Most people learn about Occupational Therapy when they, or a loved one, are recovering from an accident, illness, surgery or stroke. We see these gentle occupational therapists, working hand-in-hand with physical therapists, helping people relearn or find new ways to put on socks, cook meals, and navigate the world.
In reality, occupational therapy has a much broader definition, and it is a critical component of the holistic care we provide to the amazing children at Dakota Boys and Girls Ranch.
The name itself is misleading. When we hear “occupation,” we think it pertains to our work or career. But, in this case, an occupation is defined as the everyday activities people do to occupy their time, and the things that bring meaning and purpose to life. Occupational therapists focus on helping develop, improve, sustain, or restore independence to people who have had an injury, illness, disability or psychological challenges.
It is the area of psychological and psychiatric care that where kids need occupational therapy (OT).
Many of our Dakota Boys and Girls Ranch boys and girls couldn’t tell you, or even visualize, what it feels like to be calm. They have had pretty significant trauma in their lives, which affects their brain and body functioning and puts them in constant fight or flight mode.
While psychotherapy and psychiatric care are vital parts of the work we do, children can’t always find the way to talk about the anger, tension, fear, or confusion that they are feeling in their bodies. Some of our kids say, “I can’t feel calm. I don’t even know what that means!”
As psychiatrist and writer, Dr. Bessel Van der Kolk, says, “The body keeps the score.”
Occupational therapy at the Ranch focuses on helping kids learn to be aware of what they feel in their bodies, and to find ways to manage or “regulate” their bodies and emotions. Self-regulation happens for most of us automatically. We know what is appropriate terms of what we can do, and when we can do it. Because of the trauma our kids have experienced, many have never learned to self-regulate… and self-regulation is a critical “occupation” that can be learned through OT. We do that in a variety of ways, including the use of zones of regulation, sensory tools, and horses.
Zones of Regulation
“Kids who have been traumatized,” says Ranch psychiatrist, Dr. Wayne Martinsen, “have an internal level of arousal or hyperawareness. They startle more easily. Get angry more easily. Some kids can face the trauma and talk through it. But for some, OT may be the key to unlocking and lowering the internal arousal. There is a healing piece with that, and it really does make a permanent difference.”
“You can calm the emotional turmoil or agitation with medication, but perhaps we can use lower dosages, or eliminate the need for medication over time, if OT can help kids identify their feelings and learn ways to calm down. Less medication means lower side effects,” says Martinsen.
To help children learn to identify when their self-regulation is an issue, and begin to teach them to independently regain control, Ranch OT’s first teach the child about their own personal “zones of regulation.”
Zones of regulation, as described in “The Zones of Regulation” by Leah M. Kuypers, OTR/L, teach students how to regulate and control their emotions.
Ranch residents each have their own zones of regulation chart. By tracking their zones throughout the day, they can learn to understand their personal triggers. The goal is for students to recognize times and situations that may be difficult for them, so they can use the tools before they move up the ladder to the red zone.
Students begin to realize they are more successful when they remain in the green zone where they are in control of their behavior and emotions.
Occupational therapists introduce residents to the zones of regulation and help them identify what they are feeling. The zones are also integrated into every aspect of the children’s lives—at school, in therapy, and in the cottages where the children live, sleep, eat, and interact with their peers.
When Chloe* came to the Ranch, she was very aggressive and had been in multiple placements (extended family, foster homes, group homes, residential treatment and hospitals). Chloe had been subjected to physical, emotional and sexual abuse, most of it when she was under five years old.
When Chloe learned the zones of regulation, it was like a light bulb went off. The zones of regulation gave Chloe a tool, a language, to help her understand what she felt.
Chloe said, “I never had the ability to communicate what I was feeling before. This helped me do that.”
Chloe put the zones of regulation chart up in her bedroom and used the chart to identify and communicate her feelings.
Often, our kids our unable to identify what they are feeling and where they are at in the zones chart. All staff at the Ranch are trained in using the zones so they can notice when a child may be moving into an unhealthy zone, and suggest to them that they may need a sensory break or to go to the OT room for a few minutes.
In additional, Occupational Therapy Assistants are with the kids throughout the day—in the morning before school, at school, and in the cottages until bedtime—so they can work with the children as they go about their activities of daily living.
Once children learn the zones of regulation, OT’s can guide them in finding “sensory tools” that will help them calm themselves and focus.
Sensory integration is based on the concept that all the information we receive about the world comes through our sensory systems—our sense of smell, touch, movement, taste, sight, and hearing. The ability to integrate the massive amounts of information coming into the senses develops normally in most children, and allows us to concentrate, reason, think, control our actions, and learn. It also is vitally important in developing self-esteem and self-confidence.
When sensory integration is interrupted by trauma, or in the case of kids on the autism spectrum, doesn’t develop properly, children are unable to regulate their emotions and actions.
Sensory tools range from small to large. Swings, rocking chairs, lights, and ball pits are used by Ranch OT’s to help children learn what helps them get back to the Green Zone. Smaller items, like stress balls, Thera-putty, and gum are very useful in that children can have them with them, or teachers can have them in the classroom.
Occupational therapy is especially important in the classroom, where children need the ability to focus on learning. The teachers at Dakota Memorial School in Minot all read Kuyper’s book last semester, and worked with Occupational Therapists and the students to create coping skills tool boxes for each classroom. The tool boxes include sensory items like stress balls, Thera-putty, Play Dough, moon sand, writing grips, hand-held stretchy items, and sugar-free hard candy.
Renae Fettig, OT on the Ranch’s Bismarck campus, works closely with children in the classroom. “What do they need to do to learn? If I see a child shaking his leg, I can assume he needs to move to concentrate.”
Some kids who are stressed need to wrap a blanket around themselves. Others need to find a quiet place where they can collect their thoughts and calm themselves down.
The Ranch has several balanced learning classrooms—classrooms that let kids choose the environment best for their learning style. These include specialized work stations, and special lighting. If students feel restless or unable to focus, they are encouraged to move around to find the space that is best for them at that time.
In addition to helping children feel calm, these techniques and tools also help them feel safe so they talk and open up more.
“Getting a child’s sensory system organized can improve their vocabulary and speech,” Fettig says.
The Cutting Edge
Martinsen says, “Everything we do here—psychotherapy, medication, OT—is a different pathway to healing. Our goal is to get these kids back to the community and back to their families as soon as possible. The more different approaches you use, the more successful you can be, and the more quickly you can do it.”
In terms of using occupational therapy as a tool in residential treatment, Dakota Boys and Girls Ranch is on the cutting edge.
“In terms of complexity and integration, there isn’t even anyone who comes close to what we do, especially in North Dakota,” Martinsen says.
*Name changed to protect confidentiality