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Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 203 of the OT Schoolhouse Podcast. Struggling to figure out how occupational therapy fits within your school's MTSS framework? In this episode, Dr. Courtney Boitano shares findings from two groundbreaking studies on sensory processing interventions for kindergarten and fifth-grade students. As a faculty member at San Jose State University and a school-based OT with over 15 years of experience, Courtney provides practical insights into implementing tiered sensory supports that actually work. You'll learn how to use free screening tools like the Strengths and Difficulties Questionnaire (SDQ) to identify students who need additional support, why teacher consultation may be more impactful than you think, and how to implement Zones of Regulation strategies across different tiers. Whether you're new to MTSS or looking to refine your approach, this episode offers evidence-based strategies you can start using tomorrow to support students and empower teachers with sensory processing challenges in your schools. Listen now to learn the following objectives: Learners will identify the research findings from tier 1 and tier 2 sensory interventions with kindergarten and fifth-grade students
Learners will implement evidence based teacher consult strategies as a high- impact MTSS intervention.
Learners will Identify the Strength and Difficulties Questionnaire as a screening tool to identify students who may benefit from sensory processing interventions and determine appropriate tier- level supports.

Guest(s) Bio
Courtney Boitano OTD, OTR/L, BCBA-D Courtney Boitano is a faculty member at San Jose State University teaching in the occupational therapy masters and doctorate (OTD) program. Courtney also teaches the Pediatric Clinic course at SJSU. Recent research has focused on the role of school-based occupational therapy practitioners in MTSS to affect students’ sensory processing. As an occupational therapist, she has over 15 years experience working in a variety of pediatric settings and school-based practice. Her clinical practice, OT OuTside focuses on children with developmental disorders and parent support.

Quotes "The consultation piece was huge. It was like a different person filling out the post-test of the SPM because they didn't just see the tip of the iceberg—they understood what was beneath it." — Courtney Boitano OTD, OTR/L, BCBA-D “MTSS can, can work beautifully when it there's alignment at, administrator level” — Courtney Boitano OTD, OTR/L, BCBA-D “MTSS isn't just the OT doing MTSS. It's not just the reading specialist doing RTI. It's not just the behaviorist doing PBIS, but it's all of us like really working together to see how can we support the student in across these domains and how can we like bridge it together.” — Courtney Boitano OTD, OTR/L, BCBA-D Try to get your foundation under you with everything else, I think, before really diving into MTSS.” — Jayson Davies,M.A.,OTR/L Resources 👉Strengths and Difficulties Questionnaire (SDQ) 👉Sensory Processing Measure (SPM) 👉Zones of Regulation 👉San Jose State University OT Program 👉OT Outside (Courtney's Practice) 👉California Foundation for Occupational Therapy 👉Courtney's Research Article Episode Transcript Expand to view episode transcript Jayson Davies Jayson, hello, and welcome to the OT School House podcast. If you are a school-based OT practitioner, or maybe you're thinking about becoming one in the future, I want you to know that you are in the right place. I'm your host, Jayson Davies, an OT practitioner just like yourself. Today, I'm thrilled to welcome Dr. Courtney Boitano to the OT School House podcast. Courtney is a faculty member at San Jose State University with over 15 years of school-based OT experience, and today she's here to share with you research on sensory processing interventions within the MTSS multi-tiered system of support framework. If you've been wondering how to actually implement MTSS in your school, beyond just talking about how tier one is for 80% tier two is for 15, and tier three is for the final 5% of your students. This is the episode for you. We're diving into Courtney's research with kindergarten, as well as with fifth-grade students, to uncover what really works when it comes to sensory supports, primarily at tiers one and two, by the end of this episode, you're going to learn how to implement free screening tools to identify students who may need sensory supports, understand the practical difference between tier one, two, and three interventions, and also discover why teacher consultation might be your most powerful MTSS strategy, even though it may be the hardest to prioritize. Stay tuned to learn how Dr. Boitano implemented this 10 week MTSS program, and how you can too. Stay tuned. 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 Courtney, welcome to the OT School House podcast. It is such a pleasure having you here today. How are you doing? Courtney Boitano Good, thanks for having me. I'm so excited to be here. Jayson Davies Absolutely. Well, I have to start with something here. I was just on the California Foundation for Occupational Therapy, and looking at the awardees, and I happened to type part of your name in, and it just came up like nine different times. You apparently have figured out how to get some support with your research, and what it looks like some of your students' research through the CFOT. That's awesome. Courtney Boitano Yes, yeah, I'm so grateful for the work they're doing to support research and getting our work out there. Jayson Davies Yeah, and for those of you who are not in California, the California Federation Foundation, sorry for occupational therapy. It's kind of this: they are not associated with our state association, but they are closely aligned in their goals and furthering the aspect of occupational therapy. And they do have several different grants that they offer every single year. And Courtney has apparently used it for herself as well as really enabled her students to use it, which is just fantastic. What has that process been like? You know, helping your students understand that they can get support that way. Courtney Boitano Yeah, it's been so helpful to, for not only their learning, but also that kind of sense of empowerment, of like we're, you know, doing great work, and there is support out there for it, and to get even that, you know, practice of writing a grant proposal, and the some of the research I've done that we're going to talk about today was funded through a CFOT grant, and it just also makes, you know, getting those different protocols, you know, it's costly, or having a little incentive to give to participants just helps all of that research come together as well. Jayson Davies Yeah, yeah, absolutely. Well, really quickly, thank you, CFOT, for, you know, making that possible for many of the OT professionals out there that want to find some research, because in some cases, like today, that eventually leads to several published articles and information for us to talk about on the OT School House podcast. So, thank you, CFOT, not sponsored, just a nice little shout out. All right, Courtney, you have a lot of experience within the world of occupational therapy. You are on staff at San Jose State University, you have been a school-based occupational therapist. You also have some of your own clinical experience with OT outside in that platform. How have these experiences really led you into these articles that you ultimately published about with MTSS? Courtney Boitano Yeah, and I've gosh, when I graduated from USC with my master's, I knew I wanted to be a school-based OT. They had an opportunity, it was a training grant that we could, a small cohort of us could complete our level two field work in. In schools, and you know, concurrently, while we were doing our coursework, and I loved the experience so much. I was at Long Beach Unified, and just had an amazing mentor, and it was great to, you know, have that clinical practicum experience, and be able to talk about it in our coursework with, you know, our instructor, and I then did the OTD at USC, and was working at LA Unified, and just went straight into schools. So, now, for like, gosh, almost 20 years, I've been working in schools, and, you know, still do a little consulting here and there, supporting students and schools, teachers, administrators. I just love that aspect of Jayson Davies it. Yeah, yeah. Wow. Fun note, I also had access to that school-based OT special program at USC. That correct me if I'm wrong, but when you came out, you also got like a little, not a stipend, but they helped with your student loans, right? Courtney Boitano Exactly. Yeah, it was amazing. It was an amazing training grant. Jayson Davies Yeah, yeah, I did not do that. I did not think I'd end up in the schools, and that's kind of funny now, right? So, yeah, kind of wish I would have done that program, you know, given where I am today. But that's awesome. I'm glad, you know, that's really cool, because it's not many people get to come out of school with the foundational understanding of school-based OT. USC had that program in place for, for so many years, I don't think they have it now, because it was a grant, right? So it's really awesome that that you're able to get that. You said you landed at LAUSD after that, right? Courtney Boitano Yeah, yeah, so I was at LA USD, and then I worked for the Southwest Selpa down there in Southern California. Ended up working with a smaller school district down in Southern California, but just have always been so drawn to that energy that schools provide, and that that collaborative piece. Jayson Davies Yeah, How long would you say it took you to a learn about MTSS, or did you already know about it from the USC program? And then, how long did it actually take you to, you know, what? Say, I can see students beyond the IEP, and let me actually figure this out. Courtney Boitano Yeah, you know, it's really funny. Recently, I was going through some of my, you know, old like school materials, like, yeah, it's you know, when it was just like paper, you know, printed with that plastic comb, and so I had this booklet on RTI in public schools, and I remember, I think LAUSD, you know, they would do different like in services for the rehab professionals, OT, PT, and so it was like an in-service on that, and it's really interesting to look back at that, and then to look at where we are now with RTI and MTSS, and to see that we've been doing it now, you know, for a very long time, but just that evolution of how it's become so encompassing in so many different realms and domains where students and teachers need that support, so it's been especially, I think, helpful for us as OTs, as we've had these conversations about case load versus workload, and these different models, and to to look at how we can make that happen, because we can reach so many more students when we are implementing RTI MTSS frameworks. Jayson Davies Yeah, at LA USD, were you at that time, were you able to get into MTSS at all, or did it take you a little bit further down in your career to actually figure out how to make it actually work a little bit? Courtney Boitano Yeah, I'm definitely kind of with that. That evolution of what it's been has been how I've also evolved in my own practice of how to do it, and it's so it is. It's hard when you're a new grad and working in the schools and managing the caseload and the different school sites and and just building those relationships and knowing how to do it, so I think there were little like glimmers of being able to do it. I remember my first, you know, first year collaborating with the adapted PE specialist, and there was a great team, you know, APE Speech and myself, and we worked really closely together, and would be at the same site on the same days, so we could do some like really cool groups and kind of bring in those tiered interventions, and I would say that's almost more unique, right, to have that kind of like magical team chemistry come together, where it's like we all were like, oh yeah, we could be doing this and have these different groups, and so it was, you know, long story to say, you know, it's been easier at, you know, some schools versus other schools and. And also, just as I mentioned, kind of having that relationship and rapport building, so it's become easier as I've been able to establish a rapport with the teachers, with the administrators, with the school site. Jayson Davies Absolutely, part of the reason I asked you that question is because I wanted to hear that answer. I kind of assumed that that was going to be the answer, because that's my answer too. Like, MTSS is not something that you can jump into most school sites and start doing on day one. Most schools don't have MTSS built within the confines of OT, or OTs built within the confines of MTSS, to probably say it more correctly. And so it is something that you, as OT, kind of has to, you have to take that on, and maybe you do find a really awesome SLP and an AP teacher or a PT that, that will do that with you, but I often, you know, get asked, and I'm sure you have too, from, you know, newer students, like, what to focus on in your first year as a school-based OT, and, like, MTSS was the last thing I'm telling people to focus on, not because it's not great, like it is great, but it's so difficult, and try to get your foundation under you with everything else, I think, before really diving into MTSS 10 years from now, that might be different, Courtney Boitano yeah, for sure, Jayson Davies but that's how I kind of view it right now, so awesome, I think that is helpful for everyone listening in their first year, maybe even first few years of school-based OT. Courtney Boitano Yeah, all Jayson Davies right. Well, let's go ahead and dive into kind of explaining MTSS from the from the way that you actually perceive MTSS. Everyone has a slightly different understanding of MTSS and RTI, but I would love to hear kind of how you explain MTSS, whether it be to a fellow OT, a teacher, or a parent, even. Courtney Boitano Yeah, and kind of building off of what we were just talking about, how it's evolved. It's been interesting to really see how the terminology has even changed with these frameworks, and how you know, and in kind of doing this work with students, and we've looked at the literature, you know, you go back and it's like it was called early intervening services initially, and then you started to see RTI creeping into the literature a little bit more, and now that more prevalent term that's being used both in the literature and then at school districts is that MTSS term, and so I really, you know, see it as being kind of MTSS as that broader umbrella, and then response to intervention that RTI is kind of that that part underneath the umbrella, those tiered interventions across domains, whether it's for reading, behavioral support, OT being in there, and you know, with MTSS, it's really governing those multiple processes that are supporting students, and so it's, you know, RTI is under that PBIS, the positive behavioral interventions and supports, also falls under that umbrella, and that biggest piece, kind of tying it all together, is that collaborative piece, right? That it's multiple professionals working together, it's not just OT doing MTSS, it's not just the reading specialist doing RTI, it's not just the behaviorist doing PBIS, but it's all of us like really working together to see how can we support the student in across these domains and how can we like bridge it together. So I love that that umbrella image to see how it all, it all falls under that, and it all has to be covered under that umbrella, Jayson Davies yeah, yeah, absolutely. I mean, it takes a village, right, to raise any human being and to support any human being on campus. Definitely takes a village. So, yeah, along the lines of that, I think most of us understand that there are three tiers of MTSS and RTI. There was three tiers too, as well. How do you overarchingly describe the three tiers of MTSS? Courtney Boitano Right, you know, I always go back to those percentages because it, it makes sense to me when, when we're looking at that, you know, tier one being that the 80% of students, tier two being that 15% of students who need just a little bit more support, and then that, you know, tier three being that 5% that smaller percentage of the students who need that more one on one focused intervention, and so I can really, you know, see how when the team approach comes together to meet the students and the teachers, I include the teachers in there of how, how are we doing those tiered interventions for the teacher, not just for the student, but you know, there are those those teachers, I think we can even kind of align some percentage. Is to teachers, there's some teachers, you know, where we can, we'll kind of get into this, you know, where it is like maybe we're doing an in-service, or maybe there's a teacher who needs more of that one on one consult with the OT, and so, how can we meet both the needs of the students and the teachers within those tiered levels? Jayson Davies Yeah, it's so interesting how MTSS can look very different, like two OTs can implement MTSS even at the same particular school, but it's going to look so different. I do feel that the teachers are one part of the dynamic, of course, we are part of the dynamic at play, all the other team members are part of that, and it all influences what your program can actually look like, right? Like, we have to, to a degree, play to our strengths, and some teachers we collaborate really well with, and other teachers maybe we don't have that same connection, but that doesn't mean we can't get creative in a different way to continue to support that teacher at various levels, and of course, their students. So, yeah, absolutely. How do you find that MTSS and special education work together or integrate together? Does that question make sense without additional context? Courtney Boitano I think so, and I mean the way that that I conceptualize that is, you know, MTSS can certainly be and is used for the general ed population, right, but where we bring in that that special ed piece is, you know, where we are seeing, and let me back up a little bit, of like I think the classroom dynamic has changed so much from 20 years ago, 10 years ago, to even five years ago, right? The classroom looks so different, so even in a, you know, quote unquote general education classroom, like we are seeing kids with significant needs whose needs aren't being met, and so I think, you know, just keeping that kind of binary separation of general ed and special ed, of course, you know, we have our, you know, frameworks and laws to really define that, but we're seeing it kind of intertwined so much now, and so MTSS really provides a great way to meet the needs of kids, whether they are in general ed or, you know, are in a special day class, you know, in special education, getting an IEP, or have a 504 plan, or have nothing, right? And so I think MTSS really helps to kind of bridge that gap, because you know, like I said, the classroom is looking so different, and teachers are needing so much support, and we really can provide that support to them, because that, that support they're needing is, you know, behavior management, you know, kids having decreased attention spans and a need for more movement, more differentiation, and how they're being taught, and so, and how their needs are being met, and so we can really help teachers understand that. I think we have a really unique perspective for that, so going back to your, you know, question of like MTSS, I think really is that perfect bridge between special ed and general ed, and then just what the classroom is looking like these days. Jayson Davies Yeah, yeah, one something that's come up a few times is about I think people forget that even if a student is in a classroom, a more contained classroom, a special education classroom, per se, that, and maybe they have direct OT one time a week for 30 minutes or less, consult, or whatever it might be, that they fall outside of this realm of MTSS, but I don't think that's true. I mean, we can absolutely still be supporting that teacher at tier one that's going to support that student. We can potentially have that student involved in a group inside the classroom at tier two, whether or not that is on the IEP or not on the IEP, because we just happen to have a tier two program in that classroom, and I think that sometimes goes forgotten a little bit. Courtney Boitano Absolutely, I agree 100% And yeah, I don't think they can be separated, of like, oh, MTSS is just for that general ed, and yeah, it has to be embedded across, you know, general ed, the, you know, essay sai classrooms for all levels of kids, like we, we really need that, Jayson Davies yeah, yeah, all right, I want to start diving into your research a little bit, you did two different, you have two different published research, one, the effects of sensory processing at tier. One and tier two among kindergarten students, and the other is tier one and tier two for sensory processing with fifth grade students. So, you've done this kind of twice with two different populations. My question here is, before we dive into that, this is a question that I go back and forth with all the time as an occupational therapy practitioner going down the MTSS route, are we providing occupational therapy as MTSS, or are we providing a specific support, such as handwriting, fine motor skills, sensory processing, social skills, emotional regulation, as part of that MTSS, and I ask this because I feel like sometimes if we just try and say OT is MTSS, it's just too broad, it doesn't allow us to go into one specific area. Obviously, you kind of have well defined this as sensory processing, and I'm wondering if that was, I mean, for research it has to be on purpose. But yeah, trying to collect your thoughts on that. Courtney Boitano Yeah, I think you raise a really good point, and I think it's one of the things that I often come to, just as an OT, of like what we're doing as occupational therapists is is going to look different based on the unique needs of the individual, or in this case of the classroom, and so this was defined, you know, as okay, we're doing, you know, the OT was specifically, you know, defined as sensory processing, because that was the unique need in both the classrooms, and you know what, I continue to emphasize is the unique need, really across classrooms. Now that's what I'm constantly hearing teachers really struggle with, is like really that, and when I say sensory processing, that you know self regulation, you know, kids being able to do that modulation to, you know, bring that arousal level, you know, we have to be able to match that arousal level to different activities, settings, environments, and that's a big challenge right now, and so this was, you know, sensory processing was chosen because that was the need, and how this all came about, so I can dive into a little like context. Let's Jayson Davies go in. Yeah, let's go for it. Courtney Boitano So, so at San Jose State, we have these really unique clinics on campus, and I lead our pediatric clinic, and so one day we're on campus, and then as a school-based OT, you know, when I started teaching our clinic course, I was like, well, you know, so many grads go into school-based OT, can we have one day be at a school? And so we got this contract with a local, it's a parochial school, so a local school nearby, and one day a week, the student, a small cohort of students, usually around like 10 to 12 students, we go to this school, and this was all, you know, we don't have the manpower, there's just, you know, a few of us, so it's not individual services, so we're doing RTI, this was, you know, okay, How can we expose students to those tiered interventions, so we're doing tier one whole class and tier two small group interventions, and so in response to the needs, you know, following the pandemic, the school administrators, you know, noticed that the fifth grade students, and so that was the first study that came about, also because at San Jose State, master's students do a group research project together that is led by a faculty mentor, and so I, you know, had this kind of need from the school with administrators, kind of saying, like, these fifth graders don't have tools for self-regulation, you know, following the pandemic, we're just seeing a, you know, huge shift in how they're showing up in the classroom, so I thought, okay, this could be a great research study, so it, you know, really was this great opportunity, not only for education of, you know, the clinic students, the research students, and then just to kind of satisfy my own curiosity, but to really meet this, this unique need that we're seeing across schools. So, so we did that first with the fifth graders, and then there were a few shifts I wanted to make, so then we did it with the kindergartners, so I could talk about a little, a little bit more about the fifth graders, but if you have a question, Joe, Jayson Davies I, that's exactly what I want to dive into, is that that first article that you have, you were looking at specifically tier one and tier two for sensory processing for fifth grade children, so I mean, let's. Just dive into, I think, a little bit of the methodology, like what did it actually look like. Courtney Boitano Yeah, so because you know that was kind of the problem that was brought to us, of like, here we have this fifth grade class and they need tools for self-regulation, so we did, we use the SPM, the sensory processing measure, as a screening tool, and what that really turned out, and it was at two different schools, so the one school where we have the clinic, and then we did another nearby parochial school, so same kind of makeup of students, so we can get some comparison, and the difference was that at one school they had us, this, you know, OT students coming in and doing, you know, the tier one and tier two interventions, and then at the other school, the fifth grade teacher got a workshop, like a in-service that I led one one day, you know, after school, and so what we found with using the SPM as a screening tool was that in reality, you know, there was just a small handful which aligned with what we know about RTI, right, that there's going to be about 15% of students who really, you know, are showing that they need that, you know, tier two intervention, and so this is, you know, wrapping everything into a nutshell, real briefly. But after looking at that, it was like, oh, you know, that using the SPM as a screener for the whole class is just not feasible. It's time consuming for the teacher. It's really cool. Jayson Davies So the teacher had to do it. Oh Courtney Boitano yeah, so the teacher filled out the SPM, and the, you know, it was costly too, because the, you know, cost of each SPM. So, what we found, you know, from doing that with the fifth graders was that there were some results with the in-service, you know, teachers were understanding the zones of regulation more, and we chose the zones of regulation because it was already kind of being used in the school, so there was some kind of base knowledge of what the zones of regulation is, and it aligned with their social emotional curriculum, and we also, in terms of what that intervention looked like it also brought in some like mindfulness-based strategies, so things like, you know, helping the kids with, like, okay, what are some coping strategies when you are, you know, getting into the yellow and red zone, you know, breathing techniques, taking a break, and it was great to see that the teacher's understanding of what these terms were was, you know, really changing, so because you know I saw that the SPM was not a great screening tool, and we were then hearing, like, you know, our kindergarteners are coming in, and I was like, that would be a great class to do it with, because they don't have the knowledge of the zones of regulation. So, what could this look like with a group of young kids who are coming in? Some have had preschool, some haven't had preschool, some have had, you know, a junior kindergarten program, TK program, some haven't, so we're really, you know, kind of getting a broad, broader mix of background coming in, and one of the things that we then changed with this, instead of using the SPM as a screener, is that we did the Strengths and Difficulties Questionnaire as a screening tool, and this was one the I don't know if you're familiar with the SDQ, but it's a free tool, and it really kind of can tease out some of that behavior, and the like kind of more sensory like components of, you know, like being fidgety, decreased attention, and I have a BCBA also, and I have a BCBA because when I was working at the SELPA, they had a small cohort of students, they offered, or not students, of people working in the Selpa. Yeah, they said, you know, if you're interested, we're going to have a cohort, and I was like, "Gosh, I'm constantly getting asked the question, is it sensory or is it behaviors? It's like, "Sure, I'll do it Jayson Davies if you're gonna let me go for it. Yeah, sure. Courtney Boitano So that's always been interesting to me to look at kind of that behavioral piece, and that's what teachers really identify, right? They identify the behaviors. Yes, I often use that, like iceberg, you know, analogy of like what you see above the iceberg, at the tip of the iceberg are the behaviors, right? The, you know, kids blurting out, the kids out of their seat, you know, they can't focus, but then we, you know, with our OT perspective, we understand what's underneath that I. Iceberg, so all that to say, I thought, okay, the SDQ really kind of helps to tease out, like, okay, what is that behavior, and what we can then look at, like, what are these sensory components underneath that iceberg? So we replicated it with the kindergartner students, but this time instead of just doing the RTI interventions, the tier one and tier two, and the in-service, we added a consultation piece, so we had three kindergarten classrooms, instead of just like before, we had 2/5-grade classrooms, we had these three different groups, and what we before I jump into what we found, the interventions that were being done for the RTI group, the same idea of following the zones of regulation, because the teacher used the zones in the classroom, but also including, you know, some real like hands-on kindergarten age, you know, different artwork. They are doing sensory activities to, you know, understand, kind of bring in that interoception piece about, like, when we're feeling this way, when our body is feeling this way. Like, what does that tell us, and what can we do with those kind of, you know, mindfulness-based strategies, of, you know, the breath work, asking for help, being able to, you know, advocate for yourself and take a break when you need to take a break, and then one teacher got, you know, consultation, and then another got just that in service, so what was interesting about this, and jump in if you have a question too. Well, I was gonna Jayson Davies ask, so just to clarify, so three different classrooms, one just got one in service up front, I'm assuming that was, or did all the teachers get that in service, or did you literally just sit down with one teacher. Courtney Boitano No, that's a good question. So the teachers that this was at another school, so two schools again. So two teachers at this one school got the in service. All the teachers, you know, grades K through eight got the in service, and then at the other school it wasn't the in-service, it was RTI intervention. So then the other school, the third teacher got both the in-service and the consultation piece. Jayson Davies Okay, so in service, and then what? How often was the consultation? Courtney Boitano That was about every two weeks, I want to say, Jayson Davies okay, over the course of how long? 1010, weeks, okay. And then course or classroom number three, then was the one who actually had the RTI intervention itself, and kind of just really briefly, what did that look like? I know you talked about zones of regulation a little bit and interception, but as far as like frequency and whatnot, what did that look like? Courtney Boitano Great question. So it was once a week, and it was broken into that tier one whole class, so going in and doing like a whole class, you know, activity on, say, you know, understanding our internal cues one week, and then next week about, you know scenarios and role playing different zones of regulation, and then there was also a tier two small group component, so then breaking into small groups with the different activities for zones regulation. Jayson Davies okay, so I'm assuming the classroom itself, the tier one was like a 30 minute collaboration lesson with the teacher, and then some students got an additional 15 to 30 minutes for the tier two part of it. Okay, gotcha. And again, over the course of 10 weeks, right? Courtney Boitano Yeah, Jayson Davies awesome. Okay, was the SDQ is that what was used to determine Tier One and Tier Two in that case, or how? How do did that determine who was Tier Two? Courtney Boitano Great question. So we use the SDQ as a screener for then who would we would have administered the who we would administer the SPM to, so then we use the SPM again, but instead of just using it for the whole class, we were then able to administer the SPM. The teacher filled out the SPM for the students who the SDQ total difficulty score was elevated. Jayson Davies Interesting, how big or so were these classrooms, just in general? I'm assuming 15-ish kids, Courtney Boitano right? Yes, we had 11 who consented to participate for the RTI group, and so not all 11 had, you know, had these elevated scores on the SDQ. So I want to say it was about Jayson Davies like five. Courtney Boitano Yep, I was just gonna say five. Who, then we administered the SPM four. Jayson Davies okay? And then were those five, if they got the SPM, did that basically mean that because they had the elevated score, or whatever score on the SDQ, those five were in tier two, and you use the SPM to help with the data for only the kids who were at tier two. Is that summarized correctly? Courtney Boitano Right. Yes. Yes. Jayson Davies Okay. Got it. Courtney Boitano Lot of things going on with the study, because we had the teachers completing the zones implementation surveys, you know, the zones of regulation came out with some data collection tools, which wasn't in existence when we did the fifth grade study, so it was really, it was interesting to bring that in, to use that as a survey to, to have to be able to measure then how the teachers were implementing and understanding the zone, so we used those measures as well for the teachers. They were completing different surveys, and and we were able to kind of look at that for both the students and the teachers. Jayson Davies Yeah, I really wanted to break that down a little bit, because school-based OT practitioners are always trying to figure out, like, well, how do I know when a kid needs tier two intervention, and so you know you're kind of providing that, and of course this was research, so you probably did more than you really might need to do in a clinical setting, maybe you don't need to do the SPM, you just use the SDQ, which is already free for anyone to access, and of course the SPM does get expensive. And then could you have used the, I mean, if you didn't have the SPM, would you have just used the SDQ again later, or maybe you already did that? Courtney Boitano You know, that's a.. that's an interesting question. I do like using the SPM for that follow-up piece, because I really think that is the great bridge between, okay, here are these behaviors that the teachers are seeing and are reporting, and then we can bring in the SPM to really back that up and give some concrete examples of, you know, well, here are these different areas where we're seeing, like, oh, you know, actually, you know, their auditory scores are really hearing on the SPM are really high here, or we can really kind of tease it out a bit more, so I think the SDQ serves as a great screener for that, and what was interesting, I mean, our results were not as, as great as I would have loved to see, like, oh, all the SPM scores, you know, really changed, but what we did find was a positive correlation between the results of the SDQ on the total difficulty score, so it gives you a total difficulty score on the SDQ with elevated scores on the SPM, so it did show, like, oh, this really can be a good screening tool if you didn't have the time, you know, didn't have the resources to, you know, I mean, it's mainly time, it's really time consuming for the teacher to do an SPM on, say, 20 kids, but the SDQ shorter, faster, so you could use it as that screening tool, and we did see this positive correlation. I mean, granted, it was a small sample size, so we want to be careful with general generalization, but, but then what we saw too is, so because the SDQ is more kind of behavior-oriented, and it gives you some pro social scores. We saw that there was a negative significant correlation between the pro social scores on the SDQ and the social participation subscale on the SPM. So, what that means, yeah. Jayson Davies Explain. Courtney Boitano as the pro social behavior scores went up on the SDQ, the social participation difficulties went down, and vice versa. So that's what we would want to see. So we would want to, you know, we don't want to have these elevated scores, and then seeing that, you know, if they're having more social participation difficulties, we would want to see that. Then you know their scores are kind of. Jayson Davies Yeah. Courtney Boitano opening out, leveling out. Jayson Davies It wouldn't make sense if both scores were elevated for good social and difficulty with social skills. So, okay, we're going to take a quick break, getting closer to the end of the episode, but I do want to follow up with you more about the results, and also ask you one more question about using that SPM. So, we'll be right back. All right, Courtney, I do want to move on more to the results, but first, going back to the SPM, this was in a parochial school, you know, not your typical school setting. Mean, or not, your typical public school setting, I should say. In the public school setting, you've worked in LAUSD, a few other school districts, you know the whole referral process and the assessment plan to use standardized tools and whatnot. Can you picture what that would look like when we're using it in this process, whether it's the SPM, the SDQ, or any other tool, when we're using it as this like screener versus an assessment tool on an IEP. Do you think that, and maybe you have more insights on this? Do you feel like we have to let parents know that we're using the SDQ or the SPM if we are giving it to the entire classroom or a group of kids as opposed to an individual student used for the purpose of an IEP. Courtney Boitano I think that's a conversation that is often had about, like, okay. Where is this kind of gray area of, is it? Are we able to do this, you know, just as kind of practitioners in a classroom, or.. and I think just the broader, because there are, you know, nuances and different have different rules for that, but I think just as a broader kind of lens to look at MTSS, I think when we can have these really intentional systems in place at the administrator level, so really looking at kind of that macro level of like having this in place of like we're doing a screening tool, using a screening tool, doing a screening for all, maybe it's at the start of the year, for every grade, you know, K through fifth, parents are, you know, asked to complete the STQ, or we're asking, you know, teachers to do it, and it doesn't need to then come from the OT per se, we can help advocate for this, but if there's a real intentional system put in place, and this is where I think MTSS can can work beautifully when it there's alignment at that administrator level of we're going to be using these screening tools, and then OT can come in and say, oh, you know, I'd really like to look at those SDQs that had elevated scores. I know that that might be indicative of sensory processing challenges, and I'm going to, you know, then when I'm in the classroom, I'm going to just do an observation, and we can certainly be doing an observation, and then say we notice, oh yeah, gosh, that here's three kids who I'm really seeing some red flags. Then we could go that step further, of maybe we need to, you know, start some data collection, get some, you know, consent in place to maybe, you know, whatever the school's policy is for that data collection period to then you know maybe have an SST and and go you know further down the line but I think when it really is done intentionally and across again that collaborative piece of it's part of the PBIS so the behavior support team is involved it's this, you know, hopefully, gosh, you know, the school counselor, if a school can have a counselor, you know, they're involved too, because it has metrics that can be really indicative of needing additional mental health support, we can really then create that wraparound support we, we strive for. Jayson Davies yeah, yeah, I like to often like kind of compare a really like if we were to put a screening process in place as occupational therapy practitioners, it needs to be a system like what you're talking about, and I often kind of just compare it to the way that a lot of schools do like vision screening every so many years, every student gets screened for vision, and you know it's every kid doing it, it's not being singled out who's getting it. I notice might go home a week or two before saying, "Hey, your kid's going to be screened, please let us know if you don't want this to happen. Like, that is something that can happen, but yeah, it has to happen at a systems level, and you could probably start with just the three kindergarten classes on campus first year, and maybe work up from there, but yeah, I do think it needs to be part of a system. I would not advise an OT just to go ahead and start this screening process without reaching out to the principal and saying, hey, I found this new SDQ that I've heard about on a podcast, and it'd be really great if we could just give it to every kindergartner, and you know, look at the data and see if there's something we can do. There you go. Yeah, a template to use. Courtney Boitano A little like anecdotal story of my own children's school, you know, public school. They, as I. Was, you know, doing this study, and kind of came across the SDQ. I was like, oh, I've done this before, and so my kids' school, they did that, they did that, they sent it out, kind of same thing, just like you said. We're, and it came from the counselor, we're going to send out the SDQ, totally optional to complete it, and they did it two times a year. Jayson Davies Oh, wow. Courtney Boitano And it was so great, and this school also has a really strong PBIS program and systems set up, and it is where I have seen I often go back to it, just, you know, mentally, of like this is where RTI was done so beautifully, because I was also providing some OT services there too, and so I was able to go in and, like, co-treat with the teacher, I would lead a center while she was doing her writing workshop, and while I only had, you know, two kids on my caseload in that classroom, I was able to touch all 20 by having them come through my center, and you know, just kind of give that OT lens of like, oh, you know, those little pencil grip adjustments, or like, oh, I'm kind of noticing that this one, you know, their writing is all over the place, let's try it, you know, slant board, or whatever, those little, those little weeks we can provide. Jayson Davies Yeah, I love the idea of MTSS, but I will admit it is hard to put into place, and that's why we're seeing a lot of professional development around it. Dr. Jan Hollenbeck, Jamie Spencer, and Mahler Bushel just presented about it at AOTA Inspire in Anaheim, and it was a full packed room, like everyone wants to do this, but it's not easy, and it's great, like we have the ideas now, we just got to put it into place, and we got to put the systems in place with support from other people, which is like where this entire conversation started by you talking about your amazing APE teacher and speech therapist that you got to work with, so all right. Before we do wrap up, though, I know that you kind of teased a little bit ago that the findings weren't exactly what you'd hoped for, but this is also a small study, and kind of a, you know, pilot per se. What were some of the results that kind of, you know, were not what you hope for, and also just, you know, how you feel that it can move forward. Courtney Boitano Yeah, for sure. Yeah, I mentioned, you know, of course, I wanted to see that we would really see big changes on the severe difficulties and moderate difficulties on the SPM, and that wasn't the case, but what we did find, you know, as we kind of sat with the results, and like, okay, what does this tell us? You know, one of the things we thought of, the students and myself, is like, I think, you know, it really shows how the teacher's understanding of sensory processing changed, and we, we know that, because we also had this qualitative component where we interviewed them, and we were able to, like, really hear what, what this was like for them to be a part of this, and they had a totally different lens on doing the, you know, pre and post of the sensory processing measure, they had a totally different lens after even just the in service, so we saw that, you know, the in service was really helpful, both for the fifth grade study and then the kindergarten study, that the teachers gained so much, but the consultation piece was huge, so in doing the post test of the SPM, it was a, it was like a different person filling it out, right, because they didn't just see the tip of the iceberg, right, they didn't just see the behaviors, they understood what was a little bit beneath it, which was just so cool to the testament of OT and what we can provide from these different modalities, right, whether we are working with the students or we are doing an in-service for K through eight teachers, or we are doing that consultation piece a couple times a month, and again, like really tailoring it, that's the nice thing about that consultation, really tailoring it to the unique needs of that teacher of that classroom of the students in her classroom. Jayson Davies so you had a total of three different tier one interventions, you had the upfront workshop, you had the consult with the teacher, would you call that still tier one? Courtney Boitano Well, no, I kind of think of it different. Jayson Davies tier two. Courtney Boitano Yeah, I would say, like, yeah, that's more.. I mean, maybe even tier three for the teacher, because it was that one on one time. Jayson Davies Interesting. Yeah, I like to think of the personally, I like to think of tier one as being like beyond the classroom, so multiple teachers. First, I like to think of tier two as being classroom specific, because I think that just kind of puts it in a nice shell, and then maybe small group, which then it confuses - it gets confusing because now you're saying wait as a classroom or small group, and then tier three being more the individual. Either way, the point of my question was to kind of go back, would be of the three different models you used, if you were talking, you know, to a school-based OT and said, 'Hey, I want to get involved with MTSS. Would you, would you advise one versus the other? Courtney Boitano I would highly advise that consultation piece, and I often talk to colleagues, you know, working in schools, and really, you know, as they share the, like, the consultation piece is the hardest, because it's what it's where we kind of can feel like, oh, we have wiggle room, right? Like, oh, I have an IEP, like I'm not going to make that consultation time, like I could push it off, right? Or, you know, just to the teacher isn't available when you're available, and. Jayson Davies Yeah, it's hard. Courtney Boitano It's very hard to really figure out how to do that, but kind of going back to where we started with, like, how does this work well? And I think it works well when we have that rapport built, where we, we build that community at our school sites, and I've, it's why I love school-based OT. It's, you know, I've some of my best friends are teachers that I've worked with, right. And it's just the hanging out for 15 minutes over lunch in their room, and that's the consultation piece, right? Or it's, you know, they're doing car line in the morning, and I'm out there with them, chatting, and you know, having it's also great to get to know that, you know, the family side, yeah. work with, but you know, finding these ways where we can build that community, so that that consultation starts to happen more seamlessly, where we, you know, can become kind of more top of mind for the teachers to be like I'm going to run that by Courtney, I'm going to run that by my OT, so it doesn't seem like such a big ask or a big kind of to-do item on our on our list of things to do, and so I think, like, that is one of my big takeaways. It's so impactful for the teacher to get that opportunity to problem solve, to troubleshoot. We can offer a few, you know, suggestions and strategies. They can try it and tell us whether or not that worked. They're with the student five days a week, where we might only be with them once a week, maybe twice a month, and so it can really help with that carry over and empower them, like the teacher at the school who got the consultation piece. She was a veteran teacher, you know, 20 plus years, and she said at one point she was like, I just feel like all of my tools in my toolbox are not working anymore, and you know such a sense of defeat, right? Of like, I know what I'm doing, I'm a good teacher, but nothing is working. But then there was a sense of empowerment, right, where we can offer those tools, and she's doing it, not the OT coming in and leading the group, it's not the OT coming in and making environmental adjustments, but she's doing it for what works for her and her class. And then she felt the sense of empowerment and could speak to the parents too, and actually bring up some of her concerns. That was a big piece too, of sometimes feeling like I don't know if it's my place to bring up some of these concerns, but where we can help with that explanation of what's going on, not just from a behavioral but from a nervous system perspective, and increase their knowledge of what to do, build that toolbox up again can be really empowering for for teachers who are feeling like this is a different classroom than I stepped into 30 years ago. Jayson Davies Yeah, one on one can be so impactful. I'm wondering if you think that if you had met with, assuming that there are other kindergarten classrooms at that school, do you think you could have had similar impact if you met with all two or three of the kindergarten teachers at the same time? Courtney Boitano Absolutely, because I think that also builds a sense of comradery. I mean, hopefully they already have that sense of camaraderie amongst themselves, but really gives that opportunity for them to to use each other to to build off each other strengths, you know, they know the school system, they know the administrators, so to really get some of those conversations going about, you know, how they could even advocate as the kindergarten team, right, or the first grade team, or whatever it might be, Jayson Davies yeah. Yeah, I just think that's a way that you can, it can be difficult to talk to three, four, or five different teachers, time consuming, but yeah, if you can meet with all the kindergarten teachers at once, maybe even K and one, if they're having similar concerns, or at least maybe TK and K, like that can save you some time and help more people all at the same time, so for sure, very cool. Courtney Boitano Yeah, I love trying to go to their team level meetings, like a number of, you know, will get out early one day a week for collaboration, and then they'll break into, like, they'll have maybe a faculty meeting, and then break into their team level meetings, and so I'll try to go to, like, whatever is kind of top of mind that I know they're needing some support, and even just listen, you know, maybe some weeks I'm not saying anything, and I can, you know, get some charting done, but, but just hearing what's going on, right, and it just also builds that that sense of community, and being being someone who's on their team too. Jayson Davies Yeah, yeah, that's important, having someone on your team. So, all right, Courtney, I think that is going to wrap us up. We talked a lot, and we did not get to dive into every single detail of your articles, but that's okay. They are available, they're out there on the JOT C to read, and you can access them there. So, thank you all. Thank you, Courtney, so much for your time. I really appreciate it. And thank you all for listening to this episode. Really quickly, Courtney, where is the best place for people to potentially find you if they just want to learn a little bit more about you, about the research you've done, your, you've done, and are doing? Courtney Boitano Yeah, I have a website for my small private practice, OT outside.com and then also, you know, at San Jose State on our website, and it can easily be reached there as well. Jayson Davies Fantastic. And if you are potentially a student listening, San Jose State, you could go there and learn with Courtney and the rest of the staff that they have up there, which are some amazing people. I always enjoy when we get to AOTA and get to see some of my San Jose State friends, it's always fun. So, Courtney, thank you so much. Really appreciate it. And we'll definitely have to stay in touch, especially when you have new research coming up, perhaps soon. All right. Well, thank you so much. We appreciate it. Courtney Boitano Thank you. Jayson Davies Well, Courtney, I want to say thank you one more time for joining us today and sharing your research on MTSS, as well as how you actually implement these sensory interventions in practice. Your work at San Jose State, as well as in the schools, is helping us to understand how to make MTSS more sustainable and impactful, especially through teacher consultation, which, as you shared, can sometimes be a little difficult to prioritize, as well as implementing, so thank you for that. Really helpful. Now, I don't think I've mentioned this quite yet. I usually do, but be sure to find all the links that we referred to in this episode in the show notes, like the SDQ and the zones of regulation at ots.com/episode 203203 203203 and if you want to dive even further into implementing MTSS within your schools, building consultation skills, and getting support from a community of school-based OT practitioners like us, who are doing this work right alongside you, I'd love to have you join us inside the OT School houses school-based OT collaborative. There you'll get access to courses, monthly mentorship calls with myself and a supportive community of practitioners navigating the same challenges that you are every single day. Head on over to OT School house.com/collab to learn more about all the resources, mentorship, and CEUs that we have available, and join us in the community. Thanks again, Courtney. Really appreciate you being here, and also thank you for listening. Until next time, keep making a difference in the lives of your students, and yeah, we'll catch you in episode 204 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. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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 Schoolhouse Podcast

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 202 of the OT Schoolhouse Podcast. Are you still relying on the Peabody or BOT as your go-to assessment? You're not alone, but you might be missing something critical. In this episode, we dive deep into occupation-based assessment with Dr. Alysha Skuthan and Dr. Erin Gaby, who recently published groundbreaking research on the occupational profile in school-based practice. This conversation is for every school-based OT who has ever wondered: What actually makes an assessment occupation-based? Why does the occupational profile matter? And how can I fit it into my already overwhelming workload? The research reveals surprising findings from their research showing that 35% of school-based OTs don't complete occupational profiles, despite it being a formal requirement in the Occupational Therapy Practice Framework. You'll hear practical strategies for collecting occupational profiles, honest talk about barriers like time constraints and parent communication, and compelling reasons why using occupational language in your reports matters for advocacy. Plus, they discuss occupation-based alternatives to common standardized tests and share their favorite tools like the School Function Assessment. Listen to learn how shifting to occupation-based practice can transform not just your assessments, but your entire intervention approach. Learning Objectives — Learners will identify the key characteristics that distinguish occupation-based assessments from skill-based assessments — Learners will recognize why the occupational profile is an important component of every SBOT evaluation — Learners will identify the importance of using occupational language in evaluation reports for professional advocacy Guest Bio Alysha Skuthan, PhD, OTR/L, CWHS is the capstone advisor and an adjunct assistant professor in the Post-Professional Occupational Therapy Program at Shenandoah University where she facilitates doctoral research and academic writing. As a pediatric occupational therapist of 11 years, she prioritizes occupational engagement through occupation-based practice and family centered care. She is well published with over 18 peer reviewed publications, more than 40 poster presentations, and an AJOT Authors & Issues Webinar: Session 39. She graduated from Nova Southeastern University and the University of Florida. Erin Gaby, ppOTD, OTR/L, BCP earned her entry-level Master of Science in Occupational Therapy from Milligan College in 2006. Since 2007, she has worked within the Greene County TN Public School System, where she has spent the past 19 years supporting students and school communities through occupational therapy services. In 2023, Erin obtained board certification in pediatrics through American Occupational Therapy Association. She further advanced her education by completing her post-professional Doctorate in Occupational Therapy from Shenandoah University in 2025. Quotes "We are occupational therapists. Occupation is what gives us our skill. That's our special sauce because nobody else is an occupational therapist but us." — Alysha Skuthan, PhD, OTR/L, CWHS
"If we aren't using occupational language, then no one else is. We as OTs are our own worst enemies because if we're not advocating for our profession, nobody else is going to know." — Erin Gaby, ppOTD, OTR/L, BCP
"If we want to have therapeutic benefit, we have to have that rapport. And it starts with finding out what do they like? What's important to them?" — Erin Gaby, ppOTD, OTR/L, BCP "The occupational profile allows me to facilitate participation with the kid, that active engagement, which is so essential in therapy." — Alysha Skuthan, PhD, OTR/L, CWHS "I've never regretted picking up the phone and calling a parent. I have regretted not picking up the phone and calling a parent." — Jayson Davies, M.A., OTR/L Resources 👉AOTA Occupational Therapy Practice Framework, 4th Edition
👉 School Function Assessment (SFA)
👉Pediatric Evaluation of Diability Inventory Computer Adaptive Test (PEDI)
👉OT Schoolhouse Occupational Profile Template
👉Integration of the occupational profile in school-based occupational therapy evaluations: A mixed methods survey
👉Dr. Wendy Stav
👉Bruininks-Oseretsky Test of Motor Proficiency(BOT)
👉Beery Visual Motor Integration (VMI)
👉Miller Function & Participation Scales (M-FUN)
👉Goal-Oriented Assessment of Lifeskills (GOAL)
👉Print Tool — Occupation-based handwriting assessment
👉Evaluation Tool of Children's Handwriting (ETCH) Episode Transcript Expand to view episode transcript Jayson Davies Are you skipping the occupational profile during your evaluations because maybe they take too long? If so, you are not alone. We're going to talk about that research in just a moment. However, you might be missing one of the key pieces to your evaluation that AOTA actually requires. Welcome to the OT School House podcast, where we dive deep into school-based occupational therapy practice. I'm your host, Jayson Davies, an OT practitioner with over a decade in school-based OT experience. Today, I'm joined by two incredible OT practitioners, Dr. Alysha Skuthan, a faculty member at Shenandoah University and a leading researcher in occupation-based assessments, as well as Erin Gaby, a school-based OT practitioner with 19 years of experience, who recently completed her post-professional doctorate, which, of course, we'll be discussing right now. Together, Erin and Alicia published research revealing that over a third of us school-based OTs aren't completing occupational profiles during our evaluations, and that is despite it being a formal requirement within the occupational therapy practice framework that document we call the OTPF. In this conversation, we are going to break down what actually makes an assessment occupation-based, why the occupational profile matters more than you might think, and practical strategies for fitting it into your already overwhelming workload. So, if you've ever wondered if conducting an occupational profile is really necessary, or how to conduct it in an efficient manner, or maybe even how to incorporate it in your real report that you have to write for that IEP. Today's episode is for you, and if you already know all that, well, stay tuned anyways, because we're going to talk about how this occupational profile can actually guide which assessment tools you use later in your evaluation. Let's dive in with Erin and Alysha. 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 Erin and Alysha, welcome to the OT School House podcast. I hope you are having a fantastic afternoon, and I want to start off with just a really fun question, and you know what, Alysha, we'll start with you. What was the first assessment tool you ever remember using in your school-based OT practice? Alysha Skuthan Oh my gosh, I was ill prepared. Jayson, no, I'm just gotcha. I think, right? I think, honestly, probably the first tool I ever remember in schools was the PD, or no, yeah, I think it was the PD. Jayson Davies the PD. Alysha Skuthan Yep. Jayson Davies all right. And you know, we're going to start talking about some occupation-based assessments here in a moment, and maybe that one will come back up. But I also want to throw it over to Erin really quickly. And for you, the same question, what was the first school-based OT assessment tool that you recall using? Erin Gaby I would say it was probably either the Peabody or the Berry Visual Motor Integration, that's probably what I was shown first when I first started. So. Jayson Davies that's very common, right? Especially the Peabody, that's a common one. So now I want to throw it to whoever wants to respond first to this one. Is that an occupation-based assessment tool? Erin Gaby No. Jayson Davies Perfect. That should be the answer. I think that's the answer for most of us. I think a lot of people would have responded with the Peabody as well. The PD might be out there, the bot, whether it's the two, the three, whatever iteration that was out there when they came in the SPM sensor profile, right, those are very common assessment tools that we get to know in our first few days as a school-based occupational therapist. But today we are here to talk about occupation-based assessments, and let's dive in. And I really want to start with you, Alicia. What does it even mean to be an occupation-based assessment, like we throw this term or word, we also say don't use jargon, and this is obviously a jargon-filled word. What does it mean? Alysha Skuthan Right? Great question. So, I think it's so it can be so muddled, but yet it should be so clear, because we are occupational therapists, right now. I try to explain to my husband, who's not an OT, and he goes, yeah, occupation, you use occupy, I go, yeah, can you elaborate, you got it after all these years, he goes, maybe, right, so it's just it's one of those terms that can be so nuanced, but when we think more about occupation based, I think the key is to prioritize occupation as the focal point in what we do, right, so that is what gives us our skill that's our special sauce, because nobody else is an occupational therapist, but us, right? So that's why it's intended to be infused in what we do. So, how can we incorporate occupation at the core through the lens when we do assessments, when we do our treatments, and when we do interventions? So, occupation-based practice is really at the forefront. Prioritizing occupations instead of more of the rote skill type practice, which might be, oh, stack these blocks, oh, write your name, oh, do this. It's looking more holistically that top-down approach for what are the occupational challenges that the child might be experiencing when we're in schools, and how can I best facilitate that type of progression versus only writing a name, only doing a button, only you know, looking more specific at the skills, occupations more holistic, looking top down at overall, what are they able to do, are they able to engage in their everyday routines in school, what does that look like, what are those overall occupation-based implications? Jayson Davies Gotcha, and okay, you kind of answered this already, but I'm gonna, I'm gonna go a little bit further. I'm gonna press if a school-based occupational therapist, your practitioner, right, is listening. Like, I just want to be able, in 10 seconds, to recognize if this assessment tool that I use 300 times a year is occupation-based, is there a quick question that they can ask themselves? Alysha Skuthan I think, yeah, I think it's what goals do you create, right? So, I think it's, and when we have something like Aaron mentioned, the Peabody, right, it can be very specific, like I'm making a goal for them to build VMI, I'm making a goal specifically to improve fine motor, whatever that might mean, right, versus I have an assessment like the SFA, where it's looking holistically at their performance within schools. My goals are going to be more related to their participation, they're going to be related to more of their academic performance, they're going to be related to larger scale contexts, which are the occupations that we want to dive into when we're doing these more specific assessments. I'm not saying there's not a place, but it's not occupation based in the same way I think that we're trying to do occupation based practice when we push in in the classroom, when we're in that academic setting, it lends itself to occupation, but yet sometimes those assessment tools that are so rote, we've done them so many times, fall into that skill based assessment, and we miss out on the overall occupation. Jayson Davies Man, I wish we could all talk about occupation the way that you do. That would be fantastic. Alysha Skuthan Thanks. I'm a little obsessed, so it's a problem, but I'm willing to admit I have a problem. Jayson Davies It all starts with understanding that part, right? Alysha Skuthan Right. Jayson Davies Okay. Now you have been completing this work for some time, and we're going to dive into Aaron's work, specifically about the occupational profile in just a moment, but this is to a degree a piece of your larger project where you are really trying to support OT practitioners to be occupation-based, not just in assessments, but in general, and I just want to hear from you, like, a where that started, and kind of be where it is now. Alysha Skuthan Yeah, great question. I appreciate that you're calling me old. I'll take it. It's okay, but I have to first give to it's fine. It's fine. Dr. Wendy Stav, she's phenomenal, fantastic. She was my mentor back when I was getting my PhD, and she opened up my eyes to I identified occupation was not happening with what I was seeing in pediatric practice, but she helped paint the picture of, oh my gosh, it's actually lack of occupation-based practice, and that was my light bulb moment of a, I am sick and tired of doing the Peabody, I am not going to do it again, these goals, if I see one more goal for stacking blocks from a level two field work student who comes in, or from an assessment I'm given when I collect a patient from somebody else. Right, we all share them. It was just.. I was done. I was tired of seeing it. I'm like, what? What makes me skilled, right? If there's.. if somebody else can come in, a developmental specialist, and say, okay, these are the results if I was doing EI of this limitation developmentally here. What makes me unique as an occupational therapist. So it just was a lot of reflection, and I go, "Oh, wow, you know, I think I missed out when I was first practicing on this concept of occupation, because I was so focused on getting that insurance check mark, getting my billing taken care of, that I didn't take a step back and reflect on, am I actually doing occupational therapy or am I doing skill-based supports that don't require this OT lens that we grow and we acquire during our time in clinic, clinical practice, and back in schools. So, it led me to my dissertation, and that came in several publications, and I've been grateful to continue working on that. But my one of my biggest studies came out in age ot 24 no, 24 I don't know what year it was, 2021 I think it was 2021 maybe, maybe 22 My son was born like it's a model, but it came out in a jot, and I really dove into, okay, what are OTs out there using, especially pediatric wise? Am I right? Is it really the Peabody? Is it really the bot, or am I? Is it something where there are other assessments I'm not familiar with, because I'm still growing. We're all learning every day as OTs, right? So I wanted to take a big scale approach and quantitatively explore what's out there. Do people know what occupation-based assessments are, and if so, why not? What does that look like? So then I did a qual study where I dove more specific. Into what that implicates for practice when they do pick occupation-based assessment tools, and then it's just spiral from there. So it's just a continuation of how else can I look at this occupation-based assessment component and highlight, okay, there is a problem, but what can we do to kind of fix that problem and help us as a profession use occupation intentionally, beginning at that assessment piece. Jayson Davies Okay, I've gotta, I've gotta ask this follow-up, because I can, I can hear people screaming at me. You mentioned, like, what are the outcomes of using an occupation-based assessment? I believe you would, where you would go forward from that is the actual intervention itself. Before you mentioned that, I was going to ask, like, what is the problem with non-occupation-based assessments, like, you know, the Peabody BD and the Bot Three, but let's go with the more, I think, positive kind of the direction you were going, and why is, how does it help us down the road? Alysha Skuthan I think it changes our perspective, right, so when we pick the skill-based assessments again, there's a time and place. If a kiddo comes in and they're having really specific visual motor integration, great, pop out the beery, fine tune, facilitate, but yet when we get those specific skills, what is our overall goal here? We want to make sure we have the translation and the application to the occupation, because that's our job, right? We can practice and say, okay, yes, this kiddo can now do a puzzle. Great. So, what, right? So, for me, and when I, you know, did some of these studies and things, when therapists intentionally use occupation-based assessments, it was very common that they said their perspective shifted, so occupation remained the focus, and depending on their setting, when it was school-based, it was that collaboration with the teacher and really intentionally integrating into the classroom and that child's routine, right? So that way the occupational focus could be embedded into the appropriate contextual facet, whatever that would be for that particular child. And when I talked to outpatient clinicians, I saw that the therapist who did and were intentional about it really focused on the caregivers, right, rather than them being the OT end all be all. You got to come see me, I'm going to give you the supports. It was a how can I shift my perspective through parent coaching and modeling through this occupation lens? Because that kiddo is with that parent way more than I'm with them. So how can I facilitate the occupational engagement when I'm not here? Right, it's just it's just that mindset shift. So interventions tend to look more occupation-based versus a here's a worksheet, right? Try this grip, try this whatever specific tool that would be more skill in nature, and instead can be okay. The occupation, the problem is that this child can't sustain attention in the classroom. It's not that they can't write right, they have that component, but how can I tie in handwriting within this overall occupation to promote the attention, to promote the participation in the classroom, which is the occupation that we're looking at there. Jayson Davies Absolutely, and part of being an occupation-based practitioner is using an occupational profile. Cue the segue over to Erin. This is perfect, because I, I use an occupational profile. One of the things that at the OT schoolhouse we did years ago is we actually kind of adapted a OTs version of an occupational profile kind of to fit the school needs, because it's a very different environment, and we needed something, you know, specific to our environment. That said, I never thought about it really as an assessment piece, like for me it was just kind of this knowledge background, right, like getting to understand. So, Aaron, I want to kind of jump over to you here and kind of say, or ask, what was your hypothesis, and why address the occupation profile when it is very well established in the OTPF? It's something that I think we all learn about in OT school, so why was it necessary to kind of dive into it further? Erin Gaby So I've been an occupational therapist in a school setting for 19 years, and so I've seen a lot of OT evaluations like come across my desk, and I started noticing that I was not seeing that section that said occupational profile, and I remember one specifically that I got from another therapist that was actually it was working in our district but not on staff, and there was like two sentences at the start of the report, and then it just jumped right into like a visual motor test, and I kept thinking, I just really want to know, like, what does this student like, like, what's their favorite toy, or what's their favorite thing to do, and I wasn't seeing any of that, and so it just made me really want to explore, is it just these that I. Seeing, or is this going on in other places as well? Like, is it just me, or is it a practice issue? Jayson Davies Yeah, absolutely. To follow up on that, right, you brought up some questions that are in our occupational profile, like, you know, what does the kid enjoy, where what are their routines, you know, what client, what type of environment does their classroom look like? I know that's part of the occupation profile as well, but I'm going to be honest, I think when we're asking these questions to a teacher or a parent as a school-based therapist, what is your kid's favorite toys? What are their TV shows? What do they enjoy? What do they not enjoy? I sometimes wonder, like, are they like wondering why are we even asking these questions, so like I guess for us, as though as a profession, like why is that so important before we dive into the VMI or a different tool, Erin Gaby right? It's, I mean, I feel like a lot of it's about intrinsic motivation, like I really need to develop a rapport with that student. If we want to have, you know, a therapeutic benefit, we have to have that rapport, and so it starts, I feel like, with finding out, you know, what do they like, what's important to them, what works well for them, because we can use that, you know, to our, to help us, you know, like help that student. Alysha Skuthan I think it's definitely like you said, Erin, participation over compliance. I know that's a buzzword that kind of pops up lately, but yes, totally agree. Jayson Davies Yeah, yeah. For me, one of the reasons that I key in on occupational profiles so early on in my assessments is because I feel like it can guide me through the rest of my evaluation process, not only the rapport that we're able to build with not even just the student, the teacher, and the parent through the occupational profile, but also feel like it guides me because if I don't understand the real concerns from all the different parties, then how am I supposed to know where to go with my actual evaluation? Does that resonate with either of you? Erin Gaby Yes, absolutely. I mean, I feel like in the school setting, especially like when you're working with children in general, it's not just that child that you're working with, I mean, there's parents, there's teachers, there's classroom assistants, there's other therapists, I mean, it's, it's a huge team, and so it's so important to get, you know, all that perspective for sure. Jayson Davies Great. All right. Well, we take a very quick break. When we come back, we're going to dive back in with Aaron to discuss the components of an occupational profile, and also why some of us use it, but don't say we're using it. So, stay tuned. All right, we're back. Erin, you mentioned a few different components of it. We talked, you know, about rapport, participation. What are some of the key components to an occupation, occupational profile, especially when we're using it inside of the school-based realm. What do we want to collect? Erin Gaby I think we start with kind of the things that people traditionally think about, where you're trying to find out, is there, you know, medical history or their, you know, family history, you know, experiences that they've had, have they already had special education services before, any school therapies already previously, you know, or outpatient therapies. But then it goes, you know, we expand that and start looking more at the environment, like what are some supports that that child already has in place that could help them, and then also, what are some of those barriers or things that they don't have in place right now? Just like one example might be even like insurance or family supports in place, you know, what is their family life like? You know, is the parent working, you know, things like that. I mean, all those things that I think we, as OTs, consider, and we look at those details, even though others may see, like, you know, they may not understand why we're looking at those specific details, but then finding out, you know, what is that occupation of concern in the school setting, asking the teachers, you know, asking the student when you can, and asking the family, you know, what are your concerns? So. Jayson Davies Yeah, no, I think that's true. I always like to get as many people as I can to tell me both whatever the concerns might be, as well as, you know, what they view as the student's strengths, and so that way the more information that we have, it's data, the more data we have to then continue on with either the rest of our evaluation, eventually our actual recommendation synopsis, and then our intervention. So it absolutely does help you mentioned a report once upon a time, right, having two sentences. About the student in the ideal world, what does an occupational profile look like on an evaluation from your perspective? Erin Gaby I guess just going based on like how I've done my own is it's just the very first thing that I start with on my evaluation template, it's it's the very first page and I just go through, I usually start, you know, with the background information that I have, and then, you know, having that section on what are that child's strengths, and then a section of what are the challenges currently, and really that section is very key, because you're finding out right there in that moment what is the occupation of concern, and that you said it kind of guides you for the whole rest of the evaluation process. Jayson Davies Yeah, Alysha, what about you? Is there anything in particular that you really like to use in your evaluations? Alysha Skuthan I mean, I think it's intentional. I feel like the occupational profile can be conceptualized with intentional questions, right? Just kind of really looking in the moment, seeing the response of the child again, if applicable, right? If the kiddo can participate, and then diving into the additional personnel, but tailoring what I ask, so I can create that comprehensive perspective. But I always want to know what the kid likes, right? I always want to prioritize that on there, what they don't like, because if I come in with a bluey worksheet and it's going to be a mass hysteria panic meltdown, let me avoid that, right? Like, let's use our questions, so we can create a beneficial session for the children and for the whole team, right? And I know I mentioned before briefly, but I think the occupational profile allows me to facilitate participation with the kid that active engagement, which is so essential in therapy, by looking at the environment, knowing the parents' background, knowing the kiddos' background, right, more specifically outside of just the OT assessment results, right, or whatever assessments we end up selecting in that in that timeline, in that process. So, I think for me, the like session section is most important to paint that whole perspective, so if Erin's out of town, I can take over her, you know, caseload for the week, and I'm able to jump in where she left off. Jayson Davies Yeah, awesome. Thank you. Now, Erin, diving a little bit deeper into your, your actual work, Alicia, your work as well, you guys are co-authors on this work, you had some interesting findings: a) not everyone's using an occupational profile, and b) as I kind of hinted earlier, some people are using an occupational profile to a degree, but not calling it that. Let's start with the first part of that, and let's break that down. Why do you cited 65% of participants are completing an occupation or profile? I just kind of like, okay, well, that means reverse math, right? Did the math the opposite way. 35% of us are not conducting an occupation or profile. Let's first start with maybe the why. Did you glean any as to any reasons as to why it might not be being used? Alysha Skuthan I think, based on, you know, the results and things, why people don't use it, there were several factors that were listed, right, when we looked at all the themes from the responses that we gathered from participants, and one of the factors that I found most interesting was that the therapists themselves were a factor, right? One therapy, one participant, she said, you know, verbatim, I've never heard the term occupational profile before. Today, I graduated OT school in 1988 and I go, 'Whoa, okay. Like, as I'm reading, I'm going, 'Okay, like, I appreciate the honesty, and I'm so glad that people were reflective in that moment, right? That maybe it's something that they might not remember it from OT school, or maybe you know things have shifted obviously in the past. What would that be, x number of years, right? So I think that the therapist themselves can sometimes be barriers, because we're not required to take a CEU on the occupational profile to be practicing, right? We have to maintain up-to-date and evidence, but again, that's an opportunity for our profession to say, well, what does that need to be, so we can create that consistency, time constraints, workload, like my caseload is too busy, I don't have time to add this occupational profile to an already busy, we all know what IEP season looks like, right? We get it, right, but that was a common barrier listed, sometimes they would say lack of space or access to caregivers to parents to kind of get that again, that holistic perspective to support that profile. Right, I mean, I remember where I well write the note home to parent, you hope you get a response right. Obviously, we can use email communication, other methods, but I distinctly remember towards the beginning of my career I would send home a note and then never hear. I'm like, that's great, great communication, right? So I understand, right? Jayson Davies I want to ask you on that. I want to ask you on that really quickly, because that happens a lot, right? We send home a flyer in the backpack, or a question on the backpack, we hope we get it back. We send home an email, hope we get it back. Sometimes the email just initially, or it just comes back, like this email does not exist, it happens, or. We just can't get in touch with the parent. Do you allude to that in your report? If something like that happens. Alysha Skuthan Do we, Erin, talk? I know we mentioned that as something that the therapist indicated that they don't do, but I think it wasn't really the results of our study where it gleaned on what to do next. I think that'd be a little bit outside of the scope of just the study results, but as far as if you're asking, you know, clinically or my perspective on it, I feel like it's our job to get to know the family outside of only IEP season, so creating that intentional involvement, whatever that might mean, right? And Erin, feel free to jump in with what you think that might look like as well, of course. Erin Gaby Just when you were mentioned to you about the do you include that like in the report, I don't, I had read a school psychology report, actually just today, where she had noted, she said I, you know, reached out to the parents or by phone and received no answer, and she had actually typed that into the school psychology report, so. Jayson Davies Yeah, I've seen that too, and I think it was after I saw it in a school psych report that I was like, should I be doing this, and you know, I'm not saying it's in regular practice of mine that I put that into the report, but we all have cases where we know that something might go to trial and might be reviewed by others, and I go back and forth as to whether or not that helps hurt or does nothing for our evaluation, like it's kind of like throwing someone under a bus, but at the same time, if you don't put it in, then you get back to the whole if it's not documented, it never happened type of thing, and so if it's not documented that you tried to reach out to the parent, then it's not, yeah, so sorry to throw you both on the spot there, but like I think it's just something, it's one of those things that comes up, and we each have to kind of figure out what we're going to do in that case. Alysha Skuthan Agreed, and I think you're fine, throws on the spot, we don't mind, but maybe Erin. Hey, no, I'm kidding, but we're good. I think it's important we have to document it right. If we don't have that opportunity, then who else can we lean on here? Right, who else in the scope of the child's everyday participation in school can we then ask to facilitate what this occupational profile needs to include? But I think if we don't document it, then that can cause us to be in an ideal situation as we progress into, you know, our trajectory within the care for that child. Erin Gaby It kind of gets to circle back around, it could kind of just contributes to that occupational profile, because you're thinking, oh, okay, so maybe this child, you know, doesn't have maybe the same parent support in place, and that's being very judgey. I don't, I'm not trying to judge, just it's just something like a thought that might be something that you. Jayson Davies Makes you wonder. Erin Gaby Yeah. Jayson Davies Yeah, and maybe you follow up again, or you try, and I mean it's hard. Not every occupational therapy practitioner can can go to, like, back to school night and track parents down, or anything like that, but you know it's nice if we can be visible, and at least, like, it's nice to be able to put a face with a with a name and a parental face with a child face, and like, these two go together, and yeah, that's hard when you have 100 kids, I get it, teachers have 30, and it's hard for them, but you know we try, we try our best. So, all right. Alysha Skuthan as we can. Jayson Davies What were your initial reactions when you heard that 65% use an occupational profile, obviously alluding to 35% don't? I don't know which one of you was actually the first to see that data point, Alysha Skuthan that would be Erin. Jayson Davies Yeah, do you remember that moment? Erin Gaby Well, it's like we, where we use the Google form, it automatically made these cute little pie charts, the data charts. So I was a little, I'm kind of a nerd, but I was a little obsessed with, like, I would go in and check and see every time somebody was surveyed, I could say, oh, you know, you would see the pie chart shifting. Jayson Davies Yeah, yeah, I do the same. Erin Gaby Though. Yeah, but it's.. it's one of those things. Sadly, in some ways, I wasn't surprised. If that makes sense, I guess, just based on what I had seen on the reports I had reviewed before of OT evaluations, so I wasn't super surprised, but also it did is a little disheartening, I guess. Maybe. Jayson Davies Yeah. Erin Gaby To see that. Jayson Davies Yeah. Alysha Skuthan I thought it was going to be lower, to be honest. Jayson Davies Oh, really? Alysha Skuthan I did, yeah, because I think there's not the intentionality with integrating that particular phrasing on the assessment, so it might just be the perspective of, okay, you know, actually I might be doing components of the occupational profile, which likely does happen, right? And that's a limitation we talked about, was we weren't there, you know, explaining or there in moment, it was a survey, right, and so I think that there might be some. Participants potentially out there who are doing components of the profile, but it's just not through the lens of a comprehensive occupational profile. So, I was expecting it to be lower, just because I know the language isn't always available. As Aaron said, it's not something I see often. Jayson Davies Gotcha, gotcha. And, as we kind of alluded to earlier, some people use an occupation profile, but maybe don't call it that. Before we dive into the details of that, were those people included in the 65% who do, or the 35% who don't? I know it's been a little while since you looked at the numbers, but how would that, would that go? Erin Gaby I think the way we worked with the question was, it was just that, do you, com, you know, do you complete an occupational profile as a part of your evaluation? So it wasn't just, we didn't specifically ask, do you complete components of it, we just kind of asked in general, but then in the qualitative data people, some of the participant comments specifically would state, oh, well, I use components of it, but just not formally. You said. Jayson Davies Gotcha. Okay, that makes sense. So then let's talk about, did anyone share with you what they called it, instead of an occupational profile If they put it on their evaluation? Erin Gaby I think some of it fell under what you would consider like a background section, like background slash history section. Some people commented that they did that instead. Jayson Davies Okay, no, I think that's fair. I mean, like, for a long time I did have it, was just background that was the evaluation wording that you know was passed on to me from the OT practitioners before, and even if I had created, I probably would have thought to do the same thing, because we're not trying to use jargon, potentially. However, as occupational therapists, occupation is very key to what we do, and so I also see the value of being forward with it and making this our occupational profile and putting it as you kind of alluded to Aaron, like right there, front page occupational profile, boom, here it is, trying to try to figure out how to phrase this, but I guess, where do you both fall, and I'll let you both answer this one, like where do you fall on kind of the reason, or the reason not to call it occupational profile in our actual evaluation report. I don't know. I'll let you, whoever wants to speak up first. Alysha Skuthan Well, rock, paper, scissors. No, I'm kidding. Do you want to go ahead? Me, okay? I think it needs to be there, right? I mean, we are occupation, obviously. I'm very biased with my perspective on the importance of occupation, but. Jayson Davies Not at all. Alysha Skuthan If we, if we don't, not at all, right? Ha ha. But if it's not on there, then we don't have the opportunity to educate and to further reinforce the nuances and the beautiful thing that makes our profession what it is, right? So I think if there's a concern for therapists out there that it might be jargony. Okay, add a sentence that defines what it is, right? Give it - I'm not saying the whole OTPF definition, but give little components and say this is the background information to facilitate, or to, you know, allow us to do our therapy sessions, whatever we want to do to simplify, remove the medical air quote jargon, right? I include it, I think it should be there. Jayson Davies Yeah, and Erin, you, you already talked about, you put it on your first page. Do you call it occupational profile? Erin Gaby I do. In one of the references that we used in our publication talked about the importance, like, if with occupation-centered practice, is that you use that occupational language, and not only your words, your verbal words, but in your written language as well. And so I thought this is perfect example. Your OT evaluation report is that written language, and it's just two words, but it's so impactful, and I don't know why we're so hesitant, I guess, to use that language, because if we aren't using it, then no one else is, and if I could go on and on, this is kind of.. I could get on. Jayson Davies Advocacy here. Erin Gaby You know? If sometimes I think we, as OTs, are our own worst enemies, because if we're not advocating for our profession, nobody else is going to know. I mean, if other OTs don't know, then we can't expect, like, our teachers and parents and other school team members to understand that. Jayson Davies Yeah, I completely agree with that. I, there have been times, and I always talk about having in a while, but I often talk about using the IEP as a platform to advocate, like we get our 10 minutes of fame at the table in the IEP, and like everybody has to shut up and listen to us, and you know that is a great opportunity to say, hey, here's. My report. Here's my template. Yes, the first two words you see on their occupational therapy, right into that, you see occupational profile. Let me tell you what an occupational profile is. And here is, here's what I have learned about your student through, you know, all the important people in his or her life, and I think that is a great way to to advocate for our profession, while not being like overly like it's not like blunt in your face. Like, let me share with you what occupation means. Like, it's a nice little way to do it. So, yeah, I agree. I'm on board with that. All right. The occupation, though, DPF, the Occupational Therapy Practice Framework Number Four: list out three steps, basically, for an evaluation has to include three steps. In my opinion, it should be more. I go in depth in that in other places, but three steps: occupation or profile, basically an assessment of the skills of the client, and then a recommendations, essentially like a summary recap and recommendations synthesis is actually the word I believe they use. Number one is occupational profile. Does that mean that it is required in our evaluations? Erin Gaby Yes. Alysha Skuthan Yes. There's literature, it shows yes. Erin Gaby And I even look at, I mean, the the OT practice framework. The first edition was released in 2002 and so this is not a new thing now. Granted, before that was the uniform terminology, and you know that was something different. So, if you graduated during that time period, you know, maybe that's one thing, but this is, you know, any graduate has graduated since 2002 should have had that awareness, I guess. Jayson Davies Yeah, and a little bit of a follow-up, because the OTPF is not a researched paper, right? Like, it's not like someone went out and did research and then said, okay, you know, an occupational profile has been shown to be, you know, lead to occupation-based services and all that good stuff. So, Alicia, I want to come to you, because I think you're probably the one to have done some research on that. Like, where did the idea of an occupational profile actually come from? Because, yes, it's mentioned in the OTPF, but where did it originate? You, do you have that knowledge. Alysha Skuthan No. Jayson Davies No? Alysha Skuthan I don't. I know it's on OTPF, right? And I know the components that go into it. I know I facilitate it with my students, right? and the client children I work with, but I don't know where that specific phrase originated from. I wish I did. Jayson Davies We'll have to look into that. That'll be part two. All right. Alysha Skuthan let's do it. Jayson Davies If I were to ask you this, what makes occupation-based practice, or what is the research behind occupation-based practice as improving, you know, client outcomes? What would the response to that be? Alysha Skuthan So occupation-based practice and client outcomes, I would say that literature base is continuing to grow, and I'm working on it, but I don't think there's anything specific that states, you know, okay, occupation-based practice, you can't prove anything, right, causation, it doesn't have correlation does not prove causation, right, but there is a, there are a lot, there is a lot of information out there on I'm part of this occupation-based forum. This group, we have a whole website, we are saying, yay, occupation, because it's needed, and there's a growing body of literature and evidence in there where we're doing clinical trials, and we've gone in and we've given occupation-based tools, and we say, okay, clinic, now go for it, see how your practice changes, and there are positive outcomes reported by clients, by caregivers, by therapists. There is growing data out there to support the influence of intentionally using occupation-based practice and facilitating positive outcomes, but it's growing. It's not as if occupation is a new concept yet. In the literature, in the research, we still have a lot of work to do. Jayson Davies That is a very important, important point, because I was just gonna say, you know, whenever we think about learning about the history of occupational therapy, right, we go back to the wars, right, and talking about how soldiers were coming back and getting occupational therapy, and a lot of it was very arts and crafts, and, and like these, these little occupations that help people to improve, but that was before the age of everything needs to be research-based, and we're in that age now, and so just because something doesn't have research behind it from the 20s, 30s, 4060s all the way up until like now, right, doesn't necessarily mean that it is not an established practice that has shown benefit. It just means that maybe there isn't research behind it. Alysha Skuthan I would say not behind, you know, it 100% meaning okay, you. Assessment, then do this intervention, and you get this exact outcome right. And I think there will always be variability in it, because every therapist brings their unique therapeutic use of self to the situation, and every client, in our case, children, students, it's going to be different, right? But I think it's important for all of us to just reflect on, and I'm going to sound.. I guess I don't know, whatever. Have you to think about the theory, to think about the model that we are using to kind of guide what we're doing? Right, are we intending to focus only biomechanically? I see a deficit, I'm going to facilitate a deficit, or can we take something like the dynamic model of occupation-based practice? Right, can we take something where it intentionally allows us to prioritize occupation by saying, okay, this is my framework, I'm coming in as the OT, I'm here to look at your occupations and how can I facilitate your engagement in occupations, that's why I'm here, right, that's that's my job, versus thinking about it, where, okay, I'm only looking more specifically at this particular deficit and how I can facilitate it, right, and there are other models out there too, of course, right, and we can argue how they can influence the occupation-based practice, but I think it comes about intentionally selecting a theory or a model, and that allows us to guide our occupational profile, right, thanks AOT for developing that, it allows us to, you know, take those next steps in that practice trajectory. Jayson Davies Yeah, it's so interesting. It's so interesting how things come to be in this world, and you know, like our profession is called occupational therapy for a reason, and there have been debates on that, right, on the name and our choice of name, and how that impacts us one way or the other as a profession, but we have always used occupation as a means, as an end, and it has kind of driven the way that our profession has moved forward. So, yeah, no, I like that, and yeah, it absolutely leads right then to that occupational profile. So, let's come back to your research a little bit here, Alicia. You started to talk about some of the kind of, like, the difficulties of getting an occupational profile together, but I don't know if those came directly from the research or if those were some of the things that you just kind of, you know, have experienced yourself. What did the research, what did that qualitative data that you collected say was difficult for the practitioners to put together an occupational profile? Alysha Skuthan Yeah, absolutely. So the specific ones the therapist identified that they were inhibiting factors themselves, right? Maybe it's a lack of knowledge on their part that was one that was indicated from our qual findings, time constraints, workload, physical lack, or access to parents and caregivers, right, which we've talked about already. Obviously, at this point in time, participants did mention the students themselves, right. So, sometimes students might be non-verbal, right, or it might be where there's a limited opportunity to allow them to be an active part in the acquisition of the information for the occupational profile, and then some participants also mentioned how components of the occupational profile, meaning the overall one, not one that you guys have created that's tailored more to school-based practice, or the ATA one that they also have that's directly, you know, linked to occupation, or excuse me, school-based practice, they participants said it would be too lengthy, or it's considered to be, you know, too long to include this whole overarching occupational profile. Lastly, the last, you know, when participants indicated that they didn't use it, they had said it was because they needed more education on what the occupational profile look like in practice, so that was another limitation that was indicated by the qual studies in our, in our findings. Jayson Davies Gotcha. Okay, and now let's kind of skip to those people who do use it. What did they report as some of the benefits to using the occupational profile? I know I shared a little bit about how it helps to guide my evaluation a little bit, you talked about, like, the rapport building. Anything else? Amazing Narrator you want to say anything, Erin? I feel like I've been talking. I can. I'm happy to keep going. Erin Gaby Some of the comments were about how helpful it was to kind of paint a fuller picture of the child, and another comment, which I really liked was that they mentioned how it picks up some of that information that might be missing that you might miss out on if you just use a standardized assessment, like if that's all you did with the child, you might be missing a lot of that child, but then they must, the comments were very positive of the participants that do use it consistently. They found it was very helpful. Jayson Davies Yeah, yeah, I think that's why we use it. Yeah, so Aaron, I want to ask you this, as a practicing school-based OT practitioner. What are some things that you've done it to make it easier for you to implement it? I mean, we talked about how difficult it can be to get a hold of parents. We've talked about the time constraints and some of the other constraints that people have experienced. What are some little tiny systems or things that you've done just to make it a little bit easier to get the information and put it into your report. Erin Gaby As much as possible, just like communication, just like communication one on one, and if a lot of things kind of all fall back on to just having good basic communication, so for example, if you have a student at school that the team is referring for, you know, like maybe that initial comprehensive assessment, if there are some concerns that they're thinking, "Hey, I might need the occupational therapist, you know, to see this child, you know, including them in that initial meeting when your first meeting to talk with the parent to get that initial consent, like that's an ideal time, if you can be invited to that meeting, you've already got the parent right there. The teachers there, we're all, you know, it's so hard to get everybody together. It feels sometimes like we only meet as a whole team like once a year at the IEP. So if you can get in on that initial meeting, that's a good, I feel like way to start the process. Jayson Davies Yeah, yeah, I agree. Are you, and this is for both of you. Are you pro technology or a little bit kind of, may I prefer to call and send a letter home in the backpack? Erin Gaby I find email has been pretty helpful, or even just a text, I mean, I know sometimes there's that being a little hesitant about like using your, your personal phone number, but it just seems like this parents are more responsive a lot of times I've found just with a text or an email than they are if you just to call them, but. Jayson Davies Yeah, and to be honest, it's really easy to create a Google Voice number and send a text message through a Google Voice number that is that you can delete at any time if things get a little, you know, too needy or personal. Of course, you have to be a little careful with HIPAA and FERPA and all that fun stuff, when you go that route, but yeah, I mean, you kind of have to go with whatever is comfortable for the people that you're trying to get the information from. Anyone use Google Forms or Microsoft Team Forms or anything like that? Alysha Skuthan I have, I will, I think sometimes too, when I'm doing, if I have the chance right to interact with the parents, I'll ask them right as part of my initial, hey, like, how do you like to be contacted? How can I best facilitate this with you? Do you want to text? Do you want me to knock on your door at 3am Like, what can be arranged here? I kid, of course, but I think for the parents who, when I've asked me, they want a phone call, I'm like, okay, great. I'm going to craft this time in my day, because I know that that's what they want to help this particular student, but yeah, I have used Microsoft Teams or Zoom, or whatever might work best in that moment. Jayson Davies Yeah, yeah, okay. So that's the collection of the information. What about when it's actually putting the information into your report, I know we all have a template. Is there certain pieces that you like to put? I mean, do you just basically list occupational profile and then just narrative, narrative, narrative, narrative? Do you try and break it up? Does that make it easier? What have you found just makes it easier to get the information onto the page? Erin Gaby I tend to do narrative format, but that's just my, my preference or my style of writing. But I know one of the participant comments in our study said that they made a chart, and so they just had like this organized chart, which I know on your website, Jayson, you do have that free under your free tools, like the OT profile template, so I really like that. So, even just, you know, a chart, something like that, might be a good way to keep it organized visually. Sometimes that's easier for other team members to, to read. Jayson Davies Yeah, yeah, that's your chart. I mean, everybody uses different tools, right, and a chart can can be helpful. Narrative can be just as helpful. I'm not currently practicing, but if I were today, and if I could figure out a way to basically get the raw data, whether it be from a Google form or just, you know, a paper pencil form, or however, or you know, from a conversation on the phone, I think we could even plug that information de-identified into a chat agent, Chat GPT, or Clot, and say, "Hey, here's all this information, can you just organize it for me into a nice clean narrative? These are there's many ways that this can be done to make it less time. Consuming, because we know that's a barrier, and I mean, honestly, that's probably the biggest barrier, aside from getting the information from people, like that's a barrier too, and I think those are kind of the two main points that we're addressing. Do you ever find, Aaron, that you feel like you forget to ask questions of, you know the teacher or the parent, is there a way that you kind of have it set out in your head or somewhere, or do you just look at the ot file, maybe to kind of remember what to ask, you know, the team. Erin Gaby Sometimes in the moment it is easy to forget things, but just I'm still old fashioned of pen and paper, too, like I said. If it's at the consent meeting, I've got my pen and paper, and I'm like writing down, like, notes, and you know, asking questions. But I do feel, too, after you've met, at least that one time in person, sometimes you'll.. it's a little easier to have that parent or teacher respond back to you, because you've already kind of started to establish that relationship, so it's not like I'm just a random person you've never met, and I'm calling you to ask you about your child, so. Jayson Davies That's important, right? We have to build rapport with the with the parents just as much as we have to build rapport with the student, and yeah, it is so much easier to call someone once you have that face to face, you know, you've shook in their hand, or you've seen them in person, it's a little bit easier to pick up the phone and make the call. I will say, I've never regretted picking up a phone and calling a parent. I have regretted not picking up the phone and calling a parent, especially when you get to that IEP and you just have so much more information versus not having that information, it really does help. Alysha Skuthan Absolutely, it saves a lot of potential confusion or surprises, right? During the meeting, which I know we've all been a part of, and they go, 'What? Like, I have no idea. And you're going, 'Well, you know, this is what's been happening. So, if there's any way to proactively facilitate that update or that exchange of information. Jayson Davies Absolutely, yeah, yeah. Any other, you know, findings that really came out of your research that we haven't discussed today, that is just really important, and it's really something that a school-based OT practitioner should know about. Alysha Skuthan I mean, I think we said it. Please don't be afraid to use the occupational profile, you write as a heading, don't be afraid, don't be afraid. A OTA wants us to write our specific guidelines, they say yes, do it, we can do it. I think that was our biggest finding, is just to support the profession in creating more consistency with that, not only for our students, but also for fellow therapists. Jayson Davies Perfect. Erin Gaby Just sharing the awareness that it is something that we are supposed to be doing. I think that was of our quantitative findings, that was like the biggest, had the largest effect size, was just having did the therapist have that awareness that it was requirement. So this is like another reason, like we're so thankful that you invited us onto this podcast, because it's, it's helping to promote that awareness, and we're really, that's the heart of what you know we need to be doing, so that we're all working towards that more occupation-based practice. Jayson Davies I am just happy to find a pair of OTs who will shout it from the rooftop as much as I will that we need to use an occupation profile, so thank you so much for being here. Because I, gosh, man, I think you know what the very first episode of this entire podcast, episode one, was the evaluation process in school-based OT, and I did not go back and listen to it or read the transcript in preparation for this, but I can almost guarantee you within the first 10 minutes we are talking about collecting an occupational profile, because yeah, like it is like I mentioned, it drives my entire rest of my evaluation, right? Like we have to do assessment tools beyond the occupational profile, but if you don't do the occupational profile, you're at risk of using assessment tools that are just wasting your time and not taking you in the right direction, versus if you took the time to do an occupational profile, you would actually know to go looking for the right assessment tools that are actually going to measure what is important for the student's referral reason, concerns, and strengths. So can't stress it enough. Go do it all right. Well, let's bring this back full circle. Here you all shared with me some tools that you used on day one as a school-based OT practitioner. Now, what is one occupation-based assessment tool that you might use today instead of that one that you used ahead of time, so if I recall, PD, which one of you was using the PD? Alysha, right? Alysha Skuthan That's what I saw first. Yes, today I love the SFA. I love the SFA yeah. Jayson Davies Still asking people if they need to use a floppy disk. Erin Gaby I think they are supposed to be updating. Jayson Davies I agree. Alysha Skuthan They're updating it, they're updating it. But what I love, agreed, agreed, and at least we all know when the floppy disk is, right? Like, let's, let's say no, but I like it because it really, it forces you to look at occupation, right? Yeah, and no matter what, despite the floppy disk, right, there's gonna be a question or two that will allow you to really paint that holistic picture. So that's why I would say the SFA, even though it needs this update. Jayson Davies Agreed. All right, so Erin, I believe you said the Peabody, and maybe one other one, is there a tool that you maybe prefer more now, because it's an occupation-based tool. Erin Gaby I do have, like, the PD, but we have to have a computer adaptive test version, is what it is now, and so it's, it's very simple to use, but that is a good one to use, and because it's for, you know, it crosses a broad span of ages, so from like our young and kids to older kids too. But I am really looking forward. I would love to see the SFA be updated. I hope that happens. Yeah, it's supposed to be. Jayson Davies Yeah. Alysha Skuthan It is. It's supposed to be in the PD. Great, great choice. Jayson Davies Yep. Yes, so I, yeah, we got to be one of the first ones, I think, to kind of break the news a little bit about the SFA a while back, and I'm excited for it. They're supposed to be, and you know, everything is supposed nothing is set in stone, but supposedly they're going to expand it up to high school as well, and so it might be appropriate beyond sixth grade, or is it eighth grade? I can't remember off the top of my head, so that would be nice. And maybe I'll talk a little bit more about email and social media than a floppy deal, so we shall see. One can hope, one can absolutely hope. All right, I have one more fun question here, and this might surprise you a little bit, but Erin, I have to talk about your dream of an HGTV show that revamps a classroom with consult from an occupational therapist. I love that idea. We need to make it happen. Erin Gaby I have not reached out to them yet, but I really truly, in my heart, I'm like, I would love for that to happen. Maybe they'll ask me. Alysha Skuthan that is awesome. Erin Gaby So, does anyone listening with connections with HTTP, let us know, because we think it's awesome. I personally like, back in the day, gosh, maybe 1215 years ago, this is a little more, a little less inspirational, more satirical. That satirical, is that even the right word? Anyways, we thought about having a, and it kind of exists now, is more of the office version of, like, the special education office, like, like, that'd be good, but that's kind of what they have with the teacher show, right? That Abbott Elementary, not special education necessary, but at least in an education world. So. Good times. All right. Well, we've talked a lot about a lot of things today. We discussed the office, HGTV, and then, of course, the occupation profile and occupation-based assessments. Alicia, Aaron, thank you so much for being here. Really appreciate it. Thank you for the fun conversation, as well as the insightful conversation. Really appreciate having you here. Erin Gaby Thank you so much, Jayson. Thank you. It's been great. Thank you. Jayson Davies Absolutely, we will see you next time, and keep in touch. Take care. All right, let's give a big thank you to Dr. Alysha Skuthan and Erin Gaby for joining us today and breaking down exactly why the occupational profile matters so much in our school-based OT evaluations. I hope this conversation inspired you to maybe relook at your report and how you're incorporating the occupational profile into all of that that goes into your evaluation, right? It's not just about using the bot two or using the SPM, it's about getting a well-rounded picture of our student and putting that all together. Sometimes that occupational profile can really help you when you're synthesizing your results and deciding what services you actually want to recommend, plus it's also required by AOTA within that OTP F. All right, and if you need additional help with completing your occupational profile, we have got you covered. Head on over to OT schoolhouse.com/episode 202 for all the tools, the articles, the links we reference to in this episode, including that occupational profile that I adapted specifically for school-based OT. Well, be sure to put that link over at OT schoolhouse.com/episode 202 if you want to keep learning about occupation. Based practice assessment tools, and everything else that makes school-based OT both challenging and rewarding. I'd love to see you inside our OT schoolhouse, school-based OT collaborative, that is our online community where you can access professional development courses, get mentorship and resources from myself and others, as well as connect from other school-based OT practitioners from all around the world, head on over to OT schoolhouse.com/collab to learn more and start collaborating. Thanks for listening, and I'll catch you in the next episode. Until then, keep putting occupation at the center of everything you do. 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. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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 Schoolhouse Podcast

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 201 of the OT Schoolhouse Podcast. When a student refuses to eat at school, it affects everything—academic performance, regulation, social interactions, and the afternoon meltdown that follows. In this episode, Jayson Davies sits down with Alisha Grogan, MOT, OTR/L, founder of Your Kid's Table, to talk about feeding challenges in school-based OT. Alisha brings over 20 years of experience working with extreme picky eaters and shares what school-based practitioners need to know about supporting students who struggle with lunch and snacks. You'll learn how to identify when picky eating crosses into extreme territory, why the cafeteria environment can be so overwhelming for sensory-sensitive students, and what accommodations actually help. Alisha also clarifies the often-confusing scope question: what can school-based OTPs reasonably address versus what requires outside support? Whether you're freezing up when feeding comes up in an IEP or wondering how to support a student who won't eat at school, this conversation offers practical, realistic guidance grounded in both clinical expertise and respect for the school setting. Listen now to learn how to make lunchtime less stressful and more successful for the students on your caseload. Learning Objectives Learners will identify the clinical indicators that distinguish extreme picky eating from typical developmental selectivity.
Learners will identify and address environmental barriers in the cafeteria that prevent students from eating at school—and implement appropriate accommodations.
Learners will identify scope of practice for feeding intervention in schools by understanding what is appropriate for school-based OT versus what requires outside clinic-based or medical feeding therapy. Guest Bio Alisha Grogan, MOT, OTR/L is a licensed pediatric occupational therapist and the founder of Your Kid’s Table, a platform providing education and resources on sensory processing, primitive reflex integration, executive functioning, and feeding challenges to parents and pediatric therapists. She has over 20 years of OT experience working with children with developmental delays, autism spectrum disorder, ADHD, and a wide range of sensory and regulatory difficulties across a variety of settings including school-based, early intervention, and private practice. Alisha also founded and runs a unique week-long sensory summer camp in Pittsburgh. Quotes "At school, the number one goal is just them getting the nutrition that they need." — Alisha Grogan "School is one of the things that always comes up for parents. Often kids will not eat at school, even if a parent is sending their preferred items." — Alisha Grogan "I don't know that I agree that it's a school-based therapist's job to improve the variety of foods that they're eating, but it is their job to help them have a successful meal, lunch, snack time with what they are eating." — Alisha Grogan "It's nice to hear you say some of this because we all want to support the kids as best as we can... but if we don't have the tools at our disposal, we maybe don't have the training... it gets tricky." — Jayson Davies Resources 👉SOS Approach to Feeding 👉Your Kid's Table 👉Mealtime Works (Affiliate Link) 👉Feeding Therapy Printable Episode Transcript Expand to view episode transcript Jayson Davies Hey there, and welcome to episode 201 of the OT Schools podcast. All right, you already saw the title of this episode, and you clicked play anyways. Therefore, you definitely already know that today's topic is a hot one in the schools. My goal for today's episode is to help you see just how dynamic all of the feeding concerns that you may come across in school-based OT, actually are, and to help you understand how you might support some of your students in that sensory intense cafeteria on your campus. To do that, we are diving into feeding challenges in school-based OT with someone who has been a trusted voice in the pediatric feeding space for over 14 years, Alisha Grogan is a fellow occupational therapist and the founder of Your Kids Table, where she's helped countless families and therapists, both in the clinic and in the schools, navigate extreme picky eating, sensory processing challenges, and feeding difficulties. In this episode, we are getting real about what school-based OT practitioners can and should address when it comes to feeding. We'll talk about why some kids refuse to eat in the cafeteria. We'll talk about simple accommodations that you can implement tomorrow in the schools, and we'll also discuss where you can draw the line between school support and clinic level intervention when it comes to feeding. This conversation will give you the confidence and clarity that you need to support those picky eaters that you have on campus, as well as explain the intricacies of feeding on campus in those tough IEP meetings. So, let's go ahead and get started with Alisha Grogan. 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 Alisha, welcome to the OT School House podcast. Thank you so much for being here today. And how are you doing? Alisha Grogan I'm, I'm doing great, and I'm so happy to be here with you, and talking to your, your people. It's great. Jayson Davies I can't say my people, because I believe that my people are your people, your people are my people, especially in this online space. Alisha Grogan That's true, that is very true. It's a small OT world that we live in, right? Yeah. Jayson Davies Yeah, yeah, and you have so many wonderful resources. I really appreciate them. And you know, I, as we were kind of talking a little bit before this, you know, when you really got started with your online blog and everything that you're doing, it was really early on, and you were one of the few out there. Alisha Grogan Yeah, it was 2012 early 2012 when I started, and so, yeah, actually, just this past month we hit 14 years, which is kind of crazy, and there just wasn't a lot of people, any really, there was just very few therapists present, any type of kind of specialties online, there was a lot of mommy bloggers, and so I was also, they were very, very popular at the time, people were following them every single day, kind of this was the precursor to social media, and I was cringing sometimes at at the well-meaning but misguided advice that was often being given because you know we know the complexities of development, and you know sometimes there was just, gosh, you know, I just read through these comments and I would just think, oh my gosh, there's so much we're not talking about here, and I, at the time, I really did feel this like kind of call to just like I need to be a voice pouring into stuff that's going to really help parents, or you know, there are all of these other challenges that this well-meaning blogger is, that is a parent, is meaning to cover from their own personal experience with their child, who is likely pretty typically developing, and doesn't have extra challenges, so the suggestions and the strategies are not going to probably be effective for another child that maybe has a diagnosis or has more complexities, or and families feel really unseen in that, yeah, you know, so that was such a big reason that I started in the first place. Jayson Davies Absolutely, as an occupational therapist who graduated right around that time, I really appreciate it, because I know there wasn't. I looked for podcasts and they weren't there, and even I think it was you and Kara, Kara Kosinski. Alisha Grogan Who actually graduated at my site. We went to the same university in Pittsburgh, which is crazy. Yes, Jayson Davies yeah, that's awesome. And the two of you, so helpful to all of us, you know, OT practitioners that were just kind of getting into the space at that time, because you're really too, like, the only ones out there to really look for, you know, other than research, which is a lot more difficult to read. Then the nice friendly blogs that you all write, so we appreciate that, but you know what, let's take a step back, you know, before 2012 and I just want to kind of let you share and ask you, like, what drew you into pediatrics, and maybe even more specifically into feeding. Alisha Grogan Yeah, that's a, that's a great question. When I was in high school. This is the mid to late 90s, and this was when inclusion became became a new method for teaching children of different disabilities, and I sat in my ninth grade classroom, and they came and gave a presentation about the kids that were our peers that had special needs, and how what it would look like for us to have friendships with them, and I was so moved by this presentation, and I got involved with the special needs classroom, and just ended up spending a lot of time there, I found it just so meaningful, and so it was really my work, and they were my peers, really, at the time, but I just, I fell in love with that work in that kind of population, and so when I headed to OT school, so you know, a couple years later, I had several people suggesting to me, have you thought about being an occupational therapist, because they saw what I was doing with these kids, and so when I went to OT school, I really knew that I wanted to work in pediatrics, and I know a lot of people say that, you know, you talk to most, I feel like a lot of OTs, in you know, in their first couple years, say they want to work in pediatrics, but I really knew in my heart that I would, yeah, yeah. Jayson Davies And then, so you began working in the pediatrics, what did you go straight to clinic schools contract gig? What was that? Out of school. Alisha Grogan I had the most amazing first job in Washington, DC, at a private practice. The owner was in semi-retirement, Lynn Israel. Shout out to her, I'm sure she's enjoying retirement. She's.. she was California-based at the time, but she was one of Jean Eyre's apprentices, and so I had just such an incredible experience there. There was just a mentorship program set up. We had trainings every single week. I was immediately put into an environment where I was completely supported and got this really deep foundation in sensory processing and reflex integration that truly became a lens that I looked at the rest of my career through, and still I still is so foundational to me, and how I look at everything with kids. I then ended up moving back to Pittsburgh, and worked in private school, and actually, in that private practice, we, we ran a summer camp, we worked in private schools, we ran the clinic, so I was in a variety of settings within that one practice, which was really awesome and unique. So, I, my days looked different, you know, depending on what day of the week it was, which was great. When I moved back to Pittsburgh, I was in an approved private school. I shortly started early intervention on the side, home-based care, zero to three. Eventually, that became my full-time gig, and when I moved to early intervention, my caseload became full of picky eaters, and so, because, yeah, because speech therapy, I mean, so many kids from zero to three need speech therapist for speech, so they were completely out of capacity to treat feeding at all, and so they never, and I mean never treated speech unless it was like a really specific swallowing issue, and so it was completely on OTs, and many OTs, myself included, did not have training in feeding, you know, it was a, it was one class in my pediatric, in my pediatric course in grad school, that I think we talked about a nook brush, like I don't know, I mean, I was like super vague, and I had a little bit of exposure with feeding, for sure, in my approved private school, we were working with kids that had significant physical disabilities, so the feeding looked different there, it was more of a mechanical type of feeding that I was helping them with, more of a self-care skill, also not this kind of picky eating where my kid is literally eating two foods, and if I don't drive to McDonald's and get him this food, he is not going to eat a single thing, and the parents, yeah, I'm like showing up at their house and they're looking at me like they're not taking weight. Yeah, well, we, yeah, like, what? Like, tell me what to do. Tell me what to do. And so I had to figure it out. And so I just, I started reading the research, or reading the books, started talking to mentors, I started taking every feeding course I could take, and I just kept. I kept trying everything until it, like, and then it became distilled down to a system where I could just see, you know, this kind of pattern emerge of what was really effective, what what really was helping kids, and so once I started, once I once I started getting results with these kids, my caseload soon became full of them, because then, of course, every feeding kid was put on my caseload. So, but there's a huge, the way that I treat feeding, there's a huge sensory component, obviously, that often goes along with that, and so there's, yeah, there's a really big sensory component to most of my treatment with feeding, Jayson Davies Wow, and at the time, this is, I'm assuming, kind of like the early 2000s mid 2000s ish. Alisha Grogan Mid mid to late 2000s yeah. I graduated in 2004 Jayson Davies Okay, so then at that time, I mean, were there OT lead feeding type of intervention courses? Is that kind of what you, what you went to, or did you have to go kind of go outside the world of OT to get some training? What did that look like? Alisha Grogan Well, it was, it was shifting, and that's when SOS came out. That was that was the course that really shifted everything for me, which, of course, is taught by Kay Toomey, who comes from a psych background, but, but she very much valued the role of OT and speech, and she really saw a team approach. So, I'm sure many of your listeners have taken SOS. It is, it is as, as many therapists should. I recommend that to any therapist that is, that is really doing a lot of work in feeding. SOS is just one of the, the best, the best comprehensive courses that you can take, particularly if you're in a clinic or a home-based setting. Little tricky in a school setting to implement SOS approach, but she really was multidisciplinary, and so she had such a solid understanding in this, she pulled a ton of sensory stuff in, hence, like, you know, sequential oral sensory is what SOS stands for, so the oral piece, you know, she's seen the kind of the speech end, and even just the mature end that you know OTs can cover as well, but then also this huge sensory component that was going on for so many of these kids, and so even within the even within the niche of feeding, I really became, you know, and what I, what I often use is the term, you know, extreme picky eating, or very picky eater, or because you know, obviously feeding itself can even be a pretty wide umbrella with all of the challenges, yeah, that kids can have, so you know, I wasn't really treating, although, of course, those kids would end up on my caseload from time to time, kids with cerebral palsy that had significant difficulties with chewing and coordination. Most of the kids that I were treating, although they sometimes, for sure, had oral motor stuff going on. Many of the kids that I've worked with, in person, in real life, and the families that I have serviced around the world through your kids table, have been families that these kids kind of look quote unquote typical, or they have some neurodivergence going on, you know? Maybe they have autism, maybe they have ADHD. There's no diagnosis, there's all this sensory stuff going on, and their eating is stressful, they're eating very little, they're highly specific, and there's a ton of anxiety around food, though. That's kind of that, like, is my niche within the niche. So, oh yeah. Jayson Davies Good deal. And now I think you know a lot of people, we think of feeding, we think of that clinical side of things, and you just kind of talked a little bit about that clinical side, but I'm actually interested to hear from you a little bit. When you talk to the parents, maybe even when you talk to students, do they talk about school? Do they talk about school being difficult because of this and that? And what have you heard? Alisha Grogan Oh, 100% School, school is one of the things that always comes up for parents. Often kids will not eat at school, so even if a parent is sending their preferred items, a child is not eating. This, this comes up so often, and that you know, and there are a variety of reasons that that happens. We can kind of talk through those if you want, but then also sometimes parents don't even know what to send, so sometimes that's an issue, like my kid is so inconsistent, and at home I'm standing in front of the pantry and saying, do you want this or this or this, so when I pick in the morning and I send it, I I'm guessing at that moment if that's going to be what they feel like eating and if they. Don't they're not eating all afternoon, so their academic performance goes down. They're getting dysregulated, so in social interactions are suffering. They're coming home often, having a meltdown, because they're pushed past their capacity, because they literally have not eaten, and so this becomes a significant stressor for parents, because they're worried about their school performance, understandably, and this really difficult transition that can happen when they get home, because they're now starving, and then the other element that happens is they're starving, so you have to, they're coming home, they're not having a snack, they need, they need a meal, and so now they're eating a whole meal at maybe 330 or 4o'clock when they get home from school, and then dinner is sabotaged because now they've just eaten this entire meal, and so now one of the, you know, one of the principles that I teach is sitting down to eat together, which is a huge step for a lot of families, and there's a lot of ways that I break that down into smaller steps and help families get there, or just focus on it for certain nights, if that feels like an overwhelming task, but then we're like totally missing out on any opportunity for dinner, so you're having like this, you know, weird after school huge meal, and then, and then they're hungry before bed again, you're trying to get them ready for bed, it just, it like throws off the whole cycle, so. Jayson Davies Yeah. Alisha Grogan This comes up quite a bit, I think, for these parents with kiddos that are struggling to eat a variety of food. Jayson Davies Yeah, absolutely. And I'm sure you've had a lot of, you know, parents reach out to you. I guess what, trying to figure out how to word this one. My kid, right? I have a four year old, he is typically very good with food, but every now and then he gets a little picky and stuff, and then you obviously have the population that you've been talking about a little bit. Have you ever had parents like come to you, I guess, and say, "My kid is really picky? And then, to a degree, to yourself, you're kind of like, "You're no, your kid might be picky, but not in this way. Like, I guess what I'm trying to allude to, or get to, is like, how do you determine, like, really what is more of a concern versus what is a kid who, yeah, it's picky every now and then, but maybe not as much of a concern. Alisha Grogan Yeah, I mean, this is this is something that we teach all the time, because picky eating is a subjective term that is used very easily in our culture. It's also very common. It is, it is a, it is a typical part of development for kids to be more selective from around the time they are one until usually around three and a half, and even up to five years old, where you kind of will just see some of this natural pickiness, and there's all kinds of reasons for that, like their taste buds enhance at that point, you know, when we think about what's happening with them developmentally, and they're starting to see themselves as their own entity, they're exerting some sense of control of, hey, look, I can say no to this. I'm not just, you know, passively taking this in, and what happens if I say no? And there's all.. there's all these cognitive and developmental aspects that are going into that. When a child is kind of just in a natural picky eater stage as a toddler or preschooler, when we look at kids that are more extreme picky eaters, we're really looking at this as having a significant impact on their life, either on their nutrition, on their health, on their quality of life, either for themselves or for their families, that there's sometimes a financial stress, you know, if your kid is only eating from McDonald's, and you have to pay for McDonald's every day, instead of being able to use a house, you have to get in the car, you have to use gas, you have to do all these things, you can start to feel really trapped by that, so when, when all of those, when those elements are in play, we really start to look at this as tipping more towards extreme picky eating, and there are some diagnoses now that sometimes kids get if it is in the severe state. I would say that these diagnoses are still not kind of culturally known, you know, so I still think we're still kind of generally saying picky eating, but what I'm really looking at, and this, this actually goes back to Kay Toomey's guidelines, and I have, I have used this for years, and it's when a child is eating less than 20 foods in their diet, and that does mean everything, because sometimes parents will say, well, okay, I'm counting cheese as one thing, but they eat five different types of cheese. Now, I would probably count five different types of cheese if they're eating, you know, if they take American cheese, if they take mozzarella string cheese, like those are different foods, so if we're looking at 20 foods or less, where. Looking at trying to control the food, and that you're going to see that there's a, there's distress if they do not have a food that feels safe or like something that they can eat, and you will usually see when they're in this extreme picky eating category, where it's like, hey, you know what? Maybe we need to get more help with this. We need to start approaching this from a different standpoint. You are usually going to see again some kind of gagging, shuddering, extreme anxiety when food is sometimes put on the table for some kids, like it could just be on the table and they're just looking at it. For other kids, they have to taste or touch it to get that reaction, but if, if you're, you know, if you're seeing a kiddo and they gag at foods, I mean, if there's, if there's one food, you know, like, I mean, there, we do kind of all have, you know, these unique sensory systems, and for some of us, there's a, there's a food that just really is like, oh, that, like, nails down the chalkboard, I'm talking like you're seeing this pretty much with like anything outside of their safe foods. Jayson Davies Yeah, gotcha. Thanks for sharing that. We're going to take a quick break, but when we come back, we're going to start to talk more about feeding in the school-based OT room. So, stay tuned. All right, Alicia, I want to start talking more specifically about school-based OT. I know you've worked in the private schools, but you also mentioned, you know, really you've worked with all the kids, obviously the kids go to school, and you mentioned school-based. You also mentioned some reasons, maybe why kids might go to school with their preferred food but still not eat. I'd love to hear a little bit more about that. Alisha Grogan Yeah, so what commonly comes up for kids when they have their preferred foods and they're still not eating is that they are super overwhelmed in the cafeteria environment. So that can come from a couple different places, and so obviously, as OTs, it's our job to figure out what, where is the overwhelm coming from. Number one is this a light and sound type of situation, which it absolutely can be. I have certainly worked with kids where it's just, it's so over stimulating in the cafeteria from a noise standpoint that they're getting very dysregulated, they're getting very agitated, and you know, once we get so dysregulated, our appetite shuts off, so even if you have not eaten well, you, you lose your appetite, and so it sometimes is just the noise, sometimes it's the lights, sometimes it's peers, you know, bumping into you. Some kids, they're just so dysregulated by the time they get to lunch from everything they've been doing all morning that they're just kind of shutting down, and now they're kind of in this chaotic environment, on top of everything. There's just.. there's not a chance for them to kind of calm and to be able to eat. Another big factor, though, is a lot of these kiddos that are struggling with this, you know, again, we'll call quote unquote extreme picky eating, which again in itself is kind of just an umbrella category, because they may have, you know, this diagnosis of ARFID or PFD, which is pediatric feeding disorder. If they have one of those diagnoses, and maybe, maybe they don't, they are likely to be disgusted by other kids' foods, and so even just seeing other kids, and especially if there's kids at the table that are encouraging them to try something, or maybe making fun of the food that they're eating, that also happens sometimes, because sometimes the things that they're eating are a little bit unusual, or they're eating the same exact thing every day, and kids are just going to comment on that, and so when another child, when that child is really sensitive to it, or feels like they're being watched or seen, there's just a lot of anxiety around eating, and so it just becomes a lot easier to just not eat, and to close that, to close that lunch box. Jayson Davies Yeah, and there are a ton of smells, and the cafeteria, it often kind of mushes together into this really weird smell, but a lot of kids are more sensitive to smells than I am, so. Alisha Grogan Yeah, right, absolutely, absolutely, Jayson Davies Yeah. So I kind of want to walk through this process where we talk a little bit about what you've done from kind of the clinic side to support these students at school, and then our work kind of work our way up to like what you feel would be the best thing ever for like for feeding and school based OT, but like I said, I want to start with kind of what you've done. So, what are just some of the popular things, the more common things that you've done with some of your students, not as a school-based OT, but to support them at school? Alisha Grogan Right, so we talk about having a plan with the child, so even though it's the morning, and we have to take into consideration, too, if the morning is chaotic and hard for these kids. Again, a lot of times these kids are sensory kids, they're neurodivergent kids. So going through the routine in the morning has all these it. Own stressors, like getting that arousal level up in the morning, is hard, and so we do a lot of talk about regulating in the morning, so that they're starting the day from a really regulated standpoint. Now, of course, if there is a school-based OT that is working with that kid, if I know that there's a sensory room at that school, if I know that there's bandwidth, if there's an aid, if there's somebody that's able to get them to the sensory room to start off their day, that's definitely becomes part of the plan. I would say more often than not, that is not what I'm working with. So I'm working with a family to say, even if we have five more minutes, how can, like, how can we use that time well to help get your kid regulated, so now we're talking about sensory strategies, you know, we're talking about, you know, crossing midline activities, really just getting getting the brain in a regulated place when they leave, which can actually have an impact on lunch. If they're regulated, they can also help make a choice about what they're going to eat for lunch now, that that can work the night before too, and for some families that does that. We're making a plan. Hey, this is what's going to go in your lunch. What options do you do you want to have? This is one time. Normally, I, my goal is, is that at every meal for kids that are so sensitive to these foods is that we're working towards, or they already have at least one food on their plate that they don't typically eat, so that they're getting comfortable with it, they're getting used to it. That might be a bowl that's like sitting halfway across the table at first, that might be one pea on their plate in a divided plate, where it's sure not to touch anything else. But yeah, but this at school, that is all off the table, like there's just no point, like there's no point in like making sure, so this is the one place I tell parents, like don't try to send the peas to school, like at least at this point there is definitely benefit for that as you're making progress, and then it's and then it becomes a point where it's helpful for a child, even if they're not going to eat it, to say, oh yeah, those are in here, and that's okay, and I can still eat my lunch, and you know, maybe working towards that, but for school, what I always tell parents is that the number one goal is just them getting the nutrition that they need, so that they can do what they need to at school, so whatever that is right now, that's what we need to start with, and we just start with them having a plan. We also do other things, like putting notes in, you know, if a kid is old enough to read, like something really encouraging, a joke that's going to make them laugh, that's on the, that's on the really low end of support, of like this is, this is like basically what we're doing, then if that's still like we still need more support, then I'm looking into, are there things that we can do and that are appropriate, and the child is going to respond to, like, our noise canceling headphones a good option right now? Is that going, are they are they missing out on peer interactions, or are they so upset that they're not interacting anyways, and at least this is going to allow them to be calm, and they're still with their peers, and they can, you know, eat here. Is it a weighted lap pad that's going to help them? Do they just need a fidget in their other hand that they can just kind of squeeze while they're focusing on eating? So we look at some of those supports, if it's still in a really difficult place, I have worked with parents to help them have it added to the 504 plan to have the teacher get on board, the school basically get on board with them having a quiet room to eat, and so some schools have done this where they pick a friend to go eat with them in the quiet space. There's a ton of social dynamics, and this varies so much from school to school, like what faculty is willing to do. There's, there's obviously such a concern, and even as I say it, the last, you know, like, they're just, gosh, we don't want them eating by themselves, we don't want to like pull them out, it's this social experience. This is supposed to be a fun time, but if a child is not eating and they're totally stressed, sometimes as a temporary measure to help them reset and start getting comfortable eating at school, that can be a really good solution. Or maybe they're staying and eating in the classroom, you know, they're staying in eating classroom teachers in their eating, or they're just kind of hanging out. It's just not so overwhelming. And then we start working up to them being able to tolerate it. Now, of course, if they're in feeding therapy, or they're using a home program, and they're working on these kind of underlying sensory processing sensitivities, they're following a program, this isn't life sentence. This is okay. This is where we are right now. We know that it takes time, especially with feeding, to see progress, and so as that progress is unfolding, we have hope and expectation that this lunch situation is going to get better. Also. Jayson Davies Yeah. Alisha Grogan Yeah. Jayson Davies Wow, yeah. I mean, it's amazing how much you can actually do without even technically being in the schools, but that then also leads me to wonder, because I am sure in the last 14 years you have heard from many school-based OT practitioners, and you've probably heard similar things that I've heard, like A, I want to address feeding. I don't know how. B feeding doesn't belong in school-based OT, and countless others, I am sure. And so I'm wondering, from all you know, from all the things that you've heard, and you know it's probably changed in the last 14 years. What are you seeing as current practices? What are OTs coming to you and saying, like, this is what I'm already doing or not doing as a school-based therapist. Alisha Grogan Yeah, I do. I mean, again, in my world, I'm fortunate because you know I have people taking our picky eating program, which is called Mealtime Works, and so when they come into Meal Time Works as therapists, even we've had many school-based therapists, they're open and willing and wanting to learn, so I think I do hear more often from the therapists that are wanting to help and. Jayson Davies Optimistic. Alisha Grogan Yes, optimistic, wanting to help support, they always want support in how do I make this work in this school environment, because a lot of the suggestions that I make have to happen at home too, and the thing with feeding is, oh, it is tricky, because I did early intervention for such a long time, so I was in the home, and when you're this is so different than when you're working on fine motor skills, or you're working on handwriting, or you're working on sensory processing. It's kind of like this isolated thing that this kid is going through, and the family is coming along and supporting them. Eating is very personal to people, the way that they eat, how they eat as a family. Do they eat in front of the TV? Do they eat together at all? Do they have these homemade recipes that we're making when we look at different cultures and the types of foods that they're eating, the expectations that are there. So, when we start coming in and saying, hey, it might be good to sit at the table when we eat, that can be unbelievably difficult for some families, and if you're not working with the family on an ongoing basis, like in a home setting or in a clinic setting, where you're really having a lot of that contact to support them, you really can feel like you're hitting a wall there. And I think that's where a lot of school-based therapists come, because they start learning strategies, and some of these things that I'm talking about, you know, we teach a five-step system, and so, like, our first two steps are really structure routine to just start forming this foundation. It's like steps three and four are when we get into the sensory pieces, the feeding techniques, but for most kids they really just need this foundation. And so I think for school-based therapists, as they start learning these strategies, it's like, okay, I can work on the sensory stuff as a prep activity, and like, have this be dual purpose. I can incorporate fine motor into that and make it like align with my goals, but how the heck do I start having a family start to eat together, serve non-preferred foods, you know? And I would say there's a significant.. there's a hurdle there, but I think every one of us, even if you're in the home or you're in the clinic, you're feeling that because you're you're up against an individual family's culture, and you have to be a respectful of that, and b show them the benefits of why maybe working towards some of these changes would be are really going to help their child start eating more food, which is what they're really looking for, and so I bend rules, my own quote unquote rules, all the time, because they need to work for people, they need to, you know, it can't be a totally rigid system that it's like when something is stressful that I'm asking a family to do, they're not going to do it, so for school-based therapists, and what we teach in our program is, you know, I mean, we just, we have a lot of handouts, we have a lot of visuals, we have a lot of clear step by step, so that parents feel supported in that on the on the home front. Now, I would agree with their, I mean, I agree and disagree with therapists that say feeding isn't school-based, ot it's not appropriate. Well, it is because they eat lunch there, unless they're not eating lunch. It is one of their activities, Jayson Davies Or even snack time. Alisha Grogan Right? If they're eating at all there, it is. It is part of it, but but that is way different than trying to have an impact on all of their eating throughout the, you know, 40 meals that they're eating every week, that is, you know, I think for school-based therapists, if you have a family that is motivated and is looking to you for guidance and you're able to provide. Um, handouts and visuals to them to help get them started, that that's appropriate, but it does become beyond the scope to try to make significant change in the home environment when you know, because of what you're seeing at school, and so I think that the supports, like, have to, I think I hope that it gives the school-based therapists that are listening to this, a little sigh of relief in that if you're addressing it at the school-based level and you've offered some resources to the parents, that I think you're doing an amazing job, because that's what's appropriate for your role in that setting. Did I answer that all the way? Jayson Davies I think so. I mean, my only.. I guess my follow-up would be, you know, there are some times where we get asked by the parent or by the IEP team to further address the issue inside the cafeteria, and you know, earlier you, you mentioned a few different things about the cafeteria, right? The smells, the sights, the sounds, all of that. Let's kind of frame it this way, like in your perfect world, how could a school-based OT practitioner have an impact in the cafeteria, maybe directly with a student in the perfect school-based OT feeding world. Alisha Grogan Yeah, and so for me that's number one, are identifying what the triggers are in that environment, you know. Again, we talked through all those, like, which, what is going on there, you know. We tend to see patterns, I mean, it can vary from day to day, you know. Maybe, you know, whatever, the triggers could look a little different, but if a kid is really struggling with smell, they're probably going to be really struggling with that smell most days, you know. And maybe they cook something that day that's particularly stinky, that isn't always in there, that's a little bit more triggering, but again, for the most part, you know, you're going to see a pattern, and I think that's where, you know, we need to come in and really look through that sensory lens of, and just really overall nervous system regulation, what is going on that is making it really hard for this kid to eat, and I think I think that's where we, we use our clinical reasoning assessment skills to just say, look, this is this is what I think is going on, let's try out some of these supports and to see how we can help this child eat. I don't know that I agree with that. It's a school-based therapist's job to improve the variety of foods that they're eating, but that it's, it is their job to help them have a successful meal, lunch, snack time with what they, with what they are eating. So I think that that may also mean having conversations with the parents, maybe the parents are saying, I mean, most parents are not doing this, quite frankly. When you have a child that's in this extreme picky eating category, they know that their kid is not going to eat anything out. Else, you know, parents that try, they'll wait it out and see, which is what some doctors, unfortunately, still say, oh, well, you're just giving in, you're giving them whatever they want, just wait it out, they'll get hungry enough, and they will eat. That is false. Kids that are in this extreme picky eating category, because this is like they are having serious anxiety, sensory processing difficulties with this food, or oral motor challenges, maybe even physical challenges. There are so many kids that have undiagnosed physical stuff going on that like reflux and EOE and all of this stuff that is. Jayson Davies Worth the hunger. Alisha Grogan Yeah, yeah. And so you're gonna, you're gonna, you don't give me what I can eat, fine, like I'm not gonna eat, and they will not eat. I have had countless families who have followed that advice, who have ended up in the ER because their kid was like at the point of passing out, and they're on like day two, you know? I mean, the parents always end up caving because they can see this isn't working, like this is not, this is not working, like we are trying to wait it out and see. And so that would be the only thing, if you had a, if a therapist listening right now is like, oh my gosh, I have a family that is just insistent that they're not sending the x, y, or z foods that their kid really likes, then that's an education piece. I would say again, look, it's at school, this is so important, after school time to work on this, but right now we just need them to eat, and let's start here. So, I think that that's where the therapist speaks into that. I think it can be an appropriate goal if a child is significantly struggling with lunch. You know, this is an ADL. It's happening in this setting, so it is very appropriate to say to help that child eat lunch. So, again, yeah. Then, what are the supports? Does that mean we're taking a break? Am I doing therapy while during lunchtime? If that's, if that's a primary goal, or we're I'm rotating through, you know, maybe every third session is we're one on one at lunch, and I'm assessing, and I'm trying to, I'm testing different supports and strategies, so that this child. Feels more comfortable and is able to eat the food that is being sent. Jayson Davies Yeah, I feel like in the past, for me, a lot of our quote unquote feeding goals that we would sometimes address would be more access related to the food. To be honest, it's kind of a fine motor skill, right? So, like, to open up the bag, so that they can get to the carrots to open up a milk carton to be able to put the straw into a juice box, something like that. To me, I honestly, a lot of times, froze up when it went a little bit further than that, like I didn't always have a plan, and, and it's kind of honestly a little nice to hear you say, right, that education piece is, to a degree a lot of what we can do and what we should be doing at schools, and kind of not putting necessarily the onus on us to try to expand food, because that is definitely something that does come up in IEPs, and sometimes parents are comfortable sharing that, other times they're not. I think, like you mentioned, food eating is such a personal experience in every culture, every person does it a little bit differently, but it's nice to hear some of the things that you're saying. You know that for some things we need to have more than what we can do in a cafeteria, and I appreciate that, and I'm sure other school-based OTs appreciate that as well, a little bit. So, thank you. Alisha Grogan Good. Yeah, Jayson Davies I want to switch the subject a little bit. I'm going to be a little selfish here, because I just talked a little bit about some of the difficulties that I had when I would freeze up when it came to eating, but there was one other kid, and I can see him vividly in my mind - third grade at the time when I was working with him. I still see him around town. You see those kids, right? We also, well, you all see our kids outside, okay. Anyways, he seems to be doing good when I see him, but this always made me feel uncomfortable again. And it was more along the pica world, and I don't know how familiar you are with that, but this was a kid, he, he had picky eating, and on the flip side, he would come to school, and I don't know if he had a formal diagnosis of pica, but he would eat erasers, he would eat glue, other odds, and in school, and I just want to pick your brain on that, and kind of what you have experienced, what you've, what you know about it. Alisha Grogan Yeah, I mean, clinically I probably have a few families online I have worked with that have pica, but clinically I have, and especially in approved private schools with kids that have often multiple diagnoses and multiple things going on. Yeah, it's, it's really, it's really tricky, and I do think that there is something neurological going on with it, in just terms of that it always feels very neurological to me, as in, like, there is some confusion around what is edible and what is not, and like, legitimate, like, confusion around that, and also that there is a, there's a huge sensory component, I think, also, so with, with texture, with, you know, gosh, if you think of, like, you know, if I think of a kid chewing an eraser, you know, I think of a dense amount of proprioceptive input that they're getting from that, that might be pretty, pretty rewarding, and make a kid want, make a kid want to do that, you know. We emphasize, like, whenever I'm working with a kid with pica, I do work on sensory integration a lot. We're doing a lot of deep work in texture play. I have a, like, I have a protocol, because I think earlier in my career, you know, you just like, "Oh, play in a sensory bin, and I did that for a long time, and it's good. It's so good, like, I'm not saying don't play in a sensor bin, play in a sensory bin, it's so good. I think there's so many ways to adapt it. I think we should be doing it with so many older kids, because so many kids have texture sensitivities. I think kids now more than ever don't get their hands dirty, and it totally affects all their sensory processing and all of that stuff. But I do think we need to get kids in deep textures, they need to get their feet in the textures, they need to, they need to play in the textures for a while, and they need to be in like gritty textures that are helping kind of their tactile system start to process sensations more than they even need messy textures, they need gritty textures like sand and bird seed and rice to really be playing in deep bins to kind of help their brain start to process the sensory input better, and also, you know, and then that's pulling in even sensory integration, because again, you know, I couldn't say like what pathways are particularly activated, but when I start working on sensory integration and reflex integration, and I can get to some like deep neurological stuff. We can, I have seen the needle move with some of these kind of odd challenges, that it's like, what is going on, like what is going on here? Jayson Davies Yeah, yeah. Thank you for taking on that, that question. I know that it was not an easy one, and it's not one that I prepped you for, so I appreciate that, and I completely agree, and it is really like we were really kind of at a loss, and this IEP team, you know, we would meet, gosh, probably three times, if not four times a year, because this was always coming up, and it was really hard to, like, I just felt like we continue to try to use cognitive behavioral strategies and. Alisha Grogan That's great too. Jayson Davies Yeah, but it's just so limited, like you're limited in what you can do, right? Like, especially, you know, this was a third grade. I also worked with him in fourth grade, I believe, and there's only so much time that you have eyes on a third grader and a fourth grader, right? Like, this isn't a small preschool program where you're constantly, you know, teacher has eyes on the kid all the time. I mean, he would sneak off into the cabinet in the classroom, and no one would even notice that he got it until later in the day, like it was just really hard, and you know, not, you know, you mentioned sensory integration, and you know, this is a big topic in school-based, obviously, you know, we, we don't have all that in the schools, and so that makes it more tricky as well, and, like, I don't know, part of the reason I bring this up too is just to share with all the practitioners out there, like, these are not things that happen overnight, and these are not things that we can always address as the school-based OT, and sometimes we need support outside. Sometimes we need to, in a very crafty way, suggest support from outside occupational therapy in a way that's not going to put the district really mad at you. Like, these things happen, and it's tough. And so that's why I like having these tough conversations a little bit, right? Alisha Grogan Yeah, absolutely, because it's not, it's yeah, like, if you don't have, gosh, if you don't have the equipment and the ability to treat, it's, I mean, some, yes, some of these, some of these challenges are beyond the scope of school-based practice, it just is, you know, and that's, but like you said, I know that there's a lot of politics behind kind of, kind of saying that in, in a setting, and unfortunately, I do think sometimes school-based therapists are looked at as, well, you're no tea here, so just, you know, fix it, yeah, like, yeah. Jayson Davies Yeah, another topic, another day, another podcast. We've had that topic on the podcast before. I'm sure we'll have it again. It's a tricky one, and again, like I said earlier, it's a little comforting to hear you say some of this, because we all want to support the kids as best as we can, and we all, like, we think the same way that you just kind of said, right, we're OTs, we want to be able to support these things, but if we don't have the tools at our disposal, we maybe don't have the training, we don't have a classroom full of rice bins and all the fun stuff, it gets tricky. So, Alicia, I think we're going to wrap up today, but I really appreciate your time. I really appreciate you willing to have some, some real tough conversations. I know it's not always easy, but we always appreciate, appreciate it here on the podcast. Really quickly, you did mention your course. I would love to let you share where everyone can go to learn more about that. Alisha Grogan Yeah, absolutely. So, we do. We have several courses. We have Meal Time Works, is our picky eating program. So we do go a little deeper in there, you know. It focuses on these kiddos with extreme picky eating, but it is a plan. It is a program. We have dozens and dozens and dozens of handouts in there that are all written for parents that are beautifully designed, visually appealing, that you get to use forever with your caseload, so they're yours, like when you become a student. But yeah, it's a.. if you're looking to get more help on feeding and want to feel like you have some training in it, I would definitely suggest trying that out. You can find it at your kids table.com you can just kind of click on classes, or yeah, I'm sure that'll be in the show notes, at least the website, yeah, so yeah. Jayson Davies Yep, we will link to that, we'll also link to the SOS program, as well as some of the other resources that you've mentioned, and make sure to make it super easy for everybody to find, and yeah, Alicia, thank you so much. I hope we get to do this again sometime, because it was really great learning from you. Alisha Grogan Yeah, it was great to be here. Thanks so much, Jayson. Jayson Davies All right, and that is a wrap on episode 201 Alicia, thank you so much for joining us today and sharing your incredible expertise on feeding challenges in school-based OT as well. Was in the clinic from all the school-based OT practitioners, in fact, all the pediatric OT practitioners who have had to learn a little bit about feeding. We greatly appreciate all the tools that you have put out for all of us at YourKids table.com If you want to dive more into feeding and helping picky eaters, be sure to check out Alicia's Mealtime Works program over at Your Kids table.com And, of course, to you, thank you so much for being here. Really appreciate all the work that you are doing, and all the work that you're putting in to supporting your students more. You definitely don't have to spend your time listening to an OT-related podcast, you could be listening to Serial, a true crime podcast. Maybe you like to watch the news or listen to the news via podcast, but you were here today learning about feeding, learning about improving yourself as an OT practitioner, and I really appreciate that. If you're looking for more resources, more professional development, and more mentorship to support your school-based practice. I would love to invite you to join us over at the OT School House's school-based OT collaborative. Inside the collaborative, you'll get access to our full library of resources, professional development sessions, as well as a community of school-based OT practitioners who get exactly what you're going through and are ready to support you. Check it out at OT schoolhouse.com/collab That's OT schoolhouse.com/collab Until next time, keep making a difference in all the students that you serve in their lives, and 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 OT School house.com Until next time, class is dismissed. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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 Schoolhouse Podcast

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 200 of the OT Schoolhouse Podcast. This course explores the evolving landscape of school-aged mental health in a post-COVID world and the expanding role of occupational therapy in supporting students’ emotional, behavioral, and functional participation. Dr. Monica Keen examines current mental-health trends, trauma-informed care, behavior changes following the pandemic, and evidence-aligned OT strategies for school settings. Participants will learn practical, occupation-based approaches for addressing emotional regulation, engagement, and school participation within a tiered model of support. This course is part of the OT Schoolhouse Collaborative Community, where school-based practitioners come together to deepen clinical reasoning, explore meaningful topics, and translate evidence into real-world practice. If you’re looking to earn CEU’s for this course and access a full library of professional development opportunities, you can join the community here 👉 https://www.otschoolhouse.com/collab Learning Objectives
—Learners will identify three mental illness diagnoses of school-aged children.
—Learners will identify reasons/events for childhood mental illness and how it impacts occupational engagement.
—Learners will recognize the role of OT in addressing these mental health issues in the school setting Guest Bio Dr. Monica Keen is the Program Director of the Doctor of Occupational Therapy Program at Presbyterian College and has been a licensed OT for 36 years. After a long career spanning mental health, acute care, skilled nursing, and 27 years in school-based practice, she transitioned to full-time academia in 2022. She also teaches pediatrics and mental health labs as an adjunct at Baylor University and previously taught for seven years at MUSC. Dr. Keen has authored book chapters and presented widely on school-based OT, mental health, and handwriting, including multiple webinars and a doctoral capstone on OT’s role in supporting children’s mental health. She has been featured on the OT Schoolhouse Podcast and presents nationally on school-based mental health. She currently serves as Co-Chair for Mental Health within the South Carolina Occupational Therapy Association. She holds degrees from MUSC, Boston University, and the University of St. Augustine. Her professional passions include mental health, trauma-informed care, pediatrics, and autism. Dr. Keen lives in Greenville, SC, and enjoys running, hiking, college football, and spending time outdoors with her two Boston Terriers. Quotes “Trauma results in fundamental reorganization of the way the mind and the brain manage stress.” —Dr. Keen
“Adversity is not experienced the same by all people.” —Dr. Keen
“A mass exodus… and people not wanting to go into teaching because of low pay and the burden from the pandemic.” — Jayson Davies, M.A., OTR/L Resources 👉The Body Keeps the Score (Book) on Amazon: https://amzn.to/4s4CiUm (affiliate link) 👉The Body Keeps the Score (Audio Book) on Spotify 👉 Collab Episode Transcript Expand to view episode transcript Jayson Davies Hey there. And welcome to episode 200 of the OT school house podcast. It is great to have you here today. And wow, I have been waiting to say episode 200 ever since, like, Episode 185 about and I hope it would happen, you know, during ot month. But we're close enough, you know, just the beginning of May. And today, I am super excited to hit this milestone with you all, whether you've listened to all 200 episodes or this is your first one, I'm happy to be here to celebrate with you, and I'm also excited to share a very special episode with you. Today, we're dipping into the school based ot collaborative professional development archive to share with you a fantastic a ot a approved course by Dr Monica keen. In this course, Dr keen dives into the world of post covid school age mental health, and she explores how we can use what we learned from the covid era and continue to use those strategies in our schools. Today, you'll get practical tips on supporting students emotional as well as their functional participation. And trust me, this episode is packed with insights, and Dr King's energy is like just inspirational. Trust me, you will be fired up by the end of this episode. Now what you're about to hear is the audio version of Dr King's presentation, and if you are a member or decide to become a member of the school based ot collaborative. You can actually hit pause right now head on into the collaborative and catch the video version with all the slides and resources directly inside the community. Or you can continue listening and then go into the community and take the quiz to earn your CEU certificate for this audio version. We've snipped out the Q and A for you know, privacy, but our community is buzzing with experts like Dr keen and others ready to answer your questions all about ot inside our OTP lounge. I also want to give a big shout out before we get started, to every single person who joined us at a ot a inspire, as well as the school based ot meetup that Jamie from Miss Jamie OT and I hosted. It was fantastic. Getting to meet so many of you. I wish I had the opportunity to have like, a 10 minute conversation with every single person. There just so many good things there, talking about case loads, talking about things that are going great, as well as some of the things that are not going as well. I like talking about all of it, your stories, your support. They mean the real to me, and you all made me blush a little bit every now and there, when you talked about how this podcast, how the articles, how the collaborative even have really helped you in your school based ot journey, I cannot thank you enough for coming up, having the courage to say hi and and sharing with me everything that's going on in your school based ot career. You made my weekend a blast. So thank you, and I have to give one more final thank you to everybody who came to my session at a ot a you know, we talked about services in the least restrictive environment, which is not always the most fun topic to talk about, but I appreciate you being there. We had a packed house. Really had fun with it, and I hope you all had fun, as well as learned a lot about helping students or helping you to determine services in the least restrictive environment. All right. Well, we are going to jump in with Dr keen right now. Thank you so much for being here again. Appreciate it. Happy 200th episode to all of those of you who will celebrate it. And yeah, enjoy this episode. I'll catch you at the end. 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, CLASI is officially in session. Jayson Davies Please help me in welcoming Dr Monica Keen. Dr. Monica Keen Hey, how's everybody doing? Thank you so much for tuning in. Tonight. I am coming to you guys from Greenville, South Carolina, so there is a huge time difference. And as you can see in the background, my Christmas tree is all lit up and it is dark outside. So it's really cool to know that I am reaching you guys where you're still experiencing sunshine over in California. So thank you so much for having me. It's always a pleasure to to partner up with Jayson and to talk about school age, mental health, children, children mental health in general. Just a brief little disclaimer before we get started. I always the day of my presentations, I get into this frame of thought about, you know, what do I really want to focus on? What is a point that I really want to get across? And in this particular presentation, you know, I find that occupational therapists are always looking for an. Activity, an intervention, you know, something hard and tangible that they can do to address something, and I appreciate that more than people will ever know. However, I am going to challenge you guys tonight to think about how we need to start modifying our approach with our clients, particularly our children. I'm still focusing on mental health in a post covid world, because when I began this research, it was during the covid crisis, and I've been eagerly awaiting the results of how mental health is in a post covid world. And so as I was sharing with Jayson, as I was preparing for this, I learned a bunch of new stuff about how mental health has changed in a post covid world, for our children well, and really for the world at large. So without further ado, let's jump in. We're going to do a brief review. Let me see come on in advance, would you? There we go. All right, so some learning objectives for tonight. I want you to be able to walk away from this presentation to be enlist three significant mental illness diagnoses that our school day children are facing at this point. And let me be clear that when I say school aged, I am talking about ages three, from the time when children can start in public education all the way up to age 21 and of course, when we start at the age of three, we are coming in with some special needs. We have qualified to be able to come into school practice. Number two, I want you to be able to identify reasons and events that impact child mental illness and how that impacts their ability to engage in occupation. And then, number three, recognize the role of occupational therapy and addressing these mental health issues. So covid, 19 has had some lasting impacts on everybody, and I know that some people are probably feeling that, oh, my goodness, you're still talking about covid. Yeah, I am, because it is still having great impacts, not only on our children, but public education as a whole, when I retired, it was in 2022 and I was really excited, because that was the year in 21 everybody was coming back into the school, and I was excited to have everybody back. And I was like, things are going to be back to normal. And oh my goodness, how wrong I was. That was the year that I saw the most challenging behaviors, not only in special education, but in regular education as well. And it was because of that that my desire to learn more about what is going on here, to make these significant changes in behavior, what's going on, and that is what got me to studying about how did covid impact our kids so but in order to do that, we have to look at three different sets of people. So I want you to envision, if you will, a triangle, and at the top of the triangle we're going to have teachers. In the middle of the triangle, we're going to have parents, and then at the bottom of the triangle, we're going to have children. And as I talk about this, I want you to understand that the anxiety and depression that's happening in our teachers rolls down to our parents. The parents picks up what is going on with our teachers, along with their anxiety and depression and stress, and it's coming down on the shoulders of our our school age children, and so just bear that in mind as we talk. So mental health continues to be a challenge again for all three of these groups of people, teachers, parents and students, and because of that, we are continuing to struggle both with things that have happened in the past as well as new issues that have arisen because of the changes that have come along because of covid. So new considerations have been surfacing, and it really does help us to better understand why there has been a shift in behavior. And I would love to know, you know, for those of you who are school based practitioners. Have you seen the same thing? And if so, I would love to hear what in particular that you're seeing. So let's do a little bit of review. Let's go back to March of 2020, when covid just literally stopped the world on its on the dime. Life as we knew it was no more. I mean, it would. I'll never forget. You know, I come home from work on a Friday, and then I get notified over the weekend that the school is closed indefinitely, that we're going to online learning, and they'll let us know when we can go back in the building. And as you sit. Process that you have to remember that none of us had a say in what was going on. So from teachers to parents to kids, we lost all control through no fault of our own, and as a result, too, public education took a massive hit because of covid, and because of that, it impacted mental health. Because think about it, where do our school age children spend the majority of their time? That is their occupation, that is their job. Is going to school. And so picture, if you will, that occupation has been taken away from them through no fault of their own, and they have no control. So as we were talking, the world has stopped. One day you're at work, the next time you're isolated, to be in your home for an indefinite amount of time, you've had no say in what is going on. You've had no control. You've lost it. And what do we like to do as human beings? We like to be in control of what we can be in control of, and that's very little. But when we've lost what we lost during covid, that's going to impact our income, that's going to impact our health, that's going to impact our socialization, and again, we had no say. Times were at best, uncertain. Parents were wondering, you know, am I going to continue to be the breadwinner? And on top of that, they also had to take on the responsibility of being the teacher, to ensure that while they're doing their job within their home, they also have to ensure that their child is on the computer, remaining engaged and getting and understanding the lesson that the teacher is doing through hybrid means. Children's occupation, again, school has been taken away, and now new norms and routines were thrown upon society. And to think about, you know, you've been clipping along all of your life, doing the same routine week after week, day after day, and all of a sudden you've got to come up with something new. Is really challenging. It's very stressful. So I know I'm just touching the tip of the iceberg, but please try and appreciate all of these challenges that happened. So everything's changing. What happened to our teachers? Our teachers were forced to transition. Let me move this over here. Transition in an erupt in an abrupt, short period of time, very little training on how to use digital resources, and in most cases, did not even have the equipment to adequately be able to do online teaching. Of course, I can only talk about the district that I was in, but you know, the teachers, they didn't have a choice. It was, you're going online, you're going to remain on the standards that we're expecting you to maintain. You're going to teach everything. And sorry, we don't have all the resources we're working on getting that out. Just a mess. And that was just in the district that I was in. I can't imagine what was going on in your part of the world. Research does show, and this was from one of my previous presentations, in order to master the art of teaching in a hybrid means typically takes a year and a half to master all of those skills, and we were told to have it mastered over a weekend. So let that sink in and give you some perspective. Okay, so as a result, I think this teacher's face pretty much says it all. We have our teachers who are now retiring and resigning at higher rates because of covid. One of the studies done by Rand in 2024 out of 1500 participants, a quarter of those teachers were still dealing with stress again. This is post covid. 60% of those 1500 are quote, unquote, burned out. Many report that stress and disappointments of teaching just simply is not worth it anymore. 59% of teachers reported being stressed, versus 78% in 2021 so it looks like the stress might have gone down a little bit, but nonetheless, greater than 50% that's a significant amount. Female teachers have more stress than their male counterparts. I found this really interesting, that teachers of color are less likely to report difficulty with stress or coping. Don't know the the reasoning behind that, but I thought that was a very interesting statistic. 22% are probably going to leave their job at the end of the year. 17% they're just going to stop teaching, that career, that profession, altogether, which just really hurts my heart. And then overwhelmingly, there was just a quote of. Quote, deep undercurrent of discontent. If you can get into the chat, tell me, do you still feel that there is an air of discontent in our schools today? This is going to be frustrating. Jayson Davies No worries. Money, money. I got you, um, I personally, I was just writing into the chat that like, in addition to all this, you also have inflation, and teacher wages not necessarily keeping up with inflation, so you had a mass exodus, and then people just being, like, not wanting, I think, to go into the teacher industry as much because lack of pay, plus the burden that they know teachers had during the pandemic, Dr. Monica Keen you are so right, and we're actually going to talk about exactly that in just a few slides. We're still in review, and we're talking about how the prevalence of anxiety skyrocketed from 10 to almost 50% in our teachers. Depression went from almost 16% to almost 30% and then stress overall from 12.7% to almost 51% those are gargantuous leaps and some very important mental health areas. So what about our families and again, iceberg for the teachers. Now let's go on to our families. The middle of that triangle. Here are some questions that I thought many parents were probably thinking about and just appreciate how this impacts their ability to keep a household up and running. Do I have a job? Am I going to work from home. How am I going to pay the bills? Am I going to work and be my teacher, my child's teacher? Am I How am I going to maintain the structure and routine now that everybody is home under the same roof, 24 hours a day, seven days a week, how am I going to take care of my family members that are sick? Why can't I go and be with my spouse who's in the hospital? How many of us know of friends or family who lost family members to covid while they were in the hospital and we could not even go in and visit with them? I miss my kids, or the children aren't handling this well, how am I going to be able to help them? Just think about this, if we as adults were so unsettled within our own selves, can you imagine how unsettling it had to be for our children? Some concerning statistics about what was going on in our families. In our homes, there was an increased concern about domestic violence. There was increased anxiety within the home, increased depressive symptoms, and 8.3% actually reported having suicidal thoughts and feelings. The increased negative interactions between our kids, including conflict, was higher and it resulted in the maltreatment of our children in the forms of yelling and shouting disciplining when disciplining was not needed, and the use of harsh words. And let me tell you something, as a person who has under you know, been verbally abused over my lifetime, the use of harsh words can be very devastating, and so here we are again, stuck in a home with these people, 24/7, no means of escape or a break. So let's talk about our little ones. Seven years and younger, increased clinginess and fear, not being cooperative, misbehavior, boredom, needing more attention. And we have to remember attention comes in both positive and negative forms. They just wanted more attention and then increase in anxiety. But yet, our children going into the teenage world, the puberty age, look how high the anxiety skyrocketed, almost from 2% to almost 24 Depression, depression in the ages of seven to 13, from 2% to almost 12% Post Traumatic Stress Disorder, three, 3% I Think that is significant simply because we're talking about an age bracket of seven to 13. Most problematic with our kid OTs were the changes in behaviors, the need for constant attention and reassurance, difficulties with academics. Let's talk about that for a minute. I can tell you that I am not the best hybrid learner. I'm a kinesthetic learner, where I need to see it, touch it, manipulate it, smell it, feel it, whatever, in order to get the best learning experience for myself. Well, that's not the case during covid at hybrid learning, our children were not able, some of them. We're not able to grasp the concepts. And I don't know if you have found this over the course of your career, but when you have a child who is not able to keep up with what's going on the in the classroom, I've noticed one of two things happen, either they shut down or they misbehave, and so we're having a situation where the children are also being advanced to the next grade when they haven't even mastered the concepts of the grade before them, and so once they get into that next grade, it just continues to pile on, on, on, putting more stress on our children, resulting in increased anxiety, increased depression, so on and so forth, and that is going to result in the misbehavior, anxiety, social isolation, when they just simply shut down and depression. All right, let's move on up into age adolescence. You know, during this time of adolescence, this is when they need the more most, quote, unquote, normalcy, right? And that was the least of what they were given during the times of covid. Studies showed that in our adolescence during covid, they were showing increase in depression, again, anxiety, PTSD, misbehavior, poor attention, increased impulsivity. You're going to see over and over, how these the areas of anxiety and depression just keep going up the ladder. So what is research showing? Now? This is where I got excited, because I've been waiting for this for a long time, and this is what I found out so far. All right, let me preface this by saying this is not, this is not a political agenda that I'm about to go over. When I did this in my last presentation, I forget where one of the comments said I think she was pushing her political agenda. And no, this came right out of research. So this is what our teachers are facing the end of federal pandemic relief funding. And so that means that the financial burden for them to bring supplies and resources into their classroom, a lot of it continues to fall on them. A new political agenda targeting public education, as we know, the Department of Education shut down, and that is where we get a lot of our help. For our educators. We are committed as educators to diversity and equity and inclusion, and especially as OTs, that is what we are driven to do. And so you know that has been threatened, deepening of inequities and access and support, and then evolving teaching as a profession. What Jayson was just talking about many of our teachers, again, they're just saying it's just not worth it. I'm finding over and over again that the support for our teachers is just becoming less and less, which, if they're not getting the support that they need, that is eventually going to bleed over into the classroom and with our students again. If you've got some comments about that, I would love to hear what you're noticing in your area of work. For our parents, our research is showing now that they're bringing in this concept, the reality of aces, adverse childhood experiences, and they are finding that if our parents had history of having had adverse childhood experience, and we're going to go over these specifically more in just a little bit that was going to directly impact how they handled themselves during the covid 19 pandemic. These adverse childhood experiences can have an impact on the individual's resilience, ability to cope, and how they regulate, how the parents regulate during their times of stress. Those who experience child maltreatment as an adverse childhood experience was more likely to carry out that same type of behavior on their children experiencing re traumatic events reported to have an increase during the isolation phase of covid, and mothers who experienced adverse childhood experiences were more likely to have less resilience, yeah, poor resilience during the covid experience. So now let's look at our children and our adolescents. Okay for our children, if they did not have a mental health diagnosis prior to covid, they were point one 5% more likely to develop one within two years post covid. If. They had a mental health diagnosis before covid, they were point 2.026% more likely to acquire a new one. And for our children, those usually played themselves out in developmental disorders and anxiety disorders, specifically ADHD and in some cases, conduct disorder. But when we looked at our adolescents again, if they did not have a mental health disorder prior to covid, they were point one, 9% more likely to develop one within two years. If they had one, they were more likely to acquire a new one in point zero 5% and for our adolescents that came in the form of anxiety disorder, substance abuse disorder, mood disorder, ADHD and increase in suicide attempts, that's very sobering, in addition To what this previous slide has shown you, in addition to depression and anxiety, again, our children, adolescents and teenagers, the gamut of the of our kids during their school, school age, time, PTSD, loneliness, I think that that is a very significant one that We need to pay a lot of attention to because how often do we hear children telling us that they're lonely? Psychological distress, anger? It's no to me, it's no wonder that these children do have anger, especially if they're not able to keep up in the classroom, especially if they have experienced something traumatic while they were forced to be home all of the time, and we have to remember as well that our young children do not have the verbiage to be able to express verbally how they're feeling, and so many of The times that expression is going to come out in the form of behavior. And we all know as OTs, behavior is a huge form of communication. There was an increase in irritability, increase in boredom, increase in fear and stress. And I thought this was fascinating as well. Eating disorders may have been reactivated secondary to covid, and that is because covid could have been a triggering event for those who had eating disorders previously, increasing the anxiety and the stress, thus causing them to fall back into what was familiar being their eating disorders. Any questions so far Jayson? Jayson Davies no questions. There's been some comments in there, but I was just going to say also, kids were at home all day. They were, you know, a stone's throw away from all the cupboards with all the food in it, as opposed to having to find eating times and defined school time. Dr. Monica Keen Exactly, and the parents as well. We have to remember, you know, they're trying to do their job. They're trying to make sure the kids are at, you know, sitting and attending in the classroom. It was just really chaos for a lot of homes. So I found this study, this meta analysis to be absolutely fascinating, notice, if you will. It was a cross sectional or a longitudinal study between America, Greece, Norway, Australia and Canada. They looked at children between the ages of eight to 18. They specifically looked at what were the levels of anxiety, pre covid and then post covid. So for anxiety, they gave specific results for America, Canada and Greece. And I'm not going to go over the numbers, simply because you can, you can read, but in each one, they increase. So for USA, 4.67 to 5.37 and then the same for Canada and Greece, it went up for depression, pre covid and post covid, they looked at America, Norway, Greece and Australia. And again, across the board, we are still seeing increased percentages in depression in all of those countries. So our children are not getting the interventions that they need to learn how to regulate and deal with the events that happened during covid, and they're still processing that. Jayson Davies All right. I hope you are enjoying this episode with Dr Monica keen. We're going to take a quick break, but when we return, Dr keen is going to dive into updated research as well as some practical strategies that we can use in the schools right now. Stay tuned. Dr. Monica Keen Okay, so now we're going to break into looking at aces trauma and resulting behaviors. And this is where I really got interested, because prior to the new statistics coming out about anxiety and depression, nothing was ever mentioned about adverse childhood experiences or traumatic events. It was this is what's going on, and this is why we're seeing an increase in anxiety and depression. But now they are saying that adverse childhood experiences did play a direct role in how our children were impacted during covid. So what is an adverse childhood experience? It is a preventable, potentially traumatic event that occurs in childhood. Now, when I read the word preventable, I read it as the child may not been able to prevent it, but it is something that did not have to happen, if that makes any sense. Some examples would be sexual abuse, verbal abuse, emotional and physical abuse, neglect, domestic violence, etc, etc. And there is an association when there has been a conglomerate accumulation of adverse childhood experiences and poor mental health, that goes to reason. But let's look at some specific things that happen when there is a buildup of those aces, emotional abuse, sexual violence and physical violence during dating was associated with increased substance abuse. If you experienced one to two aces during the pandemic, it doubled and possibly tripled your chances of falling into substance abuse. And if you experienced four or more of some aces during the pandemic, you had a higher chance of alcohol use, higher chance of binge drinking, and then a higher prevalence of increased alcohol during the pandemic, as well as a higher use of using marijuana. Now, thought this was really interesting as well. I learned that there are 10 original aces, and we now are looking to add more, which is going to be in the next slide. But let's look at what the original aces are, physical abuse. And again, these were labeled as preventable activities, not by the child, but the adult could have not done these things, physical abuse, emotional abuse, physical neglect and emotional neglect, two totally different things, but both carry impacting results. Parental separation, then divorce again, two things that are alike, but yet so totally different, domestic violence against the mother. Now, yeah, I'm sure that it is important if there's domestic violence against the father, but there's something more specific when the children witness it happening to the mother that it impacts them at a deeper level, substance abuse of a household member, mental illness of a household member, or incarceration of a household member. So these are the 10 original aces. And if we go to the previous slide that we looked at, remember we were talking about, if individuals had experienced these in an accumulation four or more, one or two or one, it will impact and increase their chances, as we talked about for alcohol abuse and substance abuse. So here are the ones that they are considering adding peer victimization. What does that boil down to? I think, for a child that's going to be bullying, whether it's cyber bullying, whether it's in person, peer victimization, battering, gambling problems in the household discrimination. And I want to kind of sit on discrimination for just a few minutes. Discrimination goes so far beyond the color of one's skin. In the previous presentation that I've done, there were specific statistics about the LGTBQ community for our adolescents and teenagers during the covid time, which pointed out that they had increased suicidal not only attempts, but also suicidal ideation. Because that community found its comfort and found its socialization and its peer connections in school, and so that was taken away, and they were back in a home where probably a lot of the parents didn't agree with the lifestyle, and so they were being judged, they were being condemned on a pretty consistent basis. And so when we see that word discrimination, let's make sure that discrimination covers a lot of different areas and not just race. The next two that we're going to talk about are really gaining a lot of traction in the world today as it relates to how it impacts our children's mental health. So contact with protective services that's not even talking about when they remove the child from the home, the mere fact that child protective services have come in into a situation in the home, again, where the child has had absolutely no control, and here they are being threatened to be removed from the home, even though that might be in that child's best interest, that is still the environment that that child is used to. That is their norm. That is where they have consistency, even though it might not be, probably is not positive consistency, the mere fact that that is being threatened and they're going to be removed from their parents, that is now considered an adverse childhood experience, foster care placement, again, being taken away from something that is so familiar to these children being put in an environment where they don't know anybody. They don't again, don't know the rules, the regulations, the schedule, the routine, and they are expected to adapt so very stressful poverty they want to add to the list of adverse childhood experiences, because poverty is going to directly impact their ability, the family's ability to get to resources, the things that they need, whether it's health care, food, being able to keep the lights on in the home, Being able to keep the water on when I talk to my students, when I'm teaching or when I'm presenting, especially to school practitioners, I always try to zone in on the fact that for children, for some children, school is the only place where they're going to get hot meals. Two of them, school may be the only place where they have electricity and running water, and so school is a safe haven for them. And so it's no wonder that poverty does play a role in being an adverse childhood experience. And then lastly, neighborhood violence is going to be added to the list as well. And I think that, you know, when we think about neighborhood violence, that comes in so many different ways, whether it's drug dealing, whether it's, you know, where active shooting is going on all the time, just neighborhood violence, where they see a lot of fighting in the streets, a lot of murders, neighborhood violence is going to be considered and with good reason to be another adverse childhood experience. All right, so in this particular study, mercera et al was looking at not only American children, but also Dutch children, and I found these statistics to be pretty disturbing as well. Almost 63% of high school students have experienced at least one adverse childhood experience out of the original framework that we talked about, the original 10 by the age of six, approximately 70% of children that from the US study longitudinal had experienced three or more out of eight of the 10 original aces for Dutch children nine to 13 years of age and regular ed. Regular ed reveal that approximately 45% had experienced at least one ACE in their lifetime, and 11% of those had experienced three or more of the 10 original aces. So again, we're not even looking at the other ones that are going to be added to the list, that for sure, we're going on in addition to the 10. So I put this in red because it's so important, adolescents who reported aces were more likely to experience depression, anxiety, drug abuse, antisocial behavior, suicidality and cognitive difficulties. All right, did you know that covid is now. Considered to have been a traumatic event. And I think that it should go without reason that that qualifies as a traumatic event. What I've done on this slide, and if I had the book with me, I learned it to one of my students. If you have not read the book, The Body Keeps the Score, oh, my goodness, please go get your copy tomorrow. That book was life changing for me, because it validates the fact that exposure to chronic trauma literally changes the biology of our brain. It alters our neural pathways and it causes different wiring within the brain, not that it can't be reversed, but to know that exposure to this trauma literally changes the makeup of our brain truly does validate why and how behavior is being impacted. So these were some of the direct quotes that I took from the book that I thought really hit home. Trauma results in fundamental reorganization of the way the mind and the brain manage stress. Recalling an emotional event from the past causes us to actually re experience that trauma, and we go back to the original sensations that we felt during the original event. Suppressing those inner cries for help doesn't stop our stress hormones from mobilizing the body when something terrifying happens, we will retain an intense and largely accurate memory of that event for a very long time. And lastly, and we've already spoke about this briefly, finding words to describe what has happened to you can be transformative, but it does not always abolish or stop the flashbacks or improve concentration. So again, think about our little ones who do not have the words to be able to talk about what happened to them and not express what happened to them and how that made them feel. So again, if you've not read the book The Body Keeps the Score, please get you a copy and check it out. So covid and trauma. As I said, covid 19 is now recognized as a traumatic event in the lives of some children, not all children, but some. And so with trauma comes trauma informed care, and I'm not certified in this form of intervention as of yet, but the components of trauma informed care are things that we can do at any given time in our interventions. And one of the things that I think is so wonderful about trauma informed care is that no longer do we look at the individual and in our situation, our children in the schools and say, What's wrong with you? Instead, we are now taking that approach of Tell me what happened to you. And that is such a huge shift in the approach that we're taking with our clients in order to make that relationship with them so that we can help them get past or deal with and better regulate their emotions trauma. Informed care also wants us to focus in and promote the resilience of our clients. We need to help them get back in touch with their ability to get better, their ability to regulate their emotions and their feelings, we need to get them back in touch with their ability to be to remember that they are resilient. The other wonderful thing about trauma informed care is that it really is client centered, and so you know, just like from Question one, we want to know what happened to them so that we can find out how that impacted them as a client specifically, and as OTs, when we pull on our mental health education and Our experience, we're going to help them to be be able to better navigate through that trauma, hopefully be able to give them some better cognitive strategies on how to reframe and rethink how they handled the trauma. So again, client centered care, it prioritizes a trauma. Informed care promotes and prioritizes trust and collaboration and so again, in order to have this with our client, we've got to build that relationship, and building relationships with individuals who have had trauma go on in their life is not and it's not meant to. Be an easy thing. We have to go back into our intentional relationship model and build that trust with that individual so that they feel comfortable sharing with us what's going on, and then we also you when we use trauma informed care, we want to promote the client's strengths. So instead of focusing on what they're having so many challenges with which is bringing down their resilience and it is causing increased anxiety and stress, we want to find and zone in on the things that they're doing well. We want to look at the things that they are strong in, and help them focus on that so that the other areas will come and improve with time. All right, the other thing about trauma informed care, and I know we're almost finished a trauma, informed care also has an acronym called cares, and it stands for context. We always want to understand what is the context of where our client is coming from, and so in this presentation, the context was, How did covid impact them? We want to ask questions. We we want to talk openly about the event so that they can identify the things that happen to them which are directly impacting their behavior or impacting their ability to engage in occupation and again, that's not going to come overnight. That is going to come from us using that intentional relationship model through therapeutic use of self to build that trust, respect and that friendship with our clients. Resiliency and resources is what R stands for, and we need to again, remember that we are focusing on their strengths, and we want to reinforce the resilience so that that, in turn, will decrease their stress. E stands for educate, and this is so incredibly important y'all, we have the privilege of being able to educate not only our clients, but the caregivers as well about how the trauma has impacted our clients, ability to engage in occupation, how it's impacted their behavior, If we don't understand why we're doing what we're doing. It makes it very difficult to appreciate the strategies that we are offering to our caregivers and our clients as to why they need to do certain things that that makes sense so by understanding or appreciating what our clients are going through as a result of an adverse childhood experience, as a result of trauma, that is going to help us better appreciate or understand what they are going through, and we can help open their eyes to the situation that they're in and teach them how To better regulate themselves. And again, this is for any age. School Based three to 21 we can we can work with any of those ages and educating and then self care. We want our clients to recognize that that trauma does produce stress, but we also need to remind them and empower them that engaging in self care, engaging in leisure activities, is going to help them better face the challenges that they are having, because self care always helps us feel better about ourselves. My question to you guys is, are you doing your self care, especially at this busy time of year? All right, wrapping things up, we're going to talk very quickly about internal versus external behaviors, and I do feel that we as practitioners probably cue into these things better than a lot of other professions internalized behavior. That is, of course, when we keep everything inside and we don't verbally express what's going on within ourselves, but it does come out in the form of being fearful, somatic complaints. I've got a headache. I've got a tummy ache, my neck hurts. You know, how many times have our kids in school come up to the teacher and said, on a daily basis, my tummy hurts, and we put two and two together, and we realize it's happening during a time when they're covering a subject that they don't understand. So somatic complaints are big worrying withdrawal, withdrawal and isolation, those are all examples of internalizing behaviors, whereas externalizing behaviors are going to be disruptive, aggressive, impulsive behaviors, and again, these are the children expressing how they're feeling through their behavior, and not so much through their verbiage. And what we need to do as the practitioner is not to react, but to respond and. And instead of getting upset to take that step back and to think about, what has this child gone through? What are they dealing with on a day to day basis, we need to be more aware of what is going on in our clients lives, so that we can better meet their needs through our interactions with them. And then lastly, what is our role as OTs? And so these are the things that I thought are so very important. Number one, please remember that every interaction is an intervention. I feel that we as OTs sometimes think that if we don't do an assessment or a test on a particular thing, then we're not addressing it, and that is so far from the truth. Every time we work with our kid OTs, we are addressing their mental health needs. Anytime you are hanging out with your friends, you're addressing their mental health needs. Every interaction that we do, we have the privilege of being able to know that we've done an intervention number two, that intentional relationship model be intentional in your relationships with everybody, but with our clients, especially those who have gone through trauma, when we're intentional and they can sense and that they know that we are truly interested in what's going on in their lives. That's where the trust is built, and that is where the relationship is formed using that therapeutic use of self. So so very important, we are the masters at that understanding the value of occupation. Now there's a difference in understanding what the value of occupation is versus engaging in occupation. Our goal is to get our clients to engage in occupation. So always know there's a difference between the two, but both of them are very important. What occupation is important to our clients? And once we've identified that, let's get them engaged in it. Know the occupation of your clients, and of course, we're going to figure that out through the occupational profile. And I would dare Gander to say that every time you go to get that kiddo out of the classroom to work with them, you need to be updating that occupational profile, because every single time you go to see that kiddo, they're not going to be the same. Their likes and dislikes might be the, you know, the same. They might vary a little bit, but we don't know when we open that door to get Johnny what kind of morning he's had. We don't know what Sarah had to deal with before she got to school. We don't know how Larry did on that test, and that just absolutely he bombed, and that's ruined the rest of his day. Always have that occupational profile being updated, become certified in tic trauma, informed care. I'm one that needs to fill that goal, but we can educate ourselves about what trauma informed care is, and we can go ahead and implement those the principles of trauma informed care. Always update the occupational profile and then lastly, but I think this is so important, appreciate the totality of your client's situation, being mindful of how the totality of what our little ones are dealing with will impact their behavior, and we can help them navigate beyond that journey. Help them to become successful in regulating their behavior and their emotions, but we must first understand, appreciate and gather the totality of what our kid OTs are going through with that the importance of occupation. This is the last slide. Occupations are the activities that people do every day to give their life meaning and purpose. Those can be done alone or with family or with friends. They can be done at home, at work, at school or in the community. Again, occupations are everywhere we go. Persons respond through adapting and innovation, whether occupations have been challenged or been threatened. This next one is so important, Adversity is not experienced the same by all people. That's one of the beautiful things about being an individual is that we experience things differently, and just because we experience things differently does not make our experience any less or any more than anybody else's. We as ot play a huge role in helping our clients adapt to their to occupations, as well as we are their biggest cheerleader to engage to participate back in those occupations, especially during their time of hardship and loss of OT, loss of engagement and occupation will not can it? Will impact the psychosocial well being of all individuals. So with that, I say thank you, and I am really interested in knowing if anybody has comments or questions. Jayson Davies All right, that wraps up episode number 200 thank you so much for tuning in to this special episode with myself and Dr Monica keen every time we have Dr Monty on the podcast. I love hearing from her. She teaches me something every single time, whether it is here on the podcast or in the collaborative like you just heard her presentation from plus, you know the knowledge is fantastic. I love it, but she is just also so inspiring, like she wants, she makes me want to do really cool things after every single time that I hear from her. Remember, if you want to dive deeper into this topic, and you want to earn one hour of a ot a approved professional development and access all the slides and resources from this course, you can do so by joining the school based ot collaborative at OTSchoolHouse.com, slash collab, you'll get this course as well as over 30 other courses, along with unlimited resources, our goal bank, our AI tools, everything to help make your life as a school based ot practitioner easier. Plus, if you do decide to join impact tier members also get full access to our back to school conference coming up this August that is packed with even more great content and more presentations to help you kick start your school year. Thank you one more time to Dr keen for sharing her expertise and for everything that you do for the school based ot community, and thank you for being a part of this 200th episode celebration. Thanks for tuning in. Really appreciate you being here, and I'll see you next time in Episode 201. Until then, 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 Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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 Schoolhouse Podcast

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 199 of the OT Schoolhouse Podcast. Transitioning from OT student to practicing clinician isn’t always a straight path—and in this episode, Chandler Sarkozi shares her real, unfiltered journey into school-based practice. From taking the NBCOT multiple times to navigating job options and ultimately choosing a travel-based school position, this conversation highlights the challenges many new grads face but don’t often talk about.
Chandler dives into what it actually looks like to start mid-year as a contract OT, including figuring out housing, building rapport with students and staff, and working through imposter syndrome. She also shares practical insights on the interview process, key questions to ask employers, and how a strong support system can make all the difference.
Whether you're a new grad, exploring school-based OT, or curious about travel therapy, this episode offers honest guidance and reassurance. 🎙️ Press play to hear how Chandler learned to trust herself, stay flexible, and grow into her role. Learning Objectives
Identify strategies for transitioning from OT student to school-based practitioner
Learners will identify key considerations when choosing between contract and district school-based OT roles
Determine essential interview questions to assess support, caseload, and job expectations Guest Bio Chandler is an occupational therapist who began her career as a travel school-based clinician, supporting preschool, middle school, and transition-aged students up to age 22. Prior to graduate school, she worked at a nonprofit school for autism that utilized the DIR/Floortime model—an experience that deeply shaped her relational and developmental approach. During her training, Chandler served as a SOTA board member and led an interprofessional competition, further strengthening her leadership and collaborative skills. Through her clinical work and global travel experiences, she has developed a culturally responsive approach grounded in compassion, curiosity, and collaboration. She approaches her work with a holistic lens, recognizing that meaningful progress happens when children, families, and educators are supported together. She prioritizes authentic relationships and inter-professional collaboration to create cohesive, goal-aligned support systems that are sustainable and contextually responsive. Chandler is passionate about strengthening caregivers as a way to strengthen entire communities, and she aspires to one day develop innovative, developmentally informed schools in underserved areas—creating environments that empower both children and those who support them. Quotes “I didn't come this far… to not fully finish what I started.” — Chandler Sárközi, MOT, OTR/L “Trust yourself… you're going to learn from it regardless.” — Chandler Sárközi, MOT, OTR/L “Trying something is better than assuming” — Chandler Sárközi, MOT, OTR/L “You don’t need to stress too much about knowing all the assessments before you get hired.” —Jayson Davies, M.A., OTR/L “Everything is figure-out-able.” —Jayson Davies, M.A., OTR/L Resources 👉LinkedIn - Chandler Sarkozi - Connect with Chandler for questions about travel school-based OT 👉From Student to Practitioner Guide 👉NBCOT - National Board for Certification in Occupational Therapy exam
👉Furnished Finder - Housing resources for travel therapists
👉Episode 172 with Doug Vestal - Recent OT Schoolhouse Podcast episode about student loans and financial planning Episode Transcript Expand to view episode transcript Jayson Davies Hey there, and welcome back to the OT school house podcast. This is episode 199, thank you so much for being here really quickly before we get started. I apologize if this intro and the outro later feels a little amazingly. I am overcoming a little bit of a cough cold, whatever you want to call it. And yeah, but that's not going to stop us. We are going to get through this important episode. So let's go ahead and set the scene starting a new school based ot job can feel like being dropped into the middle of a story that you're unfamiliar with, and when that unfamiliar story includes a travel contract in the middle of the school year, and maybe you just recently passed the NBC ot exam on your second, third, or maybe even your fourth try. That does not sound fun, right? Well, today's guest knows exactly what that is like. Chandler Sarkozy is an occupational therapist and assistant producer here at the OT school house podcast and one of the community managers of our school based ot collaborative community. Chandler began working with me while she was still in occupational therapy school a few years ago, and she recently made the leap from student to full time contracted school based practitioner, taking on a full caseload here in February, navigating IEPs she didn't write of course, and learning the ropes while balancing a long commute in the realities of travel therapy. In this episode, Chandler opens up about her transition, the financial decisions that led her to contract work, the support systems that saved her, the imposter syndrome that showed up anyway, and the strategies that helped her to survive and feel more confident in her new role as a school based ot if you're a new grad weighing your options, or a soon to be new grad wondering if travel therapy is right for you, or perhaps even a seasoned practitioner, curious what it's like to start mid year as a travel contractor. This conversation is for you. Let's dive in with Chandler Sarkozy, 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 Well, Chandler, here you are on the OT school house podcast. You are one of the most familiar people with the OT school house podcast, so it is going to be fun having you on the opposite end here as kind of being a guest on the show as opposed to kind of being the producer behind the scenes of the OT school house podcast. So welcome. How are you doing today? Chandler Sarkozi Thank you, Jayson. I'm doing good, a bit nervous, but cool to be on this side. So yeah, thanks for having me, and I'm excited to be here absolutely. Jayson Davies You know people who have attended the back to school conference or part of their two school house collaborative are familiar with you. People really appreciate how, how you bring value to I mean, at the back to school conference, mostly in our chat, really helping provide resources for people and at ot school house collaborative, everybody knows how involved you are there with making sure that professional development is going on and providing resources there. But here, we're here today to talk about you and your recent transition from being a student as an occupational therapist or an occupational therapy student moving into a full time school based ot position. So with that, before we dive into all that, I just want to hear a little bit from you how you kind of came into the world of occupational therapy. Chandler Sarkozi Yeah. So I knew I always wanted to help people. I just didn't know what that looked like when I was younger. And so my mom actually, she worked at a school and was friends with the occupational therapists, and she was like, I think ot would be the most perfect job for you. And I didn't know what ot was. So I was like, okay, like, I'll go check it out. I'll go shadow her friend and see what it's all about. And so it was at a school in elementary school. And so, you know, we saw kids in her small, little office, she had, like her desk, and then just like a little small trampoline, and then like a little crash pad. And it was, it was very small, but I'm like, Oh, wow, this seems so fun, like you're playing with kids all day. Like I'm sold. So that was kind of the beginning steps of me learning what ot was. And I had no idea that ot was in other areas as well. So I applied to OT school was all for, like, the working with kids being at a school, and then to find out there was all these other aspects to it, like in the hospitals. And I was like, that's not for me, but I'm here for the kids. I'm here for for learning. And so yeah, that's how I kind of learned about OT and. Applied to OT school. I, when I was doing that, I was actually getting my undergrad in human services, so another field of helping people, and then I transitioned to the OT aspect, awesome. Jayson Davies So what were some of the things that during school or OT school, that kind of helped you to solidify that maybe you wanted to go into school based occupational therapy. I know you mentioned, you know, that's kind of your roots in understanding occupational therapy. But as you mentioned, there's also many other areas of OT. So what was it that kind of solidified I want to go into school based OT? So we Chandler Sarkozi So we had our, we actually got to go into a school. So it was like an underserved school. working with those kids, it was really cool to see that dynamic. And the principal, I remember her so specifically. She was so upbeat and so just engaged with the kids. And she'd call everybody love. all the kids, even like us, the students our professors and everything. (6:01) And so going there and actually working with the kids, that was a really cool hands-on experience that we all did. And ⁓ then my fieldwork, I was at a school district doing evals for Playbased. and then one day a week we would go see the students. But I really liked the play-based evaluation aspect to that. And then my other placement was at a nonprofit that had a school, it had a clinic, and it had an adult section. So it was very cool having those three different areas and going to the school, seeing the transition students, which was different than what I had experienced before working with younger kids. So seeing that, I really liked. that aspect too. So just having a wide range of different experiences, even if some of them were short, just seeing the kids through their lifespan and how it is different working with each age range. Jayson Davies Yeah, absolutely. I mean, you know, our level our level one and level two field works really shaped what we understand about OT, I think a lot. And, you know, I never had a school based ot level one or level two, and obviously went into schools. But I know it seems like a lot of cases, people end up in one of the areas that they do a level one or level two, just because it really does shape us. And so it's so nice when you have a good level one, good level two experience that helps you, kind of get you through ot school and then into your career. And so let's go ahead and talk about that point then, because you know you go through your ot program, you go through your level ones and your level twos, and then it's kind of like, boom, you are out in the rural world here. So coming out of OT school, what was your thought process around completing the NBC, OT and then starting to work? I mean, I know nothing ever goes as planned, but, you know, go back to that moment that you graduated, what was your thinking that that, I guess, what was your thinking in terms of completing the NBC ot test and then going on to work? Chandler Sarkozi So my thinking plan was a little bit different than I think most people's, because as soon as I before I graduated, I knew that I was leaving the country. I left the country on a one way ticket. I didn't know when I was gonna come back, and so I didn't study my I had a plan that I was gonna study, but that ended up not happening. So it was months that I was gone, I didn't do what I originally said I was gonna do, oh yeah, I'm gonna, you know, study these days and make time for it. That didn't happen. So upon coming back, I was like, Okay, I want to take it as soon as possible. So I gave myself, I think, around four weeks, and I was like, I just want to take it. I want to see how I'm going to do and get it over with. So in those four weeks, all of my my cohort had already taken their exam, had already had jobs, so I had no one to study with. So it's just me alone trying to figure out the best way to study. I didn't know really what I was doing, how I needed to best study, and so I took it, and I failed by three points. And so that was super frustrating, because I was like, Oh, I was so close, but yet, so far. And so then I was like, okay, well, I need to figure out a different strategy to see if that'll help. And so I did, I studied for, I don't know how many more weeks and once again, passed, didn't pass by missing a few points. And so, you know, it just kind of got even more disappointing, like, ⁓ man, like, am I gonna get this? think I took it four times. On the fourth time I passed, And that time, I was, like, already looking for jobs. I was like, Okay, I'm passing this time. There's, there's no doubt about it, I'm staying in a good mindset about this. And so I was applying to jobs, doing job interviews, and yeah, then I found out that I finally passed and I saw those little, those little confetti things when I opened up the email, or whatever it was, and I was like, finally, I, like, texted my mom and everybody's, like, early in the morning when I got the news, and, yeah, it was finally, like a relief lifted. Jayson Davies But I think I remember that Google Chat coming in that you passed. I mean, this is, I know not everyone listening understands this, but Chandler and I meet on like a once a week basis. You know, on and off. We've skipped a few sessions every now and then, but we we meet very regularly, and I got to watch as you went through all these different emotions, per se, all these different failures, and then lifting yourself back up, and you could see how you were changing your plan in between each attempt. I mean, I remember sometimes you were going like hard at the library. Other times you're more, you know, just cuddle up with with a book or something at home. But things changed over time, and I guess, for from your perspective, what helped you, you know, once you got that email, the first three times that you know, wasn't great news, I guess. What was that experience like? Both kind of as you got that email, but then turned around to, you know, what I can do this. Chandler Sarkozi I've always not been a quitter, so I knew that no matter how many times it takes, if I keep failing, I'm gonna keep pushing through until I make it and like, I didn't come this far. I didn't go through ot school. I didn't go through all the tears and the hard times to not fully finish what I started. So, you know, I gave myself permission to feel disappointed and feel my feelings, but then I, you know, I have to pick it back up and keep going. And I think something else that helped was, by that time, my mentee from ot school, she had graduated, so she was studying for the exam as well, and she lives down the street from me, so we decided to make a study plan and start meeting up at the library. And so having her helped, you know, hold us both accountable, and we could quiz each other and ask each other questions. So I think having that that time also really helped and kept us both going, because we were both just like, Oh, we're just ready to both pass the test and be done with it. Jayson Davies Yeah, yeah, no, I totally understand that. One more question about this before we move on, because I think it's something that's not talked about very often, and that is, from your perspective, it's kind of a two part question. We'll start with part one, did you get a sense from other people in the profession, whether it be you know, even myself, that you know we met occasionally, or people from your cohort that you you know, kept in touch with, you know, did anything change relationship wise, when you let people know that, you know, I hadn't passed NBC, OT, you know, I missed it by a few points. And did that change? And the reason Matthew is because I want people who are listening to be able to kind of understand that from from the perspective, who's someone you know, who, who did have to take it a few times. Did you get a sense of anything changing when people found out that you didn't pass? Or was it similar? Were people very supportive? Did you have any hardships? Chandler Sarkozi I felt like I was, you know, incompetent when I would tell the people that I didn't pass. But nobody, you know, everybody was supportive. Nobody like said anything bad or anything like that. So I definitely tried to limit who I told each time as it went forward, just because I if I did fail, I didn't want to have to say it again or explain it. But then by that time, I'm like, You know what? It really doesn't matter. Are like, I'm taking it. If I fail, I fail. I think I got more confidence in myself to realize that either way, I'm human, I'll make mistakes, but that doesn't lower my worth. Yeah, yeah, awesome, yeah. I'm glad you've Jayson Davies had positive experiences, and I'm sure you know I always say that ot practitioners, especially are some of the kindest people and what the kindest people, and what the ethical people, and we all support one another. And you know, we just hope that that's always the case, because, you know, the NBC OT is not easy. I mean, they purposefully the pass rate, the pass to fail ratio is somewhat high, because it really is designed to make you think critically as you take the pass it or take the test. And so, yeah, you know, I couldn't be more happy for you once you pass, and I'm excited. And now, what that was back in December, Chandler Sarkozi that was in Oh, when was that? Jayson Davies Several months ago? We're just gonna months ago, yes, yeah. So that was back several months ago. And you know, like you said, once you were planning for this fourth test, and you knew you're going to pass it, you started looking for jobs. And at that point, walk me through some of the different options that you were considering, because in school based OT, I think you knew that you wanted to school based OT, or at least pediatrics. But what were some of the different options that you were weighing? Chandler Sarkozi Yeah, so I applied to some pediatric clinics, I applied to some schools, and I applied to early intervention, so all of them working with kids, I felt I hadn't done ei before, so I was, like, unsure about that one, but still, like, I was excited, because I would love to work with babies, but basically, I did some interviews with the clinics and honestly, once they told me the salary starting as an OT, like 65,000, I I feel like I've, I had so much time to think about this as I was not passing the test and as I was traveling. So those ones were out, Okay, I love traveling. I've been hesitant to look into travel therapy because something stuck in my mind if you starting out in travel therapy is not the best because they just throw you in to it. And so that kind of deterred me from doing that. But I was like, You know what? I'm gonna I'm gonna see my options. Let me just reach out to some recruiters and see what it looks like. And so I found some companies talked to them. And the one lady that I ended up talking to the most, and going with, she was very kind and understanding of all my wants and needs, because I I was very straightforward and blunt with everything that I wanted. And so she told me the options, and there happened to be an option that was close by to my house, well, not very close an hour away, but for a travel position, at least it's still in my state. So I had an interview with them, and everything seemed great. I asked a bunch of questions. They seemed very supportive, which was something really big on my list as a new practitioner coming in. I really wanted to make sure that I had a good support in the school, and that kind of right there sold me among just it, being in Illinois, being close to family as my first position, so I'm not super far away and and so, yeah, I was just weighing my options between EI and that. And I was like, and financially wise too, like, that was a big factor of mine, and so they were both on the same page financial wise. But I was like, I think having that support system and knowing that I've already been in schools, I'm comfortable there. I'm comfortable with the age ranges. So I was like, Yeah, that. That's what I'm going with. Jayson Davies All right, yeah, and then it sounds like you went directly to talking to contractors at any point. Did you apply your interview with in house districts or in house schools as a ot practitioner? Chandler Sarkozi I did, yeah, I applied to the school that I did my field work in that was actually earlier on in the process, before I even passed the exam, like maybe the second time I took the test, thinking that I was going to pass. I looked like one time prior and but I at that time, I wasn't sure about doing full time so, and they were looking for full time, so I didn't pass, and that ended up not working out regardless. So yeah, then that was pretty much when Jayson Davies it came time that you were ready after you did pass. Were there any particular reasons that you ended up going with a contract company over a school based company, whether it be an internal decision that you had made or an external in the sense that there just wasn't available positions, I guess. Why go contract route, the travel route, as opposed to in house with the district? Chandler Sarkozi For me, it was mostly about flexibility. In case I wanted to switch it up, I would. I knew that I would only be at one placement for 13 weeks if I liked it. I could continue, if the contract allowed for it, if they needed that, if I didn't, then I knew, Okay, after 13 weeks, I'm done and I can try something new. I can go into a pediatric clinic. I can go into EI I can do other things. So I felt like it gave me that flexibility of not feeling stuck in the beginning and being able to see what's out there, as well as having a stipend that's tax free money and making, you know, good money to begin with, in the contract field. So I think those were big determine, determining factors. For me, Jayson Davies I think that's a big one. I mean, aside from the financial aspect, the side that you know you can go in, you know that you have a placement for 13 weeks, you kind of get to decide if you like it or not. You also, and we're going to get more into this in a moment. You also started your contract position at a school district in like February or March, which is late in the year, as we all know, for the US public schools. So we'll talk more about that in a minute. But I think it's a good I don't think it's a bad idea. I should say, to try out contracting for the specific reason that you know, it's kind of an easy you can cut ties if you don't like it at the end of the school year or at the end of your 13 weeks. So yeah, where is there any opportunity to move further away from Illinois? And did you give that real consideration? Chandler Sarkozi Yeah, so I was really considering one of the placements in Texas, but I think I was like, I I want to be close to home for my first one, just because I don't know what to expect with everything. And I just felt like it was a good way to start, because it is a big change. It's a big transition, going from being in school to starting your career, and so just kind of slowly easing myself into it, and I thought that was a good way to start by staying in Illinois, being semi close by, and still getting the travel experience of having the travel contract, And then being able to branch out once this one's over, if that's what I decide to do, Jayson Davies yeah, yeah. I Yeah. I remember you talking about the Texas one a while back. And, yeah, when you bring up talking about the family, I've never done the travel myself. I've never lived more than like, 30 miles from where I grew up. But yeah, you know it would be an interesting experience, and I'm sure some people absolutely love it. And yeah, you what's nice is that you are going to be wrapping up your current travel contract, and just like we were talking about, you now have the flexibility. Should you decide to travel this time or in another 13 weeks after your next assignment, or whatever it might be. So that's what's nice about those short term contract jobs, is that if you like it, there is oftentimes an opportunity to stay, and if you don't like it, it's very easy to move on. Chandler Sarkozi Yeah, like I've been talking to some of my friends who are in OT and even my mom. My mom. Is a breast stenographer, I've been trying to get her to do travel therapy to to make the same amount of money in like half the year. and then she has free time to enjoy life and get to because she's always talking about, you know, just she doesn't have time and and, you know, she gets home from work and she's exhausted, I'm like, Well, this will free up your time, it'll give you more money, and you get to explore new places and see new things. And same with my friend, because she graduated with me, and I'm just like, you're young. Now's the time to try it, when you have that freedom and flexibility of maybe not having young kids or a family. So I think even for it works for young people who are just graduating, who maybe don't have a lot of responsibilities, as well as people who are older, who have older kids that already are grown, and they can now kind of live their life and do their own thing. So I think it's a wide range of people who should give it a chance and think about it and be open to the idea of seeing if it aligns with their life. Jayson Davies Yeah, yeah, absolutely. And you bring up a good point, I think this is turning out to be a good follow up episode to our recent episode with Doug vestill, right? Like you can use a travel position or a few different travel positions to help you potentially get ahead on those student loans, or to help save that six months worth of emergency fund before you know, maybe taking on a position where you can afford to get paid a little bit less because you have that cushion built up, or maybe now you have a little extra funds to start your own business on the side, which I know Chandler you kind of have aspirations for in the future, potentially, right? So like by taking on a job that might be a little bit tricky, we're going to get into that in a moment. The financial reward might be worth the short term hardship. In the event that you do have a hardship with that type of position. So yeah, I think that's a perfect opportunity for us to move on to this next question. Because, you know, everything is sunshine and roses. When we apply for that job and we get the news that, yes, we're going to take that job, they're happy to have us. But after that, what came next? What were some of the immediate not necessarily, I mean, I'm going to use the word consequence, but not in a bad way, just what were some of the immediate decisions that then had to be made knowing that you were taking this job, I think you said it's a little over an hour away from you. So as a travel therapy job, even though it's only an hour away, you still have to make some decisions. What were some of those decisions? Chandler Sarkozi The biggest decision is figuring out where you're going to live. So weighing Okay, do I want to get an Airbnb? Do I want to find an apartment on furnished nurses or furnished housing, or some website like that. Or do I want to stay in a hotel, like, like, figuring out what would be the best option. Or do I stay at home and commute? Or some days commute, and then some days stay in, like, a hotel and and kind of break it, break the drive up, so figuring out what works best. So in the beginning, I was like, Okay, let me just, let me test it out. Let me see how the drive is. Because I hadn't I work remotely with Jayson, so going to a full time job, driving two hours there and back, was just, it seemed like a lot. So I'm like, let me just give it some time and see how this goes. So figuring out that and yeah, Jayson Davies I remember one of the things for you, too, is just trying to weigh if it was worth moving all your stuff. You know, it was an hour away where it was, like, far enough that you didn't want to have to drive an hour, but also close enough that an hour didn't seem too far. So I really remember you like having to weigh do I want to move just for 13 weeks? And then I think the other problem I remember you talking about, too, was that it was really hard to even find an apartment that you could rent for such a short term. Chandler Sarkozi Yeah, I think because I was in such a remote area of Illinois, there just wasn't many options that were suitable yeah, Jayson Davies So based upon that, right, knowing that there ended up being a little bit of a hardship trying to figure out if you can move somewhere, because maybe there's limited places to live. Is there anything that you might have wanted to get information from the recruiter or someone in the process before making the decision to go to that job? Or do you feel like did you have support with this? Was it all on you? Do you. Wish you had more support with it. Chandler Sarkozi I think my recruiter did a nice job of trying her best to give me the options, like she showed me the website, and just trying her best to support me in whatever ways I needed. I did a lot of looking on my own and just things were expensive, and I was just like, it doesn't seem worth it to spend that much money in the middle of nowhere when I'm closer to home. So I was just kind of Yeah, weighing what I should do. Jayson Davies And yeah, I mean, I was driving an hour and 15 minutes to work every day for five years. So I totally understand that lots of podcasting time. Yeah, so Did, did the company offer you a stipend if you were to move? Chandler Sarkozi Yeah, so the stipend, the stipend was for food and and living, yeah, housing, so when you work over a certain amount of hours, like full time, you get the stipend if you are a certain amount of miles away from your house. Jayson Davies Okay, so it all has to do with miles away from where you currently live. Chandler Sarkozi Basically, gotcha, at least my placement, my All right, Jayson Davies yeah, was there anything else in the actual process of getting hired and getting started that was just a little tricky, a little difficult, or just anything, any stories, or anything that happened that you just have been sharing that you think was whether it was tough or easy, just general things about the process. Chandler Sarkozi I feel like the process was really smooth. It went very quickly because the position needed to be filled as quickly as possible. So it was like, I'm going to get my physical, I'm going to do the TB test. All of this within like, a span of maybe, like a week and a half. I had to get all this done, but everybody made it a smooth process. And I really don't have any bad things to say about it, other than it was just quick and like, it needed to be done and the process needed to be to be completed so I could start the job, because they wanted someone ASAP. Jayson Davies Cool, sometimes it's, it's nice when things move fast, and then you get a little like, oh my gosh, what's going on here? And the next thing you know, you're thrown into it. But if it's what you want, then it's good. Chandler Sarkozi Yeah, I think if you have a different starting date that is later, then it wouldn't have gone that quick. But I knew that it was going to be a quick turnaround. but I knew that I was starting pretty soon, so I knew that it was going to be a quick turnaround. But I don't think that happens for everybody. So depends on when you are planning to start and when you want to start, your recruiter will find you a job for that time Jayson Davies that you want, yeah, and they think you wanted to start pretty quickly, so that just kind of worked out for you. Awesome. All right, now let's dive into the actual work life, I guess we can call it, and that is jumping into a school district as a contracted school based ot in the middle of February or March, whenever you started. That's already giving me a little anxiety, having to jump into a position in the middle of the school year. But yeah, tell us a little bit about your experience. Chandler Sarkozi Yeah. So I felt like I was just being, like, dropped into, like, a story, and halfway through, and I didn't know what was going on, and it was just like, Okay, I I'm new, luckily, though I had a team of OTs and PTs, so they were super helpful. Even the first day I got there, the PT, Teresa was showing me around and just helping me out with any questions I had. And so it just, even though I was scared and nervous and thrown into it, that support system, like I said in the beginning, was everything, because I knew that I had them to ask questions, to figure out how to do things. So yeah, shout out to Nancy, Valerie and Mary, all the other OTs that have just helped me tremendously in this whole time span, and they're still continuing, continuously helping me, like even today I asked a bunch of questions, so that's been very helpful, having that support, but going in like not knowing the students names, what their goals are, like just being thrown into the classroom and just trying to figure out, okay, all these kids, who are they? What are their goals? Schools just trying to build rapport with them. And some of the kids were also new as well. So they're acclimating. I'm acclimating. And so also, just like feeling like an imposter, like I don't feel like I know what I'm doing, how am I good enough to make these decisions for these kids when I'm new, I'm just learning. I barely know them. I've been here for a month and a half, two months, so it just was a lot of like overwhelm and just feeling imposter syndrome and really just not, not knowing how to navigate it on my own. So, yeah, I guess that's just been a difficult thing to to deal with. But I just had to keep telling myself, like everyone, everybody starts somewhere. You'll you'll learn as you go. You'll learn from people like I was lucky to have those other OTs that let me shadow them in the beginning and see how they work with their kids, because I was taking on some of their case loads. So I got to see how they did things in the classroom, so I could keep things as similar as possible when I started and went into their classrooms. So I think that was very helpful to see how different OTs do different things, how different teachers and different classes run their classrooms. And so it's I'm finally getting the hang of things and understanding, okay, how each classroom is different, how I structure my time in there, the tables that I go to with the kids and and my weekly group projects that we do, and then the individual sessions. So it's all coming together eventually, but it definitely took some time to feel more comfortable and understand the routines and get to know the staff and the other OTs, PTs, SLPs and teachers and everyone, Jayson Davies yeah, and I have a lot of followers, but I guess the first one here is, do you feel that the difficulties getting started at all were related to being a contract therapist as opposed to an in house district therapist, or was it simply just starting a new job? It was going to be crazy no matter what. Chandler Sarkozi Maybe a mix of both, because I think coming in at the end of the school year, I don't think that's typical for an in house district employee, I don't know, but I think just being in the middle of it all at the end of the year, when all the IEPs are and it's just a hectic time of the year to come in, so all that added stress of like, okay, here's your Kids And now and now you have IEPs to do. You have evaluations to do, so all this additional stuff that is kind of being thrown at you, more so than maybe if you start at the beginning, when there's less IEPs and and just more, you know, you're getting to know the students. it's the beginning of the year, everybody's new, everybody's coming in fresh. So I think that, and then of course, just being a new practitioner coming in and just not being fully confident in your abilities and knowing how to do things. because, like, I feel like I know kids. I've been working with kids since I was a teenager and and I've done school based and I listened to the to OT school house. I use resources and the gold banks and everything from the collaborative so, like, I know I have a good understanding, but it's just like when you're in it, it's a little bit different when you're starting. So it was, it was a transition, and I think a mix. Jayson Davies How, how prepared Do you feel the district was for having an OT come into their program in the middle of February? Did they it sounds like you have kids that were on the caseload of other ot practitioners that are still working there. So I know sometimes when a contractor comes in, especially for a short time, is to cover a maternity or paternity leave or something like that. But it doesn't sound like that was the case, or maybe it was. Chandler Sarkozi So one of the OTs was on maternity leave, so she was there up until, I don't know, a month in or whatever. So okay, he was there to support and now she's fully gone taking care of her baby, the other one, the other ot went to part time to focus on something else, just for a short time. And I think she. Be back full time. So I took some of her caseload, and then I took some of the other OTs caseload, on top of additional students that were just given to me. Jayson Davies Gotcha? Okay? I guess the reason I'm asking is because if you come in and you're taking over a caseload for someone who's going on maternity or paternity short term leave, I feel like that can be to a degree, nice, cut, dry and easy in the sense that they had a caseload of 50, you're taking on their caseload of 50. Pretty straightforward, those 50 kids are now your 50 kids, their evaluations are now your evaluations, but to a degree, it sounds like you've kind of taken on some from this person, some from that person. And I don't know, do you just feel like that it was well laid out when you came into it as to who, what kids you were going to be seeing. Or did that kind of get figured out as you were coming in and were already there? Does that make sense? Chandler Sarkozi Yeah, so I feel like they did structure and they did organize it well, because I came in with a schedule like they had it planned out what day I was gonna see each kid, just as like a tentative schedule. It didn't have to be set in stone, but that was very helpful. The OTs put that together, the ones that I work with, and just so I could, you know, have it laid out, understand, okay, Mondays, my pre K, morning, afternoon, Tuesdays, middle school. So everything was just laid out, which I think was very helpful. Jayson Davies Yeah, good. Okay, now you've been in this role for about two months. It sounds like you have developed a little bit of a support system with the OT PT practitioners in your district. How are you feeling two months later? Is it getting better? Is it still as hard as it was day one? Just kind of in general, give an idea for those who are listening, maybe thinking about taking a contract or therapy job by God in the middle of the school year that still gives me chills. Like, does it get better? And how are you feeling? Chandler Sarkozi Yes, I definitely feel more confident and more comfortable in the position. I definitely don't have as much overwhelm, but I've also taken the time, because in the beginning, I was not doing any self care. I just felt so exhausted. I had no time or energy to put in any time for myself. I would come home and I would watch TV, and that's something I rarely do that. So when I do that, I know that I'm very, very stressed. So I just like, wanted to, like, numb out and not think about anything after the end of the day. And so now I've kind of re established my routine, and it's getting nicer outside too, which also helps. I can go outside, I can take a walk, I can do my journaling, my reading outside. So it's gotten more calm, and I feel more calm internally, and more at peace. So definitely, with time, it does get better. It is definitely stressful in the beginning when you don't know the kids, you don't know anybody's name, you don't know where you're going. I got lost in the middle school one time and just went in like a big circle looking for one of the classrooms. So you figure your way around and you you learn names, you you learn the kids, you learn what they're working on. So you know you just have to be patient, and know that it will get better, and it'll take time, but you'll get there and just push through it. And having that support, once again, is has been everything for me, just knowing that I can walk back into the OT room and if I have a question, they're right there to ask. So I think that's very important when you are taking a position to know, like, are you working with other OTs, or are you the only one in the district? Are you the only one at the school? Because it's so much easier having another ot at the school that you can communicate to, even if there's others in the district, but having them right there and accessible is just a lot quicker and easier. So having those questions that you ask at your job interviews to see if it's going to align for what you want, and if you're going to have the support that you need, because I think everybody has a different idea on what they want, what they need, and so knowing knowing yourself and knowing that, and then going forward with that and figuring out, is this something that will work for me? And. And, yeah, I don't know if I just kind of went off on a Jayson Davies I think you bring up a great point, though there at the end is, you know, being okay with asking questions at the interview. And sometimes they don't give you an opportunity to ask questions, but if they do, there are some questions I think you should ask, you should ask, you know, to help you understand if this job is going to align with your values. I know some questions that I've asked and that others have asked as well. Is asking them is ot ingrained into the MTSS or RTI program? Do you use a caseload or workload model? What is that caseload expectation? You know, how long do evaluations take? Our OTs expected to go to an IEP. I mean, all those are different questions that you can ask about in the interview. Are there any questions that you have kind of thought back now in two months that you kind of either a wished you would have asked, or maybe you did ask and you were happy that you did. Chandler Sarkozi Yeah, so one was seeing if there's like, other OTs at your actual school that you're going to be at. How does the process look for like onboarding and like chat, like, Will I have a chance to shadow other OTs to kind of see what it's like, since that was something that I got to do with the OTs that were there with me, since I was taking on their caseload. So if you are taking on someone's caseload and they're still there, like, that's a good opportunity to see if you can kind of see how they do things. If you, you know, want to get some more knowledge and learn some more things, or see how they do it. How many schools will you be going to? I think that's a big one to ask, because that luckily, I'm only at one school. It's the middle school and the priest the pre K attached. So I could just imagine going to multiple schools and just how hectic that would be. So planning for that, seeing if, if that's a thing, and if you're going to have to and if that's something that you're going to want to do or not. Are there like mentorship opportunities? Are there people that you can go to to talk to, and is your caseload already set? And kind of seeing what your caseload number is, and if you know, if they know if you're going to be in a middle school and a high school, kind of getting an idea for where they would place you. So I think those are some important questions, Jayson Davies yeah, is there any one particular topic, subject, idea, evaluation, treatment modality, that you wish you would have maybe done a little bit more studying up on prior to starting at your job? And of course, this is specific to your job, but anything in particular that you wish you had gone in knowing more about before you got this job, Chandler Sarkozi I would say, just refreshing myself with the evaluations that are used and because it was so long since I had been in school and done any of these things that I think that was just be helpful to remind myself, because it just has always kind of scared me doing evaluations. So I think that for me, would have been a thing to refresh on, Jayson Davies okay, and follow up question to that, is it okay that you didn't study all that before you got this job? And are you surviving? Chandler Sarkozi Yes, yes, I am. I am once again, because of my support system and having the other OTs there to ask and to help me get through everything that I need. So, yeah, I've survived and and I'm on upward of thriving, Jayson Davies awesome, yeah, I kind of wanted to ask you that question for that exact reason I think you can figure out right? Like I wanted everyone to realize they everything is figure outable. And even if you don't know everything before you get your job, you'll figure it out once you're in that position. And so you don't have to stress too much about knowing about the Peabody, the VMI, the bot, two, three, or whatever version they use, and SPM and the sensory profile like these are things that you will learn on the job, and that's okay. You don't need to know it all before you get hired. So, yeah, Chandler, you are figuring it out, and I'm sure everyone else listening will figure it out as well. Let's go ahead and wrap this up here with just one little piece of advice that you have for maybe a new grad who's Wayne school based OT, or travel school based OT. G maybe they're in a position to a degree similar to you, where you're thinking about some of those finances a little bit long term, and they have a long term vision. What's some pieces of advice you have for them? Chandler Sarkozi I would say trust yourself, know that whatever decision you make is going to be the right decision for you in that moment, and you're going to learn from it, regardless, and even though you may not think you're doing everything right or you just don't feel confident in yourself, with time that'll come and you will feel more competent, and just show up with compassion and a willingness to learn from others, learn from your mistakes, and just stay open and believe in yourself even when it's hard, Jayson Davies yeah, yeah, absolutely. I think that's great advice. You know, especially that you're making a decision based on a snapshot of where you are right now, and things will change just like they changed yesterday. They'll change tomorrow, and that's a great idea. Again, with a contract position, it's kind of even more true because you're taking on a 13 week or even if you're taking on a one year contract position, it's still a relatively short time in the grand scheme of things. And so you're making the decision based upon right here, right now, and who knows what will happen 13 weeks or a year from now? So absolutely, Chandler, go ahead. Chandler Sarkozi I was gonna say trying, like, trying something is better than assuming, like, you can always pivot if you need to. No decision is permanent, so give something a try and you, I don't think you'll regret it. You can always pivot if you need, Jayson Davies yeah, absolutely, Chandler, I want to thank you for coming on the show. You've been behind the scenes at the OT school house for so long, and you know everything about the podcast, but you have yet to be on the podcast. So I'm so happy you did this. I know you're not a professional speaker, or, you know someone who goes on podcasts ever, but I appreciate sharing, yes. So is there anywhere where people can go to learn more about yourself, or if they have questions for you? Chandler Sarkozi Yeah. So the best way to connect with me is on LinkedIn, and then I also created a free resource for anybody who's curious about travel based, travel school based, OT, and it's a PDF that you can get in the show notes if you're interested, and feel free to reach out or message me if you have any questions. I love connecting with other OTs and students. So yeah. Thank you so much, Jayson. I'm happy to be here and happy to get to talk to you about this. Jayson Davies Absolutely. I'm so used to saying I will put those in the show notes for you all. But in this case, I get to say we will put the show notes for you all. So yeah, once again, channel, I thank you so much for coming on sharing all your knowledge and your experience about this transition for you from student to being a contracted school based ot practitioner. Really appreciate it. I'm sure many who are listening will appreciate it as well. Thanks again. Hi. Thank you so much. All right, that wraps up our conversation with Chandler. Chandler. Thank you so much for being vulnerable and sharing your journey from ot student to contract a school based practitioner. It's one that many of us have experienced, including myself. I started off as a contracted therapist before moving into a district, so I totally understand how that feels. Thank you also for your honesty about the real challenges that you felt during this time. It's really easy just to kind of sit here and say, yeah, things are going well, even though you're struggling and working through some things. But you know, you're showing that, yes, this isn't easy, but yes, it's also rewarding. You're doing amazing work, and I'm excited to see where this journey takes you next. Also, of course, thank you so much for being an amazing team member here at the OT school house. You've really brought so much value to 1000s of practitioners who follow along at the OT school house. And I really appreciate all your support, all your stories, all your things behind the scenes that you do that no one listening right now even knows. Really appreciate it, of course, to everyone listening like yourself, if you are a new grad or even a seasoned practitioner looking for support resources and a community that gets school based ot I'd love to have you join us inside the OT school houses, school based ot collaborative. It's where school based ot practitioners like yourself come together for practical professional development, mentorship and all the resources you need to feel confident. In your practice. Head on over to OTSchoolHouse.com slash collab To Learn more and become a part of our community. Thanks again for tuning in to this episode of the OT school house podcast, and I'll catch you next time. 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. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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. 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Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 198 of the OT Schoolhouse Podcast. In this episode, Jayson discusses the often-overlooked but critical role that state and national occupational therapy associations play in protecting and advancing the profession. He highlights major advocacy wins from the past year, including AOTA's successful defense of Section 504, California's groundbreaking administrative credential legislation, Nevada's prevention of ABA encroachment on ADL services, and Nebraska's modernized OT Practice Act. Whether you're already a member or considering joining your state or national association, this episode offers compelling reasons to get involved—from joining and volunteering to simply sharing advocacy updates with colleagues. 🎧 Listen now to discover how your support can secure the future of school-based occupational therapy and ensure OT continues thriving in education settings. Learning Objectives
— Learners will identify the role of AOTA and state associations in protecting the occupational therapy profession at local, state, and national levels.
— Learners will identify recent advocacy wins that impact school-based OT practice, including Section 504 protections, IDEA, ESSA, and state-level administrative credential initiatives.
— Learners will identify how supporting professional associations through membership strengthens advocacy and ensures the sustainability of OT services in schools. Quotes "If students cannot get federal grants for OT school, they might pursue degrees where funding is available, and that's 10% of our future workforce gone." — Jayson Davies, M.A., OTR/L "AOTA isn't there to provide CEUs — they're cheap protection for our jobs, making sure we don't lose our profession in the schools." — Jayson Davies, M.A., OTR/L Resources 👉 OT Schoolhouse Abe saffer - Episode 91
👉OT Schoolhouse Abe Saffer - Episode 157 👉AOTA Advocacy & Legislative Updates 👉California OT Association 👉 Colorado OT Association
👉Connecticut OTA Association
👉California AB1009 – Administrative Credential pathway for school-based OTs (official legislative info 👉IDEA (Individuals with Disabilities Education Act
👉Section 504 of the Rehabilitation Act Episode Transcript Expand to view episode transcript Amazing Narrator 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 Hey there, and welcome back to the OT school house podcast. Thank you so much for being here. My name is Jayson, and today we have no special guest. It is just me. It is you. It is ot month. And yeah, let's just have a conversation. I want to have a real conversation around ot month, around advocacy, around a ot a, around your specific state association, and about all the state specific associations. Here in California, we have ot tag. In Colorado, they also have ot tag. I think Connecticut actually switched it up and has the Connecticut ot association. So they're coda, I believe. But yeah, whatever your state is, I want to talk about exactly what they are doing your state, as well as a ot a as well as all of us as individual occupational therapy practitioners in our own locales, if you want to call them that, our own regions, our own areas within those states, there is a lot of good things going on within the world of occupational therapy, especially school based occupational therapy. And a lot of times, we like to focus on the negative things, you know, what? What state organizations aren't doing, what the national organization isn't doing. That's what we kind of get caught up on a lot, but we forget that there is a lot of good going on. And so while you know, April is a great time to celebrate what is going well in occupational therapy and to celebrate us as individuals within occupational therapy, it's also a great time to talk about our state and national organizations about what they are doing to protect us as occupational therapy practitioners and to make sure that we don't lose our jobs in the schools and that we can continue to service those who we really enjoy servicing in the schools, you know, supporting the students and supporting the teachers, and maybe, just maybe, if you're in a state that allows it moving up into an administrative position where You can support more students and more teachers and many, many other you know, professionals and paraprofessionals to support all the students that we that we hope to help. So in this episode, I want to really focus in on some advocacy efforts, some advocacy wins at all the different levels, both. I shouldn't say both. I should say all the above at the local level as well as at the state level, and then even at the national level. I think we're going to start with the national level, because that really applies to every single person listening, whether or not you are a member of a ot a or not. Now before I do jump into exactly everything that a ot A is doing and some of the states have done this past year, I do want to kind of just make my general argument for why every single ot practitioner should be a member of both their state association as well as their national association and maybe even the World Federation of OT but primarily your state and your national organization, which all of us have, is a o, T, A. Now the way that I like to justify this, both for myself as well as for others, is that a ot a and our state association news, they're not a product that we pay for it. It's not like an exchange of money for an individual service, right? We are not paying a ot a for CEUs. To some degree, we get CEUs with our A ot a membership. And in some states, you get CEUs for your state membership. You might also get access to special events, like going to inspire or going to your state conference. You might be able to go out on a hike like I did with my region one and region two director here in Southern California and several other ot practitioners that live in Southern California, we took a nice little hike, and those are some of the, you know, awesome extra things that we get as part of being a member. But the real, you know, the crux and the core of membership, it's, it's an investment. It is an investment in our professional protection and a ot a and our status organizations, they are the only people out there fighting for us, right? We work for school districts, but school districts are not at our state fighting for us. They're not even necessarily fighting for us all the time in the local school district, even ot practitioners, right, that aren't in the schools, if they're in the hospital, you know, the hospitals aren't fighting to keep ot within Medicaid and Medicare. No, that is what OTC is doing. And the Arizona ot Association, the Oregon ot Association, and east coast, New York, Connecticut, you know, Virginia, all those ot associations, that is what they are doing. And so this member. Membership that we have with our state organization. It's not like most of our monetary, you know, exchanges. We're not getting a product in return for our investment. Instead, we are getting protection in our profession for our investment in these memberships. You know, our association membership helps those organizations to pay for policy analysis, for legislative monitoring, to keep up with all the different state senators and national Senators and House of Representatives, to see what they're up to and and to keep an eye on other professions. You know, even some people who we call our besties, like speech and PT and and some people that we might call foes like ABA, making sure that everyone is staying in line. I actually have some information about ABA going on with Nevada and just a moment as we get to some of our wins. But these are the types of things that our organizations help to protect. They pay for lobbyists within states, so that those people can go and talk to the state senators and State House of Representatives. They also build relationships with those people in government so that we can advance our profession and just kind of see what is going on when something hits the van, like many things have in the last year, a OTs is there, and, you know, they hop in their car, they jump on Zoom meetings, and they go and check in with the people that are so important in making decisions in Washington, DC or here in California, they're in Sacramento, and wherever your state is, They are there. I don't know if you get emails from your state association, but a lot of times they are the ones you know, sending out an email to us, saying, hey, we need your help everyone. Copy and paste this letter. Put your heading on it. Add your own story to it. Make it your own, but please send it to your senator and your House of Representative. Those are the types of things that our organizations are doing for us. So the key line here when it comes to understanding your state and as well as a ot a our associations, we are not buying benefits. We're not spying CEUs, that is not their purpose to give us extra things for our dues. We are really helping to fund representation of our profession of occupational therapy at all areas of the government, and that is key, because we sometimes, I think a lot of us see how fragile our profession is at sometimes, but we also don't think it could happen to us. Right? OTs not going away. But if we don't fund, if we don't pay, if we don't support our organizations, that could become real one day, other professions are willing to pay, and they're willing to pay for lobbyists to advance their ideas, their support mechanisms, they want the money that comes to occupational therapy. That's the, you know, most blunt way to say it, and they're willing to put money behind it. We're even seeing private equity get into the area of pediatric therapy services, not just occupational therapy, but pediatric therapy services in general. And wherever there's money, there are lobbyists. So we're not buying benefits when you join your state or or national organization you're buying representation of occupational therapy. Ooh, okay, I got a little worked up there talking fast if you're listening to this at two times the speed. Sorry about that, but I'm going to slow down here because I do want to highlight some really cool things that actually have happened in the past year legislatively, both with a ot a as well as at the state organization side, some of these things I've talked a little bit about, I've mentioned a few times, some of the things going on here in California, so that California Occupational therapists can actually become an administrator within the School District setting, and kind of move up, you know, not just get more pay, but also have more say of what's going on within a school and and sharing how occupational therapy can better support all students, not just students with special education, with special education services, who have an IEP and and OT is on that IEP, We know that ot practitioners can support many more students, and so that's something that here in California, we've been working on for several years. Shout out to Lisa Tess, Julie Bissell and a few others who have just been like on this for the past decade or so, really working on this, and it's been a major milestone. It's been a really big win, not just for them, but also for OTC in general, and that includes myself as an OTs member, right? Like, this is really cool stuff that we're doing. So, okay, got a little worked up there. You know, got talking about a ot a got excited talking about ot attack and all. All the really cool things that I know they're doing and the reason that I'm excited to support them, but I want to slow it down now and starting with a ot a talk about some advocacy wins, or also some areas that that a OTs still really focus on. Maybe it's not a win yet, but they're focused on and just share with you some things that are going on now. I want to preface this with, I am not, you know, volunteering with with a ot a in any capacity. I am not on the pack or anything like that the political action committee. These are things that have just been made publicly available through their website, through the newsletters that they send out, and some of those might be kind of things that you're maybe I get them because I'm a member. I don't know they send out the newsletters, but that's where a lot of this information is coming from, as well as their updates on their website. So again, these are some really cool things that a ot a has been doing for us, specifically as school based ot practitioners, and it's something that I think is worth being a member for. So the first thing is, is that a OTs actively advocating for school based ot practitioners at the federal level. They've been doing it for years. You've heard Abe Safar on this very podcast talking about what they are doing. I mean, even as recently as last year, he came on to talk a little bit about everything that's going on at the Department of Education and how a ot A is working to make sure that idea stays intact, and make sure that, you know, 504, stay intact. In fact, that's one of the big things that they worked on this past year. Both a ot A and the state associations, they work together to make sure that five oh fours were not deemed as unconstitutional. Last year, around this time, there were some states who fought to say, You know what, five oh fours are not constitutional. We don't necessarily need to be a part of them. We don't need to follow rule 504 and while a ot a as well as the, believe it was 17 different states jumped together and they said, You know what? No, we are going to make sure a, we monitor this. B, we are going to step up and say something, where we have where we have something to say. And C, we are going to find out how to be part of those conversations, whenever and wherever we can be. In the end, their hard work really paid off, and they were actually able to, you know, send out a notice saying that all the states were no longer all 17 states were no longer seeking to have section 504, declared as unconstitutional. And that was a big win. I mean, it's hard to believe that that was only about a year ago, maybe even slightly less than a year ago at the time of this podcast recording, and that was something that our A ot a membership dues helped to support, as well as state organizations within those 17 states, their membership dues also helped to support making sure that 504 did not go anywhere. I briefly mentioned, you know, the Department of Education and idea that has been an ongoing thing right now, right during this administration, there's been a lot of changes at the Department of Education, and I know that every single day, the amazing people that work in the legislative department at a ot a are constantly monitoring laws like ESSA and idea and making sure that the Department of Education isn't trying to dismantle these, or if they are trying to dismantle it, making sure that they have their voices in the room to let them know the Department of Education, you know, where occupational therapy, where the association of OT for all of America stands on ESSA and idea, and how occupational therapy practitioners like us support students who are served under IDEA or ESSA. And so this is very important. It's not something that we see right, like they're not sending out an email every day saying, Hey, today we sat in a meeting with this assistant director at the Department of Education, and we talked about this and this and this. No, they right, like that would be boring. No one wants a newsletter in their inbox about every conversation they have with someone. But you can be sure that all the wonderful people over there are doing amazing things to make sure that we don't get excluded. Like, we are very lucky that OT is directly mentioned in idea. Like, there are some professions that are not mentioned, and you know what? They're the ones that are probably fighting to say, hey, OTs mentioned. How do we get mentioned as well? And those are the same ones that we have to be careful of, because there's a possibility that if they get in there, then ot gets shaken up a little bit, and we don't want that to happen. So that's why it's very good to see a ot a actively making sure that things are going okay, because it would be very easy for a ot a to say, You know what, let's focus on Medicaid and Medicare. Care that maybe focuses more on the adult population and isn't as important as a school based OT. But the truth is, is that you know, a ot has everyone's interest at at heart all ot practitioners, I should say, and they have, you know, legislative advocates for us, not only at school based OT, but also for ot practitioners working in acute hit care and sub acute rehab and all that, you know, fun stuff. But of course, we focus on school based ot here on the podcast. And finally, the last point that I want to bring up for a ot A is that they're actively helping protect the future of the OT workforce. And this is something that is currently in the new cycle, with in respects to the amount that graduate students can actually borrow through specific federal grants for programs such as an occupational therapy schooling program, right to go to a university and get your master's or get your doctorate in an OT program. Now I will be the first to tell you that this is not my area of expertise. And in fact, when it first started to kind of come up, I was like, Is this even something I should really give much thought to? Like, how does this really impact me? But again, the more information that a OTs has put out, the more I start to understand how it definitely impacts us, because if, if students cannot get a federal grant right for occupational therapy school, then it is likely that they might look somewhere else, and they might look toward a degree where they can get funded. And because, you know, it takes money to go to school, and so if someone does go to another program to get whatever degree, let's say, just for the ease of it, they go pursue the medical doctor round, because they can get funding for that. They can get help from the government to go get their MD. Well, that is someone who is likely very smart, leaving our profession and going to another profession. And even if only you know, let's just put a relatively low number, I think 10% of people do that. Well, that's 10% of the future ot workforce that is gone right like those are people that will not be in the workforce and that later then impacts ot because if hospitals and schools and other areas where OTs work cannot hire OTs because there aren't enough of us, they will get creative, and they will figure out different ways to still support or provide the support that We provide in a different way. I'm not going to venture out to think about all the different ideas that that might look like. But as I mentioned earlier, there are other professions looking to capitalize on things like that, so we had to be careful about that like it is something that impacts us, even though we don't need graduate funds as practicing ot practitioners to get an OT degree. So yeah, that is just something that a ot A is on top of. It's still a little bit of an ongoing issue right now, but I'm pretty sure that we got the right people on it. And a ot a is there when they're on top of things, they do a pretty good job at making sure things get done. Of course, not everything, but, but they're pretty good, so I have faith in them all right. So that's going to wrap up here our conversation around what a ot A is doing for us as school based occupational therapy practitioners. And I hope that you better understand that when someone asks you, like, Hey, why or why aren't you a member of a ot a response isn't something like, oh, it's really expensive for the CEUs they provide. Well, they're not trying to provide CEUs. Those are an added benefit, but really they are cheap protection for our job. You know, a few $100 a month and and I know a few $100 is not a little, and it's for some people, it's a little. For some people, it's a lot. And you know, depends on where you are in your career, everything that's going on in your life, but to a degree, it is an insurance policy to make sure that we get to maintain our profession. And you know, the older you get, the less quote, unquote time you're going to have in your profession, the closer you get to retirement, right? But we want to protect our profession for long time to come, right? So let's continue to protect a ot a so that they can protect us all right. Now let's move on to state associations here, just like a ot a, every state is advocating on our behalf. If you're in Colorado, you've got Colorado advocating on your behalf. And one thing I didn't say actually at the top of the show or while I was talking about a ot A, is that we have to remember that these states and national organizations, they're advocating on our behalf, even if we're not paying for them. Now that is not a reason to not pay for them, because the more we pay, the more they are. Are able to advocate, but I say that they're advocating for us, and I'm not saying like, Oh, they're advocating for us if you're a member, because the fact is that they're advocating for you whether or not you are a member, because they're advocating for occupational therapy. But anyways, let's talk about the state associations here, and I'll start with California, because I know California. I live in California, and I see the updates regularly. And this year we had really exciting news, and that A, b1, 009, finally made it through the government. Went through all the rounds, went through the House of Representatives, went through the Senate, and finally got signed by our governor this year, which was the one step missing last year, and it is officially in place. And what this allows us to do is to earn our administrative credential. It didn't add any additional work to become a school based OT, which I think some people feared. They didn't make it like you had to go to extra courses in OT school, whether or not you're going to go into school based OT or you didn't have to graduate ot school and then go take another year of school in order to get this No, once you have your ot license, you can work in the schools. And then once you have so many years within the schools, and you go to an administrative credentialing program, just like any teacher would have to do to become an administrator, you can then become an administrator. Now, this is really cool. It's something that Otac has been working on for over 10 years, you know, and it's something that we finally got past, and it's really awesome. It really shows the impact that our membership dues can have on a state organization, right like this wasn't easy. Took many years. I can only imagine the amount, percentage wise, of OTs budget that had to go toward this one thing that supports about 25% of occupational therapy practitioners in any given state, but it was only possible because of our dues. It was only possible because, you know, Otac members said, You know what, I'm willing to keep paying. And thank you to every single they're probably not listening, but thank you to every single Otac member who's not in the schools that continued paying their dues to OTC, knowing that Otac was working on this rather than maybe something in the mental health field that they work in, or in the acute rehab field that they work in, like that that's important. Like that speaks a lot. You know, our OT Association support everyone, not just school based ot practitioners. And so it's really cool to see that OTC thought it was that important to support school based ot practitioners to push this through. It also took a lot of support from real school based ot practitioners. You know, this is something that I have worked on in the past. This is something that many of my colleagues, who I know in text, have been working on for years, and it's really cool to see this come through. So that was one example of, you know, ot attack, a state organization coming through, but there have been even more. So that's one example of a state organization coming through for us, but there have been more. Some of them don't necessarily always look like, advancing the profession forward, like, you know, getting an administrative credential. Others are, you know, revamping things that are already in existence. Case in point, Nebraska's organization worked to modernize their occupational therapy practice, act. And I don't know all the details of this, but this is something that, you know, they celebrated, and a OTs also celebrated with them. You know, this is important. We often say, you know, research, you know, needs to be within 10 years, and guiding documents, we want to be as recent as possible. But, you know, the same is true for our Practice Act, and it's hard to get practice acts changed because they typically have to go through the legislative process, something that is really I'm starting to see the value of within OT is that we are licensed once again. Thank you state organizations for making that possible, but we are licensed, and therefore we are protected to some extent. I actually wrote an email newsletter about this a few weeks ago that part of the reason that I'm not as worried about AI taking over occupational therapy. It's because we have this licensure in place. But if we don't protect our licensure by updating our OT practice acts within our states and making sure that you know everything is recent and that there's research behind our practice, act, then that opens up the door for AI. That opens up the door for other professions coming in and kind of stealing our thunder a little bit. So I want to give a big shout out to Nebraska and say congratulations to all of you who worked on updating your practice act. I know that is no small feat. I know it takes money, it takes time, it takes energy, countless endless nights, I'm sure. So congratulations on updating. In Your Practice Act. And finally, the third example of a big win from a state organization comes from Nevada. Well done, Nevada. You helped to pause a proposal that would have allowed ABA providers to address ADLs and IADLs through Medicaid. That deserves a clap. I hope you can hear that. I'm clapping right now. That is huge. I have heard over the last, you know, decade over decade period, school based ot practitioners complain about this on the Facebook groups, on our community, everywhere they can, about ABA providers overstepping their bounds, not just with IADLs and ADLs, but also in the world of sensory and we're seeing this. And this is a big win, like, not only because did they stop something in Nevada, but news reverberates right, like I'm talking about something in that happened in Nevada to OT practitioners all around the country that ot stepped up and prevented ABA from encroaching on our our ground of IADLs and ADLs, and that news is going to spread. And so the next time that someone says, oh, well, you know, ABA is encroaching on my ground, well now we can say, You know what? They tried. They tried in Nevada, and they got shut down. We helped them. The Nevada ot practitioners stepped up, paid their membership dues, and the Nevada ot association took care of this, along with support from a ot a and made sure that it wasn't going to happen that's going to reverberate across the entire nation, and I'm glad, because that means it is now less likely that we are encroached by ABA fun on IADLs and ADLs in California and in Arizona, and then all the other states surrounding Nevada and way beyond Nevada. So that is a win for the Nevada ot Association. You deserve a round of applause from every ot every ot practitioner, not just those in Nevada. That was huge. So thank you for doing that. We appreciate it and again, you know, it just goes to show what a state ot association can do when they have the support, both financially as well as from volunteers. Yeah, you know, we can do hard things, all right, so a OT, a has been helping us as school based ot practitioners at the federal level, within the Department of Education and beyond. We've now seen that in the States. You know, Nebraska has an updated Practice Act Nevada stopped ABA from encroaching on our ADL practices in California here, we stepped up to make sure that ot practitioners can climb into the role of an administrator level in the school based ot realm. So we got national, we got state. I also want to give out a big shout out to you and every single other ot practitioner who has advocated this year and beyond. Many of us, many of you, have advocated for additional staffing in your school district, or maybe you advocated for caseload and workload caps. Maybe you advocated to join a union so that the union can negotiate on your behalf for caseload and workload caps. These are things that don't make the news, right? You're not going to see this on Fox or ABC or CBS. Like, these are small little things. It might not even make the local paper, in fact, but they are big. Like, these are tiny things that not only affect you, but affect your ability to support the teachers and support the students that you serve, and so I want to give a big shout out to you. I hear these stories. You know, I can't think of all of them off the top of my head, but you know, I've gotten text messages and emails and Instagram threads like, hey Jayson, thank you for your caseload. Course we are implementing a workload cap in our school district, or, Hey, Jayson, you know, maybe it's someone I'm not trying to, you know, throw out my workload course out there and say that's the way it's happening. But, but I am getting people who did or did not take the workload course and are saying, hey, Jayson, you know, we just transitioned to a three to one program, and just like, awesome, because people are advocating, you know, I'm hearing from ot practitioners who have stood up and it took two years, but they are part of their union now, and now they have collective bargaining, and that collective bargaining team is helping to get them caseload and workload caps in place. Those are big like that took absolutely no money to OTC, no money to a, OT, a it just took time and energy from local ot practitioners, and that is absolutely fantastic, whether you know, you just increase your ability support students in special education, or maybe you advocated for MTSS so that you can. Support every student on campus that is huge. So thank you for advocating for you and your students. All right, so I've addressed the three areas that I really wanted to address. I addressed the national level, the state level, as well as the local level, where you have a big impact, and your ability to work at a small team can have a huge impact. And now I just kind of want to wrap up here, and you know, say, I do believe that every ot practitioner should be a member of a OT. I also believe that every member should be I also believe that every practitioner should be a member of their state organization. And if you practice in multiple states, then you know, maybe if you can afford it, be a member of both states, if you have the ability to time wise volunteer, maybe you're retired, maybe you work part time and want to have an impact on the profession, go volunteer, be a part of the association that helps sustain our profession, whether that's A member of your state organization, or even a ot a other things that you can also do is just keep informed of what's going on within the world of occupational therapy. When your state does send out a email saying, Hey, we're working on this, go to your state website and look up the bill number. And you know, what does that actually mean? How will it impact you? Read it a little bit and and show up to the meetings that your state organization has, and chime in and share your thoughts like these are all ways that you can support ot without even paying well, you probably have to pay your dues to show up at meetings, but you can keep tabs of what's going on, even if you're not necessarily paying all the dues, because you can kind of keep track. But they make it easy for us. They send us out the important things when we need to know it, so that we can take action the annual dues that we pay for a ot a and our state organizations. They don't feel exciting. They don't feel like, you know, we went to Target, we gave even up to $300 and we got something in return. Like we don't see that instant gratification. But I would argue that they are some of the most important dollars that we can spend for the future of occupational therapy, and specifically the future of school based occupational therapies, so the annual dues that we pay, they don't feel exciting. This isn't handing over our credit card for a $300 charge at Target and getting something awesome in return. This is something where we spend $300 and we see nothing, at least not right away. But the reward does come. The reward comes in the way that Otac and Otac of Colorado and Nevada and New Jersey and Virginia and a ot A Of course, give back to us through their advocacy efforts, the things that we don't see, the things that they don't share with us in newsletters, but we know behind the scenes is making our profession better and also securing our profession from other professions who might be trying to get into some of the areas that we know we can best serve our clients, our students, and the teachers that we support. So now I just have a few challenges for you, depending on where you are. If you're not a member of your state ot Association, please consider joining. Just type into Google your state ot Association. It'll be easy to find. It'll be easy to join. Just do it. Put it on otter, renew if you can, and just let that go. Let the idea of knowing that you support your ot Association and your state their advocacy efforts. Let that be enough to make this an exciting purchase. If you're already a member of your state association, consider joining a ot a just in the same exact way. Head on over to a ot a.org and join today. Hit that renew automatically button so that it just renews auto. You don't even have to deal with it. You can split it up into monthly payments or annual payments, whatever is easier for you. If you're already a member of both of your associations, consider looking at the volunteer page see where you can get involved. It could be something as simple as you know, a quarterly meeting on zoom that only takes up four hours a year. Or if you want, you can consider running for a position that takes up considerably more time, I suggest, first, by volunteering for maybe an upcoming event, or maybe a subcommittee that only meets a few times a year. So you can just get your feet wet there if you're not ready to volunteer, I totally understand that there's other ways that you can also support. When you see an email come through from your state association, forward it to your ot colleagues. When you see something on social media from your ot association or a ot a repost it or send it to your colleagues so that they know as well. If we assume that everyone knows what our state association is doing, or we assume that everyone knows what a ot A is doing, but that's not the case, so forward it to your friends, or tag them in the comments so that they see what a ot a or your state is doing as well. Another thing you can do reply to an email those state association emails that we get that you know, inform us about what's going on, hit respond and send two sentences. Say, You know what, hey, so and so whoever sending the email. Thank you so much for this email. Thank you for your advocacy efforts. I would love to get involved. Let me know if there's anything I can do, or even if you can't say that part about let me know what you what I can do to get involved. That little, simple email that you send saying, Hey, thank you for informing me I appreciate you, goes a long way in supporting them as well. All right, so this ot month, let's celebrate our profession by supporting the people and the organizations that are helping to protect it. Take one step forward, whether that's joining an association, sharing about an association, or volunteering at an association, be a part of what moves our profession forward. Be a part of making sure that ot never goes away. All right. With that. I hope you enjoy your ot month, and I will see you next time on the OT schoolhouse podcast. Amazing Narrator 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 Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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 Schoolhouse Podcast

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 197 of the OT Schoolhouse Podcast. In this episode of the OT Schoolhouse Podcast, host Jayson Davies is joined by Aimee Piller and Dr. Sultan Alfawaz to explore a powerful shift in school-based occupational therapy practice. Together, they break down how aligning OT services with academic standards can transform both student outcomes and how practitioners advocate for their role in schools. You’ll learn practical strategies for linking evaluation data and sensory processing patterns to educational goals, including how to connect assessments like the EASI, SOCM, and BOT-3 to specific academic standards. The episode also unpacks proximal vs. distal outcomes and helps you confidently determine when to use Ayres Sensory Integration® versus sensory-based interventions in school settings. Whether you're looking to strengthen your evaluations, improve collaboration with teachers, or better justify your services in IEP meetings, this episode provides a clear, actionable framework you can start using right away. 🎧 Listen now to learn how to connect your OT services to what matters most in schools—student participation and academic success. Learning Objectives
— Learners will identify how to link occupational therapy interventions to academic or state standards to improve educational relevance and advocacy in school settings. — Learners will differentiate between proximal (sensory processing) and distal (participation/academic) outcomes to strengthen clinical reasoning and goal writing. — Learners will identify how to integrate state standards into the referral and evaluation process Guest Bio A pioneer in his field, Dr. Alfawaz was the first Saudi occupational therapist to earn a doctoral degree and receive certification from the American Board in Occupational Therapy. His groundbreaking contributions to sensory integration have earned acclaim from the global OT community. He served as President of the International Council for Education in Ayres Sensory Integration and formerly held a leadership role at the American Occupational Therapy Association. Aimee Piller, PhD, OTR/L, BCP, FAOTA, is the owner and director of Piller Child Development, a multi-site outpatient pediatric therapy practice in the greater Phoenix area. She specializes in sensory integration and feeding therapy. Her scholarly interests include knowledge translation and the development of evidence-based treatment protocols to enhance clinical practice. She has numerous peer-reviewed publications, book chapters, international presentations, webinars/podcasts, and is the author of Implementing School-Based Occupational Therapy Services: A Multi-Tiered Approach to Sensory Processing Needs. Quotes “We are the minority in schools—we must speak their language.” — Dr. Alfawaz “We don’t need to memorize standards—we just need to access them.” — Dr. Piller “We’re not fixing sensory issues—we’re enabling academic success.” — Dr. Alfawaz “We don’t have to guess—we can assess.” — Dr. Piller “Meaningful evaluations lead to meaningful OT services.” — Jayson Davies, M.A, OTR/L Resources Dr. Alfawaz Linkedin Dr. Piller Linkedin Assessment Tools: EASI (Evaluation in Ayres Sensory Integration) - Mentioned as a standardized assessment for sensory integration evaluation
SIPT (Sensory Integration and Praxis Tests) - Referenced in relation to certification and data collection
SPM-2 (Sensory Processing Measure, Second Edition) - Assessment for evaluating sensory processing patterns
BOT-3 (Bruner-Oseretsky Test of Motor Proficiency, Third Edition) - Motor proficiency assessment
SOCM/SOCM-M - Sensory assessment tool referenced in the context of Dr. Erna Blanch's data collection work Publications & Articles:
"Implementing School-Based Occupational Therapy Services: A Multi-Tiered Approach to Sensory Processing Needs Book" by Aimee Piller - Book on MTSS and sensory processing
Systematic Review on Ayres Sensory Integration - Published in AJOT (American Journal of Occupational Therapy), led by Amy Piller as first author
Systematic Review on Sensory-Based Interventions - Open access article, led by Amy Piller as first author
"Call for Action" article by Colleen Whiting - Published March 2025, focuses on advocating for ASI in school settings
OT Practice Article (March edition) - By Sultan and Amy on linking sensory integration to Common Core State Standards
Special Issue in AJOT - Featured multiple resources on evidence for Ayres Sensory Integration
Organizations & Programs:
CLASI (Collaborative for Leadership in Ayres Sensory Integration) - Working on implementing ASI with fidelity in school systems
International Council of Education and ASI - Sultan serves as head of the ethical Committee
AOTA (American Occupational Therapy Association) - Children & Youth Standing Committee
Star Institute - Mentioned as organization working on school-based sensory integration
SIPSIS
Standards & Frameworks:
Common Core State Standards - Educational standards framework discussed throughout
ASI (Ayres Sensory Integration) - Evidence-based intervention framework with specific fidelity criteria
Upcoming Presentations:
AOTA Inspire Conference (Anaheim) - Pre-conference Wednesday session on implementing ASI on tight budgets (with Amy, Sultan, and Kristy Tang)
Other Resources:
Center for Autism Research, King Faisal Specialized Hospital & Research Center - Sultan's workplace in Saudi Arabia
Piller Child Development - Amy's clinic
EASI normative data collection - Middle East and North Africa project led by Sultan Episode Transcript Expand to view episode transcript Jayson Davies Hello and welcome to episode 197 of the OT school house podcast. We are getting close to Episode 200 I'm excited for that, but yeah, today 197 I am Jayson Davies, your host, and today we're addressing how we better connect our OT services and IEP goals to the educational curriculum. I really feel like this is something that can better ingrain us into the educational system. You know, we often feel like we are on the outside looking in in school based OT, and this is important, and we're going to discuss that today. Joining me, are two leaders in the world of sensory integration to help with that. Dr Amy piller, author of implementing sensory based occupational therapy services a multi tiered approach to sensory processing needs. She was also with us in Episode 192 and joining Amy today is Dr Sultan alfarez, a past president of the International Council education of air sensory integration, and he's been pioneering this work, especially with integrating sensory integration with common core standards, since his doctoral studies at USC, and it's a special honor to have Sultan on the show. Since we studied together back at USC in Gosh, 2010 to 2012 or so together, Amy and Sultan have been researching and sharing how we can connect what we do as school based ot practitioners to the Common Core State Standards, or your state standards. Not only is this about justifying services to administrators, it's also about transforming how we think about evaluations, intervention, planning and even the language that we use in the school setting. We'll walk through the entire process, from referral to report writing, discuss the difference between proximal and distal outcomes, and even briefly explore how AI tools can help streamline this framework. If you've ever sat in an IEP meeting wishing that educators and the teachers and the administrators better understood how and why occupational therapy and sensory processing matter for academic success. This episode is for you. Let's dive in. 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, CLASI is officially in session. Jayson Davies Amy, welcome back to the OT school house podcast. Sultan. Welcome for the very first time. Aimee, you were just recently on the show, like, I don't know, five episodes ago, Episode 192, but Sultan, this is your first time. So thank you so much for joining us today. Yeah. Dr. Sultan Alfawaz I'm so excited and honored and humbled, Jayson Davies yeah, and we are very excited to have you and very thankful to have you because you are on the opposite side of the world, 10 hours away. I would love for you just to quickly share kind of where you are in the world of OT and even just where you are in the world. Dr. Sultan Alfawaz I'm in a country called Saudi Arabia. I'm in Riyadh. Currently, we are actually celebrating and observing the month of Ramadan. So I'm in Saudi now with my family. So it's 10pm 10pm Saudi time, our Mecca time. I'm really, really excited to be with you, Jayson. So I've been lucky to be with Jayson when we did our master together back in 2011 right? Jayson Davies Yeah, yeah. I don't remember all that that's too long ago now I don't talk about that OTs, Dr. Sultan Alfawaz yeah, right. So yeah, to be you know, I spent most of my professional life actually in the US, but I'm glad to be able to serve my own countries as well and help them with the experience that they gained while I was in California. Jayson Davies Awesome, perfect. Well, thank you so much for being here, and let's go ahead and dive into it here, because, as you mentioned, you know, you've been doing this for a long time, and for the past three years or so, the two of you have really teamed up to address this, this concept that really hasn't been addressed, and that is kind of pairing occupational therapy services with the idea of Common Core State Standards. Or in some states, they're not common core, they're just state standards. And so my first question is, what inspired you to kind of team up and tackle this, or, like, what even made you think, hey, we need to start pairing ot with state standards. Dr. Aimee Piller Well, Jayson, it's funny, because Sultan and I, when we were preparing for this podcast, we had a we're like, how did we actually get this rolling? Because I'll let Sultan talk in a minute about how this was his doctoral work. But we, we decided we met and Calif really got it going in California at the International sensory integration Congress is when we kind of really started thinking, maybe we could do something together, like you have some very similar interests in the school system as do I, as we had from the previous podcast. And sensory of course, is something that we're both experts in. And so we just started talking and decided, well, maybe we could get. Something together with Sultan's doctoral work, and then some of the work that I do with schools on sensory so Sultan, do you want to talk about your doctoral work? Dr. Sultan Alfawaz Maybe, yeah. So even back in the days when I met Jayson, so I finished my master and I started on at USC, I did my doctoral studies, and it was during the time when Dr Erna Blanche was working on her data collection of Stasi SAS. So I took an elective course in school based with the amazing one of my amazing mentor, Dr Julie. Vessel, Hi Julie. Julie was working as at that time, she was the prime, I think, occupational therapist in Anaheim School District. Correct me if I'm wrong, Jayson. And she said, Oh my god, Susanne, you're doing really, really great work. Why didn't you link it to that education standard, right, the Common Core State Standard? And and I said, Oh my god, actually, that would be when I dived in more I was and I was already been an OT for five years, seven years, right, working in the UK, Saudi and recently, like the last three years, been in the US. And I was like, Yeah, we always, we never, ever, kind of answer that puzzle is like, how do we have the language of the administrators, right? And I was honestly as non California was like a new Californian in the market, right? I didn't know that it actually exists. You know, at that time, the Common Core by 2012 2013 I didn't even thought about it as an occupational therapy. There was a solely educational standards. But then when I dived in, I actually linked it to the soci M as a proposal. And then since then, I remember I was back to, I was working at PTN at that time, and I talked with, I talked to the one of my supervisor out there, and I shared her that even the table where I linked the SIP at that time to the Common Core State Standard for first grader, for one of my client, and she's like, Oh my god, style, if you work on this, this is going to be a game changer, because a lot of therapists, you Know, they stay in their clinical bubble, especially with languages, especially when they justify their services within an IEP meeting, that's perfect. Jayson Davies That's exactly kind of where I wanted to go, right here off the bat is, you know, like, why is that even important? Why is it important for occupational therapy practitioners to understand common core and then to start to say or ask ourselves, how does what we do impact Common Core? Why is that important? I think it's Dr. Sultan Alfawaz very helpful. I don't know if you don't mind. Amy, just adding a little bit on that is like we link our intervention to Common Core. Stay in there. We kind of validate our role, right? Why we are in this queue in the school setting rather than the clinic. We're not just fixing what they say, the sensory issues. We are directly supporting the student ability to read, write, do their math, function or actively participate in a PE class or in a social setting, right? So it changes the conversation from medical necessity to a more educational relevance. And I think it's a really, really key to secure services and even equipment, for example, for in any educational setting or school setting. And I always remind my students and remind myself, we are the minority there. We are the minority in the school district as an occupational therapist, so we cannot, like, pretend or just believe that they will understand our language. It's the other way around, where we speak their language in order to advocate for our service. I'm not sure if Amy, you want to add anything on that, yeah. Dr. Aimee Piller And I think one thing that's really important and that we focus on, it's our main goal as occupational therapist, is participation in whatever environment that client is in. And so, you know, in the case of the school setting, that's the educational goals and standards that the state sets for the students that the teachers are trying to implement, and we can be there to help support those and when we start, as Sultan said, to make our language match with the language that the teachers know, administrators know. And we can make those links between what we're doing and those common core, which is our participation goals, right then they do start to see the value and understand how important we are, as well as how we do support what they're already doing perfect. Jayson Davies And I think that's kind of what I wanted to actually address next. Because I think some people, and I've even had this internal discussion with myself, is like, is this simply trying, are we doing this just to appease the stakeholders, or is this actually going to make occupational therapy better in itself? And I kind of want to get your take on that. Like, is the whole purpose of doing this just so that administrators better understand how we fit into the schools? And even maybe even convincing ourselves how we better fit into the schools. Or do you think this is actually making occupational therapy in school based a actual better profession, because we're doing this Dr. Aimee Piller well, Jayson, I really appreciate the fact that as occupational therapists, we are often very adaptable, but we also really do want to focus on what's meaningful to the client, and in this case, that's what the school is doing. So yes, it we hope that it does justify our services to administrators, right? We want to make sure that we continue to be a part of the team and show ourselves that show others that we're relevant to the team, but it also is shows our unique ability to come in as that kind of support personnel occupational therapy can support what's already going on in the school setting. School setting. Maybe we have our own goals. Maybe we're just embedding within those schools, but we are the unique ones, and we understand how we can make this link between maybe sensory processing patterns and then reading or writing or physical education, as well as the other aspects that the kids often are referred to OT for in the school setting. Dr. Sultan Alfawaz Yeah, if I may add just to this, I think a lot of us, especially within the ASI work, or even in any other work, sometimes we have all these assessment data, and we are kind of struggling to how to convert it to everyday language and everyday participation struggles. So I always say it's very, very helpful for OTs to link these proximal outcomes Right? Which is, are the specific sensory factor we identify in our assessment? For example, He has hyperactivity or power Praxis or balances issues. These are the root causes, right? But the administrative or the stakeholders want to know, what are the distant outcomes, right? What are the participation challenges, the actual behaviors or academic circles that we see in the classroom, like a child hitting or or failing to sit still in a class, in his chair, on her chair? So the distinction matter, because schools care most about I don't know from my experience, through my time in California and even in London, about the distal outcome, participation. I'm not sure. Amy, do you circle? Do you see the same in Arizona, or do you Jayson in OT? But I see they always focus on the participation. So for us as an OT, we have to show that by treating these proximal outcomes or the cause or the sensory needs, we're kind of improving the distal outcome the academic success. I think linking that is how we justify the use of air sensory integration within this course setting. Jayson Davies Yeah, and you know, Sultan really quickly, if I can ask you, because I can't recall Amy, we might have touched upon this a little bit in Episode 192 but you use the terms distal and proximal outcomes a little bit, and I know that's very common now, especially in the sensory integration literature, but I don't think it's as common outside of the sensory integration literature. And so I wanted to just to kind of get, you know, a few sentences from you about what you're actually referring to when you talk about distal and proximal. Dr. Sultan Alfawaz I could answer it like so, for example, let's say, if we have a child with like, you know, he, we have a student to, you know, hits other when they get loud, right? This is a problem. This is more, more of an a problem, that the teacher comes to your door and they say we have this issues, right? So we do this assessment, we do the easy or we do them SPM to and we find that child has hyperactivity to the auditor, to the auditory input. So this is then the proximal, right? So this is the the proximal is the hyperactivity to the auditory where the distal is more hitting his peers or hitting his teachers around. So if we look at the Common Core State Standard, for example, social emotional learning or even classroom participation, these are standard about how to engage effectively in a collaborative discussion or following the rules for collegial discussion, right? So when you write and justifies for your intervention for that participation struggle, you could justify your treating these sensory auditory sensitivities by using ASI approach. So we are not just stopping the hitting, but we actually enabling the student to meet that standard of participation in a collaborative conversation with a diverse pattern. So we kind of frame the sensor intervention in a kind and a tool to unlock specific, I would say, academic standard, right? I don't know if Amy, you want to add anything on it, yeah. Dr. Aimee Piller Basically, in a nutshell, your proximal outcomes are your sensory processing patterns, and your distal outcomes. Are there participation goals that you have, in this case, a common core standards, as Sultan gave several examples of so that's just a great way, I think, for us as occupational therapists, to explain to those receiving our services, or those who might be supporting those receiving our services, as to, how does. Sensory processing as Sultan said, How does this child sensory processing patterns? What does that mean when he's hitting another kid, or he's not able to attend to the task, or he can't participate in the writing activity the way the other students are, and so this is the language that we use in the sensory world, because we have to link that sensory processing pattern to what's going on with this participation challenge. Perfect. Jayson Davies Thank you. Appreciate you both explaining that, because I know it's not something that we hear every day, unless we're, you know, reading articles several times a month or maybe even a week. But thank you Dr. Sultan Alfawaz and I could Jayson, if I could add one thing here as well, is I'm sure Amy as well when we teach Earth sensory integration to our participant. We always teach them, even within assessment, is how to develop your outcome measure, right, how to be proactive about it, and how to identify proximal versus distal outcome, right? And then when they go to the school practice, they're like, Oh, how can I link them. So by having this framework of having the education standards help school based occupational therapists to have a more, I would say, explicit framework to apply ASI framework within the school setting. Jayson Davies Yeah, and correct me if I'm wrong, but I in most cases, IEP goals tend to be that distal, that distal outcome and the proximal outcome might be something that you put on your treatment plan that you're kind of focused on, or something from the data that came out of the evaluation that sounded about right, yes, right, perfect. Yeah, all right. I wanted to dive into something because obviously you two are very much experts in the world of sensory integration. You know, Amy just wrote a book on MTSS and sensory processing. Sultan, you were the president for the International Council of Education. And ASI, obviously, you both know what you're talking about. And so I want to get from one or even both of you how you help under how you help under how you help therapists understand the difference between asi, asi and the SBI is the sensory based interventions. And so if I can get just, you know, a brief elevator speech on how you both kind of help OTs to understand that. Dr. Aimee Piller Well, Jayson, I think it is a really important concept, especially when we're describing different things to non OTs. So I feel like OTs, we can kind of like we use airs si sometimes along with sensory based interventions, and they maybe are using them together, but oftentimes we don't distinguish those and what their purpose is, and then also how they're the intervention is. And Sultan can also follow up on this as well, but with the arssi, we have some pretty clear fidelity criteria that we have to utilize. We're really working on internal adaptive processes. We're helping sensory integration happen in a different way, in a more adaptive way, versus sensory based interventions really are designed to help the child have a more regulated level of arousal or alertness in order to match the task at hand. So they're not necessarily designed to make lasting changes. They're really designed to modify the situation at hand, the child's arousal level or alertness level or the sensory environment so that the child can participate in the task at the moment. Jayson Davies That's a good way to frame it. Thanks. And Sultan, did you want to add? Dr. Sultan Alfawaz No, I think Amy has covered it all, and I don't know. I'm sure your audience knows about the two newly published systematic review where it showed that both sensor based intervention and error sensor integration are actually evidence based interventions. So actually, we live in the kind of I would say at that time, is a gold standard for air sensor integration, for sensory integration in general. So do you want to add anything about it? Amy, I think you are the co author, right? Your first author for both, yeah, Dr. Aimee Piller we did leave the team for those two systematic reviews. The one on air sensor integration is great. It really shows this a plethora of evidence that's come out in the last 10 years to support air SSI in many settings, including the school setting. So that's really exciting for us, I think, as practitioners, that now we can come and say oftentimes that air sensory integration has been thought of to be done outside of the schools, and maybe just due to access to equipment or space or training, but now that the evidence is coming around and showing that it's very effective, that's something and some part of the reason, you know Sultan and I do this work is to try to get that airs si into the school system, and to link the importance of it to what students are doing in school. So that systematic review was recently published in a OT, so if anyone wants to take a look at that one, and then our second systematic review was on sensory based interventions, and it had very a lot of them had some good evidence. Some had evidence that said they were not that great. And those, some of those are techniques that we use a lot in the schools. So being careful about what. Our outcome measures are, what are we trying to do? Is this right for this particular child? Is really important, and then other of the sensory based interventions had really strong evidence. So those are things that you probably want to make sure that you're embedding within your treatment in any setting, things like caregiver and teacher training was a big one. A lot with deep pressure, tactile input was big. And that systematic review is actually open access. So we're really excited about that, because we wanted not only occupational therapists to access that, but also, you know, psychologists school personnel, to be able to access that article. And so we're happy that that is also an open access article, so all practitioners can access that and have that evidence. Jayson Davies I always love when you can find an open access we appreciate that. Amy, but I had no idea that you actually were on both of those. I knew you were on the ASI one. I didn't realize you also participated as an author for the SBI one. So thank you for putting those together, Jayson, first author even, Dr. Aimee Piller yes, yeah, it was quite an ordeal to undertake, but we were happy when the with the finished product. So hopefully it will help all practitioners so that they can, yeah, better, you know, use better evidence based interventions, Jayson Davies yeah, and I'm familiar with Colleen whiting's recent works as well that are more specific to school based occupational therapy, which is fantastic, because for a long time there, everything was more clinic based, but now we're starting to see that roll out and expand, really, to the school setting, which is which is really awesome. Dr. Sultan Alfawaz Yeah, it was even Celine has done a great work Jayson and her recent article call for action was last year. I think March last year, I really encourage all your audience to read it. It's an amazing article. It helps you with the wording to advocate for ASI in school setting. Jayson Davies Yeah, and if I can ask one follow up to that, Amy, despite there being this, this body of research for both ASI as well as the sensory based interventions. In my communications with practitioners, especially in the schools, there tends to be a lean toward more the sensory based interventions. I think in some cases, just because those can be implemented in the school or in the classroom, directly in the classroom, and I think ASI there is that idea that it takes a lot more frequency to do and you have to do it in a pull out setting, maybe you call that more restrictive. But from your you know, obviously you've looked into this deeply. Why do you think there is that kind of push, especially within the school based world, to use sbis as opposed to asi? Dr. Aimee Piller Well, Jayson, you made a good point that, you know, the SBI is, can be used in the classroom, which is great. You don't have to take the kid out of the learning environment. You can implement those there, and sometimes that's what the child needs, right? Especially when we're looking at reactivity difficulties, or just general regulate, sensory regulation. SBI is, are really might be the best intervention for that child, but when we start to look at kids that have some more significant Praxis issues, or some really sensory discrimination issues that are impacting that participation, those are not going to be addressed by sensory based interventions, and that's when errors as I really becomes important. And some things that Sultan and I have presented on in the past is really trying to make that distinction, of you know, when is sensory based interventions, what this child needs to access education, and when are his the child's difficulties may be different, and they're not reactivity based. They're more sensory processing based, and that air sensory integration is the evidence based intervention to address those. And so when do we implement that in the right framework so that the child is able to and colleen's article really did a great job that it didn't take that long to show meaningful participation improvement. So yeah, maybe we have to quote, unquote, pull this kid out for some services, but then maybe it just is a few months and we can go back into the classroom and implement more sensory based interventions. So there's lots of research still yet to be done on that, but I think some of that early research shows that, yeah, maybe it's a lot right now, but it might be less in the long run. Jayson Davies Yeah, that's the hard part about school based too, really quickly. So that's the hard part about school base is that we often think in time frames of a year, but if we start to think two times a week for eight weeks, and then, you know, a break from occupational therapy, because those eight weeks were so impactful that's actually less services than one time a week for, you know, the entire school year. Sultan, did you want to add? Dr. Sultan Alfawaz No, I just want to mention that our friend Christy Tang and Amy and I are actually presenting, right? Amy, yes, and how to implement, exactly how to implement ASI in a tight budget, yeah. So that's something to look for in the upcoming AA, right? Amy. You that's coming up. Jayson Davies Yeah, a OTs coming up. In fact, this episode is coming out right about a month before, before a ot a Inspire. So if you're listening, there's still time. It's in Anaheim. Come visit Disneyland and get some CEUs at the same time. Come meet Amy and Sultan. It'd be awesome. And myself, it'd be fun to meet you. So let's take a quick break, and when we come back, we're going to really going to really dive into what this actually looks like for a school based ot practitioner in the schools. All right, we are back with Amy and Sultan, and I really want to dive into what this looks like, you know, for the school based ot practicing. And so I want to walk through this, and I want to ask you, at what point in your referral or evaluation process would you even begin to start thinking about the Common Core State Standards? Is this something that you know, right from the moment a teacher approaches you about Johnny, that you start thinking about this? Or is it during, you know, while you're doing the bot three or the SPM, or when does that start to come into play? Dr. Aimee Piller Well, Jayson, for me, it's really important to start thinking about it from the beginning, right? This are the, these are the participation challenges that we're going to see if our assessment data indicates that there might be reasons that this child's having needs, ot services. So just thinking about that aspect of what com what Common Core State Standards is this child struggling with, in addition to, maybe, like, some of the other reasons we get referrals for OT, which is oftentimes some behavioral or social emotional difficulty, as well as just but also the academic or other standards that we see. So that's important to me to think about from the beginning, because that's the participation side. And then, of course, the assessment pieces is critical to determine if they're, you know, sensory processing differences, or are lending themselves or preventing this child from participating to their potential to meet these common core state standards. Assessments really important for some all of what we do as OTs. I always tell my therapist, I'm like, we have wonderful assessments in our in our profession, very valid and reliable assessments, and we don't have to guess. We can just assess so it's easy to to implement that, to see those connections, and that's what we talk a little bit about, as we have this article coming out on how to make the link between those proximal outcomes that we identified in our evaluation process to that distal outcome of the Common Core State Standards, because that's really where we want to see the progress, right? That's where we're going to be looking at, monitoring and evaluating that progress is on that those common core standards, yeah. Jayson Davies And so I guess I'm thinking back to that referral, right? Like when we are first learning about a student. I can imagine. Well, I'll say right now, presently, a lot of times referrals come in and all they say is one word, handwriting, sensory, fine motor. And so I'm thinking like how beneficial it might be if, rather than a teacher telling me sensory or handwriting, instead they're giving me a checklist of a few standards that the kid is having difficulty, you know, completing. Does that make sense? Is that something that you've seen anyone, or maybe even yourselves, are kind of working toward doing more of Dr. Sultan Alfawaz Yeah, I don't know if Amy want to add anything to this, but for me, is like, just this is when we started, me and Amy, actually, the conversation is how to change the narratives, right? So the first things of the narrative, because I'm sure all the school OT or clinical OT, they get like crazy with all these referral with just like one things, and yeah, like all these teachers or administrator are diagnosing those kids with participation difficulties. And I think if we can't control the narratives, and I think kind of repositioning the wording more toward the education standards, I think we position ourselves as an occupational therapist in a better state, right within that IEP meeting and with other, I would say, with other professionals, I think it will add another value of why we are there, and the importance of occupational therapist, because we always need to remind ourselves students, when they are at school, this is their main occupation, from 9am to maybe 3pm right? Their main occupation is being a student meeting these education standards that were set by their state. So I think returning the changing the narratives to participation challenges which affect their meeting their education standards will help us a lot to link the outcome data to the distal outcome. Dr. Aimee Piller And Jayson, you made a great point of like, could that be part of that reason for referral? Do we create a little checklist that says, Well, how is this child doing with particular standards at that grade? Wouldn't that be valuable information? As we're doing our assessment, we would really know, like, are these linking together, or what we're seeing is that different? It's not just handwriting. There's other aspects that this child may be struggling with, and to have that data in the beginning from the teacher's perspective could be really invaluable. Jayson Davies Oh yeah, because especially the sensory run, right? We just get a referral that says sensory on it. And we know a lot about sensory, but the teachers don't necessarily. Maybe they've gone to some teacher based trainings and they understand sensory a little bit, but a lot of times they're writing sensory more as an idea, not as a definitive, you know, reason for the actual evaluation. That's what they perceive it as, and that's why we're coming in to test it further. I think it would help us greatly, if you know it. Rather than putting sensory they said, This child's having difficulty with ELA, 4.3 and whatever, math, 2.58 whatever. I don't know all the different ones, but then we could go about through our process, through the evaluation process, and kind of work, work through that. So yeah, if anyone out there is creating a referral process that includes this, please let us know, because I think that'd be be really cool to see. So let's imagine we do have that now, right? We have, you know, we've gone and we talked to the teacher, and the teacher says, Yeah, I'm having difficulty. Written language is difficult for this student, you know, this type of or this specific state standard. Amy, you started to talk a little bit more about the evaluation tools. Sultan, you talked a little bit about how we do have really good evaluation tools. I guess the this begs the question, where do we go from there, right? So if we know that a student's having difficulty in this particular standard, how do we begin to link that to the evaluation data? Dr. Aimee Piller Yeah. So when I think, if we just want to take a common example that's been mentioned, we said, you know, handwriting, right? We all get lots of referrals for that. So if we look at that from the ELA standard, you know, that's a written narratives, right? We have to write narratives. That's what kids do. There's predict different standards based on grades. So then you think about like, what are the OT skills that are, what are the OT relevant skills in that? Well, there's things like Visual motor fine motor sequencing, motor planning, those are aspects of that. And so then what assessment tools do we have that's going to look at those skills to see if this is a reason, from the sensory processing as well as motor standpoints, that this child may be having difficulties with this particular standard. So we talk about some different aspects, such as and Sultan and I have really focused in on kind of three main assessments. I think just because they're we feel that they're easily accessible and hit the things that we need from a sensory processing and sensory motor standpoint, the socm, the easy and the bot three, and hoping that therapists have access to at least one of those three tools, but there's many others out there. So some things that those tests would look at that would be relevant to that writing narratives would be things like ocular motor there's this praxis and following directions, visual Praxis on designs, there's ideation, proprioception, bilateral coordination. Are just some examples from subtests from those standardized assessments that we might use to identify if those kind of proximal outcomes are impeding that writing, narrative Common Core State Standard, Sultan, do you want to add to that? Dr. Sultan Alfawaz I think you covered it all, just like linking. And I think we're not just saying only these assessments are the only one linked to education standard, but when we go to the ASI world, these are the most commonly and acceptable gold standard assessment tool, right? Is the easier, right? And when go to motor proficiency, especially with the PE we will have bot three or bot two, right? So we're linking these sub tests just to help you to kind of road map your brain whenever I am doing this assessment. These are the education standards that are linked, or sub tests that are linked to these specific educational standards. Jayson Davies Okay, so, Sultan, you mentioned kind of using this assessment tool, right? We'll go with the bot or the easy. You know them very well, and can explain how you get there. And then you've got this physical education PE standard. I guess my question is, is this sounds to a degree really time consuming, because there's a lot of standards. Not that we can't go one by one and pull out, you know, all that, but it is very time consuming. So I guess my question is, is for the school based ot practitioner, right? How do we, how do we do this, like, I guess, in a realistic way, right? Like, I mean, I guess we just start with one kid first standard, and then start to make, like, our own internal bank of you know how this works? I know you guys have done some, but how do we make this feasible? Dr. Sultan Alfawaz So, for example, let's say balance. For example, right balance? We have a lot of kids coming to us with some issues with like, let's say balance and vestibular issues. We, you know, we always look at what is for example, for balance. For example, for first grader, piece standard requires student to balance oneself, demonstrating momentary stillness. So for an OT perspective, we always look at what are the underlying skills needed for that? So we need what vestibular processing to detect head position, proprioception. So. For example, to know where the limbs are and our core strength. So if we use a test like, let's say so cm or bot three, and identify a deficit in vestibular processing, so we know that all these three tests will assess balance correct. We explain to them the student is failing PE or not doing good in PE because they are not trying. They're failing because their vestibular system is not processing gravity correctly. This wording for Nano T may not make a lot of sense until we link them to it to we link them to an education standard. So if, as if a teacher comes to me, let's say a PE teacher struggling or reporting that a student are having difficulty within a PE class, then we could look at our assessment data, what did it indicate, and link it to that education standard for that specific grade? Jayson Davies Yeah, yeah. And I mean to a degree we should be doing this anyways, right when we get a referral, we're supposed to be looking at that referral, deciding what observations we need to do because of the concern, what assessment tools we need to do because of the concern. We're just kind of adding in that, that added idea of the Common Core Standard, or the state standard, if you're in a state that's not using common core, kind of how that helps you guide where you go with the observation and the evaluation process. Dr. Sultan Alfawaz And I think it helps as well. Yeah, it kind of helps me as well, because, you know, some of us work in clinic and some of us work in school at the same times, or vice versa, right? So it kind of help you with even the wording, to know whenever I have any referral within that concerns, right with the concerns part how that concerns is affecting his education or her education standards within that specific I think once we try start doing this, that will help us a lot on justifying the services and linking the proximal outcome to The distant outcome. Yeah. Dr. Aimee Piller Amy, do you want to add? You know, it could seem to be a big, big chunk, right? Like we have enough, we have a lot to know as OTs, do? I have to also know these, these state standards, like, that's a little bit can be a little bit intimidating, maybe a little too much to think about. But we know our craft Well, right? We know what being an OT is. OTs gave examples of how we link these vestibular processing to maybe balance or coordination. We know that, right? Maybe I don't know the standard, but teachers know the standards, just like you had mentioned earlier. Do we ask them what they're having trouble with from a standard, or do I just take the concept that they're giving me? I can plug that into some tool, lots of tools we have available to us now this concept of this grade level, can you give me the standard for that? What standard will match what this child's having difficulty with? So I don't think that occupational therapists have to concern themselves with becoming super familiar with all the state standards. They just have to know how to access them, because we can easily, and we do that all the time in our evaluation process, make the link between where these challenges might be in sensory processing and participation. We just need someone to tell us which standard it's relevant to. And there's lots of tools out there that I think can help us with Dr. Sultan Alfawaz that, yeah, especially in AI world, it's simplify and helps you to save a lot of time of just linking, because all these standards are out there, are open for public, right? Yeah, just making yourself familiar with it. It's as simple as that, yeah? Jayson Davies And I mean, yes, it takes that extra step, but I also think that it can make our evaluations much better than if we're trying to complete an evaluation off of sensory or handwriting like as the referral. Reason, you know, getting that taking that minute to to email the teacher, or to send out a Google form that you have already built and and just try and get to understand a better concept of of what the teacher is really seeing as a struggle. And the common course kind of the standards kind of work nicely, because they're defined like a teacher can say yes or no. They don't have to try and put it in their own words, what the students having difficulty with? And that gives you so much information. So, yeah, I think that Dr. Sultan Alfawaz Jayson as well. It kind of validate the teacher concerns as well. Exactly, you know, it just kind of justify their concern because they're coming to you by saying he or she are having difficulties in meeting that education standards. So it's kind of justifying their concerns. And teachers Jayson Davies have a lot on their plate, right? Like it's hard for them to sit down and write a paragraph about what they're seeing in this child, but it's much easier just to go through a checklist of, you know, the common core standards for their grade level say, yep, Johnny's having difficulty with this one, this one, this one and this one doing good on 23 but difficulty with four or five. Let's see if the OT can support with those four or five. All right, let's move to the back end of the evaluation, because now we've got this data, right. We've gone through we've now linked the difficulty. That the student is having the strengths that they that they have, back to some standards now we have this information. I want to kind of go through. What do we use this information for? And do we actually embed this into our report? Is it more for our intervention plan? How do you both see an OT actually using this data on the back end of the evaluation? I guess. Amy, would you like to start with this one? Dr. Aimee Piller Yeah, two things I kind of think are important in this area is one, it's going to provide us with the information when we talked about earlier, is this child? Does this child need errors aside? Do they need sensory based interventions? If we know clearly what our data says from the evaluation process, we know where those participation challenges are, and now how they relate to Common Core State Standard. It's really easy to determine and justify if whether or not heirs SI is best for this child, or sensory based interventions are what this child needs for the state standard. So that's an important piece of that as well. And then the second of course is that intervention and treatment planning. What's our what are we working on? What's our goal? Is our goal? How do we write a goal that supports that Common Core Standard, or that state standard? Is our goal? Separate? Are we embedding depending on where you're at and what your IEP process looks like? So those two things are very important in the evaluation process. One, making sure you've got the right intervention for what you're trying to do, and then two, that your outcome measure that state standard is somehow embedded, either influencing your own ot goals, or that you're supporting particular goals that are there already. Jayson Davies Yeah, yeah, no, I couldn't agree more, and I think it does both sides of that, right. It helps us to better support the student, and also helps us to justify a little bit, which is what I think is also important. I don't want to jump into that yet, but I do want to say, because OTs like to have kind of this, we like to have this idea that we have this report right, and we have to do this report in an IEP, or we have to present this report in an IEP. Is this a place for us to actually input? You know, Johnny's having difficulty with these three standards, and below that is exactly how air sensory integration and occupational therapy can support the student. Is that something that that might be helpful? Dr. Aimee Piller To me, that makes it really, really clear that that's educationally relevant, right, which is so often what we get in the school setting. Oh, maybe it's not educationally relevant, or prove it's educationally relevant. So that makes it so clear, no one could probably even argue that, right, that it's right there. This is how it impacts it. If you've written that really good linking between those proximal and distal outcomes, then it's even though they don't speak the language of OTs, they can see that there's a link, right? So if this, if sensory processing and integration is impacting this, this child's performance, and the state standard, and I look and say, well, what's the intervention? What's the evidence based intervention for these difficulties, then that's the support that we need to either do errors outside of the school, or sensory based interventions or and sometimes it's something else completely. We determined it wasn't sensory it was something else this child needed. But now there's no question, I think, when we talk to administrators, parents, teachers, that when we have that clear link between the what's going on, sensory processing wise, and this state standard, why would they not support our intervention? That's the evidence based one for that area of difficulty we found in that evaluation process. Jayson Davies Yeah, I really appreciate how this entire process almost tells a story that gets us to this point because, you know, we're not just starting with a referral reason of sensory instead, we're starting with a referral reason that has a defined starting point, these three or four, however many standards. And because of those standards, we went through and we did this, we did an observation in the classroom, because that's what the standards that's where the standards occur, that the students having difficulty, or we went out to PE because those are the standards that the student was having difficulty. Then we use the assessment piece, because those standards told us, hey, there might be difficulty in these areas. So we assess those specific areas, and then we get to the end, where either a as Amy you're just kind of alluding to, right, we can very much define, yes, that sensory is the justification. On the flip side, it would be really simple, you know, for ot practitioners who maybe are looking to decrease or exit services, same type of thing. It could go back the other way and kind of say, look, I looked at these three standards based upon those. I thought this might be a concern. I evaluated not a concern. Maybe something else is needed. So I think that makes a nice picture. Dr. Sultan Alfawaz You really put it in a really, really clear way of explaining it. And this is why I I feel it's kind of bridge of our language to their language, you know, like, you know, maybe some of the audience have already tried it. I've already tried it. And once, I say, in the IEP, I remember when I first introduced it in 2014 15. And I feel like there is a silence and a pause in the IEP meeting. Oh, wow. You guys talk about education standards, you know, the education centers, right? It kind of changed the conversation a little bit, and it makes it more relevant, and it makes our work and our intervention, even our assessment, why we are using this particular assessment more relevant in education standards? Jayson Davies Yeah, yeah. All right. As we begin to wrap up here, I want to give you both the opportunity to share just a few other potential in your resources, ideas, research articles that you think that maybe anyone listening might want to look into you've already mentioned a few. We'll be sure to link to those in the show notes. But are there any other aside from the assessment tools that we've mentioned and some of the research that we've already mentioned, are there any specific tools or resources that you would recommend to a practitioner who wants to start implementing this framework? Dr. Aimee Piller Well, Sultan has done a lot of work already on some how to choose the right assessment for common core. So I think a lot of the work that he's done is there, and we've tried to put that together into some upcoming presentations that we have at a OT, a pre conference that we'll be doing on Wednesday. And we mentioned already that we've got one on how do you actually implement air sensory integration when you don't have a lot of money in the school system. We've got an OT practice article coming out that just briefly defines this thing. And Sultan and I continue to work on this because we think it's important for us as occupational therapists to really justify our services and speak the language of the people who are receiving our services or supporting our services, and then also knowing too, and I know you're going to link to, hopefully link to, the two systematic reviews that are coming out because there's still a lot of, I guess, not great information, or old information floating around about arssi and how it's not evidence based, but it has been recognized, but as an evidence based intervention, particularly for the autistic population. And as well as these new systematic reviews, and then there was also just a special issue in a j that came out that had a lot of resources on the evidence of sensory air sensory integration. And so as we maybe shift in thinking or discuss that shift in thinking as a profession does airs as I have a place in the school system. If it does, what does that look like? And I know we've talked about some different things coming out in relation to that. So I do know that there's even more information in the works on how to do airs, as I with good fidelity in the school system that's being worked on by some other organizations like CLASI. So some of those things are coming out, and I think it's a really exciting time for us as a profession, but we also have to make sure we're gathering those right, that good evidence for the setting that we're in. Sultan, do you have something resources? Dr. Sultan Alfawaz No, I you covered it all. But I would always, I would add to that, like even within this world that we are living now 2026 we are living in the world of AI, even using a customized AI tool, especially when someone will come to me and was like, Oh, my God, how I'm gonna remember all these educational standard right? You could build up this customized, customized chat bot within chat, GPT or Gemini, where you could upload all the educational standards, and we'll be able to say, Oh, what is the education standard for first grader that have difficulty with balance, you know, as an OT from your ASI training, where balance fallen right, proprioceptive and vestibular process, so you know you're proximal right. And then you link these participation challenges. And I think the more we utilize technologies as well with this new evidence. And I'm saying new evidence because it's it looks like more evidence is coming up. I see, like, every two months, we see a new evidence and new articles coming up. RCT, systematic review, which is the top tier in the pyramids, right? So I think we are living in a great time for ASI, and I hope, as much as we found now more evidence in in the clinical setting, we will find more evidence with within the school setting, and I think it takes a village all of us needs to do. The more we have clarity in our framework and our intervention and linking it to the school and educational standard, the more we'll be able to be more relevant within that setting. Jayson Davies I agree it is a very exciting time. Easy the CLASI and the easy as well as the star Institute, there's just so much going on right now from the sensory world coming together and focusing on school based, and that is just really exciting for a long time. Yeah, it was like, really clinic based, clinic based, clinic based, but we are starting to see that just kind of emerge into the school based ot realm. And that's exciting. I'm excited that we're able to do this podcast together to share a little bit about that and how we can link, you know, ot services to those proximal and distal goals and and. Standards, and I'm excited to see where you both go, because it's been fun, kind of following you over the last three years at a ot a and watching as like this continues to grow, and I'm excited to continue watching that. So I think it's super, super beneficial for ot practitioners, even if they can't do this, you know, with every single standard, every now and then, right, like, just, just kind of, as you're going through your evaluation process, think about it. How does it link? And maybe think about how you can even improve it next time to make your evaluations better. Because we all know that meaningful evaluations lead to meaningful ot services, and so the better our evaluations can be, the better that we can link school to occupational therapy. I think the better that the profession is going to be. So thank you so much. I really appreciate it, and congratulations again on your upcoming article. Dr. Aimee Piller Well, thank you, Jayson. Jayson Davies All right, and that wraps up this episode. Want to give a big thank you again to Amy and Sultan for joining me today and for the incredible work that they are both doing to bridge sensory integration and educational standards, this framework is truly helping school based ot practitioners speak the language of education while providing evidence based practices. I think the better that we can show exactly how what we do is having an impact on those state standards, the more that we can kind of just show the value that we provide to the students. Also, I think within that referral process, if we can better tease out what standards a student is having difficulty with, that is going to make our evaluations more powerful, which is then, of course, going to make our services more powerful. So to all of you listening, thank you so much. I hope this conversation gave you some practical ways to connect your ot services to the Common Core State Standards, or whatever your state standards are. Hopefully this helps you to link all your data to participation goals and justify the interventions that you are recommending in your meetings. If you want to dive deeper into topics like this and connect with other school based ot practitioners. I'd love to have you join the OT school house collaborative. There you'll get access to exclusive resources professional development and mentorship from myself and the OT School House team to help you grow in your practice. Head on over to OTs schoolhouse.com/collab, to learn more. Thanks so much for listening, and I'll catch you in the next episode of the OT schoolhouse podcast. Amazing Narrator 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 OTs schoolhouse.com. Until next time class is dismissed. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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 Schoolhouse Podcast

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 196 of the OT Schoolhouse Podcast. Artificial intelligence is quickly entering healthcare and education, and occupational therapists are asking an important question: How can we use AI responsibly without losing the clinical reasoning that defines our profession? In this episode, Jayson Davies sits down with OT educator and researcher Tara Mansour to explore practical, ethical ways school-based OT practitioners can begin using AI tools. Tara shares how she teaches future occupational therapists to use AI as a “first draft partner” while still prioritizing evidence-based practice, professional judgment, and student-centered care. They also discuss privacy considerations, prompt strategies, treatment planning ideas, and how AI can support data collection, documentation, and intervention development. If you're curious about how AI might fit into your school-based OT workflow—or concerned about how it could impact clinical reasoning—this episode provides a thoughtful and practical perspective. Tune in to learn how AI can support occupational therapy while keeping the human clinician firmly in the loop. Learning Objectives
— Learners will describe appropriate ways AI tools can support school-based OT practice, including treatment planning, documentation drafting, and intervention idea generation. — Learners will explain ethical and privacy considerations when using AI, including FERPA and HIPAA concerns and strategies for de-identifying student information. — Learners will identify the "human-in-the-loop" approach to AI-assisted practice, distinguishing between AI-generated versus AI-assisted work and the role of critical clinical reasoning in evaluating AI outputs. Guest Bio Dr. Tara Mansour, OTD, MS-HPEd, OTR/L, is an Assistant Professor and Academic Fieldwork Coordinator at the MGH Institute of Health Professions with over 23 years of clinical experience. As a PhD candidate in Health Professions Education, she investigates innovative approaches to prepare students for professional practice, with a focus on integrating artificial intelligence into fieldwork education to strengthen learning and critical thinking. Dr. Mansour co-chairs the Generative AI Task Force at MGH IHP, leading initiatives to explore AI-driven innovations in health professions education. She has authored scholarly articles on AI integration in clinical education, including publications in Frontiers of Medicine, Medical Education, and the Journal of Allied Health. Nationally recognized for her contributions, she has presented at AOTA's Education Summit and Academic Leadership Conference and serves on ASAHP's Clinical Education Committee, shaping best practices in clinical training across disciplines. Quotes "AI is really… a first draft partner or an option generator. It is not a decision maker.” — Dr. Tara Mansour "The risk isn't the tool—it's turning off your critical thinking. When used well, AI can actually strengthen reasoning." — Dr. Tara Mansour “Unreflective use weakens reasoning. Over-reliance without thinking weakens reasoning.” — Dr. Tara Mansour “AI probably won't replace us soon, but we need to use AI. to basically enhance OT and to keep it at the forefront of health sciences.” —Jayson Davies Resources 👉 ChatGPT for Educators 👉Claude 👉Co Pilot 👉Google Gemini 👉Linkedin 👉Tara’s Research 👉Pearson Clinical Assessments 👉American Occupational Therapy Association 👉AOTA INSPIRE Conference 👉MGH Institute of Health Professions Episode Transcript Expand to view episode transcript Jayson Davies Welcome back to the OTs schoolhouse podcast, your source for all things school based occupational therapy. I'm Jayson Davies, and today we're diving into a topic that is reshaping our profession, artificial intelligence and occupational therapy. Joining me today is Dr Tara Mansour, assistant professor and academic fieldwork coordinator at the MGH Institute of Health Professions with over 23 years of clinical experience, including extensive work in school based occupational therapy, Tara has become a national leader in integrating AI into health professions education. In this episode, we are tackling some of the questions that you have been asking me, like, Can AI help with IEP goals. How do we ethically use AI in our practice? Will it weaken clinical reasoning for current and or maybe even future occupational therapy practitioners? And most importantly, how can AI give us back the time that matters most so we can work directly with our students, whether you're AI curious or AI cautious, this conversation will give you practical, ethical strategies to make AI work for you, not replace you. Let's get started. 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, CLASI is officially in session. Jayson Davies Tara, welcome to the OT school house podcast. It is a pleasure having you on as you know, I love AI, and it sounds weird to say I love AI, but it is true, and I love it, how it can support us. And I know you have a lot of experience with AI, so I'm excited to dive into this topic with you. How are you doing today? Tara Mansour I'm well, thank you for having me here. I'm excited Absolutely. Jayson Davies And, you know, as we get started, I just kind of want to give you an opportunity just to share a little bit about where you are in the world of occupational therapy, and you can even start to dive into, kind of how you came around into the world of AI, Tara Mansour sure I'd love to. So I've been an occupational therapist for almost 25 years, and I spent a large portion of my clinical career in school based practice. I started my career in inpatient rehab with a specialty in neuro rehabilitation, and then transitioned to school based practice working in an elementary school that housed a medically complex sub separate classroom. Over time in that same public school district, I worked across different elementary schools, the middle school and the high school, really working with a variety of students with different needs. In that setting. Also, I served as a level two fieldwork educator for many students, which led to my transition to academia, where I now serve as the academic fieldwork coordinator and assistant professor at the MGH or Massachusetts General Hospital's Institute of Health Professions. There, my role focuses on preparing future occupational therapists for clinical practice, especially through field work education. Jayson Davies And that is not an easy job. There's a lot of people that you have to coordinate with, the students, the field work educators, the people in your program Tara Mansour there sure are. It is satisfying. I love when our students come back from their level two field work placements and are ready to jump in and ready to make the transition for my students to my future colleagues awesome. Jayson Davies And before we really dive into everything, I kind of want to ask a fun question here, and that is, how is AI been the most helpful for you in this role as a field work coordinator, Tara Mansour from an education perspective, it helps me in developing resources for our students and our field work educators, from learning activities to evaluation tools. It is a great draft partner. You know, we'll talk a little bit more as we move forward about a human in the loop approach, but from composing emails to creating learning activities, I find many, many ways to utilize it within my current practice in education, perfect. Jayson Davies All right, so yeah, now let's kind of get to that point where you started to maybe the first, the first points at which you started to realize that AI could be helpful, and what brought AI onto the radar for you? Tara Mansour So honestly, AI first got on my radar because I have teenagers. They were the ones who introduced me to chat, the chat GPT app on their phones, and at first it was more of a curiosity thing. Coincidentally, around the same time, I was also hearing from field work educators that they wanted to see our students coming up with more creative intervention ideas. Well, I absolutely can appreciate and understand that I was a level two fieldwork educator myself, and very much appreciated a fresh set of eyes and creativity from my perspective now as an academic field work course. Of neater. My concern was different. I was less worried about whether students had creative activity ideas, and more concerned about their clinical reasoning. Were they grading activities appropriately? Could they create a just right challenge? Were their intervention choices evidence based? Could they successfully document the treatment session? I didn't want our students spending an hour and a half scrolling Pinterest or maybe these days Tiktok for treatment ideas. I'd rather they spend that time thinking through the clinical decision making behind the plan, especially because they're new and they don't yet have a deep toolbox to draw from. So that's when the question shifted for me, how can we leverage AI to generate idea options quickly while still teaching clinical judgment, ethics, safety and responsibility? And for me, that really became the entry point for my work with AI and OT education. Jayson Davies All right, perfect. I like that because I think there is a fear. I've done some work, some research, in AI, and some of the things that we hear is that students aren't going to have that clinical ability, that ability to process clinically because of AI. And I'm sure you probably have had this idea and wrestled with this idea as well. So I really want to kind of dive into this. It's not a resource, this program that you've started to put together a little bit and how you are trying to help the students without, you know, giving them this tool that makes it too simple for them, absolutely. Tara Mansour So, you know, AI is really, I frame it as a first draft partner or an option generator. It is not a decision maker. So while AI can indeed suggest things like goal language, intervention ideas, ultimately, as the OT practitioner or student occupational therapist, you are the one evaluating and editing everything clinical reasoning you know, lives in the filtering and the adapting. You know you're asking, does this actually match my client? Is it the right challenge level? Is it appropriate in this environment? Is it evidence based? So while AI might be able to handle some of the repetitive scaffolding pieces, the structure, the wording. Some idea lists the therapist always have has to apply professional judgment. It widens the option set, but the OT still chooses the path. Jayson Davies So I will mostly, you know, frame this all around school based OT, because that's exactly what 99% of the people that are listening to this are so I guess my question is, then, when you're supporting your students or either even other clinicians, how are you suggesting that they prompt? Is it more of because you talked about right finding ideas versus the actual clinical reasoning? Are you suggesting that they prompt in a way that's like, I have this student experiencing this strengths? Are this? What are some ideas? Or do you kind of flip that approach and say, Hey, I have this idea for painting something. How would this apply to my student? Or is it a mix of both, or more than those two? Tara Mansour Yeah, I would say it's really the first but that's just the first part. So I teach them how to enter in case study information while not providing any client identifying data. That's the first part. We do talk about prompt engineering, what makes a good part a prompt and what doesn't make a good prompt. And they get the opportunity to kind of play in that playground a little bit. Ultimately, though, what is generated by AI that is just really the first part of the assessment, because then they need to take what they have found, those intervention ideas. And maybe they scaffold that, or they they reprompt Based on what the output is right to narrow things down. But once they choose three intervention ideas, which is what we do as part of the assignment, then they have to go to the literature, they have to go to their textbooks, they have to go to peer reviewed journal articles, and they need to justify, for me why that intervention is indeed an evidence based choice. They have to go back to what I provide them as the patient's chart, looking at their precautions, and they have to determine why, ot what their final choice of interventions is based on that review. So we're not just teaching them to utilize generative AI for intervention planning ideas, but we're incorporating evidence based practice so they can effectively evaluate what AI is putting out there. Jayson Davies Yeah, that's smart. I think we all. So the term hallucination should have been like the word of the year a year and a half ago or so. It's still it's still happening. I like to think that it's happening less when I'm using it, I'm seeing less completely made up research articles being linked, but it still happens, and obviously the output definitely have to judge it and find out if it's right, just like you have to do honestly with any article, though, like any article we read, we have to go through that process to make sure it's worth reading and worth really taking information from So, yeah, absolutely okay. One thing that you brought up was making sure that your students aren't using identifiable language, right? We have to be HIPAA, compliant, fair, but compliant within the school based realm. What is important to not put into something like chat, GPT? Can we use a first name? Or can we not use a first name? Do we need to use pseudonyms? Should we just erase all information period? What's safe, what isn't? Tara Mansour So I think, you know, some non negotiables, no matter what setting you're in is no identifiable student information ever goes into a public AI tool. So I would not even consider using a first name and not a last name. I would say, you know, make up a name, no dates of birth, no school names, no facility names. You know, I think sometimes even within our communication as practitioners, we think that using initials is non identifying. When, in reality, if somebody was, you know, being, you know, if public records were being utilized, they're going to search for those initials as well. So no initials, no unique facts, and no uploaded reports or IEP documents. Jayson Davies Yeah, yeah. It's funny when I was doing sorry really quickly, when I was doing my initial, like HIPAA review, you know, for myself again, just to kind of go back and look, I forgot that you know if that first name can be attributed to you and where you work, and you only have you know one or two of people with that name on it, well, that is officially identifiable information, and anyone can go on to your LinkedIn page and figure out where you work. And so that's pretty easy. Tara Mansour Yeah, absolutely. And I think that you know, what I teach students and clinicians is to really make sure they're using generalized de identified descriptions. They can they can mention functional skill areas, maybe interest themes, goal categories that should be really more than enough to generate useful ideas without risking privacy. The other thing from my experience is that in the school system, they often have contracts with sites that do indeed allow you to provide identifiable client information. And I've heard some things around Google and public school access that has said it was FERPA compliant. But unless you have that from your district's IT department, I would always default to the side of caution and depersonalizing any added information. Jayson Davies Yeah, absolutely. While you're speaking, I was trying to look up the chat GPT free educator version, because I know they provide chat GPT to free for educators and students, I believe, but I don't know if that free version is HIPAA compliant. I want to say maybe, but definitely do your own research. And it could change, right? They can change anytime. Tara Mansour And I wouldn't go by the the external program telling you that super compliant. I would go to your IT department and make sure that you're following your own institution roles. Jayson Davies Great point, yeah, third party, or even the people that on your side, make sure you're covered from that and not don't always. I mean, we don't trust the AI for the content that they generate all the time, so we should definitely be mindful of what they are saying as well. Good point. Okay, we're gonna go ahead and take our first break, but when I come back, I want to talk to Tara about where she feels that AI can best support school based ot practitioners like us. So stay tuned. Okay, so, so there's a lot of OT practitioners in the research that we've done, they were worried about new students almost being having an over reliance on AI and not having the clinical reasoning skills because they've had chat GPT since, like your teenagers have. So the question is, is, how do we prevent that? How do we ensure that these students that are coming out of OT school aren't just relying on chat GPT, and that if chat GPT were to, you know, die overnight, they would still have that clinical reasoning. Tara Mansour So I would say this is a large concern, and I take that concern very seriously, especially as, you know, faculty in an OT education program, I actually don't think that the tool, it's. Self weakens reasoning. Unreflective use weakens reasoning. Over reliance without thinking weakens reasoning, and that risk exists with many tools that we already use. True from a school based perspective, let's think about the example of weighted vests. Okay, if a clinician reads an article in a peer reviewed journal about weighted vests, and then starts using weighted vests with their students, without collecting data, because the article deemed it effective, yet they proceed without any monitoring, without monitoring any outcomes. The issue is not the vest. The issue is the reasoning process around its use. So did they look at the evidence base broadly? Did they individualize? Are they measuring the students responses? I really think that AI is similar. The risk isn't the tool. It is turning off your critical thinking. I do believe that when used well, AI can actually strengthen reasoning, because it gives you multiple options to compare and critique, and that comparison process in itself is a clinical reasoning exercise. The key is how we teach and we model use AI should really expand their option set, not make their decisions. And clinical reasoning lives in the selection, the adaption, the justification and the outcome tracking, and that part remains fully human. Jayson Davies I want to, I want to press on that. How does, how does Chachi BT expand options? I mean, you mentioned the vestibular or the weighted vest or pressure vest, and I totally understand that, right? We need to make sure that on the back end, we are tracking data and whatnot. But you mentioned that idea of chat GPT opening up the options. What do you mean by that? Tara Mansour So it may give you a variety of interventions, ideas that you may or may not have considered, but again, that human in the loop approach. We're not using chat, GBT as our Google and then just taking what it says. We are saying, okay, these are some good options. Now I need to critically reflect on what it is suggesting and think about is it evidence based? Is this beneficial for my client, is it going to be of interest to my client? So so it expands that as long as you are not you know, what I say to my students is, if you're running late for a field work and you haven't done your treatment planning for your 8am session, you cannot use chat GBT in the five minutes that you're getting off the bus to say, I am working with a patient who had a stroke. What should I do? And then jump in there five minutes later and just translate the output of chat GBT into your treatment session? There is no reflective use in that Jayson Davies good point. Yeah, it's true, and it's interesting, because I think there is kind of this, these tools, I don't think are readily available yet, but eventually, I think that, good or bad, you will be able to do something to that degree. I think because eventually, and it's already happening, AI is being built into our EMRs, and therefore it knows what I did with Johnny yesterday. Knows what I did with Johnny last week, the week before, the week before that. It it has the evaluation in a form that is secure and HIPAA compliant, and it does know a lot about Johnny. And so to what degree should I still or do I still need to reflect upon something if it has all that background data on Johnny tough Tara Mansour question, well, we're not there. We're not there yet. I think you're right. I think that what initially was spoken about when we thought about generative AI were these standalone, large language models, chat, GBT, copilot, Gemini, you name it, but what we're really seeing now in clinical practice, just like you said, is that there are systems, there are AI systems being built in to the EMR. My concern is, less How much does it know about Johnny, and more about how much does it know about Johnny's diagnosis or appropriate interventions? What it's not going to know is Johnny's interests, that Johnny likes cars, but he hates baseball, right? And so you're not always going to be to be able to rely on the suggestions outputted, right? It also depends on what is your system. Where is your system pulling the data from? Is it pulling I would always continue to be extra cautious if data is being pulled from the web, or are you behind a firewall and it's only using the information you've provided it with? So I do think we are a long way away from simply throwing a prompt out there and being able to act on it again. From a school based perspective, it might have wonderful ideas. When students are presenting with certain disabilities or diagnoses, but it still doesn't know their interests and that personalization piece that makes us OTs, yeah. I mean, never say never. But I that wouldn't be a way in the near future I would envision teaching anybody to use the tool, Jayson Davies yeah, yeah. I also know, I mean, how many times have all of us gone into a session with an idea that we thought was great, whether it came from Instagram, Tiktok, our own brain, or chat, GPT, and then we had to go through three different interventions during that session, because students, you know, have days. We have days and and sometimes plan A and B don't work, and so you got to move to Plan C and D. So you've got to have that clinical reasoning skills to do it in the moment, not five minutes or five days before the session actually starts, Tara Mansour absolutely and I think that goes into just old fashioned treatment planning, right? Like, you know, even with with generative AI aside, students have to be able to, you know, be iterative or change their treatment plans. And to be fair, that is a more challenging experience for them, because they don't have the toolbox. They don't have the automaticity yet that those of us with more years of experience have. And so you know that goes back to a whole nother activity that has nothing to do with chat GBT per se, which is making sure our students are completing treatment plans when possible that has a variety of interventions so they're not panicking and freezing in that moment when things ultimately have to Change. Yeah, that's a best practice in field work, education, I would say, versus, you know, generative AI, Jayson Davies yeah, yeah. And that's fair, kind of touching, you know, going specific into school based OT. I often like to break school based ot into a few categories of things that we do. One is that evaluation piece. Then we kind of have the after the advice, after the evaluation. We have to do treatment planning. We actually have to do the treatment itself. And then there's some, you know, administrative side to it. There's some MTSS, do you think that AI can really support all of those areas equally? Do you find it more beneficial for particular areas? Obviously, we've talked about treatment planning a little bit, so little bit so far today, but what areas encompassing school based OT, do you feel like AI can really be supportive? Tara Mansour So, you know, I think, I don't think it's equally across all of the things that you just mentioned. I think that first draft note, writing, goal wording, again, with full human review, can be accelerated with the use of generative AI. I think that accelerated time gives students and clinicians, you know, more time to think deeply about what actually happened in the session or what to do next. I think it's important to realize, especially within the context of school based practice, this kind of technology isn't completely new. In ot we've seen earlier ways of digital assessment technology, right? Many of our evaluations moved from manual scoring to digital platforms years ago. You know, tools like Pearson's digital scoring lets you enter subset scores and generates for you structured summaries and interpretive language. If your district subscribes to that platform, the sensory profile went digital. No more hand scoring grids, right? That was an early automation supporting clinician efficiency, and I think I see AI, you know, as a part of that same evolution with a little bit more flexibility and more interactive. I think it can help with things like drafts of reports, you know, drafts of progress notes, drafts of IEP goals, drafts of present levels of performance. But ultimately, the interpretation and clinical judgment still belongs to the OT. I think the goal is, you know, time saved on mechanics, and it's kind of reinvested, reinvested in, in reasoning, if you will, gotcha. Jayson Davies And, yeah, I completely agree with the time saving thing. I've experienced this before, and I want to hear if you've experienced this, or, or, if you've, you know, worked with some of your students or other clinicians that have experienced this, where you think that AI is actually going to save you time, but then you get playing with it, and you go down a rabbit hole. I mean, we always talk about how many tabs we have open in our, you know, our Google Chrome, but oh my goodness, the chats that I have on the left hand side of my chat, GPT, like it's infinite. I don't know how many are there. So have you experienced that yourself and or from others, Tara Mansour I think, as a new clinician, or being exposed to a new tool that you are not that you are not used to using. So it's always going to be time heavy. In the beginning, the your clinical reasoning is going to be more time heavy. Learning best prompts is going to be time heavy. I don't think that it's one of these things that you introduce and all of a sudden it is, you know, a magic fix. When I was working in school based practice, I did have a student who was struggling with report writing, and a friend of mine, a peer of hers, had this company where you just entered in some of the student information from the evaluation, and it actually generated a whole report for you. Now I didn't love the format of that report, and initially, when practicing to utilize that system myself. It took me longer to write a report than if I just sat there to write the report myself, but over time, it did decrease the amount of time I needed to write the report, and I came to really appreciate that as a resource. Jayson Davies Yeah, yeah, and I agree. I mean, it takes a it takes some time getting used to chat GPT and or if you're going to use Claude, or whichever going to use, it takes some time to get used to it, and again, some time to understand prompting. You talked earlier about how you help with prompt generation for the students that you're working with and helping them understand AI, do you find that there are specific ways, or specific, I guess, templates for prompts that work out well for school based occupational therapy, or just ot in general? Or can you just write in anything? Tara Mansour So I don't, I very intentionally don't create templates as it's different for every student, every client. What you're asking, you know, generative AI to do. What I will say is, I do educate them on a process in generating good, you know, strong prompts. And I I just pulled up my slideshow that I use with them. And what I'm looking at is in generating an effective prompt. This is the outline that I suggest they go through, which is, step one, identify the client population and condition. Step two, specify the occupational performance challenge. Step three, define the intervention focus. So for example, as I bring them through this learning activity, as we are reviewing the case study, I am asking them to determine the frame of reference to their approach. Am I looking for a compensatory, rehabilitative frame approach? Am I looking for a more remediation or biomechanical frame of approach? Then I'm asking them to consider the treatment setting and available resources. Is this inpatient outpatient school based? Where is this session happening? And then they can request a specific response format, give me some intervention ideas. Or they might say, give me some ideas for a 30 minute session. Or they might say, just give me ideas that fit within the biomechanical, you know, frame of reference. And then step six, which is most important, is refine the prompt. So when you get that first round of generated text, what do you like, what don't you like? Do you need to refine your initial prompt? Or can you just dive in deeper with some additional clarifying questions? I like to think of it. This whole approach was built for those people that have experience in doing literature reviews or searching databases for literature, you might put in a few words and get 12,000 responses, and then you're going back and you're saying and this, and that narrows it down, and this, and that narrows it down. So my whole instruction of utilizing generative AI in prompting and follow up prompts really is based on that whole idea of a literature review. Jayson Davies And you bring up that idea of a literature review, and I love that, because one of the biggest problems that I've run into with AI, and we talked a little bit about hallucination making up links and whatnot, is that I don't know what Article, database, chat, GPT or cloud have access to, and what they don't have access to. And so if I'm asking it for evidence or best practices, I am sometimes shocked, because it sometimes has access, complete access to an article, and other times it's only using just the abstract, and I never know what it's actually using, unless I kind of go into or click on the link and try and figure that out. So I guess my question is is, how do we and maybe the answer is, we just have to do it, you know, on our own. How do we know if something is actually evidence based? Raised if it's citing these articles, but we don't know if it has access to it. Does that make sense? Tara Mansour Yeah, absolutely. So I think that you know, remember, some journals are open access and some journals are not open access, right? So, so it can indeed only have access to an abstract, which sometimes will give you enough information that you need, and then other times it doesn't have access to full journal articles. Regardless, you should never trust gender, you know, generative AI's output into quoting the evidence, even if you put into your prompt, find only for me. You know, peer reviewed published articles. I still would not trust the system. I think a great first step is to say, give me the DOI number and follow the link and see if it's actually a DOI, right. And again, you're still never just trusting the information that it told you about the article. But now you have the DOI. Now you have access to the article. Read the article right, or download the article, put it back into the generative AI system and ask for a summary. Even that isn't always right, but now at least you're looking at very specific information that you fit it. Jayson Davies Yeah, interesting that you say, say that I have definitely gotten a quote from chat GPT, clicked on the DOI command, F or whatever search feature, type that quote in, and then you're always like, wait, you told me this was a quote. Why can I not find this three set of words in a row in this article that you said was directly from this article? So yeah, you got to be careful. You mentioned pulling the article and putting it actually into the source or the AI, I am, I have gone back and forth on this all the time, and I don't know where we fall as a profession on this one, and where is the line drawn, because i don't know i i Just troubled with it a little bit. I have done it. I definitely have downloaded an article, put it into chat. GPT, hey, help me summarize this, or what are the key points, or whatnot. But I'm torn on this, and I don't know where the profession stands on this. Have you heard anything? Tara Mansour I haven't. I feel like I have come to my own personal judgments for how I am choosing to utilize it. What I'll say is, if an article is open access, anybody has, yeah, access to it, right? So it's not that you are uploading copyrighted protected information. I will tell you that I have, I have been able to access an article. When I say access, I mean, understand an article more that if I was just reading maybe some of the statistics, language was going over my head, and I was having trouble really engaging in that article. But rather than just pushing it aside, being able to, then again, interact with generative AI to ask it specific questions, right? Not just give me a summary, but the article talks about Cohen box, you know, statistic. What does that mean? What is that measuring that, in my opinion, is a best practice of how we're utilizing it's almost your own personal tutor. You know to go back and just say you're going to rely on something for a generated summary. I agree with you. I have fed it content different across different platforms, actually, and and the different platforms vary about how accurate the quotes are that it gives it back. But even at that, find me a quote. Find the quote right? Like you should never be in a position to just use ever what generative AI outputs and then assuming it, you know, is correct. That goes back to what I said in the beginning about that reflective reasoning. There is always a human in the loop approach. It is never copy and paste. Jayson Davies Yeah, absolutely. All right, we're going to take a quick break, but when we come back, I'm going to ask Tara how she thinks that ot practitioners like us can use AI in our evaluation process. All right, I want to go through a few common tasks that school based ot practitioners would use or would complete throughout the day, and kind of just get some ideas from you about how AI might be used, and you've already mentioned a few, but kind of just task specific here. So for any evaluation, you know, most people already have their kind of set evaluation. They do certain things in order, but how might you begin to incorporate AI into the evaluation process? Tara Mansour So, you know, I'm not sure that I would, from the get go, be incorporating AI into the evaluation process. If I was given a referral and the students challenges, I would still initially, independently identify. By which tests I was going to complete, right? I would not utilize AI per like within the testing, because it is so much more. Testing is so much more than just following the protocol. It is observing their posture. It is absorbing it is observing their pencil grasp. It's observing their behaviors in the environment. I see the possibility of entering some of the data into the system after to help it draft with that being said, Because AI was introduced as I was outside of the clinical career, outside of my clinical practice, I'm not really sure how successful that would be or necessary. I always say that we're paid the big bucks that we are because of our clinical reasoning. So I still do think it is our responsibility to, you know, evaluate that ourselves. With that being said we said earlier. There's systems like Pearson that you're entering that information, and it's generating for you some summaries. Again, you're deciding what you're including and what you're not including. But I'm not sure that I would say in the evaluation part is where I would be utilizing AI. Now, if that was moving forward to the creation of an IEP, maybe entering my de identified evaluation and asking for some goal recommendations in the goal areas that I identify, that might be a nice step. We're always looking to kind of expand our goal bank, if you will, and then utilizing that system before you've even started the treatment to help you develop, you know, data tracking sheets so that once you start your interventions, you're able to track that data to determine if they're, you know, making effective progress. Yeah. Jayson Davies And I think a piece that school based ot practitioners can really use is during their like synthesis process, because I think we often question ourselves if we're thinking the right, you know, recommendations. And I think if we use it like a thinking partner and and talk to it, hey, you know, based upon what this assessment said and my clinical observations, I'm thinking this, you know, tell me where I'm right. Tell me where I'm wrong, tell me where what I'm not even thinking about, and get some ideas that way. Tara Mansour So maybe another way I might think about utilizing it is I've seen OTs in the past write handwriting goals that a student would likely never be able to do because they don't have the reading skills to match the expectations for the written output, right? So we don't necessarily, we're not necessarily masters of our Inter you know, professional colleagues tests that they're doing, but we might say, you know, again, de identified, how do their results on these tests impact their success with handwriting, right? What does develop, you know, what is a reading level of? I'm going to make something up, you know, for mean, oh, that means that they are, you know, at the syllable level, okay, well, then I don't want to write a handwriting goal around writing full words or sentences, because, you know, they're not necessarily able to, you know, if they have such significant challenges with encoding and decoding, yeah, we have to work within those boundaries. Jayson Davies Interesting, I hadn't really thought about that that much, because we often don't understand all the assessment tools that the speech therapist use, or we don't understand the psych assessment tools, or the teacher assessment tools. And that actually came up with me a few about a week ago, my son came home with assessment. He's in preschool right now, and I never heard of it. I don't even remember the name of it, but I was really quickly able just to take a few snapshots of the assessment results. And it's like, oh, this is what this actually means. I was like, Thank you, because there were no keys to what these graphs meant and whatnot on this test. So that can definitely be helpful for us to better understand the student in a way that we couldn't before, because we didn't know what the assessment results that the teacher or psych or SLP were giving us good point exactly. Tara Mansour And it's important that we have that whole picture right when we are creating our goals. Jayson Davies I guess, moving on from the evaluation piece, you've talked about an IEP and how it could be helpful with generating, you know, drafts or ideas for goals, ideas for maybe what the present levels of performance might look like, maybe even accommodations, rather than asking you the specifics of how you might do this, I want to go a different way with this question and ask, have you created, or have you advised others at all to create custom GPT prompts or custom gpts or that kind of help make this a little bit quicker, because. You're doing it so often. Tara Mansour So I will say right now I have two Capstone students working on developing custom gbts, one to support our field work educators, and one, believe it or not, to support their fellow peers through studying for, you know, their own courses I have, you know, I will say that within the conferences I have presented with we started at the level of playing in the sandbox, of utilizing it for things such as, I have a 30 minute session. You know, it is a six year old with this diagnosis, this diagnosis, with these goal areas. I mean, in diagnosis, in school based practice matters less, right, but they it is a six year old with these goal areas. They love trains. This is the format of my typical treatment session. Give me treatment ideas and a timeline, and that is both thrilling and exciting for my audience of practitioners, I think that what you're describing would be like next level, intermediate, advanced, right? I think people have to be comfortable before they can even wrap their head around a custom GBT. I've been playing around with it myself lately. I think there's amazing potential for it, absolutely, but I don't think that is your entry point for practitioners to utilize. Jayson Davies Ai, yeah, we've been playing around with one. I created one specifically to help students or not students. Sorry, I created one specifically to help ot practitioners take their de identified, present levels of performance, their goals for a student, or sorry, their present levels of performance, maybe some accommodations that they have in place, and any other information about the student, of course, de identified, and the tool will then, basically automatically, without Any additional prompting, create smart IEP goals. It will create some treatment ideas based upon those IEP goals. It will create both pull pull out and push in ideas. It also kind of will generate, if you tell it what grade the student is, it'll say, hey, this goal is related to these standards for that grade level, which I think is a piece we sometimes miss a school based ot practitioner. So I think it can be very helpful, but it's, it takes, like you said, a little bit more advanced, and it takes some time to set up in order to actually use it. So, yeah, yeah, all right, we talked a little bit about evaluation piece. IEP, we really started this, this process with talking about treatment planning per se. Where do you feel like the best opportunity for AI use exists for school based ot practitioners? Do you feel like it is that treatment planning piece, something we've already talked about or something that we haven't discussed yet? Tara Mansour I do think it's the treatment planning piece, and I think it's the data collection piece. I will say that you know, learning to take data that is not just a conversation you have with a teacher in the hallway is something that is our speech and language counterparts are so good at, and I don't think that OTs are always great at collecting data. So I think saying these are my goals. This is my timeline. How can I track this is an amazing use to show that you know our role is justified. I just had a student finish level two field work, and she speaks to how amazing it was to personalize sessions for her children, for her students, and how much more motivated they were to participate in the session when she came to the table with pictures, she quickly printed of resources, you know, of their favorite Disney characters or their favorite something. And so I think that the hard, the clinical reasoning part of you know, what level do we want to perform this at? Do we want to be asking them to copy letters? Do we want to be asking them to, you know, write it from memory? Do we want to be asking them to write words or full sentences? But then we can kind of say this person is a reading level of four. Again, they love trains. Give me some words I can ask them to write that have to do with trains that are able to be, you know, encoded by somebody with a reading level of four. And now, in an instant, you potentially can get so much more buy in and ultimately it, you know, the impact of that is not just efficiency, but it really is about, you know, increasing students participation in performance, and that motivation might help your your students, like, become even more engaged. Watched in their sessions. Jayson Davies Yeah, yeah. I've heard the same thing from from therapists as well, really being able to kind of bring the interest of the child into therapy much more easily. I mean, if you wanted to bring bluey into your session five years ago, you had to go back and research Bluey, watch some bluey episodes. Now you can just go on and say, hey, look, this is my treatment plan. Let's, let's implement the bluey version of this treatment plan. And, you know, put a few details, like their reading level or their writing ability and and you could get a lot of pretty ready to go stuff. So yeah, Tara Mansour and look, I'm a theater kid at heart. You want to have a conversation with me about Broadway shows, I know a lot, but if you want to have a conversation with me about how the Patriots did in yesterday's game over my head, but I can do a quick search in a system that looks at the web that if I get it wrong because it's not validated, that's fine, but like, I could easily bond with somebody in the first 30 seconds of building rapport, you know. Think about how many times, you know, our middle school students come into an evaluation session with the hood over their face, and they don't want to shut they don't want to say anything, you know. But if you can do a little bit of work in advance and find out what they're interested in, all of a sudden, you can come to the table with some facts that maybe wow them, or, like, at least engage them, and then all of a sudden, you know, what used to take, you know, a lot of time. You can shorten that rapport, building time. Good point. Jayson Davies Very good point. You mentioned a little bit about the research that you got going on, but I do want to give you an opportunity to share a little bit more about that, because I personally think that, and I think you kind of share this as well, that OTs need to be addressing AI in multiple fronts, otherwise there might be some negative consequences. And so I want to understand what you're working on in terms of AI. You mentioned a few of your your students doing some custom gpts? But what else you got going on? Tara Mansour Sure, so you know again, what was already published was from something that we did in 2024 about this education process. I told you about this learning activity, and we measured for the students, what did they learn? What did they like about use learning to use generative AI? What were the ethical challenges, safety challenges? And so that's something that we did and was already published. I just recently published something else that we need to study a little bit further. It was kind of an opinion piece on how can we use things like voice GBT to train our students with professional behaviors or difficult conversations, or how to explain the role of OT to a patient, to a family member, how to have a difficult conversation with a field work educator and be able to practice in a psychologically safe environment, right? And so again, depends on the prompting, because you're asking it for feedback, but that is one pretty cool way I'm currently having my students utilize it, and something that we need to get a formal study around. One of the bigger projects I'm working on most recently is this idea of using AI for qualitative data analysis of field work educators narrative comments in the field work performance evaluations, where there is so much valuable written feedback that clinical educators or field work educators provide about students strengths, their challenges, their professional behaviors during level two field work, but traditionally, the qualitative analysis of narrative data is incredibly time intensive. You're hand coding comments, you're building theme structures, you're checking reliability, and you know, it limits how large a data set most ot education faculty can realistically analyze. And so what we're studying right now is how AI can assist with this early stage qualitative coding and theme clustering, again, with a human researcher absolutely still in the loop validating and refining the findings. The goal is not to replace your typical qualitative methods, but to scale them in a responsible way so that we can use that information to, you know, adjust our curricula, better support our students and better prepare them for clinical practice. Jayson Davies Yeah, it's it's going to be amazing. The next five to 10 years of research with AI being embedded into every facet of the world, it's going to be interesting. I mean, in OT alone, I can only imagine all the studies that are going to be if not already happening right now. I mean, we've used AI to support some of the research I've done, and I know others are doing the same. I cannot wait to get to an. Inspire in Anaheim and and wherever it's going to be next year, and just see how many, how much research is going to be coming out that is AI supported OT, basically, to a degree. I think it's going to be interesting. I think it's something that we got to do. I've said it several times that like AI will not replace us, and we're very fortunate in OT, by the way, that we have registration, like we're certified, we're licensed, we have some protections, and I think we need to lean on that, but so AI probably won't replace us soon, but we need to use AI to basically enhance OT and to keep it at the forefront of Health Sciences. Tara Mansour So yeah, we do. You know, I've heard some valid concerns, right? Like, if you speak to folks, especially those in outpatient and acute care settings that are dealing with significant challenges in productivity demands, I think there, I've heard the concern, and it's a valid concern. Well, if you make my documentation time even more efficient? Are they going to expect me to see even more patients, right? So that also limits people's interest in adoption. Per se, they're not going to be eliminated. AI is not going to take them to the bathroom or teach them how to shower, right? But how many people you might have to work with could change if things get, you know, potentially more efficient. Jayson Davies Yeah, I mean, I think it's hard, it's gonna be hard to get more efficient, because we already have these high I mean, I'm in the school based role. We don't have this nearly as much, but I hear people in, like, acute rehab. It's like 90% plus efficiency. Like 90% of the time is supposed to be with a client, and I don't know how much more you can really get out of someone, even if documentation gets easier, but I'm sure, yeah, private companies will squeeze when when given the opportunity, so hopefully it occurs in a way that is sustainable, because otherwise, yeah, won't, won't be good. Tara Mansour Well, I think that's where our own research and being on the forefront and being proactive about how we best utilize it in our practice is really important, rather than waiting for someone to tell us how we should be utilizing it in our practice, Jayson Davies I think that is possibly the most important point of this episode, because we really do have to understand it so that we can make recommendations based upon it. Otherwise, someone else is going to make those recommendations, and it's going to be someone who is at the hospital above our head, is not an OT and is worried about profits over patients, and so absolutely got to do that. I was going to ask you, I think I still will ask you this one, it was kind of on the same, same line that we're talking here. And that is, if it's not that, what are you most concerned or fearful about? Ai, is it that, or is Tara Mansour it something else? So what worries me most? I guess, I mean, yeah, while I do recommend the importance about teaching reflection. I think what worries me most is over trust and over automation. People treating AI output as an authority instead of just an input. If we do stop questioning, verifying and reasoning, that is indeed a problem. I'm also concerned about privacy, equity of access, and, you know, tools being used without the proper literacy or guardrails. My hope is that, you know, in OT, we begin to model this balanced path forward of innovation with ethics, efficiency, judgment, and always, always, you know, a human in the loop approach. Jayson Davies Yeah, that's going to be key, especially for us who are so, you know, whole human centric as occupational therapy professionals. And, yeah, we got to, we got to keep that in the loop. Tara, it's been wonderful talking to you. Where Can anyone interested in you and your work learn more about you. Tara Mansour So you know listeners can find my work through my presentations and publications, both in occupational therapy and Health Professions, education, I mean, especially around AI, literacy, clinical education, field work support. I regularly present at OT and health professions education conferences on practical and ethical AI use in both teaching and clinical practice. I'll be at a ot a inspire in California in April, and I'm running a pre conference Institute focused on using generative AI for content analysis, for both educational and clinical applications, it's going to be a very hands on and grounded in real ot workflows, ethics and that human in the loop practice. You can find me on LinkedIn. I've made some wonderful connections for research and collaborations. I with people across the country, so you can find me there. Jayson Davies Absolutely Tara thank you so much. We really appreciate it. We will link to all those different sources, your research articles, as well as your LinkedIn so anyone interested can learn more. And you're going to be in Anaheim for like five, six days. Enjoy that. Have fun. Thank you. Thank you. I'm looking forward to it as well, so we'll see you there. And yeah, Tara Mansour thanks again. Wonderful. Thank you so much, Jayson. Jayson Davies All right, that wraps up episode 196 Thank you, Dr Mansour, for sharing your insights on how AI can support and, of course, not replace our clinical reasoning as school based ot practitioners from treatment planning to data tracking, it is clear that when we use AI thoughtfully, it can help us to free up time for what matters most, meaningful student centered practice, if you're looking for more practical resources, professional development and real time support from a community of school based ot practitioners who get it and are in the thick of things just like you check out the OT schoolhouse collaborative. It's where you'll find mentorship from myself and other school based ot practitioners, access to tools like our ever growing goal bank and documentation templates and a space to connect with other practitioners navigating the same challenge as you are. Head on over to OTSchoolHouse.com slash collab to learn more. Thanks for listening, and I'll catch you in the next episode. Amazing Narrator 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 OTs schoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! 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No matter the university you attended or the experience you have in other OT settings, starting as a school-based OT is equal parts exciting and overwhelming. The caseloads are high, the calendar is packed with IEP meetings before you've even met your students, and no one has handed you a manual on where to start. The good news? You don't need to have it all figured out on day one. Here's a week-by-week roadmap for your first 90 days to help you get from overwhelmed to a point where you actually have an idea what is coming next. Get your FREE 90-Day Checklist! Before we dive in, I put together a free companion checklist that walks you through every step in this guide, organized by week. It's printable, it fits in your binder, and it's yours to keep. Enter your name and email below and I'll send it straight to your inbox. *School districts sometimes block our emails, so we suggest using your personal email to ensure you get your checklist. Week 1: Orient Yourself Get to Know the People Who Will Support You Before you worry about therapy schedules or IEP goals, invest time in building relationships. Your effectiveness as a school-based OT will depend far more on your connections with people than on your clinical skills alone. Make it a priority to introduce yourself to: Other OTPs: If your district has other OTPs, be sure to connect with them. Try shadowing or meeting up with another OTP for lunch once a month to get the support you need. The speech-language pathologist (SLP): When there isn't an OT to ask for help, SLPs can be your next best option for IEP and goal writing support. Later on, they also make great collaboration partners. The school psychologist: A key partner in evaluations and eligibility decisions. They tend to have a good sense of the referral processes and district policies. They test a lot of kids and may be able to help you understand standardized assessment data. School secretaries: They run the building (no joke). Be kind, be grateful, and never underestimate them. When you need a quiet room, copies of your report, or help finding a kid, the secretary will be your go-to contact. The custodians: They will help you solve problems you didn't know you had. The custodial staff has helped me with everything from finding a chair for a kinder kid to building a Southpaw Swing rig in the OT room. Organize Your Caseload You can't serve students if you don't know they exist. Set up a spreadsheet before your first week is over and populate it with the following for every student on your caseload: Student name and grade Classroom teacher Case carrier (If different from the teacher) Service frequency, minutes, and type (direct, consultative, or both) Date of last evaluation Annual IEP date Triennial re-evaluation date This spreadsheet becomes the dashboard that guides your week-to-week operations. It may not be glamorous (unless spreadsheets are your jam), but it might be the single most important organizational tool you build. Get the Google Sheet I developed to track my caseload by joining the School-based OT Collaborative. Quick note: To complete this step, you will need access to your district's IEP and student management systems. Don't be afraid to reach out to the IT department if you don't have access to these systems in the first few days. Get Ahead of Upcoming IEPs Scan your spreadsheet immediately for students with IEPs that are past due or due in the next 4 to 6 weeks. Get in touch with the case carrier to see if an IEP has been scheduled, and block time on your calendar now to meet with those students to review their goals before the meeting. The thing you want to avoid at all costs: walking into an IEP and telling a parent, "I haven't had a chance to see your child yet." Unless it is genuinely your very first week on the job, this erodes trust quickly. IEPs don't wait for your timeline, so flag them on day one. IEPs are such a big deal that I have heard of new school-based OTPs being asked to attend an IEP even before their official start date. So, yeah, you want to be prepared for them. Weeks 2–3: Get Moving Set Up a Schedule. It Doesn't Need to be Perfect. New practitioners often delay starting services until they can build the "perfect schedule". But let me share a secret with you. There is no such thing as a perfect schedule! Build a schedule, start seeing students, and adjust accordingly as conflicts arise. You can (and will) regularly revise your schedule as you add students, dismiss students, and make changes to students' service minutes. A schedule that starts imperfect and gets refined beats a perfect schedule that never gets off the ground. Movement is progress. Pro tip: Using a Google Doc or Sheet to keep your schedule makes it easy to share with teachers who want to know exactly when you see their students. Some teachers care, others don't. Build Your Goal-Tracking System Keeping track of student goals and progress doesn't need to be complicated, but it does need to be consistent. One approach that has helped me is using a physical binder for each school site (or every one to three schools, depending on caseload size). Organize each binder by the days and times you see students. When you finish with one student, flip the page, and the next student's goals and data sheets are right there. No hunting, no guessing. And if a student is absent, you just flip to the next student. Your daily progress notes and data tracking can live in the same binder. Prefer digital? A Google Doc or folder system organized by school and session time works just as well. What matters is that your system reduces friction so you can focus on the student in front of you, not on finding paperwork. Want to fast-track your way to being a confident school-based OT? Skip the uneasy feeling of being brand new to the schools & learn how to better support the students you serve with the A-Z School-Based OT Course. Learn and implement the processes and systems I put in place as school-based OT beyond the first 90 days to make my life easier and support my students more effectively. Click here to explore the A-Z school-based OT Course Weeks 4–6: Build your School-based OT Momentum Prioritize Rapport Over Progress This might feel counterintuitive, but for your first six weeks, worry more about building genuine relationships with your students and their teachers than about driving measurable goal progress. It is very difficult to make meaningful therapeutic progress with a student you don't know yet. Once rapport is established, students trust you, and teachers see you as a collaborative partner, progress tends to follow naturally. Show up consistently, be curious about each student, and earn your place in the classroom. That investment pays compounding returns. Conduct Your First Assessment At some point in these early weeks, you'll face your first school-based evaluation. If you're not sure where to start, Episode 1 of the OT Schoolhouse Podcast walks you through the process step by step. Don't let the unfamiliarity paralyze you. A solid evaluation follows a clear process, and you've been trained for this — even if it doesn't feel that way yet. We also have posts about completing evaluations and various assessment tools in our article archive. Get Comfortable Not Knowing the Answer You will be asked questions you don't know the answer to — in IEP meetings, in hallway conversations, even from students. This is not a failure. It is an unavoidable feature of being new to a complex setting. The professional and perfectly acceptable response to this is: "That's a great question. Let me look into that and get back to you." Then follow through. Teams respect this far more than a confident-sounding answer that turns out to be wrong. Lean on your SLP, school psych, and fellow OTPs. Find a mentor if you can. "Fake it till you make it" is not the correct approach as a new school-based OT. Weeks 7–12: Find Your Footing Start Driving Intentional Goal Progress With relationships established and your systems running, you'll (hopefully) begin to feel confident enough to shift from orientation mode to practice mode. You know your students now. You know the teachers (enough). Start pushing intentionally toward goal progress and use your data tracking system to document it. Lean Into the PLOP → Goals → Services Framework If there is one idea that will get you through 90% of your IEP meetings, it's this: the Present Levels of Performance (PLOP) drive the goals, and the goals drive the services. Services are not justified by a diagnosis, parent/doctor referral, or even a well-intentioned teacher. They are justified by a documented gap between where the student currently performs and what is required for educational participation, and by goals that aim to close that gap. Understand this deeply, and you'll be able to confidently explain and defend your recommendations to any team. When in doubt: start with the PLOP. Everything else follows. Inside the OT Schoolhouse Collaborative, I teach a course on how to determine services. Learn more about it here if you need additional support. Refine Your Schedule and Systems By now, you're starting to figure out what's working and what isn't. Adjust your schedule, move some pages around in your binder or digital system, and start building the rhythms that will carry you through the rest of the year. What NOT to Worry About in your first 90 days... Just as important as knowing what to do is knowing what to set aside... at least for now. Advanced CEU courses. Your energy is better spent consolidating what you know and applying it. Focused, short-form courses (like these) will give you far more practical value in year one than a deep dive into a specialty framework you haven't had a chance to use yet. Hours of therapy planning. Over-detailed session plans don't survive reality. Absences, scheduling conflicts, and the unpredictable energy of real students will constantly reshape your plans. You will be amazed at what you can create in the moment with just the student, some paper, a few different manipulatives, and some open space. Trust your ability to adapt in the moment. MTSS. The multi-tiered system of supports is an important framework, but it's a layer of complexity to add after you have a solid foundation in the IEP process. Get that foundation first. MTSS will still be there when you're ready. You've Got This The first 90 days of any new position are hard. In a school, they're particularly difficult because real students, real families, and real teams are counting on you. But every experienced school-based OT you admire walked through the same uncertainty you're in right now. Follow this roadmap, give yourself grace during the learning curve, and focus on the relationships that will make everything else possible. The clinical expertise you're still building will catch up to your commitment — it always does. And when you need support, this is what the OT Schoolhouse is here for. We'll be here to support you with articles, the OT Schoolhouse Podcast, and the OT Schoolhouse Collaborative. Now, go enjoy being a school-based OT practitioner! Don't Forget your FREE 90-Day Checklist! I put together a free companion checklist that walks you through every step in this guide, organized by week. It's printable, it fits in your binder, and it's yours to keep. Enter your name and email below and I'll send it straight to your inbox. *School districts sometimes block our emails, so we suggest using your personal email to ensure you get your checklist.

Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 195 of the OT Schoolhouse Podcast. Join us in this episode where Nicole Dahl shares her powerful journey as a parent navigating occupational therapy services for her son on the autism spectrum. She opens up about the challenges of understanding the "why" behind therapy activities and the frustration of disconnected communication between providers, teachers, and home. Through Nicole's story, school-based OT practitioners gain invaluable insight into what parents truly need: clear explanations in plain language, collaborative communication between all team members, and practical strategies they can implement at home. She emphasizes that while the journey wasn't always smooth, consistent OT support—combined with strong parent education—transformed her son's trajectory from struggling in isolation to thriving as a high school senior and water polo team captain. Ready to hear how better communication and parent partnership can make all the difference in a child's IEP journey? Listen now to gain perspective that will transform how you work with families and create lasting impact beyond the therapy session. Learning Objectives
Understand the critical importance of communicating the "why" behind OT interventions to parents in accessible, non-clinical language to increase understanding and home carryover
Recognize the value of collaborative communication between school-based OT, outpatient providers, teachers, and parents to create cohesive support systems for students
Identify practical strategies for empowering parents as active IEP team members through education, consistent feedback loops, and actionable recommendations they can implement at home Guest Bio Nicole Dahl is a notable marketing leader whose efforts have helped launch companies onto the Inc. 5000 list, guided by a career rooted in both purpose and performance. Her personal journey as the mother of a son on the autism spectrum—now 18—has deeply shaped her perspective, informed by years spent navigating diverse therapeutic environments. That lived experience fuels her commitment to human-centered innovation and meaningful change. At Korro AI, where she currently serves as Vice President of Marketing, Nicole is driving change by empowering pediatric providers, caregivers, and the children they serve, ensuring every child is truly seen. Quotes “I know 100% we would not be where we are today without OT. A decade ago, I never would have imagined college tours and captain of the water polo team were possible for him.” – Nicole Dahl “We undervalue how important simple communication is.” – Jayson Davies “I didn’t understand the why behind everything they were doing. I’d say he can’t tie his shoes, and then I’d see him on a swing playing with Play-Doh and think… did she not listen to me?” – Nicole Dahl “It’s coming from a point of love. When a parent keeps calling meetings or asking questions, it’s because you both have the same goal — to support the child.” – Nicole Dahl “It wasn’t that he was ‘fixed.’ He was equipped. He had tools, and he understood himself.” – Nicole Dahl Resources 👉Korro AI - AI-powered platform for pediatric therapy (OT, speech, PT) that captures data during gameplay, provides progress tracking, and includes parent portal features 👉University of Central Florida's Card Center - Resource for autism information and checklists 👉Nicole Dahl's LinkedIn Episode Transcript Expand to view episode transcript Jayson Davies Hello and welcome back to the OT school house podcast. This is episode 195 and I'm your host. Jayson Davies, today's conversation is truly special, and I think it's going to resonate with you in more ways than you might actually expect. We're speaking with Nicole Dahl, who is the Vice President of Marketing at Koro AI. You might have heard of it, but more importantly, for today's conversation, Nicole is a mother who spent years navigating the occupational therapy world alongside her son on the autism spectrum. Nicole's journey began over 15 years ago when her son was kicked out of multiple preschools, thus she and her family were thrusted into the world of IEPs, evaluations, therapy sessions and everything in between. She lived through the frustrations that many of the parents that we support right now are facing every single day, that disconnect between clinic and the classroom, the lack of communication between providers and the family, and that persistent question of, how is catching a ball in therapy going to help my son zip up his jacket. Fast forward 15 years, and her son is now a high school senior captain of the water polo team and preparing to jump out of an airplane with a Navy SEAL. That's a long way from learning to zip up his jacket, right? Well, in this episode, Nicole is going to help us by pulling back the curtain on what parents really need from us and what they want from us as school based ot practitioners, you'll share why communication matters more than we might actually realize how collaboration between both home and school made all the difference, and why educating the parents on the why behind our interventions can transform outcomes. This conversation is a very powerful reminder that our role extends beyond the student. We must support the parents, we must support the teachers, just as intentionally as we support the student, and we got to do this if we want to make that lasting change. So please help me in welcoming Nicole Dahl to the OT school house podcast. Let's dive in, 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, CLASI is officially in session. Jayson Davies Nicole, welcome to the OT school house podcast. It is such a pleasure having you here today to talk about your experiences as a parent of a student with occupational therapy as well as with an IEP. And I'm so happy to have you here. Nicole Dahl Thanks for being here. Absolutely. I'm happy to share and hopefully inspire some people and learn some fun stuff along the way. Jayson Davies Yeah, and you know, it's really interesting how you and I got connected. Never would have thought that you work with coro.ai and I'm sure you'll explain a little bit about that as we get going. This podcast is not about Koro AI, but we actually connected about you being a parent through our connection at Koro AI. So to get started, I would love to just let you kind of introduce how you fit into the world of occupational therapy, which is very different from all the other times I've ever asked that question. Nicole Dahl Yes, absolutely. So it kind of came full circle and backwards all at the same time. So I was introduced to core ot so I'm currently their VP of marketing, but really I fell in love with it from my personal experience. So I am a parent of a child on the spectrum, so I have the lived experience of being in and out of different therapeutic environments for over five years, solid in a private practice, and also school based as well. So we've gone through OT, pt, pt, feeding, speech, you name it. We've been there and done that, Jayson Davies yeah, and that is part of why I really wanted to have this conversation and and before we go way back in time to you know, when everything got started, I would love just to kind of hear an update from you about how your son's doing now, where he's at and how that's going. Nicole Dahl Oh, that'll get me crying right off the bat. I am so grateful for ot I know 100% we would not be where we are today without it. So he is currently a senior in high school. He for their last game he was captain of the water polo team. Tomorrow, he is jumping out of an airplane. What? Jayson Davies Oh my gosh, yes. So we, are we? Are we associating that with some, you know, vestibular seeking tendencies? Nicole Dahl It's more of like his open I never in a million years. Would I have guessed that he would even consider that? That's a whole different funny story. But we're an active Navy family, and so he's getting strapped to the back of a Navy SEAL like a spider monkey and and jumping out of a plane tomorrow, but, but, yes, he was the child who was sitting on top of the refrigerator as like a self soothing, I'm just cool up here type thing. But he's doing so well and looking at colleges and things like. That, and I never, you know a decade ago, would have imagined that's possible for Him. Jayson Davies That is awesome. That's fantastic. You love to hear like because I can only you know as an OT, as a parent, both, both of us, and we're going to go back right now, but like when you see your child when they're three, when they're five, when they're seven, it's sometimes hard to think what they're going to be like, you know, when they're 1516, 18. And I can only imagine how many times he has forced you to reconceptualize your perception of what he can do, what he wants to do, what he enjoys, what he doesn't enjoy. And as a newer parent, I'm looking forward to all that as well. Nicole Dahl Yeah. I mean, I would get asked, like, What's your goal for your son? And, you know, at that point, I was like, let's get out of the house without a meltdown, or let's get dressed and not fight what clothes we're wearing because they're uncomfortable. I mean, the goals back then were so different than they are now, Jayson Davies yeah, wow. All right, well, let's dive into that actually. And let's, you know, jump in that DeLorean, and head back 15 years or so. And when, like, did you first start to realize, you know what, hey, my son might need additional support. Or, hey, you know what they're he might not be neurotypical, and what was that point in your life like? Nicole Dahl So it was very different, I think, from the traditional journey we were at. So we had a hard go of it at first, because he kind of falls in between that line of, you know, standard symptoms and things like that that you would normally associate so he would be considered more on the like Asperger's spectrum of things, but he was diagnosed with ADHD and after he was kicked out of four different preschools because they said he was too much or wouldn't follow instructions, or would kind of be doing things for self soothing, of just not wanting to get off a swing and come inside when recess ends. So that was hard as a parent who was working full time saying, Okay, now we have to figure this out all over again and establish a new routine in a new place. But I was very lucky enough to find a school who in the mean in the kind of in that timeframe, I worked as a publisher, and so one of the schools advertising with me was actually a school for mostly disabilities, but they admitted children, what they can called role model children. And then so my son was admitted as a role model child. And then later the teacher was like, hmm, there's there's something else, something else here. Have you considered having him tested? And also, at the same point, I was developing a website for the University of Central Florida's card center, and going through the checklist of symptoms, I was like, This is my child. Jayson Davies Sounds familiar. Sounds familiar. Check, Nicole Dahl yep. So it was through the encouragement of the staff at his preschool that we then got on a wait list to get him tested. It took probably nine months to a year before we actually were able to get tested and get that diagnosis. And then I really think I was handed a Xerox sheet of paper that had been copied multiple times over. Of, here is autism, here's types of things you can expect. And then that was it. I was handed a referral to OT and there was no in between of, hey, what's next, or what is OT, Jayson Davies yeah, yeah. Can I ask really quickly that that evaluation process, that preschool, was this a public preschool, or was it a private preschool? And was the assessment done through like a medical model, or through more through the school. Nicole Dahl It was a private preschool, and then the referral was done at a medical clinic with a medical doctor, yeah. Jayson Davies Okay, so you you got this referral then, and you have a referral, sounds like for occupational therapy. I don't know if speech or anything else was involved, but were they then recommending you to actually, I guess, get services through the school, or were they recommending you reach out and go through insurance? Or how was that? Nicole Dahl So at first we it was a recommendation for outside private OT, and so I had submitted the paperwork to his school ahead of time, saying, you know, here's his diagnosis, here's what we do. And they were like, Okay, we'll get you on the calendar for an IEP meeting that probably took nine you know, if we're talking about the beginning of the school year system, where he's now in kindergarten, I don't think we had that initial meeting until the spring after you. The new year. So it took so three quarters of the year in, yeah. And during that time, you know, I kind of brushed it off that he was not liking school because it was a new transition, because his preschool was so amazing, but he did not want to go to school at all every day, it was a fight to get in the car and go. And I kind of trusted the process and said, you know, we're figuring this out. It's a new school, it's going to be okay. And then, come to find out, at the first parent check in, which had, you know, maybe several weeks had passed during school, the teacher was like, you know, I figured out a way for him to focus. And ever since then, it's been going better. And I'm like, Well, what, what do you mean? Like he's saying he does, like he's having a hard time, and so she had put him at a desk facing the wall by himself, isolated away from the classroom. Yeah, and that's how she got him to focus so, very inclusive, not very inclusive. He wasn't making friends. He had been kind of, you know, labeled, almost like a leper, like, oh, that child is, there's something going on with that child, because he's isolated away from everyone else. Wow. Jayson Davies Okay, and then it like you said you didn't end up getting that IEP until, you know, several months later, wow. Okay, before we dive into that AP process, I first want to ask you about your initial thoughts on occupational therapy. It sounds like to me that the first time you really heard of occupational therapy was when you got that referral. I mean, maybe you had heard of it, but this is the first time you really had to think about it. What were your initial thoughts when you heard about occupational therapy and maybe you did some initial research, like, do you recall? Nicole Dahl Yeah, I do, actually. So I had never heard of occupational therapy beforehand. I was never exposed to it. I didn't have any friends kids who had gone to it. So obviously, you know, looking online, I was like, Well, this is supposed to help with our daily life. This is supposed to help him, you know, work at handwriting to even kind of daily living goals of getting dressed, transitions in the day, things like that, to help things go smoother. So it kind of looked like this golden treasure trove of here's possibilities that can help and then, unfortunately, my experience in the beginning did not necessarily offer that interesting. Jayson Davies Okay, so let's dive into that then, and let's talk about some of those experiences. It's hard because, as you know from the experiences you have outside occupational therapy and school based occupational therapy, and throughout this podcast, I might ask you to clarify a little bit, just because it is a little overlapping, and I don't want to make you have to figure it all out all the time. But so I guess you know, as you dive into that confusion, where did that start? And was that it sounds like you probably started with outpatient before the IEP, because it took so long to get to the IEP. But correct me if I'm wrong and and go ahead, we Nicole Dahl started definitely with outpatient before we got the IEP implemented for in school and outpatient, I felt like they kind of just went off of a pre prescribed checklist, like, here's what we do for every child who has these goals. But it never felt like it was directly connected to my child. So nothing felt personalized. I often talk that we were, you know, given carry over homework that truthfully, felt like and sometimes I would even see like we're taking a piece of paper off of a stack that I'm sure every family got on their way out of the clinic that day. So it wasn't relevant to my child at all, nor was, you know, chances are it would probably get destroyed in the car before we even got home. And then I was left feeling like, Okay, I have this one five minute activity that I can do to help support my child through the week, but what else can I be doing in between? So a lot of the time I felt kind of frustrated and looking for answers that I didn't know exactly where to find or how to find to better support my child. Jayson Davies Yeah, and I can only imagine that being tough. Were you going basically once a week? Nicole Dahl We were going once a week to OT and then once a week for feeding or sorry to speech as well in the beginning. Jayson Davies Okay, so I can only imagine that is, you know, you're there for the let's just call it an hour, assuming, and you get that hour of time where your son is with the therapist, and then at the end of the hour, you're walking out with maybe a little general piece of paper, maybe some quote, unquote homework, per se, and then you're expected to come back next week with maybe that completed homework, and, you know, for the next session and and so you're for seven days, you're questioning what I'm. What the heck was it going on? What did they do? Is this working? I mean, how are you feeling? Nicole Dahl Yeah, that's exactly how it felt. And then I felt like, you know, even during the session, because they would go back, you know, into a room somewhere where all me and all the other parents were left sitting in the waiting room. Typically, that handoff was maybe no more of a two minute check in. Of, Hey, how are things going? Anything new this week? And you kind of had to have this pre script plan of, here's what we really struggled with at home. Or finally, you know, I was like, Hey, can I go back in the session with you guys? And they were like, Oh, well, that's like, really, we have the parent waiting room here, but I guess we could try, but you'll have to sit kind of on the floor in the corner, which I was fine with. But I would say things like, you know, he can't tie his shoes, and then I would see them him on a swing and catching a ball, or playing with Play Doh. And I was like, did she not listen to me? Because I said he can't tie his shoes, and now they're they're just playing. How is any of this supposed to help? I really didn't understand the why behind everything that they were doing, and I wish that had been explained to me as a Jayson Davies parent, trying to figure out which follow up I want to ask her. So obviously, you know, you came to love ot so things got better, and we'll get to that point. It sounds like you wish things were a little bit more collaborative. Communication was a little bit better. Did that eventually start to get better? Did it take, you know, multiple different therapists, multiple different, you know, clinics, or at what point did you start to transition from, you know, what? I don't understand how playing with Plato is supporting these goals to Okay. I start to understand Nicole Dahl it took being involved as a parent, and then we did have a great school therapist. Once we finally got involved with in school OT. We had also switched districts. We had moved in between, and our new ot in school had brought up things that I had never even considered, or had ever even kind of been discussed with me. So things like, you know, the teacher would say he's he's rocking and doesn't stay still all day. So then the OT would go in the classroom and say, Well, what's going on here? And come to find out the legs of his chair were uneven. So he would sit there and and teeter back and forth all day. And so the OT was like, okay, Mom, here's this little seat thing that he can sit on and kind of just wobble without making noise and a distraction. Would you be okay with getting that support in classroom 100% yes. Or, you know, in this particular classroom, the lights overhead buzz a little bit loud and can be a little distracting, you know, mom, would you be okay with, you know, getting a floor lamp for the classroom. If the teachers okay with that, yes, 100% are you kidding? I had never even considered that lighting was coming into play as a distraction. When the teacher would say things like, Oh, he's not focusing, or he's drifting off and staring into the the abyss, it was because he couldn't filter out that sound of the fluorescent lights to really be able to hear her over the lights. Jayson Davies Yeah, you know, I, as I listen to you really quickly. Like, the way that you're explaining things are the way that I feel. Like, oftentimes we should explain things, especially when we're talking to parents, but I think sometimes we try to get too smart sometimes, and like, use complex words and, you know, sensory processing and vestibular and proprioception and and all that. And it's nice to hear from a parent, like, just, you know, in layman's terms, like this is what they kind of want to hear from a therapist. Nicole Dahl Yeah, I wanted to hear real world, relevant insights for my child. So the provider would come and say, you know, what are your biggest struggles at home? Or what? You know, what goals do you have? And you know, after we got integrated with school, ot I was like, You know what I would love for Him, to be able to have a friend and to have someone that he can talk with at school, because otherwise it seems like he's really alone. And so the school of Tay was like, That's a great idea. I've got some other kids that I'm working with that I think a social group would be really valuable. So during lunch, I'm going to pull these kids and we're going to start a group of saying, hey, what's another child who maybe likes some similar things that you like, and practice those like reciprocal conversation skills back and forth, and that was a thing I had never even considered as a parent. I'm like, I know he's obsessed with sharks and dinosaurs. What? Where can we find those other children who are also obsessed with sharks and dinosaurs? Maybe ask like, which ones do you like? Or why? Yeah, but I very vividly remember the first time he asked me how my day was after practicing those reciprocal conversation skills. And it was jarring. And I had never realized that he had never asked me that before. Wow. Jayson Davies That really tugs at the heart strings a little bit when that happens on Yeah, that's awesome. So it sounds like we've got this occupational therapist in the schools. You've already mentioned them, kind of consulting with the teacher regarding the lighting, regarding the seating, as well. Now you've also mentioned a small group. It sounds like with, you know, working with you know, working with other students on social communication and social skills. Did you also, did your son ever have on his IEP individual pull out services with an occupational therapist? Yeah, he did. Okay. Very much. So okay, and then if I can, because I have a follow up, but I just want to get the the basis here, did he also have the occupational therapist ever actually go into the classroom to work with him individually? Nicole Dahl Yes, and that's where we kind of would see some of those things that hadn't necessarily been brought up as maybe a difficulty before. Is, you know, we would get feedback from the teacher, and then the provider would see it and from a different lens and say, Okay, let's try this, or even giving feedback to the teacher. Of, instead of saying, you know, time's up on this activity, come to the carpet. How to word things even a little differently. Of, hey, we're going to work on this for five minutes. That's okay. If you don't finish, you will have time later in the day to work on it, and then we're going to go to to the rug for story time, or just framing things a little differently so he didn't get caught up in the I'm supposed to finish this. I need to finish this, or I'm going, you know, it's going to be counted negatively against me, so I'm not going to go to the carpet and I'm going to sit here and finish working on my paper. Jayson Davies Yeah, yeah. And it sounds like you're the occupational therapist or occupational therapist that you know you you and your son have worked with over the years, but years have been very flexible, because one of the things that I've found is that, and the research backs this up, is that sometimes occupational therapists can be a little rigid, and the type of services that they provide, some therapists provide, or they prefer more that pull out model. Some prefer more pushing into the classroom. And it sounds like you've experienced, you know, kind of the gamut of that. And I guess my question here for you is, looking back at that, did you feel like one service was better than the other, or do you feel like it was something that needed at the right time, and that all the services you know, fit into a particular part? Does that? Does that make sense in the question? Nicole Dahl Yeah, it does. So I would say, from my lens, when things really started to click is once I got everyone talking together. So when I got the outside private, ot talking to the in school, ot talking to the teacher, I had requested, you know, for the next IEP meeting, can can you come to this? Or can we loop you in on the Zoom call? Because it's once we started talking together. That's when the biggest differences would get made, because the in school at ot would say, Okay, here's what we're working on here. So then the private ot would say, Okay, I hear that. Now we can work on this, and then I can give carryover skills for you to practice at home in between. So it wasn't just these, like, you know, little hour snippets two times a week when there's, you know, over 160 other hours in the week that nothing else is happening. Here's actually tangible things that I could be doing at home. And that's when the difference really got made is when I started understanding the why behind everything, and had skills that I could be working on at home to further their work. Jayson Davies How long did it take to get to that point? Because I know you experienced a lot of frustration, so how long did it take to get Nicole Dahl to that? It took a solid three years before we got to that point. Jayson Davies That's a lot of missed opportunities. It was, and Nicole Dahl it's huge. I mean, that's such a critical period in their life, too. And you know, there were times when a provider would leave on maternity leave, and they would say, you know, oh, we're just gonna hold his spot with this provider. Are you okay with waiting till she comes back on maternity leave. Yes, a horse of 100% we love her. Then she would decide not to come back. And then, so then we were put back on the wait list waiting for another provider. Or they'd say, you know, you can look for somewhere else to go. And then we'd try getting on a wait list somewhere else. So accessibility. Was also a huge part of that. In the meantime, too, trying to find a spot of somebody who had opening. You know, I learned both personally and professionally my work with coro, like there just aren't enough providers to handle the demand that's out there. Jayson Davies That is true, very true. All right, we're going to take a quick break, and when we come back, we're going to talk about more of that advocacy piece a little bit as well as you know how we can improve communication between parents and the parents. So we'll be right back. All right, we're back, and Nicole, I wanted to ask because in a previous conversation we had, you've mentioned that you've lived a few different places, and I can only imagine that moving while having a student on an IEP can be a little difficult, and so I wanted to ask you about that experience. Was it difficult, or was it seamless, and what made it better? Nicole Dahl Truthfully, I had a couple of years under my belt at that point, so I had learned my lessons that I need to speak up and almost, you know, get labeled as that annoying parent who's not going to go away right out of the gate. So that was the biggest lesson I had learned. Is, you know, you're your child's personal cheerleader. You're the one who's with them the most. So if anyone's going to speak up, it's, it's going to be you parents? Jayson Davies Yeah, I know. I completely agree with that. Like being on the inside right in the school, you almost get a little frustrated sometimes with parents who are like that. But when you take that step back and you realize, like this parent is simply trying to make sure that their student doesn't get forgotten, like you kind of understand it. And as a parent, I would absolutely do the same thing for my kids, like we have to stand up a little bit, just like as an occupational therapist, you've got to stand up for yourself in the school to make sure that you don't get forgotten as an employee in the school, and we're all trying to, at the end of the day, get the services and the support for the people that are important in our lives. And so yeah, I get it. Sometimes you feel a little defensive as a therapist when you have that parent who is calling an IEP every three six months, but from your perspective, right, you're just trying to get the best services for your student. So yeah, yeah, and it's coming from a point of Nicole Dahl love, by the way, whenever, when you have a parent that does that, it's and you guys both have the same goal to help and support the child. So it's a shared goal, but it's just figuring out, like, how are we communicating or not communicating what's happening behind the scenes? So there were times when they would say, you know, oh, this has actually started, and I just didn't know that it had started. Or my son didn't know that that's what that was, yeah, where it was not even, you know, he just thought he was meeting with another teacher at the school. But it wasn't said, Oh, this is your new in school occupational therapist. So when I would say, Have you started ot in school yet? He would be like, No. And then there was a time when I was like, Oh, well, you know, they said, Mrs. So and So was your new OT? Oh, yeah, her, yeah, I do meet her, yeah. So making sure things are explained as, like, super baseline, basic conversations, Jayson Davies and it's it's amazing, because in today's world, it is so simple to communicate, like you don't have to pick up a phone, you can do a quick email. We all have systems in place at the schools where we have, you know every single person and their mom's email on file that we can send a quick email and and whatnot. But it does take time. It does take energy, and it does actually take that initiative to say, You know what, something changed. It's not that big of a deal, but communicating this to the parent or to the teacher or to the outside provider, whoever it might be, really goes a long way. Like we undervalue how important a simple communication is. Nicole Dahl Just remember, like we're humans on the other end of it too. And, you know, and sometimes I don't even think parents know that that one provider could have 80 students that they're helping. So just keep that in context as well for parents of saying, you know, I hear you. I got your message. And it may even seem a little like combative to say I have 80 patients, but most parents don't know that. They may think you work with like, four or five patients, but if you don't have that inside lens, you might not understand why it's taking so long to get back to you. Jayson Davies Yeah. So that actually leads me on to a question about an IEP like being in an IEP meeting as the parent, and when it comes to the occupational therapist, you know, sitting across the table from you, let's assume this is like, maybe not an initial, but a triennial, and they have an evaluation to present. Yeah. From a parent perspective, how much detail are you expecting? Do you just want a quick overview? Do you want the full, you know, page by page rundown? Obviously, every parent's ever but your perspective, what do you like? Nicole Dahl I had both ends of the spectrum on that? You know, in those initial days, it was just a quick run through of, you know, here's the goals, here's where we're at. Any questions, okay, now we're done. And then, truthfully, it felt like just a check box that was getting hit. And at that point I didn't know what to ask for, or what to kind of dive in, or even what was possible. But then I had providers who, you know, after we kind of made that switch a few years into it, who went through everything, but I understood, they also kind of translated it, what was on the page, into parent friendly language that I could understand. And again, that's when things really started to click. And things that I could also practice at home, that I just became more aware of how to support my child. You know, there were things like incorporating motor brakes or, you know, they would set up like stickies on in the hallway floor outside. It's like a little obstacle course for him to go through. And sometimes they would even bring me and show me how it is and what it helped, or, you know, different things like that and that. I truthfully felt like that was the most valuable. Yes, it was in depth, but I had a better understanding of why they were working on the things that they were and how it supported my child? Jayson Davies Yeah, absolutely. And, and it can be hard because, like, I don't know, in the area across the nation, evaluations vary widely. In my area, in California, we would often write 1012, sometimes longer reports. And in other areas, I know it's very common to write a one and a half two page, you know, report as an occupational therapist to provide to the teacher. So I guess my question is, when you receive a report, and it doesn't necessarily just have to be ot but what do you taking out the verbal communication aspect, right? We're not in the IEP, just looking at a report. What do you hone in on? Is it the recommendations? Is it the analysis? Is it everything? What do you really hone in on? Nicole Dahl The recommendations? That was definitely the biggest part for me, other than, you know, there were things, little highlights, I felt like, because they were reports sometimes where the teacher would also have to do a report compared to the OTs report compared to the outside OTs report, and they would mesh them all together and then figuring out where the misalignments were, or where were the things that, you know, hey, maybe he's regressed a little in this skill that we had been working on over here, but it's showing up in the classroom. So that saved space where, really, everybody could talk together and figure out what was best moving forward, if anything needed to be adjusted. So everybody was on the same page. That was really helpful for me. Jayson Davies I think again, it's hard when you get a 15 or even 10 or even a five page document about your student, and then you also got a document from the school psychologist, a document from the speech pathologist. Like going through all of them is not simple. And so I think that's kind of why I wanted to ask you that question was to see, is it just, you know, mostly the recommendations. And I say that because, I think a lot of occupational therapy practitioners, we really put a lot of focus on the scores inside the assessment, as opposed to the actual synthesis and analysis that then leads to our recommendations. And I think it's important to know that your recommendations are just as valuable as conducting if not more. So the SPM or the bot three, or whatever it might be like, those recommendations aren't just they don't go or they do go somewhere. They go to the parents, and that's something that the parents can can look at. And the Nicole Dahl recommendations were obviously the most helpful from my perspective, because, you know, the reports are great. It shows, like, the measured progress, but in my brain, like, that's that's done. What are we doing next? What are we doing looking forward? Or what can I be doing to support the work you guys are doing in the in the school? Jayson Davies Yeah, all right, so you mentioned a communication has just come up, like time and time again in our conversation so far, like and I understand that, and I want to ask you beyond just you know, communication, both with yourself and with the team, is there another aspect of occupational therapy? Especially within the schools, that tended to make you feel more comfortable with occupational therapists or understand that things were going well versus going bad. Nicole Dahl It was just those feedback moments of saying, you know, hey, we talked about implementing the motor breaks between classrooms. I touched base with the teacher, and you know, she said that that's made a huge difference. Here's when they were doing it, and, you know, it's made an impact. So I just wanted to touch base and let you know that. Jayson Davies So someone's saying they're going to do something, doing it, and then touching base with you to let you know it was done and and that was the outcome, or whatever the outcome was, yeah, yeah. You know, at the end of the day, that's pretty simple, simple, right, right? And so now I ask you, because it sounds like you've also had some, you know, troubles, maybe even beyond those first few years. What was the breakdown when there was a breakdown ever? What do you mean? I guess, yeah, if the communication, and you know, the simple, you know, the simple communication, making sure everyone's doing their job is what works really well, I guess my question is, is in times with an IEP, where maybe things with the district haven't gone so well, and, you know, things maybe last year they were good, and this year they're not. What do you feel led to that? Was it just simply the communication, or was there anything else that led to, you know, something's not right here. I need to call another IEP, because things aren't going well. Nicole Dahl It was, truthfully, that disconnect when people weren't talking together, collaboratively. So when you know the teacher would say, you know, oh, I have that paper, but I have 30 other kids in the classroom, and I can't devote this special attention just to this one child, or just that, that disconnect, when it didn't feel like everybody was, was really working together. And there's so many invisible moments that that happen when each of us are are with, you know, my son, and how can we it? And, yes, it's a lot on each person to say, here's how it relates to this, or here's what we're seeing, and that's, you know, truthfully, one of the reason I love Koro is because it takes those invisible feedback and translates it into real data that everybody can see on the back end. So it brings people together and not just keeps them all isolated on their own. Jayson Davies Yeah, it's amazing. I really feel like we undervalue communication, and it's something that, and it's not just us, it's an entire school district, like, you know, it's, you know, I'm sure, from your experience, it's not just the OT, who you needed to communicate, right with? It was the SLP, the teacher, the psychologist, whoever else at the district level. So, communication, yeah, just, just so important. One thing I wanted to ask you and talk a little bit more about your son is how things changed as he got older, both in relationship to occupational therapy, but also with IEP. I mean, a did he continue to receive ot for for a decent amount of time? Or how long was that Nicole Dahl he continued. So he in school. We first got it at the end of his kindergarten year, and then we stopped receiving it as he transitioned. So the middle school he went to was six seven, so we stopped receiving it after seventh as he transitioned into high school or eighth after the end of eighth transition, or we stopped receiving ot as he transitioned from middle school to high school. Jayson Davies Gotcha, that makes sense. And can I ask then, because you already had experienced a transition from elementary to middle school. Was it even a thought to discontinue ot transitioning into the middle school, or any other services from elementary to middle school? Was it one of those things like, and you no one made the recommendation, or B someone maybe thought about it, but we decided, You know what? This is a transition. Let's hold on to it. Nicole Dahl We definitely scaled back going from elementary to middle school. A lot of those things he'd been working on in elementary school were kind of like baseline toolbox of items I felt like he needed to develop. So he was able to kind of get these strategies that that helped him, where he could then implement them on his own going into middle school. So it was more as that IEP was there as a buffer in place for middle school, saying, Okay, we're going to give him some a little bit more freedom to see, see how he does, and test it for those two years before transitioning to high school. I think. Jayson Davies That's a perfect opportunity to do something like that. And I've definitely have sat in IEPs and kind of maybe said in a slightly different way, but yeah, you know, we're going to keep it on, but maybe we're going to scale back to a consult, you know. We'll be there if necessary, you know. And we can always increase services back up again, but let's see how this goes and be able to support the teachers, yeah. So then going into high school, what made you feel, you know, OT, it's a safe point at this time to discontinue OT, Nicole Dahl well, he's always been a smart kid, so grades were never really his problem, and that also worked against us, because in the early years, they would say, you know, academically, he's fine. There's no need for intervention. But at the same point behaviorally there, there was a lot, you know, he would get in trouble for not following instructions, or even sometimes arguing with the teacher, because he would look at it from another lens and say, You know what? I know, I'm right and you're wrong, yeah, because his brain just saw things a little bit differently. Yeah, so, but it really made sense for us going into high school to give him that freedom and say, okay, you've learned years like you know this. You've got this. We believe in you to now take that step forward. In hindsight, are there some teachers he's had in his high school career where I wish we would have still had that in place? Yes, 100% but it's very isolated, and we're able to talk through it at home, because I can say, You know what? Remember, you know, let's and like, let's break that down, and we talk about it at home, but that's because I've learned so much from the providers over the years that I can help see maybe what he's struggling with, or what tools I can also say, hey, remember this, or remember when. And that's helped a lot too. Jayson Davies Again, coming back to the communication like just the more that we can empower our parents, our teachers, to be able to use the strategies that we support them with. It's just so impactful. And it leads to not just impact today, but as you just kind of confirmed, right? It leads to impact years later, and you're able to point back to those so awesome. I love it, yeah, Nicole Dahl and I would say, you know, just remember that a, you know, yes, you have your your client or your patient being the child, but really, I encourage people to think of it more as the family or the caregivers also as your clients and patients, because the more you can educate us. And I know some parents will just say, you know, yeah, okay, got it or good. But really, some parents are, you know, or depending on the day, can be struggling to get through that single day. And so don't be afraid to say the same thing multiple times, because, you know, our brains might have been so filled with what just happened in the parking lot before we even got into the school or into the appointment, that it may have went in one ear and out the other, right? Jayson Davies And you're a VP of marketing. What is it? How many times does someone have to hear something before they get it into their brain, like seven or something like that? It depends. Nicole Dahl It depends. Recent studies have actually shown that it can be up to 21 times that they need something to turn it into a habit. Jayson Davies Yeah, see, those are the things that you're not going to learn in OT school. But we need to, like, we need to remember that just because we say something one time doesn't mean that the teacher heard it, or the parent heard it, or that they it was processed. So don't be afraid to kind of, you know, in a very polite way, nudge a little bit and and send reminders. So, yeah, yeah. All right, Nicole, looking back at just, you know, the last, gosh, 18 years now, then about what are you most proud of in your son's journey? Nicole Dahl Again, I never would have imagined that where we are today is where we would have been back then. You know, truthfully, when he was in preschool and kindergarten, I never would have anticipated him going, you know, we were even wondering if he would be okay in a mainstream school at that point. I never thought he would go to college. I never thought he would drive a car or maybe even be able to live on his own, and all of those things are very tangible, and we're talking about them and having those discussions now, never in a million years, what I'd say, you know he's going to play a team sport, know all of his teammates names, be able to engage in conversation, Much less a sport like water polo, where it's so stimulating all of the time, we were just blown away watching him being able to do that. And I think back to to little him who would struggle with wearing a itchy sweater that he got from his grandma. And think it was you. Know the worst thing ever in his life, and then have to in high school, say you're going to stand up in front of a speedo in front of the entire school like I no way would I have imagined that without OT and all the supporting services in between. Jayson Davies That's fantastic. I'm so proud. I'm so proud of him. I don't even know him, and I'm proud of him. I love it. I love that you and your family have gotten to a point where it's just a point where you never knew, never potentially thought that you might get to that's just, that's really awesome. Kudos to your entire family. All right, I do have two final questions here for you, and the first one, I think I might already know a little bit of the answer, but if you were well, I mean, you are speaking to school based occupational therapy practitioners right now. What is one piece of advice or wisdom, or what do you just want them to know? As a parent, Nicole Dahl we want to be educated. We may seem busy, or we may seem, you know, passive in the process, but every parent I've ever met wants the best for their child and make us understand, if you have to, you know, stand in front of us and say over and over again, this is why I'm doing this, and this is how it can impact your child. You have to tell us the why behind things, or we're not going to understand and we're not going to get the buy in that you deserve for all the hard work that you do. Jayson Davies Yeah, yeah. I think that's what sometimes we need to hear as therapists do, to know that you know what, we do need to support a little bit, not just the student, but also the parents, and let them know everything that we're working on Absolutely. And the final question here is actually for the parents listening, because I imagine that there might be some parents who find this podcast and just really want to hear from a parent perspective. And so words of wisdom for for parents who are kind of, maybe they're in their kids in kindergarten right now, and they're just getting into school based. OT, what words of wisdom do you have for them? Check with it. Nicole Dahl That is the best advice that I got from that preschool in the beginning. As this will help, because in the beginning, you know, if I'm honest, those first two years, I didn't see a difference that it was making. I didn't understand how it was going to help. I didn't understand the why behind anything, but really just trusting the process, but getting involved to educate yourself. It takes a village that is said over and over again, but really, you have to communicate what you're seeing at home, find supports that can, you know, communicate things holistically, because your child deserves that chance. And days are hard with a special needs child, they are long, they are frustrating, but your children deserve your attention, and you're the one who can provide the biggest impact in their life and what it's going to look like. Jayson Davies Yeah, yeah. Nicole, thank you so much. It has been a pleasure. Thank you for being so open and sharing your story and letting us know about both the good and the difficult times. I know that's not always easy, and I'm just so glad we're able to do this. I think it is going to help, you know, school based ot practitioners, this episode is going to help them just as much, if not more than 100 other episodes that we have that are about the details of an assessment, or about, you know, the details of sensory processing or something like this, like it is so important. So important for us to remember that a parent is just as important to the IEP team as anyone else that's there, and that we need to work with them. They are not our foe. They are part of our team, and we need to be in communication with them. It sounds like that is just a huge piece that can sometimes either be missing or really make the entire team come together to support a student. So thank you, Nicole. Really appreciate it. Nicole Dahl Thank you for having me and sharing stories. Jayson Davies Yeah, and that's going to wrap up episode 195 thank you so much for joining us today, and also a huge thank you to Nicole for sharing her family's journey with us and reminding us why parent communication and collaboration matters so much. Nicole's story is a powerful example of how occupational therapy, of course, when paired with clear communication and teamwork, can really change the lives of the students we serve. If you found this episode valuable, I would love for you to share with another school based ot practitioner who might benefit from hearing a parent's perspective, or perhaps share it with a parent who you think could benefit from hearing Nicole's story. And if you're looking for more resources, professional development and mentorship to support your school based ot practice, come check out the school based ot collaborative at. OTSchoolHouse.com, slash collab, we've got a whole community of practitioners ready to support you, plus monthly PD courses, a global bank, AI tools and so much more. Thank you again for tuning in to this episode of the OT schoolhouse podcast, and I will catch you next time. Amazing Narrator 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. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! Thanks for visiting the podcast show notes! 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Click on your preferred podcast player link to listen wherever you enjoy podcasts. Welcome to the show notes for Episode 194 of the OT Schoolhouse Podcast. Supporting teachers can be one of the most powerful ways to create lasting change for students—but it requires a shift in how we view our role as school-based OTs. In this episode, Dr. Ellen Cullen shares her groundbreaking doctoral capstone work on occupation-based coaching, where she treated teachers as clients and used MOHO to support their self-efficacy and align their practices with their professional values. Ellen reveals how experienced teachers often don't lack competence—they lack alignment between what they value and what the system demands of them. By becoming co-designers rather than experts, OTs can empower teachers to reclaim their autonomy, reduce burnout, and implement sustainable strategies that truly benefit students. Whether you're struggling to make time for consultation or wondering how to make your impact last beyond the therapy session, this episode offers practical, immediately actionable strategies. Listen now to discover how supporting teachers isn't just good practice—it's essential to creating meaningful change for the students we serve. Learning Objectives
Learners will understand the power dynamics in classroom consultation and how to approach teachers as occupational beings
Learners will identify how to apply occupation-based coaching models (using frameworks like MOHO and IRM) to support teacher self-efficacy
Learners will understand practical strategies for integrating teacher support into existing service delivery models Guest Bio Ellen M. Cullen, OTD, MS, OTR/L, BCP Ellen Cullen is a school-based occupational therapist who is passionate about creating systems-level change that supports teachers, students, and classrooms as interconnected ecosystems. She holds an MS in Human Development from the University of Rochester and a post-professional doctorate in occupational therapy from Bay Path University. Ellen blends occupational formulation, the Model of Human Occupation, and the Intentional Relationship Model with design thinking to co-create practical, context-driven solutions alongside educators. She owns a private practice, providing pediatric occupational therapy and CBIT for individuals with tic disorders across the lifespan. Ellen is also the founder of JustGrowPlay, LLC, where she focuses on innovation and design, developing products and consulting on environments that enhance play, learning, and occupational engagement. Quotes "Teacher self-efficacy is a type of self-efficacy wherein teachers are strongly affected by their beliefs about the potential, their potential to impact student learning... It can also affect teacher stress levels and their desire to stay in the field. And as we know, teacher burnout is a huge issue." -Ellen M. Cullen, OTD, MS, OTR/L, BCP “OTs being trained in more of a medical model enter schools as outsiders… we don’t always know where we stand with a particular teacher.” -Ellen M. Cullen, OTD, MS, OTR/L, BCP “We are systems thinkers… we don’t just look at tasks, we look at motivation and the reason behind why someone does the task.” -Ellen Marie Cullen, OTD, OTR/L “If you love your teachers — in a real, human way — and co-design with them, that’s a powerful model for change.” -Ellen Marie Cullen, OTD, OTR/L “Rather than trying to go in with power, you’re going in with open-mindedness and letting the teacher have the power.” -Jayson Davies, MA, OTR/L Resources 👉 IRM Model 👉Self Determination Theory 👉Moho Model Episode Transcript Expand to view episode transcript Ellen Cullen I think this is why it's really important to distinguish between consultation and coaching in terms of how we implement that and what that looks like. We can look at consultation as being more expert driven, so the OTs are the ones providing the solutions to problems, whereas in coaching, we're asking the adults that we're coaching to find their own solutions to the problem. Jayson Davies Hey there, and welcome to episode 194 of the OT school house podcast. It's great to have you. What you just heard was Dr Ellen Cullen breaking down the difference between consultation and coaching. And now, if you're thinking, Okay, I kind of get it, but how does coaching fit into school based occupational therapy, you are not alone. The distinction between being the expert who provides solutions and being a facilitator who asks powerful questions isn't always clear cut, and implementing this shift in the day to day reality of a school setting can feel overwhelming. But here's the thing, in OT school, we were trained in a medical model where we're expected to be the expert, we assess, we diagnose, we intervene, but when we step into the schools, we're entering someone else's domain, and the power dynamics are not the same. Teachers hold the key to implementation, and if we don't bring them along as partners, our best strategies often fall flat. Today, I'm joined by Dr Ellen Cullen, a fellow school based occupational therapist and board certified pediatric specialist who has spent years exploring a powerful yet underutilized approach in school based practice treating teachers as clients through a coaching model. Ellen's doctoral Capstone challenged the traditional consultation model by using occupation based coaching to support teacher self efficacy, particularly with English language learners. But here's the twist, her research revealed that experienced teachers didn't lack confidence in their teaching. What they lacked was alignment between their values and the demands of the system. During this conversation, Ellen breaks down how school based OTs can shift from being the expert in the room to becoming a co designer and partner and guide empowering teachers to reclaim their autonomy, reduce burnout and create lasting change for students. We'll talk about power dynamics, the difference between consultation and coaching, and how you can start implementing this approach right away, even within the constraints of a caseload model. If you've ever felt like your impact fades the moment you leave the classroom. This conversation is for you. Let's dive in. Amazing Narrator 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 Ellen, welcome to the OT school house podcast. How are you doing today? Ellen Cullen I'm doing great, Jayson, thank you so much for having me. I'm excited to be here. Jayson Davies Absolutely this is going to be fun one, as I alluded to in my intro earlier, a lot of school based ot practitioners have difficulty with really supporting teachers. You know, we are pretty darn good at working one on one with a student, or maybe even in a small group with a student, but we have a lot of difficulty when it either comes to a consulting with a teacher directly away from the students, or working kind of even collaboratively with a teacher or two. And so I'm really excited to jump into that and to kind of get started, I want to ask you, why do you think that is the case? Why is it that so many ot practitioners, you know, we have advanced degrees, we really learn about people, the psychology of people, and all the different aspects of people, but we have so much trouble when it comes to working with teachers. Why do you think that is right? Ellen Cullen Well, that's a great question, and I have explored that in my own mind as well. I feel that OTs being trained in more of a medical model, maybe more of that clinical mindset. Enter schools as outsiders, so to speak. So when we meet a teacher or try to affect change within a classroom on behalf of a student, we almost feel like we're the outsider, or we can approach it as we're the expert. So we want to make sure that a teacher is receptive to what we have to say. So we want that relationship to be strong. However, we don't always know where we stand with a particular teacher, so developing that relationship can be really important to helping us feel welcome and entering that classroom space, I think when we enter that classroom space, it's almost akin to a family entering someone's home where the teacher is a caregiver taking care of the kids in that classroom. And I remember working in home care, and having that same feeling stepping into someone's home and really making sure before I entered that home that I was aware of the power differentials that could be part of that setting and part of that system. So we are trained in more of a medical model. We in our training. We don't get as much training as how to work in that educational. So working and collaborating with teachers is something that still is somewhat unfamiliar, I would think, to most OTs, unless we have a lot of experience working with teachers and feeling comfortable in that setting. And then I think teachers might have different experiences working with different OTs, and then they can come to that relationship with different experiences as well. Jayson Davies Yeah, one thing that you really mentioned right there was, like that power dynamic, and it sounds like you learned about that from maybe your was it early intervention experience or home health model? Ellen Cullen Yeah, so I worked in both early intervention as well as working with adults in home care, and I learned how when you approach someone's home, I found myself having to take a deep breath and really check my ego at the door, check all the medical model at the door, and just open myself to a human with another human being, and really entering that space as a listener. Jayson Davies Yeah, yeah. And so now kind of, how did you start to, I don't want to go into the how you applied it yet, but I guess, kind of, what are some of those, those dynamics, power dynamics that apply to school based occupational therapy. As you got into school based occupational therapy, have you been able to actually identify, I guess, what those power dynamics are, or at least kind of to, I don't even know how to say this, but like the things that we need to think about as school based ot practitioners. What are those power dynamics in the classroom going on? Ellen Cullen Sure, I my experience working with teachers has been so enriching for me, so I've really gotten an inside look at what a teacher's day is like, and what thoughts go through their head. And I can almost tell now when they look at me what kind of day they're having. So they're either looking at me like, Oh no, you're here, or oh no, I wasn't ready for you. Or Oh no, you're going to judge me. Or Oh no, what do I need to do next? What? Or what aren't I doing right? Am I another person you know? Is she gonna judge me, or do I? Do I trust her? Do I feel safe with her? I think trust and safety are huge dynamics in a relationship. So, you know, I can look at a teacher and they're either gonna, you know, sometimes they look at me like, help me. Ellen, I just need to go the bathroom. I just need to leave for a second, or it's a great day. We everything's clicking. Everything's great. Come on in. So there's, am I being welcomed, or am I like? It's not a good day. Can you just take Johnny today? So I am ready for anything. Jayson Davies So in that sense, you're what you're kind of explaining is, what I'm hearing is that rather than you trying to go in there with power, you're going in there with absolutely open mindedness in terms of letting the teacher have the power Ellen Cullen absolutely and it's easy to walk in with my agenda and my therapy plan and not check that at the door. Have it? I you know, I think as OTs, school based OTs, we have our plans, we have our goals. We're busy, just like everybody else, but we also have to be very mindful of the teacher's well being, what's going on in her classroom, her dynamics. Maybe she just met with an administrator. Maybe the tone that she's using isn't necessarily targeted towards us, but just something within the system itself she's experiencing, or a pressure coming from what happened before work, or something that's happening within the classroom. So I'm always aware to, like, check any preconceived notions prior to entering a classroom and prior to entering that relationship, Jayson Davies yeah, and I, I get that it is also much harder said than done, because, as you mentioned, right? We go in with our plan, right? Like we know we need to see Johnny. We need we know that we need to see him for 30 minutes, and then we get in there and the teacher is just flustered. Maybe Johnny, or maybe somebody else is doing something in the classroom they're not supposed to be and the teacher has to take care of that. And there just really are a lot of things going on in the classroom at all times. I guess, kind of going back to that power dynamic. We address that power between us and the OT per se, or sorry us and the teacher per se, about kind of having to have this openness, maybe taking a step back when it comes to to the power that we have. But what are some other power dynamics in the classroom that we really needed to be mindful of as we go into a classroom Absolutely. Ellen Cullen And the classrooms I work in this year, I'm in both gen ed classes, and then I'm also in special classes where there are many paras, and in gen ed classes there may or may not be paraprofessionals, so I think then you have a whole nother. Other level of dynamics going on with the teacher within her room, how she's coping with managing, push down from above, but then the push down from within, and then push down from push up from students. Like there's a whole lot of things she or he is managing, in terms of managing, and I'm I sometimes am viewed as one more piece that she or he would have to juggle. So I think as far as I can understand, when a teacher wants to claim their power, because there is so much pulling at them or expectations on them and demands on them that I don't want to add to that demand, and I can understand when they want some control. And I think changing, you know, reframing, it is I want, so bad, to give you the control instead of No, it's my piece of the pie. I think if I can put reframe it as I want that for you, and I get it and how can I help you, like when I enter in that mode of let's just take care of you. First. Johnny will benefit from a teacher who is a that a teacher's well being is being attended to? Jayson Davies Yeah, you bring up a really interesting dynamic, especially for within school based ot practice, just school based ot in general. That is the dynamic between teacher, OT, para, para, educator, and then you have the student also in there as well. That is a very dynamic situation. It's one that I have found myself in the middle of multiple times, like, do I talk to the Para? Do I talk to the teacher? You know, do I include the Para or exclude the Para from pull out services, or even when I'm in the classroom, and all that and and it's not just about, you know, working directly with the Para, but it's also about making sure, or figuring out how the teacher or if the teacher needs to be looped in. So I definitely want to address that here in a little bit, as we get more to our to our action oriented part of this podcast episode. But I do want to talk a little bit about you've done some research with this and whatnot, and I want to know a little bit about your research, but also kind of what made you dive into this, because you were very well of these power dynamics, and very well aware of supporting teachers, almost to the same extent that we support the students themselves. But was it always the case, or did it take some time getting into that? And is that what led to your research, or kind of explain what led to the research, Ellen Cullen what led to the research was really back in I would say, well, it had been building up a sense that I wasn't feeling effective as a school based OT, in terms of seeing the change a sustainable change in students, they might come and through the years, I've primarily back. I'd say 20, I'll say 2010 it was still a pull out model. And so, oh, I'm here for Johnny. So really, the interaction with the teacher and I was scheduling, and then I really would say he did great, or, Oh, he didn't do great. So it became a he did great or he didn't do great. But it was really like, where is the sustainable change in occupational engagement in the classroom, I wanted to see change, occupation based change, and I wasn't in that context. I was really that that context wasn't authentic in the therapy room, and I wasn't feeling like I mattered. What am I doing? I see great things in an OT room, but I wasn't, what did that matter if in an authentic setting, it wasn't happening? So that was driving me to go back to school to answer that question, how can I affect change? And I did go to a teacher school within a university. So I really immerse myself in a teacher's world. And I learned different theory, a motivational theory called self determination theory, which aligned nicely to the Moho I felt there were so many similarities there. I was like, how come I never learned about self determination theory? It's so Moho ish. And then I really being in class with teachers, I really started to hear their stories, and I felt such empathy for them. I really started to connect with the piece that I was missing the teacher, which I really I don't know how I missed it. They were there the whole time. I was so focused on the client being the student, that I had missed the teacher, the teacher, in the relational context of the classroom, was the one trying. Facilitating or restricting occupational performance for that student within that context. And I think I've grown to appreciate Moho embracing context more as I went back to Moho and looked at it and learned more about the intentional relationship model. So then, after my master's, which I infused Moho with self determination theory, and my thesis focused on transitions, not just the major transition for students out of school, but transitions along the way, and how important caregivers and caregiving staff are, I really didn't start diving into addressing the teacher as really an occupational being, until I then went on for my post professional doctorate. Then I really I pivoted a bit from looking at student autonomy to teacher autonomy. And I think that links real well, Jayson, with your notion of power. Where is Teacher autonomy? What are we? How are we as OTs supporting teacher autonomy and teacher occupational adaptation? So again, that's where it really you know, I hadn't seen any coaching model that looked at the teacher as the caregiver of their classroom family. We have coaching models, addressing caregivers in the home, parents, yeah, families, but who? Who's addressing in the classroom, family, the teacher, yeah. Jayson Davies And so now kind of to put a little definition, I guess, behind this right, the the teacher as the caregiver. When you're speaking to that. Are you thinking of it in a way, in a way of like, as a consultation for a student, or is it very different from that, or a collaboration for a student? Or is it very Ellen Cullen different it's and the way the system is set up now I fly under the radar with my consultation, by definition, consultation still views the OT as holding the power and being the expert in terms of us giving strategies, but not necessarily being an equal partner with the Teacher and letting the teacher make the decision. I think teachers do. They'll take what we say. Do they always implement it when we consult with them? I don't know. So the teacher always does hold the power. We just gotta, like, remind ourselves, you know, they always do hold the power. We just have to be okay with that. So coaching acknowledges it puts out some things. I love to picture us in coaching as CO designers. But what's really happening? We're letting a teacher's natural tendency to want these things happen for their student happen. We're just providing the aha moments through coaching where they're like, Yeah, and we let them own that, and then we can throw out ideas, and then they're like, Ah, no. And we're like, okay, and maybe in consultation that can happen too, because maybe some OTs are already coaching, but that's where I'm I'm really coaching it within the consult, so within the school based setting. That's how I'm I'm kind of flying under the radar. Jayson Davies Yeah, so would you consider that your coaching model is still pertaining to a specific student, and therefore you're coaching the teacher basically pertaining one particular student? Or is it more of a I'm coaching this teacher in general, or is it a little bit of both? Ellen Cullen It actually, that's a great question, Jayson, because it actually is both, but we just don't really call it that, because we in the schools have to focus on Johnny. But as I'm focusing on Johnny, I'm like, oh, to the teacher, I noticed you did that. Do you know you do that? That was awesome. So I really try to notice what the teacher is doing well, or Wow, what you think about that, or just kind of ask some guiding questions. Or teachers don't always have. I would think OTs are pretty non judgmental people. We're not like another teacher that's judging them. We're not an administrator judging them. We're giving them feedback as just a co I like to think we're just like peers together, and if we can kind of, oh, did you notice how, when you did that, he did that? Oh, so we're and I'm like, Oh, I noticed, like, how, you really seem to value checking in with the students about how they're feeling. I noticed when you did that, he just lit right up. And it just kind of helps connect teachers with their students. If you can find something like a teacher might come to you and say, Oh. Johnny today, and I can say, Yeah, but isn't that spirit? And I know you're someone with spirit like you and Johnny like you, you have the same thing going on with spirit, or I try to make a connection there. So I am helping to find values that align between the student and the teacher, to help this, you know, help that relationship. But then we're also co designing intervention in context for students and I it does start with that relationship. They have to trust you and be authentic. They know. They know, yeah, they know, if you're you know. So I think it's, I love coaching. I really think that it allows the teacher to connect with why they went into teaching and get that enthusiasm back, and we can be the ones to help them light that fire again. Jayson Davies Yeah, yeah, absolutely great. Love the ideas. So many things I want to discuss, but I do want to continue moving forward. And I want to understand what your research actually looked like, what the goal of it is, and then some of those outcomes. So if you could really quickly kind of talk us through the what the actual research entails. Ellen Cullen So my research involved an occupation based coaching model implementing an occupation occupation based coaching model with two kindergarten teachers, and the focus was on teacher self efficacy. I wanted to explore whether or not my occupation based coaching approach facilitated teacher self efficacy. So this was a pilot program, and to start teacher self efficacy is a type of self ethics efficacy, wherein teachers are strongly affected by their beliefs about the potential, their potential to impact student learning. So there's a lot of research about teacher self efficacy positively impacting student achievement and the teacher's willingness to implement innovation. It can also affect teacher stress levels and their desire to stay in the field. And as we know, teacher burnout is a huge issue. So we're really looking at will this model in terms of what I can provide to the teacher facilitate their self efficacy. So I started with opening myself up to the teachers, to whatever way that coaching would go. So I really had to make sure I focused on building that trusting relationship with these, these two kindergarten teachers, and I did that through using intentional relationship model tools, and I explored what was going on for them and both it just happened to be the two teacher volunteers within the school district were both teachers that had a high percentage of English language learners in their class. These were two experienced teachers. However, they we were coming off of covid. This was 2021 and they expressed their frustration with having to meet standardized testing criteria with these English language learners who were just coming to school, and then they had a whole class of students that were coming off of covid. So their frustration was, we have to meet standardized testing scores, but these kids are nowhere near ready to learn. So their values were, we are good teachers. We know what it takes to have them be ready to learn, but there's no way we can implement that with the demands the system is placing on us. And I said, I want to help. And that's how it began. We started. I learned about them. They're about their occupational identity. We explored occupational competence. We use the OTs short form. It was a very, it's a medical, medically based tool. However we I did say, let's frame it in terms of your teacher occupation. So that helped us get some data that we needed. And yeah, we went from there, wow. Jayson Davies So by saying, you know, how can I help? And that led you down this entire path. Now I believe that this is in in addition to the services that you were completing under an IEP correct. It's not an instead of IEP services Ellen Cullen this, yes, this capstone project was in addition to my ot caseload, so I had to work on doing my weekly coaching sessions with the teachers in addition to my ot caseload. Jayson Davies Yes, yeah. So, yeah, yeah. And that's kind of why I bring this up a little bit, because one of the things that I constantly hear and I've also experienced. Many times it's like, how do I even have time? Or how do I find time to support teachers? And given that you kind of forced yourself to do this, I'm interested to hear what were some techniques that you used, or what were the most successful techniques that you think you used that actually led you and the teachers to be able to make this time, or to set aside this time, or to, you know, a lot of people, we say we don't have time for something, but it's more that we're not making time for it. And that comes from both sides, right? It's not just the time that we have, it's the time that we have and the teachers have. And so I'm interested to hear kind of how both you and the teachers made this work, time wise. Ellen Cullen Well, fortunately, my district supported me, which was great. It really, I had a relationship with these two teachers, so I they knew me, and there was that element, and they wanted to help me as well. But I think, truly, we were all invested in this. And they really, really, they were motivated. They wanted to work on these things, and they were excited to have someone who would partner with them to try some innovative strategies that I think there was a part of them. Even though they were experienced teachers that they thought, No, nothing's going to change. They were always like, Nope, this is how it's going to be. This is how it goes. But I was like, wow, we could try. And I'll back you up. I think, wow, okay. And I'm like, yeah, it's our capstones, you know? And I was lucky. I did have a field work student with me, who happened to be an English language learner, student back in the day, himself. So it was really amazing how all these pieces fell into place. I had no idea that these two teachers would volunteer. I had no idea they were both the L slotted l kindergarten teachers, and I had no idea my fieldwork student was an L. So it was really a fascinating time. Gotcha. Jayson Davies Fantastic. Cool. Well, we're going to take a quick break and we come back, we'll dive into kind of those results of your research, and then move forward with actionable tips for school based ot practitioners who want to collaborate and consult more and support their teachers more. So we'll be right back. All right, to wrap up the last question, Ellen, when did you actually meet with those teachers? Was it during lunch? Was it after school? Before school? How did you or what time frames worked for the two of you, after school? Ellen Cullen It was after school. But what we did was, do we enacted the actual work during the day? Jayson Davies Okay? And so because of Go ahead, Ellen Cullen oh yeah. So my, well, in the in the district took away this program. We had a kindergarten support service program where I had to push into kindergarten classes anyway. So my actual coaching sessions with the teachers, like we would kind of say, How am I doing? How are you doing? Where we actually met was after school. However, the work that we did was during my ot kindergarten support program, and I think that's where a workload model is so necessary to have something like this work really well. Jayson Davies Yeah, I think that's accurate. And I also like the idea of, I don't know if you've done this, but if I knew that I needed to work with a student both in the classroom and also consult, I was very specific about putting both in the classroom and consultation on the IEP, not just one or the other, and kind of hoping that I would make time for it. I was very intentional about putting more than one service on an IEP if necessary, so that I could have both that in classroom time or the pull out time and the consultation time. So yeah, the other question that I really wanted to ask you was, how did you, or did this even come up with where, because you were working with the teachers, consulting with them or coaching them in the afternoons. Did that lead to you having missed IEPs that you weren't able to attend because of these consultations? Did that lead to other things not getting done that you know, an OT traditionally has to do, progress, notes, all that fun stuff. Did that occur as part of you needing or as part of you consulting and coaching these teachers? Ellen Cullen Fortunately for that capstone project, I was fortunate to have an OT fieldwork student that lifted some of the load off of me. However, in my typical school based life right now that wouldn't happen. I would have a real hard time implementing a coaching program like this. My district operates by a caseload model, not a workload model. However, we have built in an extra week of coaching time, so we do a. Monthly model. So we have three weeks of direct and one week that we can use for coaching. However, sometimes we do have to make up students during that week, but that, as I look at it, that is when I do most of my consultation. Jayson Davies I love that. Yeah, they're using the three to one model. Awesome. Did you were you there when that happened? Or Yes, and did that happen as kind of a result to your research and seeing the Ellen Cullen benefits of that. It was actually something that in our area where I live, a lot of school districts were moving over to that model. So when we as an OT department brought that up, it was something like, yeah, let's get on board. Other districts are doing it, so I'm really happy for that. We're real thankful to have that extra time. Now I don't know how we did it without it. How did we do our I don't know, but I think it has really moved us closer to a true workload model, although, you know the medical model pushes in, we, we, you know, still have kids in blocks of time, time slots. Jayson Davies Yeah, all right, I'm gonna prevent myself from asking you all the questions I have about a three to one model, because we will go way off topic if we do that. Well, I'll just save it for another episode. But going back to your research, I noticed that when you're talking about kind of the constructs of your research. You're talking about a working with teachers or coaching teachers their self efficacy, and English language learners. Yes, most of those. If you talk to most school based ot practitioners, I'm going to say, like 98% of them, they will say a I do not focus on English, second English as a second language students in the sense of, I may support them, but not you know any term not related to language. B, I don't touch teacher. Self efficacy and C, consultations are really difficult for me. So I guess the question here is, even though what you decided to work on like almost sounds nothing like traditional or school based occupational therapy. Why was that important like? Why is it actually important that school based ot practitioners focus, I guess, primarily on that teacher self efficacy, and is that something that should be more of our role? Absolutely. Ellen Cullen I like to think of OTs, not fixers. We are there to support all students. All students are our students. And if any student is struggling with their occupational performance in the classroom, if there's any part of that, or I'd like to think if there's any part of its teachers occupational performance that we can help support or problem solve, we are the people to do it. We are systems thinkers. Our ot education has helped us think convergently and divergently. So we can go in and out and look at big systems and then we can hone in on a problem. We we are systems thinkers, so I really feel that. Again, back to Moho, self efficacy. We're looking at volition, we're looking at values. We're looking at what matters to me. You know, the either what what values did this? Does the teacher have? What values does the student have? No one is going to engage in occupation if they're not motivated to do so. So we really need to look at those motivational constructs. That goes back to our Occupational Therapy education. That's just who we are. We don't just look at purely tasks. We look at the motivation and the reason behind, behind why someone does the task. So I think you have to look at those things. We're dealing with, humans and ELLs. I think maybe there's a stigma that, oh, OTs are medical people. There must be a problem medically or a special need. No, we can, we can support ELLs. And many times, some of the strategies we use with other students work for ELLs. They visual support ELLs routines, visual video modeling, using auditory cues like a bell for transitions, we can, we can help support L's. Jayson Davies Wow, yeah, I've never, even, never even had the thought process of supporting English student language learners like that's just not something I've ever focused on. I know we absolutely, I will shout from the rooftop that MTSS, you know, is essential for occupational therapy to be a part of. But Never have I thought like it's also essential for us to maybe to focus on students who are learning the English language and need support. And they absolutely do need support, and as ot practitioners, we probably have more to offer than we have ever even thought of. So thanks for sharing that absolutely all right. So now let's talk a little bit about your outcomes. I know when it comes to capstone projects, sometimes we get fantastic. Results, sometimes we get more anecdotal results. What have you seen, both the short term results that you know maybe went into your capstone, and then also maybe some of the longer term results? I'm sure you're still in touch with some of those teachers. Kind of what were those results for you? Ellen Cullen The results were not what I expected, I think, in different situations with different teachers that might have been different. I had two experienced teachers who knew me and wanted to support me, but they truly were honest and saying, No, this program really helped me. I did not have it in my mind at all that I would see the difference, the significant difference in value that my program provided for them, and and I was blown away by that. So the outcome, yeah, the outcome of my research showed that when the program wasn't there, the teacher slipped back into what I do doesn't matter. I'm really not supported. Standardized tests are coming. Parent teacher conferences are coming. I have the slip in student learning from covid. And what the outcomes found was that when I was there to kind of to support them and say, No, we got this, you got this. We can handle this. Let's reframe it as you know, something different in the capstone project itself, we co designed together in the classroom, put some real innovative ideas in place. The teacher they added to the program because they had a parent connection piece, which I hadn't even thought of. So they said, Oh, I think we need to get parents involved in this. I'm like, That's awesome. So but then I pulled away, and we let we didn't have our weekly coaching sessions, we didn't have our weekly co design in context sessions. And I think that lack of having a guide on the side. They felt that. And I I think they got back to like, my values do not align with the district's values. They just want to see me pumping out test scores that align with how they look to other districts. And I think they felt back into like, okay, it's mid year. We started the year Ellen. Everything was going great, but now it's mid year and and I'm back to waiting for summer vacation. I'm like, Oh, we got to keep that momentum going. And I think I would like to know what would have happened if I did a year long program. I'd like to think that the coaching that OTs do does help keep teachers rolling along with some positive momentum, that we can address volition and that like why you went into the profession, and that you do matter, and that you are a good teacher, and there is room for innovation. Jayson Davies Yeah, yeah. I'm curious, are you in a What state are you in? Ellen Cullen Again, New York State, that's right, Jayson Davies yeah, in a state that ot practitioners cannot become anything other than an OT in the school based setting, just unless they go back for school for a long, long time, right? Ellen Cullen However, my district was very, is very innovative, that they allowed me to actually run a summer program for ELLs where I was the program administrator. So I was able to be an OT leader in that capacity by using grant money to run a kindergarten driving to learn program, and that was the program we put in place during my coaching capstone project, we did a kindergarten coaching to learn program where the kids got their kindergarten driver's license. We set up rest areas, pit stops. We had all sorts of like stop signs, and the kids loved it. And we related to, oh, what are you going to do to get ready to go to the math trip? We got to get our pencil eraser. And then we, you know, instructed on strategies like verbal rehearsal and using a kinesthetic one finger pencil eraser notebook. And you know, it was all in the context of play, and all kids want to drive, so they made cars, and we had to adjust our engine speed. So in the summer, we ran that program to as a boost to get the L students ready for school, yeah, wow. Jayson Davies And you said that that was not part of your capstone, but it was kind of based upon the capstone. Because, yes, so were you during your capstone? Was that something that you might teach, or you might support your teachers with implementing something like that? Or, I guess my question here is, what did the actual time spent with the teachers look like when you were meeting with them after school. Was it focused on, you know, that volition piece? Remember why you came into school based OT? Or was it super structured? Or was it more, less structured, interview and support? Ellen Cullen It was structured. I really had to do the program with. Fidelity. So we did look at our IRM tools. I reflected on how I was being true to my own modes and my my own ot goal of using my modes very intuitively to what the teacher was looking for. So I did reflections, but the teacher and I would say, How are you doing? How are things going? What could we do differently? Let's plan for our for our in context session this week, and that's how it would go. And we always revisit our occupation, the occupational formulation, I always referred back to that story, their occupational narrative, that they told me, and that together we developed and we developed our goals, occupational formulation, style goals, based on the theory of Moho, so that it was a structured process. But we always had a plan, yeah, Jayson Davies yeah, yeah. So, okay, so now I'm going to put like, the last three questions that I've asked you kind of together, because I think some people, if let's just imagine an occupational therapist isn't listening today, or an occupational therapy as an assistant isn't listening. And they might be thinking, okay, working with teachers, working with students, with, you know, English as a second, second language learner. How is this OT? Why? Why is this being done by an OT like, shouldn't this just be teacher supporting teachers, or shouldn't this be an administrator supporting a teacher? And so I want to let you kind of answer that. Like, why is it that this is an occupational therapy program, not just a teacher getting support from another teacher, or a teacher getting support from an administrator? Does that make sense? Does that question Ellen Cullen make sense? Yes, and that's a great question. And during the Capstone, I was there to support the teachers occupational adaptation. So I was looking to have more alignment with the teacher, to teachers values and how they felt competent, and that was my role as an OT to support the teacher. So in that moment and the district doesn't pay me to have the teacher as my client. They pay me for the student to be my client. However, there are some nuances there that in order for me to have the most impact or bang for my buck with Johnny, I have to support the teacher. I have to support the teacher's occupation. So I'm always focused on occupation, and I do care about the teacher's occupational identity and their feeling of self efficacy and the mastery experiences that ot provides, or we can provide the environment and context for those to occur. Promotes teacher occupational adaptation. And if we look at our role as focused on occupation that applies to we can do that to the teacher, to a parent, to the student, to the system as a whole. Like we really need to have that systems lens of how we can impact through our skills, and we could do that in the community. So I think the more the otpf four look looks to us to look beyond the individual, we do need to extend out to different systems and show that we have value. Are we bringing value to the people that we work with. And I don't think we always frame who our client is, but I think it's real important to then apply our occupational reasoning skills to those clients. Jayson Davies Yeah, yeah. And to think about the teacher as part of the client is an important side of that. So all right, we're gonna take our final break, and when we come back, we're gonna really talk it, talk about how to implement this right now, like, how can a school based ot practitioner kind of use this? And maybe it won't look exactly the same, but how they can use this. So let's take our break. All right, we are back with Ellen, and Ellen, you've done this now as a capstone, it sounds like you're still doing some teacher collaboration and coaching within your three to one system. You've got that that week that you can kind of support teachers a little bit more and not worry as much about the direct intervention with students. I want to know what you learned during your capstone and even before your capstone, because you talked about your your past experience. Really supporting you and what you're doing now. But what did you learn that you're still really implementing today when it comes to supporting those teachers, even though you don't necessarily have this official program in place to support teachers, Ellen Cullen my capstone changed me as a school based ot everything I do now views the teacher. I have a loving response towards all teachers, and there certainly might be some teachers that I would prefer more than others, but I always approach them empathetically, and that my capstone showed me. Me a little glimpse of what their life is like in the in the constraints they're under. So I think, if anything, it allows me to be to provide a loving response towards them. And I think I just it's okay for a day for me to say, How can I help, like I or without even asking, just provide materials or say, Hey, how about can I lighten your load? And how can I do that for you? Like I want to show them that I am supporting their well being. And that is doing my job for Johnny. Jayson Davies That's interesting. The way that you wrap that up, that is doing my job for Johnny, because I did kind of want to ask that a little bit, did you ever get any pushback? Or do you get pushback in terms of, well, supporting the teacher isn't supporting Johnny Ellen Cullen i and I've been in it a long time in this field, so now I'm like, I just like, I just know I am. But I mean, I certainly think I could however. You know, I'm always careful to make sure that in my documentation, like I, I do consider that time of modeling in the classroom really good for kids, because they see a teacher and I loving each other. They see a teacher and I co designing together. They see us fail. They see us laugh. They so I think kids, kids need to see that we can be in our authentic selves, certainly professionally, but like kids learn to problem solve and be creators and fail and and I think there's sometimes with cookie cutter curriculums, teachers feel like they don't have that their autonomy has, in a way, been taken away. They're afraid during a walk through they're going to be judged for not saying the curriculum the way it has to be said. But I kind of there we just, I think, if anything, kids see human beings being real with each other. And I think that's really healthy. Jayson Davies Yeah, no, I think, I think that is absolutely true as well. I just know it's sometimes very difficult within our school based constraints. And, you know, being careful here, and I know we have to be a little careful, because of the documentation, because of the billing practices, because of how everything like it's hard. You can't obviously, you can't documentate. You can't document what did not happen, obviously. And so I just feel like you have to, if a teacher comes in and asks you for help with something, there might be some times that we have to say, Hey, that's a little bit beyond my scope. But if we can work it to Hey, yes, I can support you, and I see how this supports Johnny somehow to in relationship to his goal and or something else important for Johnny, I could see how that would work. And I think it can help two birds, one stone to a degree, absolutely. Ellen Cullen And I would want listeners to know, most of my therapy is done within context. There are some situations that I pull students, some of the older students, to do some targeted intervention. However, most of my work is done in context. So there is more of especially kindergarten, there's very much of a different kind of it's a little bit easier to do that kind of work. It's easier for me to be set up at a center, and I work on cutting. It's easy for me to just go in and do a lesson, and we're working on some executive functional, function skills, but it's based on job stations where one is shredding what it so it's easy to kind of have that environment and context, be able to bill for that, because that is occupation, and I am strategically placing myself with a certain student, but it allows for some flow and CO designing with the teacher. So I I try to, I take a cart into the classroom, and I have a lot of materials in it, so I really have forced myself to build good relationships. Make sure I'm welcome in the classroom. If I'm not, it's okay. I respect the teacher saying hey today, and I'm like, yep, oh, I got you. So I think, but I can't, I always make sure that what I am doing is delivering a skilled service. And I think we we walk that line by being real creative with how we deliver our services? Jayson Davies Yeah, yeah. And so your your capstone we've talked a lot about revolved around the self efficacy of the teachers related to a particular student subsection, yes, now, though, it's much more broad, I'm assuming, because you're not focusing on students as English language learners, but it's a little bit more broad. You have that time set aside for some consultation and coaching. What are you finding that maybe either a teachers are needing most or B that you are most effective at when it comes to supporting teachers? Ellen Cullen I feel that what teachers are looking for is help, especially with some of the more challenging behaviors they're experiencing in their classroom. And I think that's what I'm noticing more recently, is that they're feeling overwhelmed with the level of need of student that they're getting, and they're not feeling competent in terms of managing all, being able to differentiate for all of the students. So I find myself focusing a lot with the teachers on that, and they're very welcome to those kinds of suggestions. I think, I think, personally, I'm very good at like, kind of breaking down a problem, because the original problem the teacher may think is the problem, may or may not be the problem. So when I can reframe it as, what do you think? What happens before? What happened? Like really trying to break down what is happening, because I think they see it in a little different way. But we can come at it through more divergent to convergent, we can look out, and then we can look in. And sometimes that helps a teacher say, Wow, I didn't even see that. I was so focused on this. And those are things that I think we can help the teacher look at a situation maybe a little differently. Okay? Jayson Davies And I want to also ask, is there something more in relationship to newer teachers? I know you've been in this field for a little for a little while. Are you finding that newer teachers have similar concerns to more experienced teachers, or does it take a different approach? What do you see with newer teachers? Ellen Cullen Yeah, what I'm noticing some of the newer teachers, they're scared not to get tenure New York state. So I do notice that some of those newer teachers want to do things by the book. They're very scared to deviate from anything that they could potentially not have a job. And I'm very sensitive to that. So I I really gage their comfort level with like some of the more innovative ways to implement curriculum. For instance, if they're working on numbers, we set up hopscotch, and I say, Would you be willing? What do you think? What it's up to you? And they might like, Oh, that's a little, you know, whatever their comfort level is, yeah. Or I do tend to really be real gentle, because I understand the constraints that they're under, and they don't know a lot about OT. So I love to be an OT that can say, hey, we do a lot of things as OTs, but we can address this. We can address that. Are there things you're noticing with your students? Could that I could help with? And how can I be of assistance to you? So they think of us a lot, of the fine motor, the handwriting. But then then I kind of say, Okay. And then I say, Oh, do you Did you notice that, you know, I can help you with that, or, or I could, we could work to develop some solutions. So I really tried to take a take their lead on what, what is a problem for them? Yeah, that Jayson Davies that's interesting. I was just going to ask you if you felt like this model of coaching teachers, directly interacting with teachers, as opposed to focusing on just the students, has opened up your scope of practice to a degree. And it sounds like that's kind of what you're alluding to Ellen Cullen right there. Yes, yes. And it and I personally struggle with sometimes ot tries to be everything. However, when I just focus on occupation of student, or when I just focus on, say, a student's having difficulty with toileting, how can I help? So if you really look at it and through an occupation lens, it really can help keep us focused as we're occupational therapists. But yeah, our scope of practice can expand, but I have found working in education, what helped me tremendously was getting some teacher education myself, learning more about curriculum, learning about how I can take curriculum and then mesh it in a developmentally friendly way in the classroom. And that human development training and our OT training and teacher training part that I had to seek out I didn't get it in my ot program back in the day. That really helped me, because then I'm like, Oh, I know curriculum. Why? Why is you're working on digraphs. Tell me more about digraphs. Like, I don't really like, tell me, okay, I can help. Like, we could, we could, you know, slide with our finger across a digraph. We could do some fun, take a dip on the digraph, you know. So I can implement some of my motor skills along with digraphs. So I try to support teacher goals with my goals, ot goals, but they should all be goal, team goals, but, yeah, I Jayson Davies was just gonna ask you about goals, if that helps you. No, I totally get that right. Like, is it a goal? Is it ot goal? Is a teacher goal? It's actually the kids goal. I don't know, so I was gonna ask you about that. Like, does the way that you as a team write goals make it easier to facilitate teacher training, teacher consultation and collaboration? Ellen Cullen It should. Good. I mean, ultimately we should all be doing team goals. But I do know it gets tricky, mechanics wise, when you're doing progress monitoring to tease out the data collection. However, that is the dream. The dream is to see how it can all blend together, how we can integrate some fine motor visual perception into reading. I think that's a really great area to expand it. I mean, there's so many areas that they could be holistic. I know as an OT, I don't have that extensive knowledge to really be able to know the curriculum well enough to be immersing myself as an occupation based person, so that, I mean, as much as I do know, I do think that actually having a school teacher credential and part of an OT program would would be great, because then we could really be occupation based. I mean, we are. We do address occupations of like the fine motor and the cutting, but the actual occupation of learning, yeah, and, you know, I can do as much to address executive function, but there are actual components of, like, you know, just different things that I'm like, Yeah, we could do long division on the floor with a big mat and, like, I could jump to carry the number, you know, There's been, I'm like, Oh, I wish I had, I wish I had a little bit more knowledge of how you teach those things. Jayson Davies I mean, it's hard to, it's difficult to address an occupation if you don't fully understand the occupation and right, like we type in, or we write in, right? Education is an occupation. I believe it's ideal, or no, it's an ADL. But like, education is very different, K through three, four through six, six through eight, and then adult learning and high school and all that. Like, it's very different. And understand education from a large concept, yes, to the education in this classroom for this student and this teacher, and how that works together. So I totally get that and how being and having some educator training could help. Ellen Cullen Yes, and I do think that's why that collaboration between the OT and teacher is even more important in the school setting, because we do rely on them to teach us as much as they're looking to have us teach them. We really need to know in order to do our job effectively. We really need the nitty gritty of, like, how, that's how that's being conveyed in the classroom. Are you, you know? How are you? What's your mode of instruction? Like, like, what tools do you use? What, what are you going to have them do? And, and we don't always have the time to collaborate. Oh, this is our science lesson. We're going to have them do that. Great, awesome, you know? And we get that. But, yeah, Jayson Davies I want to go back to something we discussed earlier in this podcast, and I said I would come back to it. And so I want to do that. And that was the dynamic of supporting paraprofessionals as well as teachers and supporting students. And I guess, to kind of kick this off a little bit, and we'll probably wrap up with this is a, do you feel like you also need to provide that support to paraprofessionals and B, I guess it would be an or, or, do you support the paraprofessionals through the teachers? How do you see that? Ellen Cullen Wow, those are such interesting dynamics to think about, because there are so many different relationships there. I target the teacher and what their goals for their classroom are, and then I ask them how, how are you feeling about your staff, your team here is everyone on the same page with the things you value or what you'd like to see happen. And through that conversation, I get a little bit bit more insight, because I'm not there all the time. However, yeah, I, I said, I, you know, I can help. Is there anything I could do? And sometimes I know, as OTs, we, we do observe things. So sometimes I'll say, Hey, what is your feeling about, you know, a certain thing it might be, you know, you know, and rightfully so, some of our paraprofessionals are hired without knowing their job isn't to do for students. Their job is to, you know, enable maximal engagement and participation. So, you know, they may say, Well, no, I don't think they can do it. So sometimes, as an OT or a teacher, if we frame it as sometimes your job is, is not to do anything, but just be there, make sure they're safe. And I think that's like, wait, but I'm supposed to do a job. So it's interesting, because teachers have to walk. Teachers are navigating that all the time, but I think those are important relationships, but I always make sure the teacher remains the the head of their, their classroom. That is their, their domain, and I am entering it. So I think I always keep that idea present, and I'm more than willing to have the teacher hold that degree of control, because they don't have control. Over a lot, I'm finding they have a lot of things pulling at them, and I really want to make sure they know that, that I'm not there to take any of that away. But if I can help them, I'm here for them. Jayson Davies Yeah, yeah, yeah. I totally get that. It is a very unique dynamic, and it's almost akin a little bit to the OT. OT a relationship only in the sense that they are their supervisor. From the sense of they instruct the paraprofessional on tasks and how to support students and whatnot, but at the end of the day, they are not the supervisor when it comes to any type of workplace concerns, right? Like it's not the teacher's responsibility to discipline the paraprofessional, and so it's this very unique dynamic where you you're giving them a ton of support, but at the same time you're not their supervisor, so you're supervising them without their being, without being their supervisor on paper, and it is just a, yeah, interesting concept. Ellen Cullen Think about that. They're not only managing their students, they're managing staff that are also working with their students, so they feel responsible for what happens with those students through the staff, however, they're not ultimately in charge of dictating to those pair of professionals different things because they can't make the rules. So think about, think about how that would feel. I often think like, wow, that's really putting them in a precarious situation, liability, or like, just your sense of, again, self efficacy and autonomy, yes, and how, how instruction is being dosed to our students. It's real interesting because, you know, everyone has their own style. So yeah, I mean it really exactly yes, yes, yeah, that's a great point. Jayson, great. Jayson Davies Well, the classroom is a very dynamic place, as I think we all realize, but maybe don't fully understand, and I love your idea of, you know, really viewing the teachers as a client, because it's really hard to support an individual student without fully understanding the classroom. And of course, the teacher, the paraprofessionals, everyone else in that classroom, is absolutely a part of that student's learning environment. If we look at the PEO model, right, it's not just about the person, it's also about the environment, and everyone in that environment, which is everyone in that classroom. So, yeah, Ellen, are there any, I guess, tips? Last tips, don't feel like you got to go over everything, but just something that you share with other school based ot practitioners, if they want to maybe coach their teachers up a little bit more. What are maybe 123, tips that you just kind of have for them to help get started? Ellen Cullen Yes, I think if you know certainly, you can look into theories. I use the Moho. I used intentional relationship model. The Moho Clearing House has free resources that that you can use, the self assessment of modes. There's also a real quick check on modes that the teacher and the OT could use. So those are great resources. I think you know, again, I love occupation occupational formulation. It really is similar to an occupational profile. So I love getting teacher stories, but again, I know time constraints, but looking at different teacher coaching models, evocative coaching is a real good one that helped me quite a bit. But I think if, if you again, I know this sounds real simplistic, but if you love your teachers, and not in a romantic love, but a real, like loving, loving stance, and really have empathy for them, and think about CO designing and innovating with them, and then offering, offering to care for them. And you know, we care for our caregivers as OTs, that's a great model for coaching. So I would say if I gave other school based OTs some tools or things to think about, I, you know, I hope that, I hope that helps, and some references that you can Jayson, I'll share some references that they could check out. And hopefully coaching will be, at some point, a school based model that will be acceptable and I think it's authentic. It's occupation based. It's it. It helps generalize what we do so, and that's what we want to see. We want to see that generalization occur in authentic settings where occupation is occurring. So I would say, yeah, if we can reframe the school as family and the caregiver as the teacher as a caregiver that has a lot of demands on them. We want to keep our teachers. I love them. Keep our teachers because we can affect change in occupation through the teacher, the teacher as the change agent. And we as the OTs, can facilitate all that change in Johnny and hopefully in the teacher too, and in us. So it's it's good all the way around. Jayson Davies So yeah, and if nothing else, I think even with the way that we potentially frame talking about this in IEPs, could, could be helpful. I mean, when we sit in an IEP, we are sitting in an IEP with caregivers, right the parents, and they understand that term as a caregiver. And I think if we could explain in an IEP look, you know, you're Johnny's caregiver, but the teacher is also Johnny's caregiver, and they need support. And you know, maybe I don't need to see the student one on one for 30 minutes. Maybe, rather, I need to support the student. And maybe that's not called coaching. Maybe it's called consult on the IEP, but maybe you put on to that IEP 30 minutes a month of consult. I'm doing air quotes for those of you who can't see me, which you can't, because it's in an audio only podcast. But you know, calling it consult because that falls into the confines of occupational therapy, as opposed to calling it coaching. But at the end of the day, you're coaching the teacher, maybe that's the way that you could do it Ellen Cullen so well, absolutely. So the program can be delivered through consultation, and the way we deliver that consultation is through a coaching model. So it could, we could definitely, we could make a case for that, and I think it could be ready to implement tomorrow. And I think truly letting the teacher lead, and that's hard for OTs, but if we can let that happen, that only empowers the teacher as well, because they're the ones that are with the kids every day, so they're going to implement the strategies they want to implement on their own anyway. So who's kidding? We're not kidding ourselves. But you'd hope they'd see value in some some of our recommendations. It is, yeah, I mean, I think, I think we offer a good reframe, though, because we can see it from a different lens. And I think, you know, when, when it happens, it just it clicks. And I think they're thankful for that. And when we can see we've helped them, then we're, you know, then we feel a sense of self efficacy ourselves. So, yeah, yeah. I think teachers want to be heard for sure. So I think OTs are great people to do that. Jayson Davies Yeah, yeah. Well, Ellen, it has been a pleasure. Thank you so much for joining us here on the show. I think this is going to help a lot of OT practitioner not to only better understand that coaching model and how they can do that, but to also understand that, you know, things a don't happen overnight, and B, I don't want to say that you finagle the system a little bit to work for what you want it to do, but I guess it's more things are fluid a little bit. And it's not always a straight, you know, a straight line from point A to point B, and you got to kind of be a little fluid. So thank you so much. Really appreciate you coming on, and I look forward to keeping in touch. Ellen Cullen Thank you, Jayson, thank you so much for having me. Jayson Davies All right, that is a wrap on episode 194 of the OT school house podcast. Ellen. Thank you so much for joining us today and sharing your work on occupation based coaching for teachers, the way you've reframed teachers as occupational beings, and using the Moho framework to understand their volition, habituation and performance capacity, is exactly the kind of shift that we sometimes need in school based OT, to revitalize the work that we're doing and also to have more impact with teachers. Your research challenges us to move beyond the outsider expert, if you will, with all the answers, and instead become a co designer with teachers to empower them to reclaim their autonomy and align their practice with their values, and that way we can support so many more students on campus and to you the listener today. Thank you so much for being here and for your commitment to excellence in your school based ot practice. If today's episode resonated with you and you're looking for more resources and professional development and direct mentorship to take your school based ot practice to the next level, I would love to invite you to join us inside the OT school houses, school based ot collaborative. Inside the collaborative, you'll get access to exclusive trainings, a supportive community of school based practitioners, and, of course, direct mentorship with myself. Head on over to OTSchoolHouse.com slash collab to learn more and join us until next time, keep supporting your teachers, empowering your students, and remember you're making a difference every single day. I'll see you next time. Amazing Narrator 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 OTs schoolhouse.com Until next time class is dismissed. Click on the file below to download the transcript to your device. Thanks for listening to the OT Schoolhouse Podcast. A podcast for school-based OT practitioners, by school-based OT practitioners! Be sure to subscribe to the OT Schoolhouse email list & get access to our free downloads of Gray-Space paper and the Occupational Profile for school-based OTs. Subscribe now! 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 Schoolhouse Podcast

Last week, I received a question I knew I would have to address in an article one day... Well, that day has come. In response to my occupational therapy services in high school article, Meghan asked: “What about this is specific to OT versus special education or other IEP team members?” While her question was tied to supporting older students, it could just as easily apply to all school-based occupational therapy. And honestly, I would be lying if I said I’ve never asked myself this same question while sitting in IEP meetings, observing classrooms, or even while working one-on-one with students. The truth is, while what we do can sometimes look similar to what a teacher does, the actions we take and the reasons behind them are very different. So let’s talk about it. Not from a place of defensiveness or turf protection, but from a place of clarity. Why This Question Comes Up So Often This question comes up because schools are changing, and with it, so are how OT servies are provided. We’re seeing more inclusive practices, more push-in services, more collaboration, and more emphasis on real-world skills. Teachers are thinking beyond academics. Special education services are increasingly focused on functional outcomes. Speech therapists are working on participation and self-advocacy. Mental health supports are embedded across settings. All of that is good. But when everyone is supporting similar outcomes, it becomes harder to articulate why occupational therapy is at the table, especially if our answer starts sounding like, “Well… we all kind of do this.” Overlap among providers is not the problem. Lack of role clarity is. So, how is OT different from Special Education services? IDEA is a good place to start to answer that question. SDI vs Related Service One of the most important distinctions to understand is how IDEA views the two different services. Special education services exist to provide specially designed instruction (SDI). The purpose of instruction is to teach a student new skills, content, or strategies aligned with educational standards and goals. IDEA, as well as AOTA’s Guidelines for Occupational Therapy Services in Early Intervention and Schools, make it clear that school-based occupational therapy is not an instructional service. As part of an IEP, we are not in schools to teach reading, writing, math, or curriculum content, and we are not responsible for designing or delivering academic instruction. Instead, occupational therapy is considered a related service under IDEA. That means our role is to support access, participation, and performance within the educational environment. Access: Can the student physically, cognitively, and emotionally engage with classroom activities and routines?
Participation: Can the student take part in school tasks alongside peers in meaningful ways?
Performance: Can the student carry out those tasks effectively and with increasing independence in real classroom contexts? So while a teacher may be responsible for teaching a skill, an OT practitioner looks at what might be preventing the student from using that skill in the classroom, whether that barrier is related to the environment, task demands, tools, routines, or supports. OT services are provided when they are necessary for a student to benefit from special education. Not to replace instruction, and definitely not to duplicate it. Teaching Skills vs. Enabling Use of Skills Here’s a simple way I often think about it. Special education teachers often ask themselves: “How do we teach this skill?” Instead, we as OTPs are tasked with answering, “What is getting in the way of this student using the skill here?” We are trained to analyze the interaction between the student, the task, and the environment. Not in isolation, but together. This perspective is foundational to occupational therapy and is explicitly described in the Occupational Therapy Practice Framework (OTPF-4). Example of the Teacher & OT Roles: A teacher may notice that a student understands writing concepts but struggles to stay focused long enough to complete written work. While the teacher can re-explain directions or provide instructional support, the barrier isn’t the writing skill itself. Rather, it’s sustained attention during the task. In this situation, OT wouldn't focus on the writing. Instead, OT focuses on analyzing what is interfering with attention and engagement, such as task length, visual demands, seating, or the structure of the writing routine. By adjusting these factors, the OT helps create the conditions that allow the student to remain engaged and use the writing skills they’ve already been taught. The OT Lens & Looking Beyond the Student This is where occupational therapy most clearly differs from special education services. While educators understandably focus on instruction, progress, and outcomes, OT practitioners are trained to look beyond the student alone and examine: The demands of the task The physical, social, and sensory environment The routines, expectations, and supports surrounding performance Our evaluations and interventions are not only about determining whether a student can do something in a controlled setting, but also whether they can do it within the actual occupations of school, such as writing during timed assignments, managing materials between classes, participating in group work, navigating transitions, or using assistive technology independently. This is also why classroom observations and occupational profiles are so central to school-based OT practice. They help us understand performance from the student’s perspective, across contexts, rather than through isolated skill testing. Even Then, Overlap Happens. That’s Not a Problem Executive functioning. Self-regulation. Written expression. Transition skills. These are areas where occupational therapy, special education, speech therapy, counseling, and even general education often overlap. That overlap doesn’t mean services are redundant. It means teams are addressing complex skills from different angles. The special education staff may try teaching strategies explicitly. The OT may help the teacher modify task demands, environmental supports, or routines so those strategies can actually be used. Meanwhile, the SLP may support communication demands tied to the same activity. Let’s look at an example. A teacher instructs the entire class on how to copy assignments from the board into their agenda. Within a few days, most students have the routine down, but not Timmy. As you might expect, this is frustrating for Ms. Jones, who doesn’t have the time to "re-teach" this task to Timmy week after week. Enter you, the OT practitioner. You’re likely not going to pull Timmy out, practice copying from the board in isolation, and send him back to class. That would simply replicate what the teacher already did, and would likely lead to the same result. Instead, you observe Timmy attempting the task in the classroom. You talk with Ms. Jones about what she’s noticing. You check in with Timmy about what feels hard. You may assess visual processing, attention, or organizational demands before making any recommendations. Only then do you intervene based on what you learn about Timmy, the environment, and the teacher's expectations for the student. Maybe the solution is a seating change. Maybe it’s a simplified agenda format. Or maybe you discover that Timmy is intentionally avoiding writing assignments so he can later tell his parents he has no homework. Whatever the outcome, the key point is this: Your recommendations are not guesses. They're not even "educated guesses." They are the result of the occupational therapy process, grounded in observation, analysis, and professional reasoning. Could Ms. Jones have tried a different seat or a simpler agenda? Possibly. But those decisions would likely be based on intuition alone, not on a structured occupational therapy framework designed to analyze participation within real classroom demands. That distinction matters. How I Try to Reduce Confusion of What OT Is One way to reduce confusion is to be very clear about accountability. And the best time and place to do this is often the IEP. During the IEP, you likely have a moment to explain what OT is, and how you plan to support a child. This is your chance to explain your role while the parent(s), Teacher(s), and even the Admin are tuned in only to you. So use that time wisely. Here's a script you can even use in your next IEP to help others better understand your role. It may even help you to be more confident in your role. “My role as the OT is to support [student]’s access, participation, and independence within the school environment. I’m here to look at how educational task demands, routines, and environmental factors may be impacting [student]’s ability to use the skills they’re being taught.

When challenges come up, I can work with the student and/or the team to identify what might be getting in the way and to recommend supports or adjustments that help [student] participate more fully and successfully throughout the school day, and I’m happy to build on that as we talk more about [student]’s needs. Note, there's nothing about handwriting, sensory, executive functioning, or behavior here. Instead we focus on task demands, routines, and environmental factors. That leaves the door open for us to support in many different ways. Still sorting out the role of school-based OT? You don’t have to do it alone. Understanding the difference between school-based OT services and special education instruction isn’t always straightforward. Inside The Collab, school-based OTPs come together to talk through these exact questions. You’ll find: school-based CEUs designed around real educational roles peer discussion and mentorship when role confusion comes up practical tools and language to clarify OT’s contribution on IEP teams support applying evidence in ways that align with school systems If you’re looking for ongoing support to confidently navigate your role — not just read about it — The Collab is where learning turns into practice. 👉 Explore The Collab → Common Misunderstandings That Get in the Way I often hear things like: “A teacher can suport (insert skill here), so why do they need OT?” “If I push in to a classroom, how is what I do different from a paraprofessional?” "If a teacher is addressing ADLs, then why should I? So let's address the reality of each of these, one at a time. “A teacher can support [insert skill here], so why do they need OT?” Teachers often support the same skills OT practitioners address, but OT focuses on identifying and reducing the barriers that make it hard for a student to use those skills in daily school routines. OT supports access and participation so instruction is more effective, rather than replacing the teacher’s role. Often, a teacher does effectively support a student. And when they do, they tytpically don't ask for more help. If they are coming to you, it is because they need assitance. “If I push into a classroom, how is what I do different from a paraprofessional?” Paraprofessionals provide ongoing assistance, often with little training or guidance. OT practitioners focuses on determining what supports are needed and how to fade them over time - something that paraprofessionals are not paid or expected to do. When you push in, you're observing, analyzing, and collaborating to adjust supports with the goal of increasing independence - not just helping the student in the moment. “If a teacher is already addressing ADLs, why should OT?” Teachers may support ADLs as part of the school day, especially in transition programs. However, OT looks at ADLs through a participation and independence lens, analyzing why tasks are difficult and how routines or environments can be adapted to promote long-term autonomy. I have found that most teachers appreciate the guidance I can provide on supporting ADL skills - even if I only via a once a year consult. Remember, we are not there to compete with instruction. We are there to support instruction. Practical Takeaways for OT Practitioners To wrap up, if you’ve ever struggled to explain your role (or even to believe in your own role as an OTP), here are a few anchors that can help: Focus on participation, not just skills Describe your role in terms of access and independence Emphasize collaboration, not ownership (especially when it comes to IEP goals) Frame OT as enabling instruction, not duplicating it IEPs work best when we work as a team with out special education colleagues. We serve the same students. We share the same goals. But we bring different training, perspectives, and responsibilities to the team. And when we lean into that, students are better supported. 📬 Want more support like this? Subscribe to the OT Schoolhouse Newsletter for weekly tips, research updates, and evidence-based strategies for school-based OT practitioners. Join now to get our next helpful tip this coming Monday! Resources & References American Occupational Therapy Association. (2017). Guidelines for occupational therapy services in early intervention and schools. American Journal of Occupational Therapy, 71(Supplement 2), 7112410010. https://doi.org/10.5014/ajot.2017.716S01 American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Supplement 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001 American Occupational Therapy Association. (2021). Improve your documentation and quality of care with AOTA’s updated occupational profile template. American Journal of Occupational Therapy, 75(Supplement 2), 7502420010. https://doi.org/10.5014/ajot.2021.752001 Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1400 et seq.