"Ideal Daily Game Plan", Long and Short Term Goals; Tools from MY OT Toolbox for YOU

This is from something I posted Jan 3, 2011 in the forum I post in which also applies here:

Resolution List- Do you start out the New Year with a long list of things that you want to accomplish?

Here are some ideas to help you feel good about your resolutions.

1. Think big
Have two or three overall themes that guide your actions all year long. Post them up where you can read them every morning and reflect on them every evening. Give yourself a gold star for every day that you accomplish one of the big items.

Here are my personal favorites-
Speak up about the positives
Make deliberate choices
Do one hard thing every day
Set up intentions for the day before I get out of bed
Practice gratitude at the end of every day
Make quiet time for me
Be kind and honest
Before I make that snap judgment- consider I don't know the whole story
Give myself credit for what I did accomplish
Listen more than I talk
Ask more questions
Connect with friends and family

Spend more time with fun people and less time with people who complain

The second plan I have this year is to focus on one area each month. January is energy month.

I am tracking the situations and jobs that I get excited and energized to do.

I am also paying attention to the things that I ignore or put off again and again.

I am going to let that list guide how I spend my time and what things I agree to do for others. I want to learn what things are of the highest value for me and what things I need to give away or stop doing all together.

You can find this at my blog at this link, for future reference --

gpspiralcoaching.wordpress.com/2011/01/03/new-years-resolution-chart/

Thanks to Gwen for posting in January about her way of going about, and guiding clients, related to making life changes.  I'm having the wonderful experience of being able to utilize and incorporate what she's providing when working with people from the occupational therapy side, with the 'occupation of health care'. 

I thought it might be helpful for me to post an example of how I would do goals for someone if I were working with them.  I actually feel that much of what occupational therapy 'is', is common sense overlayed with logic overlayed with several years of education, most of which didn't apply to anything I've ever encountered as an OT  and then much of what I have used as an OT I found sources on outside of the educational system -- it was essentially trial by fire when I got out and so I have a lot of compassion for the medical workers and patients who are struggling and in harms way all the time.  Lumigrate is as much a commitment to help that situation overall as it is for anything related to a specific diagnosis or age/type of medical consumer.

So I encourage people who are having to do this 'self help' style to know that I've seen my family members and now my friends and their families becoming excellent health care providers and case managers.  Much of it has to do with what their life experience has been so far and a willingness to learn when given information. 

A resource I used repeatedly and I believe have sufficiently let know of my appreciation of their forward thinking related to having a catalogue and website I could direct the public to long before the bigger companies had thought of it, is a store in Denver, Colorado called The Youcan Toocan Store.  Started while I was just heading back to college to become an OT an hour away in Fort Collins, owner Martha Hanson and her daughter had the idea to start a business for the types of products families need to purchase but to not include insurance in the process because that adds a layer of complexity.  You can find what I have related to them on Lumigrate by Searching on Youcan Toocan, and I hope in the future to have a better array of information on Lumigrate to direct people to my favorite products; just as I'd set up links to my top many products their website changed and then all my links dead ended, so now you'll find I list the items I mostly recommended and let people then find that at the YouCan Toocan website.  

Also, a tip related to figuring out what a person with a specialized need requires:  Pretend you are them in terms of the physical ability, the mental/cognitive, etc.   And just like if a person is having to figure out what equipment a person needs for the bathroom, bedroom, home, community, put on your thinking and imagination caps and pretent to be that person and then go through the steps.  You'll have the strategies come to the person you are helping in a more developed way and be closer to being 'right on' or 'as good as it's going to get', which reduces frustration and increases safety and benefit to the person.  Oh, and reduces your time overall.  

Think about long term goals, then break it into what you can do in the short term to get there -- those are your short term goals.  I find I think in 'medium term goals' as well, but insurances never had us doing those. 

Example of long term goal: 

_______(name)__________ will have a team of providers i which meets needs for all body/mind/spirit medical needs by __(three months)________ . 

Example of short term goal that related to long term goal:

In one month ______(name) will have identified a primary care or specialist physician / provider and had first appointment and asked for suggestions for the other types of providers ________(name) is seeking to add to their health care team.  

Another long term goal might be: 

6 of 7 days a week _________________name will meet nutritional goals established with them and nutrition consultant.  Medium term goal might be they're doing that 50% of the time in one month and short term goal is they're hitting the benchmark one day a week at the end of two weeks.    

You can see where that goal can get broken down and overlaps into components related to shopping or acquiring groceries, budgeting of monies, etc.   

I like to keep the goals simple when written and I very much support what Gwen writes related to having them written out out where everyone sees them.  One of my friends said that she's moved to storyboarding for her goals -- she clips things out of magazines and then makes a collage essentially.  That can engage the right / creative side of the brain and be more visually stimulating and appealing to people. 

That's probably a good breaking point on this topic, so I'll leave off here.  I look forward to getting feedback on this from people.  As Maya Angelou says, "when you know better, you do better."  As I say, "Live and Learn! ... Learn and Live Better!!".  Good wishes your way on that journey for yourself or those you assist ~~ Mardy

 Yes on the trust your gut / intuition --- when I was working as an OTR in a PT clinic within a fairly large allopathic medical building in Grand Junction, CO, the first MD I marketed to (as I contracted there and had to create my own referrals and get the word out about the new service in the 20 year old PT clinic which was not 'therapy' but 'physical therapy' in the name -- talk about an uphill battle) said he needed not a general OT like what I was advertising -- he needed a clinic for PT and OT that understood how to help all the patients referred to him for autoimmune. I thought 'how easy and meant to be is this?' ... well, the clinic's management/ownership did not want a lot of patients with fibromyalgia --- they historically no showed, were difficult to deal with, etc. 

So that went on for two years, in the mean time I worked with the 'neuro' patients they referred to me --- post stroke, Parkinsons, MS, and then got a great hand-therapy experienced COTA on board, so we were very busy, and word was out about us. I had surgery at the end of 2006 and things got a big bungled by nursing with medication errors and I was there 2x as long as I should have been. My mind was blown at how I'm educated about the medical system and how a hospital works, chose the best hospital in town for my needs, in a city with a reputation of having better outcomes and lower costs (and is the home of health care reform's infrastructure from way way way back --- study Agenda 21 and education reform ... I have both of those on my website and there's a search bar, Lumigrate.com.... ). I was SO mad when I finally cleared and could ask for/demand discharge orders immediately that I remember the voice in my head saying "someone has to do something about this, what happens to other people in ordinary cities and with ordinary knowledge?" Within a month I was in a business planning / entrepreneurial class AND had seen my first patient with a FM diagnosis -- she was my very FIRST new patient after the surgery, and the first for the new calendar year of 2007. 

She had good insurance, she liked coming to see us, she never no-showed, she was willing to try PT, she was willing to go to the building's chronic pain specialist PhD psychologist -- who was so excited at her outcome that he suggested we do an education group together in the building. Since I had this one patient make us all revenue, no loss of productivity from a no-show, no crying, no whining, etc... I thought it was the time finally I'd get to do what the first MD 2 years ago had outlined for me on a paper over lunch --- all the providers people with FM need to go to and just keep going to year-round. She actually was a patient of the same pay as you go MD that I had been very helped and harmed by --- he just is hit and miss. So I presumed once she did well with us, he'd refer more patients. Did not happen. The lessons I was learning in that you can't rely on the doctors to refer you to others who are going to help you if it makes you less reliant on them. She'd gone to the MT near his office, and somehow that MT had heard about me ... that there was an OT with FM in the clinic I was at. (In the mean time for a long time I also worked PRN in home health to make ends meet until the time of hiring the COTA for hand therapy). 

So the first thing I'd do with the flow of patients which came after that --- it was interesting, as it wasn't because of her talking to people, nor was it from the doctor -- it was like everyone just heard about me in various ways -- was to teach them mindful breathing / meditation. You have to do some treatment on day of eval you cannot just eval, which is too bad because to get a whole history of body, mind, spirit on a person you need a whole appointment. So I'd get them started right away on meditation because it got them honing their connection with 'gut'. And I'd plan on seeing them about a month and lessen their load as by then they'd be going to PT and behavioral/ mental health too ... so by then they'd had all those days to be improving and having someone ask them 'how's your meditation time doing?' And I'd be able to document improvement in that goal and insurance payors never declined anything I did. I actually worked in all kinds of skilled nursing and even in a building with 100% focused medical review and was never denied a claim --- I'd be sitting there many nights with the PT and ST rewriting theirs as they'd been denied, and I'd just make them understandable to read the first time, which took longer and didn't work with 'making productivity'. I didn't realize I was doing something illegal in working off the clock to do my paperwork the way I thought it should be done --- and not worsening my adrenal fatigue from being 'in a hurry' all the time. (My mother had been a teacher and graded papers every day when she got home, it just never occurred to me therapists couldn't do what teachers do.) 

And every single patient that came to me that I got going to them for CFS/FMS etc got better, even if they had an incompetent MD for their situation, even with no advise about diet .... because I understood how to get them exercising and building that aspect up and then I'd transfer them to the PTs (as the clinic made more money that way and I didn't have time nor was I as experienced with all the things the PTs could bring to the patients). So the PTs learned my basic forumula for success with them and it was win win. I left that insurance-based situation a year later when an innovative pay as you go clinic was opening that was to be integrative medicine but then the MD changed the focus after we got underway and we all ended up going our separate ways (except him, they're still there just with a very different clinic than what we'd all envisioned before it opened). So I didn't get to try it in the new clinic because things unraveled there almost from the start. I was creating the website too, so that I did get done and since 2009 it's been on the Internet with increasing amounts of content in the forums. 

 I'd like for what I was doing in the insurance-based clinic to 'catch on', as well as how they can weave with the naturopaths, traditional Oriental medicine providers, homeopaths, massage therapists who are exceptional with FM, etc and am entertaining the thought of traveling to places where there's a willing group of providers I can bring together the way I did in the education group, the providers who spoke then learned who else was good with this type of patient in town and could cross-refer. The patient that come become VERY proactive and self-assured and become real communicators and teachers to those providers they go to in the community. 

Back then we'd not be able to put resources for them to refer to and learn from on a website because I didn't have a website. Now I do, and a lot of the info they'd want and need is there as I've added it in the months and years since 2009 when it launched. I'd say to a patient in the allopathic clinic 'you might want to ask your doctor and learn about inflammation and how that is caused in the body, including looking into foods' .. that's about as much as is 'okay' in that environment to say. They'd come back with a bottle of Rx ibuprofen and say 'my doctor didn't know what you meant with foods causing inflammation but he gave me these'. Well, no, he prescribed them, your insurance paid for most of it, and that's really going to contribute to problems I'd think and not be able to say. If they'd had a website to turn to that would have helped them. 

It is not quick fix stuff, it takes a long time to learn the information about all this, and the people who are motivated to put in study time as if they are getting a master's degree in their body and health are going to see the results of their efforts. So that's really our 'niche' at Lumigrate. I am told it helps that I have these types of conditions and really understand it, and so I try to put some story spin into many of the topics for those who like that. Those who don't don't have to read it they can just go to the resources suggested for learning. And hopefully there'll be better info about how clinics can do therapy with patients for movement and activity, as well as manual therapy. It turns out even with all the coworkers I had there who eventually worked on me or advised me, it's been via Facebook that I've realized there was more to my list of likely diagnoses which I only started wondering about in my mid 50s. .. we're works in progress!