Fostering Independence is What Occupational Therapy is All About


Happy Occupational Therapy (OT) Month! April is national OT month; a word that describes OT in a nutshell is INDEPENDENCE. Occupational therapists (OTs) are professionals who help individuals reach for or return to independence following an illness, injury, or disability. 

The goal of OT is always for the client/patient/student/resident to be as independent as possible in all that they do. This is true regardless of their age, gender, race, religion, socioeconomic status, and the geographic region where they come from and live, and regardless of their illness, injury, or disability. At Sheppard Pratt, OTs work with children, teens, adults, and the elderly who are experiencing a mental illness or have a developmental disability, such as autism spectrum disorder. Sheppard Pratt OTs provide services in our hospitals (inpatient and day hospital programs), outpatient programs, residential treatment centers, and schools. Our mission is to help those we serve be happy, independent, and productive citizens as much as possible in their lives.    

What does independence look like? Well, it depends in large part on the individual’s chronological age and cognitive functioning (developmental age), but it can also depend on the severity of their illness or disability and their level of motivation. As such, independence will look and be different for every individual. 

For young children, their daily occupations (the things that occupy their time and are meaningful and/or required of them) include self-care/personal hygiene (grooming, toileting, bathing), dressing, eating/self-feeding, playing, learning, and handwriting. For older children and teens, such as those at the Sheppard Pratt School in Gaithersburg, we add caring for their clothes (laundry), preparing food (snacks, drinks, their lunches), classroom tasks, computer tasks like typing/keyboarding, and vocational activities to their day. For adults, we also focus on working, managing a household (cooking, cleaning, paying bills), and/or parenting as part of their daily occupations. 

Teaching, helping, and safely letting children and teens (as well as adults) be as independent as possible with their daily occupations (letting them do as much for themselves as they safely can and not doing too much for them) is so important for many reasons.

Why is fostering independence so important?

  1. It builds self-confidence (when a person knows s/he can do something) and increases self-esteem (how a person feels about themselves). A person feels good about themselves when s/he can do something.
  2. It decreases the workload for parents/staff/caregivers and saves time in the long run. The more a person can safely and effectively do for themselves, the less help and supervision the person needs and the less time it will take.
  3. It can prevent learned helplessness, “a condition in which a person feels a sense of powerlessness or loss of control over a situation…and so the person gives up trying….can lead to prompt-dependency (when a person won’t do something unless s/he is prompted to do it), depression, anxiety…” which can be very detrimental to a person over time. Martin Seligman and Steven Maier, American psychologists, coined the term and did research on the theory in 1967 and ongoing research has continued to support their theory today. Learned helplessness can be caused when a person (e.g. parent/caregiver, teacher, therapist, nurse, educational assistant, mental health worker, etc.) does too much for another person (child/student/client/patient/resident).

How do OTs help foster independence? How can we all help to foster independence in our loved ones?

OTs are members of a team in the hospital and school settings and that is no different at Sheppard Pratt. Other members of the treatment team can include psychiatrists, nurses, mental health workers, social workers, psychologists, school administrators, teachers, speech language pathologists, behavioral specialists, counselors, educational assistants, and transition coordinators. We all work together to address the needs of the clients, patients, students, and residents we serve, and no one person can do it alone!  

The following tips are techniques all team members can use to help meet the needs of those we serve and help them grow and be as independent as possible. These can also be used in the home setting with parents and families:   

  1. Provide visuals/picture supports, a schedule, and manipulatives/actual objects whenever possible.
  2. Break tasks down into small steps. Or, adapt or modify the task for success.
  3. Give choices as much as possible. For example, hold the picture or actual objects/items and ask “do you want to do this or this?”, and/or “touch the one you want to do first” if there is more than one task.
  4. Demonstrate or model how to do something and take turns.
  5. Give the child/student/patient/client time to process and initiate the task.
  6. Use multi-sensory prompts (verbal, visual, gestural, and/or tactile) and/or partial or full physical prompts (hand over hand assistance) if/when needed. Fade the prompts and assistance over time as much as possible as the individual’s skill level/independence increases.
  7. Give praise to the child/student/patient/client doing a part of a task.
  8. Be patient…and remember, practice and repetition are key to learning.   

At The Forbush School at Oakmont Upper School, examples of fostering independence in our students in different settings/environments include the following: 

  • In the kitchen/lunchroom: start to open the student’s yogurt, bag of chips, or drink bottle/pouch, but let them finish opening it.
  • In the laundry room: put one sleeve on a hanger, have the student put the other sleeve on the hanger.  
  • In the bathroom: show the student both toothpaste options and say, “touch the toothpaste flavor you want to use.” 
  • In the classroom: ask the student “do you want to write your name on the board or on paper?” 
  • On a job site: tell the student to touch the picture of the task s/he wants to do first, such as restocking the utensils or the napkins.  

Occupational therapists at Sheppard Pratt can work with a client/patient/student/resident to foster their independence in all areas of their lives, and that is what occupational therapy is all about. It doesn’t matter what illness or disability a person has or what skill level a person is functioning at - it is a human need and a civil right to be as independent as possible in all that s/he wants and needs to do.  

Jennifer Norman Connor, OTR/L has been the occupational therapist (OT) at the Sheppard Pratt School in Gaithersburg since 2012. She has been an OT for more than 20 years, the latter half of which she has been working with children in schools. Jennifer has also worked as an OT in state psychiatric hospitals, acute/subacute care, and home health. Jennifer received her bachelor of science degree in occupational therapy from Virginia Commonwealth University in 1998.