Friday, November 14, 2014


I have worked in Occupational Therapy, first in home health, from 1992, then in early intervention from 2002 to 2004 with Contra Costa County which was then disbanded and taken over by Contra Costa ARC. I have worked with them ever since.
I have met inspiring and wonderful families many of whom have battled against tremendous odds. I have fallen in love with the children, and their valiant families.
There are many drawbacks to working alone in the homes - for instance, isolation from one's peers. It really does take a village to raise a child and many times, the village is not available. I recommend physical therapists, feeding specialists, and speech therapists for the children with whom I work. It would be nice to talk with them and see how we can cooperate, but so often no-one seems to have the time, or there are privacy forms to fill in and sign before we can talk and it becomes daunting. Recently it feels that there is competition between the different service providers and collaboration becomes increasingly difficult, and is not in the best interest of the population we serve.
In the beginning we were often able to talk with the doctors and nurses, but now that almost never happens. It was helpful, because doctors only see a child for 10-20 minutes and we spend far more time with them and can observe what is happening. There was wonderful collaboration with public health nurses who made many referrals. Over the years there have been more and more budget cuts and restrictions. There was a time when I could see a child for up to three times a week, now we are restricted to one hour a week, or once every two weeks. Often the referrals are 34 - 35 months of age which means we maybe see them four times at the most - what on earth is accomplished?
I could go on and on about the deteriorating system, but I won't. To compound matters us home therapists have worked with a non existent supervisor who doesn't have any idea of the work we do.
I have valiantly battled on with all these stumbling blocks, setbacks, etc. Last year we were taken off salary and paid per child. Because of stringent eligibility requirements, referrals are far fewer and therefore the amount of children I see is dwindling.  Of course ever since last year's layoff I have been struggling with what next - to work privately, to work for a registry, then it hit me last week.
That is it, I am done. I am done working with frightfully incompetent colleagues, I am done with this work. I will not take on anymore referrals.  I now have four little ones whom I care for deeply and will continue to see until they age out or go to another program, and it is high time I move on to something different.
I have reached the end.


  1. Well, Nesta, I have been surprised to find that the need to do something different pops up every fifteen or twenty years or so, even at this age. And I have no doubt that whatever you do will benefit someone somewhere greatly. Or maybe you will change your mind, which would be okay too--but I wonder if your skills and talent and loving heart would be more effective in a system that isn't broken.

    1. Thanks so much for your insightful comment - you are absolutely right in that it would be more effective in a system that isn't broken, but I am not sure whether that exists!