When I first entered clinical practice, preventative occupational therapy was far from my attention. Even after beginning to specialize in pediatrics, I found my earliest focuses concentrated heavily in the child's physical development. Slowly over time, while living and working in southern California, I became immersed in the wellness lifestyle and mentality. I began to further explore holistic and complementary approaches to health, on a personal and professional level, finding immediate and long impacting results in both my own life and clinical practice. I was fascinated by the way in which the unique skill set of the OT lent itself perfectly to the practice of lifestyle redesign. I felt strongly these practices were something the children and families I worked with, could immensely benefit from. This influenced me to develop a goal to Demonstrate knowledge in primary care and prevention interventions to promote holistic and family-centered occupational therapy services.

For several years, I was fortunate to live Southern California, a mecca for health and wellness-driven lifestyle. It was during this time I learned of The University of Southern California's innovative Lifestyle Redesign programs. This course piqued my interest as I personally had experienced the profound impact lifestyle shifts had on improving my own health and wellness. As a clinician, I wanted to have the skill set and resources to share this with my patients and families. I knew lifestyle interventions would be immensely powerful in improving overall health and wellbeing, beyond anything I could currently offer. I felt this was an intervention approach that encapsulated everything I was seeking, in broadening my practice focuses beyond physical abilities. During the Introduction to Lifestyle Redesign course, I gained general exposure to wellness-based and preventative occupational therapy. However, in the back of my mind I questioned if an intervention originating from the well-elderly population would ironically be applicable to the medically-complex children I worked with. At first I found this to be a challenge, as I could not simply apply the course directly to my own work. With each course I completed however, there were always tenets that held relevance to the clinical populations I worked with. Special topics covered including chronic pain, general co-morbidities, sleep deficits and disorders, social and community engagement, mental health, stress and anxiety management and leisure participation. Each of these felt seemingly more relevant than then next, when applied in the context of the children and families I worked with. Moreover, as I progressed through the course series I began to become more confident with the underlying approach, regardless of patient population. Generally speaking, what I took away from this course series was a refined and adaptable skill set to identify strategies and facilitate implementation of health-promoting habits and routines for overall improved lifestyle and well-being.

When AOTA began the digital badge program, I saw this as an opportunity to more concretely demonstrate my competence in this area of practice. Initially, I wondered if the content would be redundant from my prior courses. I did find there was certainly some overlap, which was actually encouraging as it further conferred what I had previously learned. Interestingly, the AOTA digital badge also provided more in-depth content on areas I had not considered. For example, one unit focused heavily on understanding the relationship between mobility and occupation, particularly within the context of community. While the course emphasized mobility and occupational access for the well elderly population, it made me reflect on the children I work with. Mobility was something so heavily emphasized and targeted within our clinical setting, in an admittedly contrived and idealized environment. I paused and considered what access and occupational engagement looks like for many of the children I work with beyond the walls of our clinic. Moreover, our practice's intensive model regularly welcomes families from around the world. I began to sit with what adopting new routines within an entirely new environment must be like. This led our team to more carefully evaluate the greater community area and develop a resources list for families. We worked to create a list that incorporated everyday routines and occupations such as food shopping, playing in the park, walking on the paths or visiting the library, with careful consideration for accessibility options. Since doing so, multiple families provided feedback expressing how this resource has greatly eased their transitions, decreased stress and enhanced their day-to-day functioning.

Another unit focused exclusively on the effects of chronic stress on both mind and body, including the relationship between inflammation and chronic disease. As a pediatric OT, I considered the unique implications of this. Certainly, there had been consideration for the chronic stressors the child is at risk for. But what I had not previously considered was the ways in which I could mitigate some of the chronic stress experienced by caregivers, parents and families. Though I am not a parent yet myself, in working with children, I can appreciate the presumably inherent degree of stress that coexists with parenting. Having a child with any disability would reasonably carry additional social-emotional stress. Moreover, parenting a child with a chronic physical disability presumably adds physical stress on the caregiver as well. I recognized lifestyle redesign would be valuable in addressing both the primary and secondary effects of disability, particularly stress, for the entire family unit. Something I noted was the lifestyle redesign program skillfully employed an individualized approach to care. However, I also noted the ability to expand this programming and services to support family-centered needs still remained to be developed.

During the Spring 2019, a colleague and I bonded over our shared interests in maternal-child health and wellness. We each brought with us slightly differing perspectives and focuses. While my experiences and interests were in lifestyle adaptations and preventative occupational therapy for children and families, hers were focused on women's and maternal mental health. Collectively, we had a mutual appreciation for the clinical gap and emerging niche of preventative occupational therapy within the context of maternal-child health and wellness. This led us to develop an original frame of reference entitled "From NICU to Community: Supporting Role Transition in New Mothers of a Medically Complex Child". At the encouragement of our professor, we sought to take the next steps in disseminating this knowledge. We toyed with several ideas of how we wanted to next proceed. Ultimately, we choose to adapt the contents of our frame of reference for a poster presentation which was accepted to the AOTA 2020 conference. For our presentation, we worked to expand upon our frame of reference through furthering the applicability of occupational therapy to any mother following an infant's birth. While the COVID-19 pandemic precluded us from presenting, this experience remains one of my fondest memories and proudest accomplishments during my time at NYU. Prior to the doctoral program, I had only wishfully considered the possibility of being a presenter further in the future. At the time, I felt I lacked the knowledge, skills and experience that warranted such a platform. During my time at NYU, I have undoubtedly accumulated more knowledge and refined my skills. But above all, this program has instilled in me the confidence and competence of being an expert in my chosen area of practice. Things that once felt not yet attainable, now seem within reach. The process of creating an accepted poster presentation was equal parts exciting, challenging and humbling. This was my first ever attempt at submitting to a conference. Having a colleague to share this learning process and experience with was invaluable.

Collectively, these artifacts demonstrate my shift towards a holistic approach to care. This shift is a theme that now permeates my practice and resonates on multiple levels. I acknowledge the relevance of treating the whole child - mind, body and soul; with particular relevance to children with physical disabilities. I recognize the integral role of the family unit, in the ability the effectively treat the whole child. And lastly, I strive to integrate knowledge and resources to establish a foundation for primary care and prevention in pediatric practice. Ultimately, I seek to provide care that promotes well-being through lifestyle based practices and preventive occupational therapy services.