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Sangita Singh
Sangita Singh

Occupational Therapy Week at MGH: Sangita Singh shares changing practices in Complex Continuing Care

MGH News: Can you start off by telling me about your role at MGH?

Sangita: I currently work as a behavioural specialist. This is a new role, not just in MGH, but in the hospital system. At the moment, my role is more specific to the Memory Care Unit (MCU). The MCU was first created five years ago for the purpose of treating patients with mild to moderate cognitive impairments. Since then, there has been an increase in the complexity and severity of the diagnoses of the patients that are being admitted in the MCU. I support the team to develop strategies to help manage a lot of the behaviors that the team sees when treating patients with dementia. Patients with significant communication and functional limitations require staff to care for them while identifying underlying causes for the behaviours team members are seeing. When you think about that in terms of the level of complexity required, these are patients who struggle with participating in day-to-day conversation and remembering how to do their daily activities.

The work we do is very complex and nuanced because we have to adjust our communication techniques to meet the gaps or impairments that our patients are experiencing. Given the shift in the patient population, the leadership in the Complex Continuing Care Unit identified that they needed some more specialized support. That’s why this role was created.

MGH News: So how do you apply your expertise as a behavioural specialist?

Sangita: Right now, my work is two-fold. The first aspect of it is assessing patients with the team. We look at the behaviors that the person is exhibiting and work together as a team to identify underlying causes for the behaviour so we can develop good non-pharmacological interventions in order to build a good behavioral plan that supports discharge decision making.

As an occupational therapist (OT) and behavioural specialist, I work with my team to look for the meaning behind the behaviour of the patient. One way we do this is by evaluating the challenges that people experience because of these diagnoses and considering what we can do to support them. A lot of this involves looking at environmental modification. By that, I mean not just the physical environment but also us, because we are part of their environments and as such, have a huge impact on what they are able to do. In MCU, the goal is to allow engagement with the environment in a way that is meaningful to them so that they feel a sense of satisfaction and accomplishment. Patients with dementia often struggle to understand and interact with their environment. We focus on stepping into their world so that they feel comfortable and can participate in the world as they see it, to the best of their ability. These interactional, non-pharmacological strategies are a significant reason why the MCU team is able to successfully manage the behaviours of our patients with dementia and much of my work focuses on supporting my team to identify and articulate successful interventions.

The second aspect of my work is looking at the program as a whole, to develop processes so that the team is able to implement comprehensive, systematic, holistic assessment and communication protocols. This requires identifying knowledge gaps and developing team processes that help bridge those gaps.

MGH News: Why are you passionate about OT?

Sangita: The reason why I really like OT is because it's very practical. It addresses peoples’ lives where they are. We weave in the element of rehabilitation where we work to maximize the person's potential. It's very practical and hands on in that way. It's also very creative because you have to work with the individual and every person is different. I love the fact that it's person-centered. It is so fulfilling when you actually see your intervention make a difference in the person's life. I love doing what I do.

MGH News: Do you have any tips for new OT’s?

Sangita: I would say three things:

  1. Keep the interest alive in what you're doing by learning new things. There are so many resources available.
  2. The second thing is to find your community. Don't feel you are alone.
  3. The third one is to take care of yourself. People give so much of themselves in the work that they do. They need to give back to themselves as well to recharge and regenerate.
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