Occupational Therapy at Genesis

Occupational Therapy (OT) has been referred to at Genesis as the missing piece in the healing puzzle, but it may be hard to understand what Occupational Therapy is just based on the name. When you hear the word “occupations” you are likely to think about employment. When Occupational Therapists talk about occupations, they are referring to a person’s functioning, life duties and interests like cleaning, helping your child, engaging in self-care and establishing routines.

Occupational Therapy helps individuals maximize and re-engage in their meaningful everyday occupations to increase independence, self-empowerment and motivation to complete daily tasks. We can look at occupations in two main categories:

1. Activities of Daily Living (ADLs) – Certain activities we all do as part of our daily routine for basic survival, like eating, personal hygiene, meal preparation and play.
2. Instrumental Activities of Daily Living (IADLs) – More complex but still necessary activities to your daily routine, like leisure, forming healthy morning & night routines, cooking, laundry, managing finances, medication management, etc.

We all know people that have had a severe disruption to their daily occupations such as a stroke, traumatic brain injury or another sort of disability. There is also a major disruption in the daily routines for survivors of domestic violence that you cannot always readily see. These survivors, often women and children, are left disempowered and unable to re-engage in their necessary occupations due to trauma, isolation and decreased independence.

The most basic tasks can be daunting or difficult for the women and children that have experienced violence at home – for example, not knowing how to create a budget or pay bills due to financial abuse or children not being able to concentrate on schoolwork or engage in healthy peer relationships and social interactions. At times, their brain can be in a state of hyperarousal, constantly telling their body that they are in a state of danger which causes emotional and physiological reactions to keep them safe from the perceived threat. On the other side, survivors can respond to trauma with hypoarousal by dissociating, or “separating brain from the body.” There is no engagement with the present, and often a feeling of numbness is noted with accompanying negative emotions like hopelessness and despair.

At Genesis, Registered Occupational Therapists (OTRs) work with clients’ needs based on their unique circumstances to create custom treatment plans using the four pillars of Occupational Therapy – health management, routines & habits, communication and life skills. Our role is to empower survivors to re-engage in these routines while providing holistic, individualized and trauma-informed care. A specific goal in Occupational Therapy is finding balance between those states of hyper- and hypoarousal in what we call a window of tolerance. Staying in their window of tolerance can help women and children remain in the present to complete their occupations and process their trauma. We give clients practical tools to return to their window of tolerance when triggered and we work to slowly increase their window so that they can have continued, more effective engagement in their daily occupations.

Genesis Women’s Shelter & Support has a long history of providing trauma-informed counseling and advocacy services to survivors of domestic violence. In our quest to continue being thought leaders in the field, in 2021 we began a pilot program to provide Occupational Therapy to our clients. We quickly saw how OT connected the mental health and temporal needs of the women and children we served. Occupational Therapy became a vital piece of the puzzle in helping our clients heal from the effects of abuse, addressing developmental delays we commonly see in our children who have grown up in a violent home and helping women in all areas of her daily functioning like household chores, mothering responsibilities, employment, relaxation and social connections.

In the medical world, when someone wants Occupational Therapy services, they are required to obtain a referral from a physician as well as a diagnosis which might involve long wait lists, insurance coverage or high costs. At Genesis, we are proud to provide Occupational Therapy services free of charge and with no referral or diagnosis required. Instead, the client’s Genesis treatment team members can connect the client to an Occupational Therapist at Genesis for an initial assessment and treatment plan – some clients may also benefit from an at-home plan to utilize between appointments. When the Occupational Therapist works with a child client, the child’s mother will also be included in treatment to help ensure the success of services and a continuum of care from the office to home.

Occupational Therapy appointments may include the utilization of the Genesis Sensory Room where clients can engage in sensory-somatic experiences (playdoh, aromatherapy or texture boards) and movement therapy (jumping on the trampoline, rocking in the rocking chair, dancing to music) to help them regulate their nervous system. Helping clients experience true relaxation or rest and emotional safety increases their ability to effectively carryout their occupations.

As our clients engage in Occupational Therapy, we have seen a decrease in trauma symptoms such as nightmares, depression, anxiety and avoidance as well as an increase in their self-esteem, safety and ability to function after trauma. Since Occupational Therapy was added as a service to our clients, we’ve been able to witness critical steps towards healing like:

• Helping a little girl strengthen her fine motor skills by learning to hold a spoon the correct way which resulted in her being able to feed herself, giving time back to mom and improving her academic success in handwriting skills.
• Teaching a young boy with Autism to sit in a chair without falling out and utilize coping skills to help regulate his emotions, thus decreasing temper tantrums due to an overload of sensory input.
• Providing education on Traumatic Brain Injury and connecting that client to an outside resource where she was able to receive a cane and can now safely walk independently without tripping, which had been the result of an incident of physical abuse.
• Hosting a craft group where clients were able to practice building a safe support network with each other and found new ways to relax and take their mind off the abuse they have suffered.

The future of Occupational Therapy at Genesis is endless. Because of the results seen initially, we are excited to expand our Occupational Therapy program, constructing a Sensory Room at our residential campus for our shelter residents to receive onsite care. As the first domestic violence agency to offer onsite Occupational Therapy services, we want to encourage other agencies to integrate Occupational Therapy into their programming. With this in mind, Genesis is working on an Occupational Therapy Manual to provide a model of treatment and instruct agencies on how they can set up a Sensory Room.

We take great pride in offering Occupational Therapy to our clients at no cost, so women and children experiencing domestic violence don’t have to worry about waiting lists or visit fees. As the missing piece in the healing puzzle, we are one service closer to providing women and children with the most holistic, trauma-informed care possible.