Angela Fuentes, OTR/L, BCTS: OT in Telehealth with Refugees & Immigrants in Schools
In this post, we will be learning about an occupational therapy practitioner working in Telehealth with Refugees & Immigrants in Schools. You will hear from the personal and professional experiences of Angela Fuentes, OTR/L, BCTS. Angela is a Board Certified Telepractice Specialist and has a Practice Area of Emphasis in Schools from the National Board of Certification for Occupational Therapy. Most of Angela’s OT experience has been with diverse populations and she is currently developing her practice with refugees and immigrants. She is a scholar of the Framework of Occupational Justice and is committed to evidence-based practices in diversity, equity, & inclusion, and teletherapy. Angela is currently working towards certification as an Assistive Technology Professional from the Rehabilitation Engineering and Assistive Technology Society of North America to better help students with learning differences leverage technology for reading and writing. She holds a Master’s in Occupational Therapy, a Bachelor’s in Psychology, and a Bachelor’s in Health Science from Cleveland State University
Q & A with Angela:
Please tell us a little about yourself and a few favorite occupations.
I have been an OT for almost 4 years and am a graduate of Cleveland State University's Master of Occupational Therapy Program. I was born and raised in the city of Cleveland and most of my OT practice has been in the city and surrounding areas, working with diverse populations in skilled nursing and home care. In the past year, I have transitioned to school-based practice and am really excited about using teletherapy to promote equity and access to OT. I feel so fortunate to have found a profession that aligns with my personal values and I love to further my learning in the field. When I'm not OT-ing, I enjoy reading, restaurants, nature, film, and music.
What motivated you to contribute to this series?
I think the time has always been right for OTs to support refugees, immigrants, and other displaced persons, but NOW is more important than ever. According to the World Federation of Occupational Therapy, there are less than 3,000 OTs who work with displaced persons yet there are currently over 70 million displaced persons throughout the world. And the numbers are only growing - especially as the climate crisis continues. I hope sharing my experience can help encourage other OTs to seek work with displaced persons or to help them feel prepared when displaced persons find them.
Please describe the UncommonOT work that you do and the setting in which you work, the population you serve, and the needs that you address.
I work full-time as an OT hired directly by a charter school management company in Ohio that has 16 schools spanning the state. Charter schools are uniquely common in Ohio as many school districts have failed to produce positive outcomes for students, especially in impoverished rural and urban areas. About 1/4 of my caseload is in-person but the majority is virtual. Although I was hired to do teletherapy during the COVID-19 pandemic, the school system has sought to employ remote specialists prior due to significant staffing shortages in special education. I was assigned to one of the company's schools in the city of Columbus that has a student enrollment of 98% Somali refugees and immigrants. As I was signing on with the company, this school had been receiving direct support and oversight from the state so a portion of my work involves internal monitoring and compliance initiatives. I work with students from kindergarten to high school who attend school in-person (with social distancing and masking). I also work with school staff who facilitate the virtual sessions. The student needs I address include functional fine motor, sensory processing, executive function, social communication, behavior management, reading and writing with assistive technology, pre-vocational skills, and leisure and work exploration. Much of my consultative and interdisciplinary work involves promoting trauma-informed care, routine and environmental modifications, cultural responsiveness, and inclusion.
What inspired you or drew you to this type of OT work?
Since undergrad, I have been interested in diversity and multiculturalism and how it affects access to care. Before that, I knew I wanted to work in therapy as a kid when I saw my younger brother receive home-based therapy for his disability and my mother, who was a nurse, thought I’d make a good OT. I have always been a sensitive, introspective person which I think are my greatest strengths in working with diverse populations. Also, being from a multicultural family with diverse abilities gives me a passion for this work.
How did you get there? Can you describe your path?
Getting to my current work was part luck and part self-marketing. I greatly credit my experiences at Cleveland State University and the professors who exposed me to non-traditional and emerging OT work early on. I was fortunate to have worked with Dr. Karen Keptner for my Master's research project which involved developing and providing a community wellness program at the Indian Health Service's Northern Navajo Medical Center in Shiprock, New Mexico. This also led to a poster presentation at the 2018 AOTA Annual Conference called, "Working with Navajo populations: A model for occupational therapy". Another formative experience was getting to co-lead a pilot OT group at the U.S. Committee for Refugees and Immigrants in Cleveland, which was a part of Dr. John Bazyk's initiative to develop a level I fieldwork for OT students working with refugees and immigrants. I was also lucky to have had Dr. Sue Bazyk as a professor for school-based practices. Aside from my professional experience, I was also drawn to volunteer work for refugee and immigrant support services with some amazing local non-profits (The Hope Center and Global Cleveland). These agencies gave me great training and real-life experiences to inform my clinical practices. The current job I have did not advertise work with refugees and immigrants, so I had no idea I was going to get this opportunity until after I was hired. Had I not highlighted my volunteer and non-traditional academic experience along with my professional experience, I don't think I would have been given this opportunity.
Please describe a typical day or OT session in your uncommon setting? What OT skills do you utilize?
A typical day almost always starts with communication with the onsite staff member(s) who will facilitate virtual sessions. Last year, the school’s administrative assistant, secretaries, and some teachers facilitated sessions by either “active” (or direct) facilitation or “passive” (includes line-of-sight or back-of-class) facilitation depending on students' needs. Communication with these personnel is ongoing in various forms and involves coaching to ensure the set-up of materials and technology, tactile or behavioral cueing/reinforcement, and continual refinement of services. With younger students working on functional fine motor skills, I usually plan my sessions with a mix of interactive digital activities and tangible table-top activities. With elementary, middle school, or high school students working on literacy, writing, self-regulation, executive function, or work/leisure, sessions tend to be more digitally oriented. I often therapeutically use Read & Write for Google and find it effective for this population, especially for using visuals, text-to-voice or voice-to-text, and word prediction to overcome language barriers and promote literacy skills. I almost always use concepts or materials from The Zones of Regulation with all students. I often correspond via email with teachers for consultation and assessments and promote virtual office hours for live screenings. I work closely with our administrative assistant who serves as a “cultural broker” with families as mistrust of outside community members is a common barrier to service provision. When planning and conducting assessments I have to be very mindful of what assessment tools lend themselves well to ELL students, are contextually relevant based on the students refugee or immigrant history, and can be administered virtually.
Can you talk about some recent highs (successes) and lows (challenges) of your current role?
A great high point of last year was working with our administrative assistant, who is Somali American and speaks multiple dialects, to service students in their homes during a prolonged school shut down due to community transmission of COVID-19. He worked tirelessly to ensure the distribution of Chromebooks and to be a liaison between the community and the school. Without him, it would have been impossible to overcome the barriers of mistrust and language to provide instruction and related services. I think the bridge he built between the community and school personnel during that time will continue to last. I’m also excited to have improved access to professional Somali interpreters this year and to hopefully observe the positive effects of a company-wide teletherapy service program I developed over the summer. Also, our special education team has grown since I started and includes highly skilled remote staff that are committed to this work. Despite this growth, staffing continues to be a challenge with turnover of teachers and makes my work more effortful. The internal monitoring is uniquely challenging and points to an added layer of systemic oppression - anti-oppressive and culturally responsive efforts are a requirement of all disciplines.
How do you continue to learn in order to stay on top of things within your role?
I LOVE this question because I think continual learning is critical in working with refugees, immigrants, and other displaced persons - the field of diversity, equity, and inclusion (DEI) rapidly evolves and applying principles of practice takes a lot of self-reflection. A huge resource for me has been the WFOT’s newly launched, free self-paced course called, “Occupational Therapy: Working with Displaced Persons”. I’ve also benefited from AOTA’s free CE webinar called, “Local IS Global: Occupational Therapy in U.S. Refugee Communities and Abroad”. I also recommend checking out “A Home Away From Home” which is a manual for OTs working with refugees available online. I’m a member of AOTA and the Coalition for Occupational Therapy Advocates for Diversity (COTAD) and follow these and many other OT organizations on LinkedIn to get current, quick, and informed practice resources and strategies. Using LinkedIn has also helped me connect with other OTs who do similarly non-traditional work and OT in DEI. To do this work well, I think it’s also important to go beyond professional resources and expose yourself to a variety of mediums. Some incredible films I recommend for learning about refugee experiences are “God Grew Tired of Us” and “Life Overtakes Me”. I’ve also found a lot of personal enlightenment from some unlikely books I’ve read for leisure including, “Talking to Strangers” by Malcolm Gladwell, which helped me examine my biases, “The Selfish Gene” by Richard Dawkins, which helped me learn to communicate complex OT theories to parents and teachers of various educational backgrounds, and “Pleasure Activism: The Politics of Feeling Good” by Adrienne Maree Brown, which helped me think about burnout in a proactive way. I also love to look for art made by refugees and immigrants since I think it can often tell stories better than words alone.
Can you share a little bit about salary and compensation in this setting? How do OT or the services you provide get funded?
I am employed directly by the charter school management company and am paid a salary along with comprehensive benefits and access to the State Teachers Retirement System of Ohio. My company pays a competitive salary and does not use a tiered pay scale.
Any career advice for our followers and listeners on how to get started on this path?
I recommend getting in touch with your motivations for doing this work. Connecting to what ignites you will be imperative to overcoming burnout. If this is a struggle for you, I recommend a meditation practice. Also, I cannot emphasize the benefits of volunteering enough!! If you're a student, volunteer as tutors with your classmates. If you're an OT balancing work and/or family, know that simply getting lunch with a refugee can transform their outlook and foster resilience against isolation or discrimination.
What’s a common myth or misconception about your job/role you’d like to call out or demystify?
In working with refugees, immigrants, and other displaced persons, I think many OTs falsely think they don't have the skills to do so or won't ever work in "that setting". The reality is, OTs have always been skilled to work with displaced persons, but may just need more conscious dedication to DEI. Displaced persons are all over the country - they are our neighbors in rural and urban communities, go to outpatient clinics, receive home-care and inpatient services. Many of us may have already worked with displaced persons without even realizing it. As a tele-OT, I work to dispel the myth that virtual OT can't be done or that it is less effective than in-person service. There is a lot of strong data that supports the effectiveness of teletherapy and its use for overcoming inequity in disadvantaged populations. Last, before my current job, I had falsely believed OTs in schools were underpaid and was surprised to find my salary was comparable to other settings.
How do we find you, follow you, be in touch with you, and promote your unique work?
Follow me on LinkedIn! I am eager to connect with OTs of all experience levels interested in this work.
RESOURCE LIST:
The Kawa Model: Culturally Relevant Occupational Therapy by Michael Iwama, 2006 https://www.kawamo del.com/v1/about/
WFOT online module, Occupational therapy: working with displaced persons https://www.wfot.org/resources/occupational-therapy-working-with-displaced-persons
IBCCES Board Certified Telepractice Specialist https://ibcces.org/certifications-telepractice/
AOTA Webinar, Local IS Global: Occupational therapy in U.S. Refugee Committees and Abroad, presented by Yda J. Smith, PhD, OTR/L https://www.aota.org/AboutAOTA/Membership/join-webinars-contact-hours.aspx
University of North Dakota Occupational Therapy Capstone, A Home Away from Home: An Occupational Manual for Working with Refugee Populations by Katherine Erickson and Keri Kjergaard, 2017 https://commons.und.edu/ot-grad/349
Mentors:
· Dr. John Bazyk, MS, OTR/L, Professor Emeritus at Cleveland State University
· Dr. Sue Bazyk, PhD, OTR/L, FOTA, Professor Emeritus at Cleveland State University ("LeBron James of School-based OT")
· Dr. Karen Keptner, PhD, OTR/L, Associate Professor/Doctoral Capstone Coordinator for OTD Program at Cleveland State University
As always, I welcome any feedback from all of you or if you are interested in being a guest on future episodes, please do not hesitate to contact Patricia Motus at transitionsot@gmail.com or DM via Instagram @transitionsot
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