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OTSH 77: Friendly Adapted Shoes with Joseph DiFrancisco, MS, OT/L, Chief Friendly Officer
Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 77 of the OT School House Podcast. Today we are talking with a former school-based OT who is well aware of the struggles OTs come across while working in the schools. In fact, it is that school-based experience in conjunction with other OT experiences that led Joseph DiFrancisco, MS, OT/L, (AKA - Joe Friendly) to create a new line of adapted shoes for people of all ages! If you have ever had a parent ask about a shoe tying goal, be sure to listen to this episode. You may have a new favorite recommendation for those parents. After you listen, be sure to check out Friendlyshoes.com to see all the styles Joe and his team have come up with to support those who may benefit from an easy to put on shoe. Links to Show References: Friendlyshoes.com Friendly on instagram Joe DiFrancisco on Linkedin Episode Transcript Download or read a rough edit of this OT School House Podcast episode 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. The class is officially in session. Jayson Davies Hey there, welcome back for another episode of the OT School House podcast. Thank you so much for joining me today. Whether you're listening in the morning on your way to work, in the evening on your way home, or maybe on a walk during the weekend, I really appreciate you taking the time to spend a moment with me and talk about school-based occupational therapy. So today we are talking with a former school-basedOT who knows all the struggles of what it is like being a school-based OT, but we're actually not going to talk about OT too much. We're actually going to talk more about his new company. Well, it's not too new anymore. But he is an occupational therapist, he still has his credentials, but he has gone on to use those credentials to create a product. That is for all abilities, people of all abilities will be able to use his. Well, I'll just share the news. Now. It's an adaptive shoe. But it is a shoe that can be used by anyone. He's here to share it with us. His name is Jo DiFrancisco, and he is the Chief Friendly Officer as he likes to say, of friendlyshoes.com. So let's go ahead, we're going to jump into this interview. I'm going to let Joe give a little background into himself and his career as an occupational therapist, and how he came up with the idea of making that adaptive shoe for everyone, kids, adults, whether you have a disability or not. Feel free to check out friendlyshoes.com and the rest of this interview with Jo DiFrancisco. Hey, Jo, welcome to the podcast. How are you doing today? Joseph DiFrancisco I'm doing all right, Jayson. Thank you so much for having me. Jayson Davies Yeah, definitely. It's a pleasure. Well, we met about a month ago in an OT program, entrepreneur type of deal, right? Joseph DiFrancisco That is correct. I believe it was the University of St. Augustine and Tech, USA. Jayson Davies The USA. St. Augustine. Nice. Love it. All right, man. Well, so I'm excited for this one. And I'm sure many of those who are listening will also be excited. Because as school-based OTs, we often get the question, what about shoe ties? What about the student's ability to put on their shoes, tie their shoes and be functional in the school? I'm sure you've heard that several times already from pediatric therapists. There's always a big question about shoe tying. So before we get into that, though, I want to give you an opportunity to talk a little bit about your career as an occupational therapist, how did you decide to become an OT? And where are you today? Joseph DiFrancisco Oh, great question. So I'm not really sure how I really ended up in occupational therapy I know that I grew up with a single mother kind of influenced me to help others. I finished my undergraduate and about physical therapy, ended up finding out about this thing called sensory integration while I was doing my kind of PT assistant work under an orthopedic in New Jersey. And no, it just seemed like there was so much more to it. So much of the unexplained I had gotten the opportunity while viewing the physical therapy stuff to watch the OTs, watch these children coming in maybe dysregulated. And then in the coming out, you're like, this is a whole new kid and, and the amount of information you were able to get into their brains during this sensory stuff. And I just one thing clicked and I'm like, Oh, my gosh, I would love to pursue this. It turned out. I think that my family and I were kinds of sensory kids. We chose sports to get this self-regulation. And I pursued it and then up at Seton Hall University. Jayson Davies Nice. And so where did life take you after college? Joseph DiFrancisco Ah, that's a great question. I have two cars, here, there and everywhere. I had plans to move to Hoboken, New Jersey, I was going to practice in Manhattan. One thing led to another my roommate fell through. So I moved to San Diego. Jayson Davies Oh, wow, big change. Joseph DiFrancisco Yeah, big change. I had the opportunity to get into San Diego Unified School District here and so out, practicing, you know, anywhere from high school mental health, middle school, elementary got to do special education, early childhood. Before I had actually come out here I practice for a couple of months by taking six months in early intervention. So it's interesting to watch through the lifespan, how much you've learned and how you can implement these things you've learned into other areas of practice. Give all of your listeners a lot of credit, school-based OT is not easy. Talking about the IPs. Talking about the data, talking about the interpretation of the data. We got out here initially, I'll never forget the first kind of tape recorder I had in front of my mouth and you're trying to do the right thing. I'm trying to help you guys. Like why are you trying to record me with this Your advocate there like it was, it was a humbling experience. But yeah, you guys do great things. Jayson Davies Thank you, Ben. So you're not in the schools anymore, though, are you? Joseph DiFrancisco I'm not. I made two years. And then my mom got sick, she got lung cancer. And then I kind of bounced around had some questioning of my whole life future had this OT education, my back pocket and just trying to think bigger, how I ended up in shoes, you assume that I wouldn't be a physical therapist. So now I ended up in shoes, I hate feet. This was also influential in my decision for OT. So I'm no longer practicing. But we still do have a rapport with some San Diego unified schools and giving shoeboxes for certain class projects and stuff. So it's good, I have a lot more insight regarding bureaucracy with my six and seven-year-old, you know, My son was having some learning challenges and speaking to the teacher, and definitely, some eye-rolling there when I said that he's having potential challenges with his Virtual Education. Like, I don't see that and you're like, Yeah, Jayson Davies Sure. Alright. Well, you kind of started to bring it up the shoes. That's what we're here to talk about today. And so I'm excited to have you on exactly to talk about this friendly. When I met you, you first introduce yourself as Joe friendly, because you are, as I like your title, the CFO of friendly. So you know, when I'm going to give you a second to just kind of tell us a little bit about what friendly is maybe like that elevator pitch. Joseph DiFrancisco The elevator pitch is always changing, I hate to say that, I've definitely turned a corner to a bit of a businessman, but I always appreciate opportunities to speak to OT. My initial kind of vision was being friendly, was helping others. And in practice, you know, starting out with, with the seniors, because I at some point was doing when I stopped doing the school-based, I ended up in skilled nursing and then home health. And then they would give us these, these hip kits. You know, these, these long handle repairs, and tight, nothing was working for me, there's a doctor told me this would work and outside of the socket, this thing ain't working. So I do this. And it just would frustrate me. In Home Health, I was able to kind of almost be friends, a couple of my patients where he had taken me when he finished his service. And we did private sessions, affluent guy here in Southern California, real hard worker, honest guy. And I had to adapt, I was looking at the shoes in the market. Everything was kind of you to know, disability shoes. If you look at some of those orthopedic shoes of the diabetic shoes, or even some of these, like easy access zipper shoes, just the upper is affected. And it's cool. But you know, people want options. So I did the right thing. And when I initially started, I started doing the fabrication of the shoe just like an OT would do a hacksaw zipper. I think I stuck a door hinge and the opposite side of the opening portal, we have Well, no, I got really unique and ended up getting something that I guess you'd call prototype, I'm not really sure. I met a cool patent attorney out here that was nice. And, you know, was friendly, in regards to prices. So I buy "be friendly", "friendly" and "friendly shoes" for trademarks. And they all went through. While that simultaneously was going on I just, you know, I was still practicing. And then I was working after hours to try to push this into real shoe manufacturers and took a lot of I guess adversities and a whole bunch of companies that just couldn't do it right and ended up in South Brazil. And then we got a prototype and I'll never forget looking at it just like now I'm gonna have to do this. Jayson Davies The real, the real moment set in, huh. Joseph DiFrancisco Yeah, the real moment set in I had my trademarks. And that takes quite a bit of time. And when we got the prototype, right, we were patent pending. And then we moved forward. And now in this process, we managed to get two patents thus far and more kind of pending. So things have changed, you know, the humility of being an OT is fantastic of my business partners are way smarter than me. We got JD is it just an attorney and a Ph.D. with some Pfizer experience and research and just a real detail-oriented guys, but they’re not like OTs, they're not willing to make as many mistakes are not willing to adjust and the ability to adapt is really what influenced us getting here are the guys that are always about being perfect and making mistakes. That doesn't really bother me. Jayson Davies Awesome. I love that being able to make mistakes and continue on. Yes. All right. So you went through a whole lot and we're gonna break that down a little bit more for everyone out there who you know, most of us are school-based OTs, we don't know patents. We don't know trademarks. We don't know all that. So we're gonna get them to break it down. But you actually mentioned that you were in a skilled nursing facility a little bit and I'm not gonna lie, I did a little bit of LinkedIn stalking you. And it says, aging in place specialist. I think it's kind of what you have out there. So share a little bit about that. Joseph DiFrancisco Yeah. So in my kind of endeavors to think outside the box, I ended up finding the ability to age in place. When you work in home health, it's just you really, sometimes in a school district or within a facility, or you're operating in big brother's watching, so you have these limitations on what you could do with home health, it's the complete opposite, right? You're just like, oh, gosh, what am I going to do? I couldn't even explain it, the simple adjustments I was making within the home, that would change everything without actually going through the thorax, right? That would actually go through some of the stuff that we were kind of forced to do within the therapy clinic. You know, for instance, color contrast thing with painters tape in the bathroom, individual with Parkinson's. I once had a gentleman that was co-morbidities, he had Lewy body dementia, and Parkinson's, and the wife was just, oh, gosh, what do we do and like, I was kind of a middle-aged five years under my belt, I was a competent therapist, but I was like, I don't really know. But I'm gonna work really hard to help, you know, figure out what we can do. And she was totally cool with my honesty. And I'm just taking that painter’s tape hitting the books, hitting online, and helping this individual age in his space that he wanted to agent. I mean, it's, it's an amazing thing, to have them actually be in their, their home and their desire environment where you know, they have this last chapter in their life. So that's how aging in place specialist started the email. And when I actually met with contractors, and I did a certain certificate through the National Home Builders Association, I realized, I knew nothing about No, I stopped doing that. Jayson Davies Awesome. All right. And so you started to go down the route. Also, in the previous segment, we're kind of talking about how you grabbed a hacksaw, you grab some zippers and, and created this first, "prototype", per se. Do you remember this specific client or that specific moment when you were? I mean, is there a story really behind it, where you decided to, hey, you know, this person would benefit from it, and you went forward with it? Or is this more of a, I don't know, an accumulation of items, then decided, Hey, I'm going to try it out. Joseph DiFrancisco I would say accumulation. I had multiple people in mind, one guy, I would say was my focus. He was, we're a big military town over here. So, you know, shout out to anyone that you know, serves the country, I think it's an amazing thing. This guy grew up with nothing and earned, you know, everything. And he would just fall and like, be like, you know, I felt like, I gotta report this to your doctor doesn't do it. I felt like four times like he wasn't, he didn't really care that much. He had a stroke. You know, when I had him do hand stuff he like, hated me. I'm like, dude, you gotta you know, this is important for everything. So he was a stroke. So neuro, you always kind of taking that same clinical approach, when you're trying to invent anything. And it just stuck in it, whether with thought processes or keys is this individuals going to do this, from what position, right, but you've been sitting most of the time, how's he going to get the foot in, he didn't have hip flexor to get the foot up. And you know, if collapsible heel technologies and various other adaptive shoes, which is great for us, that are coming to market. So he had to be able to keep his hip flexor to what it was. So entering through the back was important. And that was a guy that helped kind of influence how I manufactured the first easy shoe access. When you get to that stuff, you don't want to know about the patents and trademarks. And it's a bit of a legal wrestling match with words they make up. But when you post it, you just have to be careful what you post when you post because you know, big companies are watching, so I'll leave it at that. But looking at this individual had you know, comedy is affected extremity, upper, and how to affect his, you know, affected lower extremity. And he did have some visual perceptual issues too. So, I mean, how can I make it best for I mean, we'll call him Bill. I did it. Didn't really realize that once you actually get the foot and you got to accommodate that aging two-story perhaps. Jayson Davies Yeah, I can just imagine just like, "Yeah, we got the foot in now how do we close it up over his foot and make it so that it doesn't come off while he's walking and so many other problems that go into that?" Joseph DiFrancisco Yeah. Jayson Davies Alright. So I have a question for you. And that is, I'm sure you didn't just jump out and say, "Hey, there's no other shoe out there. That is adaptable". I'm sure you did some research, did your homework a little bit. What other types of things were out there and how did you set to be different? Joseph DiFrancisco So I mean, I did this so slowly, and admittedly, probably not to my benefit, where You have Zappos adaptive that's out there that are now our partners. They really helped out when I filed for the initial patent and trademarks, they didn't even exist. So I just kind of I did what I thought was right. And during the process, I mean, I'm sure this wasn't the best decision because I'm not a very good businessman. Currently, I wasn't aware of any competition, I think there was an easy shoe, and something called hatchbacks. That was kind of cool. But they kind of look for me, like, the fashion element is super important. So kind of, I don't want to break on a brand. But I mean, not what I was trying to work toward having this normalized upper, and how can you meet, you know, we want individuals to be friendly, and kind of like, you know, show your disabilities cool, like, you know, don't be ashamed. But we want people to have options. And this was the biggest challenge. To your question, I probably could have done more research, but I was practicing full time. And I had my son that was under a year old during the time. So I did not actively identify all of the potential competitors. And, you know, to speak to the patent process, before these large companies come to market, they have the ability to audit your stuff. So a large company came to market with something that was eerily similar to my shoe. And I'm just like, Oh, no, we posted, and they use something called a continuation pattern to defeat the claims that I had. And then, you know, the competitor and me, kind of leapfrog them. And that's where we sit today. I don't know what's gonna sit tomorrow. Jayson Davies Gotcha. And so your shoes, they don't have they have laces on them. But there's no lacing involved, right? Joseph DiFrancisco 16:47 No, so we have elastics coming out. But that takes away the ability for tension opportunities. There's not that much research, but I feel like clinically, it's common sense, at least, maybe just for me. But if you don't have proper footwear, and you're wearing slippers, you're going to be you know, the potential increase in Fall probability. I mean, you need to have these on your feet, slippers move around, you don't get something that we've found in the research called fixation of the footwear on your feet. So all the laces are free, we do have one style called "our forces" that is more of a slipper, but it is intended in a wider foot to accommodate, you know, footwear issues like funyuns, hammertoes, all these, you know, variables that are associated with aging. So, ya know, we, I think we did well, in that keeping the free laces, we have pediatric lines coming out and based on feedback, limitations, when you don't have the laces, just not worth it. So it's kind of a set, you know, set it once and forget it. And then if you're going on long tracks, and you can't tie your laces at the one potential pitfalls, you will have to require assistance. But you know, the pros versus the cons. If you can't do it, then you can't do it. So you better be that way. Yeah, absolutely. Jayson Davies So then how is it going to be for kids who can't tie their shoelaces? Just like everyday wear? If they're at school and whatnot, what does it look like for that kid? That's going to have your shoe? Are they going to have to adjust the shoelaces at all? Or is it only? Not very frequently? Joseph DiFrancisco Great question. So our first line doesn't have laces at all. And that's our friendly force. It's a wider last. So you know, we have tried to make sure that it does have some depth, and something called the instep coming across the top of your ankle area to accommodate AFOs and SMO's and KAFOs. But if the child does have the laces, if you double knot it, you should be straight. We haven't gotten many issues. We're two years in now. So we've had we've gotten a lot of feedback. So should be set once and forget it, you double knot and there shouldn't be a problem. And the zipper in the back should, you know, it's a kind of separate, separate on the zipper and off you could do with one hand that was super important with me, you could actually do it without once it's broken and kind of like a baseball glove or that door opens up through that medial portal. You could do it hands-free, which was also important. If you have the balance, if not, right, you rest your hand on some type of surface to assist that ability. So you're always looking for different strategies, but that tension is super important. I just know the OCD in me is if the shoe is moving too much in the foot, it's not gonna be good. I agree. Jayson Davies I mean, growing up, I was always a kid. I had to have my shoes super tight. I played baseball, basketball, sports, everything. And yeah, it had to be super tight. If it wasn't super tight. Then I was like down on my knee making it tighter. So yeah, you got to have that tension. You're right. Joseph DiFrancisco The opportunity because everyone seems to be different. Jayson Davies I believe it. Yeah. Joseph DiFrancisco Now we have. My daughter's here talking to me more bringing out one of our new kids for back to school and she's helping us named Charlotte. What's the name Mr. sparkles. Oh, Princess Sparkles. As he said, Princess Sparkles and gold, pink Cheetah, and we're looking for real, you know, just to have that, you know, Flash, right to be able to have some swagger and your footwear? And I don't think it necessarily existed before. Yeah, we have two different types of easy shoe accesses and rear easy shoe access, which we do have the patents on. I mean, the uppers essentially look like a regular shoe. I mean, that was the trick. Yeah. And that was a difficult part. Jayson Davies Yeah. And you know, this is an all for the most part audio experience, we might cut this up a little bit and get some visuals, but friendlyshoes.com, right? It's where people can go and check it all out. Joseph DiFrancisco Yes, Sir. Jayson Davies Alright, and we will be sure to link to that as well in the show notes. So you can check it out. And yeah, you have the two styles that I saw was the heel cup, the one that kind of opens almost like a door in the back. It's like a little door. And then you have the other one correct me if I'm wrong, that opens up more like a what are the what are they called the Ferrari doors? Joseph DiFrancisco They kind of open up what is the full form of, yeah. Jayson Davies Yeah. So those are the two main ones are there more, you said something about a slip-on. Joseph DiFrancisco The slip-ons have that we call it front easy shoe access. And then we have rear easy shoe access. And the challenge with the rear easy shoe access as an OT, you know, your, if you bring the zipper line too long, you can't reach it, then you got to elongation pull tab, and that's where that publicly-traded company tried to really compete with us. And I think they lost to an OT and just one OT in that. Making that over open and stopping a certain area on the shoe, you had to make the opposite side of the zipper bendable. So you have a straight shot into the shoe. So making you know, if you have two firms it's called heel counter, it doesn't bend. So you essentially would have to hockey stop in, we make your zipper open. And then it just bends nice and easy. And then it's easy for the individual to reach for it. I think something that OTs would love is we added an eyelid in it. And some people think it's aesthetic. I'm not sure it gets used for this much. But it's for dressing. My goal is these I got to use this dressing stick or something. Because I'm not sure in 10 years of practice I ever saw it used for anything outside helping shoulder range of motion issues through an armhole and a shirt. So yeah, so the eyelid was initially made for a dressing stick. And as we're starting to go commercial and we're starting to scale. I mean, we're talking Canada, UK. We have an interest in New Zealand. We're sending them out in the next couple of days in Australia. They don't I'm not sure they people really realize but now we're just going with it, a dressing stick-holders. Now just part of the friendly story. You know... Jayson Davies I love it. OTs making a change in style. Joseph DiFrancisco And functional change. Jayson Davies Yes, absolutely. So from the zipper, the eyelid. What else have you guys done to make Friendly a truly friendly shoe for people of all abilities? Joseph DiFrancisco Oh my gosh. Alright, so I'm going to kind of give some information here at this podcast that I appreciate everyone being Hush Hush. So the simple thing, you have to make sure there's arch support, you have to make sure that their support shank or something in the heels. So you want to have the outsole firm, but not too firm has to have the cushion for individuals that might have co-morbidities we work on different pull tabs, so individuals with gross grasp, right, and individuals that have their fine motor are both able to do it. We are working on our kids and this is the Hush Hush. Don't tell these big publicly traded companies that y'all have them contact but we're working on sensory-friendly materials we're working on left-right discrimination. We're working on color contrast in certain parts of the shoes where it is visual impairment friendly. It's just the more and more information and the more shoes we sell, the better we get. Oh, I'm having a problem, and then you know, they kind of stick me in my dark area where I just think of how to solve problems and they push on the business stuff so we're always looking for different things of how to make it for all abilities. Our push toward having that front easy shoe access was because the rear easy shoe access no wasn't forced certain abilities. So this is surely not about the money for me at least. It just doesn't. My mind doesn't stop I guess. Perhaps my curse will someday be everyone's gift that their mind that just keeps ongoing. It's just I'm always trying to develop something new. I'm always trying to accommodate different people. That sensory-friendly stuff. I think a couple of shoe brands came out with color palettes to ease autistic children's effect or regulation and you like, okay. I'm back, see the research on that. So we're always trying to Google up always trying to talk to colleagues, we're working, you know, with a couple awesome publicly traded companies, I don't want to rip on them all on research that they might have gotten through their affiliations with pediatric hospitals, and all of that, you know, the context they've had, I said before, is Apple's adaptive has been absolutely fantastic. They've helped us in every way, including cash flow, you guys get the business, they have like, net, the 90s, net, 60s, net 45. So essentially, you have to, you know, bring the goods here, and then you have to wait a certain period of time before they pay. And they just mean, they really, they help us because they know the cash flows important for us to continue to develop, continue to get information based on their feedback, our feedback, and just create, you know, hopefully, something for all abilities. We all know as OTs that it'd be impossible to have one shoe for all abilities, but I'm hoping we get different iterations to accommodate all abilities. It's a big thing for me, like, I ain't making a disability shoe, I'm just not doing it. I want, you know, my vision is to have you know, a little brother, and the older brother, the little brother with a disability, like, you know, doesn't get to hand me downs from an older brother. And like that, you know, now he's going to take the hand-me-downs, his older brother that's typically developing maybe aspiring in athletics, he's able to, you know, little brother gets it. It's like, that's your shoe. And it's, you know, it just keeps it when you guys are wearing the same shoes. That's a real width challenge. We'll discuss that later. But that's my vision, all abilities. It's not a disability show. Jayson Davies I love it, man. That's great. Yeah, that's, that's full inclusion when we're able to have, like you said, one kid who needs it needs the ability to use a zipper and another kid who maybe doesn't need the ability to use a zipper. But hey, you know what, it works for both. They can both wear it. And that's awesome. So, I want to ask you this one, what has been the most rewarding moment you have experienced as a result of creating these friendly shoes? Joseph DiFrancisco Alright, you know, I've had a couple of them. Yeah, where you will, you know, and the first one I thought I was, you know, I knew what I was doing and shoe business or anything else you're getting into. Had a Ruth Segal, a Ph.D. professor at Seton Hall, they kind of said, "Hey, guys, your first two years, play conservative, you're not going to know what you're doing." And I'll never forget around the time I hit 2 years, like, everything slowed down in OT like I've seen a lot, you know, staying hungry, you're learning. I had a woman on our first day when we had our opening party at our pop-up store, and she couldn't put her shoes on. And well, then she could like, and, and she walked in and her husband, it was an Italian gentleman like myself are very family-oriented, and he got to take care of your lady. And you know, he's helping her in and she... you know, kind of slumped back and she puts on her shoes, and her posture comes up. And she just like walks out of his door. Man, it really was, it's, it's just an amazing experience. I had another couple of grown men shed tears when it's just, I mean, it's your ability, and I laugh with my colleagues all the time, I'm essentially with our video chat on friendlyshoes.com we have the ability to essentially give OT from afar. And if we can't, you know, accommodate their needs, then I'm going to put them some other shoe company that can that's just that's the way we are at friendly. And I've had a couple of grown men shed tears. I mean, it's just it's, it's that easy. You made the technology, the ability to reach out to scale now the ability to reach out internationally just we got a five star this morning from a gentleman with Parkinson's and I know Parkinson's well neuro was like my favorite thing and having these visual cues. The other thing in addition to the dressing stick was having the eyelid to create a visual cue for the individual with Parkinson's. And I know this is school-based but the visual cue helps in addition to carbidopa-levodopa and I send them in and the medication they're having with the dressing window where they have the most volitional control of their muscular-skeletal system so I seem to be getting them as their shoes get better and better I've become a bit of an addict of having these moments and unfortunate you know, to the other side of it when I cannot accommodate it, I take it personally and I know I can't touch that the scale but we are trying our best with our you know startup wrestling match we got going on here. Jayson Davies Good deal, man. That's so much going on. And I know you and me kind of had a little chat over email and like, you know what, what about the kids in school and you already mentioned it earlier that right-left discrimination being able to put the correct shoe on the correct foot. And one thing that I do like about what you have is that the way that the shoes open up, they almost kind of prompt you as to which foot should potentially go in, and it kind of looks like and you have the zippers They're on the inside, right? Joseph DiFrancisco Me outside. Correct. Jayson Davies So they're on the inside to also potentially not make them as seen as much. I don't know if that was part of the design to it, but they're on the inside so that maybe the zipper doesn't stand out on the outside. But yeah, I think that's great. Because I use stickers, I use Sharpies I use whatever I can to try and get a kid to know what shoe goes on what foot. And so I think that's great that even just a little design, but into you can do and it's not. Again, going back to will it work for every kid? Or does it only work for a kid who has right-left discrimination issues? No, it works for everyone. But it'll help that kid with a right-left discrimination difficulty. I love it. Alright. I know you're not doing this alone. So I want to give you a chance to talk a little bit about your partners, your... everyone working with you at “friendly” to make the world a great place who's all involved in this? Joseph DiFrancisco Now a great question. As I was kind of doing this, I had a CPA that was helping me with books at my aging in place specialist company once upon a time and we were talking we got the prototype to a certain point, as I said, and ended up in El Cajon, California and met a man named Edwin Lee was treating his father and his father had, he was preparing for hip replacement and preparing for a poster or entry or lateral approach, but he was going to have hip precautions. And I'm like, I gotta test this out. And now we just ended up talking and Edwin is he's a Ph.D. microbiologist that went to Berkeley for his Ph.D. University Chicago for his undergrad. And he's the brilliant quiet guy you got to watch out for in the room. You know what he processes and what you process are two different things. He's as trusting and honest as can be. So I met him and while we were working in a coffee shop and Little Italy, San Diego, we have this kid behind us. He's like, like, why is this kiddo? He's here. He's like, he's definitely listening. And he's on his computer. And that's the introduction of Ryan Garcia. Ryan Garcia is a gentleman from Hawaii. Waimea I think it's a big island. And he's a recovering attorney. He ended up being too honest of a guy to practice law, he had the opportunity to make a ton of money in personal injury law, which you call trial attorneys. And, you know, Ryan came on at the time he was a child author. he's a proud father. We both really I mean, how we develop our kids. Now they're developing side by side, we have both our girls and competitive jujitsu, and no gender lines. no stopping our killers are gals. So yeah, Ryan came on. And we definitely had no clue what we were in for in that first year, when you're penetrating the market. It's quite difficult. No one really knows about you. Your value propositions all need to be sharpened, your pricing needs to be sharpened. So you know, Edwin Lee, Ryan Garcia, no chance I'd be here without them. Our brains are so much different. And I think that's so important. He's a business undergrad, Edwin, as I said, was a research rat. And for me, it's all about function. So he started to grow from there. And now we have a designer in the UK, we have a shoe dog, and handles all that quality control and challenging stuff. So the team just kind of growing. And now we, you know, we try our best I know down the road, we might have to develop more of a corporate structure, but we keep it as family. For the time being, it's all about family. We have another structural engineer from Turkey. His name is Barack and he's come on since and he's our real computer Guru is stuff really well in person. It's not going to scale unless you put it on the computer and put it in the right column funnels, the ability to get the message out. And as we're developing these partnerships with Zappos adaptive, this company called Juniper that's out there and it's an adaptive market space this stuff, if any, y'all with your, you know, school-based thoughts. I know we talked at the gal at the USA event the University St. Augustine event, the Legiliner, just fantastic. And she's really thinking... Jayson Davies Polly Joseph DiFrancisco Polly Yeah, no, it's great. Y'all really don't know how good an OT mind really transfers to business. Jayson Davies The dog decided to come be part of the podcast, no problem. I always tell people it's a dog-friendly podcast. Joseph DiFrancisco Oh, yes. No, I'm sorry. Jayson Davies It's dog-friendly. I always tell people it's a dog-friendly podcast. Although your dogs good so far. Your dogs are barking it'll... Joseph DiFrancisco We'll see how she gets in the future. But she's not a barker. She actually was a rescue. And when you when you're a parent, you just learn to kind of let go of control in your house. That you could do. Yeah. Jayson Davies Awesome, man. Well, let's wrap this up with one laughs good question, I think here and that is what do you think the skill that you brought to the table as an OT really made Friendly be able to happen? What skill do you have that really helped to make Friendly come to life? Joseph DiFrancisco Great question. I would glad to hear that process, I would say perseverance, you know, being an OT, not afraid to get things wrong. I'm not sure I was diagnosed with a learning disability. Not sure I believed it. But I don't see letters as everyone else does is definitely visual perception. They call it SLD, a specific learning disability. So when you go into like paragraph form, I would have to rewrite entire books, break it up from my eyes, so it's an easier process. Yet the tactile, kinesthetic kind of learning, actually, like putting it down into the structure helped kind of get that in through an additional sense of perseverance, I got so much stuff wrong, developing as a child, it's not really that big of a deal to me, my mother was probably Middle School, you know, education. She was a high school dropped out, she dropped out by age of 16. And I did my Master’s. And I keep going, I just don't mind getting stuff wrong, like other people, just these are opportunities. I tell my son, a daughter this all the time that you know, if you're getting it wrong, like that's, that's actually the best thing you could do. But the issue is, if you don't study what you got wrong, and figure out why you got it wrong, it's not really that good. I just perseverance, I get it wrong. And then I study why, and then I fix it, get wrong again. Then I fix it. That's how we started this stuff, you know, alone, without anyone and this is years and years before we even entered the market, which was two years ago. So yeah, perseverance keeps at it. You know, kind of encourage anyone listening to it, you know, you have that advocacy for your students and you get stuff wrong and don't follow the book, per se, keep trying different things. Even in my parenting strategy, I'd be lying if I didn't use both classical and operant conditioning, a wooden spoon in the house, giving an auditory cue, really, you know, the way my mom used to do it, where they hear that spoon, and they're gonna respond accordingly. And then clearly, you got to have your know your positives, the positives in everything. But even as a parent, you get stuff wrong and you make adjustments and I think that will surely bring someone to the best place, whatever endeavor they choose to pursue. Jayson Davies Absolutely, can't be afraid to make a mistake here and there. Gotta be ready to go. So, Alrighty, man, well, obviously friendlyshoes.com. Is there anywhere else where people should check you out? Joseph DiFrancisco Yes. So we are, you know, helping Zappos with their singles program. So, individuals with these KFOS EFOs, SMOs, go to Zappos adapt, that they're fantastic. And for the first time ever, individuals with these orthoses can buy different size shoes, and there's no having to buy double. So I definitely encourage you to go to Zappos adaptive, you could get the kicks. And then if you go to Australia to a company called every human couple, the nice young gentleman over there ambitious, not afraid to get stuff wrong. everyhuman.com.au and yeah, no, that's we have now a juniperunlimited.com as I mentioned before, is, is another one and silvers.com in Canada. Jayson Davies All right, good to know. Sorry, when you said different sizes, you mean like a size eight for one foot a size nine for the other foot? Is that what you're talking about? Joseph DiFrancisco Yes, sir. You could buy. And we, not only did we reinvent the shoe, but Ryan, I guess the competitive nature and him had to outdo me for trying to reinvent shoes. So he redid the shoe box. So we have our friendly shoeboxes on the Zappos platform for this singles program. So you got an A a full you need a size eight and the right and your foot without that and about half size, sometimes full-size difference you by 7.5 in the left hand, no big deal, and they handle the returns and make it really easy for us. Nice deal. Jayson Davies That's cool. It's a good thing to know. All righty, man, well, thank you so much for coming on the OTs go house podcast really appreciate having you here. And I just love hearing about OTs that are doing different things in the world and making the world a better place. So kudos to you. And thank you so much, man. Joseph DiFrancisco Jayson, thanks so much for having me, man. Jayson Davies Definitely Take care. Joseph DiFrancisco Take care. Jayson Davies Alright, everyone, I hope you all enjoyed that real and candid talk with Joe. He is an amazing person super friendly. And he just has so much going on with friendlyshoes.com. I'm super excited to see where that leads to with Zappos and all the other big players in the shoe market. It's gonna be awesome. I gotta admit, I'm just so glad there's an occupational therapist behind the adapted shoe company that is friendly shoes. You know, just like me, and maybe some of you Joe started off in the schools and he has now gone on to create his own company. And I know he said a lot of terms that maybe you don't quite understand because you don't run a business. And that's okay. You know, neither myself nor Joe knew any of those terms, maybe 2, 4, 6 years ago, and we've gone to learn about it. As you said, perseverance is key. And as an occupational therapist, I like to think that we all have a ton of that. So whatever you might have in your mind, stick to it. Go on YouTube, learn, listen to podcasts, like you're already doing, and you will make it to be successful and whatever you want to be alright. So take care, enjoy the rest of your evening, your day, whatever it might be. And we'll see you next time on the podcast. Take care. Bye-bye. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to otschoolhouse.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! 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OTSH 76: Diving into the Schoodles: School Fine Motor Assessment with the Authors
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 76 of the OT School House Podcast. Have you ever heard of the Schoodles School Fine Motor Assessment tool? I recently became aware of it and have now added it to my repertoire of evaluation tools that I can use. In Episode 76 of the OT School House, I am welcoming to the podcast the Authors of the Schoodles Assessment to further understand for myself why this tool is so valuable and how we as OTs can use it to support our practice as School-Based OTs. Please help me to welcome co-authors of the 4th edition of the Schoodles Assessment, Marie Frank, OTR/L & Monica Fortunato, OTR/L About Marie & Monica Marie Frank OTR/L Marie received her Bachelor of Science in Horticulture from the University of Minnesota in 1983. She went on to work in a variety of jobs and kept gravitating toward working with people with disabilities. She went back to school in 1994 and received a certification of the second major in occupational therapy from the College of St. Catherine. She has enjoyed working in public school systems ages birth to 21, clinical pediatric settings, and a regional pediatric treatment center. Marie has taught as an adjunct staff member at the College of St. Scholastica and provided clinical supervision to students. She has mentored occupational therapists in school settings. She is a presenter for Sensational Brain. She currently works with very young children and their amazing parents in Maplewood Minnesota. She lives in Stillwater Minnesota with her husband Ged Monica Fortunato OTR/L Monica received her degree in occupational therapy from the College of St Catherine in 1983. She has worked in a variety of settings including psychiatric inpatient and community outreach. She currently provides occupational therapy for children in the charter schools of Los Angeles. Monica is Level 1 certified by Handwriting Without Tears and has created handwriting programs that have been featured in the Los Angeles Times and on BBC radio and is a presenter for Sensational Brain. She has mentored occupational therapists in school settings and is a USC certified Sensory Integration therapist. Monica lives in Hermosa Beach California with her son Carter and husband Robert. Links to Show References: Schoodles.com Episode Transcript Download or read a rough edit of this OT School House Podcast episode 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 Hey there and welcome to the OT School House podcast. My name is Jayson Davies, and I am here with you today for the next hour or so because I know you're not gonna want to miss a moment of this one. This is an amazing episode that we have here I am interviewing Monica and Marie from the Schoodles Assessment. Some of you may have heard of the Schoodles Assessment. For others, this may be the first time you are hearing the silly word that is school and doodles put together to create an occupational therapy assessment called the Schoodles. You're not going to want to miss a second of this one because we are discussing the classroom skills as well as the support skills that the Schoodles Assessment tool addresses for occupational therapists. I am pretty new to the Schoodles myself. I've only used it a handful of times, but I'm looking forward to using it more in the future. And I know you will, too after hearing this interview. Not only are we going to get a quick introduction, actually a pretty extensive introduction into the Schoodles today. We're also going to quickly review the difference between a standardized and non-standardized assessment tool for anyone who's been out of school, I don't know maybe more than five years and just needs a little refresher on this. It actually really helped me so I'm happy that Marie shared that with me. So, let's go ahead and jump into our interview with Marie Frank and Monica Fortunato. They are both occupational therapists and sisters. Enjoy the interview. Hello, Marie. Welcome to the OT School House podcast. How are you doing today? Marie Frank, OTR/L I'm great, Jayson. How are you? Jayson Davies I'm doing pretty darn well. This is a Sunday afternoon. I'm enjoying myself and we just had a dog walk. So, the dogs happy. I'm happy. The wife is happy. Everyone's happy. We're so we're all good. How about you, Monica? Monica Fortunato, OTR/L I'm doing great, Jayson. It's great to be here with you. And just want to say thank you for everything that you do for school-based OTs. You are just pumping out the info and it's great to be a part of that. Jayson Davies Thank you so much. I appreciate it. Yeah, you know, we're on about Episode 75 ish now. And it's just amazing. We've been able to have some great conversations with OTs and I love it. So, let's go ahead and jump into it a little bit. Today we are talking about the tool that you all have developed, written, authored, which is on the fourth edition now. The Schoodle's fine motor assessment tool. And we're gonna get into all that today. But first, I'd love to hear about how you kind of got to where you are as an occupational therapist today. So, Marie, would you like to kind of share a little bit about your OT background? Marie Frank, OTR/L Sure. I have been an occupational therapist for over 20 years. And I started this with another occupational therapist. I felt disorganized, I can be very disorganized myself. And going into assessments, I would be in the assessment trying to come up with scissors or, or a shape to cut or, or something like that, and it didn't feel good to me. And the other thing that didn't feel kind of good to me as I would use the BOT and which is a great tool. But I wasn't feeling like I was getting enough information to speak intelligently about the student or get enough information to identify the need that the student had. So, we got together Amy Wang was the other therapist, she's awesome. And we started that about 17 years ago, I thought initially it was going to take about three months to put together and it took a lot longer than that because the more I dug in, the more I found I needed to dig in. And so, it took a while longer than that. And then about six years ago, Amy dropped off and Monica joined and Monica is my sister. So, this works out perfectly for us to have a business together. And Monica brought a whole new skill set to the operation, let's say and it's growing wonderfully because of Monica's expertise and ideas. So... Monica Fortunato, OTR/L Thank you, Sis. Jayson Davies I love it all I have to jump in real quick and then I'll let you go, Monica. I just love it because my family is also an OT family, my older sister is an OT. And that's how I came to find out about occupational therapy. My sister is about six years older than me. And so, by the time I was kind of heading into college, I was volunteering with her at a pediatric clinic and really learning about OT and then got to college. And that was the end of it, OTs. Yeah, so Monica, what about you? What has your OT career kind of look like? Monica Fortunato, OTR/L Well, I, like Maria have been an OT for a long time. I was an OT before she was and convinced her were great professional occupational therapy was OT you would love it. You'd be so good. And then, when I started a family and then took a few years off, and when I wanted to go back to work, Marie, at that point was a school-based OT and said, "You should be a school-based OT, you'll love it, you'd be so good." So, I went into school-based OT and that's when I started using Schoodles, you know, just taking it with me. And my first few months as a school-based OT, Marie gave me a lot of confidence. And you know, every day on my drive home, I would call her and ask questions. And as I started to use Schoodles, I was thinking of ways to make it better. Like, "oh, we could add this or what if we explored this area," and Marie loves research so much that she was doing the research. And then I was like, the boots on the ground, trying things. And that's how we came up with the fourth edition, which is the actual manual, we doubled in size added a lot more Student Workbook pages. And I know we'll talk a little bit more about everything that's in Schoodles in just a minute. But that we just interchange. I mean, my even though we're not twins, our mother says we're like twins that we read each other's mind. I don't know if that's true or not. But we work well together and feel like we have come up with something great. Jayson Davies That's funny, I like what you said about how you just kind of were using it. And then you're like, "Hey, Marie, let's... what if we did this" because I think every OT has been doing an assessment and be like, "man, if I can make one change, this is what I'd want to do." If only I could contact the author and be like, "Hey, can we do it this way, instead?" How nice it was that you just so happened to know the author of this? Monica Fortunato, OTR/L Yes, yes, that's true. Jayson Davies Awesome. And now you are a part of it, which is amazing. So, before we jump too far into this, how and why? Well, we're going to jump into all the how and why. But before we get too far, deep into it, why don't you just briefly give an overview of what the Schoodles is? Marie Frank, OTR/L Okay, it's a, Schoodles is a performance slash, observation-based, systematic assessment that uses age levels are over 20 skills to determine whether a student is delayed for his age. But it also looks qualitatively at how a student moves through a set of activities. So, you're with each activity, you're looking at a whole set and range of components to that activity, which I'm sure every OT does, anyway. But we kind of organized it for ourselves and others, and it's broken down into two separate components. It's broken down into classroom skills, which are the skills that teachers talk about. And parents talk about handwriting coloring, cutting those skills, and then supporting skills. So, the underlying skills that are needed to produce skilled fine motor work, so things like core strength and strong arm and hand muscles, and balance and those kinds of things that that's what I was digging into. When I was building it, I thought, "Oh, my gosh, there's so much that goes into the handwriting. It's crazy." Jayson Davies Right? Marie Frank, OTR/L And then the ops observations kind of build on each other, which is with each task that you look at you kind of confirm or reject each theory that you might have in your head about why something might be happening with that student. And then, yeah, okay, go ahead. Jayson Davies Go ahead. I'm sure we will get into everything. We have a lot of questions. I'm so happy for everyone that's listening. This is going to be great. Before we get too far in though, as I want to ask why schools obviously, this is a school assessment. So, I understand the school part of it, but who came up with Schoodles? Marie Frank, OTR/L Oh, hey, Amy and I love wimzie and fun. And we didn't want some stodgy name. So, we were messing around with words. And we took Schoodles, school, and doodles and put those two words together. And when Monica joined me, I asked her if she wanted to change it. And she said, No, she liked it. So that's kind of stuck in and it's mispronounced constantly, but I guess that's okay. Jayson Davies That's funny. I don't even know if you notice, but I accidentally when we put our notes together, I had accidentally typed it as a school with the owl and then d-e-l-e-s. And I had to change it. But even me, it's so it's got school in it. And so, I put the whole school word in there. I've since changed it is and correct me if I'm wrong, Marie. SCHOODLES. Correct? Marie Frank, OTR/L That's exactly it. Jayson Davies Yeah. All right. Great. That'll help you find their website when you're going to look for this later. Marie Frank, OTR/L We're not Schnoodles is when... Sometimes, which are adorable little dogs, but it's not us. Jayson Davies That's funny. That's funny. All right. So, Marie, I'm gonna I think this is going to be for you as well because you were kind of you and Amy originally developed this. You said you developed this, I think it was around 17 years ago, I think you said it was Yeah, yeah. Wow. And just for people who are in my age realm, we grew up with so much internet. And like now we all have Canva, we could easily make a quick little task to print out and cut. But 17 years ago, you said that you thought it was gonna take you three months, and ended up taking you a lot longer. So, if you could even just kind of talk a little bit about that development of what you guys went through? Marie Frank, OTR/L Yeah, you bring up a really good point that I hadn't thought about for a long time. But you're right, we didn't have all these fancy tools. But Amy was a graphic artist and a communication specialist before she was an occupational therapist, and her husband was a marketing person. And so, they had those skills. And we use very expensive computer programs put together a lot of this, the graphics and the things like the puzzles, which are something you can easily find on the internet now. So, what we did, I did a lot of research at one of the colleges that I lived near, and then some the on the internet as well. So that's how we kind of pulled it together that way. And I guess that's where we came up with the new additions to we thought we kept finding more information that we needed to add, make it current. So... Jayson Davies Yeah, and that's great because I don't think anything is ever finished. And as we all know, as occupational therapists, kids’ skills are changing. probably at least every decade, the averages have to be the norms have to be changing a little bit. I mean, kids are going to school earlier and earlier, things are changing technology versus no technology, how much all that's going on. And so, it's great that you've been able to keep updating it and the Monica has helped you with this now, the fourth edition. So, let's go ahead and jump into a little bit of the specifics. And what were the key areas you wanted to focus on when it came to creating this assessment? Marie Frank, OTR/L You know, we were looking at handwriting, because that's where you get all your referrals, right? Jayson Davies Basically. Marie Frank, OTR/L Always handwriting. So of course, that's what we wanted to pick apart handwriting, and those classroom skills, because that's not what was in the standardized test that we were using. So, I was constantly trying to marry what the bot was telling me what the BMI was telling me or what the P body was telling me with what I was trying to sort out in the classroom. So, that's kind of where we, what led us is what are we seeing in the classroom? And what do we need to be looking at with kids in school, because some of those assessments were, or clinic-based work? They were developed for clinic-based work so that's kind of where we went with it. And then and then it seems like a natural thing to do to break it into those two parts of classroom skills that are very, very identifiable things to teachers and parents and then everything that's OT related, or what we look at it what gives us efficacy, I guess when we're speaking about it with one another, and then in an IEP, and, and then we can explain those things to parents and teachers and administrators. Right. Jayson Davies Always advocating for ourselves a little bit. Whenever we can. Marie Frank, OTR/L Half our job as salespeople, right? Monica Fortunato, OTR/L Oh, wait, wait, where are you? You told me half my job was telling people what I wasn't going to do. Jayson Davies That's true, too. Monica Fortunato, OTR/L You know, what I would add to what Marie is saying is that, you know, we go to these IEP meetings, and we want to tell a story and explain something to a parent or the teacher, but mainly to the parent in a way that makes sense to the parent. And what Schoodles provides is it helps us tell the story, we have these work samples that the student-produced that we can share, and that has a real-life... apply to the real-life situation of a student and what they're expected to do in the classroom. And you know, just the age ranges, which we'll talk about in a minute. But being able to compare how the student is functioning to the typical age range, I think that makes sense to parents in a way that and teachers in a way that maybe just a standardized score doesn't. So, I think just Schoodles helps tell the story of the child and why they're struggling, where they're struggling, and why they're struggling in a way that so I liked the bot a little bit more than Marie does. So, I mean, I use it so. But those two things together worked well. For me. Jayson Davies That's great to hear because I can see you know, people who've tried to get, I mean, we almost get stuck in our ways. We find an assessment tool that we use, and we tend to go back to that assessment tool. And it's hard to keep up with new assessments or maybe not even new but just assessments that maybe your friend is Using across the country and they recommend the Schoodles, they recommend the M fund, they recommend a different assessment that you've never heard of. And it takes some energy to learn a new assessment. But that's great that you can find assessments that kind of work together a little bit. So, Monica, you actually kind of started down. So, we'll just continue with that. What is the age range for the Schoodles? Monica Fortunato, OTR/L It typically starts at age three. So, then we start with basic skills like tracing and design, imitation, you know, that is more of a preschool. And, you know, most of the tasks, if you're looking at kids who are in general education, it would like to be up through fourth or fifth grade, I use parts of it for middle school or high school students, for students that are in special day classes, who maybe are functioning at a lower level, you can use Schoodles to assess where are they as far as their developmental levels. So, the age range typically is age three through fourth or fifth grade, but I've used it all the way up to 18-year-olds. Jayson Davies Yeah. And I think we all have kind of go above the cap, if you want to call it that for assessment tools, for that same exact reason for kids who are a little bit more severe in needs and yet still appropriate to the kind of understand where their skills are. So that makes sense. But like you said, I think so around the fourth or fifth-grade level, for a Gen Ed kid student a typical developing no IEP, they might, they should be able to basically get good scores across the board. Marie Frank, OTR/L Exactly. Right. And one more qualifier for the Schoodles, you know, on the downside of it on a three-year-old side, that three-year-old would have to be able to follow some directions to be able to get useful information off of the Schoodles assessment. And if they can't, then you know, you default to the Peabody and keep going down. Right? Yes, Jayson Davies Right. Marie Frank, OTR/L But yeah, so I often get that question when I'm talking to therapists, and they're wondering about schools. So yeah, they have to be able to kind of follow directions. Jayson Davies Yeah, yeah, definitely. And I'll speak to that, actually, because, well, first of all, I love that it starts at three because that is your typical preschool-age entrance for most kids, right, three years old, that's when they're first going to move over from an IFSP if they have one, into a potential IEP preschool level. So that's great that it starts right than kind of goes along with the name Schoodles. Your second point, as you said, the kids need to have some ability to attend to these tasks that are functional. And I experienced this firsthand, Marie and Monica, were so kind to send me a copy of the Schoodles. And I did it recently, probably not to the full extent that I probably could have. Because just like what Marie was saying, these kids were in that three to four age range. But diagnosis that they had, the ability to attend, especially over a computer made that very difficult, I spent a lot of time trying to teach the task to the parent, and then have the parent teach the task to the child. But that stuff, I mean, and in this case, particular case, it was a foster parent who had only had the kids for a short period of time, which you can imagine any assessment that would be a little tricky, but yeah, no, I love it, though. I've had my hands on it and been looking at the manual. And I appreciate some of the things that that they've put into it. I'm going to ask them in just a second actually to share some examples of what you might find when you open up the Schoodles. But first, I want to ask, we're in the fourth edition now, how have the Schoodles changed from the first, second, third? Did it skip an edition? I don't know. Where are we at? How did that go? Marie Frank, OTR/L It's basically the same tool that we started with originally with what that Amy and I put together and over, you know, we kept wanting to make it a little better and add a few more things and add more evidence. So, what we've ended up with now, you know, since the first second, and the third was pretty good, but when Monica joined, we wanted to kind of redesign some of it and add some more like classroom observations, teacher questionnaires, goal, we added a goal writing template. Let's see what else did we add? We add Oh, and then most recently, we added an online version. When this was before the pandemic, we had a large school district asked us you know how they could purchase our tool but they wanted some more control over it. So, we ended up adding a membership, which we have just loved because we can add, add all kinds of new stuff. We can change things based on what therapists think and tell us and we can add new tools to that membership without having to add another addition. So... Jayson Davies Nice. Marie Frank, OTR/L Yeah, yeah, that's evolved. It's evolving. It's still evolving. Jayson Davies Right? Yeah. And you know, back to that whole, you know, technology has changed the world and things that you can do now are nice. You're right. I mean, you can add something because well, you don't have to send out a whole new book or whatever. If you change one thing, it can just be a new printout that people can access. So, that's awesome. Marie Frank, OTR/L Exactly. And therapists are kind of us don't want to be continually buying new addition. So, this is the last one. This is it. Monica Fortunato, OTR/L Is it? Really, no, we have to keep going. You know, I wanted to add an area that we expanded where we expanded our handwriting worksheets. So you know, I know we keep looping back to handwriting, but we used to have one handwriting worksheet, and now we've expanded it to handwriting A, B, and C, so that you can have with a kindergartener who's starting to write you would use a, and then, you know, they progressively get more complicated the sentence they have the cop murder, and then we're also looking for, you know, can they, if something's been dictated can they write and then also self-generation, you know, which is a school-based OT, it's really important to differentiate where the breakdown is in handwriting. Can they copy neatly? Right? Does the breakdown happen when they have to self-generate come up with the idea to access their short-term memory to spell come up with the grammar? And so, we want to analyze all of those things. And I think, between the Schoodles manual and the banded worksheets that we've made, it's very easy to say, Aha, the break that they're really falling apart when they have to self-generate, you know, and then what part of the self-generation is hard. And then, you know, as OTs, we're always asking ourselves, why, okay, if they can copy neatly, why can't they self-generate, and then we start talking to other team members, if I can just share a quick story of a boy I assess last week, he was a 10th grader, who he was, okay, we know his handwriting is bad, we need to call the OT. And so, when I was talking to him, he could copy everything was fine. He said, “I can't take notes.” And when I take notes, you know, because when the 10th grader, of course, I just asked him a lot of questions like hardware that aren't. So, it's hard when I take notes. Well, lo and behold, he has qualified, he's had an IEP for many years. And it's a learning disability related to auditory processing. So, aha, he can't listen. And the process and then also take notes at the same time. So, my recommendation was not that he needed OT because his visual motor skills were an area of strength. What did he need copies of class notes? So, I think that's where Schoodles you really can start digging into that information with real, real examples, rather than you know, BOT is never going to tell you that. So, anyway. Jayson Davies Absolutely. That's a great example. I love it. Actually, I want to continue with that. So, there are some handwriting examples that you just gave, what other classes I think you kind of refer to these Marie as the classroom skills, what other classroom skills are, are looked at within the Schoodles assessment? Marie Frank, OTR/L So, we have puzzle skills coloring, cutting, draw a person? And am I forgetting any Monica? Monica Fortunato, OTR/L Yeah, we have a copy design. And the cutting, we have a graded cutting. So, it starts with um, snipping on a straight line, curved line, zigzag line, Circle Square, and then we have our complex shape. That is an adorable little fish. So, I will say that I like the bot. So, I don't want your listeners to think that I am trashing the bot. But I will say if you give a child especially a younger child, the picture of a cute fish and say, you want to cut this out or that page from the bottom, where they always say, what am I making? Well, sorry, you're not really making anything, you're just cutting out a circle. So, then they always ask you like, cut out the square? No, no, no, it's right. But when you give them the fish, you know, as OTs we always think about motivation. Well, little kids are more motivated to cut out a cute fish. So, I have gotten a better cutting sample with the fish from Schoodles that is a common label when a circle should have been easier for them. But there was nothing in the circle that engaged them. So anyway, and there are the fishes very interesting because they like to cut off the top fin, you know, they'll kind of go and then that will tell me like, okay, they couldn't turn that corner, make it up and over. So that gets snipped off. And then I'll look at did they notice that they cut it off? Did they even see that that part was cut off? Or do they just keep going and say hey, you know, great? So, I get more information from the fish, swimming, the cutting is broken down into many different steps. And was that your question? Jayson? Sorry. Jayson Davies Yeah, basically, I mean, what are the different types of activities that we would see in the classroom that the Schoodles assesses? And you kind of went through that. So different cutting activities, handwriting, and you mentioned a few others. So great. And then going beyond that, earlier, you kind of mentioned that you kind of look at the classroom skills, but then you also look at the skills needed, I think you called them to the support skills. So how do the Schoodles then look at some of those support skills? Is it built into those classroom tasks? Is it a separate part of it? Or what does that look like? Marie Frank, OTR/L So, great question, those supporting skills are separated. And you can do them in order, or you can do them, mix them in with the classroom skills to keep your students energized and engaged. But those so they're separate. And so, you're looking for, for different things, perhaps then, in the classroom skill, so you're looking for motor planning, strength, balance, those types of things with those supporting skills. So, we would do jumping, jacks, skipping, hopping, some balance tasks, muscle testing which I had never seen done, with kids. In the school system. I was never trained that way. But it was something that we added in that we find very helpful, because you're getting your hands on the kids, and feeling their muscles, some vision, visual tracking, some of those types of things. So, lots of different little bits and pieces that you can glean information from and kind of make create your story like Monica was talking about. Jayson Davies Great, I love that I always tell therapists that our evaluations need to be top-up, top-down. And I think what your kind of explaining you start with the classroom skills, which is your very top, you're very observational, can they do this activity, and then it’s kind of sounds like you get to more of those supporting skills. Alright, now let's break it down. Let's find out what processing skills what other skills are preventing or even providing the student with the capacity to access those upper-level observations, not observations, but the classroom skills? That's a good term. I like that term classroom skills. Marie Frank, OTR/L Yep. Excellent, excellent explanation, Jayson. Monica Fortunato, OTR/L I'm gonna use that. Jayson Davies Thank you. Right. Well, let's go ahead and continue, we've used the bot. So, I'm going to kind of use this as an example. Oh, and I wanted to actually touch on that. I feel very similar to Monica, about the bot, I use the bot. However, I don't think it gives you those classroom skills that we were just talking about. And so absolutely, I think that the bot gives you a lot of information. But I don't know that it gives you the same type of information, using the story we were just talking about. It gives you the processing skills, potentially as opposed to those higher classroom skills. So, all right, go ahead. Do you want to add to that, Monica? Monica Fortunato, OTR/L Yeah, I just think the way that I look at the bot, so this could be another podcast for you that the bot score, okay, it is more than a score. I mean, I'm watching, you know, how are they problem-solving with the manual dexterity? How are they picking things up? how, you know, I'm not just looking at the score at the end, which often, you know, even like with the design copy, do they have for closure, because they have attention, and they just whip through it so fast. That, you know, they're just you know, that isn't necessarily visual, it's a visual motor delay, it's attention. So, you know, the bot gives me a lot of information that maybe I might not see all of that in Schoodles, and the districts that I work within need a standardized score. So, I know not all school districts need that Marie referenced a school district that is exclusively using Schoodles, but we need a standardized score. If I can't get it, I mean, I can say that the SPM or the sensory profile is a standardized score as part of my report. But I think marrying the bot or even the VMI, but I prefer the BOT over the VMI with Schoodles to me is like I feel like I'm done. I have I do my observations, talk to the teacher talk to the parent. And rarely Am I stumped with what's going on here. I feel like that all those data sources, you know, we have to collect data from multiple sources. And once you've done all of that you're covered basically with information gathering. Jayson Davies Absolutely. And you know what? Monica Fortunato, OTR/L The other piece of information galleries, I always look deep into the history, the IP histories. My last little piece there. Jayson Davies Absolutely. No, that's exactly what I teach in my courses to start first with that reason for the referral. And then get the information that you can gather from previous IEP IFSP is other documents that you have access to. And then that next step is to start doing those observations and figure out those classroom skills. So absolutely. All right, you actually just answered the next question, which I think was awesome about additional tools. Do you use additional tools? And I know you've already mentioned you'd like to use the bot potentially with it, maybe you'll jump in there with the SPM, or the sensory profile use, it sounded like, Maria, did you want to add anything to that? Are there other tools that you like to use along with the Schoodles? Marie Frank, OTR/L I mostly did not use the bot and use the VMI. Pretty much all the time. I liked those two, mostly because I was getting so much information from Schoodles that I wanted something very short and easy that I could corroborate with schools, and then use those scores, those standardized scores and talk to other service providers to see what they were getting in on their testing to see if it matched, to see if it was going along with what they were getting in if I was in the ballpark. So that's like, actually, what I did was, I loved the VMI. So, Monica and I diverged on our standardized testing choices, I guess. Jayson Davies Okay, that's perfect. As OTs, we all get our own little creative license to find the tools that we think will suit us best. So that is perfectly fine. Yeah. All right, I want to kind of, like, obviously not wrap up, we still have plenty to talk about. But before we kind of move on to our next session or section, I guess I could say, what does the data collection look like for the Schoodles? I think most therapists are very familiar with the bot with the VMI. How does the collection of the data? Are you marking down items as students’ complete stuff? Do you have to go back and look at the work samples the score? What does that look like? Monica Fortunato, OTR/L So, we have, um, it's a clinical observation chart that I print off. And I'll just talk about how I use it, I print them off, I have it sitting there with me, while I'm with the student, I do tell the student you know, I'm gonna write this down because I have kind of an old brain. So, help me remember later, which, sadly, kind of true at this point. But I, I write everything down. So, I'm making notes as I go along. I will look at the work samples later. But mostly, I'm able to make all my notes while I'm assessing Unless, you know, occasionally I'll have the student where you just have to move quickly from thing to thing because you lose them if there's even a slight delay. So, there is there isn't a score. That's all qualitative. And it's the most of the things we're looking at, as we talked about before, Marie is really into research. And so, she has done extensive research to find the typical age ranges or skill attainment or each area. So that's included in Schoodles. And so, when you go to write your report, you may reference that chart memory can talk a little bit more about the criterion reference chart, but a reference that chart to find out are they where they should be, you know, matching their chronological age. So that's the data collection is in real-time. And then later, you can take the information that you have and compare it to the chart and see where what level your student is functioning out. Jayson Davies Great. And, Marie, do you kind of want to hop in there and talk a little bit about the criterion reference right now? Marie Frank, OTR/L Yeah, yeah, I believe we've got about 20 skills outlined on the criterion-referenced chart that we created. And I dug into every skill and I found, it's all evidence-based information. I didn't include anything that wasn't on that chart. I wasn't, you know, me guessing on the ages, so there are some things therefore that aren't on the chart, because there wasn't any research that I could find on that, like muscle tone, we don't have that on there, because there isn't any qualitative or quantitative measurement for that or age levels of when you should have a certain kind of muscle tone. So maybe those types of things aren't on there. But there are, there are, I was surprised at how much I did find, and then put that all together on one in one place. Jayson Davies Great. I love that because that means that you can go and you can do this assessment tool. And then like Monica was kind of referencing you can have that, that "cheat sheet", I'm just gonna criterion reference right there next to you and say, all right, well, on the fish, this student was able to do this and this but maybe they weren't able to. I'm just gonna say maybe they didn't use two hands effectively or something like that. And then they can kind of cross-reference that to your criterion reference sheet and say, Okay, well at age four, that's okay. But maybe at age five, they should have been able to better use both hands to cut around the fish. All right. Marie Frank, OTR/L exactly. Perfect. Jayson Davies Cool. All right. I want to ask one more question about testing. Because I know this is something we all learned back in OT school, but it's something that I think we quickly forget. And that is a standardized test and what is and what isn't a standardized test. Earlier, you did mention that this is not a standardized test. I think I heard that correctly. Right. Marie Frank, OTR/L Yep. Right. Jayson Davies All right. So, what makes a standardized test? How is this not a standardized test? And what are the benefits or, or doubt duffles? Did I say that right? If there are any… Marie Frank, OTR/L Yeah. to not have, okay, so a standardized tool is used to compare a student's performance to a normative sample population. So, you get your standard score, you get a standard deviation, and you get percentile ranks. And this is often where you find the qualifying scores for special ed, you need standardized scores for that. But being a related service, we only need to show needs. So, we don't necessarily need to use a standard score according to IDA to be able to serve a child with a need, we just have to show that they need occupational therapy. So, I found this description that I liked. It's a standardized assessment seeks to measure the measurable, while non-standardized test measure students’ skills that are noticeable and may be significant, but cannot be quantified. Yeah. Yeah. I love Wow. Isn't that great? Well, non-standardized tools are performance-based then which is what Schoodles is, and the criterion-referenced tools are a form of non-standardized assessment. And these are not designed to compare one child's performance to another. So, this would be something like the help of the Carolina I don't know if you've used either of those Jayson. Jayson Davies No, I haven't Marie Frank, OTR/L Teeny tinies. So those have a breakdown of different age levels where kids should be attaining and achieving their, their developmental skills. So, this is very similar to that. And these types of criterion reference tools are more helpful in assessing functionality, which is what we're looking at with Schoodles, they are very helpful to measure progress. If you're in early intervention, you're constantly measuring progress and looking to see where the child is to see where you need to go. Which is another way to use criterion reference tools to see what's what, what they need to be doing next on that list. And then you can link when you see where they need to go. That's where you can get your goal. That's the next thing on the checklist for what they need to be doing. So, I think sometimes these criterion reference tools because you can, you can vary the way you're wording, the question, or you can change the amount of help you're giving. Or you can change the type of toy that you might be offering or the type of pen that you might be using can you can change things around a little bit to get the best performance out of the student, and also find out what they could do if they had this kind of help, or what they could do if they had this kind of scissors. So, what you cannot do with a standardized test, I guess that's Does that answer your question? Jayson Davies Yeah, absolutely. And you said, you know, you can use a different pen and my, my immediate, you know, reaction just, I got a picture of a red pencil in my head. And everyone knows exactly what that red pencil is. You don't have to use a red pencil with this assessment. You know what, you don't want to follow that up. Monica, you may even go with your question or where you were going with it when it comes to writing goals and measuring goals. How can you use the Schoodles in order to potentially measure the goals that you're writing? Monica Fortunato, OTR/L I think that that it actually because you've assessed function like our goals are supposed to be written, what is the educational need, what is it that you're trying to help the child to achieve in the classroom or their school environment doesn't it might not even be you might be out on the playground or you know, in a different area of the school. But, you know, the goals are not supposed to be the clinical sounding goals about increasing strength or range of motion, the goal should be related to the function within the school. So, if you have work samples, and you've collected data that directly relates to the function of the child at the school, then your goal can be taken directly from that. And you can measure with percentages. So, if you have a little, little person who maybe can copy all of their capital letters, but from memory, they can only come with five, you know, then your goal maybe we'll be able to you know in order to complete classwork x student will be able to write 20% of capital letters from memory on three out of four trials. So, the goal is derived directly from what the student can do. Now here's what's interesting as well about goal writing in and I see this on the Facebook forum. So, the OTs, Facebook, is that some school districts, there is not a separate goal for Occupational Therapy, I will say what where I work, they want to separate goal. However, you can cure. I know, I'm not saying it's right or wrong, Marie, I'm just saying that my job, I cannot show up without a goal. So. So Emery was shaking her head no, as we're talking so. But at least you can take the information from schools and contribute to the goal if it's a team that's writing the goal. So, there's a lot of good, good direct information to goal writing that you can get from Schoodles. Jayson Davies Yeah. Marie Frank, OTR/L I ended up sitting with teachers and writing goals with them because I was told not to write my own goals. And I thought, Well, how do they know? How did they know what I want? So, I would go and sit with a teacher and we would write the goal together so that it was their goal that I was supporting. Jayson Davies Yeah, and if I can jump in, and, I'm just going to do an example really quick, Monica just had a goal that she created out of thin air, which kudos to you for being a little pull a goal out of thin air, while on the broadcast. on the spot, she had a goal of you know, trying to increase maybe a student from being able to write from their own, just from memory, basically, from the move from five capital letters out of thin air to maybe 20%, which what 20%, I'm gonna guess is somewhere around like eight to 10 letters, capital letters, I don't know, I'm not a mathematician. But anyway, maybe we're trying to double the number of capital letters that they wanted. They want to be able to formulate, right? Well, now I think, Marie, and correct me if I'm wrong, you might say, Well, I'm gonna go talk to that teacher. And we're gonna say, hey, the student is going to start every sentence with a capital letter, and 20 to 40% of their sentences. And that is now a teacher and an OT goal. Am I right? Marie Frank, OTR/L Exactly. Perfect. Jayson. Yep, exactly. It was, it often did look completely different than what I had in my mind because it is it better. And it did fit better with what they were trying to do in the classroom, which is what we want. Jayson Davies Exactly, you know, I've struggled with the same, that same idea of whether we have to have our own goal, whether we can be on a teacher's goal, and I have most commonly found that it depends on the teacher and depends on the IEP team and depends how they want to do it and you have to be flexible and be able to kind of go both ways and work with the team to kind of make a make an IEP come together. So definitely. Alright, well, we're gonna kind of get to the final few questions. We can wrap it up. We've been having so much fun time flying by telehealth, obviously, right now, we are kind of getting to the tail end of the pandemic, people are starting to go back to school. I will the time that I did try the assessment. I kind of mentioned that earlier. It was over a telehealth model. Maybe I should have asked you this before I did it over the telehealth Model Can the Schoodles be used over a telehealth model? Does it look different? Does it look similar? What have you found? Monica Fortunato, OTR/L So, I have been using it over the past year remotely. So, we have we do send a package of the Student Workbook to the student ahead of time. And what we do is we send a little pair of scissors and pencils and crayons because a lot of students I work with are a low resource. And so, we want to make sure they have everything we do have to most often have to have an E helper. So ahead of time we talked about there has to be a parent sitting there helping will interview the E helper ahead of time. And usually, it's a parent, so it's a good time to both get your interview questions in and then just let them know what to expect on the assessment. Typically, they've gone well, the students that have a harder time are for me, it's very hard to manage behavior through a screen. So, you know, it's hard to control your materials through a screen. And so, but it has worked well we've figured it out when the pandemic happened, we interviewed some telehealth, OTs and asked them what they needed. And they gave us some good ideas. What they needed was videos of us doing visual motor, the fine motor coordination so they weren't having to demonstrate it and watch the child at the same time. A part of the online membership of Schoodles essentially videos of me going through all the fine motor, you know, look at me, copy what I'm doing. And so, the therapist can just play the video, and then the student will be watching the video. And then the evaluator can then watch the student and get your data that way. So, um, it has been pretty effective. And the thing about Schoodles was telehealth is I will have that student hold up their work sample to the screen. And as long as they... you've probably done this, Jayson, as long as they hold it steady, I can print a screen picture of it. Hold it steady. If I do the bot, which I've done remotely if it's only verbal directions, the VMI the bot, but I have to get those protocols back. So, we have a mechanism to get them back. But with schools, you don't necessarily because you're not scoring it. You don't necessarily have to get the actual test materials down. Jayson Davies Yeah, I often have my parents try and scan it with their phone and email it to me or something like that. But yeah, you can do the print. If the kid knows how to use it, how to get the camera in front of the camera. It's funny the things you see when the kid tries to put the paper up to up to the camera. Monica Fortunato, OTR/L to record our directions. Okay, back in it. Okay, now. Hold it real still. Jayson Davies Right? And then also, I mean, how many times have you asked to see the kids work? And then like, you can't see anything because they use the pencil and like, just to light unless they're using a dark cran or something. It's just you can't see it anyway. Monica Fortunato, OTR/L Yeah, definitely challenges with that. Jayson Davies Yeah, definitely. I will say I prefer in-person occupational therapy. I, I just do Marie Frank, OTR/L any arguments from us? Jayson Davies Yeah, shout out to anyone who's doing very well and enjoying the process and making it work because it is tricky. I know, I get comments on social media every day from people who are saying it's hard. I'm right. They're very hard. It's hard. Yeah, very hard. Alright, so I have two more questions for you. We're gonna wrap this up. The first one is, for anyone who is listening right now, maybe they've never had access to the Schoodlesand they go to their school district? Or maybe they're even just going to go buy themselves. And it comes in the mail on day one, what is your recommendation that they start with first? If they just got this Schoodles in the mail? What should they do first? Monica Fortunato, OTR/L I would highly recommend going through the manual, it's not very long, it's a pretty quick read. And it outlines each skill that you're going to be looking at and what to look for while you're with the students. So that would be it's not long, it's not like you're reading a textbook, it goes pretty quick. And we've tried to make it as you know, just the facts, you know, just we're not going on and on and on about information. It's like this is what you're looking for. This is why and next. So that would be the first and then step to dig in. You know that we have a penguin the color we have a fish to cut out I mean; the kids love it. You're not going to go wrong. You know, I think we get all nervous with these standardized tests, especially the ones that you have to say things in a certain way that does not school you just you can bring your crayons your pencil your scissors and have some fun with it with the kids. Jayson Davies Love it. Maria, did you want to add anything to that? Marie Frank, OTR/L No, I loved what she just said you know don't be nervous about it and just try even if you just try a small part of it and get you to get information from that and then you try it you know add a little bit more the next time and add a little bit more than next time to your comfort level that that and then you know always you can email us we answer Jayson Davies That's perfect. Monica Fortunato, OTR/L Or anything like that. We love to talk to other therapists. It's really fun for us. So yeah, it's you can email Monica@schoodles or Maria@schoodles. If you want a research-driven response, go to Marie. Even with babies, I've been with K through 12. So, if you have a question more to do with K through 12 what Marie knows K through 12 two but you have a question with more older students you can market Schoodles. Jayson Davies Alright, sorry, the way that this podcast works is that I come up with questions on the fly based upon what I hear. And so, I haven't asked you any questions Marie about research and Monica has been throwing it out all day long, but you love research. So, I'm gonna ask you like what is your relationship with research? Have you done research? Do you just love reading it? Are you researching the Schoodles? Marie Frank, OTR/L Oh, that's such a good question. I think I just want it to be correct. I just want to be, I am, I am such a science nerd, I want everything to have evidence. And I don't want to be putting things out there that aren't correct and true. And, and, and have science behind it, that that's just the way I am. Jayson Davies Agreed. And that goes with that criterion tool that you've talked about earlier, you went through and found all the research and, and put it on paper. So that's great. Awesome. All right. Well, you mentioned your emails, Monica@schoodles and Maria@schoodles, where can anyone get more information about the Schoodles quickly, if they want to find out more? Monica Fortunato, OTR/L You can go to our website schoodles.com. There's information there about purchasing either the hard copy of Schoodles or the memberships. There's also information if your school district has a PO or you want to group memberships on group pricing, it's all there on the website. It's schoodles.com. Jayson Davies And just because I know it's easy to do, and I did it earlier, that's schoodles.com. Marie Frank, OTR/L Yeah, Jayson Davies Alrighty. Well, that's gonna wrap us up for today. Thank you, Marie. Thank you, Monica, so much for coming on the show. It has truly been a fun experience and a knowledgeable one. Monica Fortunato, OTR/L Right. Thank you, Jayson. Jayson Davies Thank you. Marie Frank, OTR/L A delight. Jayson Davies Thank you. You guys make my job easy. So, I appreciate it. Thank you so much. Take care and have a great rest of your Sunday. Bye. Monica Fortunato, OTR/L Thanks. Jayson Davies And that is how we are wrapping up the OT School House podcast today. Thank you, again so much to Maria and Monica, for coming on and sharing all that information with us about the Schoodles and just about assessments in general. So much of what they said was appropriate, no matter what assessment tool you use, whether you're using the Schoodles, the bot, the VMI, or any other tool assessments are still assessments. And they take a lot of information, a lot of knowledge, and a lot of skills from the occupational therapist to have a good assessment. And with that, thank you one more time so much for listening to the OT School House podcast this time, and every time that you listen, I appreciate it. I'd also really appreciate it if you took a moment to leave me a review down in the comments on Apple podcasts. Those reviews help me to grow this podcast to make it better for you and every other occupational therapy practitioner that listens in at any time. Thank you so much for taking the time to learn with me today. And I'll see you next time. Bye-bye. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to OT School House.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast
OTSH 75: Journal Club: Free vs. Paid Typing Programs
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 75 of the OT School House Podcast. In this episode of the OT School House Podcast, Jayson gets real while breaking down a 2018 article outlining a specific typing program and its effectiveness versus a free typing program. In this discussion, we will look at various typing methods, the lack of available norms for typing speed, Motor Learning Theory and Keyboarding, and how a premium paid program compares to a free program. Listen in to hear why the research is still not great when it comes to typing.
Article Citation: Denise K. Donica, Peter Giroux & Amber Faust (2018) Keyboarding instruction: Comparison of techniques for improved keyboarding skills in elementary students, Journal of Occupational Therapy, Schools, & Early Intervention, 11:4, 396-410, DOI: 10.1080/19411243.2018.1512067 Episode Transcript Download or read a rough edit of this OT School House Podcast episode 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 Hey there, welcome back for Episode Number 75 of the OT School House podcast. You know, actually, as I say that I have to apologize, I think last week was Episode 74. And for some reason, I said Episode 73 in the intro, so I'm sorry about that. But we are officially on episode 75. My name is Jayson Davies. Thank you so much for being here today, and I'm looking forward to this episode. Now, this is a journal club discussion podcast. And well, what we do in these Journal Club podcast is we look at a journal article based upon some concerns that I've been receiving comments about. So recently, I've been getting a lot of comments and questions about typing. And when I say that, I mean, questions about what are some of the norms for typing, you know, what, at what speed? or How should a third-grader be using a keyboard? What should they be doing? Also, when is it time to switch from handwriting to keyboarding? Those are the two main questions norms related to speed, and when is the time to switch. Also, do OTs even address keyboarding? That's another one that I get. So today, we're going to go through a journal article and address some of those questions about keyboarding. Let's go ahead and get started. Today, the article that we're looking at is titled "Keyboarding instruction: Comparison of techniques for improved keyboarding skills in elementary students". This article comes from the Journal of Occupational Therapy, School and Early Intervention, and it was published in 2018. The actual study took place in the fall of 2016, to the spring of 2017. The authors of this article are Denise Donica, Peter Giroux, and Amber Faust. And like I mentioned, it does come from the Journal of Occupational Therapy, Schools, and Early Intervention. Now real quick, before we get into the background of this article, I just want to point out that not every article is perfect. But, that doesn't mean that we can't learn from it. So a little bit later, I'm going to share with you some of the pitfalls I think about this article. But again, that doesn't mean that there's not something that we can't take away from this article. I actually think that the background that we're about to talk about is really strong, and provides a lot of great information for us. So, let's go ahead and do that. And then I'll tell you a little bit about what I didn't like so much about this article as we get later on. So as I mentioned earlier, this article does come to us from 2018. And the actual research itself was conducted in 2016 and 2017. So this isn't going to be research that we can really say, is a result of the pandemic, things have changed, especially with typing as a result of the pandemic. But I think the authors would agree that typing has only become even more important, as a result of the last 14 or so months, with everything going all online. Thankfully, things are starting to open back up now. But we know that technology has changed, and school has changed forever when it comes to the use of technology. So, I think the researchers would agree that this is such an important topic, both in 2018, and even more so now. To start off with something that I really appreciated within this article is just some of the terminology. The authors pointed out that students who have difficulty with typing may face challenges meeting their student occupational demands. And I don't know about you, but I really like that little phrase right there, student occupational demands. I think it's something that all of us as school-based occupational therapists should actually use more frequently. I think it will help to share with others, teachers, as well as parents and administrators, exactly what our job is. We are not fine motor, or handwriting, or visual-motor specialists. While we do look at those areas, we are really looking at the student's occupational demands every day. That's what we're focusing on. That's what we're trying to improve on and make the student more independent. So student occupational demands, I think that's a great terminology are a great term to add to your dictionary. And when it comes to student occupational demands and technology, there are three areas that the researchers identified that students really have to use technology nowadays. Those three demands that are now regularly presenting themselves for students, include reading and accessing digital textbooks, partaking in computer-based testing, and also simply just completing online or word-based activities. That can be anything from playing an academic game on the computer to maybe writing a three-page essay on a Word document that can also be putting together a PowerPoint show for you to present in class. Each of those is an example of assignments that happen more and more on the computer these days, as opposed to maybe even a few years ago. And that then leads to the next point that they make in the background review of this article, and that is that just about like everything, the earlier you start, the better. And so the earlier that you introduced touch keyboarding instruction, the better because they find that it does allow for higher-level keyboarding, as the student gets older. No surprise there, right, the earlier you start something, hopefully, the better you will be in the long term. Now, one thing that I was really hoping to get from this article were some established norms as to when kids should start typing, maybe what speeds that they should be typing out, what age and you know what, it just isn't out there yet. The authors note that there is no real standardized assessment to measure words per minute and that over the years studies have found varied results, partially because there isn't a standardized way to measure this. For example, one study found that students' grades first to third, average nine words per minute, while another study found that second graders average five words per minute. I mean, yeah, that's only four words per minute, but that's a 50%, actually, almost 100% increase from five to nine, right? Furthermore, a third study found that third-graders type up to 30 words per minute. That's a huge difference. That's like a 300% increase from the nine words per minute. So it's just very up in the air right now, as far as what is a norm for a student to be typing. It's also not known when a student should be using touch typing, versus a one-finger hunt and peck method. However, one thing has been pretty consistent as far as what the research has shown. And that is that, in order for a kid to actually use typing effectively, they need to be introduced to typing prior to the grade level where the computers are expected to be used for that academic work. And I think that is pretty common sense. But you never know that we need to actually teach someone how to use something before we expect them to actually use it to complete a project. So yeah, you know, for a lot of OTs out there, you're listening to this, and you're like, "Oh my gosh, this is the same thing with handwriting, right?" We expect them to come into kindergarten expecting them to know how to write their name, and to write all their letters, but no one's ever shown them how to, you know, use a pencil to draw some simple shapes, let alone show them how to form letter A. I think that that has simply frustrated many OTs and teachers alike. Speaking of frustration, let's go ahead and dive into what the Common Core State Standards say. Yeah, I went there. Just kidding. But Alright, so Common Core State Standards. It isn't until about the third grade, that students are actually expected to do typing and produce published writing with technology. That's when you first see typing or keyboarding, within the Common Core State Standards. However, once you get to the fourth grade, it does state that a fourth grader should publish one page in a single sitting as a fourth-grader, and two pages in a single sitting as a fifth-grader. That's quite a bit of writing. I mean, especially if you haven't been taught how to touch type, and you're trying to search for letters as you write. I don't know exactly how many characters are on a single page, maybe if I highlight my document that I'm looking at right now, I can figure that out. But it's hundreds. So that's a lot of looking around a keyboard trying to find the right character that you need and the punctuation and whatnot. So if you're not touched typing, or even at least familiar with a keyboard, that can be tricky, and can probably also be a little overwhelming, I would imagine. And that then brings us back to the different ways of how students actually type. The researchers pointed out five main methods. The first method is the traditional one finger, on one hand, hunt and peck method. This is the most immature model of actually typing. The second method is one finger on each hand to hunt and peck. And of course, here you are still heavily relying on your vision. The third model is moving up to two to four fingers on each hand while looking at the keyboard. The fourth method is using all of your fingers but still looking for the letters, kind of relying at least on visual feedback. Maybe you're not looking consistently at the keyboard, but you're still relying on the visual feedback. The fifth model, which is the most advanced, most mature method of typing, is what we widely know as true touch typing, where the typer uses all the fingers on both hands without visual feedback and instead is relying on kinesthetic feedback. The author then takes a moment to actually share a little bit about motor learning theory and how that feeds into the ability to type and they talk about the different processes of cognitive, associative, and autonomous stages to get to touch typing. Cognitive stage number one is that it takes a lot of that executive functioning to plan out what key you're going to hit, using your vision to figure that out. And starting simple by just hunting and pecking, then you start to move to that associative stage where you're relying on your vision a little bit less, maybe you now you're using two to four fingers. And you're not quite always looking at the keyboard, but your stuff to look at the keyboard. And eventually, you get to that autonomous stage where you are able to just, you know, get that kinesthetic feedback, and really start to quicken up your typing and also become more accurate. Alright, so that's going to go ahead and wrap up the background review that they discussed in this article. And now we're going to move forward a little bit to the actual goals or the hypothesis that they had with that article. And here the researchers thought to discover if the learning without tears typing program would be more efficient than a free alternative online program that is commonly used, specifically the free online program that the school that they were at, we’re actually using. We'll talk a little bit about the population in just a moment. But for the goals, you just got to know they wanted to compare the learning without tears typing program to the free alternatives online. They also wanted to be able to determine if there was a relationship between the number of activities completed on the keyboarding without tears application, and the overall keyboarding speed and accuracy. So basically, they wanted to determine that if a student completed five activities of the keyboarding without tears program, would that then correlate to a one-word or two-word improvement in their word-per-minute score. So then who were the participants in this study, the study looked at Southern suburban elementary schools with grades kindergarten through fifth grade. Combined, there were a total of about 1900 kids, I believe it was 1908. About 45%, and a 55%, split between who was in the control group versus who was in the intervention group of the learning without tears. Now, I know many occupational therapists, those who work in special education, they want to know what our special education students included in that group. And they were for the most part unless they were in a self-contained class. So if they were a kid who received RSP services or something like that, then yes, they were included. And they did participate in both the learning as well as the pre and post-test. If they were in a self-contained class, then no, they did not participate in the study. Like isn't mentioned earlier, this took place in the 2016-2017 school year, it was most of the school year, they started in August to September with that pretest. And then they had the same post-test later that school year in the month of May. And speaking of that pretest and post-test, they used a website called typingtestpro.com in order to collect that baseline and then compare the baseline scores later. In that same academic year, what they use were two, one-minute timed tests, and one two-minute time test. The two one-minute time tests, we’re actually at a first-grade reading level. And then the two-minute time test was at a fourth-grade reading level. Now, this is the first thing that I wasn't too thrilled about because they tested kids from kindergarten all the way up to fifth grade using the same exact test. And so for those poor kindergarteners, and they admitted this later, and the limitations that, you know, maybe they should have done something else for the kindergarteners at least because they didn't even know what letters were some of them at the beginning of the school year. And yet they were asked to basically copy a paragraph that was written for first and fourth graders. So that was a big struggle for them. Likewise, on this testing, they actually disabled the backspace button. And I don't know about you, but if I was a kid learning to type, I'd be a pretty frustrated kid, if I couldn't use that backspace button. For those kids who get really anxious about not being a perfectionist. In fact, for most kids in general, they want they just want to be able to use that backspace button. That's what they've been taught, and they couldn't use it. And so they did do this test again, once at the beginning of the school year, and then once at the end of the school year for all the kids involved. Alright, so let's go ahead and jump into the interventions that were used. This is where it gets a little interesting. This was a quasi-experimental pretest-posttest design, meaning that there were two separate cohorts, the intervention cohort, and the control cohort. These cohorts only did one of the two interventions. One was given the keyboarding without tears intervention, the other use the free typing programs that had been used by the teachers the year before. The teachers that were providing the keyboarding without tears program received five hours of training in that program. The other teachers received no training and keyboarding, in addition to what they had already had previously. All of these interventions occurred within the computer lab at the school site, it wasn't exactly clear if there was a specific computer lab teacher that was in charge of providing the intervention, or if it was just the typical teacher that was providing that intervention. The authors did note that these students sped to anywhere between 45 and 60 minutes in the computer lab, but that not all of that time was spent on actually keyboarding practice. So it's unclear as to how much time each group actually did spend on practicing keyboarding. The handwriting without tears program notes that it is supposed to be implemented up to 10 minutes a day, or up to about an hour per week. So we can assume that was what the intervention group the handwriting without tears group use, but we're not sure about the other group. What we do know about the other group, the non-keyboarding without tears group is that they use three specific websites, they used freetypinggame.net, learntyping.org, and PBSkids.org. Now, when I first tried to type in freetypinggame.net, I actually typed in freetypinggames with an s at the end .net. And well, let's just say Google Chrome, and my router blocked me because it was going to take me to a dangerous website. So I don't know what would happen if a kid accidentally typed in an S at the end, which I think actually makes sense because there's more than one game on this website. Anyways, just wanted to point that out. I also want to point out that if you have a moment, and you've never been to freetypinggame.net, go for it look at it, you're probably going to have the same feeling I have that teachers probably shouldn't be using this website. It is a very cluttered website, there's a lot going on on it, and even when you do actually click on like the "Learn to type", it is very outdated, their, their processing is just very poor. And I can see a kid getting lost on it. The same thing happened when I went to learntyping.org it was just not a good website, period, not alone typing, it just was not a good website, period. And so I'm surprised that these are the websites that handwriting without tears learning without tears decided to go within the comparison group. PBS Kids is a more established website. It's a very popular website among educators, I believe, although it is not specifically a keyboarding website. Personally, I would have liked to see keyboarding without tears, compare their product to something more familiar to myself, and more familiar to the teachers that I know that work on typing. And that program would look more like typingclub.com or typing.com where the student can actually create an account, log in all for free and track their progress and go along with the flow. In fact, with those free websites, I know at least on one of the two, the teacher can create their own teacher account and actually have their students under them so that the teacher can track the progress that the student is making, as opposed to learning without tears using these three websites that are just really not that great. Now, I know this was done in 2016. But still, these programs have been around for a while. So I would have liked to see that. Likewise, it was noted that one of the schools was selected as the keyboarding without tears school based upon familiarity with the school by one of the researchers. I just think that the school should have been randomly selected and randomly applied to either the control or the intervention group, as opposed to the convenient leap selected. Because one of the researchers was familiar with that school. It just doesn't seem right for an article that you're publishing for the world to see. Despite all of that, let's go ahead and talk about some of the results that came about. Personally, I'm not completely thrilled by the way that they expressed all the results. And so I won't go into all the details because I'm not a researcher. I'm not someone who went to school specifically to read articles. And I just don't think that the charts and the narrative that they put out there were the easiest to understand. But what the key takeaway from the researchers say they found was that in grades K through two, those students increase their ability to improve their keyboarding method, you know, from using maybe two fingers to hunt and peck using four fingers to hunt and peck significantly more than the students who were using the free program. That was in the K through two population and the third through the fifth population, they found that those students increase the rate of typing, more so than the students in the free programs. That was the key takeaway the younger kids got better at the actual methodology of typing using their hands and improving the touch typing, or maybe not getting all the way to touch typing, but using more fingers understanding the keyboard a little bit better. While the older students improved their fluency per se, they were able to type longer and faster. Surprisingly, the older kids in grades three through five that were not doing the learning without tears program actually improved their typing methodology more than the other kids that were in the learning without tears program. Again, the typing methodology meaning how they actually typed from touch typing to the hunt, and peck method. All in all the authors came to the conclusion that this study indicates the importance of using a developmentally based comprehensive curriculum for keyboarding, such as the keyboarding without tears curriculum to improve student's typing and both general education and special education. The research also was noted to support that student's keyboarding skills improve with the exposure to keyboarding and instructional tools against such as their program and that this provides promising evidence of the keyboarding without tears effectiveness to improve net words per minute over a free web-based activity. Now, this brings me to the limitations, and based upon what I've already said, you might expect me to have a few limitations of my own, but I'm gonna start with their limitations. The researchers did note that limitations included the size of the study, as it was a small study and limited to a certain geographical location. They also noted that the free program that they use for the typing test for the pre and post-test wasn't great for the younger kids, because kindergarteners maybe didn't even know what letters look like, and they were asking them to copy a paragraph, and they didn't even know what letters were. So that would be two things that they established as limitations. Personally, like already mentioned, I think that they chose some of the worst online programs that are free for typing and that they could have compared their program to potentially a better free alternative. And you know what, they might have still found similar results, I'm not sure. As I also mentioned earlier, one of the schools that were selected as keyboarding without tears school was based on research or familiarity with a school as opposed to random selection. I would have liked to see that random selection. And they didn't exactly explain other than familiarity for why that school was selected to be keyboarding without tears or KWT school. The last and potentially most blaring limitation and conflict of interest was that this complete research project was, "supported by learning without tears". I'm not sure what the full extent of the term supported means. I don't know if a financial was supported. But it was supported by the program, which was being tested. Likewise, the two key authors which I didn't realize when I started reading this article, but at the end, they made very clear that two of the research authors actually work part-time for learning without tears. So it's really hard to take some bias out of this article. It just kind of is right there and front, but they don't put it in they don't tell you that information until the very end of the article. So that was a little disappointing for me. Furthermore, after reading this article, figuring out that there might be some bias. I actually went to the learning without tears website, lwtears.com. And I looked at their keyboarding without tears program, I looked at what their marketing materials look like I looked at the program itself because like I said, I've never used it before. And what I found was that this article is being used as a marketing ploy to say that students who use their program are typing 43% faster than students who have not taken the program. And I'm not sure that that is entirely a fair estimate or a fair statement to be making. So with all of that, I didn't come on this podcast to jump on here and talk bad about handwriting without tears. I mean, I really like handwriting without tears. It was one of the first training I ever went to. And I've been using concepts that I learned in that training for nine years as a school-based OT and I do really value all the content that they have created and everything that they put out. But I really cannot look at this article read through it and with a straight face think that Yeah, absolutely handwriting without tears. Sorry. keyboarding without tears is a better program than some of the other programs out there. I really wish I could have jumped on this podcast today with full enthusiasm for learning without tears and the keyboarding without tears program, but I simply can't. I just don't think that this was a great article, you know, yes, this may be a great product, I've never used it. But I can't say that this article really proves that their program is better than other programs out there, even the free ones. So to the authors of this research article, I really do appreciate the background that you put into creating this article. I appreciate the term that you use for student occupational demands, I think that is something that we should all be using more frequently. I appreciate the information on Common Core State Standards. I really do. I understand that there aren't any norms. Thank you for sharing that with me. But at the end of the day, the actual research itself, I just can't look at and take straightforward. I just think that there's a little too much bias involved here. And I just can't I can't say that I can't go to an IEP and say, Hey, parent, you know what handwriting without tears there, keyboarding without tears program, that is the best option. When I know that there are other programs online that are free, that might do just as much or better of a job for free. I'm sorry, that's just my final takeaway from this episode from this article that I read was that it doesn't really tell me that I really need to use this program over some of the free programs that I'm aware of. Alright, so with that, I'm going to go ahead and wrap up today's session of the OT School House podcast. This has been Episode 75 and it has definitely been real. I hope to see you next time for Episode 76. Take care and see you next time. Bye-bye. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to OTschoolhouse.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast
OTSH 74: Which Is It: ADHD or SPD? Featuring Debbie Lund, MS, OTR/L
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for Episode 74 of the OT School House Podcast. "What is the difference between ADHD and Sensory Processing disorder?" Has a parent or a teacher ever asked you that question? This has always been a touch question for me to answer. I could always explain sensory processing well, but I hadn't learned much about the neurological processes behind ADHD. To help you and I better understand the differences between ADHD and SPD, I am welcoming to the podcast, Debbie Lund, MS, OTR/L. Debbie is here to share with us her experiences of working with children who have SPD and/or ADHD and how our treatments may need to vary based on the child's needs. Meet Debbie Lund Debbie is the Owner of Two Fish Therapy, LLC. She has worked with a variety of children with various learning needs for over 20 years. Her occupational therapy experiences include working with children with diagnoses of Sensory Processing Disorder, ADHD/ADD, learning disabilities, dyslexia, visual perceptual disorders, dysgraphia, motor coordination disorders, autism, to name a few . Before completing her Master of Science in OT she worked in a variety of community settings including homes, schools, daycares, and after school programs. She has particular interest in designing new and more effective therapy and educational programs for children in schools. She works everyday to ensure that her company provides the best available; consultation to teachers, individualized learning plans for kids and schools, integration therapy with education in classroom and treatment. She aims to support and advocate for child-centered learning styles, especially for children with attention, sensory and coordination issues, with every family and child she meets. She also strives to build relationships with key professionals in the community in order to enhance potential, success and connections for families and their children. Links to Show References: TwoFishTherapy.com Two Fish Therapy on Instagram Empowerment Plans on Instagram The STAR Institute Books Sensational Kids Out of Sync Child Episode Transcript Download or read a rough edit of this OT School House Podcast episode 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 Hey everyone, and welcome to Episode 74 of the OT school House podcast. My name is Jayson, thank you so much for joining us here today on the OT School House podcast. Really appreciate you being here. This is gonna be a fun one. We're talking with Deb Lund, who is the owner of two fish therapies down in Florida, if I remember right, and we're going to talk about the difference and similarities between ADHD and sensory processing disorder. So if you have been caught in the middle of a conversation, trying to explain the differences between ADHD and sensory processing, you are in the right place. This is the podcast for you. We're going to talk about the differences in the DSM, the DSM five, the manual that kind of outlines what a disorder is, and kind of what the definitions of it are. And yeah, we're going to talk a little bit about evaluating how to determine whether we need to go in the direction of treating ADHD or treating a sensory processing, and then even what that might look like the treatment as well as the recommendations that we might provide to parents and teachers. All right. So you do not want to miss this again, this is Deb Lund, and she is the owner of two fish therapy. You can learn more about that at twofishtherapy.com, and she has a bunch of resources that you'll hear throughout this episode that she has compiled for us that you can get at the show notes for this episode. All right, so enjoy the episode. This is Deb Lund. Deb, welcome to the OT schoolhouse podcast. How are you doing today? Debbie Lund Great. Thank you so much for having me. Jayson Davies Yeah, no problem excited to have this conversation. This is a question that comes up a lot. I'm sure you've heard it many times, obviously. Because we're, we're talking about today. And that's kind of the difference between ADHD, sensory processing, and how you kind of see those differences. So I'm excited to have this conversation with you. Debbie Lund Oh, thank you, me. Me, too. I'm really excited. I do hear that question a lot. Jayson Davies I bet. Debbie Lund I think a lot of you as well, teachers, and probably pediatricians. Jayson Davies Absolutely. And I love that, you know, we already have a question a little bit down a little bit, you know, in a few minutes, maybe 20 minutes or so I'm gonna actually ask you kind of that specific question is how do we explain? How do we explain this to parents who might be wondering this and don't have a medical background. So we'll get into that in a little bit. But first, I want to give you an opportunity actually to share a little bit about yourself in your OT career and how you got to where you are today. So tell us about that? Debbie Lund Well, I like from the time I was a kid, I always wanted to be an education. So I think originally I wanted to be a teacher or something. And then as I got older, I was just I think my parents really pressed upon me how important it is to get an education and have a good education. And going through my educational career, I saw so many intelligent people like really smart folks who struggled so much to access education inside the box that we have as education, right. So, you know, in a lot of cases, quite frankly, and I think a lot of people would agree with me who experienced this, and this is even neurotypical folks like education can actually be more of a catalyst, I mean, more of an obstacle than a catalyst to people's life success, right? In terms of if you have learning differences, or if you don't fit within the style of that education. And although So, so I always wanted to support access to learning. That's what I wanted to do. So I wanted to help people get through school, I wanted to help people do well in school, I wanted to help them be successful. I was going to be a teacher. And then I thought, well, maybe I'll be a psychology like a school based psychologist. They don't got it on my undergrad, double majored in sight, I found out that it was a lot of testing and a lot of mental health. And that was not what I was looking for. And then just through working, you know, with people with disabilities, like I worked in group homes, and I worked in schools, and I worked in the community, I did some independent living stuff with folks. I happened upon OT and I apply for I was like, This is perfect. Like, this is exactly what to do. I want to enable participation. I want to enable access in school systems like this is, you know, so that's how I got there. I applied and here I am, like running a school based therapy company is out there. This was speech paths and educational assistance and, you know, Yeah, Debbie Lund wow. Yeah, it really sounds like you found the right job. Debbie Lund This also you know what, I'm Canadian.Yeah. So I went to McMaster University in Ontario. I'm from the east coast of Canada. And I actually just after grad school, packed up and drove here. Jayson Davies Drove here being Where? Debbie Lund To Florida to Florida, where I live now. Yeah, and I own this practice. And I do all of this. So it's, it's been a real adventure. Wow. So from Jayson Davies Florida what a change? Debbie Lund Definitely, yeah. Jayson Davies Yeah. And a lot more ways than just one. I mean, more than just weather. Debbie Lund Yeah. Jayson Davies All right. Well, actually, were your parents in education, you said that you were kind of instilled with education, were they in education. Debbie Lund We weren't in education, but I just I was just a big part of what they believed in, like, they just really wanted me to get an education so that I could do well for myself. Great. So it wasn't, it wasn't bad. It was just the I think it's very common for people, you know, to, to hope that their children will get the best education that they can get, you know, Jayson Davies absolutely. Alright, so I really liked what you touched upon too, with house for some education can be a something to build up upon. But for other people who might have a learning disability and maybe a little bit more tough and like you, I think you said it might be an inhibitor for some people. Yeah, like, yeah, and obstacle. There we go. Great terminology. Yeah, we're gonna get all into that. But I want to ask you one more question. And because you kind of started to talk about it is is your company? What does your company actually do? You mentioned that you have a school based OT company, you also mentioned, educational assistance. So tell us a little more. Debbie Lund Yeah. So I currently own a company in St. Pete, Florida. And we go specifically into private schools right now, to support them with their therapy services. So speech in OT. And then I also have educational assistance or reading specialists, learning specialists, educational specialists. So I have, I have a couple of tutors who work with me one Spartan trained, the other one is Linda mood Bell trained. And then I've also trained them in how to do some of the the home programs that I would generally give parents. So they'll start their tutoring sessions with a little OTs protocol, you know, important move protocol, and then they'll go into the rest of it. So we're kind of sharing and make like enabling more of that access to the treatment plans, more more frequency, intensity duration, because they're seeing me and then they're seeing them a few times a week, so they get it more frequently through us, especially if the parents aren't able to on account of schedules or whatever the situation, maybe Jayson Davies that's really cool. I would love to see some sort of research done, where there is that much incorporation between the OT and it sounds like to me, your educational specialists might be something like we call them out here. RSP resource specialist teachers or something like that. Debbie Lund Yeah, exactly. Jayson Davies Okay, great. All right. Well, that's awesome. So yeah, and we'll direct people to your website, so they can learn more about your website a little bit later. But let's jump into sensory processing and ADHD a little bit. Sounds great. Yeah. So to get started, let's start off with the ADHD side a little bit. And would you mind sharing with us a little background on ADHD and for anyone who's not quite so sure about it, this listening what it is? Debbie Lund Okay. So ADHD stands for attention deficit hyperactivity disorder. And I think like to explain it, I'm just going to go right into like differences in terms of our brain functioning. Okay. So we know that children who have attention deficit hyperactivity disorder, there's some issues with the neurotransmitters and that there's not enough dopamine and norepinephrine. So that's one that's one area of difficulty. So there's some struggle with some focus there. And then there's some difficulty with the reward system and motivation associated with those things. And then there's a lot of great imaging now, you know, like scientists come so far. So neural imaging actually show some abnormalities in the frontal regions of the brain, which is to be expected because, you know, those are the areas of the brain that are involved in executive functions, focus, tension, planning, self monitoring, working memory, these type of things. So we know that children who have attention deficit hyperactivity disorder have brain differences and their behaviors present as struggling to focus struggling to plan struggling in those areas in which those brain those brain differences are present. Jayson Davies Gotcha. Okay. The next question is going to lead right into that, and ADHD I, there's always been I mean, this is ever since I was back in high school, I remember there was always like, is ADHD are there different types of ADHD is add a thing. So I just want to quickly ask you a little bit about As far as are there different types of ADHD? And if so what are they? Debbie Lund I think that's changed, like, as of recently, and I don't know, I hate to say as a risk I feel the older I get, the more years pass. Jayson Davies It's relative, relative time is relative Debbie Lund it's relative to my age, which I really don't want to get into Jayson Davies Not on this podcast. Debbie Lund So now there are three types that you can actually have in terms of the DSM five, there's three different types. So there's the combined presentation and and it's some combination of either being the inattentive type, or being the hyperactive impulsivity type. And I'll give you some characteristics of that in a second. But just for you to understand how the diagnoses go, you can have a combined presentation, which would be the childhood or the or the adult person would have to meet the criteria of both in attention and, and attention and hyperactivity, impulsivity. So there's a list of characteristics that come with that. Or you can have predominantly inattentive presentation, or the child struggles with just hyperactivity impulsivity, or you can have no sorry, within attention, struggles just predominantly within intention, or you can have predominantly hyperactive impulsive, which is they meet the criterion for hyperactivity Jayson Davies and impulsivity, Debbie Lund impulsive over the over the plastic, and this is all happening over the past six months from which they're tested or beings. Okay? Jayson Davies So it's really based upon what? Debbie Lund they have to meet these criteria and within six months of being in the doctor's office, or whoever's doing the assessment, Jayson Davies gotcha. Okay. And then so you started to say that you would also share with us a few of the behaviors that that might look like, depending on whether they're in the inattentive type or the was it hyper activity, impulsivity, so go ahead with that. Debbie Lund So if they are in an inattentive, this is like directly from the DSM. So the Diagnostic Statistical Manual that's used to create some criteria and provides diagnosis and diagnosis codes. So for the inattentive type, here are some characteristics so they make careless mistakes or lack of attention to detail. Difficulty sustaining attention doesn't seem to listen when spoken to fails to follow through on tasks or instructions. exhibits poor organization avoids or dislikes tasks requiring sustained mental effort is easily distracted. So those are some criterion for inattentive type. For the hyperactivity, impulsivity type, it's fidgets with our taps, hands or feet and squirms and seats leave seats in situations where they shouldn't be remained seating are seated, has difficulty engaging and quiet, leisurely activities is on the go or acts as if driven by a motor talks excessively. blurts out answers, has difficulty waiting their turn, interrupts or intrudes on others. Okay, so those are some of the symptoms were acquired for a diagnosis. Jayson Davies Yeah, and like you were saying earlier, it sounds like there's three different models, not models, but three different ways that a child can be diagnosed with ADHD. And so you might get mostly that inattentive, my most of the hyperactivity, impulsivity, or a mixture of the two, correct? Debbie Lund presentation. Exactly. Jayson Davies Great. Alright, so I couldn't help but think, well, you were mentioning all of those behaviors, that it can sound like some of our kids also, who might have a sensory processing disorder, maybe some of our kids with autism, and all right, so Exactly. Right. So let's go ahead now and talk a little bit about the sensory processing side of it. I think as OTs we inherently get a little more training in sensory processing than we do in ADHD. I think maybe that's different depending on what school you went to, and what trainings you've taken. But what are some of the key behaviors that might be seen in a child with sensory processing disorder. Debbie Lund So I think in terms of like behaviors associated with being able to attend for school, like access education, and learning behaviors, very much the same as those characteristics for inattention and hyperactivity and impulsivity, and I and you know, considering where the processing breakdowns are, which we can get into or we'll get into a little bit later when we start talking about SPD presentation and neuro imaging, but it makes so much sense that higher levels of the brain would be impacted such as the areas in the frontal region, because there's the processing or as Jane Ayres would describe it, like traffic jams in the in the lower back regions, right. So if there's disruptions that affect efficiency and access to brain centers, then obviously these kids are going to struggle with attention. And they're going to struggle with impulse control in these frontal lobe regions. So those behaviors are very common in the kiddos that we see. Jayson Davies Gotcha, yeah. And one thing that I always recall from like anatomy classes, and then it was reminded of it when I took some si classes was that you have the old brain and you have the newer brain, right? And that old brain is like central located. And that's where all that sensory processing is really, that's where that traffic jam often is, is in the brain. And so those signals can't get to the new brain, which is more of the cortex and the frontal lobe, I like what you're talking about, right until they go through the old brain. And so I think it's absolutely I think you're right on and with the brain, it has to go through that old brain before it gets to the new brain. And so that's why you might see some of those similar behaviors. Debbie Lund Yeah, I recently took a course actually, with a woman who is, was a psychologist, and I was taking it trying to get a psychology perspective, just a well rounded perspective on self regulation, was a self regulation. For those looking more like, I was thinking was going to get more mindfulness yoga, sort of like, anyway, she was so well versed in sensory processing, I was very impressed by that fish, she went back to this old brain piece. And she actually talked about how, you know, Jean, who is the pioneer of sensory integration, she believed that 80% of our brain is involved in sorting, organizing, and storing sensory information. So when you think about there, it's involved in that much so that much of the brain is actually receiving, sorting, organizing and storing sensory information. It's just, it makes so much sense, really, because everything we receive in terms of learning at some point comes in through a sense, right? And then we organize those responses, we organize that information and process it and then create responses to it. So it's a really powerful perspective in terms of taking a bottom up approach for sure. Jayson Davies Absolutely. And so and, you know, our brain has to do that whether or not we have a sensory processing disorder, whether we're a typical learner or whether we have ADHD. And it sounds like the difficulties might be similar in some cases that a student with ADHD or a student with sensory processing disorder might have, they might show similar disabilities. However, the processing within the brain is different. I think you mentioned like dopamine and epinephrine, being more indicated with ADHD, as opposed to sensory processing is very much in that old part of the brain, the brainstem, correct? Debbie Lund Yeah, definitely. And the lower regions of the brain associated with visual auditory and some metal sensory processing. This is what the imaging found. But more importantly, let me I got ahead of myself. So let me just step back. So I think in terms of you're saying one of the key behaviors in kids with sensory processing disorder, and I said, Well, all of the inattentive and learning behaviors that I just described for attention deficit disorder, but also there's a need for sensory but I need to seek sensory input or avoid it. So there is a some sort of association with sensory input in a kid who has a sensory processing disorder. If that isn't there, that can actually be a key feature for us to determine whether it's an ADHD issue, whether it's a higher brain region issue whatever's going on, or whether it's rooted in sensory processing stuff. Jayson Davies Stuff Well, let's let's go into that a little bit more because I know you know it, I'm gonna, I'm gonna pull it out of you. Okay, let's kind of break down sensory a little bit what might a student or a child be seeking or avoiding when it comes to tactile? Debbie Lund Okay, so you want some specific behaviors of what they might be thinking? Like, Jayson Davies yeah, we'll go with that. Debbie Lund Okay, so So kids who seek tactile input, this is the kid Okay, who you have a difficult time setting them any like we're thinking if we're thinking kindergarten to grade three, this child Do you struggle with having him standing in a line having him sit in circles having him be anywhere close to somebody else, because he's always touching, seeking bumping crashing, or she bumping too hard tagging too hard seeking out this extra input all the time. Whereas the kid who is an avoider is going to get very upset from a tactile perspective. If they're in line and somebody just taps them gently it's going to be Oh, my goodness, you know that he hit me he hit me, you know, this over responsiveness, so the tactile input, so and then over responsiveness to clothing to to materials, like play materials and school, especially in terms of like glue, slime, sand, all of these different textures and even pencils, sometimes. Even pens. Oh, yeah, definitely for sure. Yeah. Jayson Davies All right. then what about are you you've had on yours, and I wanted to talk about it was the the ocular motor concerns when it comes to sensory processing? Debbie Lund Right. Jayson Davies And so I wanted to ask you about that one. Debbie Lund So that's huge. So when I think that, you know, oftentimes ocular motor concerns are overlooked. I think that as OTs within the school system and correct me if I'm wrong, like within like a public school system, or within a school system. Who else is considering the child's document motor skills, I don't know of anybody else who's pointing that out, right? And similar system is wired to the like, you know, our muscles or muscles within our eyes are controlled by our vestibular system. And our vestibular system also controls our postural activation, our body awareness. So when you're thinking about these kids who have sensory processing issues, and they're rooted in vestibular difficulties, you see there, they then have a difficult time controlling their eye movements. And the impact of not being able to control your eyes is tremendous when it comes to academics, particularly for what's important for, you know, administrators or for like the test givers in terms of like reading, writing, and math. Because for reading, you need to be able to sustain visual attention in order to be able to read or to attend to anything really in school, you need to be able to sustain visual attention, you need to be able to track across the page for all of that work or across the room without losing visual attention. You need to be able to your eyes need to be able to skip in a systematic like stockades just type of eye movement, from letter and letter to word to word with accuracy in order to be able to receive reading information, letter information, etc. You know, I've just narrowed it down to those two, Jayson Davies what I also think about, Yeah, I also think about copying from the board specifically going from the Debbie Lund far point to near point, divergence and convergence to like, where your eyes when you look up, your eyes naturally team out together. So your belly, your eyes, abilities to work together as a team. And then when you come in to look at your page, your eyes actually team in closer together, and whether or not those are working in an organized way affects your ability to do things like that. So yeah, Jayson Davies Great. And another term. And another terminology or term that I wanted to also ask you about was discrimination and what discrimination means in relationship to sensory processing. Debbie Lund So your ability to script discriminate is and this is actually a pattern of sensory processing disorder as well. But your your ability to discriminate is your ability to sense the subtle qualities differences, and sensory input. So let's say visual description, we're going to speak specifically to the sense of vision and example of visual discrimination would be being able to differentiate between P and Q, or B and D. Whereas if we were talking about auditory discrimination, we would be talking more about being able to discriminate between maybe cat and cap. So we're thinking of like phonics and phonemic awareness and these and listening and receiving instructions, and being able to hear your name another type of discrimination is being able to sort if it's like a foreground situation, so being able to hear your name being called when there's background noise going on behind so if you're if a child on the playground, and and there's a lot of noise going on and the teacher is calling them or the teachers giving a signal like time to come in and you know, for that child to be able to pick up that auditory cue, and, and and respond in a timely fashion like the rest of the kids. It's it's a negative, if it negatively impacts their ability to be able to do that. If they have issues with auditory discrimination. Jayson Davies Alright, and so you kind of started going down this route. So I'm just gonna go with it is describing some of the sensory patterns that a child may exhibit, I think you mentioned that discrimination is actually one of them. So why don't you elaborate on maybe give that one the full name, I'm not sure if you said it or not, but and then go on and explain the other few. Debbie Lund So there's, there's three patterns, and one of them is sensory discrimination disorder. And you know, this can happen in an all of your eight senses, or any of your eight senses. Maybe some of your senses maybe more affected, and other senses, it's the children present differently. Each child is unique, and their brains are unique. And their their experiences and the way they process information is unique. So, so there's sensory discrimination disorder. And like I said, that's the weather unable to distinguish subtle differences in sensory input, and then give meaning to them. Okay, all right, such as cap cat, P and Q, then there's also sensory modulation disorder. And that's when a child struggles or a person struggles to modulate the responses to sensory input in a functional, meaningful and purposeful way. So that for these kiddos, they have differences in the rate, they receive the information or notice the input when it comes in. And then the intensity of their experiences are different. So we're, you know, and this affects their behaviors and their responses and how they respond to it. So these kids are categorized in over responsive, under responsive or sensory seekers or cravers. So a child who is over responsive is this kid who has a huge intense experience associated with input, and their responses reflective of that, okay, and then a child and not like, you know, with treatment, where processing and probes and responses improve. And that's the whole point. But I'm saying, when there's an area of difficulty, and there's a disorder, and it's struggling, children are struggling, their responses are impacted. Jayson Davies Gotcha. Debbie Lund And then if they're under responsive, they're actually the rate in which they're receiving the information is delayed compared to other children, and they're not in the reaction times are delayed, and they're not getting the intensity that they need in order to activate those responses or activate that brain activity that's required for class. So these kids, you know, these are the kids that I think often go nest, like they often go on identify, I think over responsiveness people are more aware of, and it's more spoken about, but under responsiveness and passive. So these kids have, you know, poor strength, pouring durance, poor body control, they have they generally overall weak and they're a little bit slower or sluggish. They're very passive, they're easy going to get along with, so they often slip under the radar. And a lot of people you know, a lot of teachers, I'll hear from them, I don't know what's going on with this kid. He only does he only does his work when he wants to do his work, you know, I think he's just lazy. He's way smarter than this, his output doesn't match how intelligent he could be doing something, you know, this type of kids. So that's the I see that as the unresponsive kid, these kids that are just not identifies, Jayson Davies I can think of that kid in my head. Yeah, and, and I've also, he's also the kid that in the classroom, like you're saying, isn't getting the attention, even though he's probably the brightest kid in the classroom. He's not getting the attention that he may get otherwise, because other students are more outward with their behaviors, I guess you could say and you know, they're very much attend. They demand the attention based upon the behaviors that they exhibit. Debbie Lund Definitely for sure. And then there's the sensory seeker the sensory Craver, and those kids are still under responses. They're not getting the intensity that they need. But unlike the passive under responder, they're seeking out what they need their brain is continuously telling them light me up on more important I need to grow. We got to get you got to get me this in for if you want me to attend, I need to move if you want me to listen, I need to move you know, it's always trying to get organized by seeking massive amounts of input. So that's, that's the seeker and then there's the over responder that is presence and then there's the overall responder who avoids situation so they have such negative experiences with the cafeteria or you know such negative experiences with lighting situation or maybe noise or a public situation that they avoid interacting or those situations, just the thought of it gives them anxiety so they avoid those events or situation. Yeah, stimuli. Yeah, thanks. So those are basically the three Oh, and then their sensory based motor disorder. So there's that sensory modulation disorder. And then there's sensory discrimination disorder. And then sensory based motor disorder is actually two types and one is postural disorder and one is dyspraxia. So postural disorder is, so these are obviously difficulties with motor function and motor output. So the way we receive process and respond to sensory information for executing motor responses is affected, okay? So your postural disorder is that you have poor strength, and it's rooted in like a core strength, your core strength, your endurance is poor, poor motor skills, poor bilateral skills, here, we get into more ocular motor skills are affected I hands affected, and they struggle to stabilize their body to do functional skills at school, whether it be sitting themselves up in a chair, sitting themselves up in line, or stabilizing their bodies in order to like hit a ball with a bat or play, catch, etc. And then the other one is dyspraxia, which is, um, this is disorder in, there's a breakdown in the areas of motor planning. So coming up with an idea, so ideation part of motor planning, coming up with an idea for a motor plan, and then sequencing and planning that, and then executing that plan and evaluating it and changing it if it needs to be changed in order for you to do better the next time. Those are the three patterns of sensory processing disorder. Jayson Davies And I wrote him down just so he can, it's sensory modulation disorder, sensory discrimination disorder, and then the sensory based motor disorder. And there are kind of some subcategories within each of those, Debbie Lund yes, Jayson Davies we're not going to review all of them, you said them. If you want to go back, use that 3o second rewind button on your podcast, and you can go back and break it down, each one Debbie Lund The Star Institute has is a great place to go if you're interested in getting information like Lucy Miller, um, there's some great books I can talk about later on, as well to some resources for sensory processing. But if you're interested in learning more about it, the star Institute is a good is a good place to start. Jayson Davies I actually want to ask you a question based upon those you mentioned three main types, and then a few subtypes. How often would you say or I don't know, just frequency, whatever. Do you think that they often occur independently? Or do you think that they are often co morbid, potentially where kids who might have a sensory based motor disorder also has a modulation or discrimination disorder? Debbie Lund Definitely, So you know, I took there's, there's some great courses actually offered by a woman named Julia Harper. They're online, Julia Harper. And she, she owns a company called therapies. But, and that's where I got a lot of my training in terms of how to do assessment specific to brain areas, like we were talking about in terms of sensory processing, and what it looks like. And then protocols associated with those to help improve processing. But you know, based on that information, and a lot of other information that that I've received over the years, the idea is, is that if there's a modulation disorder, then that's that's happening at a lower level in the brain. So modulation disorder happens closer to the point of entry, we'll say, okay, where the inputs coming up through our central nervous system and our spinal cord, and then a sensory based motor disorders. And then sensory discrimination disorders are happening in areas higher than that. So if you have a modulation disorder, you're going to have some patterns, or some symptoms of affection, like affected areas above. So what's really interesting is that in these protocols, and in the teaching that that I got through those courses, was that you would learn where to start treatment and how to treat that area of the brain, and then prove and then move to the next area of the brain. So you have a systematic protocol approach in order to isn't Yeah, for treatment. So yes, they can be comorbid. Jayson Davies And you actually, I mean, it makes it sound more like it's not that they can be comorbid. Yeah, it's more like they often will be comorbid. Debbie Lund Yes. Jayson Davies Especially if it's that lower brain the sensory modulation, I think you said it was Debbie Lund like he was a child and you find that they have a modulation disorder, then they're going to have difficulty and a lot. Yeah. I think a lot of kids Who were identified and referred to us for sensory. It's because they have some sort of a modulation decided maybe that's wrong. I don't I think in my experience, I get motor referrals, but I get motor referrals more associated with fine motor skills than sensory based motor, the teachers don't know sensory based motor. Jayson Davies Yeah. And I also think I also think when it comes to sensory referrals, a lot of times for teachers, it is the modulation aspect and the behaviors that are due to the modulation aspect that the teacher feels is inhibiting the student's learning as opposed to the motor side. So yeah, definitely. All right, well, we got a good recap now a good introduction to SPD and the different types as well as some ADHD and so we're gonna continue on here. And I want to ask you, in schools we don't do especially not OTs, I mean, we're not allowed to diagnose but even psychologists in the schools don't diagnose they they do a report, they do an evaluation, but they're not diagnosing who is the person that would typically diagnose a child with either ADHD, SPD autism or whatever it might be. Debbie Lund I have like, I don't know if that changes that varies state to state, I'm not 100% sure to be honest with you. But I know here in Florida, it can be it can be your pediatrician, honestly, or it can actually be. And that's what's so interesting to me is that it can go from being your pediatrician with, with from what my family's report being a sort of questionnaire based subjective, or objective sort of experiences based on the parents reports to being on neuropsychologist, who does a full gamut of evaluation, or like a psycho educational psychologist who does a full gamut of learning, you know, so there's a variety of people who provide diagnosis for ADHD. Yeah, gotcha. Jayson Davies Yeah, I think that's absolutely, I think that's pretty consistent here. I think now it's starting to go a little bit more above the pediatrician because I think they're just kind of that refer out here a little bit. I would always recommend, I think, to a parent that if they feel that they need more information, I would definitely recommend reaching out to trying to get your pediatrician to refer you to a neuro psych especially in neuroscience, not a psychologist but definitely a neuro psych. Debbie Lund Definitely neuro psych i think is the best neuro behavioral if you can get somebody that's it. That's I think those I've had the best success in terms of comprehensive assessments and like, explaining to parents what's going on, and them having an understanding of what's going on. I think, neuropsychologist know behavioral sort of an end to end. I've had a lot of great, say, Good psychologists, as well. But I think you want to have a comprehensive evaluation. Jayson Davies I don't think I think you kind of mentioned the pediatrician, they might just do a little subjective type of questionnaire. And yeah, I mean, great. You have a diagnosis, but what have you really learned from that subjective question? Debbie Lund Right. Exactly, totally. And there's a lot to learn. Jayson Davies Oh, yeah, absolutely. And I know a lot of parents do a great job at trying to figure out what to learn through going to trainings that maybe we might go to, and parents are doing it because their child has a diagnosis. Which brings us actually to the next question, we just did a great review of ADHD and sensory processing. But we use a lot of jargon, we were talking about epinephrine and door and dopamine in parts of the brain, when you're sitting in an IEP or you're maybe it's not an IEP, maybe it's a private student. How do you go about explaining the difference between ADHD and sensory processing? Or I know, sometimes we're not comparing sometimes we're explaining it separately. But how do you explain that to a parent in a way that they understand? Debbie Lund So I def, if I'm trying to explain the differences between the two, I definitely do talk about parts of that the differences that there's processing happening in different parts of the brain, and therefore we need different treatments and different type of therapies or interventions to support performance, right, and optimize brain growth and function. So I will talk a little bit about parts of the brain if I think they're interested. You know, it really depends on the parent and you have to feel your parents out in terms of what kind of information they need. So I will talk about brain differences with some parents, I often, but I think the biggest piece is that children who have Sensory Processing Disorder need sensory experiences and sensory interventions in order to support their attention. Whereas children who just have attention deficit hyperactivity disorder won't necessarily benefit from sensory experiences to support their attention because of these different areas of the brain that it's happening in. So it's important for us to know, you know, do a good assessment and understand what's going on so that we can give the right interventions and children with ADHD, you know, that there's, they're prescribed medication, and a lot of kids have had a lot of success with medication where that's not indicated for kids with sensory processing disorder unless it's calm, calm, or more morbid. So Gotcha, yeah, it's hard. It is, and I think as long as we stay Debbie Lund it's not too late like it. And it's hard to explain, like how you would explain it to them, because it is very different for each parent, I think you have to be client centered in terms of who you're talking to, like, if a if a, if a child's parent is a doctor, you know, you're gonna come in and deliver a different message than maybe if this is their first experience and ever having the conversation about development or, you know, neuroanatomy or, you know, whatever. Jayson Davies Yeah. And then the same way also, depending on how their child is presenting to, I mean, making a specific to the way that their child was presenting. Yeah. All right, so you actually started to talk a little bit about the assessment process in there. And so I want to jump into that that evaluation process what how do you kind of go through assuming, let's almost use an example, if you get a child who someone says, Hey, they're having difficulty with attention, they may be seeking out some sensory stimuli? Where do you go from there? What's your brain start to? Where does your brain start to take you as far as what you're going to evaluate? Debbie Lund Well, I, I am generally what I generally do in my product, like what the company is, I've created a lot of questionnaires and screening tools that go over various areas of development, so I can hone in and I can better focus my lens for assessment, you know, so I get that feedback back. And I identify by by that, whether I see that there are sensory that this is definitely within the area of sensory processing in that area of development and, and whether or not I feel that they need to see me for a story if they if I should refer out to say good for us, depending on the symptoms, and how the teachers fill up those questionnaires. Okay, so that's where I start is trying to figure out what the first point of access should be. Because I have that Liberty because I'm in private school. So I'm, I'm working with the schools closely and they've been various, some of my schools have been in very, very awesome about calling me to do the screening, first as an OT, and I'm the first point of access for these kiddos. And then we discussed, you know, what we're going to talk to the parents about next. So that's really quite lovely. So that's, that's, that's where we start. And then if there are sensory symptoms associated or if there's behaviors that the teacher is observing, that look like they're rooted in, in sensory or reflective of seeking or avoiding or sensory based motor, etc, then I'll go in, and there's a few assessments, you know, that that we can choose from. So there's the sensory processing measure, which is, there's one for home and it's one from school, that's really great to give you information in terms of you're looking for a significant result for scoring. It will it breaks down the various senses and social participation in motor planning, etc. It's a great tool. There's also the sensory profile, which is when he does, she does, she has a great, great tool that helps a lot with identifying modulation and regulation. And that then I assess reflexes primitive reflexes, because that's all within that same area of the brain. And it gives me an idea of the processing is actually happening in those sensory upper brainstem areas. Jayson Davies Yeah, and if I can interrupt I am. So I don't know how to say this. I have not taken any trainings on primitive reflexes. I know very, very tiny. I know very little about it. I actually had a guest on way back in episode like 32, maybe way back when about it. And I've never actually got more into it. But I'm hearing so much about primitive reflexes and sensory being very combined the kind of like what you were just saying, so do you have any resources or any classes that you actually might recommend for primitive reflexes? Debbie Lund There's quite a few courses. It depends on how comprehensive you want to. But you know, what I can do is I can put some together for you and you can put them in the comments of this section. Based on because the thing I think the thing that's heartbreaking for me for us as OTs is that it's so it's it can be so expensive. Yeah, especially for new grads and whatnot. For us to Get the education that's needed in or like talk about in accessibility, right? So it's trying to find these courses that give you what you need considering your role in the school or what you're doing in the community or what your ambitions are for a career that are affordable for you. So there's there's a variety of different courses. There's one that's very comprehensive. There's another one through therapies who is the woman I just spoke about, which is excellent thing that I like about her courses as well is that she breaks them up into modules. So the first module you'll take, I think it's like $200, or two to $300 or something. And it's just on sensory modulation, then the next one's on regulation, then the next one's on and you can take them in pieces like that digesting information larva, but she also has a primitive reflexes that specific to clot to to school. Oh, interesting. All right. As well, Jayson Davies alright, I cut you off here. But what other assessment tools do you use as well? Debbie Lund So those are like I do my sensory profiles, my sensory processing, measure primitive reflexes, and then we're moving up into movement, right? So we're talking, I get beyond getting a sensory based motor and trying to get some more data to support that there's a motor issue happening. So then I start looking at using tools like movement, ABC, or the bot. Do you use those ones? Jayson Davies Yeah, I mean, I'm very familiar with the BOT, I don't use the Berry as much, but that's because the psychologists tend to use it. And so instead, I might use the WRAVMA, or like the DTVP, or something, you never use the WRAVMA, it's very, it's very similar to the berry, you have your visual spatial component, then you have your visual motor component. And then the motor coordination is different. It has a peg test, but it doesn't have the the VMI has like where you stay in the lines, right, you have to basically trace the same line. Yeah, it doesn't have that one. Instead, it has a pegboard speed test, which I very rarely use. But I use the first two parts, kind of like the VMI I feel like no one uses the entirety VMI they just use like to subtests Debbie Lund depends on what your your, your motivation Debbie Lund is right necessity, and everybody has their way. So that is so those those and then like some ocular motor assessments. So those are n generally for ocular motor, what I do, although I've taken a lot of great courses for like, astronaut training, and you know, like, I love integrated listening. So like I've done a lot of different things that includes a hand or visual motor integration, and ocular motor skills and tracking that incorporate that multi sensory piece, I generally do a screen and then talk to the family about seeing a developmental Optometrit or opthamologist just Yeah, because I just adopts and I want to make sure that there isn't something else going on eye health wise, etc. So I'm very, very aware of my area of competency. And I generally screen out, I generally refer out or give the families and power the families with the choice to do that, with the information that I collected. If I if I find that there's an ocular motor concern there. Jayson Davies Yeah, I do something similar. I often use just like a tennis ball and play some different games with the tennis ball to look at ocular motor skills a little bit, whether it be well and I know the bot has some tennis ball stuff built into it. If you go that far enough into the I can't remember which sub tests It is one of those sub tests but yeah, I think, yeah, playing catch dribbling, and throwing a ball at a target. So that'll give you a little bit but I go a little bit further than just having like toss the ball to themselves a little bit and just trying to focus on those eyes while they're playing with a ball game. Alright, so that's some sensory process or testing that you might do with sensory processing do anything differently if you might think more the ADHD side. Debbie Lund So I ADHD I generally So generally, if I'm screening in the relationship that I have, like, if there's nothing going on from a sensory motor and ocular motor, I start thinking multidisciplinary team family wants to find out what's going on. It's more rooted in psycho emotional or maybe anxiety or those executive functions. But I say, you know, your first stop should be a neuro psychologist and she sends you back to me or we decide we have functional behaviors to happen, then come back to me and we'll work on it, but, you know, start there and come back. So I agree, but yeah, okay, good. Jayson Davies I just think I think it's important. Debbie Lund I don't know. Everybody has a different practice, right? Yeah. No, I Jayson Davies think it's important You know, I almost I am a big believer and that I think we need to have a psycho educational evaluation to really have a good OT evaluation at least upon in the schools. I think we really should have that learning testing that's going on and some of those other tests that are going on. Debbie Lund Yeah. Yeah. I don't think one discipline should be responsible for like I do a lot of that within my company. But that's different than a school based like a I'm, you know, it's different than like a public school system where there Yes, cycad is a very, very important, but so is OT I think, especially in terms of the the younger ones, like when they're really little, a lot of developmental pieces that are so important, go missed, because we aren't there first, or we our perspective isn't considered right off the get go. Do you know what I'm saying? Where? So I played with a lot of models where I like I was mentioning earlier, we do the screening, we go in and decide who we're going to refer out to, once we've done those fundamental developmental neurodevelopmental type of screens, you know? Jayson Davies Absolutely. Debbie Lund Yeah, totally. I think cycad is so important. So is speech, so is PT, you know what I mean? Like, it all has such a massive role in the kid, and the kids development and their their progress and intervention. So once the child has been referred to psychology, or if I'm doing a screen, sometimes I'll do an assessment called the test of information processing skills. I don't know if you've heard about it, it's not very common, but it actually tests the child's short term, like their sensory memory, their working memory, and then their delayed recall for both visual and auditory. So you can see if there's a difficult time receiving processing and responding from those and whether there's differences in terms of their profit information processing skills with those two areas. Jayson Davies And what was the name of that one, again, Debbie Lund It's called the it's called the TIPS is the test of information processing skills. So it's really, I really like it in terms of coming up with in terms of like accessing new learning. And, you know, our kiddos who are struggling to fartlek working memory is huge for our kids in terms of access, and in terms of being successful and following instructions. And, you know, being able to execute any sort of multiple step. So I like to have that information, because it will show you if there's a statistical difference as well, which is really valuable. So which so if a child has stronger visual processing skills than auditory processing skills, that will be reflected in the assessment. And then you can then make recommendations in the classroom, for how the child's accommodations to be or support should be more visual or more auditory to meet their learning style. So I love that I like that test for that, that that type of information, and then maybe in terms of like, maybe the child has an auditory processing difficulty, or maybe the child needs to see a vision therapy, like, you know, somebody, an eye doctor, Jayson Davies yeah. Okay. So, I'm not going to, we're actually getting a little close to be toward the end of our time, which is perfectly fine. So we're going to skip ahead now just a little bit to some recommendations that you might provide to both a teacher and a parent, based upon your outcomes. We just don't have time to get into like solid treatment. But what are some recommendations that you would give to a parent and or a teacher, based upon maybe a will start with sensory processing disorder? What what recommendations might you give? Debbie Lund Okay, so I think that always for both of them, I always start with how important how much research search there is everywhere and evidence to support this everywhere. Sleep, nutrition, exercise, for doesn't matter if you have ADHD, if you have sensory processing disorder, the effect of a lack of sleep poor nutrition or not enough exercise on brain growth and neuroplasticity is everywhere, nobody can deny that. So, you know, even if it's your sensory processing system that's affecting your sleep, nutrition, you know, or if it's your, you know, executive functions, difficulties biorhythms whatever it is. Start there, get those, the quarter nailed down. That is such an important foundation for any future change. So I definitely recommend that those are the first first steps. All right, Jayson Davies I just sorry. In my in my mind I just came up with you know how people come up with those like words to remember things. Yeah pneumonic devices is that what theray are called? pneumonic? I just thought of Super Nintendo, it's often or NES is what they call and so I'm going to use any as as nutrition, exercise, sleep any Yes. Yes. nutrition, exercise and sleep. That's the core. Debbie Lund Yeah, it's so important, those are so important. And then you know, if it's sensory based, you know, trying to get educated yourself as a parent or as a teacher, and what that looks like what the child's specific profile looks like, whether they're over responsive, under responsive whether they have, so that you can then teach them and empower them with the education about themselves that they need in order to self regulate, and access and advocate for themselves and access activities or environments that support brain growth and success, you know, so get getting educated and learning as much as you can by working with a professional that specializes. So whether that be like psych or whether that be OT I think for OT you know, we do a lot of interventions, with alerting activities, calming activities, organizing activities, we use different tools and different strategies to support moving through those areas. So Jayson Davies sorry, I just thought of a question I wanted to ask before we went too much further. And that was, do you know of any great resources for parents that when you say, Hey, I think your student might have a sensory processing disorder, I think that your student might be over under react under reacting to sensory stimuli? Do you have any particular resources that you might share with that parent? Whether it be a book, a website? Debbie Lund Yes. So the first I Love Lucy Jane Miller's book, sensational kids, okay, Jayson Davies transitional kids. For anyone who's obviously this isn't a visual, but Deb is right now reaching back to find her. Debbie Lund Sensational kids hope and help for children with sensory processing disorder. That's awesome. That's a great book. It's very, it's very informative. And then the out of sync child is another I can give you a list as well, if you want to attach them to. Jayson Davies Yeah, absolutely. Debbie Lund And then there's a few great websites that I also recommend for information that I can send. Jayson Davies Yes, just send it to me. Yeah. And when for anyone that I mean, Debbie Lund share it with no problem. Jayson Davies Yeah, I'll put it up on the on the show notes, which should be well, it'd be OTschoolhouse.com/podcast forward slash podcast and find the episode number for this episode. And you will be able to get all of the links and great stuff that we're talking about today. Great. So we'll go ahead and do that. Debbie Lund I'm putting that together. Jayson Davies Alright. And then where were we Oh, yeah, recommend recommendations for parents and or teachers, I think you have a few more things I don't know. Debbie Lund So I always I think that in terms of teachers to like appreciating the magnitude of a sensory diet, or incorporating movement breaks or sensory breaks to give those kids that input they need. And like teaching, teaching parents and children undertake teaching parents about children, or therapists, teachers about children. In terms, I think what I think sometimes teachers and parents don't realize that it's an accumulation of experiences or a lack thereof throughout the day. So the idea of a sensory diet is that, you know, if a child is over responsive, we'll say if we're incorporating calming and organizing activities throughout the day, the chances of them experiencing overload becomes a lot less because we're helping them to organize and regulate the experiences that they're having. And when we provide, you know, supports, like sound dampening earphones, or we put the shields over the lights in the classrooms. So those one of those terrible lines, fluorescent Jayson Davies fluorescent lights, yeah, Debbie Lund yeah. Debbie Lund When we put the blue shields over top of that, we're actually supporting dampening the intensity of that input or them so that they, they sustain a regulated state and if you were intense experiences throughout the day, and that's the same with a child who's under responsive who needs more so if you can incorporate movement and exercise and alerting activities for that child, you're better able to keep them in it and adjust rate level like an optimal performance level and not in a low state, or have them overseeing and hopping up into like an an overstimulated state. Gotcha. That's my takeaway for sensory processing. for ADHD. I think those those tools are more executive functions. So we're looking more at like, exercise is still key. But using a lot of techniques for regulation that are cognitive based and top down based. So we've got some great programs. So coming at OT like zones of regulation, a lot of kids have emotional regulation, difficulties that are rooted and an intertwined with sensory issues as well. So that's a great curriculum that has some awesome visuals for the classroom that helps kids to learn how to regulate their emotions and sensory systems. And a really big one, too, I think is and it's so simple is just like, taking abstract terms that they use, like be a good listener, and making them concrete. Do you know what I'm saying? Like I think it's a social thinking curriculum has Larry the Larry's listening tool, and it's a boy. And it's basically he teaches you through a poster and a whole book, there's, it's a part of the curriculum that like, what does it mean to be a good listener, a good listener listens with their eyes, they listen with their brain, because they're thinking about what the person is saying they listen. So taking those abstract things, making them very con create and putting visual reminders on the wall, are helpful for those kiddos who just need those, those ongoing reminders. And the visuals are supportive there for them throughout the day to remind them of those things. Yeah. Right. And then mindfulness and yoga and breathing. And there's a lot of strategies associated with regulations for that for kids. And then and then obviously, I don't recommend medication, not that I'm against medication, but that's far outside of my area of conflict. Like that's not what I do. Jayson Davies I have been in too many IEP meetings, and I'm the same way I don't, I might ask a parent, like what medication they're on. But that's specifically for my evaluation purposes, basically, right? Just so I have it documented. But I cringe when I hear a teacher or an ABA therapist or PT or anyone be like I, you know, maybe you should try. Debbie Lund That makes my stomach because that is so not within your realm of right. Yeah, I know that. Be very careful. Because another thing as well is like as a parent, you like what your teacher you're not in the classroom, right? You don't know what your child's doing from the time a little. So a teacher's recommendations to you and a teacher's perspective on how your kid is doing at school, and what is going to support them. Here is a lot of weight in a lot of cases. So you really have to be careful about what you're saying for sure. Definitely. Jayson Davies It's one thing to provide knowledge that there are options out there. It's another thing Debbie Lund to try to persuade someone, or in some cases, I've even like people like teachers, parents come to me saying that they they're at this point, they feel guilty because they haven't medicated their child because they're teachers. So Oh, Jayson Davies yeah. On top of them. Yeah. Debbie Lund Yes, on top of them that it would improve their life. And, you know, Jayson Davies yeah, Wrong. Wrong. Wrong. Wrong. Go get your get your doctorate degree if you want to do that. Yeah. Exactly. All right. Well, let's go ahead. And actually, I think we're, I think we've given out several strategies of what we can do. Let's go ahead and wrap this up. And as we do, I want to give you an opportunity to kind of share a little bit about where people can find more about you. And you've already shared so many resources. And we're gonna, again, like we mentioned earlier, put some of those in the show notes, but any other resource or recommended resources that you might have, where people can learn more about you, ADHD and sensory processing. Debbie Lund Okay, so so I'll give you a list to definitely of the resources that I talked about for sensory processing, and for ADHD. And we'll put those in the notes. I would like to share that I'm getting ready to launch a variety of courses for teachers to begin with. So for classrooms for teachers, and then later on for parents that are solution focused and action plan focus. So So in my career in working so much with teachers, their number one complaint is that we're not taught this in school. So we spend so much time at the door as an OT, struggling between what we can do with that five minutes with the T shirt. If you're like, do I take this moment to educate them? Or do I just give them the tool and hope they're going to implement it? Or? No, you don't know what they don't know. And you're like trying to get this information to them. And if you give them a handout, are they going to read it like, what this situation is? So I'm in terms of improving accessibility for kiddos, neurotypical neurodiverse, whatever, I am creating some some courses that are available, and they're going to go through those areas of development, sensory motor, and then executive functions. It's going to be based on what is it like we just talked about sensory, and then it's going to talk about red flags if there's something going wrong, and then it goes into some strategies and support. So I'm not expecting them to be therapists. But I'm offering education on why particular strategies and not strategies, but accommodations or how to strategies, yeah, strategies. So particular strategies or tools can actually be solutions, because we're using them with these particular kids. So if you're an OT, and you're really solution based, and you're looking for a variety of tools, and tricks, and strategies and tips associated, I will give you a discount code if you want to as an offer, because they're not designed for OTs, particularly, they're designed for teachers and parents. So there'll be a discount code available for you. But if it's something that you think your teachers or your schools might be interested in, please follow me share with your families share with anybody who you think it might support, I would appreciate it so much. I just think there's such a massive disconnect between our professions. And you know, as OTs, we're trying to do all of this with the children, and then the teachers are trying to do something, and we need to come together more to support each other and be on the same page with what we're doing. So and once that change is made, so much so much more can be done in terms of the system, you know, Jayson Davies yeah. And are you doing that through empowerment plans are to fish therapy. Debbie Lund So I'm doing that through, I'm doing it through to fish therapy. But empowerment plans is actually the tool. So for every course of the teacher takes they're actually going to fill out their action plan as they're taking it. So as they're learning empowerment plans is actually the name that I've given the plan that there so when they leave a course, they're going to know exactly what they're implementing in the classroom. So if we're talking about we're talking about sand dampening earphones, if we're talking about whatever the strategies are using auditory tracks, any technology they're going to, they're going to have it all listed out and ready to go what they're going to implement when they leave that classroom. So an empowerment plan is taking you from education to action. And that's that's what it is. But it's not going to be the company. It's more of a tool. Gotcha. That the courses. Jayson Davies Gotcha. And so they can learn more about that at to fish therapy calm. Yeah, that's Debbie Lund the fish therapy. Yeah. Jayson Davies Great. Well, thank you so much, Debbie Lund especially my social media outlets. So if you're interested follow to fish on Instagram or follow to fish at Facebook. Jayson Davies Sounds good. Awesome. Yeah, we'll have that listed on the note page is as well. So we'll get to that. All right. Great. Well, Deb, thank you so much for coming on. It's been a pleasure talking to you for the about an hour now. It's been really great. I appreciate it. And thank you so much for coming on. Debbie Lund No, thank you so much for having me. I really appreciate it. Jayson Davies Of course. You too. Yeah. Thank you for all the information on both ADHD and sensory processing. Thank you so much. Debbie Lund My pleasure. Thank you. Jayson Davies Alright, and that is going to wrap up our episode on ADHD and sensory processing disorder. Again, another huge thank you to Deb for coming on the show and sharing with us the difference between the two the similarities between the two, and then what she does based upon whether or not she's thinking sensory processing or ADHD. Again, thank you, whatever you are doing right now if you're driving at the gym, whatever it might be. Thank you so much for joining me today on the OT schoolhouse podcast. Until next time, take care. Bye. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to OTschoolhouse.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! 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OTSH 73: 10 Things You Can Do Now, To Make Next Year Easier
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for the Episode 73 of the OT School House Podcast. Today, we are going to talk about 10 things that you can do right now, at the end of this school year, to make NEXT school year a little bit easier. Some of these are going to be pretty straightforward and you may already be doing some of them. But some of these are going to be a little bit more reflective in nature. I'm going to ask you to go a step deeper with me and think about how you can make your next school year better by wrapping up this year in an organized manner. It's just you and I today, so let's jump in to it! Links to Show References: A-Z School-Based OT Course Back To School Conference - Aug. 27-29, 2021 Edjoin.org Episode Transcript Download or read a rough edit of this OT School House Podcast episode 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 Hello, and welcome to episode number 73 of the OTs school house podcast. My name is Jayson Davies and I have to get this episode started with one thing, it's gonna be May! Alright, it actually already is May, but I'm recording this in April. So it's not quite there yet. So the N'Sync - Justin Timberlake meme was just blaring in my head right now. So enjoy, that is the one time you're gonna hear me sing since like, I think I sing in like Episode Two or something like that, I think I Rapped. But anyways, it may not happen again for a while. Welcome to May, with may comes the end of the school year is coming soon, some of you are going to wrap up this school year, this month, right at the end of the month. Others will potentially go into June a little bit one week, two weeks at most, probably three weeks. And then you have extended school year, right. So we're going to talk about that, we're going to talk about 10 things that you can do right now, at the end of this school year to make next school year a little bit easier. Some of these are going to be pretty straightforward. And many of you are probably already doing many of these things already. But some of these are going to be a little bit more reflective in nature. And I'm going to ask you to kind of go a step deeper and thinking how we can make next year better. Alright, so again, real quick, we're gonna go over 10 different items that you can do right now, or at the end of this school year, to make life easier when we come back in August or September whenever your district comes back. Alright, so stay with me, let's go ahead and do this. It's just me and you today. So let's get started. Alright, so let's go ahead and get started with the first of 10 things that you can do right now in the month of May, maybe June to make your life easier when we come back in the fall. These are in no particular order, I'm just going to go through and list all 10. And we'll see how long we go for. All right. So here's the first one. When it comes to assessments, you want to try and get any assessment that had the assessment plan signed 30 days or more before the end of the school year, you want those assessment plans wrapped up, you want to have that assessment done, you want to have the report written. And I know it's not completely in your control. But if you can even have the IEP, that is even better assessment plans that may have been initiated within 30 days of the school year, you can potentially wait on those until the beginning of the next school year. By all means if you have time to get them done, get them done. Because we all know that the beginning of a school year is hectic with scheduling and whatnot. And so if you can get those assessments done, do so. But there is a little bit of a leeway at the beginning of the school year, you have about 60 days depending on what state you live in, in order to get those assessments done. So if you use 30 days, and you don't get it done at the end of the school year, you still have 30 days at the beginning of the next school year. Now, I know you might be wondering what about if the student goes to extended school year is that part of the 60 days, typically No, that is not considered part of the normal school years. That's extended school year. And so he is why days would not count in regards to the 60 days timeline that you have to complete an evaluation. In addition to getting all the assessments done that were initiated prior to the final month of the school year, you also want to make sure that you document all of the assessments that did come in potentially in the final month of the school year, those are going to be assessments that you need to get done or whoever is the OT at that student's new school or at that school, maybe you're no longer there, those IEPs those assessments are still going to get held within the first 30 days of school initiating back up. So be sure they're documented. And also be sure to document anything that you actually did toward that evaluation. Maybe you already sent out a questionnaire to the teacher, maybe you already sent something out to the parent, maybe you already had a conversation with the parent, be sure to document whatever is done. So whoever picks it up after you or even you at the beginning of the next school year has that information ready to go. Jayson Davies Alright, on to the second tip, and that is to ensure that every student has had an annual and a triennial meeting if needed. Now, I know this may not completely following you as an occupational therapist, you are not typically a case carrier for any of your own students. Typically it is the speech therapist and or the case carrier, the special education teacher that is the case carrier and in all fairness, technically, yes, it is their job to make sure that all the animals and triangles happen when they're supposed to happen. But we all know that life happens. They get busy and maybe something slipped their mind if any of you Students, and this only takes a minute to check, just go back and look at your students, if any of them haven't had an annual, be sure to send an email to the case carrier and say, Hey, you know what, remember Johnny? in your class, we never had a meeting for him this year. Or maybe we had a an amendment earlier in the school year, but we never actually had an annual let them know. Likewise, are there any triangles that you were expecting to come up and didn't happen? Again, let the teacher know, say, Hey, you know what we need to do an evaluation, it's due now. And, you know, maybe you don't get it in by the end of the school year, but at least you help them to remember, hey, we need to get this done right at the beginning of next school year, which kind of goes back to the first tip that we had, get those evaluations done that you can, why is this important that you help out with this? Well, you know, you just want to be a good team player and you want to help everyone else out, you want to do what is right by the kids, what is helpful for the teachers as well as for your administrator, you want to be there to support them. And you know, Ida as well as every state says the IEP must be done every year. And a triennial if the team decides to do full testing needs to happen every three years. So make sure that you're being a team player and helping everyone out, it only takes a quick minute to kind of go down your caseload and just in your mind, say, Yep, we had that annual Yep, we have that annual. And you might have to check your IEP system if it comes to a name that you're not sure about. But it doesn't take too long. And it can really help. If you have your own documentation system in place, you might already haven't marked whether or not the child had an IEP. So that makes it really easy. And it's very helpful for the teachers when you're able to provide them with the assistance that they might need. Alright, so the third item on my list of 10 things you can do right now to make next year easier comes to the treatment and treatment notes side of things. As you're wrapping up your final treatments, maybe the last two or three weeks, your your final one or two sessions with a kid, I want you to just to write a little bit longer of a note than your typical Daily Note, you can do it as part of your daily note, or maybe even do it as a separate note in your own private journal, where you have access to it. So when we come back in September, whatever it might be, you have a little extra, a little something that reminds you, Hey, this is what I did the last few sessions in May or June. And also this is what my plan is when we come back from break. So start off this note, maybe again, just the last one or two notes that you're going to do with the kid for for this school year. Start off the note with in May or June the student dot dot dot, what did you guys do in May or June, and then go into in August or September, OT needs to focus on this. This is just going to help your brain have a little kickstart come August to jump back in and to know alright, yes, with Johnny, we were working on visual spatial skills. And we wanted to work on now in the new school year up in the game a little bit making things a little bit more difficult. And maybe we're now working on integrating those visual spatial skills in with some other functional school activities such as copying from the board or cutting out more complex shapes. If you'd like you can also add some data in with that extra note or just be sure to note where the data is so that you can access it next year when the IEP comes around. Alright, I believe that brings us to number four now. And number four is to update your caseload or workload document, whatever you call it, and add any necessary notes about the students. So if you already have an Excel spreadsheet or a Google Sheets file for your entire caseload, go ahead and just make sure you have a column at the far right that has notes. And what you're going to go through is just look at each student and look at the grade level, maybe look at Jayson Davies the classroom that they're in and kind of anticipate what may happen. Any moves that could potentially happen over summer, and then add notes based on that. Johnny sixth grade. Oh, well, since he's in the sixth grade, he's probably going to be transitioning. I don't know where yet, but he's going to be transitioning. Jennifer, she's in the sixth grade as well. But in this note, I can add that I know she's going to such and such Middle School. Alright, such as such middle school that OT there is Jessica. I'm going to make sure that I need to send this file for I think I said Jennifer was the name I gave the good need to send Jennifer's file over to Jessica. Things like that will help you again, make September a little bit easier. Other things that you can also add there is just notes about maybe things the kid might have mentioned such as, Hey, Mr. Davies, I think I might be moving over the summer. Well, we may not be certain about that. But that is something that we can put in the notes. Just to keep in mind. Hey, when we get Back in September, I need to see if that little kid is still here. Or if he's gone, if he's gone, I need to make sure I send an email to special education to let them know, Hey, he's gone. Can you help me figure out where he went. So I can send the file to wherever he might be. Other notes that you might want to add, or any conversations that were important during IEPs, or with the teachers such as a, maybe john is getting pretty close to being exited from OT or special education services in a hole. So maybe in September, or maybe give it an extra month, and maybe October, let's look into asking for an evaluation to see if they still need services. Or maybe you know that the parent is going to want to have a meeting at the beginning of next year. Right that in there a note to sell, Jonathan's mom loves to have a meeting every August when we come back to school. So you know, it's going to be there, just mark it down. So you have that little reminder. All right, on to number five. Number five is a fun one, it's a little more engaging, and it has the potential to make a huge change in the way that you see students over the course of your lifetime as a school based occupational therapist. So if you haven't done this already, maybe you don't do any RTI right now, I just want you to reach out before the end of the school year to one teacher, maybe two, if you're feeling really ambitious, with just one teacher, the one that you work the most with the one that knows the most about OT that gets it the understands what you do with the kids and ask them, How can I support you next year? That's it, how can I support you next year, maybe you can make a lunch date out of it or something but sit down or shoot them an email and say, Hey, I just want a moment with you. I want to I want to have a chat with you. But I want to make sure that you're kind of, you know, ready to have a conversation. So maybe set up a time don't just do this over a casual meeting in the hallway, set aside some time to ask this teacher? How can I support you next year? What can I do to not just help one kid in your classroom, but what can I do to support you and your entire classroom next year, you'll be amazed where this might go, the doors that it will open, the opportunities for collaboration will just they'll just open. Like I don't know what else to say. But they will open opportunities will present themselves when you make an opportunity to support a teacher. Again, only start with one, maybe two if you're feeling really ambitious. But I always tell occupational therapists start small. Start with just one teacher, maybe you get to one in August. And maybe you get to a second teacher in December. And before you know it next school year and the 2022 school year, or whatever that might be when you're listening to this podcast. Who knows maybe you'll have four or five teachers by then. But you want to start small? How can you support one teacher next year to support their entire class? Who knows, you might find out that they really need help with their students handwriting, you might find out that another teacher or the same teacher really wants help with teaching their kids how to use text to speech or speech to text. Maybe they want to work on an emotional regulation program with you. Maybe they really want you to come in and provide sensory brakes a few times a week so that they can learn how to do them on their own. It's just amazing what can happen when you ask a teacher how you can support them. So if there's one thing you take away from this podcast, I know we're only on number five, there's still five more items I want to get to. But this is the one I want you to take away from this. Reach out to a teacher and ask them how can I support you in your classroom next year. That's it. I almost want to stop the podcast right now just and with that, but we'll keep going. Before we do though. I want to take a quick break. And I just want to say hey, you know what, if you are enjoying this podcast, if Jayson Davies you're enjoying what I'm saying we've gone over five things already. Go ahead, jump on Instagram real quick. Shoot me a fist bump, a high five something in a DM. And I'll be sure to get back to you. And so I know that you're listening, and I know you're enjoying all this content. All right. I want to do more solo episodes like this, but I want to hear that you guys are all enjoying it. All right. So send me a quick dm and yeah, let's go ahead and keep going. All right, number six, collect and document any materials you might have given out this past year. I've been doing this for a while I know things get lost. And they go from being the OT departments sit and move cushion to teacher A's move and sit cushion. I get it. They don't have a lot of funding. They are more than happy to accept anything that we're willing to give them. And sometimes we never get it back. So here's what you need to do. Create an Excel spreadsheet, Google Sheet, whatever you use your weapon of choice, I guess I could say and you're going to mark down a few different things. You're going to go into the classroom and you're going to grab the item you're going to mark down what is the item so give it a name you Might even give it a color so that you kind of know exactly what you want it is even you can mark it, get a sharpie and mark it item three C. And then you can write down on your spreadsheet, item three seat, whatever that is. Then add also, where did it come from? What classroom? Did item three c come from? What student or students? Did that item support this past year? And yes, it's totally okay for one item to support several students, maybe not in COVID time so much. But typically, yes, something can support more than one student, maybe there is a yoga ball in the classroom and several students throughout the day, use it to roll on it, it's important to mark this down. Because if maybe two of those students transition to middle school, but three of the students that used it are still in the elementary school. Well, now, we can't get that ball to just one or the other classroom, we may have to ask special education for support and providing a ball to both the elementary classroom as well as the middle school classroom, if it's still relevant. Also ask the teacher for any feedback on how it went and how it was used. What exactly were they using that yoga ball? or whatever it might be for? Were they rolling it over the kid? Are they having a kid roll over the over ball was the kid sitting on the yoga ball during work? When was each kid using it? All of that is important because again, when you go back to special education, and you say, hey, I need another yoga ball. They're gonna ask why? Why do you need another item? Well, you see, Johnny and Stacy moved on to middle school, while Don Carlo and I don't know, I'm blanking, I've used too many names today. We'll go with Amanda are still in elementary school. And look, they were both using it for this and this, but now they're in different classes. So it'd be really helpful if there is one in each classroom, because they both need it for different reasons. You may also want to add, was it too big or too small? Was it just right? I feel like I'm reading Goldilocks to you right now. We want to have the just right material in place. So we need to know this past year. Was it just right? Or do we need to alter it when we get that item back out at the beginning of next school year. I already mentioned to note down if a student's going to be moving, you might want to also note that down on your caseload sheet Hey, students move into middle school. By the way, item three C was for that student in the classroom. So just let whoever the OT is at the middle school or if it's still yourself. Just a little reminder, hey, an item may or may not be going or coming with that student. You also want to mark on your cheat sheet if we want to call it that where the item is stored. So mark down item three, see, this is what it is, this is who it's for. This is how it benefited them. This is what the teacher said about it. Oh, and by the way, it is stored in the closet by the door. because too many times things get moved, or they get lost. And we just don't know where they are. So at least if something gets moved, it's not your fault you put down where you put it, and maybe someone moved it over summer, well still have to track it down, potentially. But at least you know where it should have been and you haven't documented. Now I'm sure there's a lot of other information you could add to this form. But I don't want to make your life too complicated. Yes, we want to be ready for September. But we also don't want to be over exhausted from this year. So I recommend actually making a Google form and sending it out to the teachers, letting them fill out as much of the information as they can first. And then you go back in and add some of the specifics to occupational therapy, and such like where the item is stored. And maybe a few other parts that I said there. But if you prefer a pencil and paper go with it that way. If you like Google Forms, feel free to create a simple Google form that helps you out. Jayson Davies Alright, number seven here is very simple only takes a few moments to do but it actually can help you quite a bit. And that is scheduling. I don't expect you to create your schedule for next year. I don't even expect you to have any idea about your schedule for next year. But if you know anything about your schedule, let the teachers that you will be working with know just a little bit. This doesn't need to be anything specific. It might just be as simple as Hey, Mrs. so and so. Mondays worked great at this school. I plan to keep Mondays going next year, or Hey, Sunday's Sundays, what is the Sundays or Hey, Mondays don't work this year was really tricky for me. I felt Mondays were not great, because they're just too many holidays on Mondays and I need to see your kids consistently, whatever it might be. Let them know that way when someone else reaches out to them about Mondays next year. They already have in the back of their mind. You know, I'm not sure about Mondays, Mrs. Amanda Oh already claimed Mondays for OT, let me check in with her, before I get back to you on if switch therapy would be good for Mondays or not. Again, you don't need to let them know exactly what good you're going to see at what time or what day. But if you can give them a general idea, you'd be surprised at how well they do and kind of blocking off that time for you. If you don't know at all, that's okay, you can skip this. But if you do know, it's great that you can do it. Which kind of brings us now to our final three tasks that you can do now to make next year easier. These last three are more reflective, to make yourself better, and to potentially even consider where you should move on from here. Alright, so number eight. Number eight is to reflect on how you were able to handle your caseload this past year. How did you do with handling the fluctuation in kids from the beginning to the end of the school year? How did you deal with the fluctuation of evaluations? Did you note High Times and low times or fast times in slow times? Who knew I could get some rhyming in today. But take a good hard look at that evaluation list that you compiled up over the year, take a look at how many kids came in or left your schools. When referrals came in, when referrals didn't commit, did things pick up in January, or were they slow all the way up until May and then all of a sudden you got a bunch of referrals in May. Typically, I see an uptick right at the beginning of the school year. And then another uptick right after Christmas break or winter break. That's what I typically see. But that may be different at your school. So kind of track that a little bit. Also take a moment to do a little self evaluation of your skills. How did you feel as an effective or ineffective occupational therapist this year? Did you feel like you were able to get items met? Get goals met with your students? If so, why? What helped? What skills Did you have that really supported you in that? Or maybe for a part of your caseload? You didn't feel competent? You didn't feel like you have the skills? Or maybe you didn't feel like you have the time mark that down? What was it that prevented you from being the best occupational therapist that you could be and helping the most students that you'll get help? You can even take that a step further. And once you're done with this little reflection, go ahead and just do a quick Google search. How can I get better at sensory? How can I get better at promoting handwriting? How can I get better at RTI, just Google that and you're going to come up with tons of resources, your districts going to be more likely to support you in some sort of training, if you can kind of give them a reason why that training is going to be beneficial for you. If you can share with them and say, Hey, I felt really good going into 90% of my classrooms. But these 10% of kids that I see, it was a real struggle for me this year, because I just don't have the training and autism or whatever it might be that I really need to have in order to support those students. Likewise, if you're looking back at the year, and you look back at your calendar, and you realize, man, it was really tough getting through the month of February and March, because I had so many evaluations in January, well then share that with your OT team. share that with your administrator, share that with the people that actually can do something to help you out. It's one thing if you share your trouble with your administrators or your team, and nothing happens, it's a complete other thing. If you're having difficulty and you don't ask for help. People can only help us if they know we need help. And so I want to encourage you to go back, look at your calendar and see. Realistically, look, Jayson Davies did you survive that month? Did you get all the students in that you needed to get in for the month of January and February if those were your tough months? If not let people know. You know, maybe nothing happens this year. But maybe next year is also tough and you let them know at the end of next year. And then the year after that's also tough. And you'll have to know the year after that. Well, hopefully over time, it will start to get better because people are going to hear Hey, you know what, Jessica, she's a great OT. But every year she's asking for one thing, a little bit of help with her caseload. Well, maybe over time, they'll be willing to listen to you. All right. So go back, look at your calendar and see how things went. And along the lines with reflecting on your caseload. I also want to ask you to reflect on the difficult times that you had within IEPs themselves. Where did you get tripped up? Did you have a struggle with writing the IEP itself? Did you have a struggle with actually presenting your assessment results in your goals and your services within the IEP? Maybe it was more of questions that you were asked by a parent or a teacher and those just Were you off? What was it this year? That kind of caught you off guard? Was there a theme? Was it a bunch of small little things? What was it that got you tripped up? And then again, just like in step number eight, or Item Number eight, I guess I can call it. What can you do about that? Where can you look to make IEP s a little bit easier for you? Heck, maybe it was simply that you just weren't getting invited to the IEP is? Well think about that. dissect that break it down. What can you do to ensure that next year, your teachers Remember to invite you to the IEP is, what can you do to maybe get your IEP done a day earlier to have your goals, your services, everything into the IEP IEP system one day early? That way, maybe you're not getting emails from the case carrier to get it all in? Or what can you do about when you're at an IEP and you have everything just set? Right? And then someone asked you a question that just throws you off your game? Like why do you think it's sensory, not behavior? In the moment, I know that can be a really tricky situation to handle. Even if you are really good at understanding sensory, that can still be an in the moment difficult question to answer. So make a plan plan for that to happen next year. What can you do now, to make that question easier, come next year, attending the back to school conference, or the A to Z school based OT course, you can never go wrong with one of those options to make you a better school based OT. But there's so many other courses out there that you can look at as well, I just want you to get the training to help you in your career as a school based OT. Alright, and that brings us to our final item for this podcast today. And you know, this is a tough one to talk about. Because I know there's some of you out there that you felt like this year, just flat out sucked. I'm not gonna sugarcoat it, you just, it was hard. I mean, even without COVID going on, you might have really struggled this year through COVID. On top of that, and I know some of you don't even want to be a school based OT anymore. And you're listening to this podcast, because you want me to convince you to stay here. And yes, I want you to stay here. But I also want you to be in a school based OT job that supports you. So this might be the time if things are really that bad. This might be the time to start opening up your search to look elsewhere. So what does that mean? And where do you go? I would recommend starting by reaching out to friends that are occupational therapists, speech therapists teachers in other districts and asking them what it's like in their district. And do they know of any OT positions that might become available in the next few months? Right now in May and June. This is the time that schools are hiring for August and September. There are jobs out there, I know it can be few and in between in some parts of the country. But you have to go online and you have to find where educational type of jobs are posted. Out here in Southern California and most of California in general, we use a website called Ed join Ed join.org. And that's where you can find most educationally related jobs, teachers, OTs, etc. However, I know that's not always the case, you might have to go directly to the districts in your surrounding area, look on their website, they might have a tab specifically for careers check there, I have not really found some of the larger job boards to be very helpful. But you never know in your area, maybe that's the place to check. Also check in with your state board of occupational therapy or your state Occupational Therapy Association. Jayson Davies Sometimes they will have a job board that you can look up jobs in the area, I really do want all of you to stay within the school based OT career, I don't want you to leave school based OT we need you, you are a OT that has dedicated themselves to learning more about school based OT, and it will be a huge loss for me as well as your district. If you leave the fields, I really want you to stay here. And I really want you to find a job where you're going to be supported and feel like you belong there. So if that isn't the position you're in right now, it's okay to look elsewhere. I'm going to be very honest with you right now, that website I was just telling you about Ed join.org out here in California. That is like therapy for me, I go on that website, at least probably like once a week just to look what's out there just to see what school based OT jobs are out there. You know, it's nice just to know, hey, if something really popped up that just like shouted at me like, hey, I want to go there. Well, at least I know about it. I don't want to miss that opportunity. But if you don't at least know what's out there, then you're going to miss application and you're never going to know and you're going to be stuck in a job that maybe doesn't feel right for you. I really hope that you are at the perfect job right now that you Love it that you want to stay there forever. But I know that's not the case for everyone. So that is just another option. All right, well, that is the 10 items that I wanted to cover today to think about right now to make next year as well as all subsequent years a little bit easier on yourself as a school based OT. I hope you've learned a little bit from these 10 items. I hope it will make your life a little bit easier. But please, if I miss something, if I forgot something, let me know shoot me a DM on Instagram. Leave me a review down in the apple podcast app or use a simple email carrier pigeon probably won't work. But any other form that you had to get a hold of me. Let me know what I missed so that I can help more OTs share the knowledge that you have and how to make every year successful year. Thank you so much for tuning in to today's episode and cheers to a fantastic end of the 2021 school year and a blessing of a 2021 22 school year. Take care. Amazing Narrator Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to OTSchoolhouse.com Until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast
OTSH 72: Journal Club - How Much of School is Fine Motor, Anyways?
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for the Episode 72 of the OT School House Podcast. Today, we are focusing on the activities children participate in during education in 3 specific grade levels as we discuss a recent brief report published in the American Journal of OT. The report is titled Fine Motor Activities in Elementary School Children: A Replication Study and was published in January of 2020. Together, we are going to discus what percentage of the day students spend completing various fine and gross motor activities. Links to Show References: Sierra Caramia, Amanpreet Gill, Alisha Ohl, David Schelly; Fine Motor Activities in Elementary School Children: A Replication Study. Am J Occup Ther 2020;74(2):7402345010. View the original 1992 article by Cermak & McHale Transcript Download the Transcript or read the episode below! Jayson Davies 00:01 Good morning, everyone. Welcome to the OT School House podcast. This is episode number 72. Now I can't believe we're 72 episodes in, this is going to be one that really helps you understand the role of occupational therapy in the school. And to do that we're going to have a discussion about a recent journal article from the American Journal of OT, the article that we're going to be looking at is titled Fine Motor Activities in Elementary School Children, A Replication Study. This is actually as the name suggests a replication study from a study back in 1992, a long time ago. All right, so almost 30 years ago, that is, I think, when this study was actually done, it was around 2015, maybe 2017. They said 25 years had passed since that previous study. So we're gonna jump all in to that in just a moment. But first, let's cue the intro music. Amazing Narrator 00:54 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's your host, Jayson Davies, class is officially in session. Jayson Davies 01:11 Welcome back to the show. Again, I say this several times. But I just love that intro music. It gets me going. You know, I just realized a moment ago in the intro, I said, Good morning. But it's morning right now, and I'm recording this but I know for you this may be in the evening, maybe you're on your way home from work. I don't know what time it is. So I'm just gonna say this real quick. Good morning. Good afternoon, and good evening, because I don't know when you might be listening to this. But I am super glad you are here. really appreciative of you learning from this podcast and trying to improve yourself as an occupational therapist through the OT School House podcast. So let's go ahead and get started with our journal of discussion. Jayson Davies 01:50 As occupational therapists, we know that education is listed as one of the nine occupations categorized by AOTA in the OT practice framework, which of course is that like, Holy Grail document of the OT profession. And as a whole education consists of all the education that we as humans participate from our very first day of preschool, perhaps maybe even before and all the way through our adult life. So I mean, from pre K, all the way through to maybe, I don't know, I'm still learning about finances and stock trading or not trading any more and more investing long term investing, but we are always learning right now you're learning through this podcast. And so education is a huge part of our life. Today, we're focusing on the routines children participate during education in three specific grade levels. As we discuss a recent brief report published in the American Journal of Occupational Therapy. The report is titled fine motor activities in elementary school children a replication study, and was published in January of 2020. But like I think I said earlier, I believe the study was actually completed back in 2017. Jayson Davies 03:50 The first two authors Sierra, sorry, I'm going to try to say your name as best as I can see our Sierra Caramia and Amanpreet Gil were assisted by Alisha Ohl and David Schelly, I believe it is in observing and coding activities of students in grades kindergarten, second, and fourth grade. Jayson Davies 04:11 As I mentioned before, this was a replication study. So real quickly, I want to talk about the original study that was completed in 1992. By McHale and Cermak. that study was completed. Again, way back before technology was really a thing in public education. And in 1992, they observed second, fourth and sixth graders and found the students spend anywhere from 31 to 60% of the school day, engaging in fine motor activities with most of that time, being on paper and pencil tasks. Again, they didn't look at technology because in 1992 technology looked very different. I'm not sure even laptops were around yet in 1992. So everything was big, bulky, and definitely not a touchscreen. Likewise, new legislation has also been put in place Jayson Davies 05:00 It has changed general education and special education in general. In the past 30 years Ida has been renewed, and the No Child Left Behind Act, as well as other acts have increased the amount of testing required in public education. I'm sure you all have seen this more testing, less time actually spent on teaching students it seems like right. So whether you love or hate Common Core, it has to be known that it has changed education. For the time being, things are very different, whether you like that they teach one math skill set, how to multiply and 18 different ways, or whether you really dislike that they do that either way, you can't deny that common core has changed education today. Now, this study is not a true replication study. Like I said earlier, they changed the grades a little bit. And they also wanted to look a little bit more broad since education has changed. They looked at three different grade levels, kindergarten, second and fourth. But it did change. Remember, they had second, fourth and sixth grade in the original study. They also had a slightly more general research question, and that is, what are the motor and technology demands of elementary school, that was their overall goal. But they did kind of break it down a little bit more than that. They hypothesize that with an increased emphasis on testing, it was likely that the number of minutes spent on fine motor activities would decrease. They also imagined that technology may replace some of the time spent handwriting. So let's talk about the participants of this research study. The study included three elementary school classrooms with about 20 students per classroom, and a small college town in New York. The reason I mentioned that is because this is a small study, this cannot really be generalized for everyone. You know, again, demographics were very specific, a small town in New York, they didn't find elementary schools across the nation. It was just one school, and three classrooms. So it wasn't a very big study. The two principal authors on this study, I mentioned them earlier, they took terms of observing the three different classrooms and took detailed notes after some initial training, I'm not going to go into all the training, but they did actually train, how to take notes for the study. Before going into the classroom. They each observed the kindergarten class one day, and then one author observed the second grade classroom for two days. And the third author observed the sorry, not the third author, the second author observed the fourth grade classroom for two days. While in the classroom, the observers noted the time that each activity began as well as what time it ended. So they could keep track of how much time the students participated in that activity. If there were multiple activities going on, they notated both activities going on, or all three activities that were going on, because that's kind of what the study required. They would do this, for instance, maybe if there were centers going on. And one group of students were at one table doing math, and another group was at another table using the iPads or whatever that might be what they didn't really calculate. They might have noted it in their notes, but they weren't really trying to calculate were behavioral outbursts, or instances where maybe one student did something out of the norm. They're trying to look at the entire group as a whole, or as smaller groups per se. They didn't want to calculate time for a student who maybe got sent to the principal's office or maybe had to go use the restroom. They didn't mark that as a group activity, right? They're looking at the larger group. Alright, so now the best part, the part that everyone looks forward to hearing on this type of a podcast where we look at a journal, and that is the results. Jayson Davies 08:57 After coding all of the data that was taken all the notes that the two authors looked at, they came up with 10 activity categories that were developed, based upon the coding by all four of the authors, they all had to have consensus on each minute of the day, fitting into one of these 10 categories. They didn't go in with these 10 categories, these 10 categories were developed based upon the notes that they were taken. So, here is the 10 categories that they looked at. fine motor, non academic content, fine motor, academic content, academic no fine or gross motor involvement, non academic content, no fine motor or gross motor involvement. Alright, I know those repetitive the next few are not as repetitive computer or other technology used by students leisure or academic, unstructured, gross motor activity, structured gross motor activity, handwriting transition time and dining. I really actually liked that they looked at the transition time and the dining. I'm going to get into that Jayson Davies 10:00 Little bit more in a second. They also developed a fine motor and gross motor composite that included those 10 activities and kind of broke it down or put all the ones that belong to fine motor and the fine motor composite, and those that fit the gross motor activities into a gross motor composite. I'm not sure they explain that very well, in the article, actually, I was a little confused. But when I did the math that kind of add it all up. Sure enough, all the activities that kind of revolved around fine motor, including the computer and technology used by the students was put into the fine motor composite, they did describe well, that transition time, they actually split that time up 25% of the transition time went into the fine motor composite, while 75% of the transition time went to the gross motor composite. And that was again, based upon the notes that they took. They found that 25% of the time with the transition time students were doing fine motor tasks such as opening and closing their backpack, opening books, closing books, getting out papers or doing something that required fine motor use. The other 75% of the time might be walking from class to recess or from recess or lunch or whatever it might be. So again, 25% of transition went to fine motor 75% of transition time went to gross motor. So what did that fine motor and gross motor composite look like? Let's go ahead and start with the fine motor component. They found that kindergarten students spent about an average of 145 minutes a day, or 37% of their school day on fine motor activities. second graders spent 198 minutes, which is about 50% of their day on fine motor tasks. And fourth graders spent 20 sorry, not 20 235 minutes, or 60% of their day on fine motor activities. In comparison, the gross motor composite stayed relatively similar, while the fine motor composite grew, like I just said, from 37% in kindergarten up to 60%. in fourth grade, the gross motor composite remained between 25 and 28% of the day, so it didn't change a whole lot like the fine motor composite did. Now I know you all want to know how much of the day did students spend with handwriting tasks, you know, since that's what most of our referrals tend to be for? Well, they found that kindergarteners spend only 3.4% of their day on handwriting, that's only about 13 to 14 minutes, which I actually think that might make some of you kind of happy because I know you like to see kindergarteners doing things other than writing. So some of you may be a little happy about that some of you might be well that's it, but 13 to 14 minutes, that's it for kindergarteners, spending time on writing, second graders jumped up to about 17.8% of their day. And then fourth grade, just another small jump to only 18% of their day, which is about 75 minutes per day spent on handwriting in the fourth grade. Surprisingly, to both the researchers and myself. students spend on average about 20% of their day, just in transitions, transitions alone, they didn't note dining being a surprise to them. But to me, it was 10% of the day was spent on dining. So perhaps that's a little bit of breakfast, maybe an afternoon snack or recess time snack. And then of course lunch. You know, when you actually look at a school day, you sometimes forget about those periods outside of the academic time, you know, you forget about how much time is really spent in recess and how much time is spent in the cafeteria. And you know, that's important for us as OTs because we don't just look at education, we look at the independence within the entire educational environment. And that does absolutely include both recess and the cafeteria. The authors were also expecting the time spent with technology to be higher than it actually was. It came out to be below 5% for kindergarteners and second graders, and at just under 14% for fourth graders, the researchers actually thought that these numbers were quite low. They were expecting technology to be more incorporated based upon the studies that they had looked at previously before getting into the classroom that looked at how much technology was being used in the classrooms. So they were actually quite surprised that it was so low under 5% for the lower grade kids and at only 14% for those fourth graders. And as I mentioned earlier, that technology use was included within the fine motor composite because well I don't know about you, but I do see most technology use as being a fine motor activity, whether it's typing or drawing on an iPad with or without a stylist, that tends to be a fine motor activity. Jayson Davies 15:05 So one final comment in regards to the numbers. I know every OT is always interested about recess, we kind of have this whole kids need recess mentality, which is absolutely necessary for the students, right? Well, under the category of unstructured gross motor activity, kindergarteners were found to have 38 minutes of unstructured gross motor activity. second graders were found to have 13 minutes. And fourth graders were found to have 16 and a half minutes. So we see this pretty high number relatively high number and kindergarten, and then it goes down for second graders, and then it increases back up. For fourth graders, I found that a little interesting that it dips down so low for those second graders. But they didn't quite have a reason for this. But it was interesting just to see that fluctuation of high low, and then backups lately as students get older. Alright, so let's go ahead and talk about the author's hypothesis and their conclusions. The author's hypothesis that there would be less fine motor demands now than in the past back in 1992, that was actually found to be inaccurate, students are still engaging in a similar amount of fine motor activities throughout the school day as they did back in 1992. However, it does appear that less time is spent on paper and pencil fine motor activities. In 1992, it was reported that 85% of fine motor activities involve paper and pencil tasks. And the current study, however, showed that pencil and paper tasks range from a mirror. And I say mirror because this is in comparison to 85%, a mere 17.8 to 37.4% of the time, the author's attribute this to curricular changes over time, such as the implementation of Common Core State Standards, which really put an emphasis on group activities, and sometimes getting away from those more traditional paper and pencil tasks. Overall, the authors were slightly surprised by how much of the day children engage in fine motor activities, and not just the fine motor activities that we can think of like handwriting or using scissors, but also all the fine motor activities that go into transition time. And the time spent with dining, and even potentially some time spent with outside of the classroom with technology, and even potentially at recess or leisure time. Those are all fine motor aspects that sometimes aren't thought about in the school. Remember, we're not in the schools as occupational therapists, just to support what students do directly in the classroom for academic tasks, we're there to help them be independent in their entire educational environment. And that does include other areas. All right, I may have gotten a little bit ahead of myself and shared most of my takeaways already. But I do have one more, one more that I really want you to take away from this article. And that is that I'm surprised that all grade levels spend more time on fine motor manipulation tasks than they do on fine motor paper and pencil tasks. That means they're spending more time with zippers, and manipulating their food, and manipulating items for counting, or maybe using scissors or glue. Other activities that are not pencil and paper, maybe they're also spending more time typing with a keyboard or using an iPad. I know the author's showed that that number was relatively low compared to what they thought it might be. But other studies are potentially showing that it is higher than what they saw in this study. All of those activities that they spend one to maybe five to 10 minutes a day on, they all add up. And so kids, you know, they spend two minutes a day using the zipper, they spend 10 minutes a day using a computer, they spend five minutes a day opening and manipulating maybe their lunch pail. But that all adds up to so much more time than what they actually do spend on paper and pencil activities. Jayson Davies 19:11 So I guess what I'm trying to convey is that if you're going to go share this article with a teacher or program specialist and administrator, or maybe even another occupational therapist, really the key point is that there is more to school than just handwriting, there is so much more that OTs can do to support students outside of that traditional. This is how we write our letters, thinking of OT that I think used to be so prevalent. We are moving on from that there's so much we can do have a really good evaluation that shows those other areas where the strengths and where the weaknesses are. So that you can say in that IEP, Hey, you know what, yes, handwriting might be an area of concern, but there's other areas of concern. And that's what a strong evaluation does for us. Jayson Davies 20:00 Now, I wasn't planning to plug this in here. But since I just kind of mentioned it, if you are having some struggles with your evaluations and conveying your assessment results at an IEP, I definitely recommend looking into the A-Z School-Based OT Course, which you can find at OTschoolhouse.com/a2z That's my course where I dive into basically nine different modules about how to be a school based OT and we absolutely do cover evaluations and conveying your results at an IEP. So go ahead and check that out if that would be of interest to you. Jayson Davies 20:36 Alright, and with that said, thank you so much for listening to the OT School House podcast. Please remember, if you haven't already, subscribe or follow this podcast so you don't miss any future episodes. We have a great guest coming on next week to talk a little bit about ADHD and sensory processing. You won't want to miss that one. So be sure to subscribe or follow. With that. Take care. Have a great week, and we'll see you next time on the podcast. Amazing Narrator 21:03 Thank you for listening to the OT School House podcast. For more ways to help you and your students succeed right now. Head on over to OTschoolhouse.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast
OTSH 71: The Eighth Sense - Interoception with Dr. Kelly Mahler, OTD, OTR/L
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for the Episode 71 of the OT School House Podcast. In today's episode, we have Dr. Kelly Mahler on to introduce us to Interoception. Very few people have ever heard of interception and even less know what it means. This may even be the first time you hearing the word interoception. Well, whether it is or is not, you're going to want to listen to this episode. Dr. Mahler is a true genius when it comes to interoception and she has so much to share with us today. Press play to learn how you can assess your client and understand whether or not they have difficulties with interoception. Links to Show References: Kelly-Mahler.com Episode Transcript Download or read a rough edit of this OT School House Podcast episode Jayson Davies 00:00 Alright, let's see if I can do this. interoception, interoception interoception. That actually wasn't too bad, better than when I practiced it. Anyways, today we are talking about interoception and we have Dr. Kelly Mahler on to talk about it. Very few people have ever heard of interoception and of course, even less know what it means. I can only imagine what they might think when they first hear the word. And maybe this is your first time hearing the word interoception. Well, whether it is or isn't, maybe you've heard it several times, you're gonna want to stick around for this episode. Dr. Mahler is a true genius when it comes to interoception. And she has so much to share with us today, like little tidbits on how you might even be able to look at your kid and understand whether or not they have an interoception difficulty. Alright, so stick around, put your phone in your pocket, it's time to enjoy the OT school house podcast. We'll be right back after the intro. Amazing Narrator 00:53 Hello and welcome to the OT schoolhouse 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 01:10 Hello, hello and welcome back to this episode of the OT school house podcast where we are doing a deep dive into interoception with Dr. Kelly Mahler. We're going to get into this pretty quickly I'm going to go ahead and introduce Dr. Kelly Mahler and then we will go ahead and get started. So I am excited for this. I hope you are as well. Dr. Mahler has served kids and adults as an occupational therapist for 18 years. She is the winner of multiple awards, including the 2020 American Occupational Therapy Association, AOTA emerging and innovative practice award and a mom's choice gold medal. She is an adjunct faculty member in the Department of OT at Elizabethtown College in Pennsylvania, and is actively involved in several research projects pertaining to topics such as interoception, self regulation, trauma and autism. Kelly is an international speaker and the author of eight different resources for interoception and kids with autism. So we are very fortunate to have her without any further ado, here is Dr. Kelly Mahler. Jayson Davies 02:12 Hey, Kelly, welcome to the OT school health podcast. How are you doing today? Dr. Kelly Mahler 02:16 I'm doing good, Jayson. Thanks. How are you? Jayson Davies 02:19 I'm doing fantastic. I am loving it here in Southern California. We have some springtime weather and it is just amazing. Remind me again. Where are you located? Dr. Kelly Mahler 02:28 I am in Hershey, Pennsylvania. And so I'm very jealous that you're having spring already have snow on our ground. Although I think it's like 40 degrees today. So hey. Jayson Davies 02:40 Nice. So I mean, you're in Hershey, Pennsylvania, obviously that is known for being like the birthplace of Hershey, right? Dr. Kelly Mahler 02:47 Yeah, that's right, like so on good days. You can smell chocolate in the air. And our streetlights are in the shapes of Hershey Kisses. Like, it's like the sweetest little place on earth to live. Jayson Davies 03:01 That's awesome. And have you been like a lifelong Hershey Pennsylvania resident? Or how's that work? Dr. Kelly Mahler 03:07 So I grew up in the next town over. It's called Elizabeth town, Pennsylvania. So my whole family still lives there. And so we're very close to help with lots of babysitting and you know, being a big part of my family's life. But we're also a little bit closer to like the Hershey Park amusement park and lots of good restaurants and stuff like that. Jayson Davies 03:28 Well, I had no idea there was an amusement park. Dr. Kelly Mahler 03:31 Oh, yes. My daughter's think that every small town has or has an amusement park, which is obviously not true. Very handy to have it in our back yard. Jayson Davies 03:42 That's awesome. Yeah, I missed when we used to have like community fairs in my old town. And now like, it doesn't happen anymore. You know, that little Carnival just never. They don't do it anymore, miss those. But all right. Well, I am so glad to have you here. As you know, I actually recently attended a training that you did, actually, last week, it was a two day six hour training or so. And it was great. So much practical information for school based OTs. But unfortunately, I know not everyone has the opportunity to hear you speak to that manner. And so I'm just excited to have you here today. So how did you become? What's your background in the OT world? And how'd you get where you are now? Dr. Kelly Mahler 04:18 Yeah, so I always knew that I wanted to work in pedes. Um, and when I got out of school, I graduated OT school in 2002. So I'm in my 19th year in the biz. And I didn't get a pedes job right away. It took me a few months, but I finally landed my first job and it just happened to be in school based OT. So I've been that's been the biggest part of my job ever since as being a school based OT. And I really love it. I've worked in so many different niches like I've been in like I've been the like primary OT for a whole school district. I've also worked in Pennsylvania, we have intermediate units, and so those are like staffing for a variety of different special education classrooms out there. So I've been in IU classrooms. And then I've also which came in super handy six years ago, I started contracting with a cyber school. And so I was hired originally to provide OT school based OT services to the cyber school students that were not benefiting from telehealth the telehealth model. So I got to go into their homes and provide OT in their educational setting, which was their health, which was such a different experience for me as a school based OT because I didn't have such interaction with families. So you know, we have a little bit, but like, I was immersed in a family culture, and it was so exciting. And then as I got to know these students, sometimes we did a hybrid model where we were doing work in the home. And but then I was also doing supplementing with a telehealth model. So I got my feet wet with telehealth before all of this COVID. So I just have always been really passionate about working with school aged children. I've done preschool school age, and I do have some young adult clients now as well. Oh, wow. Jayson Davies 06:07 Yeah, you know, that's interesting. I mean, so many things that you said, I have questions I could go on just on that alone. But the last thing you said is having some young adult clients, and I've been getting a lot of questions. One is about interoception. And another one is, what do I do with, you know, those in between students, the transition periods, students, the high schoolers and the young adults? What do I do with them. And so I think that's a growing area for OT. Obviously, that's not exactly what we're here to talk about today. But I think it's going to be a huge emerging area for Occupational Therapy. Dr. Kelly Mahler 06:39 I agree with you. And I think sometimes as a pediatric OT, it can be really intimidating to start working with adults, because you feel like maybe you don't have the skill set. But when we're talking about especially like the clients, I'm serving their neurodivergent clients, and honestly, it's this, they need the same things that I do with my school based clients, it's just done in a slightly more mature way. And working with those adult clients helps me to better understand my younger clients that don't have the insights yet, like so it has been like such a blessing to my career. Jayson Davies 07:15 That's awesome. Great. I love that idea that you were actually able to see the kids that maybe telehealth wasn't working for. Because as I'm kind of looking toward telehealth, obviously, we've all been doing telehealth the last year, and you know that there's some kids that just don't benefit from telehealth as they would from in person. And so that's cool that you were able to find a program where they understood that and then worked with you to actually go into the house to to provide that service, that must have been really a really great opportunity. Dr. Kelly Mahler 07:42 Great opportunity. Yeah. eye opening for me what families really go through on a day to day basis. Jayson Davies 07:49 Nice. Alright, so we are here today to talk about interoception. And I think the first question I should ask is, what is it because I know not everyone has been well just, I guess heard this term even. So what is interoception? Dr. Kelly Mahler 08:05 So interoception is our eighth sense. So it's just like all of our other senses where we have like, for example, our sense of vision, each sense, we know has a set of receptors and you know, this is OTs, right so your sense of vision, your receptors are your eyeballs pulling in information about all they see it outside of your body. So interoception works exactly the same way as all the other senses has a set of receptors pulling in sensory information. This time the information is being pulled from the inside of your body. So intro receptors are working. You have these receptors, first of all located extensively throughout your body. So you have them in all of your major organs. So you have interceptors in your heart and your lungs and your stomach and your bladder, your colon, your skin, your muscles, you have like very extensively almost everywhere. And these interceptors are pulling in information about how all of these different body parts are feeling like what is the condition of these body parts. So I usually give the example of your stomach like so you have interceptors the lining of your stomach pulling in information about how your stomach is feeling so is your stomach like does it feel gassy? Does it feel nauseous? Does it feel cool? Does it feel empty? You have like that tingly butterfly feeling in your stomach. And so just like all of the other senses, these interceptors pulling in all of this information travels up pathways in our spinal cord in an area of your of our brain called the insula. So what we know is the insula uses these incoming interoception messages as clues to your emotions. So if you go back to the receptors in the lining of your stomach, maybe your stomach like feels crassly or empty then your insula can use that as a clue that you feel hungry. Or if your receptors your interceptors in the lining of your stomach. Get That like, picks up that you have that little little butterfly or tingling feeling that maybe your insula uses that as a clue that you are anxious or nervous. So interoception is the sense that gives us information about how our bodies are feeling. And it provides this very tight body emotion connection. Jayson Davies 10:21 Gotcha. And I'm going to ask you about that body emotion connection just a little bit. But I want to ask is the insula, it's been like 12 years since I took an anatomy physio class, is that this same part of the brain where all the all the senses kind of go through or is that more specific to this interoception? Dr. Kelly Mahler 10:40 It tends to be more specific to interoception, and it is nicknamed the interoception center of the brain. However, like I think we have so much to learn. But I know that smell activates the insula, which kind of makes sense. I think all of our senses change the way our body feels. So like when you're listening to a certain song, it changes though it can change the way your body feels. So all of our senses are interconnected. And interoception is not something that's separate. I also was just reading some research that the certain vestibular input activates your insula. But in traditional like neuroscience literature, the insula is really known as the primarily is processing interoceptive information. Jayson Davies 11:26 Wow. Okay, so know that insula, perfect. You mentioned research a little bit, where are we at in terms of research for interoception? Dr. Kelly Mahler 11:36 Great question. We are in the infancy stage, like newborn J. Two, if you compare it to all of the other senses, and interestingly, there's a guy named Sir Charles Sherrington. And he defined interoception, back in the early 1900s, he wrote this paper, and he defined two senses. He wrote about something called proprioception, and something called interoception. Read he won a Nobel Peace Prize for his work. Yeah, everyone's like, oh, sir. Charles Sherrington, your idea on proprioception is so brilliant, right, and proprioception took off. And everyone's like, your work on interoception is so strange, we're just gonna ignore it. Over 100 years later, it was largely ignored until a brilliant neuroscientist named not named Dr. Boyd Craig. Key started studying interoception in his lab, and he was really able to give a lot of definition to the system and put a lot of research behind it. And then all of a sudden, people realize, like, holy cow, like this is a really important sense. And it does exist. And so since 2002, research has begun to emerge, and it is just exploding right now. Like the interoception. field is on fire, in neuroscience. In OT, it's getting there. I mean, there are new studies coming out almost daily. Jayson Davies 13:10 Gotcha. And actually, the reason I asked you that, partially because you mentioned it, but also I wanted to know, are there any norms established at all for interoception? Dr. Kelly Mahler 13:18 Yeah, not yet. So we know very little on the development of the interoceptive sense, we know that it's present from birth. Like if you think about like, most infants, from day one, they are equipped to notice discomfort in their body, right. And they, they're noticing that discomfort because of their interoceptive sense. So they noticed discomfort, their urge to cry, and then that is when the caregiver hopefully steps in and tends to their needs. And so from day one, we know that interoception was present. We don't know like what that developmental trajectory should look like in typical norms yet, do we need that information? It would be very helpful. But yeah, like I said, we have a lot, a lot to learn about interoception, especially from a practical application standpoint, and that's like where I want us. I mean, I'm biased, but I want us to step in and start figuring all this out, because we are the experts of performance and function and development. Jayson Davies 14:24 I have a question, but then you said something. So I have a different question. And that is, you want OT to be in the forefront of interoception. Well, who right now is in the forefront of interoception and what are they doing that we might not be doing? Dr. Kelly Mahler 14:38 Well, right now, the people on the forefront of interoception are neuroscientists, some medical practitioners and they're really trying to understand interoception from like a brain-based level or you know, neurology level. And like I said, very little work is being done on the practical application. By like, so how does interoception truly impact a whole wide variety of functional areas. And so that is where I see us as OTs to come in, take this really rich body of neuroscience, and help it to become more practical in a way that nurtures our students abilities to flourish and thrive. Jayson Davies 15:28 Yeah, definitely. That's great. Obviously, as OTs, we really have that plaque, that practical application in the real world, so that'd be great. The other thing that I was I was thinking, as you were talking last time, was that you're talking earlier about his stomach, and you know, whether or not you're hungry, whether or not you're sick, you need to use the restroom, whatever that might be. But in terms of when a baby is hungry, sick, whatever, they cry, they don't give us a different type of cry, necessarily, maybe your mom and you can, you can determine the different cry, right, but they just cry doesn't matter what their stomach feels, they just cry. So that kind of leads me to my next question, which is, you mentioned two very different terms. And those terms were implicit and explicit interoception. I think that kind of talks about that a little bit. Dr. Kelly Mahler 16:19 Yeah. So the interoception system has two main arms or categories or whatever you want to call them two main pieces. And so the first is what you said, implicit interoception. And that side of this sense is happening beneath our level of consciousness. It is all of the things that are happening in our body, that are helping to regulate our body to helping to strive for homeostasis, like that's it here, there's a word from blasphemer pass. So interoception is our sense of homeostasis. And so our interoceptive system, it notices when there's a certain change in the tissues in our body, and it activates a series of responses in order to help that homeostasis process happen. So these are things that we're not ever really thinking about, like, we don't wake up in the morning, and we're like, wow, like my livers releasing a lot of enzymes today, like it's happening, right. But then we also have the other side of interoception that you mentioned, and that's the explicit side, and that is the side of interoception, that reaches our level of consciousness. So like, we noticed when our body feels cold, and that's what urges us to regulate, like, maybe we put a blanket on or a jacket, or we go inside, or maybe we notice like a growling stomach. And that's what urges us to want to regulate to eat to help restore that comfort with our body. So there's two different arms of interoception always at work, always striving for that state of regulation. Jayson Davies 17:58 Gotcha. And so again, I already asked you about norms, you know, we know that even babies have that sensation of something's going on, but they aren't able to kind of put a, I don't know, maybe a brainwave to what that actually means. And then you have that ability to actually put something to it, you use the term, I believe it was called interoceptive. Awareness is that kind of when you link the implicit and explicit together Dr. Kelly Mahler 18:21 interoceptive awareness is typically referring to the explicit size so that the process that reaches our level of consciousness and interoceptive awareness involves our ability to notice a body signal. So we noticed the growling stomach, but then we also have to be able to connect that feeling or that body signal to the emotion like we know that when our stomach growls, it means I'm hungry, or when my heart races, it means I'm anxious. So being able to notice the body signal and then give it meaning is what interoceptive awareness can be defined as. Jayson Davies 18:58 Gotcha, perfect. So you have spent a lot of time in the schools. And I'm sure you've experienced great opportunities in school. I'm, I'm also assuming that you probably have experienced some pushback in the schools. When it comes to interoception. And the schools, how do those really tie together? Dr. Kelly Mahler 19:17 Well, there's a lot there's many, many different ways. So I think I should talk about probably the number one way and interoception has such an influence on so called challenging behavior. Yeah, so I prefer to call it regulation, but it's, um, I know that it's still and that's the pushback that I get still to this day, and 19 years and and challenging certain behavioral approaches. But if you are not understanding the way your body feels, when you're not understanding your emotions, you are not equipped to regulate those feelings and emotions independently. And what does that look like? It looks like major dysregulation all referred to by others I don't understand referred to as challenging behavior. Jayson Davies 20:06 Gotcha. So behavior is one way, does it also impact actual functional output of handwriting using scissors, other occupations on the playground and stuff like that? Dr. Kelly Mahler 20:16 Yeah, so intersection has been linked to a wide variety of aspects of our life. So it has been linked to body awareness and motor imitation, and all different kinds of self care, like sleep and dressing. And I mean, so many different I could just spend like probably the next hour listening, of course, that intersection has been found to influence in some way. It even influences social participation and our ability to understand how other people are thinking and feeling. I mean, it's so vast the influence that we're just now starting to understand how big of a deal interoception is, for a lot of our students. Jayson Davies 20:59 Gotcha. And when you started to introduce the idea of interoception into your school, I mean, I can just imagine you sitting on an in an IEP and just bringing up this, how many syllables and just interoception, like six syllables, and people just looking at you like, what the heck are you talking about? How did that go when you started to introduce it into your school? Dr. Kelly Mahler 21:21 Well, my schools already knew me as having very wild idea. I was challenging the norm. But I know and like, if you ever created this word into inception, it's not very sexy, like, I wish it were. And I was like, ooh, tell me more. But it's not right. Once you start to, like, really explain to people what interoception means, and you relate it to their own life and their own experience, like, so if you're like asking them tell me how you know, when you it's time for you to eat, or how do you know when you know, you need to go to the bathroom, or whatever it is, it's always comes back to, it's based on the way my body heals. And our bodies are designed to feel uncomfortable like that discomfort is important, because that serves as our urge to act and our urge to regulate. And so if that urge is missing for our clients, or it's confusing for our clients, or students, then it that that's where the dysregulation the breakdown comes from. Jayson Davies 22:23 Gotcha. So I'm just still trying to think of like how you got into with this school. And so when you're in the school, you're in the IEP. Now you've mentioned interoception, you say you want to work on this. Now, kind of where do you go from there with a student? Once that student? Yeah, you say I have some some concerns with this? Where do you go from there? Dr. Kelly Mahler 22:45 Well, I also try to tell and explain to the school how incorporating interoception would be a benefit of them to them. So whether it How is it going to benefit the classroom teacher? Well, if we're really actually addressing the deeper reasons behind why the student is having a hard time regulating or whatever it is in the class, then we can help them to see the benefits of what it is we're recommending. So I always try to bring it to and directly speak to whoever the stakeholders are in the room, like the administrator, how is it going to benefit the administrator like, you know, all the different players in the room and try to speak to, you know, their buy in. And then once they start to see that I still have to work hard at getting certain schools on board. And sometimes I just need to, you know, the proof is in the intervention and seeing the amazing gains that the students can make, then helps the school get on board. And I'm sure like, I mean, I'm probably no different. Like, I always pick that one teacher that loves OT so much. And I'm like, Hey, I'm gonna pick a student in your room, and we're gonna do this together. And then they start, like, create the buzz for you, right? Jayson Davies 23:53 Finally. That's one of the things I teach in my course. Yeah, exactly what you just said, One, know, your stakeholders who you're talking to know what their goals are, because they're the people that have the decision making power. You know, as OTs, we don't have a lot of decision making power, we need help from above. And then the other thing Yep, start with one teacher. Just start with one. If you can get one on board, you'll be amazed by what can come with that. So Dr. Kelly Mahler 24:18 yes, absolutely. And honestly, there's so many caregivers and people starting to learn about interoception like the schools have to get on board because especially if they're living in a if you're in a district that has a high degree of legal issues happening and due process and all that kind of stuff like you have to you have to know about this, because those savvy parents and caregivers are becoming educated and are starting to ask and push with us in schools. Jayson Davies 24:48 Yeah. So I'm going to ask you what I think it might be a little bit of a tough question and I think people out there would like to hear your answer. What about because I know OT the field can sometimes be split on a few ideas. What about the OT that says, you know, what? Does interoception really belong in schools? And you've already given some great examples as to why but what do you say to someone who's maybe a little skeptical about it, whether it's an OT, maybe a teacher, but obviously the audience here is OTs. Dr. Kelly Mahler 25:18 Why? Well, I would encourage you to think about how interoception is either impacting or supporting your student's ability to participate in the school. And we do know, like we mentioned that interoception in the research has found to influence so many aspects of participation. And so if your student is having a breakdown in participation, it is our job as the OT in the school, to think about all of the different whys and all of the different factors that are limiting that participation. And interoception is not always the main piece, it's just a small piece that we're missing. And when we incorporate it in enhances all of the amazing things that we already have in place. Jayson Davies 26:01 Absolutely. I knew you'd have a good answer for that. Great. All right, on to the next question. And that is, what concerns are red flags, perhaps should OTs look for during their file review and the evaluation that may lead you to think hey, I need to look more into this student's interoception? Dr. Kelly Mahler 26:19 Yeah, I mean, number one, that whole aspect of regulation piece, so like, if they're really struggling to manage their anxiety or frustration, or boredom, I definitely would, that sets off a curiosity in my brain, like, I need to look at their underlying interoception. If you're putting regulation supports in place, like you're using a specific curriculum, and they're memorizing the curriculum, or they're memorizing your coping strategies, and they cannot use them in the moment, that is a huge red flag to me. Like, they have to know, notice how they're feeling in the moment in order to realize, Oh, it's time for me to use the coping strategy that might have taught me or Oh, that's like, where I'm at in this, like, whatever, on my my five point scale, like, so if they're memorizing the things you're teaching, and but they're not using them in the moment, I would be suspect of that. But then there's a whole other variety of participation factors you can look at such as like, are they having accidents in the school like toileting accidents? Or are they like, are they the student that is either sprinting down the hallway last minute, because they're like, Oh, my gosh, I have to pee, you know, it's an emergency, or are they the student that is seeking out the bathroom all the time? Because they're confused about the way their body feels? Also, like looking at their feeding habits, their drinking? their sleep? So many different factors? For sure. Jayson Davies 27:40 Yeah, and I think you're right on as well. What side of sensory integration? Or how does sensory integration sensory processing play in with interoception? Dr. Kelly Mahler 27:51 That's an area we don't know a lot about yet. We know that interoception is the eighth sense. So it is not something that's working all on its own. And it you know, works alongside of all of our other senses to help us navigate the school or the day our daily routines. But exactly what that looks like. Jayson Davies 28:11 No, sure. Yeah. Yeah. because like you said earlier, you know, we have our five regular senses that everyone knows, and those do come from external stimuli. But similar to interoception, proprioception and vestibular, obviously, as OTs we know, come from more that internal stimuli are muscle stretching, and the whatever canal inside of our ears, that's not an external stimuli. And interoception is obviously in a similar so I would kind of think that those three specifically would be tied a little bit more closely together. Dr. Kelly Mahler 28:42 Yeah, I would agree with you, for sure. I can't wait to see what we learn and then next. Jayson Davies 28:48 And you're going to be right at the forefront of it. So all right, I want to continue on a little bit. You just talked about, you know, some red flags, self-regulation, being some concerns, behavior, being some concerns, being able to even just like putting types of issues as concerns. Where can therapist go from there? Alright, the teacher came to them, they have these concerns, or you're seeing these concerns, in your observations? Are there evaluations available? Dr. Kelly Mahler 29:13 Good question. And as you know, for my course, like this is a big dilemma. And the intersection feels like no one can agree on the best way to assess interoception. I do have an assessment tool called the Comprehensive Assessment of interoceptive awareness. And I'm going to be the first to admit that it is nowhere near perfect. It was just I created it for myself as a school-based OT because I needed a formal structured way to assess this new thing we were talking about and to justify why I wanted to include it in the supports that I was providing. It's not standardized, but it is really this assessment tool is so enlightening. When you administer it, you get such amazing qualitative feedback from either this Didn't themselves or sometimes we give it to like a school staff person, like someone that knows the present well to try to get as much information about their, their interoceptive experience, and it can be quite enlightening and give us insight that we might not have considered before. Jayson Davies 30:17 Gotcha. And is that part of your manual online? Dr. Kelly Mahler 30:20 Um, yeah, and do the assessment is available through a different publishing company, it's autism, Asperger's publishing company, and it's available through their website and through the current publisher. Jayson Davies 30:33 Alright, and I always put together show notes. And so I will be sure for everyone listening out there that I will find the link to it. And I'll put on the show notes if you want to find where you can get that. Alright, so we do the evaluation, we have this type of tool, aside from that actual evaluation, kind of what do you do just when you're working with a kid and you just have that little concern? Maybe you call it a screening? Or they're just some questions that you like to ask the kid or like the parents? Are there specific questions that you tend to lean toward? Dr. Kelly Mahler 31:02 Um, well, some of the questions from the interviewer that's a part of the assessment tool, I could give you some of your listeners now. And it's like, they're kind of fun questions to play around with. But like, I would just start asking the student, I mean, these are for the students that I'm supporting that have like the cognitive and communication abilities to answer some interview questions, I would just start by asking, like, tell me about like, like, what does your body feel like when you're hungry? or What does your body feel like when you're sleepy? And then I would start moving into like, some aspect of emotions, like, tell me about what your body feels like when you're excited? And then what does your body feel like when you're anxious? Or whatever emotion words would be a match for their age? and just see, like, are they like in touch? Like, Are they aware of any internal signals? Are they able to connect to those internal signals to the meaning? What is their inner experience? Like, I promise you that you will hear sometimes some very surprising insights, and things that will probably shift your ability to understand the student a little bit better, and then provide more targeted support for that learner? Jayson Davies 32:08 Yeah, and you mentioned, sorry, go ahead. Dr. Kelly Mahler 32:11 If they like, if I'm asking you those questions station, you're like, I have no idea. Like, I don't know how my body feels like, then you're like, oh, okay, like, it's too far forward thinking of me to be giving you coping skills, and regulation strategies to seek out on your own or a help card or a brake car, like you don't notice those need that feeling that need in your body, like, I need to rewind a little bit and help you to understand your body better, before you're ready to and equipped to use those strategies that I might have been doing a little bit too far ahead. Jayson Davies 32:46 Yeah, that's perfect. I was just gonna ask you to kind of elaborate on that just a little bit. Because I agree, you know, sometimes we jump two steps ahead, and we have to back up. And so for that kid, I know, this isn't the training to go six hours, I do not have you for that long. Nor do I wish for any podcast the last six hours long, I'm not Joe Rogan. But I would love to just kind of maybe hear one thing that you might do with a kid who is having that difficulty putting, I'm hungry with an upset stomach, or that feeling of an upset stomach. Dr. Kelly Mahler 33:21 So we always start like we're trying to build what we call body emotion, action connections. And it that is in line with the way that neuroscience currently says that self regulation develops. So the body peace comes from being aware of our body signals. So being aware of tight hands or hot skin or racing heart or growling stomach, and then we begin over time to learn what those what those sensations or body signals mean, like. So when my fists are tight, that's a clue for me that I feel frustrated or when my stomach growls, that's a clue for me that I feel hungry. So we start at the body level first. And we just want to help our students start noticing body signals within different parts of their body. And we do so we have tried to chunk this down and make it as easy as possible because it can be very overwhelming for many learners and students to start to notice and understand body signals. So we start with one body part at a time. And so like, sometimes we start with hands and we notice all the different ways your hands can feel. And we do it during like a lot of like fun and playful activities, helping them to notice the way their hands are feeling, understanding those body signals, and then we move on to a different body part. So over time, we're slowly building to their ability to check in and notice their entire body and understand their entire body. And you know, from the course like we are always emphasizing like there are no right or wrong interoception experiences, which is what I kind of like about this work because we're not coming in telling someone that they need to fix something like they're not doing any thing wrong. And I feel like sometimes we give that accidental message and some of the supports that we use in the schools. And so what we're trying to do with this work is to just help our students to discover self discover their own inner experience, or validating their own experience every step of the way. Because what your body feels like when you're hungry is different than what my body feels like when I'm hungry. Like what your what your hands feeling when you're squeezing a stressful is definitely what my hands are feeling when I'm using a stress ball. So we're honoring and validating each person's unique experience. And we're just trying to help our students to understand their own experience. Jayson Davies 35:40 Absolutely. That's awesome. So I have a question. And it comes straight from all the listeners and followers of the OT schoolhouse podcast. They always want to know, how do you incorporate it into a goal? How do you make an IEP goal? You know, as a school based therapist, IEP goals are like, that is the thing, you have to have an IEP goal, because then you can't have services without an IEP goal. So how do you incorporate interoception into an IEP goal? Dr. Kelly Mahler 36:06 So whenever a district is willing, I am always advocating for not having an interoception specific goal, I want to look at interoception as one of the supports that we're using to help to foster growth towards a participation based goal, a function based goal, like I don't personally, like really care if a student improves their interoceptive awareness. Like I want to know what was the like, the functional gain from that, right? Like if you just develop your ability to notice your heart rate, and nothing else, like what's the meaning of that, like you like if that helps you to become more aware of when you when you grow anxious, and you're starting to then seek out a coping skill on your own, and then you're able to stay in class longer, or participate in math class, or whatever it is, then that is amazing. So I try to never ever write interoception based goals, and help schools to see that this is just a support that we're providing your students in order for them to meet their function and participation based goals. Now, that being said, I have had some pushback from a few districts and I have agreed reluctantly to write it an interoception based goal that I like, I'll do whatever I need to help my students get the support they need. But that's not ideal. Jayson Davies 37:31 Yeah, I understand. We all want to try and make collaborative type of goals and participation, you know, in the classroom types of goals, and to make a goal where you know, maybe Little Johnny will be able to identify that he needs to use the restroom or something like that would be a very interesting goal on an IEP, then in that case, you're trying to collaborate with the teachers and have the teachers create this goal. Where do you then? Because I'm kind of in the field, you know, if you don't document it, it never happened. Are you writing then a treatment plan? And in that treatment plan, you're kind of writing how you're going to work on interoception? Does it go into the notes of the IEP? Does it go somewhere on the IEP? Or how do you do that? Dr. Kelly Mahler 38:12 Well, it really depends on your situation. Sometimes I put them in the SDI, like if I know like I want a student to have access to a body check chart, like that's just a strategy that we have, then I will put like something like that in SDI. But like I won't put them usually in a specific goal. Okay, you Jayson Davies 38:32 said SDI just elaborate on that because terms go crazy when you move from district to district, county to county state to state? Dr. Kelly Mahler 38:39 Yeah. Okay. So in Pennsylvania SDI stands for specially designed instruction. And it's like a list of things that we have in the IEP that once they get in that list, and the school is legally mandated to provide it. They're like if I put access to body check chart in the SDI is and that's something that feasibly should be happening. And we do have to, like, even specify the duration. So I could say, like, one time a day, or a five times a week, or whatever it is. And then hopefully, and I don't try to be like as highly specific law, but I'll say access to a variety of interoception supports, and then I'll put in parentheses, for example, the bar chart, or you know, whatever it is that we're recommending, and then we'll put the duration and that's like, a wish list kind of duration. That's supposed to be happening. But, and I do try to write those it definitely with support and collaboration of the classroom teacher. Jayson Davies 39:37 Yeah, and for anyone listening, every single IEP has that section. It just is called something different. It might be called your accommodations section or your instructional strategy section. But yeah, you can add accommodations or whatever it might be into that area. And that's a great example of what you might put in there. Alright, so we're going to wrap this up pretty shortly but this entire talk you have been mentioning your work and where interoception might be headed in five to 10 years. So with that, I have to ask, what are you working on? Or what are who are you working on with what? Oh, my, Dr. Kelly Mahler 40:13 okay, well, I have a lot of intervention based research going right now we want to make sure that I have the the interoception curriculum, which is our like framework for building interoception. And I use that all the time in the schools. But we want to make sure that what we're telling people and recommending to people is evidence based, and that we can come to the table, especially as OTs, we are notoriously bad. I putting evidence behind our interventions. And I do not want to continue that streak. So we are working so hard we are in year five, we have amazing outcomes through all of the work. So that's a big passion project right there of me doing all of that research with colleagues. And yeah, that's what I think the one of the biggest things, we're always working on new intersection resources to help people practicing in a variety of places. And we have new online courses that we're always trying to kind of push the bounds on new topics. Yeah. So we're just having a lot of fun with everything. Jayson Davies 41:16 Awesome. And so with that, then where Can everyone go to find out more about you? I know you have some free resources available. So where can people find those? Dr. Kelly Mahler 41:24 Yeah, so we have so many free resources on my website, it's at tele dash mahler.com. So my last name is spelled Mahler. So it's Kelly-Mahler.com, which I'm sure you'll put in the show notes. Jayson Davies 41:38 Absolutely. Yep. Of course, wouldn't miss it. Great Dr. Kelly Mahler 41:42 There's tons of free videos, printables. blog posts, you name it. It's there free resources. Jayson Davies 41:49 Yeah. And for anyone listening, if you ever have the chance to go see Kelly, whether it be live on zoom, be sure to take that opportunity. We spent, I don't know how many people were on that about 300 or so. Yeah, yeah. And so it was fantastic. We were on zoom. But if you eventually can see her live, I'm sure that'll be coming up here hopefully soon. Be sure to take advantage of it. Because you can use interoception not just you don't have to be the interoception occupational therapist. And I think some people get a little bit like, Oh, my gosh, I have to use whatever I just learned. And I'm actually gonna let you speak to this in a second is how important is it not to just use interoception? in your practice? Dr. Kelly Mahler 42:36 Yeah, it is only a small piece of what it is we do as OTs. It's a it's a really big missing piece right now. But it but it is a small piece of what it is we do. Jayson Davies 42:46 Yes. And so Kelly has so much on interoception, but she also has so much of good occupational therapy knowledge just in general. So be sure to go check her out. And with that, I want to ask you, do you have any other information that you want to share or anything like that, that I don't know, just anything for that therapists that might be looking into interoception Dr. Kelly Mahler 43:06 Yeah, I don't know, just I would just start with the free stuff and learn a little bit more about interoception. Think about how it could be impacting the students that you serve. And it has completely shifted my ability to support my students, especially the dysregulated ones in a more meaningful way. And it really falls in line with what we believe in as OT is because it's a process of validating another person's experience. It's not us coming in and telling someone what their experience should be like and how to act, quote, unquote, more typical, like it's really honoring who they are as a person. And that's what I think I love most about science. Jayson Davies 43:42 Great. Well, thank you so much for joining us today and I look forward to keeping in touch to see where you go with interoception. That'll be great. Dr. Kelly Mahler 43:49 Thanks, Jayson for having me. Jayson Davies 43:51 Definitely take care. Alright, and that wraps up this episode of the OT school house podcast. I really do hope you enjoyed that conversation with Dr. Mahler. She is just so knowledgeable when it comes to interoception and so many other areas. Be sure to check out the show notes for this episode, as well as her website Kelly-Mahler.com. To learn more about her and check out the resources she has, some are free, some are paid, but they are all wonderful. With that take care and have a great rest of your day. See you next time. Bye. Amazing Narrator 44:26 Thank you for listening to the OT schoolhouse podcast. For more ways to help you and your students succeed right now. Head on over to OTschoolhouse.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast
OTSH 70: Insights from a SBOT Trained Outside of America Feat. Ushma Sampat, MS, OTR/L, CAS
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for the Episode 70 of the OT School House Podcast. Whether you trained in the USA, Greece, India, or anywhere else in the world to be an OT, this episode with Ushma Sampat is sure to teach you several valuable lessons on understanding cultural differences, systematic biases, and how to be a better school-based OT! Ushma is a now a private practice owner in the Bay Area of California where she see clients in their natural setting, including kids in school. But to get to this point, she had to learn so much. This is not an episode to skip! Links to Show References: WorldofOT.com Ushma on Instagram World of OT on Facebook Episode Transcript Download or read a rough edit of this OT School House Podcast episode Amazing Narrator 00:01 Hello and welcome to the OT schoolhouse 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 00:18 Hey there, welcome to the OT school health podcast. My name is Jayson Davies and I am a school based occupational therapist in Southern California. I am so excited to be here with you today. I am actually really excited today for two reasons. First and foremost, you are about to hear a wonderful conversation between myself and Ushma Sampat, who is a private practice owner up in the Bay Area of California. However, she was a school based occupational therapist for five years, and she has so much to share with us today. This is honestly been one of the best conversations I've had in a long time, so you will not want to miss this. The second reason that I am excited is much shorter. And that is just because summer is coming and I love summer. I completely feel like Olaf right now the snowman. So anyways, we're gonna keep this intro pretty short. We're gonna dive right into it. Please, please listen all the way through. This is an amazing episode. Put your phone in your pocket. You don't need it. Just press play. Let it go. Here is Ushma Sampat. Good morning, Ushma! Welcome to the OT schoolhouse podcast. How are you doing today? Ushma Sampat 01:27 I'm well, thank you for having me here. I'm excited. Jayson Davies 01:30 Thank you. Yeah, I'm excited to have you here as well. I mean, we both have a course for school based occupational therapists. So I'm excited for for everyone, all the school based OTS out there to get to know you a little bit further. So that's gonna be fun. Ushma Sampat 01:44 Thank you. Jayson Davies 01:45 Well, we have several topics that we would like to get into today. But first, I want to start off by asking you about your current practice, you own a private practice up in the Bay Area in California, right? Ushma Sampat 01:56 Yeah, World of OT serves children and the whole world. So we serve families, schools and other professionals. And we do so through direct services, concepts, and an online course, as you mentioned, for fellow OTS who are new to the school system. Jayson Davies 02:12 And so how do you work in the schools through the world of OT? Ushma Sampat 02:16 So I work with kids in in variety of ways. So firstly, because I provide services in the child's natural environment, I'm seeing some of my private kiddos in the school. I also provide console services to early headstart and Head Start preschool programs. But that's another way I'm connected with the education system. Jayson Davies 02:38 I thought I actually thought that you contracted with the school directly, but you're actually seeing private kids in the school. Is that did I hear that? Right? Ushma Sampat 02:47 Yeah, that's one. And then the other is also contracted by a private school, in the school system. Jayson Davies 02:54 Gotcha. I actually want to dive into that, then a little bit is how that works. When you have a client that is a private client, but you're asked to go into the school or work with them in the school. What does that look like? Ushma Sampat 03:06 Yeah, so it's, so when I have private kiddos that attend private schools, I work with them, just like I would with any child that I was seeing in the public system. I would, they don't have an IEP for me to go off. But I'm there because the parents primarily have concerns related to school functioning. And so what I'm doing is doing a combination of push in call out collaboration with the teachers, and kind of the whole round of things that the child might need in the school. Jayson Davies 03:43 So So how does that work? As far as the school side of it? Does the school welcome you in with open arms? Or is this a private school or public school? How does that work? Ushma Sampat 03:53 Yeah, so it's because it's a private school, it's worth kind of the teachers are glad to have me as a resource, and they're happy, you know, there's one additional brain to support them. But in private school, it does look, I mean, in public schools, it will look different. So they don't allow you to be a private practitioner come in to a public school and provide services. So with some of the families that I work with, when they are attending public schools, what I would do is collaborate with the team collaborate with the teachers as an external OT, but not really providing services for the child in there. Gotcha. So Jayson Davies 04:32 now, I want to I want to continue on this because this is very interesting to me. When you go into the private school, you're going on campus, are you going into the into the kids actual classroom? Are they pulling out the kid for you to work with them in another room? Or what does that look like? Ushma Sampat 04:48 It's both so you know, there are times when my sessions are actually pushing in. So obviously things are very different. Oh yeah, recording in the COVID world. And for right now, I'm not see any of my private kiddos in their schools. But I still do provide services to a private school where I go in person, because I'm the only OT providing services for all the kiddos at that private school that's contracted me, going back to what the services would look like for my private kiddo in the school, typically, I will push in, I'll see what the teacher is doing, you know, and get a better idea. It's more like an observation and some amount of time to observe, see work samples, touch base with the teacher, probably pull the child out, depending on what I have planned and what my goal is for the session, I might push in or pull out the child in a separate space, it might be in the playground, it might be in a separate room, it might be in the library, it might be anywhere in the school, where I could really, you know, work very much like how we do it in public schools. And then the reason I've liked the approach, even if I had to pull the child out of their classroom, but provide services in the school is because I get so many more touch points with the teachers and able to collaborate with the team where if I was only providing services in the child's home, or their natural environment, which was somewhere else, but the pain points were really coming from the school, I would be missing a whole world out there. Jayson Davies 06:18 Yeah, absolutely. For these kids, do you typically also see them at home? Or is it kind of a one or the other? Ushma Sampat 06:25 It's a combination, it is, you know, I will go so wonderful teachers provide services, wherever the child needs that I will go, you know, it could be a piano class, it could be a gymnastic class, it could be in the home, it could be in the school, it's in a local park, it will really be anywhere that I could support the team. I could support the parents and I could support the child. Jayson Davies 06:50 I really love that, like, so often I drive past like a karate studio, or like you're talking to a gymnasium or something. I just like think to myself, What if I could go to the owner of that gym and be like, Hey, I'm an occupational therapist, how can I support you? So I love that you're doing that? Ushma Sampat 07:08 Yeah, I've literally I have a music studio next door. And I've actually walked in and I said, Hey, I'm an OT. And they're like, what is that? So first, when is that I was able to educate somebody about what an OT is, and how I could be a resource, whether it was me or somebody else. But then even understanding they actually had a child that had a missing finger, and was trying to play multiple missing fingers and was learning to play the piano or something. And they said, this is perfect. We need you. And so it was just me going out there being like, How can I be of support to the community. And there was actually a need and was was just amazing. Jayson Davies 07:46 That is awesome. So I'm going to put you on the spot here just a little bit, not too much. But where is the most interesting place you have gone to treat a child or or anyone? Ushma Sampat 07:58 I want to say the gymnastics class. gymnastics. Yeah, because it was so fun to just see them out of motor planning. Obviously, the gymnastics coach, like they know everything about gymnastics, but they haven't really figured out the child's difference of learning. And they've not figured that the child's not doing it. Because of the motor learning challenges, or coordination challenges. You're expecting something but the child hasn't, doesn't have the capability of mastering at this moment. And we need to take a step back. Just being able to make them see from that different lens was just so powerful and rewarding for them. And for me, Jayson Davies 08:36 that is awesome that the last like five minutes of this podcast, we had no idea we were going to talk about that today. But I love it. Thank you so much for sharing that. Ushma Sampat 08:44 Absolutely. Jayson Davies 08:45 So let's go ahead and actually move on our first topic kind of comes out of what you and I were talking about as we were kind of planning. And you shared with me some of the inherent difficulties that you had to overcome as a therapist trained outside of the United States. And that's where I want to go. Now, let's start with a little bit about your training as an OT outside of the states, though, so then we can transition back in here. Where did that take place? Where were you trained as an occupational therapist initially? Ushma Sampat 09:13 Yeah. So I was born and I grew up in Bombay, India, and I complete my bachelor's in occupational therapy at Manipal University, which is Karnataka, a different state in India. It was a four and a half year program. And the fun part about my education was that our institute was also a hospital and had clinics attached to it all within the same campus. So universities, like for OT are not very common in India, it's typically universities look like buildings, and that's your university. But I was fortunate enough to actually go to a university that had medical programs, allied health programs, engineering, architecture, but literally everything it was actually an institute it was actually in the university. So coming back to You know, having a hospital and clinic attached to, you know, on the same campus was, was amazing because from the very first day of OT school, we were hands on in the field initially observing helping our seniors and treatments slowly providing services under supervision defined having Junior under us that we were training along the way. So I mean, it was, it was very different from what it would have been here. But I'm very thankful that I did get so much hands on experience as part of my curriculum. Jayson Davies 10:31 Yeah, because here, you get a lot of the theory, you know, two years of theory, and then you go out and do some of your field work and get that hands on experience. But it sounds like you from day one, you were in there Ushma Sampat 10:42 we were, we were in it. Initially, it was like cleaning up. And then it was giving stuff to the senior that we're providing, but you're always looking, you're thinking you're being you know, your seniors or the teachers who are providing therapy are actually asking you questions along the way to actually apply what you've been learning. So you are doing the practicals and the theory in parallel all the time. Jayson Davies 11:09 Wow, I'm sure that was difficult, but also very beneficial Ushma Sampat 11:13 to say beneficial. Jayson Davies 11:16 And so then was your first job as an occupational therapist in India? Or did you move here prior to that? Ushma Sampat 11:24 No, I moved here. So it was a double, wide. And I think I, I am fortunate that I didn't work a lot in India. So besides, you know, my four years of curriculum where I did have practical’s, along with six months of internship, other than that, I didn't have a real job. And the reason I say it was a blessing in disguise is because I had so much unlearning to do and real learning to do interesting in preparation for not only my NBC OT, but being an OT practitioner in the in the country, in the States, it is very different. Jayson Davies 12:06 Yeah. And we're gonna dive into that transition in just a minute. But I want to take a step back while we're on the topic of, of your home country, and that is to ask you a little bit about education in India. How is the education system there? Mostly public education? I know you work in private education right now. But how is public education different there from it is here? Ushma Sampat 12:26 Great question. It is very, very different. And it's interesting that you say public, because the government schools in India are not called public schools. They're usually for the financially weaker section of the society or for those who can't afford private school. But since many people publicly opt for private schools, those private schools are actually called public schools. And the public schools, as we refer to in the states are called government schools. Back in India. Jayson Davies 12:55 Okay. Interesting. Ushma Sampat 12:57 So we have different boards. So federally, like countrywide, we have three boards. So we have, you know, the cbse, board, the icse board, and then the ni o F, which is the National Institute of open schooling. For children, I mean, students that learn differently, which, you know, hasn't might have been there for a long time. I'm not quite sure, but didn't have a lot of awareness, or, you know, not many schools actually had that program. And I remember when I was in 10th, grade, my school had introduced that board as part of our school as well. Jayson Davies 13:29 Gotcha. And so if you're just driving, walking, riding a bike around India, do you see more of the government schools or the quote unquote, public schools? Ushma Sampat 13:38 public? Wow. So private? Yeah. There are fewer public schools like me, my friends, most people I know, have gone to private schools. That is the norm. And I'm talking from obviously, being in a big city, I grew up in Bombay. So I was in a bigger city in rural areas, they probably only have the option of the government schools. But I want to say that a lot more people would have attended private schools. Wow. Jayson Davies 14:09 That's very interesting. All right. Very different from here in the states for you, like have to look up where private school might be, as opposed to just seeing them everywhere. Ushma Sampat 14:18 Oh, yeah. Because I mean, you know, obviously, we have a disparity in India like economic disparity, the population is too large to even accommodate for in terms of education. So everything gets filled up, no matter what you are, you're a public school, a government school, whatever school you are, you're going to get filled up because there's just so much but yeah, like I would have, I don't my family would have never considered or it's not even considered, it's like you, you are not entitled to a government school because you're making enough to go seek education yourself. Well, Jayson Davies 14:53 okay. Well, then let's go another layer deep. What about special education, I know in some parts of the world are some parts of the world special education just doesn't exist? Some places it's up and coming here in America. I mean, it's been pretty stable for a few decades now. But what about in India? Ushma Sampat 15:12 So special needs, you know, education is only in the last century been seen as a necessity. And obviously with good reason. to dive into the stats a little bit, I pulled up some stats from an article by first crayon. In India, they're 27 million people with special needs in a population of 1.2 billion. This means that 2.2% of our population has special needs. According to the census, only 61% of children with special needs age five to 19, attend Education Institute of any sort. And those are only those we know of many cases are not reported due to misconceptions, society fears and lack of diagnosis. Well, so majority of the children with special needs don't really receive any formal education in spite of the practice of inclusive education in some schools. This is the case that children with disabilities and learning differences are segregated from the mainstream schools and other regular routines, and social activities of normal children. Jayson Davies 16:18 So is there any government laws that state schools must provide special education like there is here, Ushma Sampat 16:27 so I wasn't even aware about it. But apparently, there is a government of India has put in place an act Persons with Disabilities Act of 1995, which provides cooling and services to all children. But for most children, or some children with disabilities, these are provided in special schools. Jayson Davies 16:49 So 1995, for anyone out there who doesn't quite recall, it was in the 70s, the special education started to kind of pick up here in the States. So a 20 year difference between things getting started, but that's great, at least there is something I know a lot of a lot of countries don't have anything yet. So that's great. Ushma Sampat 17:09 It's definitely a movement, I was chatting with a couple of odd who have been practicing in the schools in India. And I came to realize that not much has changed in the last 10 years from when I left systems and processes for students to receive od services are actually not present. Though there's been some movement in trying to educate and spread awareness about od arose in the School of very individual to what the aim of that school might be, in regards to hiring you. Sometimes OTs are brought on as consultants. Other times OTs are brought on to provide group services to everyone who attends that special day program at that school. Other times, bodies are given free rein to set up their own processes and systems and do as they will, I have actually supported someone in India that was going to start working in a school and had no clue what to do. And I actually consulted with her provided her some of the, you know, some of the things that we follow over your, you know, from referral to qualifying for services or not. And beyond setting up systems, obviously, with modification that would work in India, it was such a rewarding experience to even think about it. Like, it reminded me of all the things that I could have taken for granted. The laws and systems specific to the school system to the school system in the US may seem very hard to navigate, you know, as a school based ot. But it is these very processes and systems that provide us a framework for school based work, like clarity on our role, our responsibility, how do we proceed? What do we do? Isn't it so much better, Jayson, to just have the systems to help you navigate instead of running around like a headless chicken, even if it is hard in the beginning and requires you to invest in yourself and get the support early on to hit the ground running? Jayson Davies 19:06 Absolutely. I mean, and that's not just within schools, that's also just as professionals being licensed being registered or certificated in the United States, like, yeah, it's a pain in the butt that we have to take the nbcot T and get that initial registration and then go to your state and get a license. But that's also some a job security and be it's good for the people that we serve. It ensures that we know what we're doing. And the same thing in the schools. Yes, it's a pain in the butt that you have to go through a referral process and you have 60 days to get an assessment done. But that also supports the people that we serve. So yeah, definitely. Ushma Sampat 19:43 Absolutely. Yeah. Jayson Davies 19:45 All right. Well, you actually kind of started to go in this direction. I want to encourage you to go a little bit more is talking about the difference between occupational therapy here versus occupational therapy in India. Is it very similar or and not just school based, but In general, is occupational therapy similar different? or How is it? What direction? Is it going? Ushma Sampat 20:06 Oh, great question. She said, you're so good at both occupations. And the idea and importance given to independence are very different in India when compared to the States, the influence of culture is tremendous. And you know, it's often unfortunately overlooked. In India, we have a huge economic disparity. On one hand, we have people who afford to hire health for everything. And on the other spectrum, we have those who don't have even had the financial means for the basic necessities like home, food, medical expense, leave alone therapy for quality of life. Of course, there are exceptions and people that we see the people who see the need for independence. But the attitude in the first group, which is those that can afford therapy, is largely that I don't want to trouble my loved one. And if I can afford it, I will give my family my parent, the best care by hiring someone who can help them so that they don't have to go through the pain of doing things themselves. Obviously, the attitude also changes based on the age of the loved one, right? So there's definitely been more awareness and services being accessed for pediatrics as compared to adults. And one of the most obvious reason, as I was thinking about this set comes out is India's a very populated country, and there's only room for so much. So many schools, so many colleges, so many university admissions, and so many jobs, you have to do well, and you have to ace to move on to the next thing, there's constant pressure to do better. Otherwise, someone else is going to take your place. So parents are innately wanting their kids to be the best. And if that means going to therapy, Soviet. Jayson Davies 22:03 Wow. And with occupational therapy, I think you were kind of telling me that, like, no one, correct me if I'm wrong, but very few people know what occupational therapy is there. I mean, very few people know what it is here, either. But, I mean, do you see OT clinics even around in India? or What does it look like there on the ground? Ushma Sampat 22:21 Yeah, yeah. clinics have definitely started popping up. There are a lot of otas that have actually done education Master's abroad and gone back to India to start clinics and things. So I, there are private practitioners. But obviously, what we do, and the value we provide the role we play in families, or lives of children depend on what the families I mean, even though we hear we do that, but over there is more like a private od might also just be a school od because the parents are thinking so much about the need to be educationally moving forward, like play might not be as important to a parent, ADL, maybe a maid might be able to help with or I can help with as a parent, right? Like all those things might not be there yet. So the role of 40 just automatically might have become more educationally driven, or medically based, not educationally driven. Jayson Davies 23:24 Gotcha. All right. Great. Well, I want to kind of now transition to our next section or part of the podcast where we're talking about the transition. When did you and your family decide to to move them over to your San Francisco? Right? Ushma Sampat 23:38 Yeah, Bay Area. So I was initially in Mountain View, and then we've been in San Francisco. So it's all been behavior. My husband was already living in the US. So he had come to the states to do his undergrad. And then he did his master's. And he had just about got his first job when we got married. And I moved from India to the Bay area to be with him after we got married. Jayson Davies 23:59 Gotcha. And so what was that move? Like? Were there any amazing experiences or potentially terrible experiences that really stick out in your mind? Ushma Sampat 24:08 I think I am not gonna say amazing or terrible because I am who I am today because of all the experiences that I have lived in the past. But I will say, just to think about and to give you a background of what this move might have been like, in my head. I graduated from OT school, and I got married in the beginning of March, and I moved to the stage end of March, all of the same here. Wow. So it was definitely a lot to process in a very short time. And I'm not I'm not even sure if I processed all of it then. I was 23 years old, leaving behind every human I knew on the planet. My friends and family. start a new life with my spouse in a new country. I did have some extended families mistake but these are people I probably never met before. So They were related like somebody, somebody, somebody, but I didn't know them. So it was basically like starting life from scratch. My husband, sorry, Jayson Davies 25:11 I was just gonna say I just got the idea. I don't know if you've ever done a DNA test, but I can just imagine like going through your 23andme test and just like finding a random third cousin on there, just saying, hey, hey, I'm gonna come and live by you What's going on? Ushma Sampat 25:27 Yeah, yeah, yeah. I mean, yeah, it was just a lot to process and to think of it was a big move. I, you know, it was a life changing event. I was. And obviously, my husband. I mean, the only person I knew then was my husband, and he wasn't available to sit and hang out with me. It was not like we were on a long extended honeymoon, he had to provide for the family. He had to work long hours. It was lonely, for sure. Professionally, also, you know, to think that that was personally and professionally, it was challenging, because my husband and all his friends were in the area. So no guesses there. But most people are engineers, can you imagine not knowing a single other OT in the entire country you live in? Oh, my last but not the least, in addition to all of these mixes, we have been challenges. I volunteered as an od for three years before being able to get a job as an OT. What, because I was on a dependent visa. Luckily, Visa last changed after those three years. So we have to go through a lottery system to even get a visa and the Euro went through the lottery system, laws changed. And as a dependent of a skilled worker, which was my husband, I was now allowed to get an ad, which was Employment Authorization Document that enabled me to start my private practice, a benefit that my husband still doesn't have to their state because he is an h1 b visa holder. So he can only have one job and work for somebody 40 hours a week, not even part time no matter what situation you're in. And if you lose your job, I believe you have about 60 days or 90 days to find another job or leave the country while you've been here for 15 years. And he's still in that. Jayson Davies 27:16 So for anyone listening out there real quick, you can't see my face. Ooh, schmo can see my face. And I'm just like, in disbelief here real quick. I want to stop you real quick, because there's a lot to unpack there. You had to work as a volunteer for three years before you could before basically and it wasn't even because it was just three years because laws change. But you had to volunteer. Were you volunteering as an OT? Ushma Sampat 27:39 Yeah, because I couldn't earn. So my visa situation did not allow me to earn money. And so I was, you know, I had skills. I had professional goals. Thankfully, I was in a situation that I did not need to be a provider for my family. And I could actually invest money buy in regards to money because I was traveling to the job investing all the time there. And driving back doing continuing education, learning and growing because I was at least hitting my professional goals. But I could not earn. Jayson Davies 28:18 Wow. So what kind of OT job were you doing at that point? Or so I Ushma Sampat 28:22 was at? I was at a private school. I mean, obviously, you know, how many people will really hire you, you You are an OT, but you are not allowed to work? Right? Like how are you going to explain that I'm a qualified OT allowed to be an OT, but not allowed to earn, and then actually have somebody hire you. So I was working at a private school and I was working with a couple of private families, no payment, just supporting them. Jayson Davies 28:49 Wow, that's so interesting. And then so now this kind of goes into the next area of the transition. What about NBC OT I mean, most of us, most school based OTS, most OTS listening to this podcast. Shout out to everyone who's outside of the United States. I know there's several of you. But if you're in the United States, you went through the process here you got your bachelor's, you got your masters, maybe you did your OTD you took the NBCOT t you got registered, you got licensed and you're ready to practice. What was that like for you? Ushma Sampat 29:22 We have an added layer, even over there. So we and by we I mean internationally educated otif can sit the boards to be able to sit the boards have to have an additional process completed, which is called the OT Ed process. It is basically a determination at the education that you have completed. internationally. The fee including fieldwork meets the eligibility requirements to apply for the OTDR certification exam, even if we attended a world WFOT recognized approved program. So this you know process required us to complete a lot Documentation has stuff prepared, sent out via University, one of the forms that was the most time taking was a bundle of 50 forms. Thank god they now do it online. It was physical forms that I had to fill back in but back in the day, asking us to give us details and proof on each coursework and standards and how they were met. So it was really detailed. These questions were so detailed, and one of the first questions I remember so clearly, was asking me how I learned English in whatever form that was a question about how I, my proficiency in English and how I've learned it or whatever. And to prove it? Well, given that my schooling was in English, it was hard for me to digest. And given that all of us were required to take and pass the TOEFL exam, which is a test of English as a foreign language proficiency exam, any which wave as a prerequisite for the odd process. I just felt like this was, Why are you asking me this now? Like, have I not proved to you by taking a test? that English is a language I speak where I know? Jayson Davies 31:14 You got to do both? You couldn't just say yes, I know English. And here's my background. Or let me take the test. You had to say, here's how I learned English. Oh, and now I'm going to take a test on it to prove that I know English. Ushma Sampat 31:27 Yes. So can you imagine for me having had to go through everything think how do I prove I know English? My education from pre k was English, like, what do I give you a certificate? Where do I even go? Here's my somebody is to prove that I have been educated. I mean, English right? Jayson Davies 31:46 In my head, I like if I read that question, if I was in a similar spot, I can only imagine me just saying, Hey, Mom, go get that preschool work sample that I did when I was four years old. It's all in English. And let's send that to them. Ushma Sampat 31:59 Yeah, I mean, I understand some countries do have, you know, time we education isn't a different language, but you're making them to toe fall. Why then? Are you asking them a question like that that can be perceived I completely get where they're coming from, but it could be perceived as a bias, right? Like, why are you adding that layer that we already have enough to unpack we already have enough to do? And I mean, if anything, I hope, you know, this serves as a reminder, for anybody listening and needs to hear this today, too, that our only limitations are the ones we set in our own minds. The process has never been easy for me, but I kept going. This made me resilient and taught me perseverance. And there was no stopping. Jayson Davies 32:46 Yeah, wow. And to be straight up honest, the OT world is lucky to have you in the OT room. So I'm glad you continued on and made it all the way through. Ushma Sampat 32:58 Thank you. I'm glad. Jayson Davies 33:01 So we're going to actually continue on a little bit more, because that is just part of the story, I think. So you moved here or you were going through that process, you had to kind of prove that you had training in OT, you had to prove that you spoke English and multiple ways. Was there additional training that you needed specifically for Occupational Therapy. Ushma Sampat 33:25 So I was lucky enough to be around one of the last batches, I think in 2012, they moved from if I was because I had completed my OT Ed process before 2012, I was allowed to sit the exam without a Master's, for anybody listening and who is not aware, one needs to now have a Master's to be eligible to sit the exam. But I was anyways enrolled in a post professional master's program at San Jose State University. Because that that was part of my plan. I wanted to pursue my Masters all along. So that didn't change anything for me. Jayson Davies 34:00 Okay, so But now, if someone were in a similar situation, they would have to do that Post Pro masters. Ushma Sampat 34:07 So they would have to do yeah, they would have to do a post professional masters or a doctorate because it's the entry level masters now. So anybody who wants to sit the exam, whether you be you know, you're trained in the United States or internationally, you have to have a entry level masters or opposed professional masters is the minimum requirement. Gotcha. And Jayson Davies 34:27 cannon masters from say, India or from another country, that would still suffice? Ushma Sampat 34:32 That would suffice, you would still go through the OTD process. And I would think that you would have more questions to answer and more things to prove, but it would suffice. I mean, even for me, I was at you know, odd like the process was I submit everything and they get back to me and ask me questions like this isn't clear. How did you really master this? Or these standards seem like they've not really been met through your education at the level at which we require them to be have met. So I did do certain courses I, you know, I did certain courses on occupational therapy comm like IP profits and stuff, they have questions about education. And we don't have that in India. So not, you know, my OT education did not teach me about this process, even physical or junk modalities. I remember we needed 710 I forget how many hours but I and I knew that because I started this whole process when I got engaged to my husband a year before I even moved to the country. So I started the process, I started doing all the continuing education in addition that I knew I was going to have to be, you know, that we're going to come up. And I started working on all of that the whole process of getting my odd approval took me two years. Wow. And then prepared for my NBC audience at the NBC Lt. Jayson Davies 35:46 Wow. And so what was the NBCOT experience for you like the end? Did you do that before you got your post pro? Or after you got your post pro masters? Ushma Sampat 35:55 pedrillo? Okay. Yeah, so I, I was I was enrolled in my professional masters doing my course and preparing for the NBCOT and appeared the NBCOT at the same time, okay, Jayson Davies 36:07 so that that Master's kind of helped you prepare for the NBC OT, as well as a master who's Pro's pro masters can, Ushma Sampat 36:17 maybe, but I think it's actually very different, because NBC OT has so much focus on what you would do in a particular situation more clinical, whereas my master's was more management teaching. And, you know, that focus was not as clinical. So I think NBC it was all about just reading up, you know, the typical therapy and the, you know, taking courses, you know, all of that, like just there is there wasn't a community, when I was going through aid for people who, you know, are internationally educated, going through this entire process. And obviously, me being me, I saw a gap. And I'm like, I don't have the support. I'm done with it, I will make sure I get the support and do forward for anybody who's not going through it. So I do have a Facebook group. It's a small, but mighty self sufficient community of internationally educated OTS who are trying to get through the odd process and give the boats Jayson Davies 37:15 and what's the name of that one for anyone looking? Ushma Sampat 37:17 It's called OT help for international educated OTS. And you know, we can link it up at the end of the show. Jayson Davies 37:24 Definitely. Alright, well, so that is quite an experience, believe it or not, actually, in fact, I just had someone reach out to me the other day, we get like, 5% of the listeners that come from this show come from Europe, Australia, and China or Asia region. So for anyone listening, thank you so much for listening. First of all, for anyone outside of the states, it's a blessing to have you joining us, what would be that first step recommendation that you would give, for someone listening, looking to move to the US? Ushma Sampat 37:58 It can definitely feel like a never ending process with a huge investment in terms of time and money. You know, I've heard many people in us say it is expensive. Can you imagine how expensive it could be pretty for somebody who's an international applicant, but it is worth every minute and every penny. In the end, I will add one more thing. seek support from others who have undergone this process, it will save you a lot of time and headache, instead of reinventing the wheel. I know I had to do that. And I don't wish that anybody else would have to. So reach out to somebody who's gone through the process. Jayson Davies 38:38 Well said and again, we'll make sure to link to your Facebook group in the show notes. So check that out. Alright, let's talk about school based occupational therapy. You're here you are licensed, you can work. Thank God you're not a volunteer, you're actually getting paid for your work now. How do you feel all of your experiences as an internationally trained OT impacted your current skills and preferences as a school based OT, Ushma Sampat 39:04 I feel like the OT foundational skills are so ingrained in me. And the clinical exposure and hands on approach from day one of od school has really helped me solidify my clinical reasoning skills. I remember activity analysis was given so much importance. And we often use a bottom up approach, which taught me to really dig deeper, to analyze understand why and then problem solve to support. Being an internationally educated OT, living and working in a different country made me also culturally more aware and more sensitive, partly due to the exposure, but largely due to my own lived experiences. I learned to view myself in a supporting role. Give emphasis to a team approach with the parent is the expert of the child. In the natural environment at a solid foundation, and I give all of that regard to being internationally educated and having moved to another country to work, it just opens your eyes up to so many new and different things. Jayson Davies 40:15 Yeah, and I think as an occupational therapist understanding, you know, we never truly understand the culture of other people, like we don't live in their house, we don't live in their community. We don't know that. But being aware of that, and being aware that other cultures exist, and that other people live differently than we do, is just so important. And so you've had new Ushma Sampat 40:39 Yes, yeah, they value something completely different, it might be so different, and you are no one to judge if that is right or wrong. Same, like a parent knows what's best for their child, you are no one to judge whether that's the right way or wrong way. You can guide them, you can support them, but it is their way. And their culture, the values, their habits, their routines, will determine what they find meaning in, right. Jayson Davies 41:05 Yeah, and I think you'll agree with this, too. But each classroom has its own culture as well. And so you said something very important. You said, taking on kind of a supplementary role is what you learned or what you realize. And that in itself is difficult. seeing yourself as supplemental to a classroom and knowing that that teacher is the leader in that in that the president of their classroom, and absolutely. Yeah, and so I don't know, if you want to add anything to that, just about, you know, being supplemental to the classroom. Ushma Sampat 41:39 No, I think you absolutely nailed it, we, you know, look at yourself as a resource as an support for the teachers you serve for the schools you serve for the district you serve. Think outside the box, you know, you don't have to be the main hero of the film, you can be a supporting role and still add so much value. Jayson Davies 42:00 That is a quote to remember right? You can be the supporting character and still add value, I like it. Alright, we're getting down to the last few questions, but we're gonna stay on that school based OT realm. What do you feel are some of the most or maybe the most important skill for a school based OT to acquire and build upon to be successful? Ushma Sampat 42:22 Of course, I think knowledge which is very specific to the school system, like the laws that govern school based practice, the IEP process, scope of practice, all of that is very important. I also think it's very important to set a solid process for reference. And moving on to discontinuation of services, the whole thing like how why would somebody go there? Why would somebody get services or not? Why would they get concert versus direct, right? You're really trying to get into the nitty gritty of those things, striving to be a resource for the schools yourself to an RTI approach, not only the kids on the IEP, there's another thing that is often overlooked. And having a robust workload management system to help with keeping track of multiple moving pieces at school based on these we know we have a referral coming in, we have an IEP do some other teacher has given, you know, the pre referral form we have a screening done an assessment is we have a lot of moving pieces. And that is just for one side. Can you imagine having that for multiple fights, right. So moving and looking at it, from a workload perspective, instead of a caseload perspective, would be another great skill, or another great quality to invite as a school baseball team. Jayson Davies 43:44 You know, I think you just basically wrapped up the final two questions that I had really, you know, just kind of what is some advice to a school based occupational therapist, whether they're internationally trained or trained here in the United States? I don't know. Do you have one piece of advice based upon what you just said, that they should work on? Ushma Sampat 44:04 Yeah, I think first and foremost thing is make use of the privilege of being able to see the child in the natural environment. If you look closely, it gives you so much more information that is often missed when the child is seen out of context. So that's number one, I actually have two more Jayson Davies 44:23 Go for it. Ushma Sampat 44:25 And that would be collaborate with your IEP team. They bring so much expertise to the table, which is instrumental in our decision. And next steps, you know, going back to what we talked about earlier, and the last would be remember that in addition to remediation, we as OTs are also experts in modifying the environment, adapting the activity, so that the child can be more successful. Don't forget to explore your full potential. Jayson Davies 44:56 Absolutely. Well, Ushma, this has been so much Fine, my neck is actually starting to hurt from nodding with you like everything you're saying, I'm just nodding. And you all can't see that out there listening. But I'm just like nodding this entire conversation. So I really do appreciate it. And I want to give you the opportunity to share where anyone interested in learning more about you more about the world of OT, where can they go? Ushma Sampat 45:18 Absolutely. So for anybody who's new to school based OT or interested in the school based od course, you could visit worldofot-school.thinkific.com, or the short version of that is Bit.ly/schoolOT school is all lowercase and OT is capital. You can follow me on Instagram, and my handle is worldofot. Or you can connect with me on Facebook. I'm Ushma Sampat, or visit my website and you can, you know, probably get all the information you need about me and my practice at worldofot.com. Jayson Davies 45:59 All right. And we'll be sure to link to all of those in the show notes so you can get easy access to them. So OSHA, thank you so much for coming on here. Really appreciate it. Like I said, I've been nodding this entire time. Because everything that you're saying just aligns so much with the values that I shared, the school based occupational therapist, thank you so much for sharing just about how different the culture is and what we can learn from it. You know, it's important to understand the differences. But you got to go further and understand what we can learn from that. So thank you so much. Really appreciate you coming on. Ushma Sampat 46:35 Absolutely. This was so much fun. Thank you, Jayson. Jayson Davies 46:38 Thank you. We'll have to do it again on another topic in the future. It'll be great, Ushma Sampat 46:41 Done! Jayson Davies 46:43 All right. Well, take care. Enjoy the rest of your day. And we'll see you sometime in the future. Ushma Sampat 46:49 Sounds good. Take care. Bye. Bye. Jayson Davies 46:52 One last time. Thank you so much, Ushma for coming on to the podcast. It was such a pleasure to have her on and thank you, you for listening today. This was such a great episode. I cannot agree more with everything that Ushma was saying and I hope you had a chance to learn from this conversation today. It really was a great conversation and I look forward to more in the future. So with that, until next time, I will see you later. Take care. Bye bye. Amazing Narrator 47:19 Thank you for listening to the OT schoolhouse podcast. For more ways to help you and your students succeed right now. Head on over to otschoolhouse.com until next time, class is dismissed. Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast
OTSH 69: OT Month Special: Supporting Our Profession Feat. Sarah Putt, OTR/L
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for the Episode 69 of the OT School House Podcast. In this OT Month special episode, I am teaming up with Sarah Putt from the OT 4 Lyfe Podcast to talk about the importance of supporting our OT associations. We will discus the perks, the costs, and the reasons why we support our local, national, and world OT associations. The OT associations need our support so that they can turn around and effectively support us. At the end of the episode, we announce a giveaway put together to support you and OT associations all around the world. I hope you enjoy this special OT Month Episode! Links to Show References: Enter for the giveaway here! Become an AOTA Member (Affiliate link) OT 4 Lyfe Podcast Freebies! Be sure to subscribe to the OT School House email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Have any questions or comments about the podcast? Email Jayson at Well, Thanks for visiting the podcast show notes! If you enjoyed this episode be sure to subscribe on Apple Podcasts, Google Podcast, Spotify, or wherever you listen to podcasts Click here to view more episodes of the OT School House Podcast
OTSH 68: Travel Therapy as a School-Based OT with Devon Breithart, OTR/L
Want to earn 11 hours of professional development? Learn more about the OT School House: Back to School Conference Here! Press play below to listen to the podcast Or click on your preferred podcast player link! Welcome to the show notes for the Episode 68 of the OT School House Podcast. In this episode we are highlighting travel opportunities as an occupational therapy practitioner, but that's not all. We will start this conversation by discussing what you need to know if you are looking into a travel therapy position as an employee for a 3rd party company. But we are also going to discus with Devon how she used a coaching model during the pandemic and what she learned from this. Links to Show References: Devon's website Occupationaltherapy.com (affiliate link) Devon's Instagram Devon's Dynamic School OT Group The Traveling Traveler Transcript Download the Transcript or read the episode below! SPEAKERS Jayson Davies & Devon Breithart Amazing Narrator 00:01 Hello and welcome to the OT schoolhouse podcast, your source for school based occupational therapy tips, interviews and professional development. Now to get the conversation started, here's your host, Jayson Davies. Class is officially in session. Jayson Davies 00:18 Hey everyone, and welcome to Episode 68 of OT schoolhouse podcast. My name is Jayson, it hasn't changed, I swear it will always be Jayson. And thank you so much for being here today. I'm excited to have you joining me. It has just been a great day, a great week, a great month at the OT School House. And I am just super excited. And I know many of you have actually shared that excitement with me because you've been emailing me and letting me know. And I just love those all of those messages of kindness of appreciation. It has just been a great time here at the OT School House. So I really do appreciate you taking a moment to listen today. Today we do have on a very special guest by the name of Devon bright heart and she is going to kind of give us all the details on what it is like to be a travel therapist. And she's also going to share with us a little bit about what she has learned throughout the last year of the pandemic and how she developed a coaching model to use during teletherapy services. Before we dive into the interview, though, I actually want to share some great news and that is that the Back To School Conference being held in August is now officially an AOTA approved course good for 11 hours, meaning that you will get a certificate if you are registered and attend for 11 hours toward your recertification or your state re licensure. This is going to be an amazing conference. I cannot wait it is 100% virtual, but it's also 100% live in the sense that everyone the presenters and myself included will be presenting live for you to interact with I cannot wait for it. Some of the amazing presenters that will be joining us for the Back To School Conference include Dr. Susan Bazyk who will be talking about her RTI program every moment counts. Olivia Martinez-Hauge, who was on the podcast a few episodes ago talking about sensory and stress, we are going to continue to build off that discussion that we had and go so much further. And another presenter that I would like to highlight right now is Meg Proctor. She is from learnplaythrive.com, and she will be discussing strategies for kids with autism. So you do not want to miss out on these presenters and more we have discussions on assistive technology and so much more. You can learn all about the conference at otschoolhouse.com/conferenc And also be sure to register now, early bird pricing is going to end at the end of April, the price will increase. So OT month is here we're gonna get through t month and then the price will increase so be sure to check it out. Now. Again, you can find all the details at otschoolhouse.com/conference With that, let's go ahead and jump into our interview. We have Devon Breithart, talking about what it's like to be a travel therapist and a little bit about a coaching model in the times of COVID and how she's going to now bring that forward as kids start to return back to school. So without any further ado, here is Devon Brethart. Hey, Devon, welcome to the OT School House podcast. How are you doing today? Devon Breithart 03:19 I'm good. I'm really excited to be here. Jayson Davies 03:21 Yeah. And I'm excited to get to know you as well. We've been getting to know each other a little bit over social media. But I'm excited to have you here on the podcast. So today we're going to talk about travel therapy. But why don't we go ahead and start off with maybe how you became an occupational therapist. What drove you to this profession? Devon Breithart 03:38 Yeah, so I feel like I have a different story than a lot of the other OTS I've met. Because I didn't actually know what OT was until I was looking at colleges. I never had any family members who received it growing up, it was just a profession that, like the rest of the world I was blissfully unaware of until I was doing college visits. And I actually thought I wanted to be an art therapist because I really liked art. And I also really liked psychology and I knew I wanted to do something kind of in the healthcare field. So I started looking for programs near me that offered art therapy and went on this great college visit to one was touring the campus enjoying myself. And then, you know, the person leading the tour was like, oh, what are you thinking about majoring in? And I was like, Oh, I heard you guys have an art therapy program. He's like, well, we don't. I was like, Oh, he said, but we do have an occupational therapy program. And I said, well, what's occupational therapy? And then he told me, and I was like, Oh, well, that's it. That's what I'm gonna be. It's funny just made sense. Yeah. Jayson Davies 04:39 So were you a big artist growing up in Devon Breithart 04:43 bits and pieces, you're in there. So I won't talk too much about this because I don't want to be like too down on myself. I was friends with a lot of really talented artists, like much more talented artists than me in high school. So I took a lot of art classes and it took a few painting classes in college too. So I wouldn't say I'm like, talented. And even now I'm like, I'm not doing any art on a regular basis anymore. But it was it was a big part of my life for a while there. Jayson Davies 05:08 Yeah, it's always fun hearing what OTS did before OT. Because I mean, yeah, I feel like a lot of people have done some form of art. I did actually film. So in high school, I did all animation. And then I took some film classes. And now I have a podcast, which allows me to kind of do some of that a little bit. Yeah, that's really cool. So let's go ahead and fast forward now a few years, what was OT life like the first few years after OT school? Devon Breithart 05:33 Yeah. So as soon as I graduated, I knew I wanted to try to get into pediatrics that was always a place that had my heart, even in OT school. And even the jobs I held before I was done with OT school. So I just started applying to different pediatric outpatient clinics near where I was, and the one that I was really interested hired me like a month before I was set to like, fully graduate and be done. And that was great for a while. And then after a few years of that, I started feeling a little stagnant and a little bored. And I knew I needed to make some sort of change. Jayson Davies 06:07 Gotcha. Okay. So then, what happened from there. So, Devon Breithart 06:12 I had always been kind of interested in travel therapy, you know, when you first graduate from OT school, there's always like recruiters, you know, they'll be at events or little like, find your phone number or email address somehow. And they'll call you and offer you a job in Nebraska that you really don't want. But they're very certain that you do want to care about it, and they keep calling. So it's always been kind of in the back of my mind, I moved around a lot as a kid and grad school, like college, and then grad school was really the longest amount of time I'd spent in one city in a long time. And, you know, after a few years of working in the outpatient clinic, and doing some early intervention, I was like, you know what I'm going to, I'm going to do it, I'm going to try travel therapy, my partner had recently gotten a remote work job. So I was like, Oh, it's perfect timing, we can take this job anywhere, I'm getting a little stagnant at work. Let's do travel therapy, let's just see what it's like. And if we completely hate it, we can always just move back. Jayson Davies 07:02 Okay, that makes more sense. Now, for some reason, in my head, I just always thought that you are a travel therapist from day one, but totally makes sense. Let's go ahead and kind of start with just a general overview. What does travel therapy even look like? Devon Breithart 07:16 Yeah, so basically, you take short term travel contracts, that can be anywhere in the United States, there are some international contracts too. But those are way more complicated, and a whole other can of worms with Visas is in that process. So mostly, it's just contracts in the United States. But there'll be for different facilities that for one reason or another, have trouble finding a qualified ot. So that could be just due to like the geographic location, it could be just like a really rural area. It could be because there's no OT schools around the area of like, California is such a huge state. And there's only a few OT schools for the entire state, like out of all the states I've looked at California has like, the highest like OT to like citizen ratio of any of the states, which I think is interesting. And you know, it's just, it just depends on the reason why they're seeking an OT and why they haven't been able to find one through traditional means. But usually, it's something like that, where they've tried, and just due to geography or whatever other reasons, they haven't been able to find one. Jayson Davies 08:13 Yeah. And so when you're saying short term, what is what is short term? Devon Breithart 08:16 So for most travel contracts, which are I would say not usually in the school system, I'm a little bit of a rarity, because I do just take school system contracts. But most of the time, they're these short term medical contracts that are usually around three months, Jayson Davies 08:28 three months to 12 weeks or so. Devon Breithart 08:30 Yep. kind of similar to like a level two fieldwork. You did three month fieldwork sessions. Jayson Davies 08:35 So what about, I mean, are there long term contract positions? And if so, have you ever done them? or What did they look like? Devon Breithart 08:42 Yeah, so the longer term contracts are most of what I do now. And by longer term, I still don't mean like, multi year or anything like that. It's usually like a school year, like so it'll be, you know, a nine or a 10 month school year contract. Sometimes you can find contracts that include EMI as well, really, you can be in the same area up to like one calendar year, like minus one day, I think, or something like that. So if you do find a district you like and you want to work for, you know, that whole year plus, yes, why that's possible. It's just when you start looking into, you know, working for that district again, the next year that it gets a little squirrely from the travel therapy perspective. Jayson Davies 09:18 Gotcha. Sorry, when you were saying, you know, one year minus a day, it just made me think of an IEP like, like an IEP right services tomorrow, and then it goes to one day before the next it is. Yeah, it's funny. So tell me then, where have you been fortunate enough to kind of go around and work. Devon Breithart 09:37 So I was pleasantly stuck in California for a few years. California is really hard to leave. I had never been there until I moved there for travel therapy. But it always been a place I wanted to go. I was always really interested in San Francisco in particular. And it just been a place that I'd never gotten to travel to like on vacation or anything like that. So I took my first contract that was in northern Cal fornia a super small town that even other northern Californians often never heard of called kelseyville. Okay, have you heard of that? No. See, there you go. And I know you're not quite in Northern California. But yeah, I would talk to people in San Francisco about it. And they'd be like, oh, I've never heard of that place. But really small town that's north of Napa and Sonoma. So kind of in that winegrowing region Oh, so beautiful. Yeah, very beautiful. The worst roads imaginable to like, get in there, because it was literally like on a mountain. But very beautiful place. Right after that. I went a little bit further south into Santa Cruz, and I was there for close to a four year actually, maybe nice place to be. Yeah, beautiful area again. I mean, it's hard not to find beautiful. You're in California. It's just a really beautiful state. Jayson Davies 10:46 Yeah. But pretty lucky. And then Devon Breithart 10:48 yeah. And then after that, I moved a little bit more up into the bay area. And I was in a district that was in Silicon Valley. Jayson Davies 10:55 Oh, that must have been interesting. Devon Breithart 10:57 So interesting. That's actually where I was when the pandemic started. So that definitely had an interesting role to play and how, how my services were delivered, and just that kind of stuff. Jayson Davies 11:06 Yes. And so how did you end up now in Seattle? Devon Breithart 11:10 So after? Well, I guess we should say during the pandemic, I was like, Oh, my gosh, am I going to keep traveling? And I get this question frequently, right, even outside of a pandemic? Or like, oh, when are you going to stop traveling? When are you going to come home? Or when are you going to settle down? And my answer is always just like, I don't know. I guess what, I get sick of it. And so far, I'm not sick of it. But during the pandemic, I was like, Oh, no, no, I really need to make decisions about if I am going to keep traveling and what that looks like and where we're going to go because it is like, you know, especially in California, we were so locked down, we weren't doing any leisure travel, like we were barely even leaving our houses for a long time there. So I was like, I really don't want to have to move during a pandemic, and especially not moved to like another state. But then it's also like, my home state is Kentucky. So the other option is like driving from California to Kentucky. So nothing, nothing really sounded like a great option. But I think that's a similar experience that a lot of people had, nothing was a good option in a pandemic. So I knew I wanted to get to Seattle eventually. And that had always been my tentative plan for the school year. And then when Seattle became like the epicenter of COVID, in the United States, like in March, the first recorded cases were in Seattle, I was like, oh, maybe I don't want to go. But you know what I ended up here. Anyways, it was, you know, it's a pandemic across the whole country. So by the time I was up here, it was bad everywhere. So gotta be somewhere. Jayson Davies 12:39 And so I actually want to use this as an example. How did you even acquire a contract while you were in California? Like, did you decide, hey, I wanted to go Seattle? Let me find a contract? Or did you say, Hey, where can I find a contract? Oh, there's a contract in Seattle? Let me go to Seattle? And how does that work out? Devon Breithart 12:59 So what most travelers do is they'll go through a recruiting agency, and those agencies are actually who acquire those contracts and help place travelers in them. It's not a situation of like your recruiter says, hey, you're going to Seattle, and you don't have a choice about it. But it is a situation of Hey, here are the available contracts we have. Are you interested in any of them? Do you want to interview for any of them? And then if it's a good fit, at the end of that interview, you can choose to go there, you can choose to sign the contract or not. So it's kind of in the middle. It's not like you're just getting assigned to a place without any input. But it's not. It's not like you can also just say, you know, I want to go to New York City and be like, right in Manhattan, because that's not always an option, either, when there's a really desirable place that has no has no trouble filling OT positions. Jayson Davies 13:43 Yeah. And so, again, kind of going off of that you mentioned recruiters, do you always go through a recruiter? Or have you ever gone where you are your own? Alright, and I can't talk right now, where you are your own contractor per se, or independent contractor, having a contract directly with a district or directly with a hospital. Devon Breithart 14:04 So I have never done just like pure independent contracting, this is something that all travelers want to know about, like, either as soon as they start traveling, or like after they take a few contracts, they start thinking, well, what if I didn't have this recruiter at all, because they are, you know, to some extent, a middleman they are taking a portion of the pay from the contract, you know, you see it and you think, Oh, I could, I could contact school districts, I could set up a contract. I could do this all on my own. And what most travelers find when they do attempt to do that stuff on their own is that it gets a lot more complicated than they had envisioned. And you know, I'm a W two employee, I get paid, like on a W two, I'm not a I say contractor, because I'm taking short term contracts. But like, in the eyes of the IRS, I am an employee of my car, my travel agency. So that makes it a little less complicated. And when you are doing that pure, independent contracting, and you're having to pay all those self employment taxes and just all the other labor that you're putting into like by In sourcing a contract, it ends up being a wash for most people. So I have never, I've never ventured into the side of like, truly, truly independent contracting for that reason. But I know a lot of people are curious about it. Jayson Davies 15:12 Yeah. And I think there's also, I mean, when you talk about independent contractor, I know that there's also people that are independent contractors, but work through a third party. And so kind of, they're in the same situation as you except it's not a W two, it's a 1099. And then they have to figure out taxes, so Yep. Okay. Very cool. So, what do you enjoy most about travel therapy? Devon Breithart 15:35 I'm, like, normally, I'll give my answer like workwise and then not work. My might not work wise answer is not a great answer right now. Because it's literally the travel. I love seeing new places, I really love food, I love going to restaurants, I love just like walking around cities. Like I just love traveling. And so to be able to have a job that allows that travel to be like, part of the job is awesome. You know, when I was working at the outpatient clinic, and I had a permanent position, that was one of the things that I was like, that was a big reason why I look to travel therapy in the first place. Because, you know, I wasn't getting a ton of vacation time. And then even the vacation time I was getting, I wasn't making a ton of money. So it's not like I could do these like big pool trips very often, because I just didn't have the paychecks to support it at the time. Whereas with travel therapy, the paychecks tend to be a little bit higher. And you know, you're already traveling just by virtue of taking the job in and of itself. So it was able to fulfill that for me really nicely. Jayson Davies 16:34 Nice. Yeah, I have heard that they tend to pay a little bit more, but that is because you're, you have to up and move your life points. And so I don't know, maybe that leads into some of the cons. I don't know, what are some of the cons of, of travel therapy? And maybe again, you want to do personal versus versus work? Devon Breithart 16:55 Yeah, I would say. I don't know, I think for me, the biggest con is like, I don't know that period of like instability, where you're like, not quite sure where you're going to go next. Because people always ask, I get a lot of questions. Can you tell, but people are always asking, like, Oh, where are you gonna go next? Where are you gonna go next. And I really don't know where I'm going to go next until like, you know, sometimes not even like a month or two beforehand. And like for some of those travelers who take like the more short term contracts that are in like outpatient clinics, or sniffs like, they don't know, until like a week beforehand, or a couple of days beforehand, like, it's a, you have to be okay with being flexible and being able to like, think on your feet a little bit. Because very often you will not know where you're going to be in a month. And that's, that's a hard space to live in for a lot of people. So I would say that part is tricky. And it's not even, it's not even for me like being able to like not make a lot of plans, because I don't know where I'm going to be where I am. But it's more that fielding those questions. And like, I don't know, just like the physical act of moving is, is such a bear. And like, luckily for me, I'm usually only moving once a year since I am taking these full school year contracts most of the time, but it's still just like, it's a lot. And I don't even move with that much stuff like we My partner and I share one car, we have a hatchback. And all of our stuff goes into that car. And if it doesn't fit, it does not come with us. But even that in and of itself is like it's it's hard to move. Jayson Davies 18:15 Oh, I bet that's gonna be tricky. And what about your partner? Does he or she have a job that they can move around? Or how does that work out? Devon Breithart 18:22 Yeah, so he's been with me the whole time. And I said earlier, you know, he had got this remote job. And I was like, Oh, this is perfect. Now we can go travel. And then you know, he actually quit that remote job like a month before I started my first contract. Yeah, of course. So that job ended up just really not being a great fit for him for a lot of reasons. And so we actually moved to California, sight unseen with me like having this travel contract job and him being unemployed and not quite sure what his next steps were. Which again, is like you have to be okay with being flexible and rolling with the punches and travel therapy because that's like situations like that just to happen. And it's it's hard to deal with that kind of stuff when you're across the country from friends or family or support systems. But my partner also has a history in education, so he worked as a substitute. Previously, he had been a pair educator for a while. So as soon as we got to California, he started working on his sub credential there. And I will tell you the sub credential in California is much harder to apply for than the sub credential in Indiana where he was previously previously working in Indiana, like they will let you sub if you were a warm body and you maybe took a college class once in California, it is like a miniature teaching license like they wanted his essay t scores, his college transcripts like all of this different stuff, just to get that sub credential. So even that was a process in itself when we first got there, but that's what he did for a couple of years. And now he is now he's actually tutoring. He has a bachelor's degree in math. So when we moved to Silicon Valley, he started working at a math tutoring center eventually moved up a little bit in red There, and now he is still working for that same company online, actually, because like public school, they also shifted all other services online when the pandemic started. So when we moved to Seattle, he was actually just able to keep that same job because he's been working online since March. So Jayson Davies 20:17 Alright, so everyone out there here, it is possible to have a partner and to be traveling. Yeah, it's possible. Devon Breithart 20:23 Yeah, Jayson Davies 20:23 let's Cool. All right. So you did mention earlier that you had you before you started traveling, you had a full time job for about two years, you were in a pediatric clinic, essentially? How do you compare the difference between not just being from a clinic to now mostly school days, but from that travel to more permanent? What? What's been the biggest difference for you? Other than, right, I Devon Breithart 20:48 mean, really, there were so many differences. I mean, just shifting from outpatient pediatrics to school in general, you know, I really thought I was gonna be okay. And like, long, long term, I was okay. But I was like, Oh, you know, I've worked in pediatric outpatient for a few years, I've got this, I'm a great therapist, I'm going to be able to pivot to schools so easily. And I don't want to say that it was impossible or incredibly hard, because I got there. And I did it. And I was proud of the work I did in that first district. But it was still like, I mean, you know, it's just such a different setting than any other pediatric setting. There are so many laws, there's so many regulations, and it's just not something that you are prepared well, for an OT school, or at least, my OT school didn't spend a lot of time on the interesting intricacies of school based practice. So I mean, that was the biggest change, by far for me was just the really narrowing down the differences between those two settings that I'd previously thought were like, fairly similar. Mm hmm. Jayson Davies 21:42 Yeah. And as you and I both know, there, there is a big difference between outpatient and school. And we'll talk more about that mentoring and some schools in just a moment. But first, you mentioned your partner, he actually had to kind of shift in the ability to get a different type of license to be a substitute teacher or whatever, in different states. Same things with OTS. Obviously, we're licensed in each state. In fact, I think Washington is even when it comes to school based OTS, I think they already have a credential program there. Yeah. But talk about that process of originally being licensed in one state, and then having to move that over. Devon Breithart 22:17 So for travel therapy, you do have to get a license in each state that you're actually practicing in. So I actually maintain a few concurrent licenses, I still maintain my Kentucky license, just because that is still my home base. And if I ever am like to go back and work, even if it's just PRN, or something like that, I want to be able to have that license. But now I also have my California OT license and my Washington OT license. And I will say for anyone who's listening to this, who's like, Oh, I want to go to California or the west coast. If you want to start traveling apply for the Washington and California license now because they are be slyke. I will my Kentucky OT license I applied for like as soon as I was done with grad school, and it was so easy, and it cost me $50. And that was it. And then of course California is is much more expensive than that. I think once you count in like getting your passport photo and getting your live scan and getting like all these extra things done. I think it was between two and $300 for my initial California license. And then of course it was due for renewal like the very next year because of the way my birthday fell. And oh, yeah, I don't have so much more expensive licenses and much more complicated processes on the west coast. Jayson Davies 23:25 Everything is more expensive here. In California, everything. An LLC is more expensive. license is more expensive gas is more expensive everything. Yo man. You talked about Kentucky being your home, is that when it comes to taxes, you typically filed taxes in your home state. So do you have to file taxes in multiple states? If that if you're getting paid for multiple states? Or how does that work? Devon Breithart 23:50 Yes, and I will say I finally broke down this year and hired an accountant. I've done my own taxes. Like since I was a teenager, I was always very proud of that. And now my taxes are complicated enough to where I'm like, okay, I I'm not the expert on this anymore. Like, there are questions that I don't know the answer to. So you do have to file taxes in each state that you're working, as well as your home state. So for me, that's Kentucky, I'll file a Kentucky return as a resident last year, I'll also file a non resident California return. And normally I would have to file a Washington State return to as a non resident, but Washington State actually doesn't have income tax. So they don't do state tax returns in the same way that a lot of other states do. But yeah, it's very common as a traveler, you know, especially if you're taking those more short term contracts, and maybe you're bopping around several different states in a year to have to file you know, the IRS, like the federal taxes and then like three or four different state returns, just depending on where you worked. Jayson Davies 24:46 Yeah. So this is my disclaimer, we are not tax attorneys or tax professionals. seek out help. Absolutely. Okay, I again, I want to get to this mentorship in a second but I'm taking advantage because you are in Washington right now. I've heard a little bit about OTS in the schools and Washington having some form of credential. I know you haven't been there long. But do you know anything about this? Devon Breithart 25:09 Yes. So in Washington state, in addition to your OT license, which is done by the Department of Health, you have to have a credential called an ESA, or educational services associate to do any work in the school system. So this is basically a credential on top of any other OT schooling, licensing anything like that, that you've done that's specific to OTS, in the school system. Jayson Davies 25:30 As a contractor, do you need that? Devon Breithart 25:32 Yes, I think there's a like, I think if you're not going to be practicing in the state for like, you can you can get around it, I think it's that if you are not going to be in the state for longer than a year, you can technically not apply for it and not do it. But once it hits that year mark, it's like you're already late. So it's like oh, like we'll give you the entire first year that you're practicing in Washington to get this credential. And then I know some travelers will probably just say, Well, I'm only going to be there nine months, so I'm just not going to apply for it. But then as soon as they want to take another contract, they're, you know, they're already going to be due to have that credential. So I wouldn't have hadn't just did mine. It's not, it's not a behemoth. Like the OT licenses, like, it's still kind of is I still had to fill out an application online on very antiquated software that was like, what, like, what high school did you go to? And I was like, Why? Why is this a question right now. But it was it was not as arduous as the OT license. Or at least it didn't feel that way to me at the time. Jayson Davies 26:31 There wasn't like any courses that you had to take or anything like that was it, Devon Breithart 26:35 I did also have to take a course with it. So it was a pretty short course. And it was just like two days, over zoom. Normally it would be in person. But since it was a pandemic, it was over zoom, there was like two eight hour days. And it's honestly, like it's a good course to take. I would recommend people take it if they're not familiar with school based practice, because it does go into a lot of the intricacies that OT schools don't go always go into. But as someone who had already practiced in the schools, just in a different state, it was a little repetitive. I was, you know, it was already a zoom, eight hour zoom call on a Saturday. So that's hard enough in itself. It was also it's also information that I mostly knew, but at the same time, I'm like this is valuable information for people that aren't yet familiar with. Jayson Davies 27:20 Yeah, be great for I mean, it'd be a great requirement or brand new school based OTS. Yeah, Washington. Right. That brings us to something that you and I are both very passionate about mentorship, and probably something you and I both lacked in our first few years as practitioners of mentorship. What about? I mean, does mentorship exist in travel therapy? Devon Breithart 27:41 So I'll say yes and no. And short answer, no, it doesn't, unless you seek it out, you'll find that a lot of travel companies will say oh, we offer mentors will place you with a current traveler who's experienced. But then a lot of times that mentorship actually looks like someone who's on the East Coast while you're on the west coast, and then the time zones never worked out, or then they leave the company or their contract ends, and they're no longer available to mentor you. And even with that mentorship, you know, anytime you take a travel contract, unless it's like explicitly stated by the facility, those places really expect you to hit the ground running like my first day of my first school based contract, like I was providing OT services, you know, it wasn't like I had a lot of time to get my feet wet. And I was also the only OT, so it wasn't, you know, like I even had this department of other more experienced school based OTS to look to it was, Hey, this is it, you're the OT for this district. They also didn't have an OT for the entire first semester of that school year. So I owe a bunch of compensatory time that I also want to pick up. So it was just kind of like, and I don't want to say, you know, this district didn't put me in a bad position. They were very supportive. The actual caseload itself was pretty low, so that compensatory time was actually manageable to make up. And they really supported me as much as they could. But they weren't OTS, so they didn't know they didn't know everything, right. Jayson Davies 28:58 Yep. So then what did you do in order to compensate for that? Did you take courses? Did you seek out friends of speech therapist or PTs that can help out? What did you do? Devon Breithart 29:10 Yeah, so I did a little bit of everything. I luckily had a really close friend of mine in grad school who had been working in the schools for several years, basically, while I was an outpatient, she was in the schools. So I leaned on her very heavily, especially those first couple months. They're just constantly calling or texting or asking questions. I also joined a lot of Facebook groups. And Facebook groups are great. And I don't want to, you know, speak badly of them because I have a Facebook group about 30. And I think it's really valuable. But at the same time, I was also like, you know, just spending so much of my time trying to wrap my brain around school based OTD like, I was doing all the school based OT work during my work day. And then I would find myself like at home or on my lunch break. Scrolling social media, I tried to do you know, like a leisure occupation. And then it turns into work because I like look at this question on a Facebook group. And I'm like, Oh, that's a good question. I should read this whole Read and then it's two hours later. And I'm like, well, I've learned a ton about school based practice, but I really probably should eat something at some point today. Um, and then courses to, you know, I really got into occupational therapy, comm mentor or membership whenever I first started travel therapy just because it was a lot easier to get online see us rather than planning where it was going to be in person. And that was helpful. So I just took all the school based courses on there I could, I leaned heavily on my school Sykes, my speech therapist, luckily, it was like a really small, close knit team, the director of special education, his office was actually like caddy corner to mine. And I was able to talk to him every day, which does not happen in large districts. So I was grateful that it was a small and supportive district that like, understood where I was coming from understood, I had experience with the pediatric therapy bit of it, but really needed some support with like the legalities and regulations part. Jayson Davies 30:52 Yeah, I had no idea that you're in that same type of similar situation. I was I was a school employee. But I was again at a smaller district, like what you're talking about this, the head psych was across the hallway from me, the director of special education was next door to me. I mean, next door in the very next office, not next door. But yeah, and it was just learning so much. Even though they weren't OTS, I was the only occupational therapist in the district. But I learned so much about special education, just from other people that had no idea really what OT was. Right. So yeah, great experience. So my next question on here, I totally blushed. I asked, Do you think school based OT is under emphasized in school based OT? That's supposed to be Do you think school based OT is under emphasized in occupational therapy school? Or when we get our, our actual credential? Devon Breithart 31:42 Yeah. And, you know, I didn't even really start thinking about this until the last couple of years,