Pediatric occupational therapy improves the areas of fine motor, visual perception, and cognition through purposeful everyday activities. The areas addressed include hand skills, sensory function, eating, self-care, social skills, and play/leisure skills.

NEWS-Line.com's feature article "Creating Therapy That Keeps Up With Kids"

Helping Children and Their Families Overcome Challenges
by Angela Havrilla

A startling childhood experience led Patricia Delaney, OT, to her current career as a therapist and the future education coordinator at TheraPlay Incorporated in West Chester, PA. When she was 13, her grandfather was flung 20 feet from a tree he was cutting with a chainsaw, shattering his pelvis in four places and dislocating his elbow. "The trauma he went through was so vivid to me," she recalls. "Here was this six-foot-two-inch man who was very strong and stoic, and to this day, I have never ever seen him cry like that."

After the accident, Delaney's grandfather was in the hospital during his rehabilitation. He was started on a tilt table, but initially fainted or vomited whenever he was placed in an upright position. For two harrowing months, he made little progress. According to Delaney, her grandfather "really was losing heart for what was ahead d of him, and what kind of life this was going to mean for him."

Then one day, an occupational therapist began to work with him.

"I'll never forget her because she was my size, and I was 13. She was tiny and he just towered over her. He said, 'I can't even sit up,' and this OT just replied, 'What do you want to do?' and she really got into what was meaningful for him. The OT made small, meaningful goals and told him how the therapy was going to get him to where he wanted to go -- not just because it was an insurance goal or in order to discharge him," Delaney says. Her grandfather's OT took the time to learn about his hobbies, one of which was photographing lighthouses, to motivate him. "The OT said, 'This is how we can get you into a chair so you can ride in a car to get to your lighthouse.' and he started getting this whole inner drive to be more than what he thought he was going to be."

Eighteen years later, Delaney says her grandfather does many things for himself -- including yard work. "I think a lot of his inspiration came when the OT just broke things down into something very basic, very simple, and very real for somebody who just saw the world as so challenging, and saw what was ahead of him as being so unreachable."

From that point on, Delaney wanted to become an occupational therapist and began volunteering in hospitals and working in physical therapists' offices during summers throughout high school and undergraduate school.

She graduated from Arcadia University (then Beaver College) in Glenside, PA, in 1994 with a Bachelor of Science degree in biology and a minor in psychology. When she pursued her Master's of Science degree in occupational therapy at College Misericordia in Dallas, PA, Delaney was living in Connecticut because her husband was in the military. She drove five-and-a-half hours and approximately 450 miles to Misericordia every other week for a weekend master's program -- and continued to do so for three years while also working full time in the OT field. When Delaney and her husband moved back to their home state of Pennsylvania, she finished her master's degree studies by completing her affiliations.

"My last affiliation guided me toward TheraPlay Inc., where I work now," she says. "The woman I was working for at the time suggested giving them a call because there was not enough work at her practice. I sat in her office and set up an appointment with TheraPlay, after my mentor called and said to the owner, Lisa Mackell, 'Hey, I have this student who wants a job.' Then she just handed the phone to me, and Lisa said, 'I hear you want a job: let's set up a date.' We set up a date and that's kind of how it started," Delaney recalls.

That seemingly casual beginning launched her career at TheraPlay as the facility's first full-time OT in February 1999. Prior to that, two OTs put in several hours per week. "In the beginning, Lisa Mackell said, 'I have cases I can give you, although it's not going to be all here [at the office] but as long as you're willing to put in what you need, we'll make it work and build an occupational therapy department that works five days, 40 hours a week.'" Delaney explains.

TheraPlay, Inc., serving children from birth to 21 years of age, has an office in Horsham, PA, and a main office in West Chester, PA. TheraPlay treats a broad spectrum of pediatric disorders and injuries by incorporating play into therapy sessions.

"I think the first two weeks I was there I must have done 19 evaluations a week," Delaney continues. "It was amazing. I worked in Philadelphia in very [economically] challenged areas, with a lot of really wonderful families. I'd drive back to the office from Philly, then treat children at the Malvern office [the former location of the West Chester office]. I started out with a couple of kids on my caseload, and then it just kind of grew to the point where I couldn't get back out to Philly because the demand was getting very high at the [Malvern] office. It blossomed from there and now we're up to about five to six full-time OTs in our offices, and that was something we didn't foresee."

Delaney is impressed by TheraPlay's team approach, in which therapists across different disciplines collaborate to treat children. Although children come to TheraPlay for numerous reasons, many of the children Delaney and her colleagues see suffer from autism or autism spectrum disorders. "I would say at least 40 to 60 percent in our West Chester office and 60 to almost 70 percent in our Horsham office have a diagnosis somewhere in the autism spectrum disorder (ASD) range," she says. "We're working with children with poor central integration, and so we provide the sensory integrative therapy component to enhance their learning. We help them to better integrate information from their environment so we can help move them into the more abstract thinking, problem solving, and motor planning components of learning. The biggest piece that is affected in children with poor integration is their engagement with others. Although this deficit typically is associated with this diagnosis pattern, we can help kids move beyond it. Our social development skills groups offer some of that experience, although we may be doing one-on-one [at] first before they're even ready for group experience."

Although a diagnosis of autism or autism spectrum disorder is devastating for parents, Delaney dwells on what the children can do, rather than their deficits. "We don't enjoy labeling children:I'm not in that business. I'm in the business of moving them toward a greater function. I'm in the business of having the families learn to love their child for who they are, and develop them to their potential, whatever that may be."

Delaney, who is currently TheraPlay's West Chester center manager, will be assuming a new position educational coordinator. "I've sort of spearheaded going out into communities and doing a lot of consultations," she explains, "and have gotten really involved -- whether it be in schools, daycares, or even [with] behavioral health support professionals." Delaney began conducting in-service lectures as a natural result of parents asking her to speak to their children's teachers. "A certain parent will pay for me to go to their child's school and the teacher will say, 'I think everyone would like to know this.' So the next teacher in-service day, they ask me to come and speak to other teachers. Now I go to a couple different things annually that they ask me to do. I'll come in and give them a background on what they want to know, whether it be for two hours, three hours or 45 minutes," she says.

In her new role, Delaney will send various staff members of TheraPlay, including herself, into the community to educate teachers, doctors, daycare workers and any other interested individuals.

"Education is something the community is grappling for. They're looking for someone to help give them real functional pointers," she notes. "They say things like, 'As a teacher, what can I say to a parent when I've tried X, Y and Z?' or, 'So you're telling me this certain thing: what do I do with that?'"

Delaney is confident that she and her colleagues will be able to give professionals and family members the off-site help they need. "We have a ton of resources within our four walls at TheraPlay. We have PTs and OTs and speech therapists. We also have teachers on staff, and I say to teachers, for example, 'Have them [families] come in if they are concerned, and let's find out what's going on.' Or we'll give the parent a phone call and we'll talk with them and see what's going on that way. It's really great that there are people out there who want to learn so much." Delaney says she loves educating, and if her alma mater were not so far, she would enjoy being an adjunct professor there. "Being an adjunct professor may not be the thing that's going to happen anytime soon," she adds, "but I know I can do education in the community in which I live, so that's my emphasis right now before I get to those other kinds of levels."

She plans to devote certain times during the week to specific tasks that will come along with her new role as educational coordinator, but will also continue seeing patients. "My hope is that I never leave the patient environment. I think my skills and my true love are there, and I don't want to become someone just behind a desk that orchestrates things.

"I get very vested in the kids that I work with," she continues, "even though with the team approach at TheraPlay, we may not always see the same child each time. I'll inevitably have two or three parents a week that will come to an emotional _expression of some kind and want to share that with us. I love being part of them saying, 'Oh my God, I can't believe he is now enjoying this or that; I wish we would have found you guys earlier.' Or maybe, 'He's told me how much he enjoys being here and I'm seeing progress in school, where the teachers are writing notes back, saying, "Who is this kid?"' Those are the things I love hearing. You don't get those comments every day, but you get them quite often and when they do come, you just have to be in that moment and be there for that parent, because this is their whole life."

She also says her experiences with these families enhance her relationship with her own 15-month-old son. Delaney, who is also about four months pregnant, empathizes more deeply with the parents she sees now that she is one, too.

"This is a part of them that's been challenged," she says of parents who must watch their children struggle with a disability or problem. "This is part of them that they see in pain, and this is part of them pining away to be something more than what they are. Then, when the children finally feel they are moving forward and they start having a better attitude about themselves, the parents have a better attitude about themselves. The parents feel more weightless, and not as heavy -- and that's my job. That's what I love doing."