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Home Care Internships

New graduates are often discouraged from working in home care due to the lack of supervision they would receive and their own level of inexperiencesomething that can result in repetitive, "cookbook" treatment intervention that does not allow an entry-level therapist to improve skill levels.

In some settings there is also a push to meet productivity requirements shortly after hire, which can make a new graduate feel overwhelmed with the need to treat more than one patient at a time. Educators suggest that the new graduate work for at least one or two years in a physical disabilities setting other than the home before pursuing home care.

However, the Visiting Nurse Service of New York, a certified home care agency that serves the five boroughs of New York, Westchester and Nassau Counties, has attempted to solve this problem through an innovative program for new and recent graduates, the Occupational Therapy Internship Program.

The program, modeled after a nursing internship program at the same agency, was a way to tap into an area not yet utilized by some home care agencies for recruiting therapists. The philosophy of the program is this: if the opportunity for learning and satisfaction of educational needs, sufficient supervision and skill development are available in a realistic setting, then a student and graduate should consider working in that setting.

The one year, full-time, staffed salaried intern position includes a comprehensive benefits package for new graduates who are interested in home care. The stress of productivity requirements is removed initially from the mix in the hopes that the therapists absorb information accurately when it is at a slower pace. The expectation is that the intern will meet productivity requirements of 30 visits per week by the first six months of employment.

The agency hired a clinical specialist to act as an advisor and mentor for the interns. It also developed a curriculum that addresses the educational needs of entry-level therapists, for the first three months of the program, to provide a degree of structure and organization some new therapists lack. Interns also receive handouts for future reference to serve as a resource for problem solving.

The program turned out to be a positive model for therapists with years of experience, who reviewed clinical conditions, how they apply to occupational therapists, and their application to home care intervention. The clinical specialist and the rehabilitation management staff, which includes occupational and physical therapists and speech-language pathologists, conduct these reviews. On occasion, the information has been offered out to staff therapists as continuing education. Seasoned therapists appreciate the possible addition of current trends to their practice.

The program also uses the various models of supervisionindividual, group, hands-on, and distant. The clinical specialist is available for supervision and consults as needed, eliminating the need for structured supervision in some facilities. The clinician performs co-visits with hands-on supervision regularly in the patient's home to develop the new grad's skills and to ensure proper care management. Chart reviews are performed before and after these co-visits with feedback regularly provided to the intern in order to assist with documentation skill development.

The program also stresses to the interns is that although home care is often perceived as an independent field, it does not mean the therapist is alone. This is emphasized partially through observational opportunities with the other team members. Discharge planning nurses in hospitals, nurses in the home care setting, physical therapists, speech language pathologists, and social workers all allow the new therapists to shadow them to see what their roles are in home care. Seasoned OTs also agree to have the intern shadow them for several days to learn how to coordinate schedules, document and begin treatment planning.

When they return to the office, interns receive an in-service from the discipline about what they observed and common practice in that field. Managed care case managers and representatives from our cultural diversity programs also speak with the interns.

Since October 2002, 13 interns have gone through the initial training and have been assigned to work in four of the boroughs of New York. They complete a six-month probationary period during which the clinical specialist and the intern discuss care management, skill ability and ultimately determine if home care is the correct setting for them.

Some therapists new to home care have difficulty adjusting to time management, documentation, and communication issues no matter how much experience they have. In addition, some interns have the additional need for continuous supervision, which may not be feasible in a home care setting. At the end of the training, the interns can then select if they want to transition to a staff position, work on a per-diem basis, or leave the agency. So far, Visiting Nurse Service of New York has been able to transition five interns to staff positions.

For more information
Occupational Therapy Internship Program at the Visiting Nurse Service of New York, please contact 212-609-7332.

Colleen McCaul, MA, OTR/L is the Clinical Specialist in Occupational Therapy at the Visiting Nurse Service of New York, where she has worked for 7 years. She is also an Adjunct Faculty at New York University, where she has been teaching since 1995.

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