Your world with Dr. Beatrice Hyppolite
Hello,
I am Dr. Marie Beatrice Hyppolite. I hold a doctorate in Health Science with emphasis on Global Health and master’s degree in social work. I have over 14 years of experience in the field of health and human services.
This podcast is primarily focused on mental health and the quality-of-life elements that affect it such as divorce, death, domestic violence, trauma, toxic relationships, and single parenthood to name a few. It is no secret that mental health challenges continue to profoundly impact modern society although not enough discussion is given due to stigma. Research has shown an increase of 25 % in mental health crises after COVID-19. It is important to have honest, uncomfortable conversations about mental health while being supportive. Although we are interdependent, change begins with the individual, hence “your world.”
I welcome you to join me on my journey and look forward to your responses.
Your world with Dr. Beatrice Hyppolite
The Resilient World of Occupational Therapy
What exactly does an occupational therapist do? Dr. Gus Schlegel takes us on a fascinating journey through this often misunderstood healthcare profession that helps people return to meaningful activities in their daily lives.
Beginning with his own unexpected path into the field through military service during Desert Storm, Dr. Schlegel reveals how occupational therapy's roots stretch back to World War I, when healthcare workers noticed soldiers engaged in purposeful activities recovered faster than those who remained idle. This observation became the foundation of a profession that now counts over 183,000 practitioners nationwide.
Contrary to what many assume, "occupation" in occupational therapy doesn't refer to employment—it means any meaningful activity a person wants to engage in. Whether it's helping an elderly patient dress independently, assisting someone with budgeting after a brain injury, or working with a child who has developmental delays, OTs break complex tasks into manageable components. They uniquely differ from physical therapists by using the activities themselves as therapy rather than repetitive exercises.
Dr. Schlegel's own remarkable journey—from military occupational therapy assistant to PhD in public health—demonstrates the profession's accessible career pathways. His work teaching Haitian students remotely, despite political turmoil, showcases the resilience and commitment of both practitioners and students. His current role coordinating doctoral capstone projects at a university in New York brings his expertise full circle.
Most compelling is the profession's holistic approach, addressing physical, cognitive, emotional and social functioning simultaneously. Dr. Schlegel advocates for more OTs to return to mental health settings, where their unique skills in activity analysis and group facilitation are particularly valuable. By focusing on what matters most to each individual, occupational therapists restore dignity and independence through the everyday activities many take for granted.
Ready to learn more about this fascinating healthcare profession? Listen now to discover how meaningful activity becomes powerful medicine.
Hello everyone, I'm Dr Beatrice Ippolit and this is your World. Hello everyone, welcome back to a new episode of your World with Dr Beatrice Ippolit. Today I have the privilege to have in our studio a very special guest. Last time we had his wife on the show, dr Sheila Schlegel, and who helped me to practice how to pronounce the last name, and today it's my privilege to welcome with us here Dr Schlegel, gus.
Speaker 2:Schlegel. Thank you, it's a pleasure to be here. Welcome to the show. Thanks so much.
Speaker 1:Okay, so before I even go any further, tell us a little bit about yourself, what you do, where you work. I know that. You know you and your wife. You know you used to go to Haiti a lot, so let us hear all of that. We did to go to Haiti a lot, so let us hear all of that we did.
Speaker 2:We went to Haiti a lot, and Haiti has really helped shape us both, particularly me too. It's helped drive the direction that I've gone, even just in my, my formal education, and so when I was planning to obtain my master's degree, it really it had to do with Haiti, and so I received my master's degree. It really it had to do with Haiti, so I received my master's in humanitarian services administration oh, okay so after that, then the the question of what do I do with that?
Speaker 2:now, I had a strong interest in, in in public health, so then I pursued a PhD in public health. It all was really focused on the needs of Haiti, and so that's what's driven me, and so with that, I was one of the first founding volunteer instructors at a really homegrown occupational therapy program in Haiti through the Episcopal University. It's the Faculté de Sciences et de Rehabilitation, so it's the college is in Lille-Gannes, which is kind of south of Port-au-Prince, and so we educate homegrown occupational therapists and physical therapists and there's a nursing program there too, and it's just a really super privilege because, even with all the turmoil that's going on and we haven't been able to go since 2018 was the last time we were there we're still able to teach. They have had some very generous grants and donations, so they have internet, they have Zoom and Teams capabilities, so we educate, we teach over Teams, and so the students are there in the class and we are on a big screen, we have a translator, and so we teach our material.
Speaker 2:And the program initially, when it was live, was very intense, so one class at a time over two or three weeks, and so we were able to modify that model, and the reason we did that was because clinicians were coming from France, from Canada and from the United States down and spending the time there. But now, since we can't travel, we were able to spread that out to just a typical trimester, and so now our courses are 15 weeks long, just like you would find here, and that makes it a lot more manageable for us.
Speaker 1:All classes are being offered, you know, via online.
Speaker 2:All the classes, and so we have, we have labs, and the really good thing is how many times you meet per week. So it's it's one time for three hours, so it's a three credit instead of breaking it up, because you have to remember too the students.
Speaker 2:They travel from Port-au-Prince and from other places to get to to Laoguan. So in order to really cut down on travel time because it's dangerous to travel we do so. My class is three hours long and so they might have multiple classes during that day, but then on other days they don't necessarily have to travel.
Speaker 1:Okay. So then they have to provide themselves with their own computers, or the school accommodates them to have a computer.
Speaker 2:You know, and that's a good question. So we have sent computers down. Some of the students have those computers, but other students they're working off their cell phones. So I was always really impressed I would get these wonderful papers that were written by students and I know that all they had was just a cell phone. And so they're there working and typing every single word with their thumbs to be able to produce these two, three, four page papers.
Speaker 1:In a way they really prioritize that education. Oh yeah, definitely.
Speaker 2:That's wonderful. Yeah, it's amazing. They're very resilient students, and so it's such a pleasure to work with them.
Speaker 1:Okay so.
Speaker 2:It even enhances my love more for Haiti and for the people.
Speaker 1:Okay, that's wonderful, thank you. Thank you so much for your time and service and dedication that you've been putting throughout the years in helping the Asian people. Thank you so much. So what do you do? What do you have your doctorate degree in?
Speaker 2:So my doctorate work was in public health. So I have a PhD in public health, okay, and I was able to get it done. It took a bit of time, definitely, but now I'm really in a great position. I was on vacation on Martha's Vineyard and I got a phone call from just a random phone call and it was from the program director of a program in New York City and they said we came across your CV and we really liked it and we want you to come in tomorrow.
Speaker 1:Just like that.
Speaker 2:Just like that. And I said, oh my gosh, I know that I had submitted my CV to a couple of places, but I'd never finished any because we were going on vacation. I never really had finished any of the applications. And so I said, oh my gosh, that's so nice. I'm on vacation right now on an island. Is it okay if I come next week? And they said absolutely.
Speaker 2:And so I went in and they were just so kind. They asked some tough questions and then afterwards they offered me a position as the doctoral capstone coordinator. So that congratulations. Yeah. So, and I've been in that position since December and I'm in charge of overseeing the doctoral capstone projects that all of the occupational therapy students are doing. So I interface with the faculty mentors that are so our faculty, that work as mentors for the students as they're completing the capstone and also working with sites, with sites. So in fact, I was going to ask you you have such a wonderful knowledge base too, and we're always looking for sites to be able to mentor students in their particular interest. And what the students do is they during their didactic coursework. They certainly at some point they're touched by some condition or some population, and so we asked them to develop that further, to develop a research interest.
Speaker 1:I'm available.
Speaker 2:Yeah, that's great.
Speaker 1:It will be my greatest honor to work with you, Dr Schlegel. That would be wonderful.
Speaker 2:And so the students are able to pursue their interests, and one of the fun things that I tell them is because they have so many ideas and they want to go this way and that, and so what I was told during my dissertation is, gus, save the world after your dissertation is done, because a good dissertation is a finished one, and so I get to say that to the students often and say all those are really good ideas, and very often what you do for your capstone, because it is an area of interest, becomes your life work, and that's certainly my case too. My dissertation was on informal caregivers of people living with dementia.
Speaker 1:Okay, so today we're going to talk about a very specific subject. It's been around, so Dr Schlegel will tell us, or give us a brief description, how long this profession has been around and a little bit of prevalence and exactly what it is. So what people in the field? Field, what do they do? Because not too many people, even people with degrees, don't even know that much about occupational therapy. And oftentimes one thing that I've seen people tend to kind of like take, when you mention occupational therapy, they will believe that it is the physical therapy. No, ot is something and PT is a different thing. They are two different professions.
Speaker 2:Yes, definitely.
Speaker 1:You know, so walk us through it, dr Stregal.
Speaker 2:Yeah, so let me start way back when I started my career, when I enlisted in the army, the recruiter asked me well, what do you want to do? I had to do some tests, physical and everything. He said you're qualified for a lot of different things and I said well, I want to work with people, I want to be in the medical field and I want to use my hands. And so he looked through his files and he said here this occupational therapy, and so we'll explain that more. And so he read what was there and it had to do with working with people to help them return to more independent functioning or obtain a greater degree of independence. And that just really appealed to me, especially the part that dealt with working with your hands and using different activities and projects, occupations, to develop skill. And I said that's for me.
Speaker 2:And at the time I then joined and I wound up working just out of my good fortune in an inpatient mental health setting. For almost the entire time I was deployed. I was in Desert Shield and Desert Storm, but that's really where as I've learned over time too, that's really where occupational therapy comes from is from working with people from the military. So during World War I, when soldiers came back they might have had some physical condition or they might have had some cognitive or some mental health component and the nursing staff, they would give them little, little chores and little activities to do and say here, here, do this.
Speaker 2:And they found that the, the patients, that these recovering soldiers, they the ones that were participating in activities, they recovered more quickly yeah, yeah, because they were engaged, they were doing something, and there wasn't a lot, there wasn't any theory to really back it up. They just saw that it worked and so eventually, that's where the name occupational therapy will come from. That's where occupational therapy comes from, and and so I and I have to really explain this because a lot of times my patients will ask me well, I'm not, I'm 85, I'm not looking to find a job. Are you going to try and find me an occupation? And I said, well, you know what? In a way, yeah, I'm going to help you get back to doing those occupations that you want to do, because as occupational therapists we think of occupation as not something that you do to make money. We look at as occupations that are meaningful to you, that you want to engage in. And many times some of my patients they haven't been able to engage in those occupations for a long time just because of their condition and some of the deficits that they've had. So that's kind of my lead-in very often.
Speaker 2:And there's always that question well, what's the difference between OT and PT right within physical therapy? And you know, it's not always really clear either, not just with patients but with other healthcare professionals, and so I know we were talking earlier about the difference between OT and PT. I like to say that when we think of occupation, we can use occupation as a means to an end, or that occupation can also be the end product that we're looking for. And let me explain where a physical therapist and not all physical therapists, but in physical therapy there's, just because of the nature, there might be more repetitive exercises and strengthening and movement that goes on, where you're measuring a certain amount of strength and a certain amount of repetitions and that really guides you to identifying that the patient is making progress. In occupational therapy we, instead of repetitive exercises, we use very often occupation to be able to develop those skills, and those skills that they develop then translate into they're able to participate and complete, those skills that they develop, then translate into they're able to participate and complete those things that they really want to do.
Speaker 2:So let's take dressing, for example. If someone really wants to dress well, what's involved in upper body dressing, like putting on a shirt there's a lot of reaching involved, there's some sequencing involved, there's some making choices and, and so all of those components we really know how to break down into their components. We say, okay, well, you need to be able to work on being able to reach up, maybe to pull a shirt out of the closet or slip your arms through its sleeve, and that movement can be simulated by making a macrame project, and so you might have seen some of those potholes that hang from the ceiling and there's a nice plant in there and there's a lot of knots, and the knots are very intricate and they're all connected and so, and it's beautiful, there's there's color and, and so that's what they might create to be able to practice doing, doing those movements. And so the end result then eventually is they're better able to then reach in and pull out and and slip their arms through a sleeve. So that's the means to an end.
Speaker 2:We might also work on really the end product. Okay, you want to be able to reach up, and so there might be some time where we'll say, okay, well, let's practice reaching and putting something up on a shelf, and so really our focus is we want you to be able to reach up. That's what the patient wants, and we'll practice a lot of times to pulling the, the hanger off of the hook, and so that might be part of the, the care plan too. But yeah, so it could be. It can be either, but occupation is really central to what about managing their expenses?
Speaker 2:that too. That really depends on on what's important to them, absolutely so. Um, and you would find that more with um, people who might have had a traumatic brain injury or someone who might be living with a mental health condition, and I know that in the past, when I was working inpatient and also in community mental health settings, I've worked with people on budgeting, and we might just be starting with a couple of items. What's important to you? Well, I want to buy peanut butter, okay, well, you have, let's, let's look at which peanut butter is more expensive and let's make some choices.
Speaker 2:So I would bring them flyers from the grocery store and have them put together a shopping list and then try to do some budgeting and so that and, and so we'll do that in a clinic environment, but then we might go out to the store, and so when I was in the military um, we would take them to the, the commissary to, to do some shopping or to the px to do some shopping. We, we were able to do that. So that was real OT and I love that. But here in a community setting, we can do that as well. So I can go with them too, and I've done that to a grocery store or to the corner market.
Speaker 1:That's very important. What about skill building?
Speaker 2:So certainly, it just really depends on where they are On their needs.
Speaker 2:So one of the things that we're very good at is doing activity analyses, where we really take an activity and break it down into different tasks, and also really task analyses, where we take and we look at a particular task and really break it down into its functional components and steps. There's also an occupational analysis, so looking at the occupation really. So what does it mean to be a painter, what does it mean to be a teacher, what does it mean to be a photographer, and what are all those components that are required to do this? It's very complex if you think about it right. So really we're looking at physical, we're looking at cognition, we're looking at emotional and also social and putting that all together to really work on all those areas, and that's a big thing that distinguishes us from other professions.
Speaker 1:That's wonderful, and so, according to research, it seems that the profession is growing. Like I mentioned earlier, according to research, there are approximately 140,000 occupational therapists in the US, with around 183,000 practitioners nationwide.
Speaker 2:Yes, yes, and I appreciate the last number because that really it really catches kind of what occupational therapy practices look like. So we have occupational therapists look like. So we have occupational therapists. Right now entry-level programs are master's programs and doctoral programs, like the one that I work in, but there are also occupational therapy assistant programs.
Speaker 2:That's what I studied and became through the Army and I worked as an occupational therapy assistant for for five years and also during the time that I was in school for my, my therapist degree.
Speaker 2:And so the assistants, they work and support the, the clients and the occupational therapists in carrying out the care plan, the occupational therapists in carrying out the care plan, the occupational therapists, they're the ones that have that deeper understanding of theory and are able to develop the care plan, and so together there's this real connection between the therapists and the assistants together. And so that's where you, that whole number is, the 183,000 that you mentioned. So so there's really two tracks that you can. To me that's appealing because you don't limit someone who might come from a background where they don't have six years to dedicate to to education and don't have I mean, schools are expensive now don't have all that money. They can go, like I did, join the military and get their start in our career, in our occupational therapy that way. Or they can go to a community college and get their career start, maybe in two years, with an associate's degree and then later there are also bridge programs where you can transition from, like I did, from OTA the assistant to OTR, the registered therapist.
Speaker 1:This country, believe it or not, it's built on immigrants.
Speaker 2:Yes.
Speaker 1:So it's like, whatever people may want to say, but immigrants, we are the backbone of this country yes but one thing that I've noticed and I even had they you know my own personal experience in that area as well when you you first came to this country there is really nobody to help you navigate the system. Many people they tend to be on their own. Like myself, I did navigate everything on my own. I'm grateful to everything that God had allowed me to accomplish, but it was not easy. It was like, in a way, easy for me because when I came to this country I didn't have a husband, I didn't have any children.
Speaker 1:So it's like you know, when you don't have a family, so you tend to move around through, you know things much easier compared to those who came with a family. So the idea or the tendency is hey, I have a family, I have to feed. It's like many people who would love to get an education. It's like many people who would love to get an education but because of their life situations or don't know exactly how to navigate things around, sometimes can get stuck one place.
Speaker 2:They can, and so that's what makes really the associate's degree attractive. A lot of the programs they're geared toward supporting those people that want to earn a degree may have to work full time during the day, and there's really alternative formats that are popping up. There are online even occupational therapist programs, and so the programs they can be as creative as the needs are, and so that's a real good thing. And, like you mentioned the immigrants, I'm an immigrant, I'm from Germany and so I was actually. I joined the military, the US military in Germany. I was recruited there and, oh and yeah, my mom lived here and, and so I was able to, and I I had gone to school here to gone back to Germany, and that's where I was recruited then by the okay, so for occupational so, and we go by OT, you know for sure OT is fine.
Speaker 1:What are the benefits in mental health?
Speaker 2:If you look around at the different inpatient mental health settings and even outpatient settings, there's not a lot of occupational therapists, not as many as there used to be, and so one of the things that I like to promote with my students is to consider working in mental health, because there certainly is a benefit. When occupational therapists started to kind of not work in mental health as much, they were attracted to working in pediatrics or in hospitals in acute care and that that left a real void and that void was really quickly filled with activity therapists. There are rehab therapists, music therapists. They all have their relevance and importance and I've worked with really good art therapists who are just amazing. But one of the things that we really bring to the table is that ability to work with groups and also work with individuals In our curriculum we have, because other occupational therapists before us have really set the groundwork, this couple of people that you work with.
Speaker 1:are they children, adults?
Speaker 2:In a mental health setting? Yeah, in general. So that's a really good question. It could be children.
Speaker 2:So a really well-developed mental health program will have children.
Speaker 2:They might have just a unit that is just strictly for children. They might have a unit that's strictly for adolescents, because they all have different needs, right, adults, and that might be just general mental health conditions. There's dual diagnosis units and so occupational therapy has a role in every single one of those, because as OTs, we work in pediatrics, we work with development, and so when we're looking at the especially children, they could be a five or six year old who for some reason are now in an inpatient setting and we can look at that bigger picture and and look also not only at helping them with social, emotional, learning and mindfulness and using some of those, some of those strategies, but also working on just physical skill development, fine motor, all those things that those kids should be working on. That might have been delayed because there was so much focus on something else. They really just couldn't work on developing fine motor because they were, they really had a lot going on in terms of their emotional state. So it's kind of this balance as you're working on development.
Speaker 1:For the most part will you work with an interdisciplinary team.
Speaker 2:Oh, absolutely yeah, and that's one of the good things about occupational therapists. We don't like to work in the asylum, we like to reach out and make connections with other disciplines. So we're real team players and we cover that in our curriculum too how to interact and work with other disciplines, recognizing when to make appropriate referrals. We work on simulations where we're working with other disciplines. I was involved for five years in one of the universities that I worked in with simulations with social work, with nursing, with PA and with physical therapy, and so we all looked at the case and that was I always learned something from the other disciplines.
Speaker 1:What about psychologists and psychiatrists?
Speaker 2:So we had the social workers, but absolutely you could include those too, because we interface with psychologists and psychiatrists a lot of times on mental health units.
Speaker 1:When you were to develop treatment plans for clients or patients I don't know how you call them it depends on the setting.
Speaker 2:It depends on the setting. Yeah, it goes for you. We're flexible.
Speaker 1:So how that normally goes.
Speaker 2:So we would do, I think, like most any other discipline, we would do an initial evaluation and look at certain areas. That is strongly driven by the facility that we work in, but also by funding. As a clinician with a mental health background, I would always encourage clinicians I encourage my students to really look at the psychosocial aspects of the client. Even if they have a hip fracture. You need to understand what drives them, their context, Not only context externally and geographically and who's around them, but also their beliefs, values and what drives them.
Speaker 2:So that's just equally important and you need to really know that to be able to know best how to access a client. And so that evidence-based model I like to bring up a lot and I think it's just really valuable when a clinician is deciding on what type of intervention to encourage the client to participate in, and we have to consider what our own strengths are as a clinician. Am I skilled to be able to do that? Is that something? Is that an intervention that I really value and have found good success with? But I also need to understand my, my clients perspective and is that something that they want to do? And here's a good example.
Speaker 1:I'll share this with you and that was, oh, you know what you? You just nailed it because that was going to be my next question, that example.