Tea Time with Early Intervention OT Amirra!

Q: Hello! Please tell us a little bit about yourself! What makes you sparkle!?

A: Hello, hello, hello! My name is Amirra and I love all things related to babies, cute puppies, and fresh fruit. I am a dog mommy to the sweetest girls: Coco Chanel and Blue. A feisty little Yorkie and a lovable Husky-German Shepherd-Lab mix. I’m originally from North Carolina so I’m a Southern Girl at heart but I currently live and work in sunny Arizona!

Q: What degree(s) do you have? What made you interested in pursuing OT, what have you been up to since graduation?

A: I graduated from the MGH Institute of Health Professions in Boston, Massachusetts in May 2019. I initially wanted to be a Neonatologist but after a lot of reconsideration, I decided medical school was not the best path for me. I was nannying for a CHT (Certified Hand Therapist) at the time so she introduced me to the wonderful world of OT! Since graduation, I’ve been working in Early Intervention, pursuing entrepreneurship, and being involved with my state OT association.

Q: What practice setting are you sharing about today?

A: Early Intervention

Q: How long have you worked in this practice setting?

A: I started working in August 2019 so it’s been a little over a year.

Q: Can you please describe a typical day in your practice setting?

A: The nice thing about EI for me is that I am completely in charge of my schedule. On average I start my day between 8-9am and I finish around 4-5pm. If I have a cancellation or break I generally go home since I live close to the region I work but if not I’ll just have lunch in my car or make a Target run! In March of this year we switched to tele-therapy so I work exclusively from home now - my schedule is still about the same - weekends are not required but sometimes a family may request to have a Saturday session so I’ll have a weekend session every once in a while but not regularly.

Q: How many patients do you typically see? How long do you work with them for?

A: On average, I see about 6-7 kiddo’s a day and they are 60-minute sessions.

Q: What is the productivity expectation at your job? How do you find meeting it?

A: We are only required to work 27 hours a week to maintain our employee benefits

but there is no productivity requirement.

Q: What type of diagnoses do your clients typically have? Can you please provide 1-2 activities you would do in a standard treatment session with one of these clients/families?

A: There are definitely a range of diagnoses you may see in EI. However, kiddo’s don’t always have to have a formal diagnosis since the program is also to catch kiddo’s who may be at risk for developmental delays. Some of the common formal diagnoses I have are down syndrome, Autism, prematurity, Neonatal Abstinence Syndrome, Williams Syndrome (not as common), Spina Bifida.

Q: Do you have meetings to attend throughout the day/week? If so, what do they typically entail and who attends these meetings with you?

A: Yes, we have team meetings for each region. I work in 3 regions so I have 3 team meetings that last between 60-90 minutes. The meetings are where we hear about new referrals to the program, schedule evaluations, receive coaching from other disciplines and providers on difficult cases, and other related actions.

Q: What type of documentation do you complete? (i.e. how long does it take, how frequent are your notes due, etc.)

A: We have work laptops that contain a “Primary Caregiver Visit Log” that is adapted from the Shelden and Rush Early Intervention Teaming Handbook. There are 4 specific parts of the note (similar to SOAP note format). Our notes are expected to be completed with the parent during the last 10 minutes of the session and the parent is supposed to sign-off before we leave the home. This is of course different now that we are doing tele-therapy but generally I still complete my note during the last 5-10 minutes of the session so I don’t have to worry about it later.

Q: What does a typical evaluation look like? How long does it take? What assessment tools do you use?

A: I use the Developmental Assessment of Young Children (DAY-C) Second Edition. This evaluation assesses children in the following domains of development: cognition, communication (receptive, expressive), social-emotional, physical development (gross/fine), adaptive behavior. We observe certain tasks and ask parents questions in each category. Kiddo’s must score a 70 or below in one or more developmental areas to qualify for our EI program. Evaluations typically last between 60-90 minutes.

Q: What is a ball-park range of what an OT can expect to earn in your practice area (please also include approximate geographical location - rural South Carolina, suburb in Connecticut, etc.) Please also include if this rate is for per diem, with benefits, per visit, etc.

A: As with any setting, OT salary fluctuates greatly. In Arizona, the rates of reimbursement are higher so our pay is on the higher side. On the low end EI providers earn 40-50k per year and on the high end pay can be in the low 100k per year. In terms of hourly, I’ve seen anywhere from $40-$90 per treatment hour and up to $160 for an evaluation. I do receive benefits including health and dental insurance. I personally am satisfied with my pay especially as a new graduate. When I was looking for jobs I did not want to settle for anything lower than the national average which is 80k - it is possible especially depending on where you live. Keep in mind that the highest paying positions are generally for independent contracting positions.

Q: How did you get your “foot in the door” to work in this setting?

A: have a tremendous amount of pediatric experience including being a Certified Newborn Care Specialist. During the job interview, I drew upon my experiences as a NCS, professional nanny, a child care attendant coupled with my experiences during my level II fieldwork in pediatrics. To my knowledge, Early Intervention positions are not difficult for a new graduate to obtain - though due to lack of mentorship and supervision, not always encouraged. However, I’ve been doing this for a year right out of school and it has worked very well for me!

Q: What is your favorite part of this practice setting? Can you provide a favorite memory of a patient/client that you know OT positively impacted their life?

A: Oh man, I have so many favorites - where do I start! I would have to say although I love being surrounded by the cutest infants and toddlers all day, my favorite part is probably working with parents. Providing parents with the tools and resources to help their child achieve their goals and watching their knowledge and confidence grow is wonderful. I feel like myself, and my team, are truly making a difference in their lives. I recently had a family excitedly say during a session “Oh my gosh that’s the first time he’s done this!” and became emotional - the kiddo had initiated wanting to play with mom so this interaction and engagement was huge to the family. It was amazing and made me remember just what I love about this job.

Q: What advice do you have for new grads/therapists hoping to transition into this setting?

A: First, seek out mentorship which can come in many ways. There are incredibly helpful Facebook groups, and amazing therapists in the social media world who have been doing this for decades and can be a great resource. I personally had another OT as a mentor who I was able to shadow when I first started out. Seek out an agency that utilizes a team-based approach if you can. If you have the option to co-treat, take advantage of what you can learn from your co-workers in PT, SLP, or developmental special instruction. Try to use what is in the home – this is the hardest part but try to use what they already have in a therapeutic way, or keep your recommendations or supplies very minimal and cost-effective.

Q: What is the biggest mistake you’ve made in this setting? How did you correct this mistake (if possible) or what did you learn from it?

A: In the EI world, the Bagless approach is always talked about - some therapists bring in toys and objects into the home and some use what is already in the home. Initially, I was not confident in my skills as a therapist - thank you Imposter Syndrome! I wasn’t sure I could go into the home, not knowing what they have, and have a successful therapy session so I would bring in all kinds of toys and objects for my session. However, I learned this wasn’t great for carryover in the home if parents didn’t have those same tools and objects. I started to bring in less and less, and began showing parents how they could use what they already had in a therapeutic way. This was great to encourage imagination, creativity, and resourcefulness and I found carryover to be much better.

Q: How do you personally prioritize your self-care and prevent/manage burnout?

A: I recently started time blocking which is a great way to visually manage your time everyday. It helps me see the best way to use my time during the day most efficiently. I schedule breaks during my day, including going outside for walks, drinking water, and having snacks to stay on top of my activity levels, hydration and nutrition. I also set boundaries in my personal, work, and social media life to be sure I am resting and taking care of myself.

Q: If you’re comfortable sharing, approximately how much money did your program(s) cost (including tuition, fees, books, housing if applicable) A: Did you take out loans to help you pay for school? What was that process like?

A: I went to a private, out of state school so my tuition was a little over $100k for the

entry-level OTD program. I received a scholarship that covered a portion of this but I also took out loans. I only took out federal loans for OT school so my interest rate thankfully isn’t as high as it would be if they were private loans. The cost of living was also much more expensive in Boston, MA where I went to school so housing was costly. I also went out of state for my clinical rotations and my research rotation so I used loan money to cover those expenses.

Q: Do you have any advice for pre-OT/OT students who are applying to programs from a financial standpoint?

A: I have so much advice here - I’ll try to keep it short! My biggest piece of advice

would be to pursue the least expensive route of becoming an OT and go to a

school you can realistically afford with little to no amount of loans. Be sure you understand what type of loans you are taking out, interest rate, and how much it will cost you monthly after you graduate. Also, if you are working while in OT school, you can start putting money towards your loan to cover the interest that accrues.

Q: What’s next for you? Where do you see yourself in the next 5 years?

A: This question always trips me up! I honestly don’t know because 5 years ago I probably wouldn’t have said I’d be where I am today (which is a good thing!). I hope to continue to be advocating for this amazing profession, advocating for racial equity and inclusion, and building a business to support parents, infants, and toddlers.

Q: What changes would you like to see in the OT profession over the next 5-10 years?

A: More recognition! OTs are such hard working and valuable individuals, I’d like us to be more widely known and well respected as a crucial member of any healthcare professional team.

Q: If you could go back in time, what advice would you give yourself who wants to enter this practice setting as an OT?

A: Be confident in your skills and seek mentorship for your own professional and personal development.

Q: What life motto do you live by?

A: I have so many but my go to is “Everything Happens for a Reason” - even the worst moments of my life likely needed to happen, whether to make me stronger, teach me an important lesson, or connect me with someone who needed to be in my life. I truly believe there is a plan for my life so I try to see the good in every moment.


Amirra is a Pediatric OT, Newborn Care Specialist, and Early Interventionist currently practicing in Phoenix, AZ. Amirra currently serves as an executive board member for the Arizona OT Association and Co-Chair of the Diversity, Equity, and Inclusion Ad-Hoc committee. Amirra is the founder of Marvelous Mirracles, a platform designed to empower and equip therapists and families with the tools and resources to help little miracles fulfill big dreams! Amirra enjoys cooking, reading, international and domestic travel, hiking with her dogs, and spending time with family.

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