Fieldwork Data Form

FIELDWORK DATA FORM

This form refers to: Occupational Therapists and COTA’s fieldwork experience.

Length of Fieldwork: OT: Varies according to level and student needs COTA: Varies

Will Accept: X Full-Time Student(s) 0 Part-Time Student(s) X 1st Placement X 2nd Placement X 3rd Placement

Name of Center: Vanderbilt University Medical Center/Rehabilitation Services

Address/City/State/Zip: 3312 Medical Center East- South Tower Nashville, Tennessee 37232-8774 .

Center Phone: (615-8357293) E-Mail Address: [email protected] Person Responsible for Fieldwork Program:

Name : Lynette O’Brien Credentials: OTR/L, Staff Level II Therapist Phone: (615) 835-7293

Staff: 11 OTR(s) 4 COTA(s) 1 Support Staff Approximate # of Contracts with Schools: 22

Accreditation By: JCAHO Date: 2007

GENERAL INFORMATION

Setting Description of Specialty

X Hospital (e.g. Acute inpt, Outpt, Rehab Unit) Acute Care______School (e.g. Psycho-Social Program, Homeless Shelter)______Community Agency (e.g. Pediatric, Psych, Home Health)______Private Practice (e.g. Developmental Delay, Mental Retardation)______Residential Program (e.g. Rehab Unit, Long Term Care)______Nursing Home  Please call Deborah Powers, OTR/L to schedule Pediatric Students ____OTHER Phone: (615) 343-8704

Ages Served: 0-5 Years 6-12 Years X 13-21 Years X Adult X Older Adult

Primary Conditions for Which Occupational Therapy is Administered

___Adjustment Disorder X CVA/Hemiplegia X Neuromuscular Disorders Affective Disorder X Degenerative Neuro Disorder Neonatology X Alzheimer’s Disease Developmental Disorder X Oncology X Amputees _X Dementia Personality Disorder X Anxiety Disorder X Diabetes Pervasive Developmental Disorder X Arthritis Dysphagia/Feeding Disorders X Respiratory Disease Autism/PDD Eating Disorders Schizophrenic Disorder X Back Injury X Eating/Feeding Problems X Spinal Cord Injury X Burns X Fractures & Gen. Orthopedics Substance Abuse X Cardiac Dysfunction X Hand/Wrist Disorders X Traumatic Brain Injury Cerebral Palsy Hearing Disability X Visual Disability Chronic Pain X HIV/Aids Well Population Congenital Anomalies Learning Disorder Ergonomics X Mental Retardation Page #2 Fieldwork Data Form ASSESSMENTS AND INTERVENTIONS

1. Assessments: Vanderbilt University Medical Center Rehabilitation staff is working toward computerized evaluations and progress notes. MVPT, KELS, Baylor and ACL.

2. Intervention: Role of OT in Fieldwork setting: X Direct X In-Direct Describe Intervention: ADL’s – Energy conservation, work simplification, adaptive equipment and training. Home management and safety. . Neuromusculosketetal – Strengthening, range of motion, postural control and muscle tone. . Motor – Bilateral integration praxis. Gross and fine motor coordination, visual motor control . Sensory - Sensory awareness and processing perceptual processing . Splinting, serial casting and positioning . Prevention – Energy conservation, joint protection and body mechanics, ergonomic evaluation . Discharge Planning – Multidisciplinary approach to address continued rehab and community needs.

Theoretical Model(s) Guiding Practice: NDT, PNF, Occupational Performance Model + Motor Learning

PRE-REQUISITES

X CPR Physical Exam Pediatric CPR (if affiliation in Peds) X Criminal Background Check X Universal Precautions (OSHA) Fingerprinting __ Interview X Malpractice Inusrance X Car Required X Health Insurance X Immunizations/Tests - Specify Type: X Other See Vanderbilt University Medical Center The Academic Fieldwork Coordinator Student/Instructor Health Screening and must communicate via writing or Pre-requisite Checklist. verbally with Lynette O’Brien, OTR/L, X Fieldwork Experience - Indicate Type: Clinical Coordinator, to assign students. Burn/Trauma – Student must have a strong interest in this area and second Level II placement only.

STUDENT INFORMATION

NO Room Provided Meals: N/A _____on grounds ____Breakfast _____Lunch _____Dinner

YES Will assist student to find housing off campus with prices ranging from $300-$700/month.

Therapists work holidays except Christmas and New Year’s Day and weekends. Students are expected to work the same schedules as his/her clinical instructor.

Dates: Use AOTA Suggested Dates: X Use Own Dates: X . Page #3 Fieldwork Data Form

STUDENT SUPERVISION

Check all that apply: X 1:1 Model Multiple Students: One Supervisor Multiple Supervisors: One Student

Students are given the opportunity to spend days with therapists in other areas Students have the opportunity to attend rounds and/or observe surgery.

Structure Provided to Students: Low High 1 2 3 (4) 5

Students are provided with week-to-week guidelines and objectives.

Nature of Supervision specific to different Clinical instructors: Low High 1 2 3 (4) 5

Ending Student Expectation/Productivity: Varies Number of Clients per Week Productivity Expected (OT’s) Productivity Expected (COTA’s)

Students are generally provided with direct line of sight supervision up until midterm. This is left up to the discretion of the individual CI’s. By the end of week 9 (for OT students) and 6 weeks (for COTA students) are expected to be functioning at entry-level.

Years of experience as stated below are for the year end 2007 NAME TITLE DEGREE AND YEARS OT COLLEGE/UNIVERSITY IN OT SPECIALTY Kelly Floyd MS, OTR/L MS/University of Indianapolis 14 Asst. Mgr Lynette O’Brien OTR/L Indiana University/Purdue University 14 Acute Care Cari Safford OTR/L Tennessee State University 4 Acute Care Sally Lindsey COTA Nashville State Tech Inst. 24 Acute Care Michele Vaughn COTA Nashville State Tech Inst. 6 Acute Care Leilani Jones COTA Nashville State Tech Inst. 2 Acute Care Samatha Miller COTA Nashville State Tech Inst. 2 Acute Care Jim Lassiter OTR/L Tennessee State University 13 Acute Care Jeanine Hale OTR/L Towson University New grad Acute Care Shane Wood OTR/L MS/Belmont University 6 Acute Care Rhonda Dameron OTR/L Univ. of Central Arkansas 15 Acute Care Scott McLaurin OTR/L University of Alabama Birmingham 13 Acute Care Debra Gibbs Ed.D, MHS, University Of Florida 29 Department OTR/L Director Julia Rust-Jones OTR/L Eastern Kentucky University 4 Acute Care Clay Chapman MPH, OTR/L University of Tennessee at Memphis 7 Asst. Mgr Andrea Renzella OTR/L MS/Belmont University 2.5 Acute Care

Vanderbilt University Medical Center is a comprehensive health care facility dedicated to patient care, research and education. It’s reputation for excellence in each of the areas has made Vanderbilt a major patient referral center for the Mid-South. Each year over 300,000 people choose Vanderbilt University Medical Center for their health care needs. Vanderbilt University Medical Center is a twin towered, 658-bed structure with the most up-to-date systems and technology. The hospital is also home to the region’s only Level I Trauma Center, Burn Unit and the most comprehensive Neonatal Intensive Care Unit. Page #4 Fieldwork Data Form VANDERBILT UNIVERSITY MEDICAL CENTER REHABILITATION SERVICES MISSION STATEMENT

 To maximize functional independence by providing up-to-date, customer focused and cost effective treatment to our patients.

 To encourage and emphasize each patient’s role as an active participant in their own care and rehabilitation.

 To keep our referral sources informed on patient’s progress by concise, accurate and timely evaluations and progress reports.

 To provide out patients and communities with preventative education and safe methods to perform daily activities.

 To provide well-organized clinical education experiences for rehabilitation professionals and students.

 To be active consumers of, and participants in rehabilitation research.

AOTA Commission on Education (ICOE and Fieldwork Issues Committee (FWIC) Amended and Approved by FWIC 11/99 and COE 12/99.

Shared Drive –Ortho2 June, 2007/jms