<p> FIELDWORK DATA FORM</p><p>This form refers to: Occupational Therapists and COTA’s fieldwork experience.</p><p>Length of Fieldwork: OT: Varies according to level and student needs COTA: Varies</p><p>Will Accept: X Full-Time Student(s) 0 Part-Time Student(s) X 1st Placement X 2nd Placement X 3rd Placement</p><p>Name of Center: Vanderbilt University Medical Center/Rehabilitation Services</p><p>Address/City/State/Zip: 3312 Medical Center East- South Tower Nashville, Tennessee 37232-8774 .</p><p>Center Phone: (615-8357293) E-Mail Address: [email protected] Person Responsible for Fieldwork Program:</p><p>Name : Lynette O’Brien Credentials: OTR/L, Staff Level II Therapist Phone: (615) 835-7293</p><p>Staff: 11 OTR(s) 4 COTA(s) 1 Support Staff Approximate # of Contracts with Schools: 22</p><p>Accreditation By: JCAHO Date: 2007</p><p>GENERAL INFORMATION</p><p>Setting Description of Specialty</p><p>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 </p><p>Ages Served: 0-5 Years 6-12 Years X 13-21 Years X Adult X Older Adult</p><p>Primary Conditions for Which Occupational Therapy is Administered</p><p>___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</p><p>1. Assessments: Vanderbilt University Medical Center Rehabilitation staff is working toward computerized evaluations and progress notes. MVPT, KELS, Baylor and ACL.</p><p>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.</p><p>Theoretical Model(s) Guiding Practice: NDT, PNF, Occupational Performance Model + Motor Learning</p><p>PRE-REQUISITES</p><p>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.</p><p>STUDENT INFORMATION</p><p>NO Room Provided Meals: N/A _____on grounds ____Breakfast _____Lunch _____Dinner</p><p>YES Will assist student to find housing off campus with prices ranging from $300-$700/month.</p><p>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.</p><p>Dates: Use AOTA Suggested Dates: X Use Own Dates: X . Page #3 Fieldwork Data Form</p><p>STUDENT SUPERVISION</p><p>Check all that apply: X 1:1 Model Multiple Students: One Supervisor Multiple Supervisors: One Student </p><p>Students are given the opportunity to spend days with therapists in other areas Students have the opportunity to attend rounds and/or observe surgery.</p><p>Structure Provided to Students: Low High 1 2 3 (4) 5</p><p>Students are provided with week-to-week guidelines and objectives.</p><p>Nature of Supervision specific to different Clinical instructors: Low High 1 2 3 (4) 5</p><p>Ending Student Expectation/Productivity: Varies Number of Clients per Week Productivity Expected (OT’s) Productivity Expected (COTA’s)</p><p>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. </p><p>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</p><p>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</p><p> To maximize functional independence by providing up-to-date, customer focused and cost effective treatment to our patients.</p><p> To encourage and emphasize each patient’s role as an active participant in their own care and rehabilitation.</p><p> To keep our referral sources informed on patient’s progress by concise, accurate and timely evaluations and progress reports.</p><p> To provide out patients and communities with preventative education and safe methods to perform daily activities.</p><p> To provide well-organized clinical education experiences for rehabilitation professionals and students.</p><p> To be active consumers of, and participants in rehabilitation research.</p><p>AOTA Commission on Education (ICOE and Fieldwork Issues Committee (FWIC) Amended and Approved by FWIC 11/99 and COE 12/99.</p><p>Shared Drive –Ortho2 June, 2007/jms</p>