Alumni Profile: Shannon Evenson
I can remember it like it was yesterday: sitting in ‘Intro to Occupational Therapy’ in the Medical Sciences building the first semester of my freshman year at the University of Wisconsin-Madison. You would think a relatively self-assured, good student would breeze through a 1 credit intro class, but I was panic-stricken. What was this “practice framework” supposed to mean? How can one profession—one therapist--incorporate the mental, physical and spiritual strengths and needs of an individual and consider their environment, their family history, their routines, rituals and traditions? It seemed too big, too “pie in the sky,” too theoretical. It would surely take nearly ½ day to evaluate and treat someone if you were to really address all those areas! What does that look like on a day to day basis in a clinical setting? Can I really do this?
Luckily the answer was “yes.” As I continued through the curriculum, the terminology became common-place in my vocabulary. The theories and frameworks we base our practice on became clearer and clearer. When the time came to start requesting internship sites, I was not afraid anymore, I was excited; ready to apply all this knowledge to help people live the fullest lives possible. Then one day after a humbling splinting lab, my class was introduced to an Army recruiter. She spoke to us about an opportunity to complete the OT internships at Walter Reed Army Medical Center, Washington, D.C. I compared the opportunities and decided it was a good fit for my family and my career. I have since worked in outpatient hand clinics, in-patient wards and both out and in-patient behavioral health programs for the Army. Never before had it become more apparent to me, the importance of considering all of those client and environmental factors. I have found that no matter the practice setting, the person always comes with more than one area of need.
When I was practicing in an upper extremity orthopedic clinic out of Fort Campbell, KY, soldiers seeing me for arm injuries sustained in combat were also presenting with cognitive and behavioral symptoms. Some had self-awareness of this, some did not. In either case, as we built rapport through the course of our range of motion sessions, soldiers would begin to talk about the things they saw in combat and how it was effecting them now that they were back home. Participation in activities of daily living were not only impeded by the soldier’s physical injuries. The psychological impact of combat was also presenting as a barrier. In some cases where there was exposure to blast, mTBI symptoms also had to be considered. I would make the appropriate referrals to the primary physician for further evaluation and clarification of orders to begin treating not just the hand or arm, but the whole soldier, for help with cognition and symptoms of PTSD.
Similarly, in my current role as a behavioral health officer on a Combat Stress Control team, I find that soldiers who would normally shy away from seeking behavioral health treatment here in Afghanistan will allow me to relate to them regarding orthopedic injuries they have sustained. Again, as we talk, more rapport is built and then the stories begin. In evaluation and treatment from an occupational therapy perspective, I always ask about ADL routine because I believe it is the foundation of wellness and resiliency in a combat zone. It is difficult to establish a routine due to varying mission schedules, swing shifts, sharing living space with multiple other soldiers that may or may not be on the same work schedule, waking up to Skype/talk with family on the other side of the world and simply adjusting to a new climate and time zone. What are the soldiers mealtime habits? Sleep routine (shift work?)? Where does the soldier live? How many roommates? Do they work same or opposite shifts? What daily duty tasks does the soldier have to complete? What is the soldier’s physical activity routine? Are there any social or leisure activities incorporated into their day? We also ask about tobacco use and other medications and get a brief medical history. We must also consider the impact of multiple deployments and of course exposure to blast and combat. Based off of this information, we attempt to identify simple adjustments to routines/habits that can help support better function; better balance between work and leisure, better sleep habits and better dietary habits. We educate the soldier on how doing this will positively impact their ability to function in their day-to-day activities as well as to cope with the stressors of deployment. We also specifically teach coping mechanisms, relaxation techniques, communication techniques and goal setting.
Possibly most importantly we can do to help the soldier is gain perspective on the problem at hand, whether it be combat related, peer/leadership conflict or home front issues. Often, in times of high stress, it becomes difficult to prioritize and execute plans for problem solving. We also use a technique called “normalization” with soldiers experiencing high levels of anxiety or stress after combat exposure. We validate that the emotions they are experiencing are actually expected reactions to abnormal situations. Seeing a friend killed is not normal. Riding in a convoy that gets ambushed or hit by an IED is not normal. These are highly unique, stressful situations, thus they will elicit strong emotional and sometimes physical reactions. Sometimes the soldier must either consciously or subconsciously delay these reactions in order to finish the mission, or simply survive. We help the soldier acknowledge this, then move through phases of recovery with the ultimate goal of return to their military and civilian occupations—in the military we call this: “return to duty.”
More important than all the activity analysis, assessment of routine and soldier education is the therapeutic use of self. More often than not, I find the soldier just needs someone objective and compassionate to listen to them. We are not going to fix all their problems, but if we can give them the feeling that someone cared enough to listen, we have already done them a world of good. To truly make someone feel heard is a great skill. This does not mean nodding, smiling and telling the soldier what they want to hear. Don’t be afraid to say you don’t know the answer. Don’t say “I know how you feel” if you really cannot. Any person will see right through that. Developing a comfort level with this type of communication is a skill. It takes time, experience listening and a strong awareness of how your own experiences and beliefs act as filters in your ability to communicate. Consider this whenever you are listening and preparing to give feedback to a client. Take your time in your responses so that you may speak clearly and honestly. But if you work on honest, open listening skills and delivery of honest, appropriate feedback, this will be your greatest tool in your OT toolbox of treatment techniques.
- By Shannon Evenson