Heidi Nejezchleb Tringali, a private practice Occupational Therapist in Charlotte, North Carolina, who specializes in pediatric school-based services, works individually with children, and provides support and education to families and consultation to faculty on school curricula. For over two decades, Tringali has practiced as an Occupational Therapist in a variety of pediatric, geriatric and psychiatric settings, specializing in clinical education, program development, and pediatric therapy services.
Born and raised in Nebraska, Tringali lived there long enough to earn a bachelor’s degree in Special Education and Psychology from Hastings College in Hastings. After moving to Boston, she earned her master’s degree in Occupational Therapy from Tufts University in Medford. Licensed in both North and South Carolina, Tringali is certified in Handwriting Without Tears®, which helps make legible and fluent handwriting an easy and automatic skill for students. In addition, she has specialized training in sensory processing disorders and visual motor deficit treatment, and she is a member of The American Occupational Therapy Association and holds a national certification with the National Board of Certification in Occupational Therapy.
When did you first decide to become an OT? Why?
I was in my sophomore year in undergrad pursuing degrees in Special Education and Psychology. We were required to observe in a classroom, and I remember leaving that classroom observation thinking, “I can’t do that.” I went to my advisor, Jan Watkins at Hastings College, and told her I didn’t think I could be a teacher and gave her all the reasons I thought I wasn’t cut out for the job. She listened and then said, “Maybe you should consider being an OT.” I didn’t even know what an OT was, but after she explained it, I was hooked. I knew that was what I wanted to do. I graduated with bachelor’s degrees in Psychology and Special Education, and then went on to get a master’s degree in Occupational Therapy.
How/why did you choose the OT school you went to?
I applied to schools literally all over the country (Puget Sound, Colorado State University, Texas Women’s University, and Tufts University). I picked each school for a different reason, but it was my campus visit to Tufts that was the deciding factor. I loved the campus environment, it had such a strong OT curriculum, the faculty was wonderful and so knowledgeable, and it had such history being the oldest OT school in the country.
What surprised you the most about OT studies/school?
Learning how many different environments Occupational Therapists can work in. As an OT, you can work in hospitals, rehab centers, nursing homes, psychiatric centers, outpatient clinics, school systems, private practice, neonatal units, work hardening, hand clinics, academic environments, home health, and many more. OT is truly a career for life.
If you had it to do all over again, would you still become an OT? (Why or why not? What would you have done instead?)
I would definitely still become an OT if I had it to do all over again. I feel so blessed to be an OT. When someone asks me what I do, I tell them I have the best job in the world. I have been an OT for 21 years and have had the privilege to work in psychiatric units, nursing homes, home health, and in pediatrics/schools. Each environment was exciting and educational, and I always felt like I had the opportunity to make a difference. Being an OT has allowed me to have a balanced life with family and work.
Has being an OT met your expectations? Why?
Being an OT has exceeded my expectations. I have always had job security. Even during this difficult economic time, I receive one to two recruiting phone calls and four to five recruiting flyers in the mail each week. Being an OT has allowed me the flexibility to be an involved mother and a business owner. It is such an incredible experience to comfort and touch people’s lives during some of their most challenging times.
What do you like most about being an OT?
I like the problem solving aspect of the job. I currently work with children, and I love evaluating the child and his/her situation, and then taking all the pieces and putting the puzzle together to determine what is going on with the child and the best plan of care to address his/her issues. It is such a privilege to be on a team with teachers, parents, and other healthcare professionals who are so committed to these children.
What do you like least about being an OT?
I don’t enjoy the paperwork or dealing with insurance companies. When I started my own company, I decided to not be in-network with insurance companies. I found it frustrating that someone who has never met this child and who sits behind a desk, often in another state, gets to determine if this child will get services based on a narrow set of criteria and a few pages of documentation.
How did you decide to work in private practice (or group practice, etc.)?
I took some time off when my children were born. I spent that time determining what my personal needs were going to be when I re-entered the profession and assessing what the current needs were in OT. I learned that private schools had an unmet need for OT services. I was able to customize a private practice that provides 1:1 OT services to children in private schools, while providing curriculum consultation to administration and faculty, and training/education to families.
Do you work with mid-level providers? If so, what kinds?
Yes, I work with COTAs (Certified Occupational Therapy Assistants) and Rehabilitation Technicians.
Describe a typical day at work.
I drop my children off at school and then travel to one of the private schools in the local area. In a typical day, I will work 1:1 with students, consult with a teacher on a child who may be performing below his/her potential, provide a brief classroom instruction on handwriting, and attend a team meeting to establish a plan to help a child. I leave in time to pick up my kids from school and then I get to be a mom until bedtime. After hours, I am able to work in my home office answering emails, working on scheduling and billing, and having phone conversations with parents.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
Including after-hours office time and Saturday clinic hours, I work 40+ hours a week. I get seven to eight hours of sleep a night and average about eight weeks of vacation a year.
Are you satisfied with your income?
Yes. In general, OTs are appropriately paid for the services we provide. The earning potential is what you make it. You can work as much or as little as you want. There are many full-time positions with benefits, contract positions without benefits, and there are PRN positions where you work when you are available.
If you took out educational loans, is/was paying them back a financial strain?
I graduated from OT school with both undergraduate and graduate school loans. Twenty years ago, the entry level salary made it possible to pay off my student loans with little stress. I didn’t mind writing that monthly check, because I was doing a job that I loved.
In your position now, knowing what you do – what would you say to yourself 10 years ago?
Stay the course. I think when we look back over our careers it is easy to see that each job, boss, challenge, and success led us right to where we are today. Steve Jobs said, “You can’t connect the dots looking forward; you can only connect them looking backwards.” As an OT today, I use what I learned in my Special Education and Psychology classes as much as I use what I learned in my Occupational Therapy classes. Working with elderly helped me understand working with children, and all the bosses in my past have contributed to the type of business owner I have become today.
What information/advice do you wish you had known when you were beginning OT studies/school?
How to drive around a rotary in Boston, Massachusetts. Tufts University did a wonderful job of preparing me for a career in Occupational Therapy, but nothing could have prepared this small town Nebraska girl for exiting a 1978 Ford LTD II off of a rotary in Boston.
From your perspective, what is the biggest problem in healthcare today?
There are so many problems with healthcare today; it is hard to say that there is a “biggest” problem. Cost, accessibility, and insurance coverage are probably the hottest topics in healthcare today. In my business, I have clinic hours on Saturdays for children who cannot get OT services in their public schools, because, by government guidelines, they do not qualify for Occupational Therapy. It is so disappointing to see these children who so obviously need services, but because of the way the guidelines are written, cannot receive them at school. This issue feeds directly into our national underachievement in American schools.
Where do you see OT in 10 years?
OT has historically struggled with having an identity. For example, most people know what a Physical Therapist is and does, but fewer people know what an Occupational Therapist is and does. The American Occupational Therapy Association (AOTA) has worked very hard over the past few years to clarify and mainstream the OT image. As that effort continues, along with the growth in Autism diagnoses, obesity, stress related health issues, and the aging population, I see OT becoming a household term associated with health, well-being, and fullness of life in the next 10 years.
What types of outreach/volunteer work do you do, if any?
My family and I work in the children’s ministries at our church. It is a great opportunity for my children to learn how to take care of other children. I also do speaking engagements on childhood development for parents of preschool aged children. It is so important for us to support parents through this most challenging time in their lives.
How do you spend your free time? Any hobbies?
I love reading, traveling, and playing with my children. I also enjoy coaching middle school volleyball and summer volleyball camps.
Do you have family? Do you have enough time to spend with them?
Yes, I have a wonderful husband of 16 years, Tony, and a 10-year-old daughter, Sedonia, and an eight-year-old son, Thomas. It is because of Tony’s strength and support that I was able to start my own business. Having my own business with talented OTs, COTAs and support staff has allowed me to be there for my children’s school events and activities, and summer and holiday vacations. We like to travel to Nebraska to visit my family, and to the beach to relax and play.
Do you have any final piece of advice for students interested in pursuing OT as a career?
OT is a very rewarding career because you are able to work with people and truly make a difference in their lives. Although OT offers you job and financial security, that isn’t why you should pursue it. To be an OT, you should be a compassionate, resourceful problem-solver with good personal boundaries. Being able to help someone else through one of the most difficult times in their lives is the true reward of being an OT.