboration to address the many adverse influences on children’s developmental outcomes. The reinforcement of the importance of these themes by CDC staff, my three co-presenters, and the audience was validating and inspiring.

While I correctly anticipated the benefits of sharing Help Me Grow® with the large audience for this event and of learning from the presentations of my esteemed co-presenters, I underestimated the value of participating in a remarkably comprehensive planning process. The support, guidance, and critical feedback provided by the course directors and many CDC staff members heavily informed both the content and language of my presentation.

Indeed, CDC leadership and staff expressed an extraordinary level of engagement and interest. Multiple conference call rehearsals enabled CDC staff to provide feedback and suggestions. I finalized my Powerpoint just days before the event, in response to several astute queries posed by CDC Director Tom Frieden. I was so impressed with Dr. Frieden taking the time to raise critical questions on the topic of early childhood interventions in the midst of his managing the Zika outbreak!

The event also afforded me the opportunity to vet several core concepts guiding our work. In view of the CDC’s world-class expertise in research and evaluation, I explored their response to our evaluating the impact of Help Me Grow® on children’s developmental outcomes by examining its success in strengthening families through protective factors known to promote children’s healthy development. While I was encouraged to continue to pursue the collection of long-term outcome data on children’s development and academic success, our demonstration of impact on more proximate measures was regarded as evidence of the effectiveness of Help Me Grow®.

I also tested our premise that developmental promotion of all children is an even more ambitious priority than the prevention of delays and disorders. I was gratified that the Centers for Disease Control and Prevention endorsed promotion as our penultimate goal. In fact, a post-event letter from Director Frieden endorsed the critical importance of developmental promotion.

I returned home from my visit to Atlanta even more confident as to the relevance and importance of our work in advancing developmental promotion, early detection, and linkage to services.

Happy Volunteer Week: Meet Michelle & Carina!

In celebration of National Volunteer Appreciation Week, we sat down with Pet Therapy volunteers Michelle Cutrali and her precious pup, Carina, who have been bringing smiles to patients and families at Connecticut Children’s for more than 5 years!

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Carina celebrates her 12th birthday on March 26th with family and friends by her side!

What made you decide to become a volunteer?
I took Carina, aka “Freshy Pants” to agility class with high hopes of her being the next Animal Planet star. I thought it would be easy since she was very fast, low to the ground and loved to fetch. All that she had to do was run down a lane, jump a few hurdles, grab a ball and bring it back. Easy right? Carina figured out that it was faster to go around the hurdles to fetch the ball than it was to jump over them. Needless to say, we weren’t asked back to agility class!

It was at this point, where I looked at her and said, “You need a job!” I knew how much she loved children and I wanted to put in a consistent effort in giving back to my community. This was a perfect fit!

As a Pet Therapy Volunteer here at Connecticut Children’s, what are some of your primary responsibilities? 
Carina and I try to make each visit engaging and as interactive as possible. We usually visit the 8th floor. Each visit starts out by Carina checking for crumbs under the bed, meeting the parents and the patient. We talk about the patient’s pets and listen to their stories.

Also, Carina loves to snuggle! If the patient wishes, she will snuggle up in bed with them or she will sit at their feet on the floor waiting for belly rubs. She loves belly rubs!
Carina has a number of entertaining stories that I share with the patients and families that always makes them smile. On many occasions, I will ask the patient if they would like to take the dog for a walk. Carina is notorious for the many smiles that she gets for guiding a wheelchair through the halls like a sled dog!

Every patient visit ends with tricks. Carina loves to sing ‘Happy Birthday’ and her famous dance moves are inspired by Beyoncé. It’s a great feeling to see the endless smiles that a singing and dancing dog can put on kids, families, staff and admin.

What do you love most about being a Pet Therapy Volunteer here at the Medical Center?
The smiles! For us, it’s all about how we pay it forward. Our patients and families miss their pets during their stay. Our visit gives them an outlet to share stories about their loved ones and some much needed one-on-one time with a dog. Sometimes, the only way to help a child is to bring in that dog that will make them giggle, laugh and for a very short time forget why they’re there.

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Carina loves her volunteer shifts at Connecticut Children’s Medical Center.

Why do you believe Pet Therapy is so important to our patients and families?
We have been fortunate to assist in different forms of therapy with many children at Connecticut Children’s. Those children who have difficulty walking were more motivated when holding a leash and walking the dog. Walking the dog mentally stimulated them and they walked further than expected.

We have done special visits to acclimate children who were victims of dog bites. These visits are highly sensitive and involves a great level of trust from parents who wish to have their children comfortable with dogs soon after their incident. It’s amazing to see the resilience of these kids and after 45 minutes of a visit they are hugging and kissing the dog.

We get so many smiles in the PICU! Carina is the smallest of our Pet Therapy dogs and I can lift her up to bring her eye level to the children in the PICU. It’s great to see their eyes light up as soon as that dog comes close to them.

Child Life makes a great effort to accommodate the emotional needs of patients and families, as does the ArtReach program, staff and volunteers! We have been called in to do special visits for those children who miss their dog and need a little extra attention. The smile that Carina can put on that kid’s face is priceless!

What would you say to someone interested in volunteering at Connecticut Children’s?
Do it! Embrace the hundreds of smiles and prepare for the few heavy hearts. It’s the most emotional roller coaster you can go on and the most rewarding thing you can ever do!

Feel free to share anything else!
There are so many patient stories that I can think of to share, but this one stands out. We were volunteering in the Emergency Department with Paula from Child Life. Paula had a 10 year old boy that was in need of an IV and petrified of needles. He barricaded himself in the corner of his room under a blanket and surrounded by chairs to be impenetrable. Paula called us into the room and Carina walked under the chairs, put her nose under the blanket and completely surprised the boy. He wasn’t expecting a dog in the ED. Carina was able to ease his fears and within 15 minutes, we were able to have him on the bed and prepped for his IV while he was holding Carina’s paw for comfort.

Right Where We Belong

By Heather Klimkosky, Mother and CEO of the Klimkosky Family

In 2000, soon after my husband and I met we envisioned a dream of what our life would be like after we got married. We would enjoy our careers, build a house with a front porch, have two children and travel the world with them. We married on 9/15/2001, four short days after the 9/11 attacks. We learned a lot from our experience just as the rest of the world. One thing we for sure learned is that things don’t always go as planned.

We built our home (with a small front porch) and our first born blessed us 10 months later. Alexandra filled our world with love. I worked part time and watched her grow. It was the best of both worlds really! When Ally was 11 months old she began having bouts of vomiting. As a new mom a vomiting child was my worst fear. That very statement makes me laugh now.
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For the next four years Ally had numerous bouts of vomiting, mostly in the winter months when stress for her was high. She would become dehydrated, we would go to the emergency room, they would rehydrate her and we would go home. This repeated itself over and over again and the only answer we got was Ally had a virus. We went to every hospital in the area. When Ally was five years old and had missed most of her kindergarten year we branched out and drove an hour to Connecticut Children’s Medical Center. Same drill, they rehydrated her and she felt better and we were going to be sent home. But this time I begged for help. We will forever be grateful that Connecticut Children’s listened.

They did all the preliminary testing to rule things out and within three days we had an appointment with our forever angel, Dr. Zeiter. She knew exactly what we were dealing with and what to do. Alexandra has Cyclic Vomiting Syndrome. Through the years we have learned what her triggers are and how to handle an episode so it impacts Ally’s life in the smallest way possible. She is a strong kid and knows just what to do to make it better. Ally still has a handful of episodes a year but the care she gets at Connecticut Children’s is unmatched.

When Ally was five we were blessed with kiddo number two. Colin made our family complete. A bit of a gap in age but our prayers were answered. This beautiful brown haired blue eyed boy made Ally’s eyes sparkle. We lived the “normal” life of two children along with managing Ally’s CVS.

photo 1An April afternoon in 2011 changed our life forever. At a friend’s birthday party Colin had a seizure. It was the most helpless feeling I had ever had. He visited St Mary’s Hospital and then continued on to Connecticut Children’s and the plan was to wait and see. Three days later my mother’s intuition told me to bring him back to the Medical Center. Colin was just not right. Within 40 minutes of getting to the ED our whole world opened up and Colin experienced nonstop seizure after seizure, one lasting seven minutes. I will be forever grateful for Connecticut Children’s rallying around my child to make him better. Colin spent five days in the PICU, lost his ability to walk and talk. All tests showed Colin had epilepsy. We were beyond thankful as that diagnosis was the lesser of all evils. We went on to live our new normal.

Life for me as a Dental Hygienist was over. My kids needed me. Two kids on multiple daily medications, physical therapy to help Colin walk again, speech therapy to bring back his sweet words, managing Ally’s episodes, being on guard with rescue meds for seizures, managing medical bill and DR’s appointments, oh MY! We did it all and became stronger every day!

At a follow up appointment with Colin’s neurologist the doctor suggested Colin be evaluated for Autism. Autism? What’s that? Three short months after Colin was diagnosed with Autism. Time to pound the pavement and help our boy. Colin had therapy appointment after therapy appointment and Ally became his best therapist. In time we learned that Colin also has Apraxia, a convergence insufficiency with his eyes and multiple anaphylactic allergies. Colin has his struggles but seeing the world through his eyes bring a whole new dimension to life.

As for myself, I am no longer a dental hygienist. I am the CEO of the Klimkosky Family. I went back to school for education advocacy and attend any and all parent education classes to better understand Colin’s world. Any and everything we have done has proven to be beneficial because my kids are doing well. We have been able to teach our kids life lessons so early in life. We have had family toy drives in the effort to give back just as others have given to us.

photo 3It’s been a journey. Without the help and guidance of everyone at Connecticut Children’s our story may have been different. Connecticut Children’s always makes my kids feel better. With all the craziness we experienced, my family was blessed with a gift – we met a man who was able to show my kids the positive side of the hospital and master the skill of sticking their tongues out ;). My kids have had the amazing gift of being a part of events for the hospital like danceathons and radiothons. The experiences we have been blessed with give us the strength to get through the most challenging times. Being a part of these special occasions have shown us just how much Colin can really do and how strong both of my kids are. It’s a gift my daughter classically describes as better than Christmas morning! They are not scared to go to the hospital anymore. They see the positive side. Connecticut Children’s has always made us feel a part of their family.

So you see this is not the dream we envisioned in 2000 but one thing I can say for sure, if I knew then what I know now, this is exactly the dream we would have envisioned. I am forever grateful for the life we have and the strength and courage our experiences have given us.

A very special thank you goes to the entire staff of Connecticut Children’s emergency department, you are the doors, the place that continually makes my kids better. A special thank you to Dr. Zeiter, Dr. Ionita, Dr. Milanese, Dr. Kalsner, Scott Organek, Marissa Troiano, Adria Giordano, Jennifer Twachtman-Bassett and all the staff and nurses that have helped use in so many ways!

#CTChildrensTurns20: Claire Hibbs-Cusson

In honor of our 20th year anniversary, Claire Hibbs-Cusson, BSN, RN, CCRN-K, WCC, Clinical Education Specialist of the Department of Education and Development at Connecticut Children’s, joins our blog to share her story in celebration of this incredible milestone!

hibbs cussonIn 1988, I was a newly graduated RN entering the PICU at Hartford Hospital and “CCMC” was just a twinkle in the eye of the Department of Pediatrics. Eight years later Connecticut Children’s Medical Center became a reality.

Looking back across my life pre-nursing, it never really seemed like I would end up in this field. My first career was in early childhood education. After marriage and the birth of my two children though my interest in healthcare was growing and I embraced my new personal challenge of going to Nursing School. As graduation neared I was accepted into a Nursing Critical Care Internship at Hartford Hospital and this is where my nursing career began and flourished.

It is difficult for me to imagine a more challenging or rewarding career. My 25+ years in Pediatric Intensive Care, first at Hartford Hospital, then at Connecticut Children’s, never failed to prove to me that this was my calling. My first experiences in PICU remain vivid memories as I began to realize the impact I could and would have on the lives of children, families and colleagues, regardless of outcome. Lifelong relationships were born both personal and professional. Strikingly, many of my most valued colleagues are still here in a variety of nursing roles.

It has been an amazing personal journey working in a number of different roles, as well as roles within those roles, first as a PICU Staff RN, preceptor of many nursing students and newly hired staff RNs, and later as the PICU Clinical Education Specialist. Here is where my two professional fields, education and nursing, were blended into my “dream job”.

My current role as an educator in Central Education and Development affords me countless opportunities to develop and deliver education and exemplars, the fruits of my years of experience. Nurses and other professionals who come to work at Connecticut Children’s are among my “students.” Within my current role, I have a number of opportunities to impact care at Connecticut Children’s, including developing and reviewing policies, my work as a Wound Care Certified RN, PALS Coordinator and Instructor and participation in several leadership activities.

The remarkable changes I have witnessed over the first 20 years of Connecticut Children’s existence are many. One of the most exciting of these has been watching Connecticut Children’s emerge from its infancy into an independent and free-standing pediatric institution, now highly respected and recognized across the state and across the nation. Changes in regulatory processes and quality driven initiatives have directly and positively impacted our delivery of highly reliable and safe patient care. Family Centered Care has become permanently ingrained within our culture. Physical growth has far outstretched our forecasted needs, but we continue to meet the needs of our community by branching out within Greater Hartford and beyond. Professional nursing has finally found its voice, the result of concerted effort and persistence in establishing our evidence-based environment of inquiry and focus on outcomes.

Today I share with so many employees throughout the institution a palpable pride and dedication to further the progress whose foundation lies in these first 20 years. I look forward to what lies ahead in this exciting and ever changing environment.

Finally, I will always cherish the marvelous privilege of sharing in the joys and heartaches of so very many children and families while collaborating with a long, long list of colleagues and friends to restore each child to optimal health or to assist families at their most difficult times. These colleagues, co-workers, patients and families have taught me and shaped me into the nurse, leader, role model and friend that I am today.

To all who remain at Connecticut Children’s and those who have gone on to other places, “Thank you and Happy Anniversary!” You all deserve our appreciation for making Connecticut Children’s the very best place for pediatric care.