Member Spotlight: Providing Community Pediatric Services

  •   November 4, 2020

This month we shine Physiotherapy Alberta’s spotlight on Ooi Lin Pheh and gain some insight into community-based pediatric physiotherapy practice and Ooi Lin’s career journey.

Since graduating from the University of Alberta in 1997, Ooi Lin’s career path has been varied and traversed across urban and rural Alberta and around the world. Following a few years of rural practice, her passion for traveling and immersing herself in other cultures led her to volunteer at an Institute for People with Disabilities in the former Yugoslav Republic of Macedonia. Ooi Lin spoke about how she learned about culture, sustainable development, collaboration with other organizations, and different views on disability and human rights during this time and how this experience enhanced her own values of inclusion.

After returning to Canada she saw a job posting for the GRIT (Getting Ready for Inclusion) program and knew it was the place for her. Although she was new to pediatric practice, Ooi Lin received support and mentorship from her GRIT colleagues and continues to grow professionally and personally through her work with this team and the children and families they support. Now in the role of Practice Lead, she continues to learn, participate in reciprocal mentorship, and collaborate with an interdisciplinary team.

The topic of inclusion came up frequently during our conversation. Ooi Lin defined inclusion as the universal right of all people to feel they belong and accepted. Inclusion is about having a valued role within a family unit, community, or society.

“Inclusion benefits all,” explains Ooi Lin. “The child with the disability who is meaningfully participating in the neighbourhood or school community, but also for his/her peers who teach each other about diversity and empathy.”

Ooi Lin reflected on the role physiotherapists have in maximizing function to allow participation in everyday routines, providing adaptations and strategies that facilitate access and ensuring that children can participate in their community. Ooi Lin feels that physiotherapists can contribute to inclusion by supporting and building on family strengths and their vision for the child. This can empower parents to advocate for their child. By supporting these families and caregivers through education, physiotherapists can also direct families on when and where to go to ask for help. Ooi Lin says she can see inclusion is happening when she goes into a classroom and has to “look” for the child she’s there to support because he/she is just participating in whatever activity the whole class is doing.

Inclusion is not just important for children with disabilities but for children of all abilities who have the right to participate, play, learn, and enjoy the experiences of childhood. She highlighted the role that physiotherapists can play in working with community groups to provide practical insights on accessibility and barriers to inclusive recreation.

One of the challenges she sees is a lack of access to power wheelchairs for children to practice with. Kids need time to learn how to use a power chair; however, vendors can usually only loan these for a short time. This problem led Ooi Lin to collaborate with her Occupational Therapy colleagues and volunteer professional engineers and engineering students through the Association of Professional Engineers and Geoscientists of Alberta to design a family friendly power car that parents can purchase and children can use to explore movement opportunities and provide practice in preparation for power mobility. Engineers (professionals and students) are working on designing the car, motor, and controls while the therapists are providing input on seating and positioning options they want available on the car. The car will be a generic model with a standard seat that can be removed to allow a modified seating system to be included.

Ooi Lin’s perspective is that the best part of delivering programs in the community is you get to see the child in their natural routines and environment, and to understand what activities are the most meaningful for them and their family. For example climbing into their seat at mealtime or maneuvering a walker in snow at recess.

Ooi Lin pointed out the importance of coaching and working with the parents and/or other caregivers who are with the child most of the time. These team members know the child the best and are instrumental in implementing strategies. She says the strategies and activities you introduce must be meaningful and easy to implement as part of the day. They cannot simply be another thing busy parents have to fit into the already full routine. Another opportunity that arises when seeing the parent and child in the home is the ability to address caregivers’ issues. For example, a parent may talk about having difficulty or pain when lifting a child out of the bathtub. The issue may only emerge because the community physiotherapist is in the home and observing the day-to-day routines.

Ooi Lin said that another big role for community physiotherapists is working with public health-care teams to support the family to continue post-surgical home programs and adapting routine activities to target identified post-surgical goals.

When it comes to the differences and/or similarities between providing care within the health-care system and the education environment, Ooi Lin said that, although all physiotherapists work on functional goals, in the school setting the activities must fit within the class routine. For example, strengthening might occur within a yoga station, through targeting certain playground equipment at recess, or by collaborating with the teacher to set up the classroom or routine to encourage the use of a walker.

In the health system, she said, you generally work with a health-care team. However, in the education system, a lot of work is done with OT and SLP team members, but there also has to be collaboration with teachers and educators who may not have the health-care background. Making sure charting, discussions and notes are user friendly without abbreviations or jargon is especially important so that all team members understand each other, regardless of whether they come from a health or educational background.

Ooi Lin identified that a positive outcome of the COVID-19 pandemic has been a significant increase in her personal comfort with using technology so that she is much more comfortable with virtual meetings and interventions than six months ago. Virtual meetings with colleagues or families started out of necessity when schools were closed, but they continue to be an option despite school reopening. Many of the children Ooi Lin works with are medically fragile and some families chose virtual schooling rather than in person attendance out of concern for the safety of their child’s health. Access to technology and the ability to use available platforms has made virtual physiotherapy services an option.

I asked Ooi Lin what advice she would pass on to physiotherapy colleagues who may be considering providing pediatric care in the community. She emphasized the importance of always building a relationship with families. Strong working relationships are essential when discussing sensitive topics like introducing a wheelchair. It is also essential to remember that family is a key part of the team when problem solving or decision making as parents know their children best.

All children have the right to an education and inclusion. How each child learns or what they need to succeed will differ. Ooi Lin feels that physiotherapists have a supporting role to provide what is needed so that the child can succeed. She encouraged physiotherapists to watch and learn from children. Peers are naturally inclusive at a young age. Other children in the classroom will often come up with the best ideas for how to include everyone in the class. Ooi Lin remembers many recesses and gym classes where a friend came up with an idea of how to get the child with a disability to participate. Finally, she stressed the importance of collaborating with your team as each discipline provides a different lens on the situation.

“I have great respect for my colleagues and school/community partners,” says Ooi Lin. “I am so lucky to have opportunities to collaborate and problem solve with professionals who are also passionate about inclusion and care about the success of each child.”

Community pediatric clients are constantly changing, providing professional challenges and ensuring that practice never becomes stagnant. Ooi Lin feels it is an honour to take a few steps along side each family as they travel along their unique journey with a child with a disability.