It’s fashionable these days for occupational therapists (OTs) to explore non-traditional roles that don’t involve direct patient care. A colleague even asked me a few months ago, “Have you had any roles other than being a clinician?”
I replied that I started out my career by diversifying into different occupational therapy-related jobs. In my first year of work, I only saw patients for two days in a week. I spent the rest of the time supervising interns, coordinating with special education teachers, and assisting with program development in a school setting. It was only a year after that that I handled patients directly for five days per week. Later on, I dropped one day of clinical work to be a program consultant at an inclusive school. I went back to being a full-time clinician only at the height of the COVID-19 crisis. Moreover, my graduate degree is in international health, a subspecialty within public health. I even wrote in my application essay that I wanted to research school health promotion.
My School Struggles
I have a great interest in school-based practice because the social determinants of health (SDH) in educational institutions have a significant impact on the health outcomes of students with disabilities. To a certain extent, the SDH are more powerful than medical conditions. They can either build up or destroy even neurotypical children. I can attest to that because I myself was often miserable in school.
People thought that I was okay, but I wasn’t. And in many ways, I couldn’t blame them. On the outside, I was the epitome of an excellent student. I was either number 1 or number 2 in class for much of elementary and high school. My conduct was stellar. I joined lots of extra co-curricular activities and was overall a popular kid.
The truth though is that I struggled to concentrate during lectures. I was frequently daydreaming or observing my classmates. This badly affected my performance in math, wherein the primary style of many of my former teachers was to teach procedures on how to solve problems while allotting limited time to expounding on the concepts behind the solutions. Apparently, this teaching method was effective for a lot of students. But not for me. I would often try to refocus during class only to find myself at a total loss about how the math teacher went from point A to point B. Unfortunately, math lessons build up on each other. Since I couldn’t understand the previous lesson, I was often befuddled by the new ones.
To survive math, I aced the assessments by imitating procedures I didn’t understand whenever I encountered math problems that were somewhat similar to the examples that teachers used in class. But getting stumped by so many unfamiliar math problems eroded my confidence to the point that I became increasingly anxious whenever I saw numbers.
My math anxiety impacted my performance in chemistry and physics too. Smart kids are supposed to be good in math and in science, which made me feel stupid all the time because I wasn’t the best in them. I constantly had crying bouts at home whenever I couldn’t solve problem sets. The more I felt that I wasn’t good at math, the more I refused to practice solving problems.
What made things worse was that my pride wouldn’t let me be anything less than number 1. I was never obnoxious towards my competitors in the honor roll. In fact, I was helpful even to those who were vying for honors. But I hated not being the best. Moreover, I felt pressured to hang on to the attention and the privileges showered upon me as an honor student because they were necessary for my future. I needed the more rigorous curricula, competitions, science camps, and extra co-curricular activities that were unavailable to average students because they would help me get accepted at a top university.
Passing the most difficult college entrance exams would boost my ego. But more than that, an in-demand degree from a reputable university would increase my chances of getting a stable job. Becoming financially stable meant that I would be independent. I was desperate to get to that place, as I was fed up with people dictating what I should believe and how I should act so I could prop up their image. I was also anxious to get a degree that would allow me to work abroad so I could escape the Philippines.
Consequently, studying became more like running endlessly on a treadmill rather than the joy of discovery that it was supposed to be. I would start every school day longing for dismissal time because I dreaded my classes. Besides, the more I felt that I wasn’t good at a subject, especially math, the more I refused to study it except at the last minute. That’s why by the time I was in college, I had limited attention span, poor frustration tolerance, ineffective study habits, and severe math anxiety.
Seeing the Big Picture
Yes, there are those who thrive in our current schools. But there are also many Filipino students who are like what I was, as evidenced by the Philippines’ poor global academic performance. They may be neurotypical like me. But the different social determinants of health (SDH) in their settings could be causing a mismatch between their needs and what schools can provide. And if it’s difficult for typically developing kids to thrive in academics, imagine what a torture schooling must be for many children with disabilities.
Engaging in school-based practice allows me to see in real-time how various contextual factors lead to academic, physical, and socio-emotional challenges. It also gives me tools for addressing school-related problems both at the individual and systems levels. So, I can say with confidence that OTs can address the SDH without forcing occupational therapy to become a dumbed down type of public health.
(Photo by Element5 Digital)
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