The challenges that families face: a therapist-on-wheels shares her perspective

Ruth helps a young man master his shaver

Ruth Bouskila, 58, has been practicing occupational therapy since 1984 in the south of Israel. After many years working in a clinic where she treated mildly disabled children, she made a decision in September 2012 to leave her job and start working with Keren Malki’s Zlata Hersch Memorial Therapists on WheelsProgram. Via this initiative, she makes home visits (as at the time this interview was conducted) to two severely mentally and physically disabled children, working with them as well as their families. Interviewing her on behalf of Keren Malki was Fern Allen.

Ruth, how would you characterize your motivation for working with Keren Malki’s Therapists on Wheels program?

At the beginning of my career, I wanted to see significant changes in my clients and I wasn't ready to deal with the complex issues involved with working with severely mentally and physically disabled people. I wanted to do work where I could see huge leaps in a child’s life. Now, 30 years later, I see that Keren Malki offers a particular and attractive kind of challenge because it provides answers and solutions for families who might otherwise end up falling through the cracks.

It's inspirational to see parents accept that their child cannot do certain things, but can see him or her gradually become more independent in relation to their own self-care tasks. Now with my work with Keren Malki, I am taking small steps with my clients. I am making a difference in the child's and the family's lives. For all of us, it can be a steep learning curve.

Why is it so important to have the occupational therapy done in the client’s home?

By going into the home, I see what the child's and the family's needs are. I can really get into the nitty-gritty of their issues. I see the challenges they deal with daily. It’s 200 percent more effective. These real-time problems often aren't verbalized in a sterile therapy room.

It is also rare that the health insurance companies cover house visits. By seeing the child and their caregivers in the home through Therapists on Wheels, I can give tools to the parents that help to improve the quality of the whole family's life.

What gaps in the health-care system can the Therapists on Wheels program fill?

The health insurance companies generally limit the funding of extensive therapy to the age of 3 to 4. By the time they child reaches age 5, what they offer is very limited. For a child with mental and physical disabilities, that means they simply do not get sufficient therapy. Keren Malki's Therapists on Wheels program addresses that gap. For the children I see, who are complex-needs kids, it is extremely significant that they have the continuing therapy that the Therapists on Wheels program provides.

Can you share some examples of your work and successes?

A boy called Uri, age 18, needed help with self-care tasks - things like washing himself properly. He is mobile but his range of movement is quite limited. Visiting him at home, I could see he could benefit greatly by having a long brush to wash himself. I showed him how to use the brush, where to place it in the shower, how to bend down and clean his feet and toes and so on. I would have been oblivious to the need if my interaction with him were limited to an institutional setting.

Another thing: when Uri eats, the food tends to drop on the way to his mouth and messes up his clothes, the table and floor. You can work on those things in a clinical setting but when you are in the client's home, you can see the height of the table, just as an example, and the kinds of foods he eats. Being there, I can address the actual problems the family faces. In a clinic, it's not that easy. The table and chairs are not the same height as those in their home, for instance. I suggested some ideas to Uri’s parents about which utensils to use, for example, so that the food would not fall off. Again, these are the real problems that you often miss in a clinical setting.

Here's another. Yosef Chaim, is a boy of 9 who has severe mental and physical disabilities. He cannot feed himself. I showed his mother how to give oral stimulation to his mouth area so that the nerves and muscles would start to work more efficiently. Through that stimulation, Yosef Chaim moves his mouth and lips better and takes his food actively and more efficiently. I encourage him to hold the teaspoon, have it in his control and use it with a greater degree of independence.

When I began working with him, his regular caregivers would hold the bottle to feed him. When I told his mother that he could hold the bottle himself, she thought I was nuts! But I knew he could use his hands to throw a ball, and that he had an understanding how to use his hands toward a specific goal. I designed some guided exercises for him and for the caregivers. Now he holds the bottle and is certainly developing the skill. It’s a small step for a child of 9 years old – but it’s a step in the right direction!

Why is Keren Malki’s Therapists on Wheels Program important to you?

Well, my reasons are personal. I read about how the Roth family established the organization after their daughter Malki was killed [in the Sbarro restaurant terrorist attack in 2001] and that they have a younger child who is disabled. It happens that I myself lost a daughter. She died in India at age 22 when the bus on which she was traveling overturned. Wanting to do things in her memory is very meaningful to me. Against those background issues, I feel that taking part in Keren Malki through its Therapists on Wheels program is a privilege that is especially meaningful to me. I feel inspired by what is being done in a child's memory.