OTS 111: Back To Our Roots: Mental Health and The School-Based Role
- Jayson Davies
- Oct 9, 2022
- 40 min read
Updated: Nov 3, 2024
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Welcome to the show notes for Episode 111 of the OT Schoolhouse Podcast.
As OTPs, we were taught that our profession was founded on providing a safe space for those with mental illnesses, and we were there to help them engage in meaningful occupations, yet we tend to forget the importance of this.
Today, we speak with Moni Keen to address her capstone research on being an interprofessional team member and mental health in school-aged children. OTPs are often not seen as mental health providers, but we must advocate and change that narrative.
Tune in to learn how we can advocate for mental health and how we can address mental health individually with our students and on a systems level.
Tune in to learn the following objectives:
Learners will identify reasons why mental health is not being addressed in schools
Learners will identify why OTPs are not labeled as mental health providers
Learners will identify mental health diagnoses of school-aged children and youth
Learners will identify and reflect on the causes of mental health issues among our students
Learners will identify how to advocate for mental health in OT
Learners will identify how to advocate for students on a systems level
Guest Bio
Monica Keen, OTD, OTR/L
Dr. Monica Keen is currently an Associate Professor at Presbyterian College. She is the Doctoral Capstone Coordinator and comes to Presbyterian College with 33 years of clinical experience. Dr. Keen retired in May of this year after 27 years of school-based practice. She is an adjunct instructor at Baylor University and she is a contributing faculty member at the University of St. Augustine. She was an adjunct instructor for 7 years with the Medical University of South Carolina. Her 33 years of clinical practice included working in mental health at the Institute of Psychiatry at the Medical University of South Carolina, acute care, and nursing home settings. She owned a private pediatric practice for 12 years and closed the doors of Developing Abilities when she took on full-time academia. She has authored two separate chapters for colleagues’ books: one on school-based and infant mental health and the other on handwriting. Dr. Keen has done two webinars for OccupationalTherapy.com where she presented her Capstone work on OT being a part of an interprofessional team member for mental health in school-aged children. Her second webinar was on how COVID-19 impacted the behavior of school-aged children. In September of 2022, Dr. Keen was a guest on Jayson Davies’ OT Schoolhouse podcast where the topic of discussion was occupational therapy and school-based mental health. Currently, she is the co-chair for Mental Health for her state’s professional organization, the South Carolina Occupational Therapy Association.
Dr. Keen graduated with her bachelor’s degree in Occupational Therapy from the Medical University of South Carolina, and in 2008 she earned her master’s degree from Boston University. In 2019 she graduated with high honors with her clinical doctorate degree from the University of St. Augustine. She is passionate about Occupational Therapy and has a distinct interest in mental health, trauma-informed care, and pediatrics, particularly autism.
Mental health is a passion for Dr. Keen. Her capstone was on serving as a member of an interprofessional school team to address mental health issues in school-based practice. Her research findings were sobering and have ignited a desire to discover ways to re-establish OT as a recognized mental health provider.
Monica resides in Greenville, SC, and is a proud mom to two amazing adult daughters. She has two adorable Boston Terriers (Bubbles and Boomer), she loves college football, enjoys running and hiking, and being in the sun by the pool or beach is a favorite pastime.
Quotes
“We have got a significant amount of work that we have to do to regain the momentum of getting back into being recognized as a qualified mental health provider” - Monica Keen OTD, OTR/L
“It is paramount that whenever we document on a therapy session, that we do include something about the mental health aspect of that 30 minutes” - Monica Keen, OTD, OTR/L
“We know mental health is important, but we don't constantly look at it unless we put it at the forefront of our brain” - Jayson Davies, M.A., OTR/L
“Sometimes that IEP objective has to take the backseat for a session because that's not what the child needs at that point in time. Sometimes we’ve just got to meet them where they're at, and get them through that moment and then pick up the ball the next week” - Monica Keen, OTD, OTR/L
“It is being their voice for those who cannot advocate for themselves. We are their voice and we need to take that seriously” - Monica Keen, OTD, OTR/L
Resources:
Episode Transcript
Expand to view the full episode transcript.
Amazing Narrator
Hello and welcome to the OT school house podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here is your host, Jayson Davies, class is officially in session.
Jayson Davies
What is happening school based occupational therapy practitioner, I hope you're having a wonderful day. I'm having a great start today. And yeah, I hope you are as well. I'm excited for you to be here for this very episode today. We are talking about mental health in school based OT and to do that, we are bringing on Dr Monica keen. Before I introduce her really quickly, I just want to share why I am so excited for you to be here today. As many of you know, occupational therapy was founded in the mental health realm way back in the teens and the 20s of the I guess that was the 20th century, right? The 19th, 1900s or whatever was in the 20th century occupational therapy, we started in mental health, and over the last 100 years, we've wavered within mental health. We've gone up, we've gone down. And right now, some people would argue that we are kind of in the lowest of the lows when it comes to occupational therapy and mental health, and I think that is also true when it comes to school based occupational therapy. As ot practitioners, we understand and we also value the importance of mental health, but I don't think we often bring it to the forefront of our brain. We don't maybe write a goal for it. We don't actively work on mental health during our sessions, and maybe that leads to not documenting about mental health when it comes to writing our daily notes or our three month progress reports. But that may not be the best route to go, and maybe we need to reconsider that. So that's why I'm excited to bring on Dr Monica keen today. She goes by Moni, and she is just an amazing person, her attitude, her personality, is just so bubbly. I'm excited for you to hear from her. And yeah, it's going to be exciting. We're going to be talking about different mental health disorders that you might come across in school based OT. We're going to talk about why mental health and OT just aren't jiving right now. And then we're going to also talk about what we can do to help OT and mental health Jive a little bit more. We're also going to dive into a little bit about advocacy. So this is going to be a very fun filled podcast, a very knowledgeable podcast. I hope you will stick around for us, or with us. I guess I should say for this entire one. Monica is amazing. And yeah, before we dive into it, though, Dr keen is currently an associate professor at Presbyterian College. Before that, though, she was a school based occupational therapy provider for over 26 years, she has a lot of experience in school based OT and she's going to tell you all about it. So without any further ado, let us jump into this podcast with Dr Monica keen. Hello, Dr keen, welcome to the OT school house podcast. How are you doing today?
Monica Keen
I am doing wonderful. How are you doing today Jayson?
Jayson Davies
Fantastic. Even better. Now that I've got you here, you are just a bubbly person. I love having you, even in the short communications that we've had together, it's been a pleasure.
Monica Keen
Well, back at you. I'm honored.
Jayson Davies
Yes. So thank you for being here. We are talking about mental health, especially mental health and school based occupational therapy today. But before we dive into that, I would love for you to share a little bit about your current role in occupational therapy.
Monica Keen
Sure. Well, I just recently retired in May of this year from let's see about 26 years as a school based practitioner, and I have traded that in for full time academia. And I am an associate professor at Presbyterian College, which is located in Clinton, South Carolina. We're a brand new program, and we are currently going undergoing accreditation, and I am the Capstone coordinator there, and I also teach the mental health classes to the OTP students there, and it's been a wonderful transition, and I'm learning so much
Jayson Davies
that's awesome. And so if I can just follow that up as the doctoral Capstone, we have some students that listen to this podcast. What is it that the students have to do for their doctoral Capstone?
Monica Keen
Well, the biggest thing that I like to promote is that it has to be your passion. Whatever topic that you are choosing, it's got to be a passion of yours, because by the time everything is said and done, once you start the Capstone process, you are going to be involved in that for good, gracious, two full, three full semesters with field work in between, and so you are going to be an expert in that field by the time it's said and done. And as I tell all of my students, my goal for them is that their capstone will be such a dynamic project that wherever they implement their project, they will get off. A job to come on board, because there's just so many ways Jayson that occupational therapy can be used, can change the world, can make a difference. And so it's really a very exciting process.
Jayson Davies
Absolutely, absolutely. Thanks for sharing that. As you mentioned, you have retired, quote, unquote, at least from the school based world. But I'd love for you to share a little bit about your experience in the school based world. I think you were working for someone, but you also owned your own private practice, correct?
Monica Keen
I did. I juggled many, many balls prior to coming into full time academia. As far as school based is concerned, I was actually introduced a school based practice through a contract when I was working with a private company that was based out of Easley, South Carolina. And at that time, many, many years ago, I feel that school based practice, even though it was already in place, was just starting to catch hold in the state of South Carolina. And so, for example, when they hired me through the contract, I was only allowed to be in the in the county, in the school district, 22 hours a week, just 22 hours a week. And they had, I believe, four CODAs that carried out the therapy sessions. You know, I would go and do the evaluations. I would set up the treatment plans and they would carry that out. I would attend IEP meetings and write the IEPs as well. Well, jump ahead about a year and a half later, I was then an acute care team leader at the Medical University of South Carolina, and I ran into my old supervisor from the school district, and she was like, Monty, please come back. We would love to hire you full time. The state has a lot of us funds to hire our own OT and my life was never the same. I never looked back. It has been such a privilege to be able to watch how public education has changed over the years, some for the good, and some, not so much for the good. And it's really given me an opportunity to look through different lenses and to just see how occupational therapy has just absolutely grown and flourished in school based practice. And you know, as I sit back and reflect on those years, I wouldn't have wanted to do anything else. It was a very, very cool job, and I'm very grateful for having had all of those years to be able to do it.
Jayson Davies
That's quite an amazing story. I love speaking to occupational therapists who have some years behind them, because you hear about some of those. Does that change that has occurred over the last 2030, sometimes I talk to people and they've been around for 40 years in the OT world, and to see those changes from idea just coming into existence, and then the No Child Left Behind in in 2002 four, whenever that was that that made a big difference as well. So thank you for sharing a little bit about that. Sure. So then, when did mental health come into your world as a school based OT, you know, we know about mental health. I think a lot of us do, but our goals typically don't revolve around mental health. So what drew you into the mental health aspect of occupational therapy?
Monica Keen
Well, I think I need to go back just a little bit to kind of give you some perspective on where I came from. So when I was in school, back in 1983 and going through classes and we covered the mental health, you know, things, I was like, I will never work a day. And mental health, I you know depression, that's just, you pick yourself up by the bootstraps and you move forward. Well, you know what? The Lord had different plans for me, because when I graduated, the only job that was left in Charleston was at the Institute of Psychiatry, and so that was my very first job out of school, and did I learn so much? I left that job with a brand new appreciation for what mental health is and how it impacts life and occupation. So I worked there for about two and a half years or so, and it wasn't until I went back and got my doctorate degree, which I started in 2017 I knew mental health was important, and I was practicing, you know, of course, with any client that I was working with. But when I did my capstone, it revolved around, is occupational therapy, a school based occupational therapist part of the interprofessional team that addresses mental health concerns in our school age children, and the way my needs assessment was completed through a survey that I did through currently, actively practicing ot ours and actively practicing CODAs in the state of South. Carolina in the school district, so I weeded out a bunch of the fluff and just made it for school based practitioners. And I am one of those examples of I did not receive the feedback from my survey that I thought I was going to get, and the the Yeah, the questions that I asked were, let's see, we started off with some demographics, like, how long have you been an OT How long have you been doing school based practice, so on and so forth. Then I would ask some like heart scale questions, like, are you addressing mental health? And if so, what, what interventions are you using? And then I ended it up with open ended questions where I was looking for themes, you know, with the responses that I got, and overwhelmingly Jayson, I got feedback that was stating, I don't address mental health. No, we're not part of a team. I was just, you know, for those that said, Yeah, I do kind of sorta, and they would throw out a couple things that they were doing, and it just made my heart so sad, because that is where our roots are from. We are grounded in mental health, and I'm thinking that because we were not putting a standardized assessment in front of a kid and literally assessing for hard data, you know, they didn't think that they were addressing it. And I was like, No. Every time we are with a client, regardless of the age, we are always assessing their mental wellness and how they're doing, and through our therapeutic use of self and the intentional relationship model, we address those needs right there on the spot. And if we feel that further assessment needs to happen, we'll break out those standardized, you know, assessments. So it was at that point that I decided I've got to do something. I want to address this. But then, of course, those little, you know, words of discouragement come up, and I think, How can I do anything about myself? You know, I cannot make a difference, but things have changed along the way that has given me opportunity, and we'll talk about that later, to be able to have platforms to address it. So that's how my interest was totally reignited about OTs, we've got to stop graduating generations of therapists practitioners who do not believe that they are addressing mental health with their clients. We've got to get back to our roots.
Yeah, definitely, you know, and I just took some notes from what you were saying. I want to come back to it, but the intentional relationship model, let's come back to that later. But from what I understand, you had a mental health related job right when you got out of college, and then you jumped into school based ot for 2628 whatever, many years, and then you dove back into mental health now, during those years that you were in school based OT, how would you have responded If someone asked you, maybe in year 15, do you address Mental health concerns for our students?
Monica Keen
I would have said, absolutely I do. And I would give examples such as, you know, again, going back to the comment that I said, I've been able to watch how occupational therapy has grown through my 26 years of practicing in school based practice, I've also noticed that the responsibilities of our children that are put on their backs from the home setting gets greater and greater and greater every year. And so as I teach my classes about school based practice, I'm like, You guys have to understand that in a school that might be the only place these children get a warm meal. These might be the only place where they are told they have a purpose. This may be the only place where they have indoor plumbing. This may be the only you know, it just goes on and on and on, because I have witnessed time and time again kindergartners coming into school looking so weary because they had to get themselves up to come to school, to, you know, to get on the bus to come to school. Or the child who has autism, his day has absolutely been shaken because his routine in the morning was messed up because mom didn't have fruit loops instead of the Apple Jacks. You know, the kids who are experiencing, sadly witnessing domestic abuse, yeah, things of that nature. That is such a huge part of what we are addressing in school today. And so that is what I would be sharing with the people who ask me, Are you addressing mental health? We're also addressing behavior modification. You know, we're working very closely with the ABA therapist, and we're supporting each other in the behavioral techniques that we're implementing in the classroom and teaching the parents. We're supporting our teachers inside and outside of the classroom. I mean, I really feel that once you start. Up into the halls of that school. You're already on the mental health train, whether you're working with the kids, oh yeah, the teachers, the administration. It's just an all encompassing, you know, topic.
100% you know and that leads to a discussion, because my wife, she's an assistant principal at a school, and so we've had conversations about that, you know. I mean, she had to interview a custodian not too long ago, and she's got in the back of her mind, you know, he's not just a custodian, or she's not just a custodian. She is a member of that campus, and her or his interactions with the students is just as important as the teachers, the OTs, the principals, anyone else on campus.
Monica Keen
Without a doubt. I mean, you know, I think back to my high school days, when I'd been going through the lunch line, and there was one particular lunch lady who reminded me of Granny, and she would so lovingly look at me every day and say, Sweetheart, can I give you some more French fries? And she will never know the impact that she had a brightening my day. It could have been a rough, you know, start to the day I failed to test or whatever. But when I saw that lady who represented a grandma to me, and she was kind and considerate and intentional, yeah, it made all the difference, you know, in that moment.
Jayson Davies
Yeah, 100% so now this is kind of where that discussion that discussion that I was talking about leads to. Because, despite what I would call, you know, all OTs, we are mental health providers, we are often not deemed mental health providers. So what stands us apart from a the quote, unquote mental health providers that are often counselors, psychologists, so forth, and then we have OTs, and then we have teachers, administrators who fall into that realm that we're just talking about. They're not mental health providers, but like your granny and the lunch line was definitely a mental health support person for you. So that discussion, I guess, is, you know, why aren't we mental health providers, in your opinion, why aren't we labeled as mental health providers in many places? Because we are. And what do you think? Or what can we do about that? I guess.
Monica Keen
Oh, that's a multi faceted well to begin with, did you know that in the United States, out of all of our states, only eight of those states recognize occupational therapy as qualified mental health providers. That, to me, is disturbing, yeah. Why do I think that we are not recognized? There are many, many reasons. Number one, insurance companies feel that there are other disciplines that can do the same thing that we do however they are not trained to approach it. From the psychological aspect that we are implementing that activity, I feel that another part is that we as practitioners, even though we may be implementing a certain technique, we cannot bill for that particular technique under a mental health category. Does that make sense?
Yeah, you know. And that's hard in school based OT, because in school based OT, the billing is different from everywhere else. But anyway, sorry, continue on.
Monica Keen
Another reason is I feel also for occupational therapy, we have not been advocating for ourselves. It's kind of like, you know, we have to take responsibility and accountability for not promoting ourselves in that area of practice as well, and so we've got a significant amount of work that we have to do to regain the momentum of getting back into being recognized as a qualified mental health provider. Now, to let you know, I am the co chair for our state's professional organization South Carolina Occupational Therapy Association, and one of my mottos is that I want to use that platform to get the state of South Carolina's occupational therapist recognized as qualified mental health providers. And one of my capstone students is actually working to write that legislation to help promote that. But our state senator, Senator Tim Scott, is supporting the Mental Health Parity Act. Have you heard of that?
Jayson Davies
Yeah, actually.
Monica Keen
Yeah, it's it started, I believe in Delaware, and he supported the senator who actually wrote that bill, and my class, I had my class write letters to the senator thanking him for supporting this bill and then actually taking it a step further and explaining why we as occupational therapists should be recognized as qualified mental health providers in. Beautiful thing about that piece of legislation is that it specifically calls out occupational therapists as individuals who are poised and ready to be a part of the mental health team to address mental health issues. So I feel that this could not have come at a better time, and I do think that COVID 19 also was a blessing in that it has unfortunately brought on more mental health people who are struggling with mental health, but at the same time, our government is pouring more federal monies into the pot that helps to address those needs, but the people who can do it, the disciplines that can address it, are very short, very short staffed, and so hopefully we will be jumping on that train to assist them. Yeah, and you know what you mentioned, the the Mental Health Parity Act. I have to give a shout out to a OTA last week. I think it was just last week I was on the OT, a virtual Hill day, and we were speaking to senators and Congress people in California about advocating for Senate Bill 4712 is what it is that is the OT Mental Health Parity Act. So everyone out there, if you're hearing this, look up Senate Bill 4712 the mental health OT, mental health parity legislation bill, and, yeah, write in a letter, you know, take a take a page from Dr King students what they've been doing, and send in a letter. Send in a call, ask for that support, because it is a national bill, but it will basically impact all 50 states. It requires, I think it's the Secretary of Health to kind of put out information related to OTs as a mental health provider. So definitely. Absolutely. And today, I was attending the A OTA Leaders Conference, and one of the sections that we talked about was advocacy, and it really matters what you do to advocate, not only for occupational therapy and all the different areas that you can but just simply calling your Senator, writing your senator and saying, Can I make an appointment to talk with you about this? Can I you know, as you were saying about your writing, you're writing the white letter for something in your state. That's exactly what we need to do.
Yep, absolutely, yeah. All right. Well, you know what? We got sidetracked in a good way, and so I'm happy we had that conversation. I love it. But let's, let's dive back into specifically what you did in relationship to some of your research, and so you talked about earlier how things kind of didn't quite go as what you expected. So let's start with that very first part, because research, we have to come up with a an idea of what we expect, right? What were you expecting to get back from your survey?
Monica Keen
I was expecting for, you know, close to 100% of the people that I surveyed to say, of course, I'm addressing mental health, and these are the things that I'm doing. Some of the practitioners would identify things like the zones of regulation that they implement that have you heard of that social emotional learning curriculum. They talked about doing that, or they would say, Well, yes, I use sensory integration to help a child who is in emotional distress. And I'd be like, Okay, that's that's another avenue that you can do. But the mere fact that they were not identifying the strategies and interventions that they were doing as directed towards mental health emotional regulation, just was discouraging to me, just very you know, it did not sit well with me, and so it drove me to Be more cognizant in my day to day activities, and even in my interactions with anybody within the school setting, from administration down to the resource officer, the school resource officer about you know, be intentional about what you're doing with that child. Let's talk about this behavior, and let's figure out what triggered it, what is causing this to happen, and then when we could figure it out, then coming up with a strategy to be able to address it, if it should show itself again. And the success stories across the board, you know, for the years thereafter, you know, my my research came out, I found it to be very positive, very positive.
Awesome. So, yeah, all right. And so now, when you were at a school based in a school based position, were you actually writing specific goals related to mental health, or would you say it was. More of a behind the scenes. Maybe you didn't have a specific goal on the IEP, but you were still doing it.
Monica Keen
That was it exactly. It was something that we did behind the scenes, because, you know, our teachers are held to such incredibly tall standards that they are not going to specifically put down behavioral goals in in most cases. Now, we did implement some accommodations where we would have, like a check in, check out, for the child to come in. How is your day starting? How did your day end? That might be a specific mental health type of goal, but typically it was done behind the scenes. And again, I feel that if we have a child that's coming into a therapy session who was not emotionally regulated, how are we going to effectively address the IEP goal until we have assisted them in regulating themselves emotionally. Yeah? So it really is a catch 22 that you're going to do anyway. I just don't think a lot of practitioners recognize that's exactly what they're doing.
Yeah, yeah. I also think that some practitioners do realize that they are doing mental health, but on the flip side, are they doing mental health, kind of, again, kind of on the back end, on the on the down low, and would they consider that being a mental health service, or are they just saying, Yeah, of course, I do mental health, right? I always check in on the student, but I wouldn't necessarily call it a mental health service, because I'm not documenting it. I'm not writing it down that I did this, of course, I worked on the handwriting goal. I didn't work on mental health today. Now, I did some of those other things, but maybe they're just not documenting it, and therefore I'm not, quote, unquote, I'm not doing mental health. I'm working on handwriting.
Monica Keen
I see, I see what you're asking. I see what you're stating, and you know what, when I would do my documentation, I did include the mood, the behavior of the activity, especially, or the session, excuse me, the therapy session, especially if it was really good, as opposed to, you know, having a difficult time the week before, or if there was something, some type of behavior that was just out of out of sorts for for that child, if that makes any sense, yeah. So, I mean, think about it, attention to task, executive functioning, those, those types of components, they are impacted directly by how a child is feeling. If, you know, if they're in the red zone and they're out of control, no, they're not going to be able to attend to a task and complete it. If they're not feeling well, if they're if they're getting sick, they're not going to be ready to learn, to be in that zone where they are ready to learn. But I think it's also our due diligence. When we have the child that comes in who is modulated and emotionally regulated, what do we need to do to maintain that, to sustain that, to have a successful session from start to finish. Does that make sense?
Yeah, yeah. I agree. And I think that takes learning, and I think that takes maybe some professional development to really understand what you can really pull out of a session. And you're not just pulling out the handwriting legibility. You're not just pulling out the ability to cut on the line, but also pull out the mental health side of things. And, you know, it's, it's a lot, you know, we have 30 minutes or so to work with this student and to pull out all of that, it really takes a keen eye. And that comes back to the whole we're OTs, and we have that activity analysis view. You talked a little bit about the Kawa model and the intentional relationship model, and so those are all things that if we don't stay on top of it, if we don't think about on a regular basis, we kind of lose we don't lose sight of it. We know mental health is important, but we don't constantly look at it unless we put it at the forefront of our brain.
Monica Keen
Correct. And I think you also said something that was very poignant. Jayson, when you when you talk about documentation, I think it is paramount that whenever we document on a therapy session that we do include something about the mental health aspect of that 30 minutes, whether, if it's just a brief statement, affect was full range. Student was interested in all aspects of the activity. Student looking sad today, you know, inquired talk to student about how he was feeling. Student was able to identify, you know, at. X, Y and Z, because sometimes, and I know you appreciate this as a school based practitioner, sometimes that IEP objective has to take the back seat for a session, because that's not what the child needs at that point in time. And sometimes we've just got to meet them with where they're at and get them through that moment, and then pick up the ball the next week, when we when we go into into therapy, just taking the time, here's that word again, to be intentional and to address those types of needs with our children. Builds incredible relationships with our children who are on the spectrum. It builds trust. And I feel that the that our kids that have autism, when, when we have earned their trust, that's a bond that can never be broken, and that takes time and intentionality.
Yeah, absolutely, absolutely, I 100% agree. You know that bond that you build with your students is so important, and I will, in fact, I say it in my course. You know the first, the first few things that you have to do before you try to dive into the physical interventions is to build that relationship, whether this, whether it's an autistic child, a student with autism, or a student with ADHD, or a anyone else, right? Anyone, even a teacher, you have to build that bond before we can expect to get the support both ways from them and for them. Definitely.
Monica Keen
Exactly. Can I piggyback a little bit on the ADHD, yep. So when we talk about children who have that diagnosis, what are those children typically referred to as, the kid, the child, is being bad, high energy, bad. And we as practitioners, because we know about ADHD, that child is not bad because he doesn't have control over what he's doing. But if that is what that child hears day in and day out, in the classroom, at home, in the principal's office, or whatever, that is going to be a concept that he is going to embrace and believe in himself. And so there is a perfect example of educating teachers and administration, as well as the little one about behavior, about self control, about emotional regulation, and using that opportunity for ot to just really shine in the many areas where we can address that particular need. Yeah, so that, I think that's a that's an excellent specific example of how we address mental health in particular diagnoses.
Yeah, and you know, I'm familiar with the Kawa model. I think some people that listen are as well. I hope to have, I think it's Dr awama on to sometime talk about the Kawa model in school based OT, you mentioned the therapeutic use of self, and then you also mentioned intentional relationship model. And I'm not familiar with that one, so I'd love to invite you to just share just a synopsis about it, because I'm imagining that it kind of plays hand in hand with what you were just talking about when it comes to, you know, that student with ADHD and making sure that you're using intentional positive language and whatnot. So can you just briefly share the intentional relationship model?
Monica Keen
Absolutely. I mean, it's, it's really being cognizant of and being aware of how you are interacting with any individual, but particularly let, let's break it down to our kids with with with disabilities. It is taking the time to understand and appreciate where they are at. It is taking the time to step in their shoes, if we can, to try and truly get a glimpse and a feel for what they are internally, feeling what they're dealing with externally. It's being their advocate, with their teachers with their peers. It's being their buddy. It's taken the time to just intentionally get to know them, intentionally understanding how they tick and intentionally being that person that they can count on consistently in the school house. Again, it's like, aren't you intentional with the relationships that you build with the people you love, with your wife and with your children and with your mother and your you know your father? It's the same concept with the children that we work with. It's just really being present for them all the time.
Yeah, yeah, absolutely. And you know, I know there's some occupational therapists. Sorry, this just came to my mind as you were talking. I know there's some occupational therapists that their schedule is so tight and they're trying to figure out, how do I make use of that three or five minute walk from one part of the campus, from the kids classroom back to the OT room. And this is. Exactly what you could be doing during that that five minute right during that walk that is part of your treatment. It is not just a right. It's not just a transition time. I mean, it's more it's a transition time, plus it's a time to connect.
Monica Keen
And you know what? And I know you've experienced this Jayson, but I think of one of the kids that I worked with for like, four years, when I would come to the door to to get him for therapy. He would light up like a Christmas tree and get up and run to the door. And when he was he started off as non verbal, and we know music can help bring out bring out words. And so I started to sing, how is Thomas? How is Thomas? And I want you to know, by the end of the school year, he was able to sing, I am good, I am good. And we would sing the entire song from the time I picked him up until we got to the therapy room, and the last time I was able to work with him right before I retired, that would be our song that we did every single time I would pick him up. And, you know, the relationship that I was able to build with that child there, there's no money in the world that I would pay for that, you know, it's that kind of stuff that we, we were intentional in, in building that relationship, and it made a difference.
Yeah, absolutely alright. We've, talked a lot about, you know, I mean, we've talked a lot about a lot advocacy, we've talked about some models. And I will admit, I figured we'd spend the first 20 minutes really talking about your research, but we jumped right into a lot of strategies, a lot of things that are going on. And I love that you mentioned how you weren't expecting things to go the way that they did. And you mentioned they on the broader spectrum, you were surprised that OTs weren't working on mental health. Let's get more into kind of some of the specifics there. What were the really big findings that you found, maybe on a smaller level, not just that they weren't doing mental health, but what else did you find out from the research.
Monica Keen
I found out that they felt that they if they said no, that they weren't addressing it, they felt that they didn't have time, or, you know, their caseloads were too high, or they were too busy, you know, doing other things, or they felt that they were not educated, knowledgeable about how to implement mental health strategies within their therapy sessions, or they didn't feel confident. That was another big one. Their confidence level was very low when, you know, for a lot of them, when they said they did not feel that they were implementing mental health strategies. Another thing that I found was very interesting, and you might be able to compare this with your wife being an assistant principal. Many of them reported that it was administration who was taking care of the mental health aspects of things as they were, the ones that were, and I can attest to that in one school, Mr. Farmer's job was to do all of the write ups, all of the suspensions, all of the bus write ups, you know, all of that kind of stuff. Never did you find him stepping into a classroom to see how the teacher was doing with instruction because he was so busy, you know, doing all of the write ups. And so that was another response that I got from the survey was, we don't need to address it because our admin and our guidance counselors are doing that. There was just a plethora of different excuses, but those were many of the top, top ones that I recall.
Jayson Davies
Yeah, in the survey, I can kind of agree to that, because I know my wife has a kindergarten student who probably about one day a week, she ends up in the classroom for an hour or two, or sometimes even longer, to support that student in the classroom. And so yeah, you're absolutely right. That is not her job in particular. But of course, as an administrator, everything's your job. So yep, she ends up that person. You're right. Okay, so you also did some work. I mean, as COVID came around mental health, obviously you already referenced it, right? COVID brought around a lot of talk about mental health, and brought around money for mental health, but I believe you did some research in in and about this. So why don't you start us off with that area?
Monica Keen
Sure. So occupational therapy.com. Invited me to do a presentation, an additional presentation for them, about school based mental health. And when they asked me, What did I want the topic to be? I had noticed when we when when COVID hit, and especially when we came back to school, how there was a drastic change in our children's behavior. And I said I would really like to do a presentation on that how COVID has impacted school based behavior. And they were like, Great, let's do it. So as I was planning on how I was going to do my research, I decided to do it from a three tiered approach, starting with, how did COVID impact our teachers, then how did COVID impact our the parents of our students. And then how did COVID impact our students, knowing that the fallout from the top from our teachers was going to roll down to our parents, and then it was going to pick up the the difficulty that the parents was having, and then all of that Fallout was going to be falling on our children, who we know are not emotionally developmentally ready to handle the issues that were falling in their laps, much less handling their own dysregulation from which COVID had dumped on them in their little lives. So let's, let's look at that a little bit deeper. From a child's point of view, they are going from their occupation, their main occupation, which is to be a student, to get up and go to school every day and literally, literally overnight, was taken away from them, and not just for a week, no, for a whole school year and a half of another Yeah, and they are now learning from a computer, which they have to sit in front of. There, there's, oh, my goodness. It just, it's, it's huge, yeah, and we, you know, society was expecting when school got back in, okay, we're just going to pick up where we left off. No, my research showed that with our children, well across the board, teachers, parents and children, massive increases in anxiety and depression. Teachers again feeling like they were not doing a good enough job. What they went from teaching in a classroom to all of a sudden, we've got to do virtual teaching. And what they had to do, according to my research, takes a year and a half to master. To teach virtually takes a year and a half to master. And they weren't given the option. They were told, do this. Get out to your classrooms and do this. Okay, so that's the teacher's point of view. Now you've got the parents who have been told, alright, now you sit by your kids while you're trying to do your job from home and make sure that they're doing their schoolwork and they're understanding all the concepts again while you're doing your job. And then we've got the children who don't even have a concept of what's going on. They've all got to sit in front of this computer all day long. I want to go and play it just was a cacophony of a mess, a bunch of spaghetti noodles. Yeah, absolutely. And then, you know, we've noticed that there was an increase in video games. So there's an increase in isolation, yeah, they're not able to get out and be with their peers because we have to stay inside of the house. It was fascinating. All of the fun that, while very disturbing and very sad, it was fascinating. So again, that pull put even more fire on or more gas on my fire to get moving along in mental health and occupational therapy and using what I've learned in my practice day to day when I was in the schools. Gotcha, we could talk for hours about that.
Jayson Davies
Right, So, I mean, you obviously found that everyone affected. Everyone is what it really sounded like. And you know, kids went from using a computer to play a video game to using a computer all day long for for class. And I did not have a child at that time. Now I do. I can. It's hard for me to sit here and do my work while grandma's with him in the other room. And I mean, to have him right next to me would be even more difficult. So I know that was a struggle for the adults as well,
Monica Keen
Right. And so we're putting that demand on the parents, which is increasing their stress, increasing their anxiety, which is making them more short tempered with family members, including the children. I mean, it just and this was happening day in and day out again for an extended period of time. And so we are bringing back children into the school house that are still emotionally trying to figure out what they've been through for the past year. Year and a half. We are having children who academically were not ready to be advanced to the next grade because they weren't understanding the concepts that were taught to them, you know, while they were a virtual which, okay, let's, let's talk about that. That is going to make them feel like a failure because they're not understanding their concepts while they're plasma. States are moving ahead, and so what do they do? They shut down, and when they shut down, they're going to do one of two things. They're either going to isolate themselves and be very quiet, or they're going to increase their behaviors and act out. So again, I have seen regular ed students come back from the COVID pandemic, literally being assisted on either side of them screaming while they're going down the hall, because something just, it was like the what the straw that broke the camel's back, and they just ability to regulate their own emotions has been so intensely challenged. And if that's going on with our kids in regular ed, can we only appreciate how much more difficult it is for our children with special needs? so their lives have been rocked as well.
Jayson Davies
Yeah, and you know it's you did this research as a kind of hindsight looking back at COVID. And now I know that a lot of stuff going on with okay. Now what moving forward? Los Angeles Unified School District, they recently, I don't want to say that they were hit with it, but the Office of Special Education, oh gosh, OSEP, they came down on La and said, hey, you need to create a plan for all the stuff during COVID and provide services, because we know that ot services over the computer, while yes, you still provided them, they don't necessarily add up to what the student would have gotten. And speech therapy services, special education, Sai services. So what is part of the solution? I don't expect you to have the entire solution, but what is part of that solution? As school based OTs, you know, we've been back in the schools now. Some of us have been in there for nine months. Some of us have been back for a year. So what do you think we need to start doing if we're not already doing it?
Monica Keen
There's a couple of things. I think it would be phenomenal if every school, or at least every two schools, could have one ot of their own. That's a dream. That is a huge dream. Can you imagine the change that could be brought about Jayson, if that were the case, I feel that our schools need more funding for more occupational therapists, for an asunder of reasons. I also think that we need well, not only ot but I feel that our schools need to look at occupational therapies caseload as a workload and not a caseload. I think that it that whole point of view needs to truly be considered because, you know, people are in such a frame of mind that 30 minutes once a week is literally picking up a child, going into a room, turning on a timer for 30 minutes and walking. That's not what it is that is not what it is our workload is addressing students needs from the time we enter that school building until we go home at night. But as we are right now, I feel that we need to work in the the best way that we can with our teams, starting from the teacher down to the adult support. I feel that we all need to be unified as a team, truly working towards the best interest of the child. I feel that maybe we As occupational therapists need to maybe take a step back and look at our treatment sessions as a whole, and really reflect on, are we truly doing client centered therapy, even with the demand of following an IEP objective? And you're probably saying, What in the world do you mean by that? You can address IEP objectives in numerous ways. Just because, let's say we have a handwriting goal, does not mean that we have to sit down every single week with paper and pencil and write, write, write. We can do different activities to make the art of handwriting fun without picking up the pencil and paper. So again, maybe taking a step back and looking at our therapy sessions and saying, What can we do to make this an even more pleasurable learning experience for our kids? And I also think this is important. I think we as individuals have to step back and take a look within ourselves and find out and to turn be honest and say, what do we need to change about ourselves so that I can be the best interventionist that I can for this child and. Uh, during this therapy session every day of the week.
Jayson Davies
Yeah. And to add to that, I think if you think of the IEP as a IEP team specifically, you know, we have to, as an IEP team, really take that step back and really figure out what are the most important things that we want to focus on the next year. You know, because any IEP team could have 100 goals for a student, but we need to break it down and find those five, maybe six, things that are most important that we really want to focus in on and work toward those. And maybe mental health is more important this year than handwriting or using scissors or numerous other things, and so as a team, we can come together and make that decision to prioritize mental health.
Monica Keen
So absolutely, absolutely.
Jayson Davies
One of the things that you pointed out, or you pointed out several times, is supporting teachers. And I like to think of school based ot being on two separate levels. School Based OTs can obviously help the individual student, but school based OTs also work at that systems level, where you're talking about the whole school, and I think when you talk about supporting teachers, you're talking more at that systems level. I guess when it comes to mental health, a little bit. I guess you've already kind of done this. You've already kind of broken down some things that you can do for the teachers. But at a systems level, I guess the larger picture, are there any programs that maybe you recommend? Is there any thing that you might do to help the entire school, as opposed to supporting the individuals?
Monica Keen
I think education Jayson is the key. I think that while we can maybe even take the programs that are already in existence at individual schools. So like, for example, in the district where I work, the entire district had adopted zones of regulation to be in each individual school. So taking the time to educate our teachers on what does that exactly mean? What does yellow look like? What does green look like? You know, those types of things. I can't even tell you how many times when I could have a conversation with a teacher about how, how Johnny behaved in therapy today, and why I think X, Y and Z happened, and she would step back and say, I never looked at it through that lens before you. I think you're on to something. It's really I feel at a systems level, taking the time to communicate, to problem solve, to brainstorm about these children individually. You cannot group them all together. We are all beautifully and uniquely wired to function differently and so providing our teachers with those ideas of, for example, you know, why can't Susie pace back and forth at the back of the classroom while you're lecturing? Because movement helps her, you know, get the information. That's what she needs to do in order to to hear and learn the information our teachers don't know about how sensory impacting all the sensory systems really is how we best learn. It is advocating for that child at a systems level of this is what we feel they need to do in order to be successful in the classroom. It much like, you know, it goes so much further and deeper than an IEP objective. It's, it's being their voice. For those who cannot advocate for themselves, we are their voice, and we need to take that seriously.
Yeah, I think as a whole, we need to, because I believe this is true. We need to understand that we can support students just as much by supporting other people around the student as we can if we pull them out for a 30 minute session.
Monica Keen
Absolutely, absolutely. And I think we as practitioners as well as school personnel as a whole, I really do think that we need to look at that a little bit differently and be given the permission as the provider to address it in more unique and creative ways. Because again, we have to go back to being client centered, and not every child is going to respond to the same book intervention that you know, has been created over the years. I find that if, if we are given the permission to really explore how to best. Reach that child that's going to help us be more successful in our interventions?
Yeah, absolutely. Monica, thank you so much. It's been a pleasure. I have two more questions, at least two more questions. They're going to be more rapid fire, though, okay? And they're really quick. Hopefully they're pretty easy. What is one online resource you would love people to check out related to mental health and students. It can be a journal article, a website, whatever it might be.
Monica Keen
One of the websites I would really encourage is called powerfully you. Powerfully you. And it is a social emotional learning curriculum that was written by two occupational therapists based here in Charleston, South Carolina, and it is very big on interoception, and it talks a lot about teaching the child how to understand what Their body is feeling in in times of emotional dysregulation, as well as how it feels when one is emotionally regulated. It truly is a fascinating program that is catching popularity very, very quickly, and it's it's really worth taking the course.
Great. I'll have to look into that myself. I've never heard of that one, so thanks.
Monica Keen
Oh, good, yeah.
Jayson Davies
All right. And then on the flip side, something that is offline, maybe a book or something. Is there something you recommend to therapists? Maybe to check out?
Monica Keen
Oh, my goodness. There are so many. I think you know some of the oldies, but goodies, especially for our younger kids, like, how does your engine run the out of sync child? Those are two that come to the the top of my head to begin with. But I feel that anything that you can get your hands on to read about how to better understand our students their behavior and what makes them tick, is going to be a priceless read for you to invest your time in to always give us better insights into into our students behavior. And those are those types of writings are coming out all the time. So.
Yeah, you know. And if I had to answer this question, I just picked up a book, and I'm excited to read it. And it's by Dr Mona de la hook, and it's called Beyond behaviors. And I know she you looked at the polyvagal theory and how all the things in the world influence our behavior, not just, you know what we want to do. There's so many things that impact our behavior. So that would be, that would be my response. But thank you so much for mentioning the out of seeing child, the How does your engine run, program and yeah, that's, I think all I have for you, other than where can people potentially learn more about you and the work that you're doing? If they'd like to learn more.
Monica Keen
Absolutely, I can give you my email address. Would you like for me to do that?
You know what you can say really quickly, if you want to. And then we can actually, we'll just put it in the show notes. I think I'll also tag your LinkedIn account. Your LinkedIn seems to be?
Monica Keen
Yes. You can find me on LinkedIn. You can also find me at Presbyterian College. My email there is m keen@presby.edu or you can contact me through my personal email, which is Molli soo@aol.com M, O, L, L, I, S, O, O, @aol.com, and it has just been such a privilege to spend time with you, Jayson, and to talk about really, what I'm so passionate about, and I hope that that has been presented in today's conversation.
Absolutely you are definitely passionate about this, and I think you're going to make some others passionate about it as well. So thank you so much for being here. Really appreciate it, and I know we will be staying in touch. Thanks again,
Monica Keen
thanks again, bye, bye.
Jayson Davies
And there you have it, school based OT and mental health. There's so much more that we can be doing. There's so much more that we should be doing. So please help me give one last thank you to Dr keen for coming on and sharing all of that wonderful information. Thank you also for being here today, for listening through this podcast. If you're still listening, I know you got so much value out of this. I know that you are working to make yourself a better school based ot practitioner. And I thank you for doing that. I thank you for being here, for getting that professional development. And even if it is listening to a podcast, it's still professional development. I appreciate you being here. I appreciate you being on the school based OT, ot school house podcast being here today, and I look forward to seeing you in episode 112 until next time, take care. Have a great two weeks, and I'll see you next time take care. Bye.
Amazing Narrator
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